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The Infection Schedule versus the Vaccination Schedule

A baby’s body is bombarded with immunologic challenges—from bacteria in food to the dust they breathe. Compared to what they typically encounter and manage during the day, vaccines are literally a drop in the ocean”, and Dr. Offits studies theoretically show an infant could handle up to 100,000 vaccines at one time … safely (6).

It is not the mercury in vaccines, its the vaccine schedule that is the problem. Too many shots, too many antigens, too close together. Our children need to be exposed to fewer antigens, less often, so they don’t get complications from the vaccine like autism and autoimmune diseases. It is all part of greening our vaccines.

That is part of propaganda on vaccines from the More Infectious Diseases for Children, a.k.a. antivaccine groups.

What is the vaccine schedule? How much exposure do children receive from organisms and antigens as part of the vaccination schedule? The entire schedule is at CDC.

In summary there are 5 live attenuated or altered organisms and 21 different antigens by age 6. A couple of vaccines are added from age 7 to 18, but by then it is too late, your child already has autism and autoimmune diseases from the immunologic and toxic scourging of vaccines. BTW. Sarcasm.

Is the vaccine schedule a lot of virus and a lot of antigens? Is this an enormous load on the immune system, sending it spiraling out of control to damage the child? Lets find out.

Vaccines vrs disease

All data about vaccines from the PDR package insert unless otherwise specified.

Hepatitis B vaccine: each dose has 10 micrograms hepatitis B surface antigen (HBsAg).

Disease: HBsAg subviral particles reach a titer of 10^13/mL, whereas viral particles range in titer from 10^4 to 10^9/mL (3). At three liters of blood in a kid thats 3 x 10^16 hepatis b surface antigen viral particles, which are have a half life of about an hour. The molecular weight of one hepatitis B surface antigen molecule is 24 KD (kilodaltons), a child in one hour would be exposed to 7.2 x 10^17 KD of hepatitis B surface antigen, which is about 1162 micrograms. Contrast 30 total micrograms of hepatits B antigen in the three vaccines with 1162 micrograms an hour for a disease that lasts weeks.

Rotavirus vaccine: 2 mL, oral solution of 5 live human-bovine reassortant rotaviruses which contains a minimum of 2.0 – 2.8 × 10^6 infectious units (IU) per reassortant dose, depending on the serotype, and not greater than 11^6 × 10^6 IU per aggregate dose (Merck vaccine).

Disease: there is a high rotavirus particle concentration in stool of patients with rotavirus, up to 10^11 particles/mL. In contrast, the vaccine strain replicates poorly in humans: “Fecal shedding of vaccine virus was evaluated by EIA in a subset of persons enrolled in the phase III trials by obtaining a single stool sample during days 4–6 following each vaccination visit and from all children who submitted a rotavirus antigen positive stool specimen at any time. Vaccine virus was shed in 32 of 360 (8.9%; CI = 6.2%–12.3%) persons after dose 1, zero of 249 (0; CI = 0%–1.5%) persons after dose 2, and one of 385 (0.3%; CI = <0.1%–1.4%) after dose 3. (CDC)”

The vaccine results in a much milder ‘disease’ with far fewer viral particles made.

Diptheria vaccine: Each 0.5-mL dose is formulated to contain 2.5 Lf (about 25 micrograms) of diphtheria toxoid (SmithKlineGlaxo as DTaP). A toxoid is a toxin that has no toxic effect but still causes an antibody response.

I cannot find how much toxin is made in the usual case of diptheria; the wikipedia states the lethal dose for humans is about 0.1 mcg of toxin per kg of bodyweight, so 3.5 micrograms would be what is needed to kill a child.

Tetanus: Each 0.5-mL dose is formulated to contain 5 Lf of tetanus toxoid (SmithKlineGlaxo as DTaP). This is about 2.5 micrograms.

The disease: The lethal human dose of tetanus toxin is only 2.5 nanograms/kg. I cannot find a direct conversion of Lf units to nanograms. Lf is limit of flocculation. Tetanus is a unique disease. The toxin is so potent that if a patient survives, they still need the vaccine as there is not enough toxin to always incite an antibody response. So for tetanus there may be more toxoid than the disease toxin.

Pertussis vaccine: Each 0.5-mL dose is formulated to contain 2.5 mcg of pertactin, 8 mcg of FHA, and 8 mcg of inactivated PT (SmithKlineGlaxo as DTaP).

Disease: I cannot find a reference of how much pertussis is present in unvaccinated pateints. In patients who get the disease after vaccination, ” the patients with culture-confirmed Bordetella infections, significantly smaller numbers of colonies were recovered from the nasopharyngeal swabs of the children with asymptomatic infections (mean ± standard deviation [SD], 6.3 ± 3.7 colonies) than from those of the patients with symptomatic infections (44.4 ± 6.7 colonies) (5)”

Haemophilus influenza type b vaccine: 7.5 mcg of Haemophilus b.

Disease: invasive influenza leads to millions of bacteria in the lung or blood or spinal fluid, far more than 7.5 micrograms of vaccine.

Pneumococcal conjugate vaccine: 2 mcg of each saccharide for serotypes 4, 9V, 14, 18C, 19F, and 23F, and 4 mcg of serotype 6B per dose (16 mcg total saccharide) (Wyeth)

Disease: bacterial concentrations during invasive disease are in the millions, producing far more antigen than the vaccine, for the duration of the disease.

Measles vaccine: 0.5 mL dose contains not less than 1,000 TCID50 (tissue culture infectious doses) of measles virus.(Merck vaccine)

Disease: I cannot find comparative viral loads in measles vrs the vaccine.

Mumps vaccine: 12,500 TCID50 of mumps virus (Merck vaccine).

Disease: I cannot find comparative viral loads in mumps vrs the vaccine.

