Study quashes vaccine anxiety

[Skeptic Ginger]

Do you think the rate of underdiagnosis/misdiagnosis would be as high in infants, though?
Part of the reason why it's been so badly underdiagnosed in adults is because the symptoms can be so mild compared to what you see in babies, in addition to the misconception that it was gone.
I think for a while now if a baby ends up in the ER with pertussis symptoms, they're cultured for the bacteria.
Skeptigirl probably knows all about this subject.
Skeptigirl, do you think pertussis has been mis/underdiagnosed in infants at the rate it has been in adults?

Pertussis begins with about a week of mild cold symptoms. There is not a high fever as with many other bacterial infections. After a week one gets an unusual spasmodic cough. When the cough is typical, most but not all, doctors will consider pertussis. Unfortunately the cough is not always typical, especially in a person whose immunity is waning but not gone. Even with classic symptoms, some providers miss it, and some patients don't go to the doctor until they've been coughing for weeks and not getting better.

So, pertussis is often not recognized, cultured or tested for properly, and when treated, if the health department report (required by law) is not done, the contacts are not traced and prophylaxis given to everyone who needs it.

When I was a fairly new nurse, (second job, first peds job), working on a pediatric unit, we had a child with pertussis for 4 days in the regular ward. The doctor didn't think it was pertussis because the child had been vaccinated. Then the head nurse came back from 4 days off. Needless to say, she put the kid in isolation 5 minutes after walking in the door. The pertussis culture came back positive 3 days later. (We can do a PCR test in a few hours now.) I didn't know any better, nor did the other nurses, and of course, the doctor didn't either.

Fast fwd to just a couple of years ago. The EMTs called for me to follow up as they just delivered a patient with pertussis symptoms to the ED and needed me to see if it was, and give them antibiotics. I call the ED doctor and he says, "adults don't get pertussis". It was about the 5th year in a row we were having our annual pertussis epidemic! There were hundreds of cases and 60% were adults! I had received health department alerts numerous times! Makes you want to scream. I faxed the ED doctor the heath department alerts including an article that started off, "Most doctors don't know adults can get pertussis." Since he discharged the patient without testing for pertussis the health department had to go find the patient.

I'm sorry to say but a fair number of physicians are very poorly informed about a number of serious infectious diseases. I have hundreds of additional stories. If you saw the recent Time Magazine with the cover story of doctors concerned about hospitals, it's worth perusing. Doctors are afraid of medical mistakes if they or a loved one are hospitalized.

To make a long story short, the rate of underdiagnosis/misdiagnosis of pertussis is very high in all age groups.

 

[Skeptic Ginger]

A few fallacies that need correcting

Rather than address everything in Raven's post all at once, I'm going to do it in sections. And I don't think it's useful at this point to go round and round about this insult or that inaccurate claim as to what was said so let me comment about that and go on.

Quotes are taken from various posts and the link back isn't included. I tried to get the complete thought. Feel free to reply to anything I quoted out of context and I'll find the post it was in to follow up.

So, to Raven: I'm sorry if I have not gotten your sentiments correct. I understand where you are coming from in being upset when people assume you meant this or that. It makes sense to me that you are advocating for better information rather than for deciding what anyone else should do about vaccinations.

But don't be too offended since it is hard, especially in such long exchanges, to distinguish between one's view and what one is advocating if the two are not quite the same. I had to read your posts several times to try to sort out what you were actually saying.

And I can see that you have read a lot, and again you'll dismiss what I'm going to say when I say you still have some things very wrong, but I will back it up as I clarify exactly where your logic fails. I hope to argue facts and logic, not who knows more than who. We all point out the appeal to authority fallacy when used by others. While I will say I know what I'm talking about, I don't expect anyone to take my word for it. More than that is needed.

Here I want to talk about a couple of fallacies you and Pauly have both posted. And I hope to be concise and brief. I'll address some of your statements about the ages at which different infections have higher fatality and other serious consequences at in a follow up post, probably another day from now.

