| ▲ | sillyfluke 4 days ago |
| Why is there an age limit on an all encompassing vax, wasn't the famous posterchild for this disease Michael Douglas? |
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| ▲ | ZeroGravitas 4 days ago | parent | next [-] |
| This is mostly guesswork but I think you need to get the vaccine before you catch it and lots of people have it as they get older. If you have a limited supply the greater bang per buck would be to start with the young people who almost certainly haven't caught it yet and then work your way up. |
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| ▲ | OneDeuxTriSeiGo 4 days ago | parent [-] | | It's less that and more "we just haven't tested it in older populations yet". Sure you are more likely to have it the older you are but even then you are unlikely to have all the strains. The vaccine covers like 9 or 10 different strains so it can protect you from the other strains even if you already have one of them. It's generally only when you get into the 60s and up that the justification for not recommending the vaccine changes. Once you get into those later years the immune response changes a bit and you get new concerns. An example being herpes zoster (chickenpox) where after a certain age you are recommended to get the shingles vaccine instead of the chickenpox vaccine since the way the disease presents and how the body reacts to it changes with age (technically shingles can happen at any age but generally herpes zoster presents as shingles instead of chickenpox the older you get). | | |
| ▲ | ranma42 4 days ago | parent [-] | | > you are recommended to get the shingles vaccine instead of the chickenpox vaccine since the way the disease presents and how the body reacts to it changes with age (technically shingles can happen at any age but generally herpes zoster presents as shingles instead of chickenpox the older you get). If the underlying virus is the same, what is different between the vaccines? How it presents shouldn't matter as much? | | |
| ▲ | OneDeuxTriSeiGo 3 days ago | parent [-] | | > what is different between the vaccines? The shingles vaccine is a larger/more aggressive dose than the chickenpox vaccine. And nowadays chickenpox vaccine uses live attenuated viruses (i.e. modified to be non-infectious but still look the same) whereas the shingles vaccine uses recombinant proteins. This allows the shingles vaccine to deliver the higher viral load that they want for inoculating against shingles without putting a bunch of live viruses into the body. It's also worth noting that the recombinant vaccine is more effective for shingles compared to the equivalent viral load live vaccine by a significant margin. It's something like 90% reduction in incidence vs 50%. ---------- > How it presents shouldn't matter as much? It's not an all or nothing thing but it's a matter of percentages. And the big reason why they present differently is that chickenpox kind of attacks every part of the body since it's new. It of course does best at infecting the skin and nerves but it mildly affects every part of the body. But then it goes dormant in the nerves because that's where it's most "compatible" and the body is the worst at fighting it. So then with shingles your body still has the immunity but the reactivated virus is able to out-compete your immunity in the nerves and it wakes up in whatever specific nerve and spreads along that nerve. This is why shingles generally presents in a band on the body. It's spreading along a specific nerve "line" rather than spreading throughout the whole body, blood, and all. And so the because the infection can't spread broadly throughout your body it ends up concentrated in that location and presumably the higher viral load combined with focusing on the specific proteins rather than the whole virus increases the body's sensitivity to these flair ups, catching them before they can reach momentum. And then that focused immune training sits on top of the body's existing immunity for the initial "whole body" presentation of the virus. |
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| ▲ | JumpCrisscross 4 days ago | parent | prev | next [-] |
| > Why is there an age limit on an all encompassing vax Vaccines are subject to stringent safety standards since they’re administered to healthy people. The age limit may suggest that at the time of the recommendation, in the relevant jurisdiction, the manufacturer had not studied its safety and efficacy in >40 year olds. (I also don’t think it’s an age limit as much as the upper end of a recommendation.) |
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| ▲ | loeg 4 days ago | parent | next [-] | | E.g., the Shingles vaccine simply hasn't been tested in <50 populations. But if you're under 50 and you've had the chicken pox, you should ask your PCP to prescribe the shingles vaccine off-label and go get it, because shingles sucks and the vaccine definitely works. | | |
| ▲ | _heimdall 4 days ago | parent [-] | | I don't follow your logic here. The GP comment is saying that the vaccine isn't available for populations it hasn't been tested for. Why are you recommending people ignore the fact that safety and efficacy testing isn't available for their population? And how can you say the vaccine definitely works for populations it hasn't been tested on? |