Rubella vaccine: 1,000 TCID50 of rubella virus (Merck vaccine).

Disease: I cannot find comparative viral loads in rubella vrs the vaccine.

Varicella vaccine: Each 0.5 mL dose contains the following: a minimum of 1350 PFU (plaque forming units) of Oka/Merck varicella virus.

Disease: I cannot find comparative viral loads in varicella vrs the vaccine.

In all attenuated viruses, the disease cause by the vaccine strains results is far less viruses than the wild type virus. Vaccine strains replicate poorly and are less virulent, but maintain their ability to cause an protective antibody response. All attenuated live vaccine cause less exposure than the disease.

Hepatitis A vaccine: Each 0.5-mL pediatric dose of vaccine consists of 720 EL.U. of viral antigen (GlaxoSmithKline).

Disease: 2.8 x 10^3 viral copies/ml in serum (7). That would be 54,000,000 viral particles in the blood (and more in the liver) a day, much more than the vaccine.

Meningococcal vaccine: Each 0.5 mL dose of vaccine is formulated in sodium phosphate buffered isotonic sodium chloride solution to contain 4 mcg each of meningococcal A, C, Y, and W-135 polysaccharides conjugated to approximately 48 mcg of diphtheria toxoid protein carrier. Meningococcal Polysaccharide A/C/Y/W-135 (Sanofi Pasteur).

Disease: invasive meningococcal disease results in millions of bacteria in the blood and CSF. It is not unusual to see multiple organisms on gram stain, and if you can see one organism on high power, there are at least 100,000 organisms per ml.

Influenza: FLUARIX has been standardized according to USPHS requirements for the 2007-2008 influenza season and is formulated to contain 45 micrograms (mcg) hemagglutinin (HA) per 0.5 mL dose, in the recommended ratio of 15 mcg HA of each of the following 3 strains: A/Solomon Islands/3/2006 (H1N1), A/Wisconsin/67/2005 (H3N2), and B/Malaysia/2506/2004 (GlaxoSmithKline).

Disease: The mean viral load of 22 patients with H3N2 virus infection was 1.5 × 106 TCID50/mL, whereas the mean viral load of H5N1 patients was 1.6 × 105 TCID50/mL (8). Multiply the number by 3000 to get the viral load in the blood, every day, for the duration of the disease. This does not include the amount of virus in the lung, the active site of the disease. Far more antigen is present in the disease than is given by the vaccine.

A few of these pathogens, Haemophilus, pneumococcus and meningococcus, will often cause asymptomatic colonization of the throat during the winter, probably exposing children to more antigens for a longer period of time than the vaccine.

From the data I can find, compared to the vaccines, the diseases lead to far more exposure to both antigens and organisms. If the alleged ill effects of the vaccine are due to too many antigens, or too much antigens, or too frequent antigens, the diseases should be far worse than the vaccine in causing autism and autoimmune diseases. Unless, of course, the effects of the vaccines follow the principals of homeopathy: the less the exposure, the greater the effects.

Antibody potential

It has been estimated that humans can generate about 10 billion different antibodies, each capable of binding a distinct epitope of an antigen (1). Estimates of antibody specificities in an individual range between 1,000,000-100,000,000 (2). We have the ability to make 10 billion antibodies and, due to exposure to various germs and other foreign materials, we make between 1 million and 100 million different antibodies.

Lets say as an agrument that you have most of your antigen exposure is by age 18. To get 1,000,000 antibodies, you must make 152 antibodies day. I cannot find how many antigens the average human has made by age 18, but one antibody a day would result in 2160 antibodies by age 6 or 6570 antibodies by age 18. We are exposed to far more antigens in the world than 6570.

If a child is exposed to 1 antigen a day and makes one antibody a day, a very conservative estimate, then the vaccines represent about 0.694 % (15/2160)x100 of the antigen exposure of a six year old.

If a child makes 152 antibodies a day, still a conservative estimate, then by age 6 the vaccine exposure would account for .004% of the antigen exposure of the child.

If a child is aiming for 100 million antibodies, the rough maximum, then to reach that number by age 18, then they have to be exposed to 15,520 antigens a day and made 15520 new antibodies a day. By age 6 thats a total of 3,333,333 new antigenic exposures, and the vaccine schedule would account for 0.00045% of exposure.

From another perspective

“A more practical way to determine the diversity of the immune response would be to estimate the number of vaccines to which a child could respond at one time. If we assume that

1) approximately 10 ng/mL of antibody is likely to be an effective concentration of antibody per epitope (an immunologically distinct region of a protein or polysaccharide),

2) generation of 10 ng/mL requires approximately 10^3 B-cells per mL,

3) a single B-cell clone takes about 1 week to reach the 10^3 progeny B-cells required to secrete 10 ng/mL of antibody (therefore, vaccine-epitope-specific immune responses found about 1 week after immunization can be generated initially from a single B-cell clone per mL),

4) each vaccine contains approximately 100 antigens and 10 epitopes per antigen (ie, 10^3 epitopes), and

5) approximately 10^7 B cells are present per mL of circulating blood,

then each infant would have the theoretical capacity to respond to about 10 000 vaccines at any one time (obtained by dividing 10^7 B cells per mL by 10^3 epitopes per vaccine).

Of course, most vaccines contain far fewer than 100 antigens (for example, the hepatitis B, diphtheria, and tetanus vaccines each contain 1 antigen), so the estimated number of vaccines to which a child could respond is conservative. But using this estimate, we would predict that if 11 vaccines were given to infants at one time, then about 0.1% of the immune system would be “used up” (5).”

