Six Reason to Question Vaccinations

[kellyb]

2) Will people who have already had chickenpox be more likely to get shingles if mass vaccination takes place?

This myth has been discarded.
Quote:
How often does zoster (shingles) occur following varicella vaccination?

Varicella vaccine is a live virus vaccine, and may result in a latent infection, similar to that caused by wild varicella virus. Consequently, zoster in vaccinated persons has been reported. Not all of these cases have been confirmed as having been caused by vaccine virus. The risk of zoster following vaccination appears to be less than that following infection with wild-type virus. However, longer follow-up is needed to assess this risk over time.

Err..you know your link is completely irrelevant to his question, right?
Ivor was asking about an increase in shingles in the rest of the population who've been exposed to wild varicella.
That's not a "myth" that periodic re-exposure helps keep shingles at bay. It's not necessarily an absolute fact, but it's highly likely.

 

[Skeptic Ginger]

1)In the US, the CDC has said we'll basically just keep adding as many additional doses as is needed. (We're at two doses now, there's been talk of a third...yes, it wanes fairly quickly in the absence of wild circulation. )...

What makes you think the wild disease has been eliminated?

From a slide presentation on varicella case reporting in Idaho, 2006

Varicella is still common in Idaho
– Incidence rate range
􀂄 3.95 cases per 1,000 children to 12.05 cases per 1,000
children in public school school-aged children
– Possibly 1.3x to 4x higher than a similar study done in
Oregon among children in K – 5th th grade
– 488 to 1482 cases of varicella may have occurred
among all children in public K K-5th th grade
􀂄 Estimated number of cases does not include ~10,000
children of the same age attending a private school or
home school
􀂄 Also does not include adolescents and adults

 

[Skeptic Ginger]

Just love the comment by "Rab C Nesbitt" - came over all homesick like....

I am uncertain as to the benefits of universal vaccination. There are many things to consider including the need for boosters, the likelihood of up to 10-15% non-response and these people being susceptible as adults to more severe presentations of chicken pox.

Also, I understood that you could not give other live vaccines like varicella at the same time as MMR, since the response is blunted. So why are they calling for a "4 in 1"?

One thing no-one seems to have mentioned is the option of treating chicken pox in childhood with appropriate antivirals (e.g. aciclovir) to render the illness less severe - there is no reason why one should not do this, and it would avert the cases of severe chickenpox/complications, whcih as Ivor points out are rare anyway.


ETA: Here is the varicella / MMR stuff

MMRV has been approved as an effective 4 in one vaccine.

Acyclovir and similar antivirals are effective in varicella but only when begun at the onset of infection. That takes intensive public and medical provider education to get people to understand the need to treat at the onset of disease.

 

[kellyb]

What makes you think the wild disease has been eliminated?

From a slide presentation on varicella case reporting in Idaho, 2006

I never said it had been completely eliminated. In fact, I don't think varicella can be eliminated.
Circulation can slow down, though. Incidence can be reduced.

 

[Skeptic Ginger]

Yes. Oddly enough, the people who's jobs are to know about these things have actually thought about them.

From your link,

Nigel Scott, from the Herpes Viruses Association, said: "If we had to choose between the two, we would advocate vaccinating the elderly, as shingles is far more likely to cause serious health problems in many more people than is chickenpox in the young.

"Any benefits to children from a chickenpox vaccine would have to be offset against any potential increase in adult chickenpox and shingles in the elderly.

I don't know what this guy is talking about. First, disseminated zoster is the main risk of serious zoster disease and it happens only to the severely immunocompromised. That means all the 'booster' effect from exposure to community varicella is moot anyway.

The second problem from shingles is post herpetic neuralgia. While painful, it doesn't kill anyone. And an adult with shingles can get those antivirals which do decrease post herpetic neuralgia though they still need to be given within a few days of onset.

This whole zoster risk BS came from speculation that exposure to wild varicella prevented zoster. So researchers modeled the risk of zoster if the vaccine eliminated the natural 'boosting' exposure. BUT IT ALL STILL AMOUNTS TO SPECULATION!!!! There isn't hard data that confirms this will even occur AND there is not yet sufficient suppression of wild infection to fully test the models. But so far this big epidemic of zoster has not occurred.

If any of you have studies of actual epidemiology instead of speculative disease models, please post them. As kellyb's link shows there is not clear evidence the vaccine is increasing rates of zoster.

 

[Skeptic Ginger]

How does (from the report):

"During a 13-month period between 2002 and 2003, 188 cases of chickenpox complications leading to hospitalisation were reported to the British Paediatric Surveillance Unit. Of these, 112 children met the criteria to be included in the study - a rate of 0.82 cases per 100,000 children. The average age of those suffering complications was three."

Become (BBC):

"For every 1,000 children who catch chickenpox, on average between two and five of them will end up in hospital."

Chickenpox just got a more serious disease in the UK in the space of 8 hours!

Complete and utter bollocks.

You should try for Randi's million dollar prize. Ivor, the Edgar Cayce of today can divine rates of varicella disease and complications without looking at any data.

