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Outbreaks

There have been, in the last 20 years, natural, or perhaps unnatural, experiments that have helped shed light on the efficacy of vaccines.  Many societies, for reason of political unrest, religion, or a lack of understanding of science and medicine have seen the rates of vaccination decline and, with that decline, an increase in the cases of vaccine-preventable diseases.

Infectious disease spread in populations is not simple.  Hygiene, nutrition, access to health care, and education all play a role in the spread of communicable diseases.  Vaccines have been critical in driving the rates of vaccine preventable illnesses to almost zero, but they are not the only intervention in our armamentarium.

The Soviet Experience.

When the Soviet Union fell apart in the 1980′s, its medical system followed.  Some totalitarian states have been especially good at getting their populations vaccinated.  However, after the fall of Communism, the vaccination rates declined and the diseases they prevented surged.

.Diphtheria morbidity in Moscow in 1958-1999 are presented. The last epidemic which started at the end of the 1980s and reached its peak in 1994, giving a 59-fold rise in morbidity in comparison with the pre-epidemic period, is characterized in detail. During the epidemic 12,267 persons fell ill, 454 of them died (mortality rate was 4%). Having started in Moscow, the epidemic gradually spread not only over the territory of Russia, but also over some other republics of the former Soviet Union (Ukraine, Belarus, etc.). Possible causes of this epidemic emergency are considered. The ever increasing share of adult population among persons affected by the epidemic (75%) is noted. The infection adults is characterized by severity of clinical manifestations and increased morbidity among adults, is shown. Under complicated social and economic conditions (crisis situation) the increase of groups of high risk which included unemployed adults of working age, retirees as well as socially non-adapted persons, was registered.

The massive diphtheria epidemic in the former Soviet Union provides important lessons for all diphtheria immunization programs: It is important to achieve a high level of childhood immunization, maintain immunity against diphtheria in older age groups, and use anti-epidemic measures, including immunization, to control epidemics in the early phase. The immunization coverage among children should be at least 90%.

Failure to achieve high levels of immunity among children contributed to the epidemic of diphtheria that occurred in the Russian Federation during the 1990s. A major factor in this failure was the extensive list of contraindications to vaccination that was in use throughout the countries of the former Soviet Union. In 1980, the Ministry of Health (MOH) of the Soviet Union adopted an extensive list of contraindications for use of the diphtheria-tetanus toxoids-pertussis (DTP) vaccine. In 1994, the MOH of the Russian Federation revised the list of contraindications to vaccination to be largely in accord with World Health Organization recommendations. Since then, age-appropriate vaccination coverage has increased markedly: In 1996, DTP3 coverage among children 12 months of age had increased to 87% from 60% in 1990.

In the end the only way diphtheria came under control was by increasing vaccination rates.

Similar problems were seen with pertussis.

The aim of the current study was to assess the epidemiological situation concerning the emergence of a pertussis outbreak, as well as potential contributing factors and vaccine effectiveness. A retrospective epidemiological description and an analysis of the outbreak among students were performed. The basic school in Adavere had a total of 150 students in 2003. Of these, 54 cases of pertussis, with median age 12 y, all corresponding to clinical case definition, were identified with an attack rate of 36%. Regarding confirmation of the diagnosis, out of all clinical cases, 18 were confirmed by laboratory testing (2 by isolation of B. pertussis and 16 serologically based on single sera) and 36 with epidemiological linkage only. Of all the students with pertussis, 35 (65%) had received 4 doses and 6 (11%) 3 doses of DTwP vaccine; 13 (24%) students had received fewer than 3 doses or were unvaccinated. The contributing factors in generating this outbreak were close epidemiological contacts, late identification of pertussis diagnosis in the primary, secondary and later cases, as well as a too late initiated active surveillance. In this outbreak, low vaccine effectiveness and low vaccination coverage also played an important role.

As well as rubella and measles outbreaks.

The data suggest that rubella is endemic in Kyrgyzstan with periodic epidemics every 3-5 years. From January to August 2001, 1936 rubella case-patients were reported from Bishkek City and Chui Oblast; 242 were tested and 176 (73%) were laboratory confirmed. Most case-patients were 3-14 years old. However, the incidence rate per 100,000 among persons aged 15-35 years increased >/=40-fold from 1 in 2000 to 41 in 2001. These findings highlight the importance of introducing rubella-containing vaccine in conjunction with measles elimination activities.

While the cause of the outbreaks was multi-factorial, it is interesting how rapidly these infections returned with only a small decline in herd immunity. The control of these diseases was expensive and resource intensive in countries with little economic reserve. These outbreaks represent a subset of the countries that were plagued by vaccine preventable infections after the disintegration of the USSR.  Pubmed (to my mind a verb like google) almost any of the states of the former USSR and you will find other examples of the outbreaks from the decline in the use of vaccines.

Polio

Polio was almost eradicated in Africa.  So close you almost wanted to close down the crutch factories.  Then, in the 2003, religious leaders in Northern Nigeria banned the polio vaccine under the belief that the vaccine was being used as a vector by the West to spread both HIV and sterility, specifically targeting Muslims.  And you thought formaldehyde in the vaccine was bad.

In northern Nigeria in 2003, the political and religious leaders of Kano, Zamfara, and Kaduna states brought the immunization campaign to a halt by calling on parents not to allow their children to be immunized. These leaders argued that the vaccine could be contaminated with anti-fertility agents (estradiol hormone), HIV, and cancerous agents.

Even though the ban lasted a mere 11 months, Nigeria saw a resurgence in polio.  Again, we remain at the edge of the infectious precipice and it takes only a tiny push to send people over the edge.    Nigeria also served as a reservoir for polio that subsequently spread to 15 other African countries and beyond.

After the 1988 World Health Assembly resolution to eradicate poliomyelitis globally,  the number of polio-endemic countries decreased from 125 in 1988 to six (Afghanistan, Egypt, India, Niger, Nigeria, and Pakistan) in 2003 . However, during 2002–2005, a total of 21 previously polio-free countries were affected by importations of wild poliovirus (WPV) type 1 from the six remaining countries (primarily Nigeria) where WPV was endemic.”

Polio is coming under control in Nigeria with increased vaccination, with case falling from 1,129 in 2006 to 285 in 2007. Remember that most children who get ill with the polio virus do not develop clinical polio,  a complication of about 1% of the infections.  So 258 cases represent the tip of the polio iceberg (will this metaphor die in the next 100 years? And if so, what will be the replacement be in a world without icebergs?).

The damage, however, has been done and even though education programs have increased the utilization of the polio vaccine, there are still those who will not let their child receive the vaccine due to fears of contamination with birth control. And this in a society without internet connections.  Fear is much more contagious than infection and harder to prevent or treat. As a result of ongoing fear of vaccines, cases of wild type polio continue in Northern Nigeria with 258 cases in 2009, primarily in the Muslim community.

Most of the world uses the live-attenuated oral polio vaccine as it results in a better response.  The problem with live-attenuated viruses, like any virus, is it likes to mutate when it multiplies.  If the immunity to the virus is high in a population and the hosts are immunologically sound, a live vaccine has no place to go even if it mutates.  It requires non-immune hosts to perpetuate.  Herd immunity keeps any mutated strain at bay.  However, if there are populations whose immune function is compromised by poor nutrition or HIV and there are large numbers of unvaccinated people in the community, then odd things may happen. Vaccine strains can spread.  Because of the perfect storm in Nigeria, the vaccine strain was able to perpetuate in a vulnerable community and now there is a mutated strain of polio vaccine that is causing disease in Nigeria.  The vaccine strain escaped and, thanks to a little evolution, changed to have increased virulence.  This would have been much less likely to occur if the population had maintained their herd immunity.

“The number of polio cases caused by the vaccine has doubled: 124 children have so far been paralyzed, compared to 62 in 2008, out of about 42 million children vaccinated.  There have been at least 7 outbreaks in Nigeria from the vaccine strain.”

The point, and I cannot wait for some of the comments this little factoid will engender (not), is that vaccines work best when everyone participates, and as soon as compliance slips even a little, the replicative and mutational capacity of germs guarantees that they may evolve and escape into the wild.

And even stranger things have happened.

The biological properties of poxvirus isolates from skin lesions on dairy cows and milkers during recent exanthem episodes in Cantagalo County, Rio de Janeiro State, Brazil, were more like vaccinia virus (VV) than cowpox virus. PCR amplification of the hemagglutinin (HA) gene substantiated the isolate classification as an Old World orthopoxvirus, and alignment of the HA sequences with those of other orthopoxviruses indicated that all the isolates represented a single strain of VV, which we have designated Cantagalo virus (CTGV). HA sequences of the Brazilian smallpox vaccine strain (VV-IOC), used over 20 years ago, and CTGV showed 98.2% identity; phylogeny inference of CTGV, VV-IOC, and 12 VV strains placed VV-IOC and CTGV together in a distinct clade. Viral DNA restriction patterns and protein profiles showed a few differences between VV-IOC and CTGV. Together, the data suggested that CTGV may have derived from VV-IOC by persisting in an indigenous animal(s), accumulating polymorphisms, and now emerging in cattle and milkers as CTGV. CTGV may represent the first case of long-term persistence of vaccinia in the New World

Of course, the West does not, yet, have a meltdown of the medical-industrial complex nor do we have religious leaders saying vaccines are designed to spread disease and sterility.  Our vaccines cause autism. Hah. Take that Nigeria. Still, we have our own problems with declining vaccination rates.

US  and Great Britain

H. influenzae is killing again.  There have been two mini-outbreaks in the US, one in Minnesota, with five cases and one death and another in Philadelphia, with 6 cases and 2 deaths.  In both outbreaks, the deaths were in unvaccinated children.

Measles has been on the upswing in Great Britain, in large part to a decrease in vaccination.

The national average (of MMR) in Great Britain is 84 percent, but in some areas of London the vaccination rate hovers at a dangerously low 65 percent. Areas with vaccination rates that are consistently below 80 percent run a high risk of an outbreak.

There have been over measles 1200 cases in Britain with one death.  At work one of the social workers has been collecting a three word sentence from everyone  that would be your legacy, three words you would want to be remembered by.  I chose “Left them laughing.”  Dr Wakefields may be “Let measles return.”

Measles is back in the US as well.

During 2008, more measles cases were reported than in any other year since 1997. More than 90% of those infected had not been vaccinated, or their vaccination status was unknown. “

The number of measles cases reported during January 1–July 31, 2008, is the highest year-to-date since 1996. This increase was not the result of a greater number of imported cases, but was the result of greater viral transmission after importation into the United States, leading to a greater number of importation-associated cases. These importation-associated cases have occurred largely among school-aged children who were eligible for vaccination but whose parents chose not to have them vaccinated.

Mumps is also making a comeback in the US.  The index case acquired his disease in Great Britain (over 7900 cases) and brought it to the NE, another failure of homeland security.  Since

January 29, 2010, a total of 1,521 cases had been reported, with onset dates from June 28, 2009, through January 29, 2010, a substantial increase from the 179 cases reported as of October 30, 2009 (1). The outbreak has remained confined primarily to the tradition-observant Jewish community, with <3% of cases occurring among persons outside the community. The largest percentage of cases (61%) has occurred among persons aged 7–18 years, and 76% of the patients are male. Among the patients for whom vaccination status was reported, 88% had received at least 1 dose of mumps-containing vaccine, and 75% had received 2 doses. This is the largest mumps outbreak that has occurred in the United States since 2006.