Compared to the antibody response to the antigens of life, the vaccine exposure and schedule is minimal, a wee dribble of a smidgeon of an immunologic challenge. The ability of the immune system to respond to antigens is vast, with a capacity that exceeds the minds ability to comprehend. The immune system is big. Really, really big. You just don’t realize how incredibly vast the immune system is. I mean, you might think it’s a long way down the road to the chemist’s, but that’s just peanuts to the immune system. I hear Carl Sagen chanting billions and billions.

Normal flora/Antigens of life

We have, on and in us 10 to 100 times more bacteria than there are cells that make us. How many cells is that? About 100 billion (100,000,000,000) bacteria. That is just our normal fora. These represent maybe 1000 separate species of bacteria. These bacteria are kept at bay by the immune system. We go from sterile to a complex and enormous normal flora in months. In the first year of life a baby is exposed, for the first time, to all the bacteria of his parents and siblings and some from the family pet and environment as well. Thousands of bacteria that become its normal flora. An enormous number of organisms and antigens, thousands of times greater than the exposure from the vaccine schedule.

The number of bacteria that is your own ecosystem, of course, pales into insignificance compared to the bacteria in the soil, at about a million species per gram of soil, plus those in the water, on your pets, in the air etc etc. Millions upon millions of bacterial species everywhere you can look. Estimates as high as a billion different bacterial species in the world. And then there are the viruses, the yeasts, the moulds, the parasites, the mites. Perhaps millions more.

I see everyone and everything like “Pig-Pen” in Charlie Brown, but rather than a cloud of dirt, we are all in a cloud of micro-organisms. We are also exposed to the antigens of food and plants. Innumerable molecules our body is ready to recognize and respond to with an antibody.

These micro-organisms are kept at bay by the immune system. Each bacteria has multiple sites that can elicit an antibody response. It is not one organism, one antibody. The number of antibodies that the body develops against a germ depends on the the complexity of the organism which in turn determines how many antibodies are made against a particular organism.

We use the multiple antibodies made for some organisms diagnostically. For a simple organisms like HIV, we do a western blot and look for the presence of an antibody response to 8 different proteins. For Lyme, we look for antibody response to 10 proteins. For more complex organism like S. aureus we can make dozens of different antibodies.

Lets be conservative. Lets say that we respond with 3 antibodies to each species in our normal flora and we made 3 antibodies to 100,000 environmental organisms, about 100,000 fold less than what is out there.

That would be 303,000 antibodies. To make that many antibodies by age 18 we would have to produce 46 antibodies a day. That is about 5 times in a day what the entire vaccine schedule requires over six years. For just the normal flora, that would be about half an antibody a day, assuming three antibodies for each of the 1000 species of bacteria, again probably a gross underestimate. In about one month you would be exposed to all the antigens (and more) and make all the antibodies that are needed in the vaccine schedule over six years.

I realize that this is simplified, that the live vaccines result in more antibody response than killed vaccines etc. You want to multiply the vaccine antibody response by a factor of three, fine. Even if I am off by a log or two either direction, the magnitude of the needed immune response to vaccines is trivial compared to the immune response to the normal bacteria found in us and in the world.

Diseases

How many infections are out there that normal people may encounter in a life span? Lets crack open Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases, the standard ID textbook, and start counting. You may want to skip to the bottom. I counted those germs that are normal part of human existence or part of routine environmental exposure. Counting bacteria is like counting ballots in Florida. The interpretation depends on the person doing the counting. I didn’t include Brucella or malaria or trypanosomes, for example. I counted primarily from tables rather than text, and given the number of organisms I have to find on Pubmed that are not in Mandell, I know this is a Reader Digest condensed version of micro-organisms that can cause disease. It is a tour of the citizens of my world, what I try and kill every day.

Organism serotype/genotype

Monkey Pox 1

Cowpox 1

Parapox 4

Molluscum contagiosum 1

Tanapox 1

Herpes Virues 8

Adenovirus 51

Papillomavirs 92

BK 1

JC 1

Hepatits B 12

Parvovirus 2

Reovirus 3

Orbivirus 100

Colivirus 1

Seadonavirus 1

Rotavirus 30

Alphavirsu 20

Rubella 1

Flavivirus 9

Hepatitis C 7

Hepatitis G 1

TT virus 1

RSV 1

Metapneumovirus 1

Measles 1

Paramyxovirus 3

Vesiculovirus 9

Influenza 3 a year

Bunyavirus 5

LCM 1

Lassa 1

HTVL 1 and 2 2

HIV 2

Enterovirus 64

Hepatits a

Rhinovirus 100 plus

Norovirus 1

Astrovirus 1

Hepatitis E 1

Chlamydia 15

Mycoplasm/Uroplasm 14

Rickettesia 15 plus

Q fever 1

Ehrlichia 11

S. aureus 1

Coagulase negative staphylococcus 15

viridins Streptococci 17 plus

Streptococcus Pneumonia 84

Group B streptococcus 8

Enterococcus 12

Other streptococci 6 plus

Diptheria 1

Corynebacterium: 35 plus

Listeria 7

Bacillus 11

Erysipelothrix 1

Neisseria 9

Moraxlla and other gram negtative diplococci 12

Vibrio 8 plus

Campylobacter 8

Helicobacter 3

Enerobacteriaceae 29

Acnitobacter 9

Pseudomonas 5

Shigella 3

Salmonella >2400

Haemophilus 6 plus

Pastuerlla 12

Yersina 3

Bordella 8

Legionella 50

Capnocytophagia 4

Bartonella 9

Other gram negative bacilli 30

Syphilis 1

Leptospira 11

Lyme 1

Clostridia 12

Anaerobic gram negative rods > 30

anaerobic cocci 14

anaerobic gram positive rods 8

mycobacterium 20

Norcardia 6

Actinomycosis 5

Candida >150

Aspergillus 4

Mucor species 14

Cryptococcus 2

Histoplasma 1

Coccidiomycosis 1

Blastomycosis 1

Cutaneous Fungi (athletes foot) 39

PJP 1

Toxoplamsa 1

Trichamonas 1

Babeisia 3

Bowel pathogens 17 plus

Helminths 15

Nematodes 15

Trematodes 13

Tapeworms 8

Grand total 1374 potential pathogens, counting Salmonella once. This is, obviously a gross estimate, probably a gross underestimate, of the number of pathogens that can infect us. Obviously, not everyone is exposed to every one of these pathogens. Keep in mind that each organism makes dozens of proteins and carbohydrates for the immune system to recognize and to respond with a specific antibody. I would bet the list represents more than 13,740 antibodies.

