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Vaccines and Autism: A Deadly Manufactroversy

I was recently asked to write about vaccines and autism for Skeptic magazine. I approached the project with trepidation. So much has been written, from Paul Offit’s book Autism’s False Prophets to a veritable flood of blogorrhea on the Internet. I didn’t have anything new to add, and I couldn’t hope to cover all aspects of the subject.

After some thought, I realized I could contribute something useful. I could organize the highlights into a concise and accessible story. While it awaits publication in the magazine, Michael Shermer elected to pre-publish it in the e-Skeptic newsletter. You can read it here.

Posted in: Vaccines

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48 thoughts on “Vaccines and Autism: A Deadly Manufactroversy

  1. Jojo says:

    As a parent of a young child, I have to thank you for this article. This topic comes up from time to time when I am speaking to other mothers. There is a lot of concern surrounding vaccinations and it’s difficult for many parents to sort out the information. Your article will be a great resource to reference when the topic comes up. It’s clear, concise, and accessible to the general reader and I suspect that most rational parents will appreciate what you have done.

  2. Michelle B says:

    Excellent article and will become a solid reference for me.

  3. hatch_xanadu says:

    Beautiful article, HH. And yeah, in fact, even though there is already plenty of outstanding writing on the subject, this piece makes an excellent reference because it’s all-encompassing without overly referencing “spin-offs” as blog entries and response articles, while excellent, will often do, risking confusing and distracting and dissuading those who are already half-convinced of the autism/vaccine “connection”. It also includes an element of gentleness that may help those folks see reason.

  4. SF Mom and Scientist says:

    Great article. I was so glad to hear that Jenny McCarthey’s son’s paternal grandmother said that he was already showing signs of autism before the shot, and that she is writing her own book. As much as I hate to say it, this will probably have a bigger impact than all of the science.

  5. Dash says:

    Excellent article, I’ve already started spreading it around :)

    Actually the comment about Grandma is the one bit that rubbed me wrong. It’s hearsay, and if we’re going to tell parents that their opinions aren’t as good as evidence, then Grandma’s opinion definitely isn’t as good. Trust me, I would love the smoking gun of a health professional’s report on her son, and hopefully that is what Grandma will have in her book, but until then I’m uncomfortable using it. I’ve also been in the reverse situation – my eldest had a speech delay, and while I love and get on with my mother in law, having her tell me there was nothing wrong and I didn’t need to do those exercises was frustrating to say the least.

  6. pmoran says:

    I know what you mean, Dash, but the vaccine-autism link is largely sustained by the hearsay evidence — it is assumed that mothers are sensitive to, and can relied upon to report accurately any change in the behavior of their children..

    So I personally would be prepared to lay this on the table for Mc Carthy to dispute with medical reports if she can.

    I would also definitely point out that when three presumably carefully selected “best cases” of vaccine damage were recently tested in the courts of law, it was found that neurological problems were evident before the vaccinations that were supposed to be causative, or otherwise lacked the clear temporal association that was being claimed.

    I agree this will have more impact than quoting studies.

  7. Harriet Hall says:

    I was hesitant about using the “Grandma” anecdote because it is hearsay, but I was careful to identify it as hearsay, and I thought questioning Jenny’s reporting was reasonable.

    I could have given verified examples of the same thing in non-celebrity families, but the anonymous patient has less impact. There are many documented instances of parents who thought their child developed autism after the vaccine but where objective evidence from 1st birthday videos and other sources showed that autism was present before the vaccination. There are also many documented cases where parents have convinced themselves they saw an improvement in their autistic child’s behavior after some ineffective treatment. A classic example is the child whose behavior suposedly responded in minutes to a Lupron injection, when the mechanism of Lupron is to reduce the body’s production of testosterone and it could not possibly have any noticeable effects that quickly.

  8. SF Mom and Scientist says:

    Dash, unfortunately presenting scientific evidence does not always convince people. For some people, it is these anecdotal stories, whether or not they are scientifically verified, that tug at their heartstrings. I wish it was not that way, but I do think this type of story will work where science won’t. (Trust me, it pains me to type these words.)

  9. Dash says:

    I agree it’s effective, and yes if it’s questionable Jenny should be called on to prove her statements. There does seem to be grounds to quetion the diagnosis http://bit.ly/ZhUh6 . And I know about the autism omnibus cases, but I agree it’s more effective to question Jenny.

    My worry is purely for the credibility of our own position – if we start arguing with anecdotes, aren’t we then in a position of saying well our anecdotes are better than yours. How can we tell people anecdotes aren’t any good if we’re using them too.

    It’s a dilemma I face often on parenting boards where I find myself in the position of saying “Trust me! My study trumps your neighbour!” At the moment, the silent majority do have a respect for scientific evidence, I just don’t want to do anything to damage that. But I don’t know how that balances against children’s lives – is it more important to protect children by convincing people now based on emotion, or more important to educate people on better ways to make decisions?

  10. Psyche78 says:

    I almost feel like the forest is being missed for the trees. Perhaps it is a case of focusing on the visible target, but I would submit that if you are trying to increase vaccination compliance, training all of your resources on Jenny McCarthy and those who believe that autism is caused by vaccination is not the way to go. Rather, it is going to be a usage of valuable resources that will alienate more people on the fence, and in some ways, a waste of effort because while you are only answering the questions about autism and vaccination, it is dubious as to whether you are answering the questions that are keeping people from actually vaccinating.

