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Why Universal Hepatitis B Vaccination Isn’t Quite Universal

I am just a parent with some questions about vaccine safety and was happy to find your website.  I have noticed that the Scandinavian countries do not routinely recommend HepB vaccination unless the mother is a known carrier.  I did not see this addressed anywhere on your website and I hope you or one of your colleagues might consider discussing the reasons that some advanced countries are not routinely giving this particular vaccine. Thank you.”

Vaccination is a complicated and at times confusing topic that generates a large number of quite reasonable questions by parents like the one above.  At the same time, the ever-wandering aim of the anti-vaccinationist movement appears once again to be falling on the vaccine against Hepatitis B, and I’ve heard them pose this very question with the intent of sowing doubt in the current vaccination schedule.  Regardless of the source, this question is clearly on the mind of some parents, and I am happy to answer it.

As usual, this question has quite a bit to parse out.  I think it may be most helpful to examine why we vaccinate against Hepatitis B the way we do in the US, how most countries in the world approach the problem, and finally examine the reason why eight European countries do not universally vaccinate against HBV.  First things first though: what is Hepatitis B?

HEPATITIS B

Hepatitis B (HBV) is a double stranded DNA virus found in the bodily fluids of infected people including their blood, semen, and saliva, and can be transmitted through sexual contact, exposure of infected fluid to mucous membranes, or through injection.

As the name suggests, infection causes damage primarily to the liver, though the spectrum of disease experienced by any one person can be quite broad.  In adults, 50-70% of infections are asymptomatic or mild enough to not come to medical attention.  The remaining adults experience a range of hepatitis lasting weeks to months, with ~1% of these being a fulminant, life-threatening infection.  Adults are relatively efficient in their ability to clear the virus after the initial infection, and only ~10% become chronicly infected carriers.

Children, on the other hand, present a very different pattern of disease.  Though ~90% of infected children are initially asymptomatic, they are rarely able to clear the virus.  90% of infants and 25-50% of those 1-5 years old will become lifelong carriers.

Chronic Hepatitis B infection is a serious problem.  Beyond the ability of most chronic carriers to spread the virus throughout their lives, ~ 20% of people with chronic Hepatitis B develop cirrhosis, a condition where the liver cells are lost and the liver becomes progressively more fibrotic and dysfunctional.

Cirrhosis isn’t the only life-limiting problem to result directly from chronic Hepatitis B infection.  Hepatocellular carcinoma, a primary cancer of the liver, is in the top 10 cancers in both sexes in the US, and 60-80% of all cases are cause by Hepatitis B.  All told, around 25 % of people who become chronically infected with Hepatitis B will die from its complications.

Hepatitis B is a major cause of worldwide morbidity and mortality. More than 1/3 of the world’s population has been infected with Hepatitis B and 5% are chronic carriers.  That totals up to around 350,000,000 people chronically infected, and around 620,000 deaths from HBV yearly.

As in many health care related issues, the worldwide epidemiology of HBV infection does not necessarily reflect that of the United States.  Even so, the picture isn’t particularly pretty.  Around 5% of the US population has been infected with Hepatitis B, and 0.3 are chronic carriers.  Most HBV infections occur in those aged 25-44 (4/100,000), with the lowest rates of infection in those under 15 (0.1/100,000).   In 2007 4,519 new cases in the US were reported to the CDC, though this represents a fraction of the total number of infections.

These numbers are significant.  To put this in perspective, the mortality from HBV in the US was 5 times higher than Haemophilus influenza type B and 10 times greater than measles before vaccination was introduced.

The Hepatitis B Vaccine

HBV is a relatively stable virus posing a serious public health threat with humans as the only known reservoir, and as such is a prime target for prevention, and theoretically eradication, through vaccination. The first vaccine against HBV became available in 1981, and the current recombinant vaccine has been in use since 1986.  As a recombinant vaccine it contains proteins normally made by HBV, but does not have the virus itself, and therefore carries no risk of HBV infection.

As far as efficacy is concerned, the HBV vaccine has a very high response rate, inducing an appropriate antibody response in more than 95% of people from birth to 30 years of age, and decreasing but still significant response rates in older age groups.  Immunity from the vaccine lasts at least 20 years in healthy individuals.

The HBV vaccine has an excellent safety record.  The most common side effects are pain and swelling at the injection site in ~3% of people, and fever in ~1%.  The only serious confirmed reaction is anaphylaxis that occurs in 1/600,000 injections with no deaths reported in over 20 years of use.  Concerns regarding the HBV vaccine’s association with demyelinating diseases, the use of thimerosal in its formulation in the past or aluminum at the present have all been investigated and found to be without support; I will give such allegations no further time in this post.

Strategies of Hepatitis B Vaccine Use

There are a number of viable strategies available to countries seeking to address the spread of HBV in their populations, and variants on each.  When deciding which strategy is best for any given country, there are multiple factors to consider, including disease severity, the availability and efficacy of treatments, the risk and cost of infection, the risk, efficacy and cost of vaccination, etc.

The first option is to vaccinate people at high risk of infection.  In situations where the risk of infection is very low this makes good sense.  For instance, in the US the risk of contracting Yellow Fever is essentially zero at baseline without vaccination.  No risk or cost of vaccination, no matter how small, is small enough to offset zero risk of disease, therefore we do not routinely vaccinate against it.  However, if you were to travel to an area where Yellow Fever is endemic, your personal risk can suddenly become significant, and easily justify the minimal cost and risk of vaccinating you as a person at high risk.

Since the majority of people infected with HBV have identifiable risk factors, this approach makes some sense.  However, it has several major drawbacks.  It requires all individuals in a high-risk group to have health care, be identified, and to acquire the vaccine before they are infected.  This is labor and cost intensive, and extremely unlikely to capture the entire target population. Well executed, this approach can protect a majority of people at high risk, but in the case of HBV it will not immunize a large enough population to generate a herd immunity effect. The greatest flaw of this approach lies in the 1/3 of HBV infections that occur in people with zero known risk factors who, by definition, are unable to further reduce their risk, and are left unprotected by a vaccine. These shortcomings guarantee this strategy will fail to fully control the spread of HBV in the community.

The second approach is to vaccinate the entire population as they enter into the age of greatest incidence of infection, adolescence and early adulthood.  This addresses one of the shortcomings of the first strategy, namely the need to identify people at high risk.  It also takes advantage of the fact that children more reliably have health-maintenance office visits than do adults, and are more likely to be given vaccinations as part of a universal schedule.

Though this captures a large majority of the total number of infections, it too has a flaw; it fails to address the people infected in early childhood.  Though this is a relatively small number of people (4% of HBV infections), remember that children are far more likely to become lifelong carriers, and thus make up a disproportionate number of the infected at any one point in time (24% of chronic carriers).  While more effective at reducing the prevalence of HBV in the population than only vaccinating high-risk groups, this strategy too has little hope of eliminating HBV.

The third possible strategy is to vaccinate people at the time of birth.  This strategy addresses the problem of perinatal infection, prevents the acquisition of HBV by people during early childhood when the risk of chronic infection is highest, and since the immunity it induces lasts for decades it covers the entire population during the highest risk times of their lives.  Universal vaccination with HepB vaccine at birth, even in regions with a low prevalence of chronic carriers like the US, could reduce mortality by an additional 10-20% compared to early childhood vaccination.

Even this strategy has a drawback, however, and that is time.  Beginning an immunization program with only infants would take a few decades to generate a maximum reduction in HBV in the population.

The US Vaccination Strategy

Though the burden of disease from HBV in the US is relatively low compared to say, heart disease, it remains a significant public health threat only partially addressed through screening, education, and preventative measures, and with limited treatment options.  This makes it an ideal target for vaccination.

From 1981 through 1991 the US vaccinated only people with identified risk factors. Predictably, this campaign had an underwhelming effect on HBV infections seen during this time period.

In 1991, the strategy was reworked to better address the various methods of HBV transmission in an attempt to eliminate HBV spread in the US.  The new strategy is an amalgam of all three strategies described earlier. In addition to vaccination of high risk groups, we began universal vaccination of all infants at birth, vaccination of adolescents, and prenatal screening of pregnant women to identify children who would require not only vaccination at birth but also Hep B immunoglobulin (HBIG).

Since its launch in 1991, we have seen a steady decrease in Hepatitis B infections. Hep B incidence in the US fell from 10.7/100,000 in 1983 to 2.1 per 100,000 in 2004. (25,916 total cases down to 6212 cases).  Though it’s true other factors have been contributing to HBV’s decline, most notably the public education campaign aimed at curbing the spread of HIV, this doesn’t account for the pattern of HBV decline across age groups.  There has been a 95% drop in HBV in people under 15 years of age, 87% in ages 15-24, 71% from 25-44, and 51% decrease in people over 45 years old.  This is precisely what you would expect from a pediatric vaccination campaign.

Using a cost effective and exceptionally low-risk intervention of universal Hep B vaccination the US is well on its way to control, if not elimination, of HBV.

The Northern European Vaccination Strategy

The strategy taken by the US is typical of most developed nations, even those with a relatively low incidence of HBV.  In 1992 the WHO recommended the inclusion of HBV vaccination in nearly all national vaccination programs.  Since that time, the vast majority of countries (177/193 countries) have adopted infant HBV vaccination into their childhood schedules as can be seen here.  This graphic also illustrates the few countries that have instead opted to vaccinate only high-risk individuals, primarily those in Northern Europe, including Scandinavia.

The reason these countries have not adopted universal vaccination against HBV is the exceptionally low level of HBV in their population and the associated costs of prevention.  Sweden, for instance, has one of the lowest prevalences of HBV in the world at 0.05%.  This is 6 times lower than what we have in the US, with the majority of cases occurring in those engaged in high-risk activities or in immigrant populations that tend to have minimal contact with the indigenous population.  The public health organizations of these Northern European countries consider HBV to be a minor public health problem best addressed by targeted vaccination.  The cost of instituting universal vaccination would not offset the benefit of further reduction in HBV prevalence in their countries.

It is interesting to note that though these countries have low baseline rates of HBV infection, they have not generated the same relative decrease in rates that countries, like the US, have been able to produce with universal HBV vaccination.  This fact, in combination with high immigration rates to these countries from areas of heavy HBV, makes it likely that the cost/benefit ratios of the Northern European countries will sway even more strongly in favor of universal HBV vaccination over the next several years.

It is also worth noting that of the many factors being weighed by the medical community and public health officials of these Northern European nations, serious concerns of the Hepatitis B vaccine’s efficacy or safety are not among them.

Conclusion

We will continue to make progress in medicine by never being satisfied the care we provide is good enough; the ongoing debate about how best to apply the Hepatitis B vaccine is an excellent example of this concept.  The inconsistency between these nations’ vaccination policies is little more than physicians and health care officials seeking the most efficient and effective use of the vaccine within the unique conditions inside their borders.