All these numbers are rough estimates, ballpark figures as it were. But accurate for comparison. I watch a Blazer game as I type this. I estimate the numbers in this post are accurate to the same degree as the statement: NBA players are 6 foot 7. I paint with broad strokes, but the picture is clear. The number of pathogens and antigens from disease are a humdred times, a thousand times greater than the exposure from the vaccine series.

Remember the comparison: the vaccine schedule is 5 live-attenuated or altered organisms and 21 antigens by age 6.

I wouldn’t give a child 10,000 vaccines. Or 100,000. Or a million. That is what life is for. A million or more ‘natural’ vaccinations from exposure to “the slings and arrows of outrageous fortune, the heart-ache and the thousand natural shocks that flesh is heir to.” I have no problem with the vaccine schedule. I prefer “to take arms against a sea of troubles, And by opposing end them”. It is a little known fact that Hamlet wanted to be a pediatrician. There is nothing immunologically special about the pathogens targeted by the childhood vaccines. What makes these infections special is their ability to kill and our ability to prevent them.

What vaccinations offer is small, controlled, harmless amounts of antigens and neutered pathogens, rather than the prodigious free-for-all of morbidity and mortality from natural disease.

No matter how you slice it, the vaccine schedule represents a miniscule exposure to antigens and organims compared to what people encounter as part of life. Worrying about the exposure from the vaccine schedule is like worrying about a thimble of water getting you wet when you are swimming in an ocean.

————————

(1) “Development of the immunoglobulin repertoire”. Clin. Immunol. Immunopathol. 79 (1): 1–14. PMID 8612345.

(2) immunobiology.arizona.edu/files/AntibodyDiversity.pdf

(3) Mandal, Douglas and Bennett. The Principals and Practice of Infectious Diseases,

(4 ) http://cmr.asm.org/cgi/content/full/18/2/326/T4

(5) http://pediatrics.aappublications.org/cgi/content/full/109/1/124

(6) http://www.parenting-qa.com/index/Parenting/Infants/Health.

(7) J Virol Methods. 2008 Mar;148(1-2):74-80. Epub 2007 Dec 21.Click here to read Links Comparison between serum and saliva for the detection of hepatitis A virus RNA.

(8) Influenza A H5N1 detection. Emerg Infect Dis [serial on the Internet]. 2005 Aug [date cited]. Available from http://www.cdc.gov/ncidod/EID/vol11no08/04-1317.htm

Posted in: Public Health, Science and the Media, Vaccines

Leave a Comment (26) ↓

26 thoughts on “The Infection Schedule versus the Vaccination Schedule

  1. isles says:

    Wow! You are a guy who knows what to do with a reference book. Thank you.

    Just to clarify – when you talk about Haemophilus influenzae type b – with respect to disease, you are talking about Hib and not influenza?

  2. David Gorski says:

    This whole new mantra of “too many too soon” and “green our vaccines” that antivaccinationists are spouting these days is a direct result of the utter failure of their previous vaccine bogeyman, mercury/thimerosal, to show any correlation with autism or other neurodevelopmental disorders and particularly studies showing that rates of autism have not fallen nearly seven years after thimerosal was removed from vaccines. A more resounding epidemiological refutation of the “mercury in vaccines cause autism” hypothesis is hard to imagine.

    So now antivaccinationists are moving on to ideas that are much more vague and, more importantly, difficult to falsify scientifically, such as the concept that there are all sorts of “toxins” in vaccines and their new favorite, “too many too soon.” Surprise, surprise! It turns out their fearmongering over this is just as brain dead as their fearmongering over thimerosal was.

  3. TsuDhoNimh says:

    Isles … yes, he’s talking about Haemophilus influenza typeB infections. Viral influenza is also on the list.

    Doc … that’s an impressive list. Thanks.

  4. qetzal says:

    Minor typo:

    I cannot find how much toxin is made in the usual case of diptheria; the wikipedia states the lethal dose for humans is about 0.1 mcg of toxin per kg of bodyweight, so 35 micrograms would be what is needed to kill a child.

    Should be 3.5 micrograms.

  5. overshoot says:

    About 100 billion (100,000,000,000,000) bacteria.

    100 billion = 100,000,000,000
    100 trillion= 100,000,000,000,000

    (US usage; UK usage skips some ranges that have names in the USA.)

    OK, so I’m an order-of-magnitude geek. Sue me.

  6. Mark Crislip says:

    fixed.
    damn those factors of 10 or 100
    thanks

  7. MitoScientist says:

    As a fellow Portlander, I too enjoy reading scientific or medical literature while watching the Blazers, and with a hot team this year especially, it is a little harder to do both at the same time. My hat is off to you good sir!

  8. MedsVsTherapy says:

    I had also read that article regarding the number of invaders to which the newborn/infant/toddler is exposed, relative to the number from a recommended vaccine schedule.

    I believed it, but then went on to wonder whether there was not somehow a qualitative difference between the garden-variety germs encountered from dog-kisses, etc., and the vaccinations. Such as: ruote of adminsitration making a diff, etc. Can’t think of any. But that article had such a smart tone to it, I had trouble trusting its otherwise slam-dunk logic.