    As individuals who champion science and logic, you should know that in attempting to devise a solution to the problem, you must first determine what the problem is and clarify the parameters. If the problem here is that the number of people who are vaccinating for measles is declining, wouldn’t one the first steps in determining how to address said problem be to determine, scientifically, the reason for such vaccine refusal? I’ll admit I have not done a thorough search of the literature on characteristics of vaccine refusers or their reasons for refusal, but from my perusal, it does not seem that good studies have been done to ascertain why people are refusing vaccinations; please correct me if I am wrong. Anecdotally, the parents I know who are refusing vaccines or selectively vaccinating are not being influenced by Jenny McCarthy; these parents are looking at the schedule and wondering why there are so many more vaccines on it than when they were growing up. They are wanting specific information about the risks and benefits of the individual vaccinations, not vague threats about how they are harming their children by not vaccinating and are bad parents, or the consequences of a measles outbreak. They want to be talked to, not talked at.

    The ammunition seems to be primarily pointed at Jenny McCarthy, but she is a relatively latecomer to the vaccination debate. To focus solely on her may end up doing more damage than good when it comes to increasing vaccination rates and trust in vaccination.

    BTW, I attempted to find numbers to support the contention that vaccination rates have been falling. The only study I was able to find concluded that the trend has been increased compliance with childhood immunization, not decreased (http://www.childtrendsdatabank.org/indicators/17Immunization.cfm). Could someone point me in the right direction to find the data/studies supporting the repeated contention that immunization rates are falling? Thanks!

  11. Harriet Hall says:

    My article described the falling immunization rates in the UK, with the associated consequences. While the overall immunization rate in the US is pretty good, there are local areas where the rate has dropped, and those areas are epidemics waiting to happen – and the disease can then spread to other areas. There are already many examples of preventable disease outbreaks where most of the affected children had not been vaccinated.

    Please see this article from the New England Journal of Medicine: http://content.nejm.org/cgi/content/full/360/19/1981

    Look at the map of immunization exemption rates by county. “the state-level nonmedical-exemption rate in Washington was 6%; however, the county-level rate ranged from 1.2 to 26.9%”

    “parents are looking at the schedule and wondering why there are so many more vaccines on it than when they were growing up. They are wanting specific information about the risks and benefits of the individual vaccinations” The information about risks and benefits is readily available; the risk/benefit ratio is very small. And of course the reason there are more vaccines is that we are now able to protect our children from more diseases. Duh!

  12. Psyche78 says:

    Harriet Hall wrote, “The information about risks and benefits is readily available; the risk/benefit ratio is very small. And of course the reason there are more vaccines is that we are now able to protect our children from more diseases. Duh!”

    I believe I was quite respectful and polite in my response, and am therefore a little confused as to the tone of your reply. I should hope that I am merely misinterpreting your tone based upon this being the Internet and that you do not speak to your patients in the same condescending manner when they pose questions to you.

  13. SF Mom and Scientist says:

    Psyche78 wrote, “Anecdotally, the parents I know who are refusing vaccines or selectively vaccinating are not being influenced by Jenny McCarthy; these parents are looking at the schedule and wondering why there are so many more vaccines on it than when they were growing up.”

    Why would an increase in the number of vaccinations be a matter of concern, unless someone was out there promoting this idea? Are we concerned that there are more types of chemotherapy to help more cancer patients?

    I would think the increase in the number of vaccinations would be a cause of joy for parents. (I know it is for me.) We can protect our children from diseases that we had no protection from. It seems that the concern about the number of vaccinations has come from people like Jenny McCarthy promoting these ideas.

  14. Harriet Hall says:

    Psyche78,

    I meant no disrepect to you. The “duh” was directed to the parents you cite who are “wondering why there are so many more vaccines on it than when they were growing up” and who apparently are not even trying to use their brains. Isn’t it obvious why more vaccines are on the schedule? As SF Mom says, more vaccines are a cause for joy, not a reason for becoming suspicious of vaccine safety.

    I’m surprised that you reacted to that one word and didn’t comment on the rest of the content of my comment. You asked for numbers about vaccination rates and I gave you some data. And I did it respectfully.

  15. wales says:

    psyche78 hit the nail on the head. For the parents I know who question the vaccination schedule, Jenny & Co. and Oprah are just some sort of side show, largely ignored. These parents are reading package inserts and questioning why no testing for carcinogenesis, mutagenesis and impairment to fertility. They are asking what is the rationale for creating more new vaccines and mandating vaccination for millions of children for diseases affecting statistically insignificant portions of the population (Hib for example). They are looking at VAERS statistics. They are asking why their kids and their kids’ friends have such high rates of chronic disease and remembering how when they were growing up in everyone got measles and chicken pox but childhood asthma and diabetes were rare. For them, autism is just one facet of the risk/benefit analysis. In fact, I would say Jenny is probably more of a product of this whole generation of questioning parents, rather than a cause.

    And yes, it is all a bit odd, what with US kindergarten vaccination rates at 95% and the remaining 75% of the population vastly undervaccinated.

  16. givemethetruth says:

    Dr. Hall,

    My question for you is what is your source of information when you say the risk/benefit ratio is very small. Is it from the CDC? And if so, where do they get their #’s from? Is it from VAERS? And if so, how accurate can that be when the CDC, FDA, etc. say that because it’s a passive reporting system (VAERS) that it’s prone to UNDER-reporting. They also say these reports are not all verified, suggesting they could be caused (adverse reactions) from things other than the vaccines. How do they manage to use it “both” ways? How accurate can these #’s be??? How is a parent supposed to get accurate information. I dare to say it is NOT that easy.