Posted in: Public Health, Science and Medicine, Vaccines

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126 thoughts on “Why Universal Hepatitis B Vaccination Isn’t Quite Universal

  1. history punk says:

    When I was preparing for my thesis defense at Google University, I was informed that vaccinations were a source of immense income for “Big Pharma”. My literature review include all manner of blog posts and forum comments with the usual arguments.

    Now, you’re saying that the Hep B vaccine prevents an expensive to treat, possibly life-long disease? When did that happen?

  2. windriven says:

    Great post Dr. Albietz. Let’s hope the northern Europeans get on the bandwagon. From what you’ve said it would appear that the world can rid itself of this disease, much as it has of polio and smallpox.

    I had the Hep B vaccination regimen when I was living in China, largely because my work often takes me into hospitals. This involved a series of 3 injections, a few months apart as I recall. Can anyone tell me if it is still done this way?

    Your post mentioned risk factors but you didn’t enumerate them. So I off this, lifted from the Mayo Clinic website:

    * Have unprotected sex with more than one partner
    * Have unprotected sex with someone who’s infected with HBV
    * Have a sexually transmitted disease such as gonorrhea or chlamydia
    * Are a man who has sexual contact with other men
    * Share needles during intravenous (IV) drug use
    * Share a household with someone who has a chronic HBV infection
    * Have a job that exposes you to human blood
    * Receive hemodialysis for end-stage kidney (renal) disease
    * Travel to regions with high infection rates of HBV, such as Africa, Central and Southeast Asia, and Eastern Europe

    These risk factors beg the question of how infants and young children become exposed to the disease. Doesn’t transplacental transmission suggest that maternal HBV testing should be part of routine prenatal care? Is it safe to assume that infected children who did not acquire the disease in utero were exposed via a family member with a chronic HBV infection?

  3. Plonit says:

    In the UK, there is extremely low incidence of HepB outside of the following populations: injecting drug users, sex workers, men who have sex with men, people from countries with endemic HepB and their children.

    We do routinely test for HepB antenatally, and have a very high take up rate of HepB vaccination of babies born to HepB+ mothers. The difficulty is in ensuring the follow-up, I think the coverage is only 70% for 3 injection regime (the first injection is received by more than 90%).

    Given the very low incidence of the disease, it is very unlikely that the UK will introduce HepB to the vaccination schedule unless it can be included as a component of a multivalent vaccine. None of the current multivalent vaccines include both HepB and Hib, and Hib has only recently been introduced into our programme (as part of mulivalent vaccine with DTaP/IPV) and going with a HepB containing vaccine would mean dropping Hib, which poses different risks.

    We could give HepB as a separate vaccine, but when the JCVI looked at this in 2005, their back of the envelope workings were that a routine infant vaccination programme would save between 8 and 48 lives (lower estimate is based on US disease progression data, higher estimate on Taiwan disease progression data) at a cost of between £37,000 per year of life saved (based on Taiwan disease progression) or £102,000 per year of life saved (based on US disease progression rate).

  4. John Snyder says:

    Windriven:

    Infants are exposed to hepatitis B during the birth process when the mother is carrying the organism. I work in a hospital in which a large number of Chinese mothers deliver their babies. In this population, a significant percentage of these women are chronic carriers of hepatitis B, presumably because they became infected when they were born. When a mother is a chronic HBV carrier, thre is a 5-20% chance of transmission at the time of birth. If the mother happens to be acutely infected, or has a flare of her hepatitis at the time of birth, the transmission rate increases to 70-90%. Immunoprophylaxis of infants born to mothers who are hepatitis B surface antigen positive (HBsAg), as determined by prenatal testing, is quite effective at decreaseing the rate of transmission. This has been routine practice in the US since 1982.

    It should be reiterated, however, that older infants and children can be infected in other ways. Frequent and close contact with individuals who are infected with HBV can expose children to contaminated bodily fluids. It is also important to note that HBV can remain intact and infective on surfaces for up to 7 days, posing another potential means of transmission.

  5. Th1Th2 says:

    John Snyder,

    “Immunoprophylaxis of infants born to mothers who are hepatitis B surface antigen positive (HBsAg), as determined by prenatal testing, is quite effective at decreaseing the rate of transmission.”

    “Immunoprophylaxis” is another term for sensitization and vaccination causes anaphylaxis not prophylaxis.

  6. Harriet Hall says:

    Thanks, Joe. This will be a great resource when people have questions about the vaccine.

    In considering the cost/benefit ratio, aren’t we being short-sighted? If we look at the entire future of humanity, the present cost of eliminating diseases with only human reservoirs pales beside the future cost of treating the disease throughout the generations. The number of illnesses and deaths prevented each year in the present pales beside the number of deaths preventable for endless future generations. We eliminated smallpox, and we know how to eliminate polio, measles, hepatitis B and other human-only diseases. It may be expensive and difficult, but isn’t it a worthwhile goal? Once these diseases are gone, no one will ever have to get the vaccines again.

  7. JerryM says:

    I’ve received the HB vaccine, and it was indeed still 3 shots several months apart.
    Other than a punctured vein from the initial blood test I suffered no ill effects.

    At risk adults get the vaccine for free in the Netherlands.
    Some groups are also targeted with information and encouraged to get the vaccine, though that information is often overlooked I’m afraid.

    Children from parents from regions where the prevalence is high also get vaccinated, but the rest doesn’t.

    I’m not too worried about HepB here, then again I’m vaccinated.

  8. Basiorana says:

    Th1Th2, I thought anaphylaxis was an allergic reaction. Hep B vaccination at birth to children of HepB positive mothers is considered post-exposure prophylaxis, in the same category as a rabies vaccine.

    I always figured the best strategy would be to test all women for HepB, and only give the vaccine if the mother is HBV+ or refuses testing (or just wants the vaccine); then vaccinate all the other children at 11 along with the meningitis shots.

  9. Th1Th2 says:

    Basiorana,

    “Hep B vaccination at birth to children of HepB positive mothers is considered post-exposure prophylaxis, in the same category as a rabies vaccine.”

    Are you inferring that neonatal exposure to Hepatitis B+ mothers will not confer natural immunity as oppose to vaccination?

  10. storkdok says:

    @Th1Th2
    You do realize how far out in left field you are, don’t you? You have demonstrated here that you don’t have the slightest grasp of immunology.

  11. storkdok says:

    Dr. Albietz, very good post! One that all pregnant women should read in order to understand how important it is that we test for Hep B in pregnancy and for the infant vaccination.

  12. Basiorana says:

    “Are you inferring that neonatal exposure to Hepatitis B+ mothers will not confer natural immunity as oppose to vaccination?”

    Sorry to be repetitive from the actual post…

    There are two kinds of Hepatitis B infection. The first kind is acute hepatitis, which lasts less than six months. If a baby gets acute hepatitis from the infection, they MIGHT get a natural immunity to future infections. They also might just die of fulminant liver failure within those six months, or might have permanent liver damage, or otherwise be very harmed.

    There is a second kind, called chronic hepatitis. This is a lifelong infection, and Dr. Albietz described it’s symptoms and concerns very well. What’s more, if they then go get a liver transplant for the liver disease, the virus will simply reinfect the new liver and make them sick again, so they are poor candidates. Now, since 90% of children infected at birth will get the chronic form– that means only 10% of children infected are likely to be able to get the natural immunity, and of them, most will die since a baby’s liver can’t handle the acute stage, it’s too much for it to handle when it’s still so undeveloped.

    Thus, natural immunity CAN happen at birth, but the chances are pretty damn low. It’s not like measles, where the majority get it, recover, and remain immune. Babies just die fast, or spread it while dying slow.

    However, if you vaccinate soon after birth, before the virus has had time to replicate and spread in the baby’s body, the baby’s immune system responds to the vaccine (which cannot cause infection), learns to fight Hep B, then attacks the wild virus. Thus, it is prophylactic– it prevents disease– but is post-exposure, since you aren’t vaccinating them before they are born.

    Now, it CAN cause anaphylaxis (an allergic reaction) but that’s pretty rare, and while it might be a risk to consider if the mother does not have Hep B, the low chance of anaphylaxis does not compare to the extremely high risk that a child born to a HBV+ mother will contract the infection and will either die within six months of liver failure or will have the lifelong chronic form.

    (We just went over this in Virology– SBM is helping me study, instead of distracting me for a change! :D)

  13. Th1Th2 says:

    Basiorana,

    You forgot to mention that on top of your morbid characterization of Hepatitis B is that it is generally benign and self-limiting disease. In the setting of an optimum cell-mediated response, this resolves the disease. This type of immunity does not even warrant antibody production. So you better stop there and don’t sensationalize Hepatitis B like it’s the end of the world for these babies. Ridiculous.

    You said, “However, if you vaccinate soon after birth, before the virus has had time to replicate and spread in the baby’s body, the baby’s immune system responds to the vaccine (which cannot cause infection), learns to fight Hep B, then attacks the wild virus. Thus, it is prophylactic– it prevents disease– but is post-exposure, since you aren’t vaccinating them before they are born.”

    Do you have any idea that infection takes precedence over replication? The cellular uptake of HbsAg whether via vaccination or wild-type virus is the first sign of infection. Vaccination is just a short cut of infecting cells with HbsAg—geewhiz, how can that be prophylactic?

    “Babies just die fast, or spread it while dying slow.”

    Your ideas are just laughable. These babies didn’t die because they were not vaccinated but because they were malnourished. How could you even vaccinate these protein-deficient babies? Where do you get the antibodies from? Too bad your opinion does not carry any logic let alone real facts.

  14. Th1Th2 says:

    storkdok,

    “You do realize how far out in left field you are, don’t you? You have demonstrated here that you don’t have the slightest grasp of immunology.”

    Another senseless comment that has no bearing at all. Too bad.

  15. Basiorana says:

    “You forgot to mention that on top of your morbid characterization of Hepatitis B is that it is generally benign and self-limiting disease.”

    I actually expressly mentioned that it IS, for adults. 90-95% of adults have a benign, self-limiting disease; a very small percentage might have liver failure but usually it’s a flu-like illness.

    It is not, for children. 90% of newborns exposed at birth do NOT have the self-limiting form. 10% do, of which a decent percentage will die because the self-limiting form can either be benign or it can be very severe causing long-term damage, and the risk of long-term damage increases in infants with undeveloped systems. Surely you would not argue that a newborn’s liver is as capable of handling the stress of an infection as an adult’s?

    As for the paragraph “Do you have any idea that infection… how can that be prophylactic?” that makes no sense from an immunological or virological point of view. Vaccination is prophylactic because it teaches the immune system how to fight the virus before the immune system actually has to fight the virus in a form that could cause disease. This can be because the disease has not spread enough to register with the immune system or because the immune system has never been exposed.

    In fact, the phrase, “infection takes precedence over replication” makes no sense. Infection is required for replication, but infection means one thing in the virology context (ie, infection is entry into the cell) and another in the layperson context (ie, infection means getting sick).