First fallacy: Improvements in sanitation, nutrition, lifestyle and so on really account for the decrease in infectious diseases or at least in the fatalities and serious outcomes. Vaccines only had a small impact. The conclusion from this is vaccine risk is underestimated compared to disease risk. IE vaccines are worse than the diseases if you carry the belief out to its extreme position.

As I said in an earlier post, if that were the case then one way to test for it is to see if these diseases, or their serious consequences decreased during the same time frame, or after specific general health improvements if the improvement affected something specific about the disease. So, did polio cases go down, for example, after the vaccine, or after improvements in potable water supplies?

The evidence shows clearly that the majority of declines in mortality and complications from virtually all of these illnesses had occurred well prior to widespread vaccination against them.

If you look at the entire graph, from say, 1900 or so onwards, what you almost always see is an 80% to 95% decline by 1940 or so, when the first mass vaccinations for these illnesses were introduced, followed by much more modest declines to present day. But of course, if the graph is edited to BEGIN in 1939, then one can “show” a 80% to 95% decline from THAT point on and credit vaccination with that impressive figure.

Most medical historians and other experts on infectious disease readily acknowledged that factors other than mass vaccination were responsible for most of the declines in complications and mortality, which occurred well prior to vaccines. Incidence remained almost universal, but complications and mortality dropped dramatically.

Here's the data I found. Achievements in public health, 1900-1999 Impact of Vaccines Universally Recommended for Children -- United States, 1990-1998

Polio

Polio. Polio vaccine was licensed in the United States in 1955. During 1951-1954, an average of 16,316 paralytic polio cases and 1879 deaths from polio were reported each year (9,10). Polio incidence declined sharply following the introduction of vaccine to less than 1000 cases in 1962 and remained below 100 cases after that year.

Cases of paralytic polio and deaths from polio are reported here for the 5 years immediately preceding the introduction of the vaccine. In seven years the rate went from >16,000 to < 1,000 and to < 100 in one more year.

Raven mentioned that only 5% of total polio cases result in paralytic disease. (She used both figures, 5% and 2%. To my knowledge it is 5%.) But that fact is well known. Those 16,316 cases of paralytic disease plus 1,879 cases resulting in death represented 5% of the average total cases of polio every year for 5 years before the vaccine campaign was implemented. But they also happen to be the only cases ever counted and reported in justifying vaccine use. I'm not sure if Raven thought that only 5% of the 16,000 were serious cases or if 16,000 cases didn't seem like a lot. Otherwise the fact polio is benign 95% of the time is not as important as how many paralytic cases there were.

As far as I know, fairly soon after WWII, the USA was experiencing a high standard of living. If the cases of paralytic disease were decreasing due to lifestyle, you would not expect such a dramatic decrease to take place over 8 years, but not start until 10 years after the standard of living went up.

On the other hand, the decrease couldn't match the introduction of vaccine any closer than it does.

There may very well have been a decline in paralytic polio prior to 1955. But it wasn't enough to eliminate 18,195 cases of the worst outcomes of polio a year.

TEN YEARS LATER...

Measles

Measles vaccine was licensed in the United States in 1963. During 1958-1962, an average of 503,282 measles cases and 432 measles-associated deaths were reported each year (9-11). Measles incidence and deaths began to decline in 1965 and continued a 33-year downward trend. This trend was interrupted by epidemics in 1970-1972, 1976-1978, and 1989-1991. In 1998, measles reached a provisional record low number of 89 cases with no measles-associated deaths (13). All cases in 1998 were either documented to be associated with international importations (69 cases) or believed to be associated with international importations (CDC, unpublished data, 1998).

Here we have 432 fatalities per year in the 5 years immediately preceding the vaccine. (Killed measles vaccine was introduced in 1963 and the live vaccine in 1968.)

