Blame Manichanh

My PA friend sent me this article from one of them PA magazines
http://www.jaapa.com/pneumococcal-disease-swinging-away-at-a-dangerous-killer/article/177825/?DCMP=EMC-JAAPA_Perspectives

It got me all riled up and my comment ended up being a pretty good overview of several vaccines so I gotta save it here.   You can stop reading now if you're not ready to spend like an hour thinking about this mess.



Are you serious?   How about instead of reading CDC reports and recommendations and parroting them to PAs,  we look at the actual clinical trials and quantify the benefits and risk of the vaccines you covered?  


PCV-7:  The 2 prelicensure trials show a decrease in IPD which becomes less pronounced over the short 3 year span of the studies.  There is a marked serotype replacement phenomenon that continues to be studied to this day.   PCV-7 was just mentioned in a JAMA article which reported a RCT showing serotype replacement with 19A nearly twice as often compared to unvaccinated controls.   Additionally there is zero mortality benefit demonstrated in any PCV7 clinical trial and the pneumonia benefits don't reach statistical significance unless the trial was outside of the US where attack rates are much higher.  
PCV7 isn't even recommended at this point with the new PCV13 taking its place.  There were no clinical trials used in the approval of PCV13 except for immunology studies which showed borderline responses for 3 of the 13 serotypes by the by.  


http://tinyurl.com/ybnc3xp  


http://www.ncbi.nlm.nih.gov/pubmed/17456820


http://www.news-medical.net/news/20100224/FDA-approves-Wyeth-Pharmaceuticals-Prevnar-13-pneumococcal-disease-vaccine.aspx


http://jama.ama-assn.org/cgi/content/abstract/304/10/1099?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=pneumococcal&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT




Routine influenza vaccination was summarized so well by Cochrane that I've nothing to add:
http://www2.cochrane.org/reviews/en/ab004876.html (in the eldery)


http://www2.cochrane.org/reviews/en/ab005187.html (health care workers)


http://www2.cochrane.org/reviews/en/ab000364.html ( patients with asthma)


http://www.digitaljournal.com/article/288946 (swine flu and routine influenza vaccination) 


Why would you recommend routine influenza vaccine?  Is it because the CDC recommends it?  That is NOT evidenced based medicine.  It's expert opinion based medicine.  


As for adult vaccination with PPV23:   The results are underwhelming 


http://www2.cochrane.org/reviews/en/ab000422.html


I do like the baseball analogy.   PAs are like the designated hitter in the majors.  They're paid less but reap huge rewards for the team.  I agree it's time for the PAs to "step up to the plate" but only metaphorically speaking.   It is time for PAs to join their brothers and sisters watching the GAME from the stands.  It is they who pay your salary and it is they who you are duty bound to advocate for.   Stop playing the GAME and start examining the men behind the curtain.