We went through this with the measles discussion. Just because someone quotes a rate in a news report or other article does not mean it is a precise number. Complication and death rates are not precise. They are precise enough to compare vaccine to infection. And specific cited deaths and complications are precise. The problem with rates is estimating underreported cases.

 

[Skeptic Ginger]

As virtually every child currently gets chickenpox (90%+) in the UK, there should be little difference.

If the birth rate was the same for 19 years and no kids died before getting chicken pox then you could take 90% of the pediatric population and divide it by 19 years to get your annual incidence. That isn't the case. Nor is the annual case fatality and complication rate the same.

Not to mention you are taking 19 years of cases and using a single year of deaths for the case fatality rate. Try again.

 

[Skeptic Ginger]

Perhaps not every child hospitilisation is reported to the British Paediatric Surveillance Unit. (That's a sinister sounding name)

I'm trying to find a copy of the report rather than reviewing it through the Scotsman or the BBC, anybody know how it can be found?

This is particularly true when the death is from invasive group A strep. The death certificate may or may not list varicella as the precipitating event.

 

[Skeptic Ginger]

And from the US:

http://www.reuters.com/article/governmentFilingsNews/idUSN1429730720070314

And we all know those Reuter's reporters are so well qualified to write these comprehensive evaluations.

Like I said, get a booster, BFD!

 

[kellyb]

From your link, I don't know what this guy is talking about. First, disseminated zoster is the main risk of serious zoster disease and it happens only to the severely immunocompromised. That means all the 'booster' effect from exposure to community varicella is moot anyway.

The second problem from shingles is post herpetic neuralgia. While painful, it doesn't kill anyone.

I dunno about that:

http://www.bmj.com/cgi/content/full/323/7321/1091?ijkey=a62d623c6766cfef204206445d03280d1b65c796

In these 94 cases, physicians gave chickenpox as a definite or contributory cause of death in 75 (80%) (table 1). In the 19 remaining cases (20%) the disease present was herpes zoster (shingles).

 

[Skeptic Ginger]

It is not a ridiculous statement, it just goes against your totally screwed-up perception of risk.

1 in a 1000 (at most in the US) unvaccinated children die of measles. Once you have had measles you are immune for life. Vaccination has nothing to do with it. There is a 1 in 345 chance you will be killed with a firearm if you live in the US your entire lifetime.

And to answer your second post, no, I'm not anti-vax at all. I'm anti-scaring-people-with mis-information-and-sanctions-if-they-don't-comply.

Why focus on guns? Motor vehicle accidents kill more people. Let's not vaccinate any kids because guns and cars kill more of them than infections. And don't bother with that smoke alarm battery either. Why pay for a smoke alarm battery when cars kill so many people.

Your risk perception is bizarre.

 

[Skeptic Ginger]

....

The issue is with coercing parents to have their children vaccinated using lies, mis-information and (in the US) sanctions for non-compliance for what amount to pretty small risks to the children's health.

If there are any lies here, Ivor, it is this claim by you.

You perceive the vaccine information to be slanted to the point of deception. You claim public health officials only care about rates of coverage like it gave them brownie points or something. You claim health care providers are not as intelligent or diligent as you are when they come to a different conclusion about the risk/benefit analysis on the use of vaccines.

So what is it, Ivor, that gives you such powerful insight as to be able to claim your analysis is superior to the ACIP guidelines which are written after careful deliberation by a group of highly qualified experts and who make their rationale and all the research they consulted publicly available for all to see what went into their rationale? How is it with such a faulty evaluation of these vaccines the entire health care community with the exception of a very tiny minority of the usual suspects doesn't notice the ACIP is simply a group of vaccine promoters out to get said brownie points? But you, Ivor, in your wise knowledgeable expertise can recognize this scam people with the actual expertise cannot recognize?

Amazing those of us in health care are such dupes.

 

[Skeptic Ginger]

Only if spending the money on prevention or treatment for 'that some other way' would not save more lives using a similar amount of money. MMR is probably worth it. Varicella vaccine, no way! E.g, let's save 100's of kid's lives in the third world before we save 7 in the UK.



It's not the harm to 'these children's lives', it's all the other kids (and adults) who don't get treated (as well as they could) because there's less money and resources left to spend and use on them. Try explaining to a mother's children that she's going to die soon because we spent all the money vaccinating them against chickenpox, meningitis and flu.

Well, let's spend the money people waste on useless remedies to save those people. Why single out vaccines that do save lives as the cost which used up the funds for whatever life saving measures you are referring to here? We could save a lot of people with the money people waste on chiropractors, homeopathy, and useless superstitious medicine. Try explaining to a mother her child died of cancer because someone else bought Headon and Airborne.

 

[Skeptic Ginger]

Now that's why I said I was listening to the paediatric epidemiologist, because that's exactly the calculation he was making. Would introduction of the chicken pox vaccine be value for money (he used these exact words), in terms of lives saved and serious illness averted. Remember, the lives saved by the vaccine have worth, just as do lives that might be saved spending the money in other ways. This was exactly the topic of the discussion, and to be honest I'm more inclined to listen to an "authority" on that one, because it is a very complex calculation.

Rolfe.