  17. SF Mom and Scientist says:

    wales, I know this is anecdotal, but the few parents I know who questioned the vaccine schedule became fearful from what they heard in the media. It may not be Jenny herself, but I have not met a parent yet who came up with this idea on their own.

  18. Harriet Hall says:

    What is my source of information about the risk/benefit ratio of vaccines? The scientific literature and the consensus of scientific experts who have reviewed all the published data. The CDC, the AAP, the AAFP, WHO, etc. etc. They all agree. None of them rely on VAERS.

    VAERS is a blunt instrument that only provides anecdotal evidence and that at best can only suggest risks that then must be verified by proper studies. Reporting is voluntary and selective. Real risk might not show up there; spurious risks show up due to post hoc ergo propter hoc errors, over-reporting by people who intend to sue manufacturers, etc. Some of the irrational fears of vaccines have been sparked by a misguided reliance on VAERS data.

  19. Harriet Hall says:

    “why no testing for carcinogenesis, mutagenesis and impairment to fertility”

    Do you have any reason to think vaccines might cause these?

    “what is the rationale for creating more new vaccines and mandating vaccination for millions of children for diseases affecting statistically insignificant portions of the population (Hib for example).”

    You are conflating two different issues here. “Mandating” vaccines is a political decision which I have not even addressed. The rationale for “creating” more new vaccines is to help more children. And I don’t know what you mean by “statistically insignificant.” Hib vaccines prevent an estimated 20,000 cases of Hib disease in the US every year. 3-6% of cases are fatal, and 20% of the survivors have permanent sequelae. That seems pretty significant to me, and I suspect you would think it significant if your own child died of a preventable Hib infection.

    The Hib vaccine causes no serious side effects. I can’t understand why a parent would deny his child the protection it offers, even if the risk of catching the disease is low. Those same parents buy fire insurance for their house, and the risk of a house fire is low.

  20. wales says:

    From the VAERS website: “The majority of VAERS reports are sent in by vaccine manufacturers (42%) and health care providers (30%). The remaining reports are obtained from state immunization programs (12%), vaccine recipients (or their parent/guardians, 7%) and other sources (9%). ”

    Please let’s dispense with this notion that a significant number of VAERS reports are litigation based. No one said VAERS should be “relied upon” as a sole source for decision making, but the data do indicate uncertainties about vaccine adverse reactions and should not be dismissed.

    SF mom: Many of the questioning parents I know first started researching the topic when the noticed the dramatic increase in the number of currently mandated vaccines vs. the number they received as a child. Some were first made aware of this by THEIR parents. As you say, purely anecdotal.

  21. wales says:

    Regarding statistical significance, no one is saying that a vaccine adverse event or a disease complication or death is not significant to the individuals involved. My point is that VAERS has over 30,000 reports year to date, and that Hib estimates are 20,000 cases annually pre-vaccine. 20,000 or 30,000, both are statistically insignificant (less than 1%) in a birth cohort of 4 million. There are two sides to the coin, if one is going to emphasis the statistical insignificance of vaccine injury, one must also examine the statistical insignificance of disease complication and mortality.

    If the risks on both sides are statistically insignificant, parents can make a rational decision for or against vaccination, or for selective vaccination.

  22. Harriet Hall says:

    No matter who submits the reports, VAERS is based on assumptions of post hoc ergo propter hoc. Givemethetruth asked if assessments of the risks of vaccines were based on VAERS data. They aren’t. Possible risks suggested by VAERS have to be studied to see if the adverse effects are more common in those vaccinated than in those not vaccinated.

    Yes, there are more vaccines available today. By itself, that fact is not a reason to “start researching the topic.”

  23. Th1Th2 says:

    Stop this never-ending denial. Vaccines do cause autism!
    You have been forewarned.

    “Adverse events reported during post-approval use of Tripedia vaccine include idiopathic thrombocytopenic purpura, SIDS,
    anaphylactic reaction, cellulitis, AUTISM, convulsion/grand mal convulsion, encephalopathy, hypotonia, neuropathy, somnolence
    and apnea.”

    http://www.vaccineshoppe.com/image.cfm?doc_id=5966&image_type=product_pdf

    Just say no to vaccination.

  24. Psyche78 says:

    @SF Mom: “Why would an increase in the number of vaccinations be a matter of concern, unless someone was out there promoting this idea? Are we concerned that there are more types of chemotherapy to help more cancer patients? I would think the increase in the number of vaccinations would be a cause of joy for parents. (I know it is for me.) We can protect our children from diseases that we had no protection from. It seems that the concern about the number of vaccinations has come from people like Jenny McCarthy promoting these ideas.”
    I understand your point, but believe the analogy falls flat. Chemotherapy treatments are strictly for patients with cancer who need them and the choice to undergo chemotherapy is not one that mandated by government agencies. As for why the increase in vaccinations is a concern, it’s not the increase in the number of vaccinations, per se, that is the problem, it’s the increase in the number of mandated vaccinations that is the problem. Individuals hold different beliefs about health and the utilization of medical intervention. For every person who has carries a bottle of Tylenol with them everywhere in case of headache or pain, there is likely to be another person who eschews the use of analgesics for minor or temporary pain. In the same vein, there are going to be parents who unquestioningly follow the recommendations of doctors 100% and there are going to be parents who want to know why their particular child needs a particular intervention, including vaccination. The more mandates there are, the more questions there will be. Most of the selective vaxers I am familiar with do vax with MMR, DTaP, and IPV. It is the newer vaccines, the ones that were not around when they were growing up, that they question and tend to refuse, such as Prevnar and Rotavirus. Varicella is a big one that is questioned, as pretty much all of the current parents had chicken pox as children and do not view it as a threat –they did not need protection against as children, so why should they need to protect their children against it now; even the literature describes it as a generally mild disease.

