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Voices for Vaccines

Jul 28 • 12 tweets • 9 min read

Today is #WorldHepatitisDay2022! To honor it let's talk about Hepatitis B.

The Hep B vaccine is now given at birth, but starting *this year* all adults <60 are recommended to get it.

I talked to the CDC's former viral hepatitis lead Dr. John Ward to understand why 🧵

First, what is viral hepatitis?

Viral hepatitis comprises a few different infections caused by viruses Hepatitis A, B, C, D and E. While A and E mostly cause acute disease, the others including B often lead to chronic infection.

HepB in particular is a lifelong infection.

HepB is harmful because chronic infection is a leading cause of liver cancer.

In the US, between 1-2 MM people have chronic HepB. Most are unaware. And while it travels through body fluids, it's so infectious that transmission can happen through casual contact. (Dr. Ward ⬇️)

@GretchenLasalle

We started vaccinating for HepB in 1981. We actually vaccinate on the first day of life because...

1⃣ Babies are much more likely to progress from acute HepB to chronic HepB.

2⃣ Immunizing early better protects the community by lowering overall prevalence. (@GretchenLasalle ⬇️)

However, uptake was low early on and so most adults are unvaccinated (or not fully vaccinated).

Starting this year the CDC recommended that all adults under the age of 60 get immunized. They did this because some 20,000 people are still getting acute HepB infections yearly.

@kevinault

For adults, risk is lower. 4% of acute infections become chronic, and risk factors affect exposure.

However, 1) an 'at-risk' approach hasn't worked from a public health perspective and 2) the vaccine has close to no serious risks: cdc.gov/vaccinesafety/… (@kevinault⬇️)

We're also not always sure how someone got infected, and CDC cites an estimate of up to 1.9MM chronically infected persons (more ppl than live in several states).

So it just made sense to make protection more available, and reduce stigma at the same time. cdc.gov/vaccines/acip/…

Hepatitis B—when it does become chronic—is a very costly disease in terms of treatment, so the HHS hopes to eliminate it and other hep infections as a public health problem within the next decade.

We're fortunate to have access to a vaccine in the US because many don't...

@GlobalHep

Dr. John Ward now works to implement vaccination thru @GlobalHep, and emphasized Africa.

Only 10% of children in Africa get the HepB vaccine, and around 2.5% of infants are infected with the virus.

Getting to 90% coverage will safe 550,000 lives in the next decade alone.

The vaccine is cheap at 25 cents/dose, and is one of the UN's "Best Buys in Cancer Prevention."

And yet, we also need better access and high levels of buy-in among citizens, doctors and governments.

So until it's gone, everyone should be an advocate for #HepB vaccination! (End)

@GlobalHep

I forgot to add... @GlobalHep came up with a song about Hepatitis B vaccination! It's an unexpected bop so please give it a listen. #globalhep #WorldHepatitisDay

@tfgh

Finally, tagging some accounts that might be interested in sharing 🙂

@tfgh @tephinet @MRC_Outbreak @cdchep @Hep_Alliance @NO_hep @HepAus @swang8 @EndHep2030 @EuropeLiver @HepBFoundation #Hepatitis #HepatitisB #WorldHepatitisDay

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Jul 7

Since the EUA for COVID vaccines for kids under 5, there have been some high-profile misconceptions about the recommendation.

It's an issue because this virus isn't going away and newborns have a chance at immunity before infection. So here's why we recommend the vaccine (🧵)

First, authorization.

The concern here has been that the vax trials were too small to detect many severe outcomes. And so some people say we "don't know" whether vaccine works.

That's misleading. The stated basis for the EUA was what's known as immunobridging. (2)

Immunobridging is when you have a new use for an effective vaccine and want to get the dose right.

Both the Pfizer + Moderna trials showed good immune response in kids (>=1 GMTR) with high statistical confidence. This—not efficacy—is why the vaccine was unanimously approved. (3)

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Jun 10

Over the #COVID19 pandemic, many people feared 'long-term' effects of vaccines.

Those are very unlikely. But ironically, warnings about long-term effects from disease were often downplayed.

We know *for certain* that infectious diseases can cause long-term effects... A 🧵 (1)

I'll start by saying this: I'm not writing this to inflate the risk of infections, or so you'll avoid every disease ever.

I'm writing this because some people have taken a realistic concern about diseases and misapplied it our means to prevent them. (2)

https://twitter.com/Michigan_Noah/status/1472717056437112837?s=20&t=HFfB_-7KzG3nsyU1XHrv0w

My repeated attempts to address concerns about long-term effects from vaccines have led me to believe that people must not know what infectious diseases can do.

So in this 🧵 I will cite a variety of sources to show they are what cause such effects. (3)

https://twitter.com/Michigan_Noah/status/1475293124004044801?s=20&t=HFfB_-7KzG3nsyU1XHrv0whttps://twitter.com/Michigan_Noah/status/1475293124004044801?s=20&t=HFfB_-7KzG3nsyU1XHrv0w

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May 2

Recently, a paper in Scientific Reports began circling that suggests mRNA vaccines may have yet undetected heart risks. The authors used EMS data in Israel looking at calls for cardiovascular events.

They also draw some conclusions that go beyond their data. A 🧵 (1)

First, it should be noted that some people are saying this was published in Nature.

It wasn't. Scientific reports is a mega journal, publishing the largest # of articles in the world and specifically selects papers for their methods rather than their immediate importance. (2)

That's not a knock against the authors, because for the most part we're not looking at their methods.

So what did they do?

They looked at rates of emergency medical calls for two conditions--cardiac arrest (CA) and acute coronary syndrome (ACS)--across Israel during COVID. (3)

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Apr 21

One common objection to vaccination goes like: "I'm healthy. I'll overcome disease naturally."

People believe that because we evolved to deal with viruses, we don't need to immunize.

Turns out this isn't true. Today you face viruses a caveman would never dream of. 🧵 (1)

This thread is about a term we hear often, natural immunity 🍃

There's a certain ring to it as if getting sick is what your ancestors would have wanted.

And while it is true that we have an *amazing* immune system, the world is much, much different than it used to be. (2)

Let's start with some facts. You obviously did evolve to handle a lot of exposures throughout your life.

We know this because even your average baby--with an immature immune system--fights off millions of potential microbial threats every single day | kqed.org/stateofhealth/… (3)

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Mar 1

I reached out to Dr. Paul Offit for comment on this study. Here's what he said. (🧵/4)

1⃣ The drop in observed protection against infection is not surprising. When the 💉 was approved, 45% of kids in this age group had antibodies. Many more do now. So 💉 has a robust competitor.

2⃣ The 💉 still functions as intended. A 💉 against mucosal infection won't stop infection forever.

"I don't think it's weaker" Paul said. It should still provide long-lasting protection against severe disease (thru memory B and T cells) and beget hybrid immunity post-infection.

3⃣ A max of 8 kids in the 5-11 💉 group were hospitalized per week.

"I mean, who are these people? We don't know," said Paul. They could be kids who were at risk (e.g. immunocompromised), not quite representative of the broader population.

It's a low # to draw conclusions from.

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Mar 1

How does COVID compare to other diseases in kids?

Does infection cause long COVID? How about diabetes?

Why can't we do off-label vaccination for kids under 5?

These questions and many more answered by Dr. Paul Offit! Check out our full length interview: