Understanding Live Vaccines and Vaccine Shedding

New Hampshire's GOP Is Taking A Stand—Against The Polio Vaccine

Centers for Disease Control and Prevention

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New Hampshire could soon beat Florida—known for its anti-vaccine Surgeon General—when it comes to loosening vaccine requirements. A first-in-the-nation bill that's already passed New Hampshire's state House, sponsored only by Republican legislators, would end the requirement for parents enrolling kids in child care to provide documentation of polio and measles vaccination. New Hampshire would be the only state in the US to have such a law, although many states allow religious exemptions to vaccine requirements. 

Currently, Republicans control New Hampshire's state House, Senate and governor's office—but that isn't a guarantee that the bill will be signed into law, with GOP Gov. Chris Sununu seemingly flip-flopping when it comes to disease control. Sununu did sign a bill in 2021 allowing people to use public places and services even if they did not receive the Covid-19 vaccine. But the next year, the governor vetoed a bill that would bar schools from implementing mask mandates. 

The polio vaccine, first offered in 1955, and the MMR shot, which treats the highly infectious measles, mumps, and rubella viruses, are two very crucial vaccines both in the US and internationally. Since the year 2000 alone, vaccines against measles are estimated to have saved over 55 million lives around the world. 

The CDC recommends that kids get their first dose of MMR vaccine between 12 and 15 months of age, and a first dose of the polio vaccine at around two months old. All states currently require children to have at least started vaccination against measles and polio in order to enroll in child care, according to the nonprofit Immunize.Org. A CDC report found that for the 2021-2022 school year, around 93 percent of children had received the MMR and polio vaccines by the time they entered kindergarten. That figure drops to less than 80 percent for both vaccines—the lowest rate in the country—in Alaska, where a measles outbreak could be devastating. 

Rises in anti-vaccine sentiments have largely been linked to concerns that vaccines cause health issues, like the debunked claim that the MMR vaccine leads to kids being autistic. What parents may want to keep in mind is that polio and measles themselves are disabling conditions: according to the World Health Organization, 1 in 200 polio infections leads to irreversible paralysis. Children who get measles can experience symptoms including swelling of the brain. Death is always a possibility, too. 

"Childhood vaccines have helped protect generations of Americans from potentially devastating vaccine-preventable diseases," S. Wesley Long, a professor of pathology and genomic medicine at the Houston Methodist medical center, told Mother Jones. "Many of these diseases still exist around the world, and we rely on our collective immunity, often from childhood vaccines, to prevent these diseases from circulating in our population."

The bill would strike language requiring that immunization records be submitted to child care agencies, but would keep those requirements for students enrolling in kindergarten through 12th grade. As of 2022, according to the nonprofit ChildCare Aware of America, there are some 700 licensed child care centers and homes in New Hampshire (which doesn't require the Covid-19 vaccine for enrollment in child care, either, despite its efficiency in reducing both death rates and acute symptoms). 

Vaccine hesitancy is rising among parents of young children. A 2023 survey from the Pew Research Center found that around half of parents with kids four or younger thought that not all standard childhood vaccines—a list that also includes hepatitis B, rotavirus, DTaP and chickenpox—may be necessary. Anti-vaccine misinformation plays a role in this phenomenon, which began before the Covid-19 pandemic, but has certainly increased since. In a 2019 UK report, about 50 percent of parents of young kids encountered false information about vaccines on social media. 

While it's nice when a beloved celebrity makes a comeback, comebacks of the very infectious measles and polio epidemics are less welcome. As New Hampshire's state epidemiologist, Dr. Benjamin Chan, said during a state Senate hearing on the bill, "as vaccination levels decrease, this is putting our children and our communities and our childcare agencies at risk."

There Is No Withdrawal Of The AstraZeneca Covid-19 Vaccine, The Benefits Are Considered Greater

KOMPAS/TOTOK WIJAYANTO

The medical personnel at the Army Central Hospital displayed the AstraZeneca vaccine that will be administered to registered vaccine recipients at Kolese Gonzaga, South Jakarta, on Wednesday (5/5/2021).

JAKARTA, KOMPAS — The Indonesian government has not withdrawn the Covid-19 vaccine produced by AstraZeneca. It is hoped that residents will not worry about reports of side effects of thrombosis and thrombocytopenia from administering the vaccine because the benefits are much greater as protection for the community.

Head of the Communications and Public Services Bureau Ministry of Health Siti Nadia Tarmizi, when contacted, in Jakarta, Saturday (4/5/2024), said the government was not interested Covid-19 vaccine produced by AstraZeneca from circulation. This vaccine is now no longer available in Indonesia.