    @Harriet Hall: I believe you are misunderstanding what I am trying to say. The increase in the number of vaccines is not being seen as a reason to question vaccine safety, it is reason there is more refusal of vaccines. In your first response to me, you indicated that vaccine refusal rates are being measured by the number of non-medical exemptions being filed; I am assuming that when researchers are looking at these exemption they are viewing the number of exemptions as the number of parents refusing all vaccines. I think it is a mistake and it may be causing more alarm about vaccination refusal than there needs to be. In most states, in order to qualify for a religious or philosophical exemption, the law states that the parent(s) must be opposed to the practice of vaccination; the way the laws are, vaccination is supposed to be an all-or-nothing deal. Parents who choose to selectively vaccinate or even just delay vaccination are not covered by the exemption law. So what do a lot of parents do? Go ahead and selectively vaccinate (or vaccinate on a delayed schedule), but refuse to have their child’s doctor indicate that information on the school/daycare health history; then the parent(s) file for a religious exemption. The county/state counts the child as being unvaccinated, when in reality, s/he may only be lacking one mandated vaccine – and it may not be MMR, DTaP, or IPV.

  25. Chris says:

    Th1Th2:

    Stop this never-ending denial. Vaccines do cause autism!

    So with all the dozens of studies on PubMed from several countries, covering several vaccines and including hundreds of thousands of children…

    Your proof is one line in a DTaP package insert possibly written by a “let us cover our ass” legal aide?

    So tell us, exactly what are the odds of getting autism from the DTaP, versus say adverse affects from pertussis (which Dr. Sears said on the Age of Autism blog causes 20 deaths per year, he seems okay with that), diphtheria (the Choking Angel), and tetanus (Lock Jaw)?

    Please be sure to document with some better science.

  26. Harriet Hall says:

    Psyche78,

    I think I understand your point better now. I did not get into the separate issue of making vaccines mandatory, and I won’t now. I’m only concerned with the scientific evidence for the risk/benefit ratio that has led to current recommendations by professional organizations like the American Academy of Pediatrics. I think your reasoning is misguided when you reject vaccination for the less dangerous diseases like chickenpox. Chickenpox is not as benign as most people think. It can leave permanent scars, it can cause pneumonia (and result in permanent miliary calcifications throughout the lungs) and many other serious complications, and it can kill. If a pregnant woman gets it, the effects on the fetus can be devastating. And then there’s shingles. Do you realize that every year there are approximately 5,000-9,000 hospitalizations and 100 deaths from chickenpox in the United States?

    Although the risk from chickenpox is small, if the risk from the vaccine is smaller, doesn’t it make sense to vaccinate? Do you have some reason to think the risk from the vaccine is higher? Don’t you think it’s a worthwhile goal to try to eliminate the disease entirely so those 100 children a year won’t have to die and so no older people will ever get shingles again, and so we will no longer need to give the chickenpox vaccine? If your child caught chickenpox and died, wouldn’t you regret not vaccinating?

    The fact that we didn’t get those vaccines when we were children should not be an issue. When we were children, we got all the vaccines that were recommended by the current scientific consensus; isn’t it inconsistent to reject the current scientific consensus for our children? Do parents think their judgment is better than all the scientists and doctors who have reached a consensus and made a recommendation for the vaccine? If the only objection is that the vaccines have been made mandatory, that’s just a silly “you can’t make me” knee-jerk response. Those who follow the science will give the vaccines based on current recommendations, whether they are mandatory or not.

  27. Harriet Hall says:

    Th1Th2 didn’t read far enough. In the reference he cites, it goes on to say the reported conditions are not necessarily due to the vaccine. And in one study in that reference, it lists deaths due to motor vehicle accidents and drowning. If he expects us to believe vaccines cause autism on the basis of that reference, then logically he should expect us to believe that vaccines cause motor vehicle accidents. Strange, since most of the vaccines are given to people too young to drive. Perhaps Th1Th2 imagines that a toddler sitting in his car seat in the back of the vehicle can send some kind of spooky influence to incapacitate the driver. I don’t think so!

  28. Psyche78 says:

    @Harriet Hall

    I am aware of the complications of chicken pox, and that 1 in 80k healthy children will die of the disease and that the death rate and complication rate tends to be highest amongst infants (who cannot receive the vaccine) and adults. I am also aware that the efficacy rate of the vaccine varies between 75-85% and that the duration of immunity can be as low as 5-6 years (instead of lifelong), which is encouraging the examination of adding chicken pox booster vaccines to the recommended schedule; I am also aware that between 1995 and 1998, the serious complication rate of the vaccine was 1 in 33000. As is inevitable with the reality of medicine, the initial projections of lifelong immunity through one shot from the vaccine are not coming to fruition. Th vaccination program began only 15 years ago; as we learn more about the effectiveness of the vaccine over time, more and more boosters may need to be added. So, it starts coming down to weighing numbers and chance: the risks and benefits from naturally catching the disease while young (and I say this, because if my son has not caught the infection by the time he is 10, I will have him immunized for chicken pox) vs. the risk and benefits of having to have a series of vaccinations for the rest of his life; weighing the low risk (from the disease) that one is exposed to once vs. a statistically lower risk (the vaccine) that one is exposed to multiple times. The single vs. multiple event element is what gives me pause and makes the analysis not as simple as you suggest.