Letting vaccination rates decine is associated with increasing disease from vaccine preventable illnesses in part due to a decline in herd immunity.  A recent study in Jama demonstrated the converse: increasing vaccination rates leads to decreased disease in unvaccinated populations.

They vaccinated the children of 25 Hutterite colonies with the influenza vaccine and the children of  another 24 colonies with the hepatitis A vaccine and then looked at the rates of PCR proven influenza in those that did not get the vaccine.  In the influenza group, 39 (3.1%) of those who did not get the vaccine developed influenza while 80 (7.6%) of the unvaccinated in the hepatitis A vaccine groups developed influenza.  This  suggested the overall effectiveness of the influenza vaccine in protecting those who did not get the vaccine, herd immunity, at 60%.  Herd immunity, it seems works. And do let Dr. Jefferson know that the rates of influenza in the influenza colonies was  about half that of the hepatitis A vaccinated colonies.

Immunizing children and adolescents with inactivated influenza vaccine significantly protected unimmunized residents of rural communities against influenza.

So vaccines work.  They prevent disease in those who get the vaccine and they can prevent disease those that do not or can not get vaccinated.

Unfortunately, fear of vaccines is increasing in the US .

Our study indicates that a disturbingly high proportion of parents, > 1 in 5, continue to believe that some vaccines cause autism in otherwise healthy children

Despite at least 15 studies that show no link between autism and vaccines (except the recent study from Poland that suggested the MMR may protect against autism), the unwarranted fear persists. Irrational fear, as Nigeria has demonstrated, is hard to remove.

If I were convinced that vaccines, despite all the evidence to the contrary,  were the cause of autism or other disease s, and I were to read the that fear of vaccines was up and vaccine use was down, I hope  I would not gloat.  In medicine I am used to bad outcomes occurring as a consequence of what I know to be the correct course of action.  No good deed ever goes unpunished in health care.  I would not be proud that my actions have lead to an increase in morbidity and mortality in children.  I would hope it would be a bittersweet, sad victory, since my success at burning down the vaccine house will take many children with it.  If vaccine rates fall further, some may have the legacy of “Helped plagues return.”

Posted in: Public Health, Vaccines

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86 thoughts on “Outbreaks

  1. We adopted by daughter from Kazakhstan (former USSR) in 2004. Her medical records showed her up to date on her vaccines. Our pediatrician ordered one titer (can’t remember which) which she should have shown immunity for. The results showed no immunity.* So, due to her age, we re-vaccinated.

    The explanation for the lack of immunity of internationally adopted children after vaccinations received in the orphanage is usually possible dilution of vaccine, improper storage or old vaccine. I’m not sure if this would be a problem in the general public or if it only effects orphanage vaccinated children.

    *my apologies for improper medical terminology.

  2. edgar says:

    “The explanation for the lack of immunity of internationally adopted children after vaccinations received in the orphanage is usually possible dilution of vaccine, improper storage or old vaccine. I’m not sure if this would be a problem in the general public or if it only effects orphanage vaccinated children”

    We had a vax guy come speak to us in Public Health school.
    He said his ideal degree would combine the principles of ID and the mechanics of refrigeration.

    The cold chain is a very real barrier to wordwide vax

  3. WilliamLawrenceUtridge says:

    That so much pointless death and suffering is being caused by, well, stupidity, irrationality, paranoia and stubbornness boggles my mind.

    Nature is red of tooth and claw, and evolution is a merciless reaper. The only “good” I can see coming of this is that eventually, over many generations, the number of people who resist vaccination should be reduced due to the the morbidity, mortality and sterility (yeah, part of morbidity…) that can be the results of vaccine-preventable diseases. Those who ignore science will suffer for it.

  4. EvidenceBasedDC says:

    Vaccinating the third world will always remain a challenge. A lack of sanitation, education and funding are problems that will not be resolved anytime soon. Mistakes like the most recent story from China will continue to fuel fear for some time. The real culprit was most likley the over-heating of the ampules during transportation.

    http://www.breitbart.com/article.php?id=CNG.1b07d1be69ebdf895fab113ba26ecde7.321&show_article=1

    Perhaps the problem with vaccination in the United States stems from the media’s propensity to sensationalize the outliers? Any medication or treatment will have a certain percentage that either don’t respond to treatment or have advese effects. The general population’s relative lack of knowledge regarding statistics and how they work is preyed apon by those who are eager to sell a story.

    My personal dilemma with vaccination is philosophical. From a public health perspective I believe that it’s irresponsible not to vaccinate. In terms of political thought, I do think that people are free to make bad choices. If we remove the freedom do things that endanger ourselves and others, are we truely free? Many of my patients ask my opinion and are shocked to find I’m a pro-vaccine chiropractor (as are most reasonable DCs). The problem that I run into time and time again is that the “autism connection” has been run through the news cycle so many times that it is now accepted as fact by the layperson. This is an example of how consensus does not necessarily equal fact.

    I am curious as to anybody’s thoughts regarding “alternate vaccination schedules” that some pediatricians use/give the option to use and whether or not there are any inherent risks or benefits to them.

  5. edgar says:

    “I am curious as to anybody’s thoughts regarding “alternate vaccination schedules” that some pediatricians use/give the option to use and whether or not there are any inherent risks or benefits to them.”

    I am interested in this, too. I think the first thing I need to know is when CDC recommends a certain schedule, I know it is in part due to compliance issues (which are very important). So the thinking is “well, lets give the kid as many vax as we can, while we have him/her in our hands, because they may not come back.” As we know, these often coincide with well-child visits. We also know there is quit a bit of provider education out there encouraging vax for a sick child visit in which the child is not very sick, for the same reason.

    This is a fair and altogether reasonable position to take in light of lack of follow up. However what I do not know is how the schedule reflects the biological/natural history of a particular disease, and when it is age appropriate to have a child vaxed. For example, is is obviously not necessary to vax an infant with guardacil.

    But if the schedule is mainly due to concerns re: follow up compliance, then it strikes me a reasonable to be OK with alternative schedules who do not want to have their kid get multiple injections (for whatever reason), especially if the parent appears vigilant and keeping/making appointments.

  6. Ash says:

    More recent data related to flu vaccination: http://www.thespec.com/News/BreakingNews/article/748801.

    In Ontario, where the flu vaccine has been free for everyone for several years, the incidence of influenza has been lower than in other provinces where only high-risk groups were vaccinated for free.

  7. provaxmom says:

    “If we remove the freedom do things that endanger ourselves and others, are we truely free?”

    But when you don’t vaccinate, you are endangering others as well. If I do not wear a motorcycle helmet, and crash, only I die. If I do not vaccinate, and contract measles, chances are I will not be the only one sick. I really don’t understand how it is legal to claim “philosophical exemption” from vaccines, but not, say, carseats. Both protect children, and are decisions that children are unable to comprehend and make for themselves.

  8. EvidenceBasedDC says:

    For most reasonable parents (I’m discounting the autism nuts), the concern seems to be about the amount of aluminum in the vaccine and any effects it could have on their child. We’re talking about micrograms here, but multiple vaccinations in one visit to appear to approach if not exceed what is considered a “safe” amount (depending on the company that made the vaccine). The Aluminum salts used are an adjuvant that triggers a more robust immune response to the vaccine. The CDC acknowleges that aluminum has a cummulative effect in the body, and that by 60 months most infants have recieved about 4 milligrams from vaccines. The medical community does say that for patients with renal problems this could be an issue.

    For most children this clearly isn’t a problem. I haven’t been able to find much credible information on this either pro or con. The argument seems to go something like this,

    “It’s how we’ve always done it”

    “The sky is falling, aluminum will kill us all.”

    Any thoughts?

  9. EvidenceBasedDC says:

    That should read “by 6 months”. Sloppy typing.

  10. rork says:

    Glad to see the Hutterite/JAMA article put to good use.

    The news for me was also that there is a way to make such randomized studies ethical, perhaps by 1) Letting people get vaccine from outside sources if they want to (my presumption), and 2) having the control arm not be placebo, but some other vax that benefits the recipient. Part of the message for Dr. Jefferson is that such studies can be made ethical.

  11. EvidenceBasedDC says:

    ” I really don’t understand how it is legal to claim “philosophical exemption” from vaccines”

    Therein lies the rub. I don’t know how people justify it either. The question is really, should they be able to? Forced vaccination isn’t something many people would be comfortable with either. It all depends on your worldview. We’re talking about alot of emotion and deeply held personal beliefs. Science flies right out the window.

  12. rork says:

    I thought the lack of sanctions was that we did not want government to appear to be forcing people to get vaxed, since that feeds their conspiracy theories. We must convince them.

    Certainly, in the U.S., I would hope that if religious exemption is granted for anything, then anyone can be exempted for any reason or no reason – otherwise (to quote an older Tom Jefferson) who will you make your inquisitor.

  13. EvidenceBasedDC, Edgar asking for SBM thoughts on Bob Sears’ “Alternate” vaccine schedule:

    Here you go!
    http://www.sciencebasedmedicine.org/?p=512

    A shorter commentary:
    http://www.kevinmd.com/blog/2009/08/delayed-vaccine-schedule-dangerous.html

    Paul Offit’s 8-page response in Pediatrics to Dr Bob’s book:
    http://tinyurl.com/PaulOffitOnDrBob

  14. Chris says:

    EvidenceBasedDC:

    I am curious as to anybody’s thoughts regarding “alternate vaccination schedules” that some pediatricians use/give the option to use and whether or not there are any inherent risks or benefits to them.

    That was covered at the end of Dr. Snyder’s review of Dr. Bob Sears’ book which advocates an alternative schedule. Dr. Paul Offit has also written about it in Pediatrics.

  15. Dawn says:

    @EvidencebasedDC: IIRC, the only study that found issues with aluminum were in premature infants who were receiving doses in their IV fluids daily for a prolongued time. For the doses in vaccines, an infant/child with normal renal function should have no problem clearing the aluminum between vaccination visits. If you check on Todd W’s site, he has the research links.

    While I don’t like the terminology of “forced vaccination”, in a sense, I am for that. My state “forces” me to wear a seatbelt in a car, a motorcycle helmet when I’m on my motorcycle. Yes, if I’m in an accident and don’t have my helmet on and I am killed, that affects only me. But if I am in an accident and not killed, only severely injured (major brain damage, paralysis from spinal damage, whatever), that affects everyone, because, eventually, the state will end up paying for my care one way or the other. Is it fair for me to put that possible burden onto the state? Or, if my bad driving/riding causes an accident that I am not involved in, aren’t I still responsible?

    I see vaccination as the same thing. It is a preventative measure for the good of all. Some people NEED exemptions, due to health issues, some are too young for vaccines. Those people are at higher risk for injury. Therefore, it is my responsibility as a citizen to do my part and make sure MY children are vaccinated, not only to protect my children but to protect those who are vulnerable. I don’t want to see people forced, but neither do I think it fair that the vulnerable are MORE vulnerable due to fellow-citizen’s irresponsible behavior. Just as I protest those people who drive or ride unsafely, I protest those who don’t vaccinate.

  16. Dawn says:

    Oops..I referred EBDC to Todd’s site, and just realized Todd hasn’t shown up here to comment yet! Sorry. Todd’s site is:

    antiantivax.flurf.net

  17. “I don’t want to see people forced, but neither do I think it fair that the vulnerable are MORE vulnerable due to fellow-citizen’s irresponsible behavior. Just as I protest those people who drive or ride unsafely, I protest those who don’t vaccinate.”

    Although I am probably more for everyone possible getting vaccinated than I am for seatbelts (I’m for both, just a matter of degree), I do have my concerns about forced or completely mandatory vaccination. Just from a public relations/sociological perspective I feel that more mandatory vaccination would arouse more dissent than the system we have now.

