Six Reason to Question Vaccinations

Ivor the Engineer said:
In the case of disease that only exist in humans, it would seem sensible to try to eradicate them. So let's send skeptigirl and the other members of the vaccination squad over to the third world and rid the world of measles before we think about chickenpox in the West. Once a disease has disappeared, no one has to be vaccinated against it.
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You aren't thinking that one through properly, are you?
For starters, eradication of diseases with only a human host relies on global eradication. Your concept is flawed.
 
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Deetee said:
You aren't thinking that one through properly, are you?
For starters, eradication of diseases with only a human host relies on global eradication. Your concept is flawed.
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I think we have a misunderstanding.:) I didn't mean stop vaccinating in the West (or anywhere else), just make sure places that aren't vaccinating against measles (for lack of funds, etc.) can and do. The money being allocated for new vaccination programmes in the West, such as Varicella, could be used to fund it.
 
skeptigirl said:
Well, let's see. I could do what you did after missing the fact the overall incidence of invasive pneumococcal disease went down when you posted about the vaccine making things worse and just not answer this.
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Well, I did answer...I answered with a question, though. ["How can cases of IPD go down three or fourfold, and deaths not decrease?"]

When I was misreading the " * " on the meningitis part, I was thinking it was deaths AND meningitis that had gone up or not changed, but now I'm down to wondering about death from the ABCs data, and what types of IPD have gone down. The IPD cases aren't broken down by type there, and I can't find Prevnar's effectiveness against pneumococcal meningitis anywhere, or it's effectiveness against "bacterial meningitis- all causes" anywhere.

And the effectiveness against ear infections, according to the package insert, says this:



http://www.wyeth.com/content/ShowLabeling.asp?id=134

The vaccine efficacy against AOM episodes due to vaccine-related serotypes (6A, 9N, 18B, 19A,
23A), also assessed in the Finnish trial, was 51% (95% CI: 27, 67) in the per protocol population
and 44% (95% CI: 20, 62) in the intent-to-treat population. The vaccine efficacy against AOM
episodes caused by serotypes unrelated to the vaccine was -33% (95% CI: -80, 1) in the per
protocol population and -39% (95% CI: -86, -3) in the intent-to-treat population, indicating that
children who received PrevnarR appear to be at increased risk of otitis media due to
pneumococcal serotypes not represented in the vaccine, compared to children who received the
control vaccine. However, vaccination with PrevnarR reduced pneumococcal otitis media
episodes overall.
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I don't think they evaluated any possible increase in h influenzae or staph ear infections, either. But looking at JUST pneumo OM, that's awfully close to complete replacement. How do we know something similar isn't going on with the "killer" forms of IPD?
 
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Ivor the Engineer said:
Perhaps it's because the rationing in the US isn't as explicit as it is in the UK that many of you think I don't care about children (or people in other age groups) dying?
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I don't know. Why do people keep assuming I'm an American ?

The fact remains there is a finite amount of money put into the NHS each year, and it is only sensible to try to reduce the rate of mortality and morbidity by the maximum amount possible with the money available.
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Yeah, which is why death by accident isn't as easy to prevent as giving someone a simple vaccine.
 
skeptigirl said:
Or maybe because we have more kids with health problems more vaccines are indicated. Your logic here leaves a lot to be desired.

No one knowledgeable about health care in the US thinks we have the most efficient system for the 'public' good. Some people believe the system has other advantages, specifically lots of capitalist incentive for research and development. The reasons for our high infant mortality and other bad grades in our health care system are well known and it isn't vaccines. It is substandard health care for the poor.
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Thanks for demonstrating my point so well Skepticgirl! Indeed, vaccines are not the solution to all health problems, which was the point I was trying to make. Every country that wants to have low infant mortality and good childhood health outcomes has to make choices. The choices that the U.S. has made haven't been as successful as the choices that Sweden has made, or Norway, or Hong Kong. Preventing childhood poverty and malnutrition are healthcare choices, just as vaccinating is a healthcare choice. Preventive actions that keep children from becoming sick or lessen the likelihood of their dying if they become sick are equally effective approaches.