    Also, what babies are malnourished? Babies who contract Hep B at birth and are vaccinated usually don’t get infected or get a milder form and have lifelong immunity. Babies who contract Hep B at birth and are not vaccinated will either die quickly of some form of liver failure, which is not a sign of malnutrition, or will live and seem to thrive for many years then start having cancers, liver problems, etc. This is scientific evidence from long clinical trials. They show no symptoms of protein deficiency and there is no difference regarding breastfed v. not. This is particularly evident when looking at infections in developed nations, where protein is in abundance and mothers will be far more likely to eat too MUCH protein than too little.

  16. Scott says:

    Basiorana,

    There’s no point to arguing with him. Th1Th2 has no knowledge of the subject, is completely unwilling to obtain such knowledge, and really is nothing more than a very persistent anti-vax fanatic. You’d have better luck arguing with your dining room table, which at least won’t spout the same foolishness that has been demolished dozens of times already.

  17. Th1Th2 says:

    Basiorona,

    “Vaccination is prophylactic because it teaches the immune system how to fight the virus before the immune system actually has to fight the virus in a form that could cause disease. This can be because the disease has not spread enough to register with the immune system or because the immune system has never been exposed.”

    Is this the way you “teach” vaccination to children like an “apple a day, keeps the doctor away”? Funny. Care to explain how an exposure to antigenic preparation will prevent the disease and inoculation of recycled craps and junks in vaccines is healthy for the immune system? Let me tell you this, toxins and poisons do not teach the immune system how to react but it is the immune system’s inherent function to eliminate them out of the body.

  18. Watcher says:

    LOL!

    I’m sorry, but do you read ANYTHING on this blog? I mean actually read it and take it in? Search “toxin” and you’ll see a post just awhile back from David Gorski about the toxin gambit and why the argument doesn’t stack up. But hey, keep choppin’ that wood.

    As for how an “antigenic preparation” can stave off future infections? It happens all the time when we get sick. Afterwards, upon reintroduction to that same antigen our immune system is able to recognize and better fight off the infection that is characterized by that antigen. In essence, a vaccination is a simulated primary exposure towards a potential infector so that when our body sees it again it is more ready. Do you want me to go into the actual immunology of it? I’m just asking because it seems like you might need a refresher on it. I’d be happy to oblige :)

  19. weing says:

    Th1Th2,

    How about I get the rabies vaccine and you don’t? Then, we both play with a rabid puppy and let him take a tiny bite of our arms? Naw. That would be unethical.

  20. Th1Th2 says:

    Watcher,

    “In essence, a vaccination is a simulated primary exposure towards a potential infector [sic] so that when our body sees it again it is more ready.”

    Before you can even think of future exposure, I guess you have to mind that vaccination is first step of getting diseased. Of course, vaccination is an INTENTIONAL exposure to antigens that represents diseases, isn’t it? Babies who were not vaccinated and non-diseased obviously were NOT exposed to antigens of these diseases, am I right? Vaccines are designed to infect cells intracellularly with antigens to make them immunogenic, otherwise, they are ineffective. The same thing goes with natural exposure to chicken pox (pox party) should bring about the signs and symptoms of the disease. But why is that not all babies develop chicken pox? It’s because natural immunity does not rely on immunological memory but on a vital cell-mediated immune response—and vaccines never possess such inherent function. The pathologic evidence of the disease is inside every vaccine—-100% sure—-they are antigens FFS! In short, they are made literally from craps, junks, pus, infected mucus, etc.

  21. Th1Th2 says:

    weing,

    “How about I get the rabies vaccine and you don’t?”

    I’ll be fine because I don’t carry the pathologic evidence of rabies and you do. FYI, not all rabid animals can contract rabies. In case you are not a human, I just wanted you to know that the innate immune system is capable of neutralizing and eliminating viruses and you don’t get that from any extrinsic sources.

  22. weing says:

    Are you saying I have Negri bodies and you don’t? Good grief. Enjoy your ignorance till reality bites you.

  23. storkdok says:

    *Don’t feed the troll, don’t feed the troll, don’t feed the troll*

    *Head hits keyboard*

  24. weing says:

    storkdok,

    Sorry. I won’t do it again.

  25. Th1Th2 says:

    weing,

    “Are you saying I have Negri bodies and you don’t? Good grief. Enjoy your ignorance till reality bites you.”

    Negri bodies????? Hahahaha. You don’t know what you’re talking about, do you? You don’t need to have the Negri bodies for you to contract rabies kid. And besides the presence of negri bodies should not be considered a conclusive and diagnostic test for rabies, check with CDC. All you need is a good amount of rabies viral antigen that is capable of infecting cells and a good vector for it is the rabies vaccine—Negri bodies-none, rabies virus–yes!

    Study well genius.

  26. storkdok says:

    @weing

    I was trying to control myself. My brain hurts. I think I sprained it with the mental gymnastics I am reading.

  27. Harriet Hall says:

    I don’t want to feed the troll, but I’m fascinated to learn that apparently nobody could get rabies until the vaccine was invented to give it to them. :-)

  28. backer says:

    After thinking about this endless debate for a few days i had a question for all of you who willfully vax against disease…

    Would any of you willfully infect your children the current H1N1 flu virus? After all according to the CDC numbers there is only a .004% chance that it will be serious enough to land you in the hospital, and only a .0001% chance that it will kill you. it think 99.9% chance of no serious side effects FROM THE ACTUAL VIRUS rivals vaccine safety any day.

  29. Harriet Hall says:

    backer,

    It is irrational to look only at risk and not consider the risk/benefit ratio.
    It would be irrational to infect children with a virus that has only risk and no benefit. The vaccine has a very small risk but a significant potential benefit – to public health as well as to the individual.

  30. Chris says:

    It is actually quite disturbing that backer thinks a 1 in 10000 chance of death is acceptible. By implication she must be okay with the over 200 pediatric deaths by flu, almost all from H1N1. As long as none of those children are hers, it must be okay.

    From http://www.cdc.gov/h1n1flu/update.htm :

    Since April 2009, CDC has received reports of 234 laboratory-confirmed pediatric deaths: 198 due to 2009 H1N1, 35 pediatric deaths that were laboratory confirmed as influenza, but the flu virus subtype was not determined, and one pediatric death associated with a seasonal influenza virus.

    But then again, backer is a troll who has no concept of science, statistics or that she is being completely off-topic. I shall ignore her from now on.

  31. Th1Th2 says:

    I think some vaccine apologists in this board are suffering from intentional and selective delusional disorder. According to them, antigen exposure from wild-type sources are thought to be bad whereas exposure to antigens prepared from vaccines is a healthy choice. Goodness gracious! I did not even know antigens are beneficial, I thought they were enemies that should be cleared out of the system. I hope these people should provide evidence, if any, about the benefits of initiating antigenic exposure to a host who has never had any type of exposure. And please avoid the use of such words like “teach” and “simulate” if possible because the innate immune system is not ignorant although I admit that some persons are.

  32. Chris says:

    Troll1/Troll2:

    According to them, antigen exposure from wild-type sources are thought to be bad whereas exposure to antigens prepared from vaccines is a healthy choice. Goodness gracious! I did not even know antigens are beneficial, I thought they were enemies that should be cleared out of the system.

    This will be my only answer to this troll. Do not expect any more responses.

    It has been explained to you several times that the vaccine version of the antigen has been modified, so all it does is educate the immune system to recognize the wild type so it has to put up a better and faster immune response. The vaccine version does not cause the same kind of disease (sometimes it will cause a sore arm and a mild fever, but at a degree much less than the actual disease).

    For instance outside of variolation the original vaccine for smallpox was not smallpox, but cowpox (a completely different disease). It was a similar but much milder disease that primed the immune system to fight back against smallpox. Which led in later years with modern medicine was still young to the idea of modifying disease causing microbes to prime the immune system. So polio, measles, mumps and other virus vaccines have had their kick knocked out with various methods. But newer vaccines (like HepB) don’t need that… all that was needed was to strip the virus so that only part of it exists, like the outer protein layer, to prime the immune system (in terms you might understand: to make the immune system smarter). There is no genetic RNA or DNA system in the vaccine to replicate in cells (which is what viral infections tend to do).

    Yes, modified antigens are good in that they make a smarter immune system, without causing disease.

    Why is this a difficult concept for you? It has been explained to you multiple times in painful detail, but the concept eludes you. You have been provided evidence (and it is abundant in the medical literature, just do an educated search of PubMed), but you choose to ignore it. Are you so set on your anti-vaccine crusade that your brain has blocked any actual input?

    Do you really want to try weing’s rabies experiment? Only a couple of humans have survived rabies without the vaccine treatment pioneered by Pasteur, and they only survived with incredible medical intervention which in one case involved a forced coma. But if you truly want to put your convictions on the line, you can be the first (and hopefully the only) test case of rabies treatment from conventional vaccine type to something else. Since some crazy homeopath called Andre Saine has claimed that homeopathy works better than real medicine, you could call on him to treat you for rabies (see http://www.theness.com/neurologicablog/?p=41 ). Good luck with that.

  33. Calli Arcale says:

    FYI, not all rabid animals can contract rabies.

    BWAHAHAHAHAHAHAHAHA!!!!!!

    I should know better than to read Th1Th2 posts while drinking Mountain Dew. It’s quite painful in the nose.

    (Hint for the obtuse: “rabid” literally means “afflicted with rabies”.)

  34. backer says:

    Chris-

    Let me set the record straight. Since you have mischaracterized me on many occasions here you go. First of all I am a male. I am an industrial engineer. I have a PhD. I am also a member of mensa. I hold 5 patents of which you undoubtedly use, or know someone who uses, at least one on a daily basis.

    I have never claimed to know about medicine but what i do know is risk. This is what i can’t quite figure out about the people on this board. Risk somehow gets replaced by “social good”. Guess what, your child is not, nor ever will be, my responsibility. This whole concept is a fictional delusion invented to make people feel guilty for not being vaccine lemmings. It bears no relevance to the rest of the world and how we live. If “social good” were truly a concept we would all be perfect drivers, never breaking the speed limit or any traffic laws because it wouldnt be socially good to speed for risk of killing someone in the group. This is completely bogus. The REAL world scenario is risk vs. risk. It both categories there is benefit which=good and risk which=bad. You don’t compare goods you compare bads. Maybe you need to be an engineer to understand this i can see how it would be over your head, so let me explain.

    Lets say i am building a crane and i have a material that is 99.9% safe, It is well tested and i know the long term, and short term impact and effects of this material. It has been use for 100′s of years and has passed virtually every test. Someone comes along and has another material it too has tested 99.9% safe and is said to have special benefits. We know in the short term it performs wonderfully. It doesnt however have a long standing track record and we arent sure the long term impacts of it. The risk in both cases is someone could be killed if this material fails. which material do I use?

    To further illustrate this point…

    what happens when 3 babies die in a crib that has sold over 2 million units – recalled and taken of the shelves

    what happens when 1 person dies in on of the tunnels in Bostons big dig – street closed

    what happens when a child dies as the result of a vaccine – *shrugs* , and, oh well, thats cost of doing business.