    This is just a sense I have of how some people response to health laws, I really can’t back it up with evidence, but I do feel pretty concerned that there would be a major backlash.

  18. EvidenceBasedDC says:

    @micheleinmichigan, I agree whole heartedly. I feel that it would be damaging to public health efforts. The harder people are pushed the harder they will push back. Resposnsible journalism would ameliorate this problem immediately, since irresponsible journalism created it. I’m not going to hold my breath.

  19. Todd W. says:

    @Dawn

    Yeah. I don’t comment as much over here. There are fewer misinformed individuals in the comments over here, and the authors do such a good job explaining things. Thanks for the plug, though.

  20. wales says:

    For those who don’t understand “why philosophical exemptions are allowed for vaccination but not for seat belts”: vaccination has risks. The risks may affect only a small percentage of those vaccinated, but there is much uncertainty as it is often impossible to prove vaccine injury. I suppose seat belts have their own risks, but haven’t seen any statistics on this. Even so, each person is free to exercise their own seat belt “exemption” at the risk of injury and/or vehicular citation.

    Confining the risks of vaccination to the hypothetical risk of autism risk is naive. See this March 22, 2010 FDA release regarding suspending use of the contaminated Rotarix vaccine http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm205625.htm.

    A limited number of contaminant viruses are tested for in vaccines. Unless every conceivable virus is tested for it is impossible to know how many “extraneous viruses” may be present in various vaccines. Planets not visible to the naked eye existed well before they were “discovered” by humans using telescopes.

    Being unaware of risks does not mean they do not exist. No “proof” of risk is not the same thing as “proof” of safety.

  21. mariawolters says:

    Edgar, EvidenceBasedDC, hopefully Crislip or Albietz will correct me if I’m wrong, but current vaccination schedules are based on a delicate trade-off: At what point will the vaccine become most effective? At what age are kids most endangered by infection? How can we reduce the number of visits needed to ensure full vaccination? What diseases pose enough of a threat to warrant a vaccination campaign? How strong do vaccinations need to be to be effective?

    The vaccination schedule of each country is an evidence-based solution that balances all these demands. For example, here in the UK, HepB is not routinely given because it is not endemic – kids only get the vaccine if their parents come from a country where it is a threat. The two doses of the MMR are given at 1 and at 4 – these are preschool boosters which are given before children start school. My German paediatrician thinks the doses need to be spaced more closely to achieve the optimal immunity boost.

    If you want the SBM team’s take on alternative schedules, I would encourage you to google “Sears site:sciencebasedmedicine.org”. This top hit is fairly illuminating: http://www.sciencebasedmedicine.org/?p=512

    Also, when talking about the side effects of not vaccinating, let’s not forget that kids with vaccine-preventable diseases share the waiting rooms of their GPs and paediatricians with babies. I will never forget the horrific story of the two German kids who caught measles from a tween as babies. They recovered and grew up happy and healthy. Several years later, their development began to reverse itself. Subacute sclerosing panencephalitis – a rare late consequence of their measles infection. The girl who had started school as normal age six was an unresponsive shell at age nine.

  22. David Gorski says:

    Actually, seatbelts have risks, too. They occasionally kill in a crash, as do airbags. However, even with that risk you have a far greater chance of death or serious injury in a car crash without seatbelts and airbags than you do with them.

  23. Dawn says:

    @micheleinmichigan – I know what you mean about the backlash. I don’t like forcing anyone to do something against their will.

    However, all through history people have been forced to do things against their will for the good of the community – look at the forced home imprisonment of Typhoid Mary as an example.

    We don’t have the public health nurses now to enforce quarantine for measles, mumps, chicken pox, that used to be out there (I still have a few of my grandfather’s signs from his MD days). Can you imagine how difficult it would be to get one of these antivax parents to stay home with their children for the required time?

    I can recall, from my nursing days, the financial impact it had on a coworker who, never having had chicken pox (and negative titers), was exposed to a woman who broke out the next day. This single mom (pre varicella vaccine days) had to stay home for 21 days until pronounced safe to return to work. She lost an enormous amount of money since she did’t have the sick/vacation time to cover the time off work. (We all chipped in some money to get her groceries and cover a few bills till her next paycheck).

    I recall the woman, 8 1/2 months pregnant, in the ICU with fulminent chicken pox, because she’d never had it and her cousin brought her exposed child with her when she’d visited. Mom nearly died. Baby was born with chicken pox and nearly died too. Such a “safe” disease.

    I can recall, from childhood, my neighbor with mumps. She was in agony from the pain and could barely eat. Except for a “mild” hearing loss, she got over it without serious sequelae.

    Believe me, I am VERY pro vaccine because I remember when we didn’t have a lot of them. I have a smallpox scar on my arm and remember my mom scolding my brother when he didn’t want to eat his sugar cube with the polio vaccine on it. (He wanted to save it for later!) My mom recalled the polio epidemic years and blessed every day that she didn’t have to worry about her kids. My great uncle was one of the lucky ones who had smallpox and survived…his face was horribly scarred but he was alive.

    So, maybe I’m a bit more pragmatic but, well, family history (and yeah, we have some “quirky” family members who probably would have been diagnosed as autistic if they were alive today).

  24. wales,

    That’s why there is a special Vaccine court in the US where people who suffer consequences from vaccines can go for compensation. They don’t have to prove they were harmed through a known mechanism, just that they might have been through a possible mechanism.

    Vaccination is a public health measure, so getting vaccinated helps other people as well as yourself. If you happen to suffer a harm from it, it’s only fair that you be compensated.

  25. mariawolters, Edgar, EvidenceBasedDC,

    Upsthread I posted some links that were held for moderation. There’s the SBM link that Maria posted, a shorter commentary, and Paul Offit’s 8-page article on “alternate” vaccine schedules in Pediatrics.

  26. swienke says:

    “Most of the world uses the live-attenuated oral polio vaccine as it results in a better response. The problem with live-attenuated viruses, like any virus, is it likes to mutate when it multiplies. If the immunity to the virus is high in a population and the hosts are immunologically sound, a live vaccine has no place to go even if it mutates. It requires non-immune hosts to perpetuate…Because of the perfect storm in Nigeria, the vaccine strain was able to perpetuate in a vulnerable community and now there is a mutated strain of polio vaccine that is causing disease in Nigeria. The vaccine strain escaped and, thanks to a little evolution, changed to have increased virulence. This would have been much likely to occur if the population had maintained their herd immunity.”

    Considering the difficulties in ensuring widespread vaccination in third world countries in conjunction with the information in the above paragraph, wouldn’t it be better to use a dead virus in the vaccine so as to prevent its mutation (and therefore making sure that an epidemic would only occur amongst the unvaccinated)? Or is the effectiveness of the live vaccine so much greater than that of a dead one that it generally offsets the risk of mutation and spreading back to the vaccinated population?

  27. wales says:

    Alison, your summary of vaccine court is overly simplistic. About 70% of the eligible cases filed are dismissed. http://www.hrsa.gov/Vaccinecompensation/statistics_report.htm#claims_filed

    Anyhow, monetary compensation for death or injury of a child is hardly comforting to parents, however “fair” it appears to you.

  28. Chris says:

    wales, that is probably because one actually has to prove harm. When the vaccines are not the cause, it is hard to prove cause even with the lax evidence required for some cases (50% plus a feather). Summary of some of the vaccine court cases here:
    http://neurodiversity.com/weblog/article/189/

  29. wales says:

    Chris, you are right, it is hard to prove cause. That was my point.

  30. wales on vaccine court:

    “Anyhow, monetary compensation for death or injury of a child is hardly comforting to parents, however “fair” it appears to you.”

    Of course not. Which I guess is why there’s no non-vaccine court where the families of infants and immunocompromised people who are killed or harmed by vaccine-preventable disease can go to seek compensation from a fund maintained by vaccine-refusers.

  31. professional_lurker says:

    AC,

    Which I guess is why there’s no non-vaccine court where the families of infants and immunocompromised people who are killed or harmed by vaccine-preventable disease can go to seek compensation from a fund maintained by vaccine-refusers.

    I think this is actually a good idea, and if there could be reasonable people that could write some legislation that wasn’t profoundly sensational, I’d probably support it. Offer the states some incentives for compliance with data reporting and start doing some real surveillance of disease incidence. Just as the vaccine injured are to prove that the vaccine caused their injury, the person harmed by the disease which allegedly was caused by vaccine refusal will do the same. As long as we continue to look for someone to blame when something happens to us, the only resolution is through the courts – so perhaps the two groups should just stop dancing with each other and agree about something. Anything.

    There could possibly be some additional part of the “fund” that could be set aside to fund some research or something positive that will further educate people in their communities about infectious disease in general… not just vaccines. Would this kind of effort from people that selectively vaccinate their kids absolve them from wrongdoing in your eyes?

    Dr. Crislip,

    H. influenzae is killing again. There have been two mini-outbreaks in the US, one in Minnesota, with five cases and one death and another in Philadelphia, with 6 cases and 2 deaths

    How has this impacted nontypeable strains of this bacteria? Has it been observed more with the absence of type B circulating?

  32. moderation says:

    @Wales … as was noted in the email I recived from the CDC … the contaminant virus found in the rotavirus vaccine was noted to be a non-pathogenic virus. This would seem to be an example of how the system SHOULD work. Also, the most frequent reason that claims are turned away from the Vaccine Court is there complete lack of scientific plausability. The vaccine court attracts a lot of claims due to its low threshhold of proof … as Allison said, “They don’t have to prove they were harmed through a known mechanism, just that they might have been through a possible mechanism.” (see the judgement in favor of the child with a mitochondrial disorder … no proof of cause, but a plausible possible cause)

    Speaking to alternate vaccine schedules the some of reasons for a universal schedule seem obvious:

    1. efficient tracking of vaccination delivery
    2. intra-provider consistency of delivery
    3. delivery of vaccine prior to possible disease exposure
    4. likely access to patients prior to exposure (teens are a lot less likely to be seen routinely than infants)
    5. allowing for administration of vaccines when age appropriately safe

    All that being said, in the clinical world when a parent insists they follow an alternate schedule, whether Sear’s or just “I don’t want them to have more than 2 pokes at a time”, the pediatricians I know work with these parents to obtain as timely as possible vaccination of their children.

  33. weing says:

    “How has this impacted nontypeable strains of this bacteria?”

    What are you talking about? How have the outbreaks of H. influenzae type b in Minnesota and Philadelphia impacted nontypeable strains?

    “Has it been observed more with the absence of type B circulating?”

    Has what been observed more? Are you referring to the article you misunderstood in another thread about H. influenzae epidemiology?

  34. BillyJoe says:

    PL,

    If you think that your tactics haven’t been figured out yet by other posters in these threads, please think again.

    Please, spare us the disingenuous questions already.

  35. “Would this kind of effort from people that selectively vaccinate their kids absolve them from wrongdoing in your eyes?”

    I have no problem with parents who selectively vaccinate their children for good reason, whether there is a fund or not. Some children can not be vaccinated due to health disorders, allergies or other reactions to certain vaccines. Why should they should have to pay a fee for that. Parent’s who chose to not vaccinate for poor reasons can not be absolved of the consequences, regardless of any renumeration.

    Once again the car analogy. If you choose to speed or drive recklessly and cause an accident that is your responsibility. Carrying liability insurance doesn’t make it okay to speed.

  36. professional_lurker says:

    Weing:

    What are you talking about?

    Serotype replacement.

