We know vaccines have been a miracle for public health. Now, new research led by the World Health Organization has found vaccines have saved an estimated 154 million lives in the past 50 years from 14 different diseases. Most of these have been children under five, and around two-thirds children under one year old.

In 1974 the World Health Assembly launched the Expanded Programme on Immunization with the goal to vaccinate all children against diphtheria, tetanus, pertussis (whooping cough), measles, polio, tuberculosis and smallpox by 1990. The program was subsequently expanded to include several other diseases.

The modelling, marking 50 years since this program was established, shows a child aged under ten has about a 40% greater chance of living until their next birthday, compared to if we didn’t have vaccines. And these positive effects can be seen well into adult life. A 50-year-old has a 16% greater chance of celebrating their next birthday thanks to vaccines.

What the study did

The researchers developed mathematical and statistical models which took in vaccine coverage data and population numbers from 194 countries for the years 1974–2024. Not all diseases were included (for example smallpox, which was eradicated in 1980, was left out).

The analysis includes vaccines for 14 diseases, with 11 of these included in the Expanded Programme on Immunization. For some countries, additional vaccines such as Japanese encephalitis, meningitis A and yellow fever were included, as these diseases contribute to major disease burden in certain settings.

The models were used to simulate how diseases would have spread from 1974 to now, as vaccines were introduced, for each country and age group, incorporating data on increasing vaccine coverage over time.

Children are the greatest beneficiaries of vaccines

Since 1974, the rates of deaths in children before their first birthday has more than halved. The researchers calculated almost 40% of this reduction is due to vaccines.

The effects have been greatest for children born in the 1980s because of the intensive efforts made globally to reduce the burden of diseases like measles, polio and whooping cough.

Some 60% of the 154 million lives saved would have been lives lost to measles. This is likely due to its ability to spread rapidly. One person with measles can spread the infection to 12–18 people.

The study also found some variation across different parts of the world. For example, vaccination programs have had a much greater impact on the probability of children living longer across low- and middle-income countries and settings with weaker health systems such as the eastern Mediterranean and African regions. These results highlight the important role vaccines play in promoting health equity.

Vaccine success is not assured

Low or declining vaccine coverage can lead to epidemics which can devastate communities and overwhelm health systems.

Notably, the COVID pandemic saw an overall decline in measles vaccine coverage, with 86% of children having received their first dose in 2019 to 83% in 2022. This is concerning because very high levels of vaccination coverage (more than 95%) are required to achieve herd immunity against measles.

In Australia, the coverage for childhood vaccines, including measles, mumps and rubella, has declined compared to before the pandemic.

This study is a reminder of why we need to continue to vaccinate – not just against measles, but against all diseases we have safe and effective vaccines for.

The results of this research don’t tell us the full story about the impact of vaccines. For example, the authors didn’t include data for some vaccines such as COVID and HPV (human papillomavirus). Also, like with all modelling studies, there are some uncertainties, as data was not available for all time periods and countries.

Nonetheless, the results show the success of global vaccination programs over time. If we want to continue to see lives saved, we need to keep investing in vaccination locally, regionally and globally.

Meru Sheel, Associate Professor and Epidemiologist, Infectious Diseases, Immunisation and Emergencies Group, Sydney School of Public Health, University of Sydney and Alexandra Hogan, Mathematical epidemiologist, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Endometriosis is a condition that affects women and girls. It occurs when tissue similar to the lining of the uterus ends up in other areas of the body. These areas include the ovaries, bladder, bowel and digestive tract.

Endometriosis will affect nearly one million Australian women and girls in their lifetime. Many high-profile Australians are affected by endometriosis including Bindi Irwin, Sophie Monk and former Yellow Wiggle, Emma Watkins.

Symptoms of endometriosis include intense pelvic, abdominal or low back pain (that is often worse during menstruation), bladder and bowel problems, pain during sex and infertility.

But women and girls wait an average of seven years to receive a diagnosis. Many are living with the burden of endometriosis and not receiving treatments that could improve their quality of life. This includes physiotherapy.

How is endometriosis treated?

No treatments cure endometriosis. Symptoms can be reduced by taking medications such as non-steriodal anti-inflammatories (ibuprofen, aspirin or naproxen) and hormonal medicines.

Surgery is sometimes used to diagnose endometriosis, remove endometrial lesions, reduce pain and improve fertility. But these lesions can grow back.