    You mentioned shingles several times as a reason for vaccinating against chicken pox. From what I am familiar with, the chicken pox vaccine does not protect against shingles. Based on the literature that I have been able to access, including the Goldman article in the International Jounal of Toxicology in 2005, the chicken pox vaccine may be leading to an increase in shingles cases that is likely to last several generations, shifting the burden of disease to the older population and making a more severe disease more prevalent. Thus, when you ask, “Don’t you think it’s a worthwhile goal to try to eliminate the disease entirely so those 100 children* a year won’t have to die and so no older people will ever get shingles again, and so we will no longer need to give the chickenpox vaccine?” my response: most countries do not routinely vaccinate against chicken pox, and until they are also doing so, it will be difficult to eliminate chicken pox, so we will need to continue giving the chicken pox vaccine and then will have to try and get adults vaccinated for shingles (knowing that vaccination programs for adults are notoriously difficult to implement). While it might be a worthwhile goal, the realization of said goal is likely to be unworkable as things stand today.

    You ask: “Do parents think their judgment is better than all the scientists and doctors who have reached a consensus and made a recommendation for the vaccine?” Dr. Hall, with all due respect, I think we both know that recommendations made by the Academies and governmental agencies are not purely based on science. There is a tremendous amount of politicking involved, and more than just the unbiased doctors and scientists are involved. I am not subscribing to conspiracy theories, but the information that comes out guidelines and recommendations are not always based on the evidence alone. Furthermore, recommendations and guidelines are just that: recommendations and guidelines. In actual practice, they should be combined with knowledge of the individual and the individual’s health history and situation in order to come to a decision about intervention/treatment; they are not to be taken as a blanket protocol for treatment. Would it surprise you to know that after discussing my concerns with my son’s doctors, with them knowing his familial health history, that they are 100% supportive of my decision to selectively vaccinate and to space out the vaccinations he did get? So, I would ask you: Do doctors and scientists who have no familiarity with my son or his health history think they are in a better position to judge his medical treatment than his personal doctors and his parents?

  29. Harriet Hall says:

    What exactly are you afraid of? Do you have any evidence that a single chickenpox vaccine or multiple repeated vaccinations cause serious enough side effects to outweigh the value of the shot? Do you know of any evidence that spacing out vaccines offers any advantage?

  30. wales says:

    Some clarification is in order here for varicella (chicken pox) hospitalization and mortality rates.

    Dr. Hall said “Do you realize that every year there are approximately 5,000-9,000 hospitalizations and 100 deaths from chickenpox in the United States?”

    VARICELLA HOSPITALIZATION: The CDC’s pink book states that In the prevaccine era, approximately 11,000 persons with varicella required hospitalization each year. Hospitalization rates were approximately 2–3 per 1,000 cases among healthy children and 8 per 1,000 cases among adults.” It goes on to say that “Since 1996, the number of hospitalizations and deaths from varicella has declined more than 90%.” In summary, the current number of hospitalizations due to varicella must be less than 1,100, not 11,000. If the current rate were 11,000, it would be the same as it was prior to vaccine development.

    VARICELLA MORTALITY: Dr. Hall suggests we should try to eliminate varicella “so those 100 children a year won’t have to die”. Dr. Hall first says that the current annual varicella mortality rate is 100 in total. Then she states it is 100 in children. Which is it? NOTE: if the current varicella mortality rate is about 100, it’s roughly the same as it was for the 25 years prior to vaccine development.

    http://www.ncbi.nlm.nih.gov/pubmed/10915066

    The article abstract states that for the 25 years prior to the vaccine (1970-1994), the annual varicella mortality rate was about 90 in total (2,262 deaths in 25 years). It also states “From 1970 to 1994, varicella mortality declined, followed by an increase.” A post-vaccine increase in mortality, that’s interesting. It also states that adults had a 25 times greater risk of mortality and infants a 4 times greater risk of mortality than children 1-4 years of age.

    The Pink Book says this about varicella “Complications are infrequent among healthy children. They occur much more frequently in persons older than 15 years of age and infants younger than 1 year of age. For instance, among children 1–14 years of age, the fatality rate of varicella is approximately 1 per 100,000 cases, among persons 15–19 years, it is 2.7 per 100,000 cases, and among adults 30–49 years of age, 25.2 per 100,000 cases. Adults account for only 5% of reported cases of varicella but approximately 35% of mortality.” So the adult mortality rate may be about 35 and the child mortality rate about 65 annually.

    http://www.ncbi.nlm.nih.gov/pubmed/15689583

    This paper says that varicella related deaths declined to 66 per year during 1999 through 2001. If that is a more accurate number than the round “100”, then deaths are about 23 for adults and 43 for children each year.

    Psyche78 is correct, it is the proliferation of recommended vaccines plus boosters, and exaggerated disease complication and death rates that have many parents questioning. The thoughtful responses I’ve seen here are about as far from “knee jerk” reactions as you can get.

    “Those who follow the science will give the vaccines based on current recommendations, whether they are mandatory or not.” The implication is that those who do not are science heretics. Thoughtful parents who examine the complication and mortality statistics may arrive at very different conclusions.