    Are you referring to the article you misunderstood in another thread about H. influenzae epidemiology?

    Then explain the 657% increase in NTHi (to be fair, that article did focus on nontargeted vaccination groups) since the widespread use of Hib vaccine, because you didn’t in that thread. Rejecting this inconvenient fact as an incorrect interpretation of the article is intellectually dishonest. You should either reveal errors or omissions in my facts or logic, not pose a broad question in an attempt to discredit my citation of it.

    If you think that your tactics haven’t been figured out yet by other posters in these threads, please think again.

    Questioning the motive of the opponent and not addressing their statements is not a valid argument. I’m a reasonable person, if you are having difficulty with me, then it’s no surprise that the more vehement of anti-vaxxers would bother you and you would attempt to stereotype anyone that dare say anything negative.

    Micheleinmichigan:

    Parent’s who chose to not vaccinate for poor reasons can not be absolved of the consequences, regardless of any renumeration.

    What are considered poor reasons? Are the consequences of being infected with a communicable disease somehow stronger than being vaccine injured? (I don’t mean to imply you suggest that, as a debate tactic, I’m just asking)

    Once again the car analogy. If you choose to speed or drive recklessly and cause an accident that is your responsibility. Carrying liability insurance doesn’t make it okay to speed.

    You must first choose to get into the car in the first place in order to speed or drive recklessly, and be at least 16 years of age. If a person decides that their lifestyle does not suit using a car and decides to bike, or take a bus, obviously, those laws will not affect them. If they are injured in an accident by a reckless driver, then it should be up to local law enforcement, and eventually the courts to determine the penalty. A day old baby receiving the hep B at the hospital cannot compare to this in my mind. I am having difficulty drawing the same parallels that many of you do when comparing vaccination to driving. In order to make this parallel with anti-vaxxers, you have to both agree on what the risks of vaccines actually are. You can’t use the data from clinical trials, because clinical trials (with healthy people) don’t exactly show the real population. There is obviously some room for interpretation here. We can’t use VAERS, since it’s a laughable excuse for reaction reporting / tracking. So where do we go for remedy (because you cannot compel someone to take a biologic by law without offering remedy… a large reason why exemptions exist) – we have to go to the law. It’s sad. But it’s true.

    I saw this upthread but didn’t address it, and would like to now:

    Also, when talking about the side effects of not vaccinating, let’s not forget that kids with vaccine-preventable diseases share the waiting rooms of their GPs and paediatricians with babies.

    Yes they do. This is due in part to people not knowing anything about communicable disease and they very often panic in any acute situation. I don’t have much experience with peds offices anymore though, so I’m not entirely sure there’s a way around being exposed to infectious disease if you allow sick people to inhabit the same space as those ‘well’.

    One office I worked for did not see sick patients during the day. They saw them before 9 (when the office opened) and after 3:30 (when it closed). I would think this kind of policy would certainly limit exposure to those who are sick and / or ‘contagious’ (regardless of vaccination status).

  37. weing says:

    PL,

    Your questions still do not make sense and you. What serotype replacement? Your analysis of that paper is fallacious. It is the old post hoc ergo propter hoc.

  38. BillyJoe says:

    PL,

    “Questioning the motive of the opponent and not addressing their statements is not a valid argument.”

    Understanding your motive is the reason for not addressing your statement! Asking innocent sounding questions whilst poised with a slapping hand over the answers you think are coming.
    Sorry, school-teacher, my name is Maxwell.

  39. Sid Offit says:

    Some totalitarian states have been especially good at getting their populations vaccinated

    Like in Amerika

  40. Sid Offit says:

    Failure to achieve high levels of immunity among children contributed to the epidemic of diphtheria that occurred in the Russian Federation during the 1990s

    after the fall of Communism, the vaccination rates declined and the diseases they prevented surged

    Really? That’s not what I herd.

    —————————–

    The outbreak occurred in spite of high vaccine coverage with a primary series among school-age children. [Vaccines 4th ed. - Plotkin P222]

    Despite high levels of vaccination coverage against diphtheria, an ongoing outbreak of diphtheria has affected parts of the Russian Federation since 1990
    MMWR Morb Mortal Wkly Rep. 1993 Nov 5;42(43):840-1, 847.
    Diphtheria outbreak–Russian Federation, 1990-1993.
    Centers for Disease Control and Prevention (CDC).

    ———————-
    Igor A. Andreyev, Moscow’s chief epidemiologist at the time, attributed the situation in part to social instability, an increase in migrants and drifters and “people who live in the subway tunnels.”

  41. Sid Offit says:

    Measles is back in the US as well.

    Mumps is also making a comeback in the US

    ———————-

    So?

  42. weing says:

    “So?”

    Vaccinate! Increase herd immunity.

  43. wales says:

    “Failure to achieve high levels of immunity among children contributed to the epidemic of diphtheria that occurred in the Russian Federation during the 1990s.” Um, that may have “contributed”, but was not the most important factor. Quoting the paper below “Arguably the most important factor for the diphtheria epidemic was the development of large populations of adults susceptible to the disease as a consequence of successful childhood vaccination programs. The decreased opportunity for naturally acquired immunity, along with the waning of vaccine-induced immunity in the absence of routine adult revaccination, has resulted in a high proportion of adults susceptible to diphtheria as documented by serologic studies in many countries”

    http://www.cdc.gov/ncidod/eid/vol4no4/vitek.htm

    The paper gives a variety of reasons for the outbreak outbreak of diphtheria in the 1990s: “Numerous factors appear to have contributed to the epidemic: 1) increased adult susceptibility, which is reflected in the age distribution of cases and deaths; 2) increased susceptibility of children; 3) a clone of closely related strains of C. diphtheriae, gravis biotype, associated with most of the cases in Russia, even though its role remains uncertain; 4) highly crowded urban populations and service in the military; 5) the breakup of the former Soviet Union, perhaps by disrupting vaccine supply to all countries other than Russia and initiating large-scale population movements throughout the Newly Independent States.”

  44. provaxmom says:

    “So?”

    Are you suggesting that eradicating diseases is an antiquated notion?

    I grew up in the 70s, no one I knew ever had mumps or measles, we didn’t have to worry about it. Now some a$$hat brings their kid to day care unvax’d, and the baby next door to my brother gets measles. Really? In 2010, we have to worry about measles?

    You can interpret those statistics any way you wish. I believe in this country, compliance rates are up above 95%. That still doesn’t mean 95% coverage in all geographic areas, some are much lower than that.

  45. wales says:

    I too grew up in the 1970s. According to the CDC Pink Book appendices, from 1970 through 1980 the US averaged about 34,500 cases of measles per year.

    I knew several people who had measles in school, including college outbreaks in the mid 1980s. In college we pondered this (especially my pre-med friends): the fact that all of us had been vaccinated, but some of us got measles and some didn’t. I was exposed to it but didn’t get it. My friends missed a few days of school. And of course chicken pox was rampant.

  46. Professional Lurker – Sorry, I can’t respond. I just have not idea what you are trying to say. You are making too many claims without sources or data to back them up and it appears you have a bias that you are not being open about.

    Since I come to this site to inform and educate myself and you have left me a little unimpression of your reliability as a source, I’m afraid discussing your opinions falls too low on my priority list.

    best, michele

  47. BillyJoe says:

    wales,

    “In college we pondered this (especially my pre-med friends): the fact that all of us had been vaccinated, but some of us got measles and some didn’t.”

    Are you still pondering it?
    Hint: the seroconverison rate for the measles vaccine is 95%

    “My friends missed a few days of school”

    They were lucky.
    On the other hand, a percentage of their fellow sufferers would have had the following complications: pneumonia, encephalitis, subacute sclerosing panencephalitis, corneal ulceration, corneal scarring, and a fatality rate of 3 per thousand.

    But even they were lucky.
    The fatality rate in third world countries is as high as 28%

  48. professional_lurker says:

    The responses of Weing, Billy Joe and micheleinmichigan are all three different kinds of the same response:

    Your questions still do not make sense and you. What serotype replacement? Your analysis of that paper is fallacious. It is the old post hoc ergo propter hoc.

    In order for your rebuttal to be meaningful, you are required to explain why my analysis is fallacious. Serotype replacement occurs when a vaccine effectively removes a microbe from the environment, it is also called replacement disease.

    Billy Joe,

    Understanding your motive is the reason for not addressing your statement! Asking innocent sounding questions whilst poised with a slapping hand over the answers you think are coming.

    This is still not a valid argument. Appeal to Ridicule.

    micheleinmichigan:

    You are making too many claims without sources or data to back them up and it appears you have a bias that you are not being open about.

    What claims? I wasn’t aware that I needed to declare interests in order to post here. I have four children, two fully vaccinated, one partially and one that isn’t at all. If people are incapable of civil dialogue (as demonstrated by the three responses I got) then this issue will continue to magnify.

    you have left me a little unimpression of your reliability as a source, I’m afraid discussing your opinions falls too low on my priority list.

    Ad hominem.

    I’ve seen numerous posts (not here, necessarily, provax in general) on how to address people that might vaccinate, if they could simply be adequately convinced and their concerns addressed. I might suggest that these kinds of responses (logical fallacies) probably don’t do much to bridge the gap of misunderstanding.

  49. Sid Offit says:

    I grew up in the 70s, no one I knew ever had mumps or measles, we didn’t have to worry about it.

    Nobody worried about it in the 50s and 60s either. In the pre-vaccine era it was described both as a minor annoyance and a trivial disease. The Brady Bunch even had a measles episode in which the family was concerned not about the measles, but rather about whose doctor the children would use.

  50. Sid Offit says:

    @BillyJoe

    a fatality rate of 3 per thousand.

    —————————-

    You mean 1 in 8,000. In the prevaccine era there were 4 million cases of measles with 4-500 related deaths.

  51. Harriet Hall says:

    PL

    Replacement disease is a drop in the bucket compared to the disease prevented and lives saved by the vaccine.

    Sid Offit,

    No one I know has AIDS. Does that mean I don’t need to worry about practicing safe sex?

    Mumps and measles may have been misperceived as minor annoyances, but some children died and some boys were rendered sterile.

    Accurate information from medical statistics trumps opinion from personal experience every time!

  52. BillyJoe says:

    This is still not a valid argument. Appeal to Ridicule.

    Okay, I have to spell it out then:

    I am not advancing an argument, I am refusing to advance an argument. And my reason is your track record in subterfuge and mischaraterisation, either deliberate or out of ignorance, of other poster’s arguments.
    And I am not ridiculing you, I’m denegrating your methods and threatening you with Maxwell’s solution.

    (Hey, that last bit is a joke)

  53. wales says:

    BJ: A mortality rate of 3 in 1,000 for measles in the 1970’s in the US?? Really?? Do the math, look at the CDC Pink Book appendices. For the period 1970 – 1980 the average annual mortality rate was 0.79 per 1,000 cases. Even the higher mortality years of 1970 and 1971 had a mortality rate of less than 2 per 1,000, all other years less than 1 per 1,000. Given that the actual number of cases was probably higher than reported, the mortality rate was probably even lower.

    Can you document your 3 in 1,000 figure? Thanks.

  54. Chris says:

    wales:

    Do the math, look at the CDC Pink Book appendices. For the period 1970 – 1980 the average annual mortality rate was 0.79 per 1,000 cases.

    Why is that acceptable? Especially when greater numbers were left with permanent disabilities like deafness, blindness, paralysis, etc.

    Acute measles mortality in the United States, 1987-2002:

    Overall the death-to-case ratio was 2.54 and 2.83 deaths/1000 reported cases, using the NCHS and NIP data, respectively.

