Approximately exactly 16 years ago, I was given a mantoux.
I didn’t know what it was. I thought it was something else. It was just—one day the teacher said “next Monday, we’ll have the mantoux vaccination”. Fear bathed the entirety of the class, yet very few hesitated.
The mantoux sting was supposed to be a small price to pay for eternal defense against an unknown disease. Turns out it’s not even a vaccine. But it is potentially life saving.
Three weeks ago I realised my motivation to discover the full extent of the miracle that we call vaccines. I made allthevaccines.org, a website in which I’ve tried to compile information about all human vaccines.
Today is the day the MVP launches. It features:
- Almost all vaccines that are actively consumed in the Western world.
- Almost all diseases for which there are vaccines for humans.
- Links for each vaccine to trusted entities such as the CDC, the European Medicines Agency, the Electronic Medicines Compendium, the FDA, pharma manufacturer websites, and other government websites.
Why did I make it? Well, I wanted a place to find all vaccines and read about them. I couldn’t find any. Searching for non-covid vaccines is also almost impossible, as all websites imply covid vaccines when they say vaccines. So I took upon the challenge of compiling this info. We’re still in the early stages but I think it is currently in a usable state.
In the process of building it, I’ve learned a lot about vaccines. For example, I learned that smallpox is the only human disease we have successfully and completely eradicated. There is no smallpox in the wild anymore and there is no need to take a vaccine for it. How amazing is that?
It seems there are just over 30 diseases that affect humans for which we have vaccines. One of them is called Japanese encephalitis. Having lived in Europe my whole life (as a non-doctor), I had never heard of it.
I learned about a guy, Maurice Hilleman, who developed over 40 vaccines. That sounds a lot, but I have no idea how many more these are in relation to the average vaccinologist. Turns out it’s way more.
“Very few people, even in the scientific community, are even remotely aware of the scope of what Maurice has contributed,” Anthony Fauci, director of the US National Institutes of Allergy and Infectious Diseases, noted at the symposium. “I recently asked my post-docs whether they knew who had developed the measles, mumps, rubella, hepatitis B and chickenpox vaccines. They had no idea,” Fauci said. “When I told them that it was Maurice Hilleman, they said, 'Oh, you mean that grumpy guy who comes to all of the AIDS meetings?'”
It was once estimated that Maurice’s work saves ~8 million lives per year. That’s probably the most amazing metric of all time.
TB sucks. Or: what is the mantoux really?
Maurice created successful vaccines for lots of diseases. One of the diseases that he didn’t create a vaccine for, is Tuberculosis (TB).
Tuberculosis (aka consumption) is caused by a bacterium (not a virus), the mycobacterium tuberculosis. TB can be either active or latent. If active, then one has the symptoms and the sickness. If latent, there are no symptoms and there is a ~10% chance it will progress to active. If left untreated, there is a ~45% chance of death.
In the futuristic year of 2022, there is no good vaccine for TB. There is one semi-good, though, the BCG vaccine. It’s semi-good because:
Among children, it prevents about ~19% from getting infected and among those who do get infected, it protects a ~58% from developing disease.
— Source from 2014
What’s worse, as many times as you get boosted by it, the efficiency percentage does not improve. If that wasn't enough...
...the BCG vaccine is also racist:
Trials conducted in the UK have consistently shown a protective effect of 60 to 80%, but those conducted elsewhere have shown no protective effect, and efficacy appears to fall the closer one gets to the equator.
— Source:doi:10.1016/S0140-6736(95)92348-9
As the reader might have already guessed from the attitude of this vaccine, we don’t even know how long the protection of the BCG lasts (ok, we do approximately but it’s not conclusive, much less for non-white people, see doi:10.1001/jama.291.17.2086). But this is where we come full circle.
There was a guy called Charles Mantoux. He thought, what if, we could detect the latent kind of TB. Then we could save that 10% and everyone would be happier. And so we did. The Mantoux test (aka tuberculin skin test or TST) is a test to check if someone has latent TB.
The test goes as such:
- Extract tuberculin, aka “purified protein derivative”, from the TB bacterium.
- Inject it intradermally.
- Wait 3 days.
- Measure the diameter of the induration (aka hardened skin) in the injection spot.
Now, it would be great if we could just say: if it’s within a to b millimeters, then one is latent TB positive. But this asshole disease and its test have yet another trick up their sleeve. A person’s conditions and risk factors change the range of what is considered positive. CDC has an interpretation of the, so called, classification of tuberculin reaction but as one might have guessed, measuring a pimple is not exactly conclusive (doi:10.1164/ajrccm.159.1.9801120). Briefly, if someone has “no known risk factors” for TB, then to be positive is to have an induration diameter of 15mm or more. However, if some is HIV-positive, then even 5mm is enough to be latent TB positive. Having had contact with a TB patient is another reason for such a low cut off point.
If this method does not seem very credible to the esteemed reader, I sympathise. Not only does 15mm (or 5mm) seem quite arbitrary but it also looks like there are many reasons to get a false positive, including having gotten the BCG vaccine (!), as well as many reasons to get a false negative. How are we all not dead with TB, I do not know.
I do plan to find out though. I’m sure it will be equally interesting with what I have discovered until now.
Future improvements for allthevaccines.org include distilled info of the most important bits for each disease, as well as—hopefully—exactly all (rather than almost all) the vaccines that are actively manufactured and consumed (still searching for a comprehensive list).
Finally, allthevaccines.org is open source. Hack it away at:
Later!