  31. wales says:

    Dr. Hall asks “What exactly are you afraid of?” with regard to varicella (chicken pox) vaccination. By the same token, what exactly are vaccine proponents afraid of? Perhaps the point is that fear is not the best basis for this decision.

    When stated this way “The varicella vaccine has reduced the risk of varicella related hospitalization by 90% and death by 34%” the impact of the vaccine appears impressive. Here’s another way to examine the US reduction in varicella-related hospitalizations and deaths from 1970 to the present.

    Risk of Varicella Hospitalization age 0-18:

    Pre-vaccine 0.01467% (or 99.98533% no hospitalization)
    Post-vaccine 0.00147% (or 99.99853% no hospitalization)

    Risk of Varicella Death age 0-18:

    Pre-vaccine 0.00013% (or a 99.99987% survival rate)
    Post-vaccine 0.00009% (or a 99.99991% survival rate)

    Assumptions: Pre-vaccine hospitalization rates of 11,000; post-vaccine rates of 1,100. Pre-vaccine mortality rate of 100; post-vaccine rate of 66. Just for fun, I erroneously assigned all US varicella hospitalizations and deaths to the 25% of the population aged 0-18, eliminating 75% of the population and thereby inflating the percentages (the denominator is 75 million, rather than 300 million). Pre-vaccine period is 1970-1994. Post-vaccine period is 1995 to present.

    A perfectly rational atheist with zero leanings toward alternative medicine or other so-called “woo” treatments might reasonably choose to forego the preventive medical intervention of varicella vaccination given these statistics. Taking into consideration of course the social risks of being labeled a science heretic or of being ostracized due to social norming programs encouraged by vaccine proponents. If one wanted to add fear to the equation one could examine the uncertainties regarding both disease complication and vaccine safety.

    In our post-vaccine era, adults are much more susceptible to varicella due to the loss of natural life long immunity which has been replaced with waning vaccine-induced immunity. Adults are also at much higher risk of contracting the disease, as well as suffering varicella related complications and death. This vaccine is particularly difficult to rationalize based upon health risks. The economic benefit of preventing workplace absenteeism is also questionable, if you weigh the cost of time off work for parents of children contracting varicella in the pre-vaccine era, vs. the cost of time off work for adults themselves contracting varicella in the future. And of course considering the millions (billions?) of dollars spent on varicella vaccine in the US……..well, time will tell.

  32. Harriet Hall says:

    “Adults are also at much higher risk of contracting the disease”
    But the statistics show that the incidence of infection is decreasing. The risk of hospitalization and death have decreased.

    You can speculate about what you think are disadvantages of the vaccine, but the reduced risk statistics speak for themselves.

  33. wales says:

    I heartily agree, the reduced risk statistics speak for themselves.

  34. daedalus2u says:

    Wales, you have made a number of unwarranted assumptions coupled with very sloppy thinking. Those people who got varicella in the post vaccination era, were they vaccinated? There are a lot more immunologically challenged individuals around now than there were in 1995; people on immunosuppressants due to transplants and people with HIV.

    Both the papers you linked to are available open access. If you look at the actual numbers, the deaths due to chickenpox in 1990-94 in the under 20 age group was 240, for an average of 60 per year. In 2001 the number was 4. Of the total deaths in 2001 (26), 85% were in the 20 years and older group. The group not expected to have been vaccinated. Deaths in the under 20 age group went from 60 to 4, a reduction of 93%.

    Your speculation that the deaths in the +50 age group were due to waning immunity from vaccination doesn’t make any sense. The paper discusses that some of the deaths attributed to varicella in the elderly were likely misdiagnosed, and that many of the deaths were associated with cancer and HIV infection.

    Varicella is extremely contagious. If there were no vaccine, essentially everyone would get it. If you want to compare the cost of absenteeism with the cost of the vaccination, it is a no brainer; a week (or two) of lost pay caring for a child with varicella compared to the cost of a vaccination?

    A treatment that will reduce my child’s chances of dying from varicella by over 90% and will likely prevent the disease entirely? Sign me up. Where is the data suggesting that vaccination is a bad thing? The two papers you cited show it is a good thing.

  35. wales says:

    To clarify, the hospitalization and mortality risks were statistically insignificant both before and after the vaccine.

  36. wales says:

    Sloppiness? Dr. Hall says that 100 children die every year from varicella, you say it’s 1. Which is accurate? I don’t know. Let’s assume you are correct and I’ll revise my previous calculation to reflect one death annually.

    Varicella Risk of Mortality

    Pre-vaccine 0.00013%
    Post-vaccine 0.0000013%

    A difference of opinion regarding decisions based upon statistically insignificant risks is not attributable to sloppy thinking.

    I didn’t make any speculations regarding past deaths for those over 50+ attributable to varicella. My comments were regarding future adult susceptibility. Since the vaccine wasn’t licensed until 1995, it will be decades before the naturally immune adult population disappears.

    I did not suggest that any paper published in a medical journal would imply that vaccines are bad. I am not foolish enough to think that will happen.

    “A treatment that will reduce my child’s chances of dying from varicella by over 90% and will likely prevent the disease entirely?”

    Yes, the vaccine results in an increase in the varicella survival rate from 99.99987% to 99.99991%. You are free to sign up, others may make a different decision.