    BillyJoe may have the information for Australia.

  55. “I knew several people who had measles in school, including college outbreaks in the mid 1980s. In college we pondered this (especially my pre-med friends): the fact that all of us had been vaccinated, but some of us got measles and some didn’t. I was exposed to it but didn’t get it. My friends missed a few days of school. And of course chicken pox was rampant.”

    Yes, we were in college at the same time. As I recall, this is when they decided to start recommending a 2nd measles vaccination (booster.) I’m not a doctor or scientist, though. I only remember this because my mom harassed me until I went in to the clinic to get the booster. :)

  56. BillyJoe says:

    Can you document your 3 in 1,000 figure? Thanks.

    No, I’ll just accept your figure.
    But, what is your relevant point?

    (The 3 in 1000 rate was the average rate in developed countries for the years 1992 to 2004)

  57. wales says:

    Michele: Yes, I think we were even in college in the same state? MI? Which may have experienced high measles outbreaks in the 1980’s due to widespread outbreaks across the border in Canada.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1486406/pdf/cmaj00287-0055.pdf

    Chris: No one said any mortality rate was acceptable, but neither is it acceptable to distort the facts by tripling the mortality rate.

    BJ: Merely an observation. My experience was completely different from the experience of someone (provaxmom?) who said no one she knew got the measles in the 1970s. In my experience many people got it, they did not go to the doctor when they had it (thus it was widely underreported) because the parents of children in the 1970’s had all had measles themselves and were not as frightened of it as people are today.

  58. wales says:

    Another interesting fact from the measles paper cited above: “Subjects vaccinated before 1980 were at greater
    risk than those vaccinated after 1980. This could have
    been because of a higher rate of primary vaccine failure
    before the addition of an improved heat stabilizer to the
    measles vaccine in 1980 or because of poorer vaccine
    handling practices before 1980.” I was not aware of this. Presumably the seroconversion rate for those vaccinated prior to 1980 was lower than 95%. Given that and waning vaccine-induced immunity, this indicates today’s adults may be widely susceptible to measles.

    Which may explain this paper’s findings that measles is increasing in adults.

    http://ije.oxfordjournals.org/cgi/reprint/28/1/141

  59. weing says:

    “In order for your rebuttal to be meaningful, you are required to explain why my analysis is fallacious.”

    I told you. Post hoc ergo propter hoc fallacy. It would be so much better for you if you figure out how by yourself.

    “Serotype replacement occurs when a vaccine effectively removes a microbe from the environment, it is also called replacement disease.”

    So the incidence of H. flu remains the same in children, despite getting the vaccine, they just don’t get type b? I didn’t get that from the article. The incidence of type b before vaccination was greater than 30 out of 100k and decreased by over 99% since the introduction of the vaccine.
    http://www.cdc.gov/mmwr/preview/mmwrhtml/00055745.htm

    That non type b H. flu remain in the environment is not surprising. They were causing disease before the vaccine and will continue to do so until we get vaccines for them. The total incidence of H. flu is still less than 1 in a 100k.
    People over 65 were getting H. flu before the vaccine came out and they continue to do so. There were and are many reasons for this. The vaccine is not one of them.

  60. The paper’s finding or conclusion is this. “Conclusion – Canada is currently experiencing a situation that is likely to occur in other countries that embark on measles elimination. This situation occurs when an advanced control level has been sustained for many years, but without 100% protection; less than complete protection allows susceptibles to accumulate. Adults, the age group most likely to travel internationally, are likely to import measles, which can lead to re-establishing endemic measles virus transmission. In the absence of effective control measures, such importations could lead to outbreaks of thousands of cases. Countries that have moved rapidly from high levels of endemic measles to elimination are less likely to experience this problem because most adults would have previously had measles.”

    The conclusion then goes on to discuss the pro and cons of “effective control measures.”

    I didn’t see any indications in the paper that “today’s adults may be widely susceptible to measles.” But, it is rather long, so I may have missed it. But I believe if one is concerned about their measles immunity coverage, they can get a booster.

  61. PL said “What claims? I wasn’t aware that I needed to declare interests in order to post here. ”

    You don’t need to declare interests to post, only to gain my trust as a reliable source. The other way to earn some of my trust is to display a real mastery of a particular field of knowledge, show an aptitude for putting together a logical argument, or be funny.

    “I’ve seen numerous posts (not here, necessarily, provax in general) on how to address people that might vaccinate, if they could simply be adequately convinced and their concerns addressed.”

    I don’t come to the site to convince parent or alleviate their concerns. Like I said before, I come here to inform and educate myself and sometimes to join in interesting discussions about science, medicine or ethics. Since I am a parent of a child with medical needs, I sometimes choose to advocate from a patient/parent perspective to medical professionals.

    If you have concerns, rather than forgone conclusions, I’m sure one of the doctor’s here would be willing to address them, if you just come out and say them, rather than infer, imply and innuend (that is to use innuendo :).

    To me your posts read much more like YOU are trying to convince people that vaccines are have a overall negative rather than overall positive impact.

    See that’s the thing about “Ad hominem” if you are not putting forth an argument, how can I attack it with an appeal to the personal or emotional rather than factual. If you just want information, how is “Ad hominem” relevant? And if you are only looking for vaccine information, why from me? A fine artist with two children?

    Nope, to me, it sounds like you are trying to convince me and people like me, of your argument against vaccination, and for some reason you think I owe you the time to listen and discuss.

    Perhaps you do not have an aurgument you are presenting. But, maybe it will be useful for you to know that is how you come across, based on your posts in this thread and the former ““Vaccines didn’t save us” (a.k.a. “vaccines don’t work”): Intellectual dishonesty at its most naked” http://www.sciencebasedmedicine.org/?p=4431.

    But, now, I really do have gardening, child rearing, cleaning, etc.

  62. gaiainc says:

    Hib… the reason that particular serotype was chosen for vaccination was because that serotype caused the worse disease (like meningitis or epiglottis). Since the vaccine, Hib-caused meningitis has plummetted so much so that recommendations for how to treat febrile infants were re-written. I have been doing medicine for 15 years now, taking care of kids on a neear daily basis during that time. If non-Hib serotypes were causing the same problems that Hib was, by now I should have seen at least one case of epiglottis or one case of Hib menigitis, based on pre-vaccine prevalence rates (and the fact that I was at the local area children’s hospitals). I haven’t. I’ve seen meningococcal meningitis in an adult, but not Hib. Changing serotypes is only a problem if the change in serotypes is causing more disease. No evidence has been presented to show that it has. I am thankful I have never seen a case of epiglottis and I hope that I never will.

    Oh and what weing said as well.

    I do not understand not vaccinating. I really don’t. You are preventing people from getting sick. The risks are minimal in comparison to the risks of the disease. A part of me think it has to do with this stupid value that somehow suffering is good. While I understand that life is not a pain-free state, there is no reason to make someone go through a disease when it could be prevented. That mentality is completely beyond me.

  63. BillyJoe says:

    “I do not understand not vaccinating.”

    It’s because the antivaccinators spread misinformation and fear.

    If parents are confused about vaccines as a result of misinformation and fear spread by anti-vaccinators, they are less likely to vaccinate their children. So the antivaccinators don’t have to win the argument. They just have to confuse. And they know it. On the other hand, the pro-vaccinators must win the argment and win it in numbers. That might require a ratio of a 100 to 1. The whole of the medical profession against the handfull of antivaccinators.

    Look how difficult it has been even on this blog – a small and select subportion of the population – to win the argument. There’s always another exaggerated little tree of doubt in a forest of fact to distract us with.

    I don’t doubt that most anti-vaccinators are sincere, but that can only mean they are ignorant, not only about vaccines, but also the scientific process and how facts are derived and how absolute certainty can never be achieved. How it’s always going to be a question of risks versus benefits. They want the benefits to be risk free. They live in a fantasy world where no one ever dies in a car accident.

  64. EvidenceBasedDC says:

    It is truely an unfortunate state of affairs when people are willing to take the word of a reporter on the evening news over that of a qualified healthcare professional. What they fail to understand about media in general is that that reporter isn’t there to present facts, they are there to get ratings which in turn generate advertising revenue. Apparently anti-vaccine stories sell. Where folks get the idea that the TV news has there best interest at heart, and their family doctor is out to screw them over is beyond me.

  65. professional_lurker says:

    Micheleinmichigan,

    To me your posts read much more like YOU are trying to convince people that vaccines are have a overall negative rather than overall positive impact.

    I’m not trying to convince anyone of anything, and I’m sorry you think I’m negative. I’m just addressing the other side of the argument, that no one discusses here in any meaningful way. I get irritated when people make broad statements regarding the vaccine program and they ridicule parents of vaccine injured children. My bias? Yes, I have one. I have three actually. This bias has not kept me from realising when and where the program works and is necessary. This irritation is no doubt present in some of the things I say, but it’s only because I’ve been saying the same thing for years and have lost the ability to sugar coat anything. My profession has taught me that the devil’s in the details, and in some cases that relate to vaccines, nobody is bothering to look.

    See that’s the thing about “Ad hominem” if you are not putting forth an argument, how can I attack it with an appeal to the personal or emotional rather than factual.

    The fact that you took the time to publicly tell me that you were ‘on to me’ and that your unimpression of me absolved you from making further contact is kind of confusing me. Why bother responding? It was a good time to be passive aggressive, that’s why.

    I’m not making appeals and it is not me, that is trying to convince people to vaccinate. I am here to be convinced. There’s a lot of garbage to sift through out there, but just because some garbage is out there, it doesn’t mean that everything out there is garbage. You see, I’m one of those parents that went looking onto the internet to find out what happened to my kid after he got vaccines at 8 weeks old and didn’t like what I found. My doctor emphatically denied the events were related, it wasn’t until much later that I realised she wasn’t supposed to do that. It wasn’t up to her to decide whether or not my child had been injured.

    From those posting more often, they just seem to be concerned about my psychological profile and my debate tactics… never once addressing anything I have posted in any meaningful way. I engaged you, because you were not being like that, so This isn’t the first time I’ve tried to have a discussion with someone that believed the polar opposite as I and have been met with the same kind of discriminatory reply. I do appreciate you taking the time to explain why though.

    The arguments I’ve made have been logical, if they weren’t, (sorry, OT.. post hoc weing? really? by that principle, the same is true of vaccines and the decrease in morbidity and mortality) nobody’s doing a very good job of explaining why. If I have found my way here, in all that there is on the interwebz, obviously, I am looking in the right places. If you have to be provaccine and refuse to acknowledge any of the real risks associated with the vax schedule, then this isn’t the place for someone like me to find the answers I need. Thank you for helping me realise that.

    Gaiainc

    If non-Hib serotypes were causing the same problems that Hib was, by now I should have seen at least one case of epiglottis or one case of Hib menigitis,

    Apologies, that’s not what I was trying to say. There is evidence that NTHi is increasing since the implementation and wide spread use of the vaccine (to be expected). I do not discount your experience in any way, and I’ll ask you the same thing I have asked other people regarding bacteria in general. If a lot of people can harmoniously carry this bacterium, how do you explain people who suffer serious illness and more invasive disease? What is different about that population, and is it worthwhile to study that population further? When other serotypes step in to fill the void created, it’s kind of a gamble… you have to just sit back and wait for the results and make sure a more virulent pathogen doesn’t step into its place. When it does we’re scrambling to create another vax to contain new types that are causing problems.