"There is no (withdrawal). "Currently the vaccine (Covid-19 product from AstraZeneca) has also run out since early 2023," he said.

Also read: AstraZeneca Covid-19 Vaccine Triggers Side Effects, No Case Reports in Indonesia

Based on data from the Ministry of Health, there have been at least 452.41 million doses of the Covid-19 vaccine administered to the public. Of this total, 73.98 million doses were given using the AstraZeneca Covid-19 vaccine (AZ). The other most frequently administered vaccine types are Sinovac (266.3 million doses) and Pfizer (85.9 million doses).

Chairman of the National Commission for the Study and Management of Post-Immunization Adverse Events (Komnas PP KIPI) Hindra Irawan Satari said, of the more than 70 million injections of the AstraZeneca vaccine given to people in Indonesia, there were no reports associated thrombosis with thrombocytopenia. It is hoped that the public will not need to worry too much about this risk.

"The condition of TTS (thrombosis with thrombocytopenia) related to the administration of the AZ (AstraZeneca) vaccine occurs 4-42 days after the injection is given. So, after the AZ vaccine has been fully administered in Indonesia, if there are cases of TTS found, it is not caused by the AZ vaccine, but by other diseases," he explained.

The AstraZeneca vaccine is a type of vaccine developed based on adenovirus. This vaccine was developed by AstraZeneca in collaboration with the University of Oxford. AstraZeneca's Covid-19 vaccine production began to be used in Indonesia in March 2021.

Also read: Profits and Losses of the AstraZeneca Vaccine amid Limited Supply

The Director of the Postgraduate Program at Yarsi University and also a Professor at the Faculty of Medicine, University of Indonesia (FKUI), Tjandra Yoga Aditama, said that the side effects of administering the AstraZeneca Covid-19 vaccine are not actually new. These side effects were a concern in 2021 when the vaccine was first used.

Benefit

Quoting the European Medicine Agency's (EMA) report on April 7, 2021, there is a possibility of a connection between the AstraZeneca Covid-19 vaccine and unusual blood clotting with low platelet levels, which rarely occurs. However, the benefits of the vaccine in preventing Covid-19 are greater than the risk of its side effects.

KOMPAS/KRISTIAN OKA PRASETYADI

The Covid-19 Task Force screening personnel in North Sulawesi checked the blood pressure of prospective vaccine recipients during a mass vaccination event in Manado on Wednesday (24/3/2021).

In addition, on March 19, 2021, the World Health Organization (WHO) issued a document stating that the AstraZeneca Covid-19 vaccine has significant benefits in preventing infection and reducing the risk of death from Covid-19 worldwide. Monitoring is still needed regarding suspected side effects.

The use of Covid-19 vaccines has been temporarily stopped in several countries, such as Sweden, Germany, France, Spain, Denmark, and the Netherlands. However, many other countries, including Indonesia, continue to use the AstraZeneca Covid-19 vaccine as a preventive measure against Covid-19.

Also read: AstraZeneca Vaccine Protection Declines After Three Months

"So, side effects of the Covid-19 Astrazeneca vaccine are nothing new. "That has been known since 2021. Only the benefits of vaccination to protect someone from Covid-19 at that time were much higher than the possible side effects, and that is very rare," said Tjandra.

After the AZ vaccine has run out in Indonesia, if there are cases of blood clotting found, it is not due to the AZ vaccine, but is caused by other diseases.

This was also conveyed by epidemiologist and health security researcher from Griffith University, Dicky Budiman. The protection from vaccines is far greater than the potential side effects that may arise. The significant benefits of vaccines have been proven through the experience of tackling other diseases, such as polio.

Before the existence of polio vaccines, outbreaks in the community caused by the disease frequently occurred. However, after the widespread administration of polio vaccines, cases of polio are now rarely found.

Risk communication

Nevertheless, Dicky stated that risk communication needs to be more massive in responding to information related to the side effects found from the use of the AstraZeneca Covid-19 vaccine. This is especially important for the Indonesian community who have previously received the vaccine.

"The symptoms of TTS related to the use of the AstraZeneca Covid-19 vaccine generally occur after two weeks or one month following the injection. If it is more than that, especially more than one year, the impact will disappear. If there are TTS effects, it is likely not related to the AstraZeneca Covid-19 vaccine," he said.

Also read: Mitigating the Risk of Blood Clots from the AstraZeneca Covid-19 Vaccine

The condition of TTS can occur due to other conditions besides being related to the administration of adenovirus-based Covid-19 vaccines. Other conditions that can trigger TTS include autoimmune diseases, cancer, the use of certain medications, severe infections, and genetic or familial factors.