  35. Harriet Hall says:

    backer’s analysis is missing one important concept. When herd immunity decreases and the disease increases, the non-vaccinator himself is at greater risk. It is a future potential personal risk rather than an immediate risk. If backer has purchased any kind of insurance he ought to understand the concept.

  36. Harriet Hall says:

    “Not all rabid animals can contract rabies”?
    Actually, no rabid animals can contract rabies because they have already contracted it.

  37. Watcher says:

    Vaccines are designed to infect cells intracellularly with antigens to make them immunogenic, otherwise, they are ineffective.

    Untrue. Vaccines are meant to mimic a primary infection and are generally made up of antigens only like LPS’s and other markers specific to a type of infection. There is no infection as antigens themselves aren’t infectious. It’s akin to saying my arm is able to throw a ball when it’s not attached to my body.

    It’s because natural immunity does not rely on immunological memory but on a vital cell-mediated immune response—and vaccines never possess such inherent function.

    Data please?

  38. Th1Th2 says:

    Chris,

    “The vaccine version does not cause the same kind of disease (sometimes it will cause a sore arm and a mild fever, but at a degree much less than the actual disease).”

    That is an understatement. The live polio vaccine causes paralytic polio, no argument about that. A virus that harbors the antigen is the same as a syringe that contains the same antigen. Inactivated polio vaccine still would cause polio to the extent that is subclinical, less symptoms than the actual disease—from asymptomatic to non-paralytic form of polio. A little haircut would make them look good, wouldn’t they?

    “For instance outside of variolation the original vaccine for smallpox was not smallpox, but cowpox (a completely different disease).”

    Now the question is, why didn’t Jenner use the actual smallpox virus? Because he would have killed the child if he do so. And besides the word “cow”, other than being holy, is a little more acceptable to the public than alternatives like monkeypox, buffalopox, camelpox, rabbitpox, sealpox and mousepox. If vaccines hitherto have injured, damaged and killed innocent children, how many more were sacrificed during the advent of crude vaccination.

    “There is no genetic RNA or DNA system in the vaccine to replicate in cells (which is what viral infections tend to do).”

    Replication occurs AFTER infection. Viral antigens should infect the cells before any replication would take place, as in the case of live virus. Killed vaccines, on the other hand, are inactivated not to replicate but MUST infect the cells to be processed and presented. The cellular uptake of exogenous antigens is the first sign of infection. The antigen load in every vaccine is a direct reflection of the levels as if virus are replicating.

    “Yes, modified antigens are good in that they make a smarter immune system, without causing disease.”

    They may not cause the symptoms of the disease. The immune system is a lot smarter than antigens, modified or not. You wouldn’t drink poison just to prove that you can vomit, would you?

    “You have been provided evidence (and it is abundant in the medical literature, just do an educated search of PubMed), but you choose to ignore it.”

    Where is the evidence that says that the initiation of intentional antigen exposure (natural or vaccination) is beneficial to healthy and non-diseased newborns? You opinion does not count.

  39. backer says:

    harriet-

    backer’s analysis is missing one important concept. When herd immunity decreases and the disease increases, the non-vaccinator himself is at greater risk. It is a future potential personal risk rather than an immediate risk. If backer has purchased any kind of insurance he ought to understand the concept.

    harriet you missed the ENTIRE point of my analysis. I am saying let’s hold vaccines up to the scrutiny of everything else in the world. They get no pass, they get no special category. If a bridge is even SUSPECTED of failing. It is closed, no questions asked. (take the recent bridge in New York for example) these people are now driving and extra 2 hours a day just to get home, no doubt putting them at greater risk of an accident then actually using the bridge. Did this bridge get a special pass? HELL NO! I would suspect that the bridge will be fine for at least another year. plenty of time for them to build a new one. however it is closed instead. This is what happens in virtually every other case EXCEPT vaccines.

    Do you not realize that your view CONSCIOUSLY kills and disables children?

    Before you say it, not vaccinating does not bear the same consciousness. I do not KNOW that my child will infect another child that will potentially die or be disabled. However vaccine proponent do KNOW. That is why your position is disturbing to me and you should push for 100% safety. For now the only 100% safe vaccine is one that is not used.

    At least my position affords me the ability to say that i am not CONSCIOUSLY killing children.

  40. weing says:

    To Th1Th2 a picture of Morgan Fox in his bed is as effective as the real thing.

  41. weing says:

    I meant Megan Fox.

  42. weing says:

    backer,

    So you’re killing them uncosciously. Is that supposed to be better?

  43. weing says:

    unconsciously

  44. Th1Th2 says:

    watcher,

    “There is no infection as antigens themselves aren’t infectious.”

    If vaccine antigens are incapable of infecting cells then they are all worthless. Antigen recognition and presentation takes place within the cells in order to activate the specific immune response.

    Oh I see, you’re talking about “infectious” like the being snotty, malaise, headache etc in short feeling sick. Vaccines induced diseases in their subclinical form. Asymptomatic infection serves to enhance and prolong the immune response. That’s what vaccines do, it fools the body not to generate symptoms of the disease–but you had the disease.

    Data for what? When did vaccines contain cells? They don’t even have antibodies, for goodness sake let alone they are antigens.

  45. Th1Th2 says:

    backer,

    “At least my position affords me the ability to say that i am not CONSCIOUSLY killing children.”

    Don’t worry, all vaccines are consciously titrated to sub-lethal dose.

  46. Th1Th2 says:

    weing,

    “To Th1Th2 a picture of Morgan Fox in his bed is as effective as the real thing.”

    First of all, Megan Fox is not a threat to me. And besides I couldn’t afford her. So a centerfold of her will bring out the same result, kwim?

    You’re not a misogynist, are you?

  47. Calli Arcale says:

    You crack me up, Th1Th2, you really do. For the edification of other readers:

    * antigen recognition occurs outside of the cell; this is what white blood cells are for. You’d think somebody named after a couple of them would know that.

    * this is a good thing, because not all bad things are viruses

    * some vaccines definitely do contain cells — bacterial cells — though modern technology has allowed many to be replaced by acelluar variants (pertussis, for instance, is not caused by a virus)

  48. Scott says:

    Before you say it, not vaccinating does not bear the same consciousness. I do not KNOW that my child will infect another child that will potentially die or be disabled. However vaccine proponent do KNOW. That is why your position is disturbing to me and you should push for 100% safety. For now the only 100% safe vaccine is one that is not used.

    Thanks for proving that you haven’t the faintest understanding of risk.

    If you don’t vaccinate, there is a risk that your child will die or be disabled. There is similarly a risk that you will cause ANOTHER child to die or be disabled. You are very knowingly, deliberately, and yes, consciously taking on that risk. There is ABSOLUTELY NO DIFFERENCE, aside from the fact that the risk you are subjecting your child, and everyone else’s children, to is very much greater.

    If you like bridge analogies, not vaccinating is akin to closing a road with a patch of ice on it, and detouring traffic over a bridge that’s known to be about to collapse.

    There is not a single thing in the entire world that is 100% safe. No bridge. No road. No medical intervention. No building. No activity. NOTHING AT ALL. That claim is utterly clueless and moronic. It actually manages to surpass your usual level of foolishness, something I hadn’t thought was possible.

    Wonderful proof that one can have an advanced degree in a technical field without any actual understanding of logic or reason.

  49. Calli Arcale says:

    Oh, and “cowpox” wasn’t called that for PR reasons. It’s called that because it primarily infects cows.

    backer:

    Your argument is understandable, but flawed. I realize you don’t give a rip-van-winkle about your next door neighbor’s kids, or even your nieces and nephews. But you should care at least about your own, and all of the recommended vaccines are recommended not merely for herd immunity but for the patient’s own protection. They wouldn’t recommend them if they didn’t stand a chance of reducing the patient’s risk. The schedule is influenced by public health concerns, but the actual vaccination is for your own good, first and foremost. That’s why they don’t routinely vaccinate against yellow fever in the US; there’s virtually no chance you’ll ever catch the disease, so it’s not worthwhile.

    You make an analogy to speeding, saying that because many of us exceed the posted speed, we must all be heartless bastards. But this is not true, and doesn’t invalidate the premise of mass vaccination. Required vaccination isn’t analogous to choosing to obey the speed limit. It’s analogous to the government posting a speed limit in the first place. And the speed limits are there for the common good. Yes, people exceed them, but not grossly. They definitely influence the speed at which people travel, and thereby influence the safety of our roadways. That benefits all of us who use the roads, just as routine vaccination benefits everyone who uses the public school system.

    You make an analogy to product recalls, saying that if a crib kills three kids, 5 million units are recalled, but if a vaccine kills 1, “too bad”. There are two major problems with this analogy. The first is that the crib’s design defect can be expected to affect all children pretty much equally, whereas real vaccine-related deaths are the result of very rare circumstances. The one kid with an undiagnosed egg allergy, for instance. Most kids are not allergic to eggs, or have already had it diagnosed, so the danger of anaphylaxis is not the same for the entire population. The second is your assumption that a product recall is necessarily associated with real risk. It isn’t. More often, it’s about liability than actual protection of customers. A company might recall cribs when the deaths were only because of misuse or not actually related to any design defect, because of the PR damage if they don’t. They might not even make any substantial changes; they might just retire the product line. Vaccine manufacturers tended to have the same attitude, and would withdraw from the market because of the threat of lawsuits. After all, for the most part, they’re not making much money off of these vaccines. It would take only a few lawsuits to eat up their profit margin. The only reason they don’t withdraw from the market is because of the Vaccine Injury Compensation Program, which gives out generous settlements with low standards of evidence, at no cost to the vaccine manufacturers. It doesn’t shield them completely; a plaintiff can still sue directly if they fail to get satisfaction from the VICP. But it eases the risk, and makes them less risk-averse.

    If a bridge is even SUSPECTED of failing. It is closed, no questions asked. (take the recent bridge in New York for example) these people are now driving and extra 2 hours a day just to get home, no doubt putting them at greater risk of an accident then actually using the bridge

    I live in the Twin Cities. We recently had a spot of bother with a bridge that you may have heard about. It was on I-35W, and crossed the Mississippi River gorge just below St Anthony Falls. It had some damage, and was on the schedule for an eventual replacement, but was thought able to last a while longer. It was even receiving upgrades. Then, during rush hour, August 1, 2008, it collapsed.

    Don’t be so casual about the risk of a bridge collapse unless you are an actual bridge engineer and can explain why the New York authorities were foolish to close that suspect bridge.

    Do vaccines get a special pass? Absolutely not. In fact, they are subjected to extensive testing, far beyond what a bridge gets. Lots have been recalled for a variety of reasons. There was recently a shortage of meningococcal vaccine because the sole manufacturer discovered potential (not confirmed) contamination.

    Do you not realize that your view CONSCIOUSLY kills and disables children?

    No, I do not know this. I know that there are those claim it does, but that is not the same thing. People claim all sorts of things about vaccines. Many of them are not true, including the claim that they cause autism.