Whether they take medication or have surgery, many women and girls continue to experience pain and other symptoms.

Pelvic health physiotherapy is often recommended as a non-drug management technique to manage endometriosis pain, in consultation with a gynaecologist or general practitioner.

The goal of physiotherapy treatment depends on the symptoms but is usually to reduce and manage pain, improve ability to do activities, and ultimately improve quality of life.

What could you expect from your first appointment?

Physiotherapy management can differ based on the severity and location of symptoms. Prior to physical tests and treatments, your physiotherapist will comprehensively explain what is going to happen and seek your permission.

They will ask questions to better understand your case and specific needs. These will include your age, weight, height as well as the presence, location and intensity of symptoms.

You will also be asked about the history of your period pain, your first period, the length of your menstrual cycle, urinary and bowel symptoms, sexual function and details of any previous treatments and tests.

They may also assess your posture and movement to see how your muscles have changed because of the related symptoms.

They will press on your lower back and pelvic muscles to spot painful areas (trigger points) and muscle tightness.

If you consent to a vaginal examination, the physiotherapist will use one to two gloved fingers to assess the area inside and around your vagina. They will also test your ability to coordinate, contract and relax your pelvic muscles.

What type of treatments could you receive?

Depending on your symptoms, your physiotherapist may use the following treatments:

General education

Your physiotherapist will give your details about the disease, pelvic floor anatomy, the types of treatment and how these can improve pain and other symptoms. They might teach you about the changes to the brain and nerves as a result of being in long-term pain.

They will provide guidance to improve your ability to perform daily activities, including getting quality sleep.

If you experience pain during sex or difficulty using tampons, they may teach you how to use vaginal dilators to improve flexibility of those muscles.

Pelvic muscle exercises

Pelvic muscles often contract too hard as a result of pain. Pelvic floor exercises will help you contract and relax muscles appropriately and provide an awareness of how hard muscles are contracting.

This can be combined with machines that monitor muscle activity or vaginal pressure to provide detailed information on how the muscles are working.

Yoga, stretching and low-impact exercises

Yoga, stretching and low impact aerobic exercise can improve fitness, flexibility, pain and blood circulation. These have general pain-relieving properties and can be a great way to contract and relax bigger muscles affected by long-term endometriosis.

These exercises can help you regain function and control with a gradual progression to perform daily activities with reduced pain.

Hydrotherapy (physiotherapy in warm water)

Performing exercises in water improves blood circulation and muscle relaxation due to the pressure and warmth of the water. Hydrotherapy allows you to perform aerobic exercise with low impact, which will reduce pain while exercising.

However, while hydrotherapy shows positive results clinically, scientific studies to show its effectiveness studies are ongoing.

Manual therapy

Women frequently have small areas of muscle that are tight and painful (trigger points) inside and outside the vagina. Pain can be temporarily reduced by pressing, massaging or putting heat on the muscles.

Physiotherapists can teach patients how to do these techniques by themselves at home.

What does the evidence say?

Overall, patients report positive experiences pelvic health physiotherapists treatments. In a study of 42 women, 80% of those who received manual therapy had “much improved pain”.

In studies investigating yoga, one study showed pain was reduced in 28 patients by an average of 30 points on a 100-point pain scale. Another study showed yoga was beneficial for pain in all 15 patients.

But while some studies show this treatment is effective, a review concluded more studies were needed and the use of physiotherapy was “underestimated and underpublicised”.

What else do you need to know?

If you have or suspect you have endometriosis, consult your gynaecologist or GP. They may be able to suggest a pelvic health physiotherapist to help you manage your symptoms and improve quality of life.

As endometriosis is a chronic condition you may be entitled to five subsidised or free sessions per calendar year in clinics that accept Medicare.

If you go to a private pelvic health physiotherapist, you won’t need a referral from a gynaecologist or GP. Physiotherapy rebates can be available to those with private health insurance.

The Australian Physiotherapy Association has a Find a Physio section where you can search for women’s and pelvic physiotherapists. Endometriosis Australia also provides assistance and advice to women with Endometriosis.

Thanks to UTS Masters students Phoebe Walker and Kasey Collins, who are researching physiotherapy treatments for endometriosis, for their contribution to this article.

Peter Stubbs, Senior Lecturer in Physiotherapy, University of Technology Sydney and Caroline Wanderley Souto Ferreira, Visiting Professor of Physiotherapy, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.