  9. sarahcookson says:

    This is an excellent post, it is so going up in our clinic. Many thanks Mark, once again for your grouse work. Australia thanks you.

  10. Fizzizist says:

    Impressively informative. Thank you very much.

  11. daedalus2u says:

    If you are immunosuppressed, essentially any type of heterotrophic bacteria can be a pathogen. People have gotten endocarditis and liver abcesses from the lactobacilli in yogurt and even from mushrooms.

  12. adiemusfree says:

    My kids must have been pretty special, methinks. Not only did they survive the vaccines they got during their formative years, but they also bred their own variants of every virus known (and unknown) to humankind as they went to daycare and school.
    AND then they distributed these to all and sundry in their own version of a mini-immunisation machine!
    Anyone who has visited a daycare must have encountered way more mutant bugs than contained in any series of vaccines – the vision of Pigpen is so accurate!

  13. Val Jones says:

    Terrific post – great way to put things in perspective. I liked the thimble analogy. :)

  14. jaia says:

    Neat calculations, but what about the fact that the body responds somewhat differently to vaccines than most other antigen exposures? I refer to common things like tenderness at the injection site or fever. If most antigen exposures caused those, we’d be sick all the time! Is it the amount of antigen in a vaccine, the presence of adjuvants, or the fact that the material is injected that causes the difference?

  15. storkdok says:

    Great post, very meticulously documented, thank you for taking the time to put this together!

  16. just the facts says:

    You have addressed the quantitative aspect of your argument. However, your display of mathematical prowess has neglected the qualitative aspect of some of the research you cite.

    I am always surprised to see physicians quoting the 2002 Offit et al paper to support the idea that increasing numbers of vaccines administered in one day are safe or that they won’t “overwhelm or use up” the immune system. I agree with Paul Offit when he quoted Carl Sagan (in a 2005 presentation to the New York Academy of Sciences) as saying “Extraordinary claims should be backed up by extraordinary evidence. (By the way, you misspelled Mr. Sagan’s name in your blog.) The 2002 Offit paper was a traditional review article, not an original contribution. As you undoubtedly know, traditional review articles frequently exhibit author bias (as compared with systematic reviews). The 2002 paper cites a single source for the claim that an infant has the capacity to respond to 10,000 vaccines at one time. The sole source is a 1990 theory paper by Cohn & Langman (expounding upon the “Protecton Theory”). The Protecton Theory paper was published in 1990 in Immunological Reviews simultaneously with critiques of the theory by 8 leading immunologists. The 8 expert critiques are not mentioned in the Offit et al 2002 review article. Today this 7 year old traditional review article citing a 19 year old theory with no subsequent studies or evidence whatsoever for the extraordinary claim is still frequently quoted by physicians and the media. If Offit has actually published papers on his own studies of this subject, please enlighten me.

    When discussing an infant’s capacity to respond to antigens, the 2002 Offit et al article extrapolates from theoretical antigen exposure as discussed in the Cohn, Langman paper to vaccine exposure. Obviously antigens and vaccines are not equivalent due to the route of exposure and the additional components present in vaccines. The cumulative dose of thimerosal, aluminum-based adjuvants, formaldehyde and other components contained in 10,000 vaccines would exceed all government agency (FDA, EPA and CDC) recommended maximum exposure amounts to those compounds. This is one reason the theory is untestable.

    Of interest is the fact that Offit wrote a chapter on this subject in the 4th edition (2004) of “Vaccines” edited by Plotkin, Offit and Orenstein, which was subsequently omitted from the 5th edition (2008). Perhaps the editors of Vaccines concluded that this theory is untestable and therefore no longer warrants inclusion in the text. However, that doesn’t stop physicians from continuing to quote the paper, and to credit the theory with non-existent studies by Offit. (examples: Offit’s 2005 Babytalk magazine comments cited by you and a Feb. 23, 2009 Newsweek online article entitled “Six Top Vaccine Myths” comprised of an interview with a pediatrician who claims to “debunk” vaccine “myths”. The Newsweek article also contains a link to the Offit et al 2002 paper.

    One other point that I find bothersome. Offit published a 2003 book “Vaccines, What You Should Know”. The intended audience of the book is obviously non-scientists, as it contains no reference citations. This book also cites the Cohn, Langman theory. The problem is when Offit takes a flying leap from acknowledging it as a theory to proclaiming it a fact, in the space between two sentences. (uppercase emphasis is mine). “Although this would mean that adult humans could make antibodies to more organisms than infants, the scientists ESTIMATED that even young infants COULD respond to about 100,000 different ORGANISMS at one time. Therefore, the eleven VACCINES required for all children WILL use up only about 0.01 percent of the immunity that is available.” The 2002 paper states it as a prediction rather than a fact, as is appropriate for an unproven theory “But using this estimate, we would predict that if 11 vaccines were given to infants at one time, then about 0.1% of the immune system would be “used up.”

    See my comments on Gorski’s Sept 28 review of Offit’s book “Autism’s False Prophets” regarding Offit’s double standards of communicating science to the public.

    I am open to being disabused of the notion that it is speculation to rely upon a 2002 traditional review paper and a 1990 theory paper as evidence for the immune system capacity of infants and that this theory can be extrapolated to vaccines.

  17. Calli Arcale says:

    Grand total 1374 potential pathogens, counting Salmonella once. This is, obviously a gross estimate, probably a gross underestimate, of the number of pathogens that can infect us. Obviously, not everyone is exposed to every one of these pathogens. Keep in mind that each organism makes dozens of proteins and carbohydrates for the immune system to recognize and to respond with a specific antibody. I would bet the list represents more than 13,740 antibodies.