    That is why your position is disturbing to me and you should push for 100% safety.

    Weren’t you the one earlier who said that in the real world, it is only ever risk versus risk? You seem to understand the real world when it suits your purposes, but not at other times. Nothing is 100% safe. Breathing isn’t 100% safe.

    It’s like you said — compare risk versus risk. Which has more risk — vaccinating, or taking your chances that you might be exposed to the disease? Obviously, it depends on many things, but it’s ridiculous to expect a 100% safe anything.

    You are expressing a view which is very common, though. It is the idea that *blame* is more important than risk. You have said that you’d rather take the risk that some microbe might kill your child than take the risk that a medicine you paid for might kill your child. You say this without regard for what the relative risks are; I think your real concern is blame. This goes right along with your corporate recall analogy, considering that recalls are about liability.

    BTW, since you seem to put some sort of emphasis on qualifications, I am also an engineer. I am not a member of Mensa; I have been consistently put off by the low quality of their publications and the strong correlation I’ve seen between professed Mensa membership and closed-mindedness.

  50. Th1Th2 says:

    Calli Arcale,

    “antigen recognition occurs outside of the cell; this is what white blood cells are for. You’d think somebody named after a couple of them would know that.”

    WBCs play a role in cell-mediated immunity, so how can it be outside? You mean humoral? You sound confused.

    “this is a good thing, because not all bad things are viruses”

    Well, I don’t think asymptomatic poliomyelitis or asymptomatic hepatitis are good either.

    “some vaccines definitely do contain cells — bacterial cells — though modern technology has allowed many to be replaced by acelluar variants (pertussis, for instance, is not caused by a virus)”

    I was referring to “immunological memory” as in T- and B- memory cells, that vaccines do not inherently possess. Please check the previous discussion

  51. backer says:

    weing-

    So you’re killing them uncosciously. Is that supposed to be better?

    are you kidding? is this a joke? did you actually think about this before you typed it?

    are you aware that there are children in africa dying of starvation and lack of clean water? Are you consciously with holding food and clean water from them?

    that is the difference.

    and it is subconsciously not unconsciously. But i get your point.

  52. Th1Th2 says:

    Scott,

    “There is not a single thing in the entire world that is 100% safe. ”

    True that. There is no poison in this world that is 100% safe, a good example of that is a vaccine. Carefully prepared to be less toxic compared with what Jenner used.

    If Jenner’s experimentation is a success and 100% safe, has there been any attempt to replicate it using the same old method? Any volunteers from this board? Calling all vaccine apologists.

  53. backer says:

    Scott-
    you know what i think of you. nothing illustrates it better whenyou open your mouth and nothing substantial comes out, only more ad hominems.

    If you don’t vaccinate, there is a risk that your child will die or be disabled. There is similarly a risk that you will cause ANOTHER child to die or be disabled. You are very knowingly, deliberately, and yes, consciously taking on that risk. There is ABSOLUTELY NO DIFFERENCE, aside from the fact that the risk you are subjecting your child, and everyone else’s children, to is very much greater.

    so i will ask you some simple question to show the err of your ways.

    Are you 100% certain my child will be infect with one of these diseases?

    Are you 100% certain my child will be disabled or die even if they contract these diseases?

    Are you 100% certain if my child is infected they will infect another person?

    If you answered No to any of these questions then you are wrong.

    on the other hand i am 100% certain children will die or be disabled by vaccines.

    So, study hard over your christmas break and you might actually have something to contribute when you get back.

  54. Harriet Hall says:

    Backer,

    Do you buy car insurance or homeowners insurance? Are you 100% certain you will have an accident or a house fire? I am 100% certain that insurance costs money.

  55. Scott says:

    you know what i think of you. nothing illustrates it better whenyou open your mouth and nothing substantial comes out, only more ad hominems.

    Anyone who actually reads will recognize that there’s a great deal of substance there.

    so i will ask you some simple question to show the err of your ways.
    Are you 100% certain my child will be infect with one of these diseases?
    Are you 100% certain my child will be disabled or die even if they contract these diseases?
    Are you 100% certain if my child is infected they will infect another person?
    If you answered No to any of these questions then you are wrong.
    on the other hand i am 100% certain children will die or be disabled by vaccines.

    Complete and absolute FAIL. In case you didn’t notice, the analogous formulation of your questions would be

    Are you 100% certain some unvaccinated children will be infected with one of these diseases?
    Are you 100% certain some unvaccinated children will be disabled or die even if they contract these diseases?
    Are you 100% certain if some unvaccinated children [are] infected they will infect another person?

    The answers to all of which are unequivocally YES. Your completely clueless attempt to equate a general risk with an individual certainty has no meaning whatsoever.

    Again, thanks for proving beyond a shadow of a doubt that you have no clue what you’re talking about.

  56. Scott says:

    Oh, and one followup – if you wonder why my attitude is so hostile to you, just consider that you are, effectively, advocating mass murder. That does tend to tick me off, particularly when it’s backed up by arguments which are so utterly wrong and so completely contrary to the facts that they never even approached the same ballpark as rational.

  57. Th1Th2 says:

    Calli Arcale,

    “(Hint for the obtuse: “rabid” literally means “afflicted with rabies”.)”

    Hint for the chowderheaded:

    —–Studies have shown that not all bites from rabid animals result in infection with the rabies virus.

    http://www.state.nj.us/health/cd/rabies.htm

  58. Chris says:

    backer:

    First of all I am a male. I am an industrial engineer. I have a PhD. I am also a member of mensa.

    Well that solidifies my opinion of industrial engineers. There was a reason the program has never been accredited at my university, especially with the abysmal grasp of statistics that you show. I have never seen anyone use statistics in such a distorted and outlandish manner as you have shown.

    You do not know risk.

    You were asked for the risks between the disease and its vaccine, and you come up with idiotic chances of anyone getting the disease that includes in the data set the entire population (which includes the 90% vaccinated population and those who have already had the disease). Stupid stupid stupid.

    By the way, I am an aerospace/mechanical engineer specializing in random vibration analysis of structures. Statistics are a big part of predicting chances of failure. I would never ever say that a structure has a 100% chance of not failing, but I can give you a idea out to a three standard deviations.

    No one in their right mind with even the slightest bit of statistical analysis would expect 100% safety.

    Calli Arcale:

    I am not a member of Mensa; I have been consistently put off by the low quality of their publications and the strong correlation I’ve seen between professed Mensa membership and closed-mindedness.

    I agree. Perhaps the closed mindedness is because they have their heads shoved up too far into their own posterior.

    Until the trolls actually give me real data on the relative risk of (and staying on topic) of the risks between the HepB vaccine and getting hepatitis type b (and I don’t mean the chance of getting it in the first place!, get that through your pointy little heads)… I shall ignore them.

    That means if you answer me with anything other than actual data (which I will recognize by scanning if I see a journal name, article title, date and author name), I will not read what you write.

    Okay, I shall stop feeding the trolls. Really, I will… starting right now!

  59. Harriet Hall says:

    “Studies have shown that not all bites from rabid animals result in infection with the rabies virus.”

    Hint for Th1Th2: We know that. That’s not what you said.

  60. Scott says:

    Okay, I shall stop feeding the trolls. Really, I will… starting right now!

    I’ve intended to do the same a few times before. Then one of them will post something so incredibly delusional and dangerous that it makes me angry enough to overcome my best intentions. I admit I ought to do better, particularly with not posting while angry!

  61. Th1Th2 says:

    Harriet,

    Guess what? Insurances do not confer immunity from fire and accidents, and so are vaccines.

    Measles outbreak in a fully immunized secondary-school population

    We conclude that outbreaks of measles can occur in secondary schools, even when more than 99 percent of the students have been vaccinated and more than 95 percent are immune.

    http://content.nejm.org/cgi/content/abstract/316/13/771

  62. backer says:

    scott, chris, and harriet-

    i will ask like i have MANY times before. show me the data that correlates with your position. DATA NOT STUDIES. DATA DATA DATA. i have ask many times and you still seem to fail to give it to me.

    and i still have yet to get an answer on this one…”which material do I use?”

  63. Scott says:

    i will ask like i have MANY times before. show me the data that correlates with your position. DATA NOT STUDIES. DATA DATA DATA. i have ask many times and you still seem to fail to give it to me.

    The data is in the studies!

    and i still have yet to get an answer on this one…”which material do I use?”

    Perhaps because it’s utterly irrelevant because your analogy completely fails?

  64. Harriet Hall says:

    backer,

    Do you have car insurance?

  65. Calli Arcale says:

    i will ask like i have MANY times before. show me the data that correlates with your position. DATA NOT STUDIES.

    That’s an odd thing to say. Where does data come from if not from studies? Where do you get *your* data? I presume you look it up in various texts. Where do you suppose the authors got it?

    We conclude that outbreaks of measles can occur in secondary schools, even when more than 99 percent of the students have been vaccinated and more than 95 percent are immune.

    You *do* know, don’t you, that 95 < 100?

    You're funny, Th1Th2. ;-)

  66. Chris says:

    Scott:

    The data is in the studies!

    Yeah, he was pretty much moved under the bridge with the other trolls with that bit. Especially after I dug up census data that had the incidence of diseases back to about 1912. That is data, right?

    He didn’t like it because it showed measles pretty much occurring at about the same average rate per decade up until the 1960s. He keeps wanting to bring up just death rates, which brings in other confounding factors like improvements in hospital care, etc.

    Oh, and then there is the cherry picking. Dear trolls: why do you think the second MMR vaccine was added to the schedule in 1989 for school age children? It is called seeing a pattern with constant monitoring, and correcting. No one in their right mind expects the vaccines to be 100% effective nor to last forever.

  67. Th1Th2 says:

    Calli Arcale,

    “You *do* know, don’t you, that 95 < 100?"

    Analysis of the 1989-1991 outbreaks concluded that more than 80 percent vaccination coverage is required to prevent measles epidemics.

    http://synapse.ucsf.edu/articles/2008/September/18/measles.html#1

    Again, you're saying?

  68. Th1Th2 says:

    Chris,

    “It is called seeing a pattern with constant monitoring, and correcting. No one in their right mind expects the vaccines to be 100% effective nor to last forever.”

    No one says vaccines are safe either, at least for Pluserix and Immravax. So how would you correct those children who suffered MV-induced meningitis?

  69. backer says:

    harriet-

    “Do you have car insurance?”

    only because the law requires it.

  70. backer says:

    chris, scott-

    The data is in the studies!

    no studies have been done on the data i seek. I continuously say this and you people continuously fail to produce it. It is BLINDINGLY OBVIOUS that it doesn’t exist by your inability to produce it.

    Especially after I dug up census data that had the incidence of diseases back to about 1912. That is data, right?

    first of all this is not what i have asked for over and over. second your census data is worth nothing because there is no control. your census data compare vaccines effectiveness to nothing. Since i am so ignorant when it comes to science maybe you can show me what part of a controlled study implores comparing something to nothing?