This is part of the ACIP evaluation of vaccines and for that matter, lots of things in health care are evaluated this way. Ivor just assumes no one but he has looked at this issue. He's poorly informed.

Meningococcal vaccine was available for decades before we used it on kids and college students. You gave it to travelers going to equatorial Africa where meningococcal disease incidence was high. It wasn't until after the vaccine was expanded to cover more strains that it became cost effective to vaccinate kids in the US. And we still don't give it to health care workers despite the fact they take a lot of prophylactic antibiotics after exposures to patients with meningococcal disease.

Annual chest X-rays for people with inactive latent TB infection was abandoned years ago after it was determined active cases were not efficiently detected using the X-rays. Careful symptom analysis and X-rays only for people with symptoms is now the standard. We don't test everyone vaccinated for hepatitis B after the vaccination to see who are the vaccine failures but I test people who have a certain level of blood exposure risk. Pap smears can be every 3 years instead of every year in low risk women. Mammograms and colonoscopies are
targeted for specific age groups and risk factors.

That is how preventative health care is always assessed, including vaccine use.

 

[Skeptic Ginger]

...

Personally, I'd only offer it to children who had passed a certain age (16?) without contracting chickenpox, as 80% of the deaths from chickenpox occur in adults.

Again, you are misinformed. See my posts above about invasive group A strep after chicken pox.

Have you ever bothered to look at the ACIP analysis of the cost effectiveness of varicella vaccine in kids or are you just going by your wealth of personal expertise? And just because you don't appreciate it, there is a cost benefit in preventing a parent from staying home from work with a sick kid.

 

[Skeptic Ginger]

These people are crazy. If knowing two dead kids killed in the same year from the same disease is not enough to convince you to get a vaccine for your own kids, then you have to be just crazy. These two dead kids were healthy until they got meningitis. There was nothing different about them, except they caught a deadly disease that my kids weren't exposed to yet. Of course I want to protect MY kids from the same fate. This not "fear" but common sense for crying out loud!

You don't care about your kids, that's your problem, don't go around saying parents with an ounce of common sense are "just controlled by fear".

Sheeesh!

Which brings up another good point. I'll spend the money to vaccinate my child, thank you. If you, Ivor, are going to have the government rather than the markets control how our health care dollars are spent then have the government outlaw promotion of worthless products like Airborne and Headon. That will save you a whole lot more money for your other concerns than griping about the cost effectiveness of vaccines.

 

[Skeptic Ginger]

Almost precisely argued.
If it is purely an economic equation let us weigh the benefits of universal vaccination against chicken pox against the losses from the occurence of chicken pox. How much does is cost to hospitalise these children and what is the cost , in purely economic terms, of their death? As Rolfe has said the economics may point to universal vaccination.

But is there not an emotional cost?

The severe injury of a child or even its death produces a dysfunction in society that is immeasurable. This is the cost/benefit we should be considering, not purely the numbers ascribed by an accountant or a mere engineer.

Everything from lost parental income simply staying home to care for a child to complications from hospitalization, long term disability, lost income the dead child will not grow up to earn and so on. All Ivor seems to be counting is the primary fatalities and nothing else.

 

[kellyb]

More on shingles vs. chickenpox:
(from Canada)

http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/99vol25/dr2511eb.html

Approximately 172 cases of chickenpox were hospitalized each year. The vast majority (92%) of the 861 hospitalizations between 1992 and 1996 were coded as chickenpox alone with the remainder coded primarily as secondary streptococcal infections (4%), encephalitis (2%), and pneumonia (2%). Most (18/19) hospitalizations due to encephalitis were in children < 10 years of age.

During the period reviewed, there were 10 deaths in hospital associated with chickenpox of which seven were persons > 20 years of age. Adults > 20 years of age comprised one-third of the hospitalization costs related to chickenpox.
The average annual number of cases hospitalized with herpes zoster was 524 of whom 97% were adults > 20 years of age. There were approximately 29 deaths in hospital associated with herpes zoster each year and all occurred in persons >= 20 years of age.

So shingles is about 3 times as deadly according to this...

 

[Skeptic Ginger]

Many people have natural immunity to bacteria that cause meningitis. In fact, no one knows why the few who do get it, get it. Currently, it's considered just extremely bad luck.

If you worry enough about your kids getting meningitis to do something about reducing their risk of contracting it by a small amount, you must be in a state of constant fear, given all the much more likely risks to their life they face every single day. Talk about ignoring the elephant(s) in the room.

State of constant fear? Give me a break. That is based solely on your bizarre thinking about these issues. Do you live in constant fear because you use a seatbelt?

My son is living in the dorms this year at college. I drove him to our HMO and he got a vaccine. All done. No more thought need be given the matter. I don't dwell on the things he could get which there are no vaccines for. Why should the availability of a vaccine make me fearful of a disease?

 

[Skeptic Ginger]

...

Let's not forget that the varicella vaccination wares off after less than 20 years, meaning that more than one shot is needed to avoid cases of breakthrough chickenpox in adulthood.

Why not think of having childhood chickenpox as a very safe one-off medical treatment?

You use an ignorant risk benefit analysis to ask this question. BFD!, a booster dose in 20 years. Wow!, such a burden!