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| ▲ | LorenPechtel 4 days ago | parent | prev [-] | | It's an age limit to the approval caused by a lack of studies. To study it in over 45s you need suitable over 45s--but there aren't a lot of over 45s with risk but not prior exposure. |
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| ▲ | BjoernKW 4 days ago | parent | prev | next [-] |
| The rationale is that most sexually active people have already been infected with HPV anyway, so the largest benefit of administering the vaccine is at a young age. |
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| ▲ | colingauvin 4 days ago | parent | prev | next [-] |
| A lot of replies that are mostly true, or somewhat true, or simply missing the real reasons. There are two factors here: 1) Vaccine-derived immunity is a function of the individual's immune response, which in general, weakens significantly with age. It is not unrealistic for a vaccine to simply fail to elicit any response in someone old enough. 2) It is very, very difficult to recruit folks without HPV that are over 40 for a clinical trial. Most people of that age, who were never immunized, most likely have had it. This significantly convolutes the signal. 3) This is all especially confounded once something becomes "standard of care". Every year there are fewer and fewer people age 40+ with HPV. For these reasons, the vaccine is currently officially ??? in people over 40. Most doctors will prescribe it anyways if you ask. It may or may not infer immunity. It almost certainly will not harm you. |
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| ▲ | Fomite 4 days ago | parent | prev | next [-] |
| To be blunt: Cost-effectiveness. |
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| ▲ | vharuck 4 days ago | parent [-] | | In the US, recommendations come from the United States Preventive Services Task Force. They explicitly do not consider cost in their decisions. They look at harm vs benefit, usually with a focus on mortality reduction. Most insurance companies will base their coverage on the USPSTF. https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.htm... | | |
| ▲ | Fomite 4 days ago | parent | next [-] | | Decisions as to whether or not to pursue regulatory approval for, example, expanded coverage of the HPV vaccine to men, or older age groups, is very commonly informed by cost-benefit calculations. I've worked on those projects, seen presentations by my colleagues, etc. There was a good two years of my life where this was what I worked on (mostly strain replacement post-vaccination). It's a level of evidence that's generated (usually) prior to ACIP, and it is presented to them, while there is not necessarily a bright line threshold. https://pmc.ncbi.nlm.nih.gov/articles/PMC7652907/ | |
| ▲ | fsckboy 4 days ago | parent | prev [-] | | if you suspect that the cdc has been captured by big pharma, "and we don't care about cost of these recommended drugs" should pretty much seal the deal for you :) | | |
| ▲ | epistasis 4 days ago | parent [-] | | Oh wow how the conspiracy theories change. There used to be fears of "death panels" controlling access to medical care when Clinton tried to propose universal health care. The CDC and FDA are about safety, not cost management. And they get significant complaints about how much they regulate pharma and are impediments to pharma for that! Now the conspiracy theorists of the other side seem to be having their day in the public mind. | | |
| ▲ | Fomite 4 days ago | parent | next [-] | | This isn't a conspiracy theory - I worked on projects around that during graduate school, and talked to my colleagues who worked on them. Cost-effectiveness thresholds are a consideration that goes into how widely a vaccine will be rolled out, etc. That was, for example, why boys were originally not part of the recommendation for the HPV vaccine. It would double to cost, while doing very little to prevent cervical cancer via indirect protection. Once the evidence accumulated that it was associated with other cancers, that stopped being true. Similar logic applied to older women and men. | | |
| ▲ | epistasis 4 days ago | parent [-] | | Cost considerations would be more from the CDC's Advisory Committee on Immunization Practices, not the mentioned above United States Preventive Services Task Force. (Oh, and I see that another comment parallel to mine up there now mentions ACIP too...) In any case, somebody thinking that evaluating safety and efficacy aside from cost considerations means that there's collusion with pharmaceutical companies would be a conspiracy theory. | | |