    Since different types of bacteria can actually have a inhibitory effect on others (inter species competition) this can create their own problems, leading to other kinds of bacterial infections (like staph for example). Breastfeeding has shown to be protective as well, (if you are wanting evidence of this just pubmed it, it’s there) so please tell me why it’s wrong for a mother deciding to wait on this vaccine since she is still nursing and her child isn’t in day care? This is when she is told she is selfish for not protecting her neighbor. At some point, public health has evolved into the mentality that it is selfish to protect your own kids and that you are supposed to do your part to protect society first. Well I did that (so did a LOT of people that are now being ridiculed). When my son had a reaction (likely to the pertussis component) and it was denied and I was subsequently treated unprofessionally – I finally turned my back on a preventative health care system that abandoned me when I needed it the most, and that’s not my fault. My reward has been to have my mind up for grabs in a propaganda nightmare that won’t end. And I am definitely not alone because you hear my story on message boards all across the web. The inability for the powers that be to not reach common ground (and rationality) somewhere is just further isolating a large percentage of people that would otherwise be receptive to vaccinating. Until someone takes the time to adequately convince me, I’ll just keep randomly posting when I’m irritated enough. Obviously, you are all free to file my posts in the trashcan, as I suspect many of you are anyway.

    Sorry for the intrusion here folks, it’s appearing to be members only. I do appreciate the constructive criticism micheleinmichigan, I’ll try to be less negative. It helps when people make specific claims, and not just broad sweeping statements that don’t stand up to scrutiny. It also helps to concede when things go badly or not as expected, because when you don’t, things get out of hand and it becomes impossible to defend anything when you are in constant damage control.

  66. Harriet Hall says:

    professional_lurker said,

    “If you have to be provaccine and refuse to acknowledge any of the real risks associated with the vax schedule,”

    No one is denying that there are real risks associated with vaccines; we are only saying that those risks are much smaller than the risks of not vaccinating.

    “There is evidence that NTHi is increasing since the implementation and wide spread use of the vaccine”

    To my understanding, that increase is very small compared to the huge benefits resulting from the vaccine.

    “If a lot of people can harmoniously carry this bacterium, how do you explain people who suffer serious illness and more invasive disease?”

    Chance, genetic variation, defects in the immune system, who knows? Yes, of course this should be investigated, but meanwhile we should do what we can to protect people from disease.

    “you have to just sit back and wait for the results and make sure a more virulent pathogen doesn’t step into its place. When it does we’re scrambling to create another vax to contain new types that are causing problems.”

    So what is the alternative? To do nothing because we can’t foresee the future? To just let babies die because this “might” be a problem?

    “tell me why it’s wrong for a mother deciding to wait on this vaccine since she is still nursing and her child isn’t in day care?”

    Maybe it’s not as wrong as for someone who is not breastfeeding and whose child is in day care, but it’s still risky. Why would it be wrong for the mother to vaccinate anyway? Especially since there is no evidence that delayed vaccination is safer. There are documented cases of breastfed children catching these diseases. I don’t think there are any reliable data, but I think vaccination on schedule is likely to be more protective than breastfeeding and avoiding daycare.

    What I’m hearing is that you had a bad personal experience, a very atypical one, and as a result you rejected the whole system that it represented. And you are offended by our trying to make well-meaning parents feel guilty when all they are doing is trying to do what’s best for their child. All these hurt feelings are too bad, but that does nothing to change the facts and the evidence. Vaccines work. There are good reasons for the recommended schedules. And the more parents who refuse vaccines, the more likely the diseases will recur and hurt the children of others.

  67. weing says:

    PL,

    Harriet covered most of the points I would in response to your comments. I just wish to express my condolences at your bad and traumatic experiences. Whether they were caused by vaccines, I have no idea. If they were, it is unfortunate that your child ended up with the short straw.

  68. BillyJoe says:

    “I just wish to express my condolences at your bad and traumatic experiences. Whether they were caused by vaccines, I have no idea. If they were, it is unfortunate that your child ended up with the short straw.”

    I had not heard of this.
    Did he mention it in one of his posts here?

  69. Paulz says:

    “…the vaccine strain was able to perpetuate in a vulnerable community and now there is a mutated strain of polio vaccine that is causing disease in Nigeria. The vaccine strain escaped and, thanks to a little evolution, changed to have increased virulence.”

    Presumably this mutated strain of polio virus in Nigeria that infects those already vaccinated will soon make its way to the rest of the world?

  70. professional_lurker says:

    Dr. Hall,

    No one is denying that there are real risks associated with vaccines; we are only saying that those risks are much smaller than the risks of not vaccinating.

    And you quantify this how? With trial data using healthy people and a piss-poor database that addresses reactions? Please be specific and do not encompass the entire programme and the diseases under the same umbrella.

    To my understanding, that increase is very small compared to the huge benefits resulting from the vaccine. [addressing serotype replacement of Hib vax]

    Huge benefits? How do you interpret these findings?

    http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=12898433&cmd=showdetailview&indexed=google

    I see 56.7%, what do you see?

    I’m not sure how you are determining that increases in HI meningitis due to other types (because of plucking type B out of the environment) is small, please elaborate. I’m sincere here, please explain it if I am so misinformed.

    Chance, genetic variation, defects in the immune system, who knows? Yes, of course this should be investigated, but meanwhile we should do what we can to protect people from disease.

    The meantime has shown that we are possibly creating more virulent types of this bug. When you say “people”, would you please clarify that you mean children… because as far as I know, we are not requiring adults to get this vax (and a whole host of others, yet have no idea talking about herd immunity and forgetting that most adults aren’t vaxxed). And the fact that you so nonchalantly dismiss the question as “who knows”, tells me that you don’t really care why it becomes invasive in a subset of children, only that vaccinating everyone under every circumstance is the answer. You have not convinced me with your broad assumptions that this is the reasonable course of action to prevent children from having this bug become invasive (opportunistic is probably a better choice), let alone my breastfed nonvaxxed child.

    So what is the alternative? To do nothing because we can’t foresee the future? To just let babies die because this “might” be a problem?

    Sensationalise much? I see you’ve quietly substituted the word “people” for babies, at least now you’re being more truthful. The literature is riddled with evidence whereby breastfeeding protects against this invasive disease and other respiratory illnesses. You might equate that to “nothing” since it’s it was an inconvenience for you and you don’t want to dribble breastmilk on your flight suit. If you want to protect your child from this disease by jabbing him/her, fine, I’ll choose another route.

    Why would it be wrong for the mother to vaccinate anyway? Especially since there is no evidence that delayed vaccination is safer. There are documented cases of breastfed children catching these diseases. I don’t think there are any reliable data, but I think vaccination on schedule is likely to be more protective than breastfeeding and avoiding daycare.

    There is no evidence that vaccinating on schedule is safe whatsoever other than the hypothetical capacity of the human immune system (ie. ‘yer baby is challenged more at the mall than they are getting vaxxed). Children can, and do, get sick… all. the. time. If it is your contention that vaccinating a neonate on their first day of life is safer that not doing it, by all means, let’s have it. By vaccinating this early, we certainly have removed any chance of having any reasonable (random) control group to study the overall health outcome of both populations later in life.

    What I’m hearing is that you had a bad personal experience, a very atypical one, and as a result you rejected the whole system that it represented.

    Then you are not listening. Yes. I had a bad experience, I’m still on this blog trying to wind through the maze of disinformation, aren’t I?

    And you are offended by our trying to make well-meaning parents feel guilty when all they are doing is trying to do what’s best for their child.

    Uh, nope. I’m offended at discrimination against the unvaccinated and somehow holding the vaccinated superior as if they are exempt from spreading the very disease they’ve been vaccinated against. This mindset ignores history, which is replete with vaccine failure, both primary and secondary. You may not think you’re discriminating, but you are.

    All these hurt feelings are too bad, but that does nothing to change the facts and the evidence.

    My feelings weren’t hurt, my son’s nervous system was. I’ve conceded that those adamant about pushing vaccines as a one-size-fits-all program simply don’t care what happens to those that participate along the way. You’ve demonstrated exactly why… guess it’s “too bad”. There were many things happening in my family’s world at the time, this was just the straw that broke the camel’s back. What happened to me, is far from atypical… by saying that, you’ve shown me that you don’t know a thing about the people that you despise for questioning vaccines the way they are currently administered.

    Vaccines work.

    Why am I not surprised at this utterly broad statement? It’s a catch phrase, that does not stand up to scrutiny. Obviously, some of them work.

    Efficacy for the flu vaccine? 56% – 80%

    Efficacy for the pertussis vaccine? 85%

    Efficacy relates to seroconversion, and to be clear, just because you seroconvert, that does not mean you’ll resist the bug if you come into contact with it. Confounders.

    There are good reasons for the recommended schedules.

    What was the good reason that ignited the idea to vaccinate a baby the day they are born? How much do we know about the day old infant, other than they have no gut flora and have only incorporated oxygen into their environment for a few hours? Are you going to tell me that the nervous system of a day old baby is the same as an adolescent like Merck does with Recombivax? If so, it’s up to you to substantiate that, not me. A person that realises that this disease is not worth the unknown risk of the vaccine to their day old baby is not an antivaxxing nutbag.

    And the more parents who refuse vaccines, the more likely the diseases will recur and hurt the children of others

    Being obtuse is not helping to convince me that I am required to protect my neighbor’s kid before I protect my own, especially since I already participated in the program.

    Some vaccines certainly have their time and place, like Measles… if you give people an option to get a measles vaccine during an outbreak and not require they jab their 1 year old regardless, you’ll get herd immunity. Keep on with an all-or-nothing attitude, you’ll get more of the same. The irony of the fact that we created a susceptible population with the implementation of this vaccine and are now blaming those refusing it when tragedy strikes is not lost on me either.

    Obviously, there are some real tragedies regarding this vaccine and its refusal.

    weing and billy joe,

    The convulsions happened about five hours after the two month round where he got Hep B, DTaP, rota, Hib, prevnar and IPV. Convulsions followed by two seizures and the next two days he was inconsolable. I was told he was probably exposed to a virus before getting the shots and that what he was experiencing were normal side effects from the vaccines anyway. There’s no way to know what caused the problem anyway, since he got so many that day… but between me and his then neurologist, we surmised that the pertussis component was the likely culprit. I don’t normally air my child’s bad experience with vaccines unless I’m asked, or provoked and during the beginning of my about face, I was ashamed to admit what had happened because I felt like it was my fault. micheleinmichigan told me I was negative and that I appeared to have a bias I wasn’t revealing. Both of which were true. I was hoping that we might be able to have a discussion without it coming to personal anecdote and that’s why I didn’t say anything.

    Conflicts (other than adverse events in my family due to over-vaccination):

    None declared

  71. Chris says:

    My son had seizures before he had any vaccines. Your anecdote is an anecdote.

    But you should know that other parents have had to deal with seizures, and most of time they have no relationship to when a vaccine was given.

  72. Harriet Hall says:

    Paulz said,

    “Presumably this mutated strain of polio virus in Nigeria that infects those already vaccinated will soon make its way to the rest of the world?”

    I think there was a misunderstanding. There were two strains in the Nigeria epidemic. One was the same strain as the oral polio vacccine. In communities not protected by herd immunity, the live virus in the oral polio vaccine strain can occasionally infect the non-immune and spread. It doesn’t have to “mutate” to do that, and vaccinated people will not catch it. The other strain in Nigeria was a wild strain. People who are immune to polio, whether from natural infection, oral polio vaccine or IPV, are protected from both those strains. There is no known strain of polio capable of infecting those already vaccinated.