KOMPAS/TOTOK WIJAYANTO

The medical staff of the Army Central Hospital is preparing to administer the AstraZeneca vaccine to prospective recipients who have been registered at Gonzaga College in South Jakarta, on Wednesday (5/5/2021).

Symptoms of blood clots related to vaccines include shortness of breath, chest pain, swelling in the legs, persistent stomach pain, as well as neurological symptoms such as severe and persistent headache and blurred vision.

Other symptoms include, among other things, skin disorders in the form of spots. If these symptoms are found, you must immediately seek help from a health professional. "There is a difference between vaccine-related TTS or VITT (vaccine-induced immune thrombotic thrombocytopenia) and other TTS," said Dicky,

"Usually, in VITT cases, when examined in the blood, there are antibodies found called platelet factor 4 or PF-4. This is a characteristic of TTS or VITT cases, especially those related to adenovirus vaccines, such as AstraZeneca and Johnson & Johnson," he explained.

Adacel Polio

Consumer Medicine Information (CMI) summary The full CMI on the next page has more details. If you are worried about using this medicine, speak to your doctor or pharmacist.

1. Why am I using Adacel Polio? Adacel Polio contains the active ingredients diphtheria toxoid, tetanus toxoid, pertussis toxoid, pertussis filamentous haemagglutinin, pertussis fimbriae 2+3, pertactin and poliovirus types 1,2 and 3 (Vero). Adacel Polio is used to help to protect you or your child against whooping cough (pertussis), tetanus, diphtheria and polio.For more information, see Section 1. Why am I using Adacel Polio? In the full CMI.

2. What should I know before I use Adacel Polio? Do not use if you or your child has ever had an allergic reaction to Adacel Polio or any of the ingredients listed at the end of the CMI, or if you or your child ever had a disease of brain without an apparent cause within 7 days of a previous pertussis, tetanus or diphtheria vaccination. Talk to your doctor if you have any other medical conditions, take any other medicines, or are pregnant or plan to become pregnant or are breastfeeding.  For more information, see Section 2. What should I know before I use Adacel Polio? In the full CMI.

3. What if I am taking other medicines?

4. How do I use Adacel Polio? Adacel Polio is given by your doctor, nurse or pharmacist. More instructions can be found in Section 4. How do I use Adacel Polio? In the full CMI.

5. What should I know while using Adacel Polio?

Things you should do

Tell your doctor, nurse or pharmacist before you receive the vaccine if you or your child

is allergic to the active ingredients or any of the other ingredients in this vaccine.

is suffering from an illness

has a bleeding problem or bruise easily.

ever fainted from an injection

has not previously received the complete course of tetanus and diphtheria vaccination

had a disease of brain without an apparent cause within 7 days of a previous pertussis, tetanus or diphtheria vaccination.

Driving or using machines

Adacel Polio should not normally interfere with your ability to drive or operate machinery. However, it may cause light-headedness, tiredness, drowsiness in some people.

Looking after your medicine

Adacel Polio is usually stored in the surgery or clinic, or at the pharmacy. However, if you need to store Adacel Polio, keep in the fridge between 2-8°C. Do not freeze.

6. Are there any side effects? Common side effects include a local reaction around the injection site such as bruising, redness, itchiness, tenderness, pain or discomfort, warmth, burning or stinging, swelling or the formation of hard lumps or scars, rash, headaches, tiredness, weakness or fatigue, fever, rigors, soreness, aching muscles, muscle tenderness or weakness (not caused by exercise), joint pain or swelling, irritability, nausea and vomiting, diarrhoea. Serious side effects can include red, itchy rash or hives, swelling of the face, lips, tongue or other parts of the body, shortness of breath, wheezing or trouble breathing, a temporary inflammation of the nerves, causing pain, weakness, and paralysis in the extremities and often progressing to the chest and face, severe pain and decreased mobility of arm and shoulder, fits or convulsion, fainting, tingling or numbness of the hands or decreased feeling or sensitivity of the vaccinated arm, a paralysed nerve in the face, dizziness, generally feeling unwell, pale skin, stomach pain. See your doctor immediately if you notice this. For more information, including what to do if you or your child have any side effects, see Section 6. Are there any side effects? In the full CMI.

Active ingredient(s): Pertussis Vaccine - Acellular and Diphtheria and Tetanus Toxoids (Adsorbed) Combined with Inactivated Poliovirus Type 1, 2 and 3 (Vero cell)

Full Consumer Medicine Information (CMI)

This leaflet provides important information about using Adacel Polio. You should also speak to your doctor or pharmacist if you would like further information or if you have any concerns or questions about using Adacel Polio.