    Don’t forget, also, that the human body also makes antibodies to things that aren’t pathogenic, so the total list of antibodies would be much longer. For instance, I have Type A- blood. I can be expected to carry antibodies to Type B blood, because the same protein is also made by bacteria in the wild and is virtually certain to have entered my body at some point. (This is why giving B blood to a person without B blood can result in a massive immune reaction; they already have antibodies to it.) If either of my children had been Rh+, I might also carry antibodies to the rhesus factor, but fortunately they inherited my rhesus negativity.

    Responding to just the facts, I’m wondering what exactly is wrong with the data cited above that he feels it is inappropriate to use it to extrapolate whether or not vaccines could “use up” a child’s immune system capacity. The data suggest that the immune system’s capacity is extraordinarily vast; it seems to me to be a rather odd claim that a handful of proteins might use it up. If we cannot handle a few vaccines, we are shockingly fragile creatures, ill-suited to life on Earth, and I would have to wonder how we came to survive on such a wide swath of this planet.

    just the facts makes one specific claim which I’d like to respond to:

    The cumulative dose of thimerosal, aluminum-based adjuvants, formaldehyde and other components contained in 10,000 vaccines would exceed all government agency (FDA, EPA and CDC) recommended maximum exposure amounts to those compounds.

    That is not true at all. The doses are far within the maximum exposure limits. It is true, however, that the cumulative dose of ethylmercury received in a lifetime does exceed the *daily* recommended limit of methylmercury exposure. This is what folks like those at Generation Rescue base the “limits exceeded” claim. It’s highly disingenuous — to the point where it would be fair to call it a lie.

    BTW, did you know that your body makes more formaldehyde in a day than is in any vaccine? True. People get all scared about it, but it’s actually a normal waste product of your body’s metabolism. You certainly don’t want too much of it, but the amount in a vaccine is not going to cause any problems.

  18. wales says:

    You have taken the comment out of context. Offit’s claim was regarding ONE infant’s ability to respond to 10,000 vaccines. As stated, the amounts of the referenced compounds contained in 10,000 vaccines most certainly would exceed safety limits for one infant/child.

  19. wales says:

    BTW, As of Sept, 2008, the ASTDR had not established a MRL (minimum risk level) for parenterally administered aluminum compounds, present as adjuvants in the vast majority of vaccines administered to children. ASTDR lists MRLs for only oral and inhalation routes of delivery.

    http://www.atsdr.cdc.gov/toxprofiles/tp22.html

  20. Ooooh, Calli, you’re my opposite blood type! We could generate a WARP bubble if put into containment fields aboard the Enterprise!!!

    …Oh wait, that’s antimatter, not antigen. No FTL travel for us!

  21. trrll says:

    BTW, As of Sept, 2008, the ASTDR had not established a MRL (minimum risk level) for parenterally administered aluminum compounds, present as adjuvants in the vast majority of vaccines administered to children. ASTDR lists MRLs for only oral and inhalation routes of delivery.

    And it is unlikely that one ever will be, because nobody is ever injected with enough aluminum to worry about. Nobody rational is concerned about about the tiny amount of aluminum in a single injection, because the great majority of it is eliminated rapidly, and the peak blood level of aluminum that is (very) briefly attained after vaccination is not much different from that which is (chronically) attained from normal dietary intake of aluminum, which is on the order of milligrams per day.

  22. wales says:

    Trrll, if what you say is true, then it would appear to be a no-brainer for ATSDR to establish a MRL for injected aluminum. If parenteral and oral delivery of aluminum exhibit the same rates and modes of excretion, why not simply apply the oral MRL to a parenteral MRL?

    Here’s an interesting transcript http://www.fda.gov/CbER/minutes/tox120202.htm from a 2002 vaccine workshop. In a discussion of the safety evaluation of adjuvants, Dr. Natalie Garcon of GlaxoSmithKline states “Actually, the adjuvant, the only one that is licensed for human use, is the one which is the most empirical. I mean, nobody knows how it works, nobody knows the biodistribution. I mean, it has really not much known about this one………Actually, I believe that if alum was coming now, it won’t be accepted.” [no typos, transcribed verbatim] And Mr. Martin Feder of Apovia states “Natalie (Dr. Natalie Garcon of GlaxoSmithKline), you said something: Very little is known about alum. And I think this highlights one of the problems of vaccine toxicity. Very little is published. Having had to write a short review of alum toxicity recently, I was horrified to find how few publications there were on this. And I see a problem. “

    This four page summary of a National Vaccine Program Office May 11-12, 2000 workshop on aluminum in vaccines is interesting. http://www.dhhs.gov/nvpo/nvac/documents/Aluminumws.pdf

    The summary states that “There seems to be abundant data concerning risk levels for ingested aluminum, but scant data about risk levels for injected aluminum.” It also states “we learned about “pervasive uncertainty”, a phrase used in this workshop to denote missing data on pharmacokinetics and toxicities of aluminum injected into humans.”

    For every alarming fact revealed about the lack of evidence supporting the safety of injected aluminum this summary simply repeats the fact that aluminum adjuvants have been used for 70 years with an “apparent” wide margin of safety, without addressing the fact that childhood exposure to injected aluminum compounds has increased dramatically over the past two decades due to the proliferation of ACIP recommended vaccines and doses.

    Even more interesting is the 400+ page transcript of the May, 2000, Aluminum in Vaccines meetings which was released under Freedom of Information Act request. http://www.nationalautismassociation.org/library/AluminumMay_11.pdf I can hear sbm brains shifting into dismissal mode over the source of the transcripts. If anyone has proof that these are not legitimate transcripts please do share your sources with the rest of us. Here’s Sam Keith of ATSDR on the topic of Toxicokinetics:

    “We do know that when aluminum binds to the larger proteins it tends to, as the protein is larger, it tends to bind more irreversibly, and it can inhibit the formation of neuronal microtubule.”