  73. Harriet Hall says:

    Professional_lurker cites a study showing a 56.7% vaccine response. I quoted the following once before, but will do it again:

    “Due to routine use of the Hib conjugate vaccine since 1990, the incidence of Hib disease in infants and young children has decreased by 99% to fewer than 1 case per 100,000 children under 5 years of age. In the United States, Hib disease occurs primarily in underimmunized children and among infants too young to have completed the primary immunization series. In developing countries, where routine vaccination with Hib vaccine is not widely available, Hib remains a major cause of lower respiratory tract infections in infants and children.
    Sequelae 3%-6% of cases are fatal; up to 20% of surviving patients have permanent hearing loss or other long-term sequelae.”

    And this study says “Use of conjugate Hib vaccine in developed countries has reduced carriage of Hib to almost zero among vaccinated children from prevaccination levels ranging around 5–10% (2, 3, 10, 11, 17, 18). Statistically discernible increases in carriage of other H. influenzae serotypes have not been detected (3, 10). There is some evidence that the incidence of invasive disease from H. influenzae serotype f has increased since the introduction of widespread Hib vaccination (19), but the causes of this increase have not been identified.” http://www.pnas.org/content/94/12/6571.full

    In PL’s last long comment, he is essentially demanding that I present all the evidence that has been accumulated to support vaccination (much of which has been previously presented on this blog), re-hash all the reasons for all the public health recommendations for vaccines, etc, He is sounding more and more like a denialist, and I get the feeling that he won’t approve of any vaccine with the current level of evidence and is demanding pie in the sky. He seems more concerned about hypothetical imagined dangers than about the real dangers that have been proven to be diminished by vaccinations. The data are out there. They show that the immunization program in the US has eliminated 99% of the cases of vaccine-preventable illness across the board (the actual numbers vary with the disease), and I don’t think at this point that there is anything to be gained by trying to spoonfeed the data to PL and argue with him.

  74. weing says:

    PL,

    Again, I have no idea whether the seizures were due to the vaccines or not. This could be the old post hoc ergo propter hoc fallacy again. I don’t know. You are convinced otherwise. Your understanding of vaccine literature is fraught with so many errors, I do not know where to begin. It betrays reading biases into abstracts of articles and is of the kind acquired via google university and worthless. That, I do know. If you really want to educate yourself on this and discuss it seriously, then you would need to take some courses in a real school. You would do yourself a big favor.

    Paulz,

    Actually, there is hope with the polio vaccine and it appears those opposed to it have learned something, albeit the hard way and progress is being made.

    http://www.nytimes.com/2010/04/13/world/13polio.html?scp=2&sq=polio&st=cse

  75. weing says:

    How about a thought experiment?
    Let’s for the sake of argument, agree that a child suffered some damage after a vaccine. Suppose we had no vaccines.
    The diseases become common and the child gets exposed not to the modified virus, not to the antigens that would have caused the damage but the real McCoy. Does anyone seriously think this child, who was unfortunate enough to be susceptible to adverse events from the vaccine, would fare better with the real McCoy?

  76. weing – “Again, I have no idea whether the seizures were due to the vaccines or not.”

    I know that diagnosing seizures or cause online is impossible. But, since my kids are young this rang a bell and I looked it up. Just for any remaining readers general information. Seizures are one of the stated problems on the DTaP vaccine information sheet This is given to the parent when the vaccine is given. I’m quoting with liberal editing, due to a two page sheet.

    First.
    “Getting diphtheria, tetanus, or pertussis disease is
    much riskier than getting DTaP vaccine.
    However, a vaccine, like any medicine, is capable of
    causing serious problems, such as severe allergic
    reactions. The risk of DTaP vaccine causing serious
    harm, or death, is extremely small.”

    “Moderate Problems (Uncommon)
    • Seizure (jerking or staring) (about 1 child out of
    14,000)
    • Non-stop crying, for 3 hours or more (up to about
    1 child out of 1,000)
    • High fever, over 105oF (about 1 child out of
    16,000)

    Severe Problems (Very Rare)
    • Serious allergic reaction (less than 1 out of a million
    doses)
    • Several other severe problems have been reported
    after DTaP vaccine. These include:
    - Long-term seizures, coma, or lowered consciousness
    - Permanent brain damage.
    These are so rare it is hard to tell if they are caused
    by the vaccine.”

    The sheet also includes what to do in the case of a reaction after a vax.

    “• Call a doctor, or get the person to a doctor right away.
    • Tell your doctor what happened, the date and time it
    happened, and when the vaccination was given.
    • Ask your doctor, nurse, or health department to report the
    reaction by filing a Vaccine Adverse Event Reporting
    System (VAERS) form.
    Or you can file this report through the VAERS web site at
    http://www.vaers.hhs.gov, or by calling 1-800-822-7967.
    VAERS does not provide medical advice”

    http://www.immunize.org/vis/vis_dtap.asp

    The sheet also states that if your child has had one of the moderate or severe reactions to DTaP that you should talk to a doctor about the advisability of receiving another.

    Each time my children are vaccinated, I am given the relevant vax sheet. I have never felt that vaccinating my kids was risk free, only less risky. Sometimes that is very sad, but I can’t see a way to get around it.

  77. wales says:

    Why bother with the two page propaganda piece (VIS) when you can read the 9 page vaccine package insert? http://www.immunize.org/packageinserts/pi_diphtheria.asp

    For Daptacel: “If any of the following events occur within the specified period after administration of a whole-cell pertussis vaccine or a vaccine containing an acellular pertussis component, the decision to administer DAPTACEL vaccine should be based on careful consideration of potential benefits and possible risks. (1) [See Dosage and Administration (2.1).]

    • Temperature of ³40.5°C (105°F) within 48 hours, not attributable to another identifiable cause.
    • Collapse or shock-like state (hypotonic-hyporesponsive episode (HHE)) within 48 hours.
    • Persistent, inconsolable crying lasting ³3 hours within 48 hours.
    • Seizures with or without fever within 3 days.”

    The VIS quoted by Michele says that “inconsolable crying for 3 hours or more”, as well as seizures and high temperature are only “moderate” problems, yet the package insert shows them listed under “warnings and precautions” and labeled as “adverse events”. Odd how the package insert advises parents to retroactively give “careful consideration of potential benefits and possible risk” after having experienced any of the adverse events This benefit/risk analysis business is not so simple. Giving careful consideration after the fact is too late for some unfortunate children.

  78. professional_lurker says:

    Dr. Hall,

    I’ve read the 1997 paper by Lipsitch. It’s a mathematical model that hypothesizes serotype interaction. Discussing actual types that may hypothetically replace b is pretty irrelevant to nontypeable strains. Since we’ve shifted the burden to older populations, paying attention to what is happening to them is merely responsible and at least we’re doing that:

    http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=17304452&cmd=showdetailview&indexed=google

    As to your last paragraph:

    he is essentially demanding that I present all the evidence that has been accumulated to support vaccination

    If that’s what I was demanding, then I’d ask for it. I haven’t, so your conclusion is a diversionary tactic from the actual arguments I have made… none of which are sensational and unsupported like yours.

    He seems more concerned about hypothetical imagined dangers

    That is a laughable statement considering you just linked a 13 year old paper that was based on a mathematical model.

    I don’t think at this point that there is anything to be gained by trying to spoonfeed the data to PL and argue with him.

    All you’ve been spoonfeeding me is your biased opinion and an old paper based on what might happen.

    Lastly, I’m not a man. If you’re meaning to make a point to your readers to avoid talking to me, by talking about me and not to me, I suppose you could be more childish if you tried. You’re right, there’s no point in discussing anything with you… because in your mind there are no valid reasons to question any aspect of the current schedule the way it’s being administered. And if the data are out there (for the very specific things I asked you about… nice try making it sound like I’m asking for the sun, moon and stars…I might call that a red herring) then you should have no problems providing it to me. Alas, you have no desire to substantiate any of the broad claims you repeatedly make. You have certainly not convinced me to run out and catch my unvaxxed kid up on their jabs.

    If you are going to discriminate against those that go against the schedule, you’re going to need a whole lot more than your opinion to make an impact.

    Weing,

    I don’t know for sure that the vaccines caused the seizures, how will I ever know? I’ll never have enough evidence to prove it to anyone, so why bother discussing it? Evidently the only correlations allowed are those that demonstrate that morbidity has been reduced by the widespread use of vaccines, certainly no confounders there. Likewise the only shift in diagnostic criteria the medical profession apparently admits to actually happening relate to autism.

    I can assure you had my child been exposed to any sort of vaccine available disease, that my then peds doctor would have had no trouble blaming any complication on that challenge. Funny how the challenges created by vaccines could never do such a thing in some people’s eyes. What happens when you repeatedly challenge a human infant from the day they are born until they are two? Well who knows?

    Your understanding of vaccine literature is fraught with so many errors, I do not know where to begin.

    Well, you’ll need to find a place to start, because unless you are specific in your accusations of my education, that you know nothing about, then your argument is not valid… no matter how many different ways you say it.

    It betrays reading biases into abstracts of articles and is of the kind acquired via google university and worthless. That, I do know. If you really want to educate yourself on this and discuss it seriously, then you would need to take some courses in a real school. You would do yourself a big favor.

    Simply slandering a person (another ad hom) and providing no details as to why your slander is correct is a logical fallacy. Period. And you are doing it over. and over. and over.

  79. wales says:

    On the topic of seizures, those readers with vaccine-aged children should be aware that the information contained in the DTaP VIS dated 2007 (the one currently available on the CDC website) contradicts current recommendations with regard to controlling fevers in children who have had seizures. From the DTaP VIS: “Controlling fever is especially important for children who have had seizures, for any reason. It is also important if another family member has had seizures. You can reduce fever and pain by giving your child an aspirin-free pain reliever when the shot is given, and for the next 24 hours, following the package instructions.” This contradicts a March, 2010 article in The Journal of Pediatrics which states “Antipyretic agents are ineffective for the prevention of recurrences of febrile seizures and for the lowering of body temperature in patients with a febrile episode that leads to a recurrent febrile seizure.” http://download.journals.elsevierhealth.com/pdfs/journals/0022-3476/PIIS0022347609012013.pdf

    Further, the JPEDS piece states that the ineffectiveness of antipyretics with regard to seizures is not news. “The American Academy of Pediatrics Practice Guideline published in 2008 summarized the available literature on the use of antipyretics in preventing febrile seizure recurrence and came to the same conclusion as the authors: Although antipyretics may improve the comfort of the child, they will not prevent febrile seizures. Importantly, families must be counseled that administration of an antipyretic will not prevent febrile seizure recurrence. Too often, families express feelings of guilt that had they administered the medication earlier, their child would have been spared from having another seizure.”

  80. Harriet Hall says:

    Professsional_lurker,

    First, let me apologize for referring to you as “he.” How was I to know?

    When I said “those risks are much smaller than the risks of not vaccinating.” you replied “And you quantify this how? With trial data using healthy people and a piss-poor database that addresses reactions? Please be specific and do not encompass the entire programme and the diseases under the same umbrella.”

    That came across as very antagonistic and biased. To explain how we quantify this, and to be specific for each vaccine would require citing a huge body of data, much of which has already been discussed on this blog. It would be a waste of time for me to cite the pertinent studies, because your words make it clear that your mind is already made up and that you have already decided that those studies are inadequate and the system for detecting reactions is inadequate. You have set the bar too high. Your prejudice is showing.

    You cite an article showing a 56.7% response to Hib vaccine while ignoring the 99% reduction in disease in the US and you claim substitution of other strains while ignoring the studies that show only a small increase in non-type B strains that pales in comparison with the number of vaccine-preventable illnesses that were prevented, and data that show no increase in the disease burden for non-typable strains. You are cherry-picking, looking for anything that sheds doubt on vaccines and failing to put the information into context.