Where to find information in this leaflet:

1. Why am I using Adacel Polio?

Adacel Polio contains the active ingredients diphtheria toxoid, tetanus toxoid, pertussis toxoid, pertussis filamentous haemagglutinin, pertussis fimbriae 2+3, pertactin and poliovirus types 1,2 and 3 (Vero).

Adacel Polio is a vaccine used to help to protect you or your child against whooping cough (pertussis), tetanus, diphtheria and polio.

Adacel Polio works by causing the body to produce its own protection against whooping cough, tetanus, diphtheria, and polio. It does this by making substances called antibodies in the blood, which fight the bacteria and toxins that cause these diseases. If a vaccinated person comes into contact with these bacteria and toxins, the body is usually ready to destroy them.

It usually takes several weeks after vaccination to develop protection against these diseases.

Use of Adacel Polio during pregnancy allows antibodies to be passed to the baby in the womb from the pregnant woman to protect the baby from whooping cough during the first few months of life.

Most people will produce enough antibodies against these diseases. However, as with all vaccines, 100% protection cannot be guaranteed.

The vaccine will not give you or your child any of these diseases.

The chance of a severe reaction from Adacel Polio is very small, but the risks from not being vaccinated against these diseases may be very serious. Polio, whooping cough, tetanus and diphtheria cause significant sickness and sometimes death in unvaccinated infants, children, and adults.

This vaccine is for use as a booster in adults, adolescents and children aged four years and older who have previously received childhood immunisation. Children from four to six years of age should have already received four doses of whooping cough, tetanus, diphtheria and polio vaccine. Adacel Polio is not intended for primary immunisation.

2. What should I know before I use Adacel Polio?

Warnings Do not use Adacel Polio if you or your child:

had an allergic reaction to Adacel Polio or any of the ingredients listed at the end of this leaflet.

had an allergic reaction to another vaccine designed to protect against pertussis, tetanus, diphtheria or polio.

had serious encephalopathy (disease of brain) without an apparent cause within 7 days of a previous pertussis, tetanus or diphtheria vaccination.

Always check the ingredients to make sure you or your child can receive this vaccine.

Adacel Polio is not recommended for use in children under 4 years.

Check with your doctor if you or your child:

Has or ever had any other medical conditions, such as:

a poor or reduced immune system due to medication (e.G. Steroid or medicines used to treat cancer (including radiation therapy) diseases such as some blood disorders, malaria, kidney disease requiring dialysis, HIV/AIDS or cancer

a progressive illness affecting the brain/nerves or uncontrolled fits

After vaccination, you or your child may be at risk of developing certain side effects. It is important you understand these risks and how to monitor for them. See additional information under Section 6. Are there any side effects? Pregnancy and breastfeeding

Tell your doctor or nurse if you are pregnant or breast-feeding, think you might be pregnant or are planning to have a baby. Your doctor will help you decide if you should receive Adacel Polio during pregnancy.

Adacel Polio may be administered during pregnancy for prevention of pertussis in young infants.

3. What if I am taking other medicines?

Tell your doctor or pharmacist if you are taking any other medicines, including any medicines, vitamins or supplements that you buy without a prescription from your pharmacy, supermarket or health food shop.

Having other vaccines

Tell your doctor if you or your child has had any vaccines in the last 4 weeks.

Your doctor will advise you if Adacel Polio is to be given with another vaccine.

Your doctor and pharmacist may have more information on medicines and vaccines to be careful with or avoid during vaccination with Adacel Polio.

Check with your doctor or pharmacist if you are not sure about what medicines, vitamins or supplements you are taking and if these affect Adacel Polio.

4. How do I use Adacel Polio?

Adacel Polio is given as an injection, usually into your upper arm muscle by a doctor or nurse.

How much is given

The dose of Adacel Polio is a single dose of 0.5mL.

When to receive Adacel Polio

Adacel Polio is generally given whenever a booster dose of tetanus and diphtheria is required and where a booster dose of whooping cough and polio is considered necessary.

5. What should I know while using Adacel Polio? Things you should do

Keep an updated record of your vaccinations.

Call your doctor straight away if you or your child:

does not feel well after having Adacel Polio

has any signs of allergic reaction which may include difficulty breathing, shortness of breath, swelling of the face, lips, throat or tongue, cold, clammy skin, palpitations, dizziness, weakness, fainting, rash or itching.

Driving or using machines

Adacel Polio should not normally interfere with your ability to drive or operate machinery. However, it may cause light-headedness, tiredness, drowsiness in some people.