Adequate vit A intake, preferably from an adequate diet, would prevent a great many of the cases, serious complications (esp. blindness), and deaths from measles in Africa. (source, the UN).

Much easier and cheaper to mass vaccinate for measles in Africa than to address the root causes behind why the complication and mortality rate from this illness is 10 times higher in African children who contract it than it is in American children who do AND behind why incidence is bound to be higher regardless of vaccination or not; inadequate nutritional status, esp. vit A deficiency in the case of measles, which accounts for the majority of severe complications, overcrowding, contaminated water and living conditions, war, extreme poverty, lack of access to medical care, etc.

So I looked this source up and found a UN site with the information vitamin A can also halve the number of deaths due to measles. If you scroll down to figure 11 you'll see the improvement from vitamin A in 3 studies. However the case fatality rate after the vitamin A intervention stayed above 2% in all 3 studies.

The rate of death and serious complications from measles used by the CDC to weigh risk and benefit of measles vaccine was ~1 death per 1,000 cases and an additional 1 very serious complication per 1,000 cases. That is well under the 2% fatality rate vitamin A reduced measles deaths to in the three studies.

From ACIP for MMR vaccine

Encephalitis with resultant residual permanent central nervous system (CNS) impairment (encephalopathy) develops in approximately 1 per 1,000 persons infected with measles virus. Whether attenuated live viral measles vaccine can also produce such a syndrome has been a concern since the earliest days of measles vaccine use. In 1994, the IOM noted that most data were from case reports, case series, or uncontrolled observational studies, and concluded that the evidence was inadequate to accept or reject a causal relation (150).

Serious side effects from MMR vaccine (since it is usually combined)

Expert committees at the Institute of Medicine (IOM) recently reviewed all evidence concerning the causal relationship between MMR vaccination and various adverse events (149,150). The IOM determined that evidence establishes a causal relation between MMR vaccination and anaphylaxis, thrombocytopenia, febrile seizures, and acute arthritis. Although vasculitis, otitis media, conjunctivitis, optic neuritis, ocular palsies, Guillain-Barre syndrome, and ataxia have been reported after administration of MMR or its component vaccines and are listed in the manufacturer's package insert, no causal relationship has been established between these events and MMR vaccination.

The ACIP guideline gives very detailed information on those side effects. The rates can vary with vaccine strain used and country so I'll let anyone interested sort through it themselves (it's about mid page). The rate of serious adverse events was significantly lower with vaccine than wild virus infection.

THIRTYFIVE YEARS LATER

Hib vaccine

The first Hib vaccines were polysaccharide products licensed in 1985 for use in children aged 18-24 months. Polysaccharide-protein conjugate vaccines were licensed subsequently for use in children aged 18 months (in 1987) and later for use in children aged 2 months (in 1990). Before the first vaccine was licensed, an estimated 20,000 cases of Hib invasive disease occurred each year, and Hib was the leading cause of childhood bacterial meningitis and postnatal mental retardation (8,18). The incidence of disease declined slowly after licensure of the polysaccharide vaccine; the decline accelerated after the 1987 introduction of polysaccharide-protein conjugate vaccines for toddlers and the 1990 recommendation to vaccinate infants. In 1998, 125 cases of Hib disease and Haemophilis influenzae invasive disease of unknown serotype among children aged less than 5 years were provisionally reported: 54 were Hib and 71 were of unknown serotype (CDC, unpublished data, 1998). In less than a decade, the use of the Hib conjugate vaccines nearly eliminated Hib invasive disease among children.

And again, the rates of vaccine adverse events is substantially less than the rate of meningitis or epiglottitis with HIb disease. The specifics are available on CDC's website as are other sources to verify all these numbers.