  37. Psyche78 says:

    Dr. Hall,

    Why does it have to be that one is driven by fear if one questions the need for an intervention? Isn’t it possible that one is simply being a cautious and critical consumer of medicine? You ask whether I have any evidence that a multiple administration of Varivax causes serious enough side effects to outweigh the value of the shot; I am not the one proposing intervention and therefore, I am not the one tasked with responsibility of showing that the status quo – with it’s short and long-term risks already known – is safer than the new intervention. Those who propose the change/intervention are tasked with showing the safety of it, and, seeing as how the addition of 2nd booster was only made in 2006, there are no long-term studies to support/not support the safety. Science is capable of many things, but being able to predict the future accurately is not one of them; we can hypothesize, but we can not know. In 1995, when the vaccine was added to the schedule, parents were told that Varivax would provide lifelong immunity. A case-controlled study a few years later suggested a drop in efficacy over time of only 13%. Results from the 10-year long Antelope Valley study indicated the drop in efficacy was higher and that breakthrough infections were not as mild as previously thought. What will we learn about the efficacy/safety of the Varivax booster over the next 10 years? You may consider it paranoia to want to take a conservative approach and see what the results are, I consider it the prudent approach.

    With regards to spacing out vaccinations, you ask what evidence shows that spacing out vaccines offers any advantage. I would counter, what evidence shows it is harmful to space out vaccinations and/or shows significant clinical advantage to not spacing them out? The fact is that people do have adverse reactions to vaccination. People do have allergic reactions to vaccinations, and are cautioned to avoid particular vaccinations if they are allergic to an ingredient in the vaccine. How exactly is one supposed to know whether a two-day-old infant or even a two-month-old infant is sensitive to yeast or allergic to eggs or gelatin? Parents are advised to introduce new foods one at time, with a spacing of least several days apart, to infants and young children, yet it’s ok to inject a bunch of different substances from different shots all at once into the same infant? Inserts indicate that if one has a serious reaction to a vaccination, one should refrain from having it in the future; if you inject 2 or 3 different vaccines at once, and there is a serious reaction, how is one to know which vaccination to avoid in the future?

    All intervention, especially new ones, need to be examined with a critical eye. Simply choosing to intervene because said intervention is deemed “safe,” especially when there is little to no overriding clinical benefit, is not always the best plan of action. The prescription of antibiotics in cases of viral infection “just in case” seemed fine for years because antibiotics are generally safe – what was the harm, right? After years of overuse, we have come to realize that this action has led to the development of antibiotic-resistant bacteria against which we have fewer medications. We are now in worse position when it comes to fighting disease than we would have been with a more conservative approach to using antibiotics. When the benefits of intervention do not clearly outweigh the risks of not intervening, the possibility of unintended consequences should temper our impetus to intervene.

  38. daedalus2u says:

    You are being disingenuous. ~100 is the number (in the US) that died per year before the vaccine was available. The number that currently die is going down. As of 2001 it was only 4.

    You used false numbers in your “analysis”. Most of the deaths now are in older people. Being exposed to the wild-type varicella (because there was no vaccine) didn’t give those older people immunity that protected them from dying. With booster vaccines they can be given more immunity as they need it.

    I asked for data showing it is a bad thing. The only data you presented was in those two papers which showed it to be a good thing. Show me some data by which you calculate that it is a bad thing.

    The lost time caring for a child is many times more expensive than the vaccine.

  39. Harriet Hall says:

    Psyche 78,

    The danger in spacing vaccines or in not administering them together is that it prolongs the period during which the child is not protected. I think new interventions ARE considered with a very critical eye. Especially in today’s litigious environment.

    I respect your position more now that you have explained your thinking, but I still can’t agree with you. I still think your reasoning depends too heavily on speculation. You are accepting a known risk (however small) to avoid a hypothetical risk.

  40. wales says:

    Daedalus please be more specific, your vague accusation lacks credibility. Exactly what “false numbers” did I use in my analysis? I disclosed all of my assumptions and their sources, all legitimate.

    Daedalus says “Most of the deaths now are in older people.” According to the CDC’s Pink Book, adults account for 35% of varicella deaths. According to Dr. Hall, 100 deaths annually are attributable to children. You cite 2001 as having 4 deaths. Which one is accurate?

    You asked for information proving that vaccination can be damaging. Specifically with regard to varicella:

    “Unlike immunity to Variola, Measles, Rubella and Mumps viruses, immunity to Varicella Zoster is not sterile, but serves to suppress or to contain the persistent latent infection. Though it may provide some degree of protection against reinfection, (or better, “superinfection”) there is increasing evidence that this protection wanes over time and that superinfections do occur. This waning of protection is associated with increased risk of clinical episodes of herpes zoster. Recent studies provide convincing evidence that repeated exposure to children with varicella boosts immunity and reduces the risk of zoster in adults. This has important implications. Several authors have warned that reduction in the circulation of varicella virus, as a consequence of widespread vaccination, could lead to an increase in the incidence of herpes zoster. This implies a perverse result—vaccination of one segment of a population (young children) leading to indirect protection and hence to reduced boosting of immunity, and ultimately to increased incidence of disease in another segment of society (adults).”

    Also this “The ecology of varicella and its immunity (different levels of protection against infection, chickenpox, zoster and transmissibility in the presence or absence of boosting exposures) is complicated. It is hoped that the immunity associated with the vaccine strains will be long lived, and that the risk of zoster associated with vaccine strains will be lower than with wild-type varicella-zoster virus, but the situation will need close monitoring in the coming years to ensure an overall public health benefit from this intervention.”

    Excerpted from Vaccines by Plotkin, Orenstein & Offit (2008), Chapter 71 “Community Immunity” page 1583

    We’ve all heard about the current shingles vaccination campaign. Another vaccine to curb the negative consequences of the varicella vaccine.