    I would love to here your analysis of how SARS disappeared without a vaccine?

  71. backer says:

    harriet-

    Measles outbreak in a fully immunized secondary-school population
    We conclude that outbreaks of measles can occur in secondary schools, even when more than 99 percent of the students have been vaccinated and more than 95 percent are immune.

    even though we might have gotten off to a bad start, i must say i respect your level-headedness. You seem to have a better grasp on reality then the ad hominem twins.

    I am curious as to why you posted this article? It seems to lend credibility to my position.

  72. Calli Arcale says:

    backer,

    The reason why vaccination rates above 80% do not always prevent measles outbreaks is because failure to vaccinate tends to be clustered — that is, failure to vaccinate isn’t random, but the recommendations assume that it will be. Assuming the people who don’t get vaccinated (for whatever reason) are randomly distributed, 95% coverage should pretty much guarantee measles can’t spread past one, maybe two kids.

    But unfortunately, this doesn’t match reality. People who don’t vaccinate for medical reasons tend to be pretty randomly distributed, but people who don’t vaccinated for religious or other personal reasons tend to already know one another, or at least move in the same circles, which will increase their exposure to one another, thereby increasing the chances that a large proportion of the 5% non-immune population will contract the disease. (5% is an epidemic.) I’m not sure there’s a good solution to this, besides educating people.

  73. backer says:

    Calli Arcale-

    The schedule is influenced by public health concerns, but the actual vaccination is for your own good, first and foremost.

    I have expressed my position many times, in many other posts but i have never expressed it to you. I disagree with you on this, although this may be the intent, i think it has been abused.

    That benefits all of us who use the roads, just as routine vaccination benefits everyone who uses the public school system.

    apparently this isnt true in light of the study that harriet posted

    there’s virtually no chance you’ll ever catch the disease, so it’s not worthwhile.

    I agree and like i have said in other posts on other topics. Most of the vaccines in the current schedule fall into this category.

    product recall is necessarily associated with real risk. It isn’t. More often, it’s about liability than actual protection of customer

    agreed, however it wasnt my intention to make them analogues, I was merely trying to illustrate the value we put on life in other circumstances. I do not however see this in relation to vaccines.

    Don’t be so casual about the risk of a bridge collapse unless you are an actual bridge engineer and can explain why the New York authorities were foolish to close that suspect bridge.

    again…I was merely trying to illustrate the value we put on life in other circumstances. i wasnt saying the closure was trivial, it is most likely very necessary.

    No, I do not know this. I know that there are those claim it does, but that is not the same thing.

    read the package inserts if the possible side effect include death…then you do know this.

    Weren’t you the one earlier who said that in the real world, it is only ever risk versus risk? You seem to understand the real world when it suits your purposes, but not at other times. Nothing is 100% safe. Breathing isn’t 100% safe.

    It’s like you said — compare risk versus risk. Which has more risk — vaccinating, or taking your chances that you might be exposed to the disease? Obviously, it depends on many things, but it’s ridiculous to expect a 100% safe anything.

    read CAREFULLY what i said again and see if i ever said i expect 100% safety. I choose my words very carefully so i cannot be painted into a corner. I don’t expect 100% safety, this is, as you said, impossible.

    You are expressing a view which is very common, though. It is the idea that *blame* is more important than risk

    I would love for you to point out where i placed blame. I have expressed before that i see value in vaccines, they are important under the proper circumstances.

  74. backer says:

    chris-

    By the way, I am an aerospace/mechanical engineer specializing in random vibration analysis of structures. Statistics are a big part of predicting chances of failure. I would never ever say that a structure has a 100% chance of not failing, but I can give you a idea out to a three standard deviations.

    although i have no reason to doubt you i find this hard to believe considering that you, more than anyone, should understand why i value data over studies.

    And again i never asked for 100% safety for some reason i get mischaracterized when others can’t read carefully.

  75. backer says:

    The reason why vaccination rates above 80% do not always prevent measles outbreaks is because failure to vaccinate tends to be clustered — that is, failure to vaccinate isn’t random, but the recommendations assume that it will be. Assuming the people who don’t get vaccinated (for whatever reason) are randomly distributed, 95% coverage should pretty much guarantee measles can’t spread past one, maybe two kids.
    But unfortunately, this doesn’t match reality. People who don’t vaccinate for medical reasons tend to be pretty randomly distributed, but people who don’t vaccinated for religious or other personal reasons tend to already know one another, or at least move in the same circles, which will increase their exposure to one another, thereby increasing the chances that a large proportion of the 5% non-immune population will contract the disease. (5% is an epidemic.) I’m not sure there’s a good solution to this, besides educating people.

    I wasnt asking for a synopsis on the study. i was asking for personal motivations.

  76. Chris says:

    It is obvious the trolls have trouble reading.

    I repeat: I will not read what you have written on this post (which is about hepatitis B and its vaccine) unless during a scan I see a journal, title, date and authors that shows the relative risk between HepB and its vaccine.

    That means that you post the information (not a link!) to a real study that exists in the medical literature. Do not lecture me on some perceived deficit, nor try to ask questions. Until you provide the proper research on the subject of this blog posting, hepatitis b, you do not deserve my time.

  77. backer says:

    chris-

    that is fine with me. I don’t bear the burden of proof because i have said many times i am not against vaccines.

    but i did just noticed this which i must respond to, because i wouldnt want you to be the engineer on any project i was a part of if this were your level of attention to detail.

    You were asked for the risks between the disease and its vaccine, and you come up with idiotic chances of anyone getting the disease that includes in the data set the entire population (which includes the 90% vaccinated population and those who have already had the disease). Stupid stupid stupid

    again go back and read and notice i chose the diseases AT THIER PEAK. Which did not include a 90% vax rate

  78. Calli Arcale says:

    backer, I don’t have much time, so I will only address parts of your post.

    there’s virtually no chance you’ll ever catch the disease, so it’s not worthwhile.

    I agree and like i have said in other posts on other topics. Most of the vaccines in the current schedule fall into this category.

    That’s actually not true. Currently, you have very little risk of contracting, for instance, measles. But this is only because everybody is vaccinating against it. If MMR is taken off the schedule, rates of the disease will climb rapidly, and as the population is largely naive to the disease, it will spread more rapidly than in a population never vaccinated against measles. This isn’t a hypothetical situation, either. Japan took MMR off the schedule for a year or so, and disease rates immediately climbed. The same has been seen in clusters of unvaccinated children in California and Switzerland. The problem is that the diseases on the schedule are all highly contagious, and found in populations with which we have a lot of international commerce, so it wouldn’t take much to get them endemic again.

    product recall is necessarily associated with real risk. It isn’t. More often, it’s about liability than actual protection of customer

    agreed, however it wasnt my intention to make them analogues, I was merely trying to illustrate the value we put on life in other circumstances. I do not however see this in relation to vaccines.

    You missed my point. It’s not that less value is placed on life in relation to vaccines. (Quite the contrary; if less value was placed on life, why would the government care if we vaccinated?) It’s that a general design defect causing infants to be strangled in a crib is not comparable to the risk of, say, GBS due to vaccines. More on that in a moment.

    Vaccines have been recalled on many occasions when they were found to have problems. The ones that are left are very safe, and getting constantly safer as the manufacturers work to improve them. Some of the major innovations include the use of adjuvants (which let them use less antigen) and recombinant DNA (which allow them to literally design an antigen rather than just seeing what they can breed naturally).

    You later alluded to the listed side effect of death. I don’t know how closely you read drug package inserts, but this side effect is listed on practically everything. The most common way to die due to a drug (vaccine or otherwise) is by anaphylaxis. It is important to understand what this means so that you can understand how this risk applies to you. If someone dies of anaphylaxis (severe allergic reaction) after a flu shot becuase they have an egg allergy, this does not suggest my risk is any greater if I get a flu shot. This is because I am not allergic to eggs.

    Vaccines in particular are known to be associated with a very rare syndrome called Guillaine-Barre Syndrome. There were 25 GBS deaths reported after the 1976 swine flu vaccine. Does this mean that you risk dying of GBS if you get the 2009 H1N1 vaccine? Not exactly. In fact, it doesn’t even mean that you would have this risk if you received the 1976 swine flu vaccine. This is because GBS actually occurs in the general population, whether they’ve been vaccinated or not, and this makes it difficult to tell what actually caused a particular case. The best that can be done is to look at the data — is the rate of GBS higher in people who’ve recently been vaccinated than it is in the general population? The data says that it isn’t. If vaccines do cause GBS, it must be extremely rare, essentially a freak accident.

    It is, however, plausible that they could cause GBS, which is why it continues to be listed as a side effect despite the lack of definitive evidence that they really do. GBS is an autoimmune disorder occurring in response to the presence of foreign antigens. Obviously, that condition is present in vaccines. But it is also present every day of your life, as you are exposed to thousands or even millions of antigens daily, most of them harmless but some of them pathogenic.

    You don’t have to be vaccinated to die of GBS. Any infection could trigger it, including subclinical infections. Theoretically, even a non-pathogenic antigen could cause it, so you could theoretically get it just from scratching your skin on a post, even if you don’t pick up any pathogens. Is this a significant risk of a vaccine? That’s up to you and your doctor to decide, but the actual data points towards “no”. After all, you could just as easily get GBS the next time you get a cold.

    read CAREFULLY what i said again and see if i ever said i expect 100% safety. I choose my words very carefully so i cannot be painted into a corner. I don’t expect 100% safety, this is, as you said, impossible.

    Yes, I did notice your tendency to try to twist out from what you’ve said previously. Clearly, you are more interested in “winning” (whatever that means in a conversation) than in actually being understood. But I’ll explain how I got that impression. From your own post earlier in this thread:

    That is why your position is disturbing to me and you should push for 100% safety. For now the only 100% safe vaccine is one that is not used.

    You were the one who brought up 100% safety. If you did not meant to imply that you expect vaccines to be 100% safe or not be used, it would be helpful if you explained just what it was you did mean.

    I would love for you to point out where i placed blame. I have expressed before that i see value in vaccines, they are important under the proper circumstances.

    I got that impression from the larger context of that same quote:

    Do you not realize that your view CONSCIOUSLY kills and disables children?

    Before you say it, not vaccinating does not bear the same consciousness. I do not KNOW that my child will infect another child that will potentially die or be disabled. However vaccine proponent do KNOW. That is why your position is disturbing to me and you should push for 100% safety. For now the only 100% safe vaccine is one that is not used.

    At least my position affords me the ability to say that i am not CONSCIOUSLY killing children.

    You do not generally wish to vaccinate because you do not wish to do something with a known risk; you’d prefer they take their chances in nature. This is not an uncommon view, and it is very human, and very understandable. Unfortunately, it is so emotionally charged that it tends to blind us to the actual risks. That’s where science comes in, of course. It helps us cut through that gut feeling, of not wanting to do something which might cause harm, preferring instead to let nature take its course, even when the actual data shows that nature is cruel.