The rational approach to having healthy children is to look at what is actually causing children to die. Top cause of death. Next cause of death. Make a list. Figure out what can be changed in each case and put money and effort into changing it. Sometimes the best change may be a vaccine. Other times it may be improving drinking water safety. Upgrading housing. Getting crap out of the food supply. Ending the civil war. Providing emergency rations in a famine. The assumption that more vaccines will always result in fewer deaths just doesn't always hold up.

If varicella is not a major cause of death in children and low birth weight is, then why not put more effort into trying to prevent babies being born below a viable weight?

Just seems to me that any country trying to improve their infant and child outcomes would do much better to take Sweden or Norway as a model than the U.S., judging by current results.

So, do you all think that Sweden and Norway and Hong Kong would have lower infant and childhood mortality rates if they added all the vaccines currently on the U.S. schedule? Or not? And why? And, of course, what should they cut back on so that they can pay for all of the additional vaccines? Think carefully on this one, because we wouldn't want to cut back on something that is already working to keep children alive and healthy.
 
MinorityView said:
The rational approach to having healthy children is to look at what is actually causing children to die. Top cause of death. Next cause of death. Make a list. Figure out what can be changed in each case and put money and effort into changing it. Sometimes the best change may be a vaccine. Other times it may be improving drinking water safety. Upgrading housing. Getting crap out of the food supply. Ending the civil war. Providing emergency rations in a famine.
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The problem lies in getting the funding and effort to do all of this. If some corporation could figure out how to turn a huge profit at it, it'd be happening right now.

If varicella is not a major cause of death in children and low birth weight is, then why not put more effort into trying to prevent babies being born below a viable weight?
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Actually, some progress IS being made in that area - fewer pregnant women smoke, for example. Another reason why you see more LBW infants is a LOT more assisted reproductive technology in developed countries.

Just seems to me that any country trying to improve their infant and child outcomes would do much better to take Sweden or Norway as a model than the U.S., judging by current results.
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Sad, but true. I've read a couple of articles which made a pretty good argument that what with tax subsidies and so forth, the folks here in the USA are actually PAYING for 'socialized' health care - we just aren't getting it.

Think carefully on this one, because we wouldn't want to cut back on something that is already working to keep children alive and healthy.
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"We" in this case obvously does not include that moron-in-charge we have here in the States. :mad:
 
It doesn't always make sense to go for the numerically biggest killer first while ignoring killers of smaller numbers of kids if the the smaller numbers are more easily preventable. If the biggest killer has multiple complex causes, and the causes are very difficult to influence, then you would spend forever, and lots of money often with negligible impact.
 
Professor Yaffle said:
It doesn't always make sense to go for the numerically biggest killer first while ignoring killers of smaller numbers of kids if the the smaller numbers are more easily preventable. If the biggest killer has multiple complex causes, and the causes are very difficult to influence, then you would spend forever, and lots of money often with negligible impact.
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How about developing a safer delivery system for nicotine which still gives the instant 'hit' smoking does?
 
If cigarette companies were forced to replace all of their cigarettes with inhalers, would people still smoke?
 
And should money that currently pays for treatment and prevention be diverted to pay for research into new treatments and preventative measures?
 
Professor Yaffle said:
It doesn't always make sense to go for the numerically biggest killer first while ignoring killers of smaller numbers of kids if the the smaller numbers are more easily preventable. If the biggest killer has multiple complex causes, and the causes are very difficult to influence, then you would spend forever, and lots of money often with negligible impact.
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Yeah, that is precisely the point I was trying to make.
 
Kaylee said:
snip...
History has proved him wrong. When was the last time anyone had polio?