  41. wales says:

    Daedalus, as for being disingenuous, that 100 deaths per year came from Dr. Hall’s comments. She attributes it to children only. Is she disingenuous too?

  42. Harriet Hall says:

    I can’t find the source I quoted the 100 from, but now I have found a reference from a source that I consider highly reliable: the NEJM. “Varicella-related deaths averaged 145 per year from 1990 through 1994 and declined to 66 per year from 1999 through 2001,” It provides other details and points out that they were not counting cases where varicella was a contributing factor. [When you add those cases it comes out to around 100, so maybe that's where the other website was coming from] It breaks the numbers down by age and ethicity, and it appears that the mortality was and continues to be highest in the youngest age groups. “the large decline in deaths among children led to a higher proportion of varicella-related deaths among adults. This statistic should not be confused with the numbers and rates of deaths, which also declined dramatically among adults.”
    “most deaths related to varicella continue to occur among persons who do not have high-risk conditions and who are eligible for vaccination.” “The reduction of varicella among infants, who are not eligible for vaccination, is solely due to herd-immunity effects” ”
    “Varicella-related deaths are now preventable by vaccine. The United States was the first country to implement a universal vaccination program for childhood varicella, and our analysis clearly documents the dramatic national decline in varicella-related mortality for all ages, races, and ethnic groups after the increased use of vaccine.”
    http://content.nejm.org/cgi/content/full/352/5/450

    Elsewhere I found a statement that no deaths have been attibuted to the vaccine.

    Information about adverse effects can be found at http://www.aafp.org/afp/20021201/2113.html See table 2. In every case, the incidence of the adverse effect with the vaccine is less than the incidence with the disease.

  43. Calli Arcale says:

    With regards to spacing out vaccinations, you ask what evidence shows that spacing out vaccines offers any advantage. I would counter, what evidence shows it is harmful to space out vaccinations and/or shows significant clinical advantage to not spacing them out?

    Why don’t you ask the kid! He/she is the one who’s gonna get stabbed a bunch more times because some palooka decided to be scared of combo shots. Seriously, if you don’t have evidence that either is better, why would you *not* want fewer needle sticks?

    The fact is that people do have adverse reactions to vaccination. People do have allergic reactions to vaccinations, and are cautioned to avoid particular vaccinations if they are allergic to an ingredient in the vaccine.

    This is true. However, the “particular ingredients” are the same whether you space them out or use the combo shots. Seriously. People aren’t allergic to the antigens. They’re allergic to various components in the delivery mechanism, most famously egg albumin. Separating out the shots doesn’t help you avoid allergies, since they’re already pretty well grouped by stuff that would be the same anyway.

    In fact, if you’re at risk of injury from the MMR, getting the three components separately will *triple* your risk, because you will be facing the same risk three times as often as you would otherwise.

    How exactly is one supposed to know whether a two-day-old infant or even a two-month-old infant is sensitive to yeast or allergic to eggs or gelatin?

    Strictly speaking, the two-day-old infant isn’t allergic to eggs. It’s only on the *second* exposure to a foreign antigen that you have a reaction.

    But on a more serious note, you don’t know. Life’s like that. The best you can do is play the odds. The allergies related to vaccines are uncommon, and if you’re worried about them, make to keep a close watch on your child after each vaccination so that prompt medical attention can be provided if your child develops a serious reaction.

    Parents are advised to introduce new foods one at time, with a spacing of least several days apart, to infants and young children, yet it’s ok to inject a bunch of different substances from different shots all at once into the same infant?

    Actually, there is growing evidence that the “new foods only a few days apart” thing may not be necessary, and may even be harmful, given how rare true food allergies actually are. It needs more study.

    Besides that, I think you underestimate the amount of exposure a kid gets from their environment compared to the puny exposure in vaccines. And as I noted earlier, most of the shots contain the same stuff anyway, so this still isn’t an argument in favor of single shots. If anything, it’s argument in favor of *combination* shots, since the total exposure to the adjuvants and preservatives and inactive ingredients is greatly reduced if you use the combo shots.

  44. Psyche78 says:

    Calli Arcale,

    By spacing out, I was referring to not giving the DTaP shot at the same as the MMR shot, not giving the MMR as three separate components. Second, the MMRV combo shot has been shown to have a higher risk of seizures than giving the MMR shot separately from the varicella shot ( http://cme.medscape.com/viewarticle/571595), so the combo shots are not always a better option.

  45. HCN says:

    What does the MMRV have to do with the MMR, which has been around since 1971? Issues with one vaccine does not mean another vaccine is bad.

    Plus the MMRV is not even readlily available in the USA.

    So tell us why giving three shots instead of one is better? Don’t mind the difference between the DTaP or MMR.

  46. VetImm says:

    As PhD qualified immunologist (no longer working in research albeit) my pet peeve is the toxic ignorance being peddled by the anti vaccinationists. It’s bad enough the following Dr Quackfield has here in the UK but the fact parents are turning to a glamour model and her comedian boyfriend for advice on major health issues in the US beggars belief!

    Rant aside, I saw this story today that just reiterates to me at least, that blogs like this and people standing up to speak truth unto all are more important than ever.

    http://www.medindia.com/health-press-release/Federal-Vaccine-Court-Rulings-Against-Autism-Families-Due-to-Governments-Refusal-to-Fund-Sound-Science-43136-1.htm

    How many children would they like to see die in the “unvaccinated” control group before they understand what ethical actually means!!!

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