| ▲ | fsckboy 4 days ago | parent [-] | | have you ever wondered if it's a great idea to have former generals populate the defense department, procurement, and revolving door employment with defense contractors? what could go wrong? what could go expensive? you are one of the generals in this scenario, thinking that evaluating safety and efficacy aside from cost considerations couldn't possibly lead to higher costs because you yourself and everybody in your industry are so darn smart, clever and by god ethical. what did you do before this? work on creating the covid 19 virus, or just calling people who questioned it "conspiracy theorists"? what's that, you were in caves tracking down the zoonotic transfer, which you'll find any day now, scientific consensus and all, peter daszak assured you you'll find it and he's beyond reproach! and I resent you saying that I'm a conspiracy theorist because I have not said any of this is happening, I am pointing out the vector where it could happen (go back, look, where did I say any of this was happening?) it's simply, methinks the lady doth protest too much | | |
| ▲ | potato3732842 4 days ago | parent [-] | | >have you ever wondered if it's a great idea to have former generals populate the defense department, procurement, and revolving door employment with defense contractors? what could go wrong? what could go expensive? The real question is why are people who are capable of identifying the problem when it's generals sitting on the board of Lockheed or a telecom industry insider heading the FCC suddenly unable to do so when it's someone who's made their career engineering stormwater solutions taking a position at the EPA or the pharma industry funding research that the CDC will base its policy on. The CDC, the DOD, etc, etc, these are all symptoms of the problem and a distracting sideshow. As usual, the real evil is in the minds of the people who peddle double standards and the fact that we have architected society such that this behavior is mainstream and those who engage in it are not marginalized. |
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| ▲ | fsckboy 4 days ago | parent | prev [-] | | clear financial incentives are never conspiracy theories: always follow the money. thinking that they are conspiracy theories? that's a conspiracy theorist. | | |
| ▲ | epistasis 4 days ago | parent [-] | | There's no clear financial incentive on the decisions here. If there were, it would be collusion, and not in the open, and therefore not clear. | | |
| ▲ | fsckboy 4 days ago | parent [-] | | the cdc decides to make recommendations no matter how expensive, and big pharma collects the expensive, and the expert community works for the cdc and big pharma? do you even understand what regulatory capture is? do you understand how framing something as saving lives no matter the cost draws attention away from funneling money to big pharma no matter the deficit? let me guess, you work in this area too. | | |
| ▲ | epistasis 4 days ago | parent [-] | | Since you already replied to my other comment, hopefully you understand now that ACIP takes into account cost as part of its recommendations, but the independent group we were talking about in this thread does not. Even with CDC its recommendations, it's not the final word. The reasoning you're highlighting here is highly conspiratorial | | |
| ▲ | Fomite 3 days ago | parent [-] | | There's also a much less pronounced revolving door at the CDC as compared to the DoD I would argue. |
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| ▲ | JohnTHaller 4 days ago | parent | prev | next [-] |
| It's likely that they haven't tested it as thoroughly in older folks and that most older folks have already been exposed to HPV. |
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| ▲ | codr7 4 days ago | parent [-] | | Already exposed without having any issues from it. | | |
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| ▲ | phkahler 4 days ago | parent | prev [-] |
| Conspiracy theory: they want old people to die. |
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| ▲ | user432678 4 days ago | parent [-] | | Finally, affordable housing! | | |
| ▲ | pixelpoet 4 days ago | parent [-] | | Yeah, screw those old people with their houses! We should deliberately kill them off so that we can have cheaper houses! But please, don't let the next generation do that to us when housing turns out to be expensive for them too! Brilliant. | | |
| ▲ | robocat 4 days ago | parent | next [-] | | I have yet to see my government subsidise dangerous recreations based on a cost benefit analysis. I think government costs for a retiree are about NZD27000 a year. A government should be subsidising a good deadly recreation for say NZD10000 a year. Assume expected life remaining is 10 years, assume recreation has a 10% chance of clean death, assume low chance of expensive ongoing chronic outcomes. Suggestions: Car racing, climbing, fentanyl habit, boat racing, ocean sports, Russian roulette, foreign legion soldiering, free climbing, wingsuiting. Maybe a better way would be to allow people to gamble with their lives to win a few tens of thousands (need to balance costs against expected savings). Pay out to winners, but saves the government their expected lifetime of expenses for the losers. Let the old and unhappy roll-the-dice and the winners get to live it up a little . . . | |
| ▲ | user432678 4 days ago | parent | prev [-] | | Fun fact, that’s what happened in my country of birth, which is USSR. To some extent. |
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