The evidence is clear, these diseases decreased with the vaccines to extremely low numbers. With better lifestyle and health they decreased as well, but not enough to claim vaccine benefit is being overstated. And the ACIP uses actual disease rates at the time vaccines are introduced, not some misleading figures disguising some other cause for the decrease in diseases as Raven suggests. I await the data that contradicts this evidence. Once again, not being able to post a link shouldn't stop anyone from posting a citation.

In addition, ACIP compares the vaccine benefits to serious outcomes of these diseases, not the total number of cases.

Second Fallacy: Vaccine use interferes with the body's immune system. Getting vaccine preventable diseases provides benefits that outweigh getting the vaccines.

There were some incorrect facts about these diseases being relatively safe in childhood and worse in adults but I will give some quick numbers for a few of them.

Measles, mumps and chicken pox carry greater risks before age two and from late teens on. Raven posted only that there was > risk if the infection occurred in adults.

If you get chicken pox before age 2 shingles can occur as early as your teens. Otherwise it is more common in your 40s and older. There has not been any significant problems with shingles in vaccinated children. (I'll get back to that if I didn't already address it sufficiently.)

HIb, pneumococcus, and influenza carry greater risk if infected before age 2 and after age 65.

Pertussis is more dangerous under age 5 but especially under age 1. It's miserable for everyone because you can have severe coughing spasms for weeks to months.

Hepatitis B acquired perinatally has a much greater risk of becoming chronic. I believe (need to double check) that risk of becoming chronically ill goes down through late teens and begins to rise again as you get older. But there is no guarantee one won't become a chronic carrier no matter what age one is infected. And this vaccine has one of the lowest rates of serious side effects.

If those facts are not correct (allowing for the ages not being absolute) then give a source because I know these diseases well. I work with them every day. You don't have to link to the source. I didn't have any trouble finding the UN site.

So, I give these age related risks because part of the fallacy is that if you get these infections at a supposed "safe age" you'll have better immunity when you need it later. It just isn't so.

Second part of the fallacy is that the vaccines are unnatural and that has particular overall effects.

Actually, vaccines tend to act very differently upon the immune system than natural exposures, esp. when administered to neonates. There is a documented tendency towards skewing of the immune response from a predominately TH1 mode to a predominately TH2 mode, with more of a stimulation of humoral as opposed to cellular immunity.

For example, infants born to naturally immune mothers carry measles antibodies for an average of 12 to 16 mths, vs. those born to vaccine immune mothers, who lose their maternal antibodies to measles by an average of 9 mths. This has been the reason for delaying the MMR until 18 mths until fairly recently, since natural maternal antibodies interfere with the vaccine’s effectiveness.

The rate of re-infection upon exposure to rubella among vaccinated women is estimated to be as high as 80% vs. an estimated 3% rate seen in naturally immune women. Fortunately, re-infection, following either natural infection or vaccination is far less likely to result in CRS in a fetus the woman may be carrying at the time than is initial infection. But this is but one example of the differences in duration/efficacy between the two forms of immunity,

So lets look at this logic. Of all the infections one can get we vaccinate for a handful. There are 200 known upper respiratory pathogens. Heaven knows how many intestinal and STD pathogens there are. Then there are skin and GU pathogens. Why on Earth would humans have evolved in a way that skipping a handful of "natural" infections had any impact at all on one's immune system. How would that handful of killed vaccines which stimulate the immune system put us out of balance?

Live viral vaccines are no different than mild cases of "natural" infections. 95% of the people infected with polio have mild or no disease. 30% of people infected with chicken pox have no disease. 85% of people infected with hepatitis B have no disease. Raven posted as if this was something an infectious disease practitioner didn't know. Or that it wasn't taken into consideration when weighing risk and benefit of vaccines. Before smallpox vaccine was developed, milk maids who had had cases of cow pox were noticeably not getting smallpox. They were getting a natural vaccine instead.

There has been some theory exposure to dirt or some germs was healthy and we are disinfecting everything at the expense of our immune systems. Asthma was lower in farm kids than city kids so dirt was the suspected protective mechanism.