Looking after your medicine

Adacel Polio is usually stored in the doctor's surgery or clinic, or at the pharmacy. However, if you need to store Adacel Polio:

keep Adacel Polio in the original pack until it is time for it to be given.

keep it in the refrigerator, store at 2°C to 8°C. Do not freeze Adacel Polio.

Do not use Adacel Polio after the expiry date which is stated on the carton after EXP.

Do not use Adacel Polio if the packaging is torn or shows signs of tampering.

Keep it where young children cannot reach it.

Getting rid of any unwanted medicine

If you no longer need to use this medicine or it is out of date, take it to any pharmacy for safe disposal.

6. Are there any side effects?

All medicines can have side effects. If you do experience any side effects, most of them are minor and temporary. However, some side effects may need medical attention.

See the information below and, if you need to, ask your doctor or pharmacist if you have any further questions about side effects.

Less serious side effects

Less serious side effects

What to do

local reaction around the injection site such as bruising, redness, itchiness, tenderness, pain or discomfort, warmth, burning or stinging, swelling or the formation of hard lumps or scars

rash

headaches

tiredness, weakness or fatigue

fever

rigors

soreness, aching muscles, muscle tenderness or weakness (not caused by exercise)

joint pain or joint swelling

irritability

nausea and vomiting

diarrhoea

These are the more common side effects of Adacel Polio. Mostly these are mild and short-lived. If however, these symptoms persist for more than 1 week, then you should tell your doctor.

Speak to your doctor if you have any of these less serious side effects and they worry you.

Serious side effects

Serious side effects

What to do

dizziness

generally feeling unwell

pale skin

stomach pain

pain in the vaccinated arm

swollen glands in the neck, armpit or groin

large reactions at the injection site (larger than 5 cm), including extensive limb swelling from the injection site beyond one or both joints. These reactions start within 48 hours after vaccination, may be associated with redness, warmth, tenderness or pain at the injection site, and get better within 3-5 days without the need for treatment.

The following side effects are very serious. You or your child may need urgent medical attention or hospitalisation:

sudden signs of allergy such as red, itchy rash or hives, swelling of the face, lips, tongue or other parts of the body, shortness of breath, wheezing or trouble breathing

a temporary inflammation of the nerves, causing pain, weakness, and paralysis in the extremities and often progressing to the chest and face

severe pain and decreased mobility of arm and shoulder

fits or convulsion

fainting

inflammation of spinal column

tingling or numbness of the hands or decreased feeling or sensitivity of the vaccinated arm

a paralysed nerve in the face

All of these side effects are rare.

Call your doctor straight away, or go straight to the Emergency Department at your nearest hospital if you notice any of these serious side effects.

Tell your doctor or pharmacist if you notice anything else that may be making you feel unwell.

Other side effects not listed here may occur in some people.

Reporting side effects After you have received medical advice for any side effects you experience, you can report side effects to the Therapeutic Goods Administration online at www.Tga.Gov.Au/reporting-problems . By reporting side effects, you can help provide more information on the safety of this medicine.

7. Product details

This medicine is only available with a doctor's prescription.

What Adacel Polio contains

Active ingredients

(main ingredients)

not less than 2 IU (2 LF) diptheria toxoid

not less than 20 IU (5 LF) tetanus toxoid

2.5 micrograms pertussis toxoid

5 micrograms pertussis filamentous haemagglutinin

3 micrograms pertussis pertactin

5 micrograms pertussis fimbriae 2 + 3

29 DAgU Poliovirus inactivated type 1*

7 DAgU Poliovirus inactivated type 2*

26 DAgU Poliovirus inactivated type 3*

Other ingredients

(inactive ingredients)

aluminium phosphate

ethanol

phenoxyethanol

polymyxin B sulfate

neomycin

streptomycin sulfate

formaldehyde

glutaral

polysorbate 80

water for injections

Medium Hanks 199 without phenol red (including phenylalanine)

The manufacture of this product includes exposure to bovine materials. No evidence exists that any case of vCJD (considered to be the human form of bovine spongiform encephalopathy) has resulted from the administration of any vaccine product

*These quantities are the same as those previously expressed when measured by a suitable method.

Do not take this medicine if you are allergic to any of these ingredients.

What Adacel Polio looks like

Adacel Polio is a sterile, uniform cloudy, white suspension for injection.

Aust R 106576 - Syringe

Who distributes Adacel Polio

Australia:

sanofi-aventis australia pty ltd

12 - 24 Talavera Road

Macquarie Park

NSW 2113, Australia

Tel: 1800 816 806

This leaflet was prepared in November 2023.

ada-pol-ccdsv15-cmiv5-21nov23

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