    Perhaps you want to invoke the precautionary principle and say we shouldn’t use vaccines if there is even any remote possibility of harm. We could let children continue to suffer from these illnesses while we wait for perfect certainty, but there is no perfect certainty in the real world.

    The current vaccine recommendations were put together by a lot of scientists, epidemiologists, immunologists, pediatricians and other experts who did their best to evaluate ALL the available evidence, weigh the pros and cons, and apply their collective wisdom. Those experts have children and grandchildren of their own and sincerely thought they were doing their best to protect them. If you want to convince us they were wrong, you’ll have to do better than bringing up hypothetical dangers: you’ll have to show us new and compelling evidence of real dangers. So far you haven’t done that.

    You said “If you are going to discriminate against those that go against the schedule, you’re going to need a whole lot more than your opinion to make an impact.” I don’t think anything I said constitutes “discrimination.” If you’re going to criticize the schedule, you are the one who is going to need a lot more than your opinions and fears to make an impact.

  81. weing says:

    PL,

    Are you setting yourself up as an authority on vaccines? If not then, don’t talk about slander. If yes, then I’ll see you in court. If I hear a kid telling another that he knows how to multiply and proves it by telling the other one that 3X3=7, then I know the kid doesn’t have the requisite knowledge and needs to go to school. I am telling you the same thing. You don’t have to take my advice and can go on believing your misunderstandings but your claims of knowledge will still be fraudulent.

  82. professional_lurker says:

    Hi Dr. Hall,

    First, let me apologize for referring to you as “he.” How was I to know?

    No problem.

    That came across as very antagonistic and biased. To explain how we quantify this, and to be specific for each vaccine would require citing a huge body of data, much of which has already been discussed on this blog.

    I apologise for the snark. Giving you the benefit of the doubt, perhaps you are just misunderstanding me. I don’t particularly have a problem with clinical trials that measure immunogenicity. I’m saying that measuring sera when an organism stops showing symptoms to disease is a little bit fallacious, and if you are being honest with me, you will admit this. Being serologically immune is not a guarantee that you will not get the disease (like my thoroughly vaxxed teenager that got pertussis despite being “immune”), otherwise people who have been vaccinated would not become sick and spread disease during outbreaks. And they do. I’m not saying that being vaccinated doesn’t mitigate the risks – in some cases it obviously does, as with measles vaccine.

    When you talk about ‘risks’ associated with vaccinating, unless we are actually making a concerted effort to track adverse events, you simply cannot quantify that statement in the real world. Trial data is limited to mostly healthy subjects, and once a drug enters the market place, its safety profile clearly evolves. I certainly don’t expect you to provide me with trial data for each vaccine, I can retrieve that myself. What I’m saying, is that with an inadequate reporting system, we simply don’t know the risks. Human physiology alone tells us that brand new babies have naive nervous systems and that brain development is ongoing throughout childhood. Have we really looked at the mechanisms at play during vaccine challenges (inflammation, drug metabolism, P450), or are we just addressing risks based on symptomalogy? And who’s tracking adverse events? I was admonished for suggesting the vaccine my son got five hours before convulsing was related… if he had been exposed to some sort of pathogen, would that be acceptable then? Why the double standard?

    You are cherry-picking, looking for anything that sheds doubt on vaccines and failing to put the information into context.

    Well, that study wasn’t all that I posted. I also posted the paper on NTHi. And there are certainly more available for anyone really looking:

    http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=12508153&cmd=showdetailview&indexed=google

    http://www.ncbi.nlm.nih.gov/pubmed/17516405

    Humans were asymptomatic carriers of this bug, and it’s now virtually removed as a commensal as well. To some vulnerable children, this vaccine may very well be worth it to get. But broad claims of success (which are true) without viewing the totality of the data are disingenuine, especially when breastfeeding has been demonstrated to protect against this disease and it doesn’t become opportunistic in everyone.

    Honestly, my bar isn’t set that high. I vaccinated two children into oblivion, if I were setting it at unattainable heights, I wouldn’t have done that. I’m still receptive to vaccinating, but the attitude of public health officials in general (like WHO changing the definition of pandemic halfway through the H1N1 campaign because it needed to be changed and then denying they did it, and CDC changing reporting criteria from laboratory confirmed to clinical thereby increasing incidence overnight) is quickly making this diminish.

    The current vaccine recommendations were put together by a lot of scientists, epidemiologists, immunologists, pediatricians and other experts who did their best to evaluate ALL the available evidence, weigh the pros and cons, and apply their collective wisdom.

    Indeed. I am fully aware of what is involved in making these recommendations and I’ve done a fair amount of investigation into CBER guidance and subsequent recommendations. Some vaccines certainly do have their time and place, something I have never denied. The issues I’ve raised here have been rather specific, so portraying my viewpoint as a rabid antivaxxer trying to debunk “the system” does not apply. Do you know what evidence was available when the 1991 ACIP recommendation was made to vaccinate newborns prior to hospital discharge with Hep B? Why did we go from vaccinating over two year olds in the late 60s and 70s to day old babies ten – fifteen years later? Where are the data that says these challenges are not perturbing the naive nervous and immune systems of neonates? The fact that the scientific consensus is that humans adapt to stimuli at a monumentally slow pace is not lost on me either.

    Clinical trial data measuring safety and efficacy of a vaccine is fine and good (I understand why we don’t use bona-fide placebos), however, this is not reflective of how vaccines are actually administered in the real world… which is more than just concomitantly, we’re talking 7 and 8 vaccines in a single well visit. This certainly has not been evaluated, and if I’m mistaken, please direct me to the evidence. (nothing mathematically derived, nor hypothetical… an animal model will suffice)

    If you want to convince us they were wrong, you’ll have to do better than bringing up hypothetical dangers: you’ll have to show us new and compelling evidence of real dangers. So far you haven’t done that.

    Obviously, we are both prejudiced. It is YOU who are trying to convince me they were right, and for others to vaccinate on schedule. I’m not telling anyone to not vaccinate, nor to vaccinate. I don’t expect my neighbor to protect my child, that is MY responsibility. If my child succumbs to infectious disease, that is nobody’s fault by my own. I cannot control what other people do. Since I have no way of knowing who is immune to what, I just treat everyone like they have the potential to spread disease (because they do). I simply find this to be the most responsible way to live. Discriminating based on vaccination status is a slippery slope, so it behooves all of us to coexist. If you are going to tell me there is no danger to a neonate from being vaccinated on his birthday, you are going to need more than a study-in-the-making looking for subtleties on a population level. The human organism is a bit more complicated than that.

    weing:

    Are you setting yourself up as an authority on vaccines?

    Please give me the new coordinates to your goal posts.

    If not then, don’t talk about slander.

    Slander is not reserved solely for the legal profession. The free dictionary says: 2. A false and malicious statement or report about someone.

    Sums it up.

    If I hear a kid telling another that he knows how to multiply and proves it by telling the other one that 3X3=7, then I know the kid doesn’t have the requisite knowledge and needs to go to school. I am telling you the same thing.

    No, you’re not. You’re making the constant Appeal To Ridicule, without ever addressing a single thing I have said (save for a minor contribution to nonencapsulated strains of HI), only that what I’ve said is worthless, fraudulent and I should go to a real school. In order for your repeated attempts to discredit me to have any bearing, whatsoever, you must demonstrate what makes it worthless and fraudulent. Don’t pretend to be a skeptic while citing rudimentary logical fallacies that are simply designed to flame people that you don’t like. What is this? A playground?

    but your claims of knowledge will still be fraudulent.

    Prove it.

  83. Archangl508 says:

    PL,

    “If my child succumbs to infectious disease, that is nobody’s fault by my own. I cannot control what other people do. ”

    If a child is unable to get vaccinated due to the presence of an immunodeficiency and that child is exposed to a unvaccinated carrier of a pathogen, who’s fault is it that the immunodeficient child gets disease? In my mind, its the fault of the unvaccinated carrier.

    No, you cannot control what other people do, but as a society we can provide guidelines to help control risk for all of the members of society. For example, making vaccination mandatory for participation in the benefits offerred by living in society, such as public schools. You do not have to send your child to a public school and can therefore choose not to vaccinate your child and to not send them to school.

    “The issues I’ve raised here have been rather specific, so portraying my viewpoint as a rabid antivaxxer trying to debunk “the system” does not apply.”

    It does if one examines the rhetoric that you use. For example, up above you refer to vaccination as “jabs” and I imagine if I look further I would easily find similar examples. Such rhetoric is commonplace amoung the rabid anti-vaxxers, the goal of which is to make the prospect of vaccination sound more scary and more dangerous. Extreme points of view often use such inflammatory rhetoric to advance their cause in the absence of any good evidence. Just take a look at the Birthers, Tea Partiers, alt-med nuts, and climate change deniers.

    If you would like to not be thought of as being a rabid anti-vaxxer perhaps you should consider your word choices more carefully.

    “Well, that study wasn’t all that I posted. I also posted the paper on NTHi. ”

    It is difficult to understand your point about serotype replacement. Obviously if you create a reduction in a particular pathogen it is possible that another pathogen will fill in that space. But Dr. Hall’s point is that more lives were saved over the time prior to any serotype replacement occurring than if the Hib vaccine was not created. You have provided no evidence against that point, especially since the other H. Influenzae types are not shown to be any more prevalent than Hib prior to the beginning of the vaccination campaign. Perhaps now research should begin on producing vaccines to provide immunity to the other types of H. Influenzae as well as Hib. Battle against diseases is never going to end. We will never win, only stem the tide.

  84. weing says:

    pl,

    “Please give me the new coordinates to your goal posts.”

    You brought up slander, not me. Discrediting you would apply only if you were an authority on vaccination, which clearly you are not. There is also no malice on my part, but I detect malice in the words you are using. If you consider telling someone that they are wrong, slander then I can’t help you, much less prove anything to you. I checked out the original papers of the abstracts that you linked to and could easily see that you totally misinterpreted them. That’s fine, since you are a lay person. Nothing to be ashamed of. My suspicion is that you may be misrepresenting them, but that’s just me. Just know that they do not support your anti-vaccine stance.

    What physician ever told you that vaccines were 100% safe and effective? If they did, they were wrong. My son was fully immunized against measles and yet when I checked his titers, he was non-immune and I had to re-vaccinate him. All the more reason to vaccinate all that do not have contraindications.

    I also suspect that from your earlier reply, that you do think that a child that is susceptible to an adverse reaction to the vaccine, would fare better with the real disease instead. What makes you think so?

    BTW, how do you understand ad hominem and appeal to ridicule anyway?

  85. squirrelelite says:

    For a little look at the history of the polio vaccine, I suggest watching The Polio Crusade, an American Experience episode from last year that was rerun locally tonight. It covers the March of Dimes and the development of the Salk vaccine. Dr Paul Offit was the academic advisor for the film and is briefly interviewed a couple of times. Linda Hunt from NCIS:LA is the narrator.

    It is available (probably for a limited time) for online viewing at:

    http://www.pbs.org/wgbh/americanexperience/films/polio/player/

    A brief transcript/introduction is posted here:

    http://www.post-polio.org/amex_PolioRelease_2119-2.pdf

    The pictures of paralyzed children being placed in iron lungs to save their lives are gripping.

    Informed consent was unheard of then and the methods used to test it would not be acceptable today. But, it is still remarkable that they were able to trace problems to a contaminated batch from one supplier, stop production, and then resume safe production only a couple weeks later.

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