    And that’s the thing; you are not looking at the actual data. Yes, it does take work to get it. But you are a smart man. You can read a study and form an opinion on the quality of the research. You have (intentionally or otherwise) equated vaccines to “consciously killing children”. Yet the data does not bear this out. Vaccines are safer than vitamin tablets. (Seriously, they actually are.)

    It does seem as if I’ve misunderstood you — either that, or you are shifting your position to avoid being caught at something. You don’t need to; this isn’t some sort of competition. If we are misunderstanding your position so dramatically, you may want to rethink your strategy of expressing yourself carefully to avoid being painted into a corner. You’d do much better if you went for clarity rather than tactical advantage.

    Heh — I ended up taking far more time than I intended in writing this post. I had better get back to work. ;-)

  79. Watcher says:

    If vaccine antigens are incapable of infecting cells then they are all worthless. Antigen recognition and presentation takes place within the cells in order to activate the specific immune response.

    No, antigen recognition takes place on the outside of cells through toll-like receptors on the surface of T cells. Presentation also takes place here. Now, there’s something to be said about endocytosis and break down of the infectious agent inbetween those two steps, but that is NOT infection.

    Oh I see, you’re talking about “infectious” like the being snotty, malaise, headache etc in short feeling sick.

    No, I wasn’t. Sorry.

    Vaccines induced diseases in their subclinical form.

    Describe what you mean by “subclinical form” and we might be able to talk about this further.

    Asymptomatic infection serves to enhance and prolong the immune response. That’s what vaccines do, it fools the body not to generate symptoms of the disease–but you had the disease.

    How exactly? Can you explain the cellular mechanism by which this takes place? I can explain mechanism by which vaccines confer long-term immunity, not symptom relief.

  80. Th1Th2 says:

    watcher,

    “No, antigen recognition takes place on the outside of cells through toll-like receptors on the surface of T cells. Presentation also takes place here.”

    You are talking about antigen recognition by an effector immune cell which is dependent on the antigen-presenting cells (APC). Yes, that occurs AFTER the foreign antigen

  81. Th1Th2 says:

    watcher,

    “No, antigen recognition takes place on the outside of cells through toll-like receptors on the surface of T cells. Presentation also takes place here.”

    You are talking about antigen recognition by an effector immune cell (T-cell) but that only occurs AFTER the foreign antigen is taken up, processed intracellularly and displayed on the surface by an antigen-presenting cell (macrophages for example).

  82. Th1Th2 says:

    watcher,

    “Now, there’s something to be said about endocytosis and break down of the infectious agent inbetween those two steps, but that is NOT infection.”

    You see, natural infection and vaccination are virtually the same in a manner that their antigens need to infect the cells, processed within, and be recognized to activate the necessary immune response.

    If you label something “infectious” because of external symptomatic manifestations, then you are misguided.

  83. Th1Th2 says:

    watcher,

    “Describe what you mean by “subclinical form” and we might be able to talk about this further.”

    Just compare the symptomatology of a disease against the adverse reactions from the equivalent vaccine and you will get the “subclinical form”.

  84. Watcher says:

    Exactly, I never said otherwise. You stated:

    Antigen recognition and presentation takes place within the cells in order to activate the specific immune response.

    Which both Calli and I stated as wrong from both of our lines of evidence.

    I’m still looking forward to your explanation of:

    Vaccines induced diseases in their subclinical form.

  85. backer says:

    calli arcale-

    does seem as if I’ve misunderstood you — either that, or you are shifting your position to avoid being caught at something.

    i appreciate you taking the time (or lack there of) to write a detailed post however i think it boils down to your quote above.

    I completely agree that MMR is effective. I have never stated otherwise. However mumps and rubella are self limiting, so i see no reason for them to be included.

    I also think DTaP is beneficial. take a look at the 1980′s vax schedule and that is about the extent of what i think we should be exposing our children to. Nothing more, i just see no need.

    My main concern isnt immediate adverse reactions. My main concern is that we have NO IDEA how these vaccines effect us in the long term. I simply hasnt been studied. I just can’t justify preventing my child from getting varicella, and later finding out her diabetes was link to the vaccine. Until more extensive long term studies are done it don’t think “safe” can be used as a vaccine label.

  86. Th1Th2 says:

    watcher,

    You should know the chronology of events on antigen recognition and presentation and know the casts involved. Macrophages recognize foreign antigens and digest them. Is this event take place inside the macrophage or outside? Then the antigen is processed and displayed on its surface. This is the time T cells (Th, CTLs etc.) interact with the antigen OUTSIDE the antigen presenting cell, in this case, the macrophage. T cells, once activated, serve as the receivers and one of the effector immune cells.

    Antigens are processed intracellularly before they can be presented on the cell surface. That’s very basic, I suppose.

  87. Th1Th2 says:

    watcher,

    Addendum

    Macrophages

    Macrophages are the body’s first line of defense and have many roles. A macrophage is the first cell to recognize and engulf foreign substances (antigens). Macrophages break down these substances and present the smaller proteins to the T lymphocytes. (T cells are programmed to recognize, respond to and remember antigens). Macrophages also produce substances called cytokines that help to regulate the activity of lymphocytes.

    http://www.chemocare.com/whatis/the_immune_system.asp

  88. Th1Th2 says:

    backer,

    “I completely agree that MMR is effective. I have never stated otherwise. ”

    I believe you are suffering from transient dementia. Yesterday you quoted the article regarding “Measles outbreak in a fully immunized secondary-school population” and yet you are claiming that MMR is effective. What gives? Vaccines cannot be trusted and so are are people with ambivalent “feelings” about vaccines like you. It’s dangerous.

  89. Watcher says:

    I realize the order of non-self encounter to a primary or secondary immune response. And again, that has no bearing on making your argument any more true or fact-based than before :)

    Processing is different than “presentation and recognition within a cell.” That was my only point. If you have some type of evidence to back this hypothesis up, some type of intracellular antigen recognition machinery, then now would be the time to present it. Because as it stands right now, you’re acting a troll and dodging the issue.

    You know, you’d go a long way towards a reasonable argument if you would just answer:

    Vaccines induced diseases in their subclinical form.

  90. Th1Th2 says:

    watcher,

    “Processing is different than “presentation and recognition within a cell.” ”

    Just admit it, you sound so confused. You’re intentionally quoting me for something I didn’t say. FYI, my original premise was “Antigen recognition and presentation takes place within the cells in order to activate the specific immune response” and not the other way around. You keep on pushing your T cells in the discussion ahead of the NORMAL pathway of antigen recognition. Fatal mistake. It’s a shame you don’t know this basic concept.

    “You know, you’d go a long way towards a reasonable argument if you would just answer:”

    Vaccine induced diseases at least in its subclinical form. For example, OPV causes VAPP, the mumps vaccine causes parotitis, LAIV vaccine causes influenza and so on.

  91. Calli Arcale says:

    backer,

    i appreciate you taking the time (or lack there of) to write a detailed post however i think it boils down to your quote above.

    No problem. ;-) I do think these sorts of conversations are much more productive (and more fun!) when we try to work together to understand what one another is saying.

    I completely agree that MMR is effective. I have never stated otherwise. However mumps and rubella are self limiting, so i see no reason for them to be included.

    I also think DTaP is beneficial. take a look at the 1980’s vax schedule and that is about the extent of what i think we should be exposing our children to. Nothing more, i just see no need.

    They’re *all* self-limiting, at least when they don’t kill you. (And yes, all three can kill you, though measles is much more likely to do so.)

    To understand why mumps and rubella are a target for vaccination, you need to understand what they do. Death isn’t the only side-effect worth avoiding. Mumps can cause sterility (and even when it doesn’t, male survivors have said that the orchitis was terrible). Rubella is particularly nasty to unborn fetuses, killing or blinding them, so preventing its transmission is a big deal for public health.

    DtaP is actually a more modern, safer variant of an older vaccine. It’s hard to find a standalone tetanus vaccine anymore; they’re usually grouped with an acellular pertussis vaccine. Pertussis is rough on grownups, but deadly to small children. Tetanus, of course, is a disease where a clinical infection will *not* produce immunity, and where it is not possible to eradicate the pathogen; it’s a ubiquitous part of the environment, and only accidentally dangerous to us.

    There are a whole bunch of new vaccines. I’m not sure why you want to avoid them. I don’t see any reason to assume people in 1980 were any smarter than people in 2009, or more capable of producing a flawless vaccine schedule. Science marches on, and now we have vaccines for things that we didn’t then. Not all are mandatory. In fact, most aren’t; they’re just recommended.

    Chickenpox: about as deadly as measles, actually, and has the added nastiness that it can lie dormant in your body for decades, only to flare up later as the shingles. Shingles is excruciating, can be crippling (I have a relative who had half her face paralyzed by shingles), and can even be deadly.

    HiB: one of the most awesome of the new ones. Haemophilus influenzae B (no relation to the flu virus; this is a bacterium with an unfortunate name) was one of the leading causes of bacterial meningitis before the vaccine was introduced.

    Meningococcal: this was the other leading cause of bacterial meningitis. I had meningitis as a child. It nearly killed me. Now, these diseases are so rare that many ER pediatricians will never see a case.

    Pneumococcal: this one won’t prevent all cases of pneumonia, but it will prevent a few of the deadlier ones, which have a habit of setting up shop after an influenza infection.

    My main concern isnt immediate adverse reactions. My main concern is that we have NO IDEA how these vaccines effect us in the long term. I simply hasnt been studied. I just can’t justify preventing my child from getting varicella, and later finding out her diabetes was link to the vaccine. Until more extensive long term studies are done it don’t think “safe” can be used as a vaccine label.

    Diabetes? There’s no plausible reason to think a varicella vaccine would cause diabetes. But varicella can and does kill kids, and it’s worse if you get it as an adult. Do you really want to let your daughter take her chances with chickenpox? I’ve had chickenpox. It wasn’t too bad for me. But my brothers were sicker, my mom still has scars from her childhood bout, and a good friend of mine wound up with pox in her eyelids, down her throat, and in unmentionable places as well. Plus, there’s my relative with Beall’s Palsy as a result of shingles. I had both of my kids vaccinated against it.

    As far as long-term safety, did you know that the varicella vaccine was invented in 1974? It’s certainly been around long enough for long-term risks to show up, though it wasn’t approved in the US until the late 80s, IIRC. (Shortly after I got chickenpox, ironically enough.)

    I think there is more data of the sort you want than you realize. Even in the absence of such data, we know enough to make certain conclusions. The ingredients of these vaccines are not generally novel, apart from the antigen. Sometimes a novel adjuvant or preservative is introduced, but here in the US, the system is very conservative about such things. Europe’s been using squalene in vaccines for years; the FDA isn’t ready to approve it for that use yet. Upshot: by the time they *do* approve it, we’ll have plenty of long-term evidence of safety.

  92. Calli Arcale says:

    Man, I talk too much. I need to go get my kids now!