Big problem with that hypothesis was it was only an hypothesis! It was never more than that. A new study just came out showing kids in day care got more asthma. Plenty of germs and natural infections there. Researchers are always getting these far out ideas. Once in a great while something comes of it. But in this case, some people latched onto this concept that was only speculation as if it was confirmed by the research. The only thing confirmed was more city kids get asthma than farm kids. I can think of at least one better hypothesis than the "kids need germs" theory. It's called air pollution. Rubber tire particulates, smog, hair spray, you name it.

So missing a few infections or having a few killed vaccines is in no way significant in terms of overall disease burden a person suffers in their life time. And while it might sound good that disease is natural, and vaccines unnatural, one needs to be real careful not to look for reasons that might be so and then consider the speculation as fact or evidence.

The rotovirus vaccine had to be stopped (soon to be restarted) because severe side effect showed up. That's what the ACIP does. It very carefully evaluates risk and benefit. You follow the evidence not look for what you want it to say.

More to follow but these are the main points. Much of the rest is re specific statements.

 

[kellyb]

To make a long story short, the rate of underdiagnosis/misdiagnosis of pertussis is very high in all age groups.

I totally agree, but do you think it's really as high in babies, under 6 months, specifically, when the fatality rate is highest, as it is in adults?

 

[Beth]

Rather than address everything in Raven's post all at once, I'm going to do it in sections.

Thanks skeptigirl. This is interesting information. A few comments.

First fallacy: Improvements in sanitation, nutrition, lifestyle and so on really account for the decrease in infectious diseases or at least in the fatalities and serious outcomes. Vaccines only had a small impact.

While the information you've given is certainly indicative that vaccines reduced disease risk in and of themselves, it doesn't show that it is a fallacy to say that improvements in sanitation, nutrition, lifestyle and so on accounts for a large portion of the decrease in infections diseases or fatalities and serious outcomes because it doesn't address the time period (first half of the twentieth century) when Raven claimed those improvements caused a major decrease in disease risk. Perhaps you are right, perhaps Raven is. The data presented here is inconclusive on that aspect.

Second Fallacy: Vaccine use interferes with the body's immune system. Getting vaccine preventable diseases provides benefits that outweigh getting the vaccines.
.....
So, I give these age related risks because part of the fallacy is that if you get these infections at a supposed "safe age" you'll have better immunity when you need it later. It just isn't so.

I'm sorry, but I didn't find your information on this aspect particularly convincing. You gave no cites, sources or figures for this information at all.

Second part of the fallacy is that the vaccines are unnatural and that has particular overall effects.
So lets look at this logic. Of all the infections one can get we vaccinate for a handful. There are 200 known upper respiratory pathogens. Heaven knows how many intestinal and STD pathogens there are. Then there are skin and GU pathogens. Why on Earth would humans have evolved in a way that skipping a handful of "natural" infections had any impact at all on one's immune system. How would that handful of killed vaccines which stimulate the immune system put us out of balance?

Again, no cites or sources to discredit what Raven has said. Clearly, we know such vaccines do have an impact on the immune system - that's why we give them, to get that beneficial change. Currently we give children a lot more vaccines that we did 30 or 40 years ago, many for diseases that have a relatively low risk of serious consequences. What is the overall effect on the human immune system? As near as I can tell, it's not well studied or understood. Your claim that it doesn't have an effect is also a hypothesis. Could be you are right. Could be Raven is. But what you've written here is just as much speculation (though perhaps founded on more extensive experience) as what Raven wrote.

The rotovirus vaccine had to be stopped (soon to be restarted) because severe side effect showed up. That's what the ACIP does. It very carefully evaluates risk and benefit. You follow the evidence not look for what you want it to say.