    “Neurologically, from the studies we have reviewed, neurological seems to be the most sensitive health endpoint that we are considering for aluminum…”

    “…here is a curve for infants following this path indicating that the body burden of aluminum from injection is higher than from dietary intake.”

    “…ATSDR developed a minimal risk level for aluminum based on the oral route of exposure…. we are in the process in this effort of looking at the data and assessing whether an injection MRL is resolvable.”

    NINE years later, still no MRL for injected aluminum at ATSDR. ATSDR’s oral MRL is 1 mg/day. Vaccines contain varying amounts (limited to 0.85 mg per dose by the FDA, according to ATSDR), infants and children can receive 9 or more doses of vaccines in one day under the ACIP schedule.

    More from the Aluminum toxicological profile on ATSDR’s site:

    “Human and animal studies have investigated the aluminum retention in the body. Within the first day of receiving a single injection of 26Al citrate, approximately 59% of the dose was excreted in the urine of six subjects; 72 and 1.2% was excreted in the urine and feces, respectively, during the first 5 days (Talbot et al. 1995). At the end of 5 days, it was estimated that 27% of the dose was retained in the body (Priest et al. 1995; Talbot et al. 1995). When 26Al levels were monitored more than 3 years after a single subject received the injection, a half-life of approximately 7 years was calculated (Priest et al. 1995). However, when the subject was re-examined approximately 10 years after the injection, a half-life of about 50 years was estimated (Priest 2004).”

    “There is a rather extensive database on the oral toxicity of aluminum in animals. These studies clearly identify the nervous system as the most sensitive target of aluminum toxicity and most of the animal studies have focused on neurotoxicity and neurodevelopmental toxicity.”

    “Neither study evaluated the potential neurotoxicity of aluminum following acute-duration exposure; intermediate-duration studies provide strong evidence that the nervous system (in adults and developing organisms) is the most sensitive target of aluminum toxicity.”

    http://www.atsdr.cdc.gov/toxprofiles/tp22.html

    No proof, but indications of “pervasive uncertainties” for those of us who care about such things. I don’t see how anyone rational could be unconcerned.

  23. trrll says:

    trrll, if what you say is true, then it would appear to be a no-brainer for ATSDR to establish a MRL for injected aluminum. If parenteral and oral delivery of aluminum exhibit the same rates and modes of excretion, why not simply apply the oral MRL to a parenteral MRL?

    Because that’s not how science works. To establish a MRL for injected aluminum, one would need to do the experiments with injected aluminum. Since the amounts are small, and injected aluminum has been shown to be very rapidly eliminated, and there is no evidence whatsoever that aluminum produces any harm, nor any rational reason to believe it would. It is fairly unlikely that anybody will ever invest in doing those experiments.

    This four page summary of a National Vaccine Program Office May 11-12, 2000 workshop on aluminum in vaccines is interesting. http://www.dhhs.gov/nvpo/nvac/documents/Aluminumws.pdf
    The summary states that “There seems to be abundant data concerning risk levels for ingested aluminum, but scant data about risk levels for injected aluminum.”

    Oh, now we are quote-mining, are we? You should be aware that engaging in this kind of selective quotation pretty much destroys any chance of your being taken seriously–is more or less equivalent to hanging a sign around your neck that reads, “crackpot.” Let’s see what comes after your quote, shall we?

    “The oral minimum risk level, for example, appears to be in the range of 2–60 mg/kg of aluminum per day but there are no comparable data for injected aluminum. The uncertainties notwithstanding, there appeared to be a large margin of safety for aluminum adjuvants.”

    “…here is a curve for infants following this path indicating that the body burden of aluminum from injection is higher than from dietary intake.”

    Oops, there you go again. Let’s see what the very next sentence says: “And for most parts of the curve, less than the MRL curve.”

    The reason why quote-mining destroys your credibility is because it arises from a kind of disordered thinking that underlies most kinds of obsessions, revealed by a behavior commonly known as “cherry-picking” — seizing upon little bits and pieces that support your obsession, and ignoring the rest.

    For every alarming fact revealed about the lack of evidence supporting the safety of injected aluminum this summary simply repeats the fact that aluminum adjuvants have been used for 70 years with an “apparent” wide margin of safety, without addressing the fact that childhood exposure to injected aluminum compounds has increased dramatically over the past two decades due to the proliferation of ACIP recommended vaccines and doses.

    One could give many, many more vaccine injections, and the systemic exposure to aluminum from vaccination still could not be reasonably be characterized as “dramatic,” given the much higher long-term exposure to aluminum from oral sources.

    No proof, but indications of “pervasive uncertainties” for those of us who care about such things. I don’t see how anyone rational could be unconcerned.

    And of course, you omitted (and I suspect, failed even to notice) the many comments from the documents you cited that showed that none of the participants in the discussions you cited were at all concerned about systemic toxicity from the small amounts of aluminum introduced by vaccines, although there was some reasonable concern about local reactions.

    I’ve noticed that purveyors of vaccination FUD “fear, uncertainty, & doubt” almost never go so far as to articulate an actual hypothesis of how the supposed “toxins” will cause harm, because it is difficult to do so without confronting the extreme implausibility of what you are proposing. This is one of the first lessons learned by scientists: always make your hypotheses explicit, because it is very easy to fool yourself into thinking a vague hypothesis is plausible.

    So you are imagining that somehow, a toxic effect results from a very brief exposure to blood level of aluminum that is similar to the chronic blood levels that are attained by normal dietary intake…levels which are far, far below those that have ever been found to cause any kind of toxicity, neurological or otherwise.