  93. Th1Th2 says:

    watcher,

    “If you have some type of evidence to back this hypothesis up, some type of intracellular antigen recognition machinery, then now would be the time to present it. Because as it stands right now, you’re acting a troll and dodging the issue.”

    Hint for the confused: Study how NK cells are able to recognize and destroy infected cells with INTRACELLULAR antigens like tumor antigens even without presenting the antigen on the cell surface.

    Good luck with that.

  94. Watcher says:

    Just admit it, you sound so confused.

    Nah, not even close :) Although keep poisoning the well bud! It seems to be a fav of yours …

    You’re intentionally quoting me for something I didn’t say. FYI, my original premise was “Antigen recognition and presentation takes place within the cells in order to activate the specific immune response” and not the other way around.

    You said that. Emphasis mine since you got your panties in a bunch about “misquoting” you.

    I said presentation and recognition within a cell. How is it different?

    I gave an example (toll-like receptors) of how presentation and recognition occur extracellularly and do not recognize antigens inside themselves or inside any other cell for that matter. I’m not “pushing T cells in the discussion ahead of the NORMAL pathway of antigen recognition,” because as Ive said already, it was an example that proved your thought (that recognition and presentation takes place inside cells) completely and utterly wrong. Macrophages (or dendritic cells) perform in a similar way. They recognize not self through surface proteins, engulf it, break it down and then put it on the surface of themselves for presentation to T-cells. Depending on whether or not this is a primary or secondary (ie type) immune response depends on the presence or absence of memory B-cells, ie it’s the pathway of cells (macro to T to B naive or B memory), not anything to do with intracellular recognition and presentation.

    Vaccine induced diseases at least in its subclinical form. For example, OPV causes VAPP, the mumps vaccine causes parotitis, LAIV vaccine causes influenza and so on.

    OPV hasn’t been used since it was replaced with an antigen-only substitute IPV in the 90′s. Could someone get polio from it? Yes, a very small chance, but it was never denied that it could. And you know what? As a result, polio no longer exists in the western hemisphere. Vaccines work! It’s the same for LAIV, when given a live, if attenutated, virus there is a small chance that you could come down with a case of it if especially if you’re immune compromised like pregnant women and young children (which is why it’s recommended that they not get it!). But chances are, you wont, and you’ll gain immunity to that inception of the virus. Live vaccines work better and produce a more full immune response, but antigen-only vaccines have their place too because they can’t cause infection making them safer in that aspect, but less people gain immunity from one dose.

    Study how NK cells are able to recognize and destroy infected cells with INTRACELLULAR antigens like tumor antigens even without presenting the antigen on the cell surface.

    Because there are markers on the surface of the tumor cells that signal the processes going on inside the cell. Can you point to me to some of these studies that show NK cells responding to intracellular-only antigens in cancerous cells?

  95. Zoe237 says:

    Cali Arcale (or anybody, but she seems willing to answer questions without belitting people), a couple of questions.

    If hep b is only “good” for 20 years, wouldn’t that mean kids vaccinated at birth would be unprotected at age 20? What’s the deal with that? Do we need boosters?

    Chickenpox: Why does it seem that the rate of shingles has gone up since the mandating of the chickenpox shot? Does the shot protect you from shingles later on? How long is this one good for? And what are the mortality/morbidity stats for this one pre vaccine?

    I admit (whilst ducking lol) that these two strain my credulity and strong belief in vaccination. It’s not that I think they are dangerous, but I’m not sure I see the need before the age of 11-12, at least from an individual, low risk, cost analysis standpoint. Public health, sure. My children were vaccinated on schedule, in spite of my own doubts of the early need for these two.

    Final question. I have searched for this answer high and low and haven’t really gotten a clear response. Is there any reason to think that breastfeeding can interfere with antibody response in an infant or toddler in any vaccines?

  96. Th1Th2 says:

    watcher,

    “I said presentation and recognition within a cell. How is it different?”

    OK you are not confused, just hallucinating. The difference is your next response:

    “Macrophages (or dendritic cells) perform in a similar way. They recognize not self through surface proteins, engulf it, break it down and then put it on the surface of themselves for presentation to T-cells.”

    Did you notice the order of events? Recognition before presentation. Of course macrophages are the first to recognize exogenous antigens.

    “I gave an example (toll-like receptors) of how presentation and recognition occur extracellularly and do not recognize antigens inside themselves or inside any other cell for that matter.”

    Here is my answer:

    Antigen processing and presentation are processes that occur WITHIN a cell that result in fragmentation (proteolysis) of proteins, association of the fragments with MHC molecules, and expression of the peptide-MHC molecules at the cell surface where they can be recognized by the T cell receptor on a T cell.

    http://pathmicro.med.sc.edu/bowers/ant-pres.htm

    Do not argue anymore. It’s useless.

    “And you know what? As a result, polio no longer exists in the western hemisphere.”

    Polio never vanished, it continued to exist. Because of vaccine modification from OPV to IPV, the disease became subclinical (asymptomatic poliomyelitis).

    “Live vaccines work better and produce a more full immune response, but antigen-only vaccines have their place too because they can’t cause infection making them safer in that aspect, but less people gain immunity from one dose.”

    Vaccine antigens, whether live or killed, MUST infect the cells to enable an immune response.

  97. Zoe237 says:

    Also, it looks like the United Kingdom, France, Japan, eight provinces in Canada also don’t recommend universal infant vaccination for hepatitis B. Is there a reason that it must be given at birth versus two months to negative HBV mothers? How will the inclusion of hep b in the combo vaccinations affect the birth dose?

  98. Chris says:

    Zoe237, Calli has the patience and fortitude that amazes me. Her comments are always worthwhile. What I can do is point out the answers to your questions from what Dr. Albietz wrote above:

    Adults are relatively efficient in their ability to clear the virus after the initial infection, and only ~10% become chronicly infected carriers.

    Children, on the other hand, present a very different pattern of disease. Though ~90% of infected children are initially asymptomatic, they are rarely able to clear the virus. 90% of infants and 25-50% of those 1-5 years old will become lifelong carriers.

    and

    Around 5% of the US population has been infected with Hepatitis B, and 0.3 are chronic carriers.

    Compare that with that of Europe:

    The reason these countries have not adopted universal vaccination against HBV is the exceptionally low level of HBV in their population and the associated costs of prevention. Sweden, for instance, has one of the lowest prevalences of HBV in the world at 0.05%. This is 6 times lower than what we have in the US,

    In short, the US has more chronic carriers of HepB. Previous strategies did not work, but after the infant vaccination started …

    we have seen a steady decrease in Hepatitis B infections. Hep B incidence in the US fell from 10.7/100,000 in 1983 to 2.1 per 100,000 in 2004. (25,916 total cases down to 6212 cases). …snip…There has been a 95% drop in HBV in people under 15 years of age, 87% in ages 15-24, 71% from 25-44, and 51% decrease in people over 45 years old. This is precisely what you would expect from a pediatric vaccination campaign.

    I don’t know, but I would bet real money that the Canadian provinces that have pediatric vaccination for HepB would be the ones with the largest immigration population from countries where Hepatitis B is endemic.

    About chicken pox and shingles: The studies on shingles have been inconsistent. One common answer is the number of people who are now reaching the age to experience it (Baby Boomers, I think a study in Alberta noted that shingles was going up before the varicella vaccine was introduced), and another is that people who have had chicken pox need occasional exposure to keep the immune system primed (which is what the shingles vaccine does).

  99. Zoe237 says:

    Chris, thank you for answering my questions.

    ” I don’t know, but I would bet real money that the Canadian provinces that have pediatric vaccination for HepB would be the ones with the largest immigration population from countries where Hepatitis B is endemic.”

    Yes, that makes sense to me. Dr. Albeitz’s explanation was great from a public health perspective. What I still don’t understand is why *my* (or any low risk) kids can’t wait until age 11 or 12 to have the vaccine, given that I’m negative, my husband is negative, and we don’t live with anybody else. Our risk factors are pretty much non-existent. So it’s the individual benefit to children in low risk households that I don’t get. I have read that something like 30% of people don’t know how they got HBV, but I’m assuming those people at least had some risk factors (perhaps living with multiple people).

    It’s a non issue since they are already vaccinated, but it is something I wonder about. I also talk to a lot of other moms who don’t get the rationale for a vaccine in childhood against a disease for which they have no individual risk factors (or, in their words, a sexually transmitted disease). Every time I hear the “too many too soon” mantra, it’s relating to chickenpox and hep b, and I’d like to know how to respond. It seems like this is a blanket recommendation based on a limited high risk population of children, along with the fact that it’s easier to get them to the doctor in infancy. And I have read tons of information and rationale from the CDC and the AAP and still am skeptical (but willing to be convinced.)

    Connecting the dots from public health to individual risk is something that us laypeople struggle with. I can certainly understand it with something like measles (in which my kids have close to zero risk, but only because of herd immunity), but this isn’t a disease transmitted by casual contact.

    Regarding shingles, the theory I had read was that occasional exposure one you mentioned, but I thought that had been somewhat disproven.

  100. Chris says:

    I just wrote an answer, and I hit the enter key and it went away… aargh!

    Any way, long story short… it is a game of large numbers. Sure, you and your husband may not have HepB because you have never ever had any other sexual partners. But if you read one paragraph above (emphasis added):

    Hepatitis B (HBV) is a double stranded DNA virus found in the bodily fluids of infected people including their blood, semen, and saliva, and can be transmitted through sexual contact, exposure of infected fluid to mucous membranes, or through injection.

    …. You will see that there is a possibility of a kid getting HepB by touching a toy that had been in the mouth of a child with HepB and by touching their nose. It is a small possibility, but when you deal with large numbers that chance gets bigger. And the chance gets bigger if you live where there are more chronic carriers.

    And many of those carriers do not know they are infected. Vaccinating all infants makes sure that you get the children of those who are infected but do not know it.

    I went to my county’s website and checked their newsletter which lists the running count of reportable diseases (http://kingcounty.gov/healthservices/health/communicable/epilog/%7e/media/health/publichealth/documents/epilog/vol4908.ashx … check to see if your county has something similar). I took the bit on HepB, and tried to edit it so it would show up here (which is where I hit the wrong key!)… so for my second attempt:
    ________Cases in October Cases through October
    _____________2009_2008____2009_2008
    Hepatitis B (acute) 0 ____0 _____10 __28
    Hepatitis B (chronic) 58 _80____ 546_ 754

    You will see that in a county of almost 2 million, having between 600 to almost 800 new cases of chronic HepB per year is not a small number. As Dr. Albietz wrote:

    These numbers are significant. To put this in perspective, the mortality from HBV in the US was 5 times higher than Haemophilus influenza type B and 10 times greater than measles before vaccination was introduced.

    …and another paragraph he wrote:

    More than 1/3 of the world’s population has been infected with Hepatitis B and 5% are chronic carriers. That totals up to around 350,000,000 people chronically infected, and around 620,000 deaths from HBV yearly.

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