This example is illustrative of why I prefer to wait until a vaccine has been on the market for several years before agreeing to have my children vaccinated if the disease is not one I consider a serious risk for my child. Unexpected adverse consequences are NOT always going to be discovered in the trials and I don't consider the ACIP to be very quick in discovering, acknowledging or dealing with those problems. So I find waiting several years until I feel more confidence in their recommendations to be a reasonable strategy when the risk of the disease is small and the risk of adverse effects of the vaccine are still IMO uncertain.

More to follow but these are the main points. Much of the rest is re specific statements.

I'll look forward to it. it's interesting reading. I also appreciate the tone you have adopted for this post.

 

[Skeptic Ginger]

I totally agree, but do you think it's really as high in babies, under 6 months, specifically, when the fatality rate is highest, as it is in adults?

For an infant with partial immunity resulting in a milder case, or just a milder case by luck of the draw, they could slip under the wire. Not every provider will order the tests if the infant isn't too ill. The providers aren't always aware of the current outbreaks, and many providers have big gaps in their infectious disease knowledge. Though usually providers treating infants are up on inf. disease. Pertussis can look like a very mild cold at first.

Most infants who develop the pertussis cough get pretty sick. Those are likely going to be diagnosed. What happens is the coughing totally wears an infant out. Those kids are likely going to make it to the hospital will likely be diagnosed. But, that also depends on the hospital. Children's Hospital in Seattle or any similar large pediatric hospital will more than likely make a correct diagnosis. But the tiny hospital in Craig Colorado I had my first job in, or one like it, doesn't have the same resources. There aren't residents and med students making rounds, a well equipped lab to do the quicker tests, and more than one pediatrician to ask some hallway advice of.

So clearly less infant cases will be missed but a few still might be.

 

[Skeptic Ginger]

Thanks skeptigirl. This is interesting information. A few comments.

While the information you've given is certainly indicative that vaccines reduced disease risk in and of themselves, it doesn't show that it is a fallacy to say that improvements in sanitation, nutrition, lifestyle and so on accounts for a large portion of the decrease in infections diseases or fatalities and serious outcomes because it doesn't address the time period (first half of the twentieth century) when Raven claimed those improvements caused a major decrease in disease risk. Perhaps you are right, perhaps Raven is. The data presented here is inconclusive on that aspect.

Antibiotics, sanitation, vaccines, and lots more all had huge impacts on health and longevity.

The fallacy both Raven and Pauly presented was that the ACIP risk and benefit evaluation of vaccines were invalid. Their reasoning was that the vaccines were given credit for improvements that really were from other actions. Raven [implied, thinks, whatever] that [some, all, whichever] vaccines aren't needed because with better health the infections prevented by vaccines are not serious. Infectious diseases evolve just as humans do. Sometimes the germs win, sometimes we do. The idea all one needs is good health and [most, all] infections will occur without serious consequences is naive.

Risk and benefit analysis by the ACIP for all vaccines uses very specific data of the adverse outcomes of disease, not simply total cases. And the data both before vaccines are introduced and after the results of vaccine use is measured and carefully evaluated. If benefit by far exceeds risk, which it does, then the recommendation is to vaccinate. That is the issue here, not what percentage of your current good health you can attribute to sanitation vs vaccines.

Raven dismissed this data with a logic argument. It is a logical hypothesis the other measures which have improved our health would have had an impact on disease outcome. But an incorrect assumption was made that vaccine recommendations didn't control for other variables in measuring vaccine impact. I'll still comment on these "graphs" if Raven says where to find them.

I'm sorry, but I didn't find your information on this aspect [age of greater risk from particular infections] particularly convincing. You gave no cites, sources or figures for this information at all.

Raven gave no source for her claims these infections were harmless at this age or that age, nor have you. I spent a lot of time trying to wade through pages of information, some of which was inaccurate, most of which cited no sources either. I didn't have the time to find a source for something that can be found in any infectious disease manual or textbook. Disease risk is in every official ACIP recommendation for each specific vaccine. Each includes disease age related data as well as serious outcome data.