    It might be educational for you to look into the toxicology of metals a bit more deeply. What you will discover is that the danger of metals is not that they are extraordinarily potent, but rather that some fraction of the metal in the body is eliminated slowly (in the case of Aluminum, a pretty small fraction), such that long-term exposure to modest levels can cause metal levels to gradually build up into a dangerous range. So acute exposure is not normally a problem, unless the dose is very, very high.

    What is more, there is not a hint of evidence that these tiny amounts (relative to dietary ingestion and other ingestion of aluminum–remember, we cook in the stuff, make baking powder and antacids out of it, and spray it in the air in deodorants) cause any acute toxicity at all. So have worked yourself up into a FUD frenzy based not on evidence, but on absence of evidence–evidence that is absent because nobody reasonable is likely to do experiments looking for a paradoxical kind of acute toxicity that works the opposite way from known toxic effects of metals, for which there is no known mechanism (and indeed, it is hard even to conceive of a plausible mechanism) and for which there is not a hint of actual evidence.

  24. Just an observation, but it’s interesting to me how cherry-picking and fuzzy thinking that often leads to wooful thinking seems to go hand-in-hand with disorders such as OCD, bipolar disorder, and high-functioning autism. My family is full of these, and it seems that the more strongly afflicted family members are the most prone to falling for (or instigating) cultish or magical thinking.

    Latching onto an idea and not letting go, for instance, then cherry-picking the literature for every scrap of data that supports one’s position, while ignoring the overarching scientific consensus– seriously… that is in a nutshell half my extended family!

    It’s like that old Darkwing Duck cartoon, wherein the villain was trying to lead the hero into a trap. The villain’s minions had raised a HUGE FLAG with the villain’s image on it over the skyscraper where they had set up the Seekrit Headquarters. The sidekick tried to point out the flag while hero comically failed to see it of course– but then he noticed a TINY CRUMB on the street! Looking at it under a magnifying glass, he pronounced that this crumb could ONLY have come from the dinner rolls served at x restaurant, which was located on the top floor of y skyscraper (where the flag was flying)! When the hero and his sidekick arrived, the villain said the line that never fails to describe me and many of my friends and relatives: “I see you found the crumb. I knew you wouldn’t notice the flag.”

    I see a lot of this behavior in the DAN! and green-ur-vaccines crowds. Of course, in this case, the Autism Flag is flying over a completely different building from the one the “hero” is searching.

    OCD people– we often fail to notice flags, because we have focused, WITH LASERLIKE INTENSITY, on crumbs.

  25. wales says:

    Ah, the standard cherry picking retort, a sbm favorite.

    Trrll, apparently you missed this one in your excursion to the cherry orchard regarding “2-60 mg/kg per day”. ATSDR states an oral MRL for aluminum of 1 mg/kg/day. Here’s how they arrived at it:

    “Using a NOAEL/LOAEL approach, the NOAEL of 26 mg Al/kg/day identified in the Golub and Germann (2001) study was selected as the point of departure for the MRL. An MRL based on this NOAEL should be protective for neurological effects, neurodevelopmental effects, and for delays in maturation. Dividing the NOAEL by an uncertainty factor of 100 (10 to account for the extrapolation from mice to humans and 10 for human variability) and a modifying factor of 0.3 to account for possible differences in the bioavailability of the aluminum lactate used in the Golub and Germann (2001) study and the bioavailability of aluminum from drinking water and a typical U.S. diet results in an MRL of 1 mg Al/kg/day.”

    http://www.atsdr.cdc.gov/toxprofiles/tp22.html

    Those pesky uncertainty factors, they are inconvenient.

    Theodore Eickhoff, the author of the 4 page workshop summary, also supplies a transcript summary. In the meeting transcripts he acknowledges the uncertainty factors with regard to a MRL for AL and quantifies them “…we are still dealing with 1,000-fold uncertainty factor.” In his 4 page summary where you picked the “2-60 mg/kg/day” comment Eickhoff fails to quantify the uncertainty factor or apply it to his “2-60 mg/kg/day” figure. An oversight perhaps, or cherry picking?

    You were right about one thing: peak aluminum levels in the blood following injection are temporary, as the aluminum is rapidly transferred from blood to body tissues.

    Sam Keith of ATSDR in the May, 2000, transcript from the NVPO Aluminum in Vaccines Workshop:

    On the subject of the Priest human IV aluminum study: “….it was found that over half of the aluminum transferred from blood to body tissues within 15 minutes………..there is a potential rapid release at the injection site of an adjuvant. Once systemic, there is a rapid transfer to bodily tissues.”

    “Rabbit and rats……….both tend to show the same thing after a reasonably short period of time. Bone seems to be the greatest depot followed by kidney and brain and muscle……”

    “………..there in the body is a depot that once it grabs on to the aluminum retains it and does not want to let it go……..perhaps aluminum never reaches a steady state in the body but accumulates over a number of years.”

    After reading Perky Skeptic’s comments I cannot fathom why I should be concerned with credibility. It seems to be a scarce commodity here.

  26. Anthro says:

    Perky Skeptic: MY family is full of similarly afflicted people, but we are all skeptics and get very cranky with woo and “belief” of any kind.

    Point is, these are just individual observations and while they might make for an interesting hypothesis, they aren’t scientifically valid assertions.

    I think you meant this as a lighthearted observation and my response is similarly well-intended. I’ve seen your moniker elsewhere and enjoy your posts.

    Dr. Crislip:

    I have been enjoying your QUACK CASTs enormously and am very happy to have come across this post which expands on the opening quote (which was in a podcast I recently listened to). I am from Seattle, but raised my family in Portland and enjoy all your northwest references, especially now that I am trapped in the Midwest. You must feel a little lonely fighting the alternative crowd there, though, as it is rampant there in my experience (not that I have escaped it here).

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