Homeopathy is not evidence based medicine. That being the case, there is no reason to pay attention to anything they have to say. I personally think that their only value lies in the historical and psychological areas.
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In India, about oh, now, probably.

In Australia, years ago.
 
Here are the latest (June 2007) published minutes from the JCVI. Of relevance to this thread:

3.3 Hepatitis B

The Committee was reminded of the further work on a targeted hepatitis B vaccination approach in which immunisation is offered to all infants with one or more parents born in a country with a high or intermediate enemicity for hepatitis B, and in areas with higher Hepatitis B incidence. This work was dependent on the availability of data from the Office of National Statistics (ONS) on the likely number of children who fall into this category, and this data had been requested.

It was noted that in some areas, where a significant proportion of infants are recommended the vaccine, that implementation of the vaccination programme may be easier to deliver by targeting all children in that area.

A targeted vaccination approach was recently introduced in the Netherlands, and Sweden are currently in the process of introducing a programme.
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So only targetted HepB vaccination of children is being looked at for the UK.

8. Rotavirus

A subgroup consisting of JCVI members, laboratory scientists, clinicians and epidemiologists were asked via correspondence to review published papers on rotavirus disease burden, vaccine efficacy and safety and cost effectiveness. They were asked to comment on the suitability of these vaccines for the routine immunisation programme, including where the two vaccines were interchangeable and whether they could be safely given with the other vaccines already in the programme.

The subgroup considered that:

The current data on rotavirus disease burden was reasonably robust and consistent with other developed countries.


Although some groups of children may be at increased risk, overall the group considered that all children are at risk and it would be difficult to determine risk groups


The two vaccines (RotaTeq and Rotarix) are comparable in terms of their vaccine efficacy and the impact they would have on burden of disease. They are not interchangeable. It is not known what impact these vaccines would have on genotype replacement.


There has been no signal of risk from intussesception with these vaccines. There has been a potential signal for Rotateq from the US of an association with Kawasaki disease. Currently there is insufficient evidence to confirm a causal association between RotaTeq and intussusception and Kawasaki's disease. However, in view of the serious nature of these conditions, the diseases will be further evaluated by analysis of spontanous reporting data and post-marketing surveillance.

The conclusions of the subgroup would be written up in detail and reported at the next meeting, together with additional safety data from post-marketing surveillance.
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And there has been this recent study done of the cost-effectiveness of the rotovirus in the UK:

Rotavirus is the most common cause of gastroenteritis in children aged <5 years old, two new vaccines have recently been developed which can prevent associated morbidity and mortality. While apparently safe and efficacious, it is also important to establish whether rotavirus immunization is cost effective. A decision analytical model which employs data from a review of published evidence is used to determine the cost effectiveness of a rotavirus vaccine. The results suggest that some of the health sector costs, and all of the societal costs, of rotavirus gastroenteritis in children can be avoided by an immunization programme. The additional cost to the health sector may be considered worthwhile if there is a sufficient improvement in the quality-of-life of children and parents affected by gastroenteritis; this study did not find any evidence of research which has measured the utility gains from vaccination.
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13. AOB
The Committee asked for an update on proposed subgroups. The Pneumococcal subgroup will meet in September 2007 and the Varicella subgroup plan to meet at the end of the year.
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So we'll know next year what the recommendation on Varicella vaccination is going to be in the UK.
 
More on the pneumococcal conjugate vaccine and staph:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1482988
If the association is causal and acquisition of S. pneumoniae eradicates S. aureus carriage, then use of pneumococcal vaccines may eliminate the “protective” effect of S. pneumoniae against S. aureus carriage and an increase in S. aureus carriage will follow. Increased S. aureus otitis media has been observed among vaccinees in a pneumococcal conjugate vaccine randomized trial (23). Whether the current increase in severe community-acquired S. aureus infections, including methicillin-resistant S. aureus (6), is partially caused by the recent introduction of the pneumococcal conjugate vaccine is yet to be determined.
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