ACIP sources on CDC website

Again, no cites or sources to discredit what Raven has said.

No sources for what? How many organisms cause disease? Try common sense. How many times a year does the average child have an infection? So what logic says the human immune system needs to get chicken pox and measles to keep it in balance? Or that a vaccine is going to have this huge impact on one's immune system because it stimulates antibodies without a course of illness symptoms?

I use The Control of Communicable Diseases Manual on a regular basis. There's a new edition every 5 years and the current one is 2005. You can get used ones cheap. Even one from 2000 is still pretty valid. Most of what changes are newer diseases like HIV where new information comes out between editions. For numbers of different infectious organisms it starts on page 1 with AIDS and ends on page 606 with zygomycosis. There is only a page or two for most diseases with a couple that are longer. But there are also groups of organisms like the section on streptococcal disease includes many different strains. So among those roughly 500 possible infections the number of vaccines we use is negligible as far as potential disruption of the normal immune system process.

The bottom line in this equation is still risk benefit. I don't buy the premise vaccines impact the immune system as Raven does. But one can add 'potential harm' to the risk benefit assessment even though there is no evidence of any demonstrated harm. The known harm from the infections themselves still outweighs the potential but unseen risk to the immune system.

Clearly, we know such vaccines do have an impact on the immune system - that's why we give them, to get that beneficial change. Currently we give children a lot more vaccines that we did 30 or 40 years ago, many for diseases that have a relatively low risk of serious consequences.

Relative to what? How many cases of infection? That is half of the equation.

Rabies is virtually 100% fatal with only one survivor known. Why don't we give rabies vaccine to every kid? It isn't because of risk of side effects. It's because there are so few cases. I vaccinate veterinarians for rabies as well as the city animal control officers. And King County (here) has had a rash of people exposed to rabid bats in the last year so the public health has given quite a few rabies series. The vaccine is very safe. Yet it isn't even recommended for kids in countries that have many rabid animals and rabies deaths every year. Why? Because there aren't enough total cases to warrant vaccinating everyone. And, because there is an alternative of vaccinating after exposure.

Before measles vaccine, almost every single person on the planet got measles before age 30. (Want a source? Look at the recommendations for measles vaccine. If you were born before 1957 you don't need the vaccine. Why? Because almost everyone born before that time has had the infection.) If there is one death per 1,000 cases and 1 serious adverse event per 1,000 cases of measles (both extremely low estimates assuming all those other health improvements in the population) but virtually everyone gets the infection eventually, your total number of deaths and adverse events following infection is huge.

What is the overall effect on the human immune system? As near as I can tell, it's not well studied or understood. Your claim that it doesn't have an effect is also a hypothesis. Could be you are right. Could be Raven is. But what you've written here is just as much speculation (though perhaps founded on more extensive experience) as what Raven wrote.

The premise for the hypothesis is illogical.

I hypothesize that acorns affect your immune system. We need to destroy all oak trees because they are weakening our immune systems. Hey, I could be just as right as the guy who hypothesizes it's not affecting your immune system.

What's wrong with that picture besides its absurdity? There is no evidence of anyone's immune system suffering this imagined harm. We have had vaccines now for ~50 years. MMR and DPTs have been given to 80% give or take of the population born in the last 35 years. Do you see a problem? Do you see 35 year olds keeling over as their immune systems fail?

And to think the immune system hasn't been well studied is ludicrous. Spend some time on a medical web site dealing with bone marrow transplants and see just how much research has been done on patients when we totally wipe out their immune system and grow it back. Take a look at the volumes of research on AIDS and see how much we know about the immune system. And in case you're thinking such research only looks at immune function pathology, that would not be correct. In order to see how things go wrong you must first see how things are supposed to go.

This example is illustrative of why I prefer to wait until a vaccine has been on the market for several years before agreeing to have my children vaccinated if the disease is not one I consider a serious risk for my child. Unexpected adverse consequences are NOT always going to be discovered in the trials and I don't consider the ACIP to be very quick in discovering, acknowledging or dealing with those problems. So I find waiting several years until I feel more confidence in their recommendations to be a reasonable strategy when the risk of the disease is small and the risk of adverse effects of the vaccine are still IMO uncertain.

All new drugs should be reserved for patients that older drugs do not work for, until the new drugs have been in use long enough to establish a safety record. It isn't practical to test a drug on hundreds of thousands of subjects before approving it. If a risk occurs in 1 of every 100,000 doses it may not show up in drug trials. And some drug companies have been over zealous with new drugs recently making overall trust in these companies harder to have.

But, don't forget to look at vaccine use in other countries as well. Sometimes, like with hep B vaccine, the drugs are in use long before licensed in the USA. In fact, many drug companies don't get US licenses for their products because it is more rigorous than in many other countries. Which is OK in some cases but maybe not so in every case.

When there is a new drug, you have to weigh the benefit. You are making the same claim that these vaccine preventable diseases are "not one I consider a serious risk for my child". And why is it you believe this? Because the data is easily found contradicting that except for perhaps, hepatitis A disease in children.

I'll look forward to it. it's interesting reading. I also appreciate the tone you have adopted for this post.

So hopefully my frustration isn't coming through too harshly here.

 

[kellyb]

Thanks, skeptigirl. I appreciate your tone as well.
One more thing:
What about that discrepancy between the Mumps vaccine's 95% seroconversion rate, but it's 65-80% effectiveness?

 

[Beth]

Antibiotics, sanitation, vaccines, and lots more all had huge impacts on health and longevity.

The fallacy both Raven and Pauly presented was that the ACIP risk and benefit evaluation of vaccines were invalid. Their reasoning was that the vaccines were given credit for improvements that really were from other actions. Raven [implied, thinks, whatever] that [some, all, whichever] vaccines aren't needed because with better health the infections prevented by vaccines are not serious. Infectious diseases evolve just as humans do. Sometimes the germs win, sometimes we do. The idea all one needs is good health and [most, all] infections will occur without serious consequences is naive.

Hmmm. That's not quite how I interpreted Raven's argument. I think Raven is saying that the benefits of mass vaccination of the entire population are overestimated due to the concurrent reduction in risk of getting disease due to other improvements such as sanitation. I thought she was arguing that it would be more benefical to improving overall health in undeveloped countries to concentrate efforts at improving living conditions rather than mass vaccination drives. Likewise, there is the idea that the drive to get vaccination rates up to as close to 100% as possible in developed countries isn't necessarily the best use of our resources for improving the overall health of the population. This is a somewhat different argument and not one that you've addressed. Perhaps she will return and clarify her point.

Raven dismissed this data with a logic argument. It is a logical hypothesis the other measures which have improved our health would have had an impact on disease outcome. But an incorrect assumption was made that vaccine recommendations didn't control for other variables in measuring vaccine impact. I'll still comment on these "graphs" if Raven says where to find them.

Yes, I'd like to see those as well. However, I don't recall her making that assumption. Perhaps I didn't read her posts closely enough.

Raven gave no source for her claims these infections were harmless at this age or that age, nor have you.

She didn't make that claim, nor have I. In fact, I haven't made any claims at all, only offered a few opinions. I'm finding this thread a good source of ideas and information, but haven't yet made up my mind about things. Raven has provided sources for a good many of the claims she has made. Thus far, I haven't seen any clear rebuttals to the actual claims she's made, though you have provided lots of rebuttals to claims she hasn't made.

I spent a lot of time trying to wade through pages of information, some of which was inaccurate, most of which cited no sources either. I didn't have the time to find a source for something that can be found in any infectious disease manual or textbook.

You're not obligated to spend any time looking up anything for posts on this forum. However, if you want to convince someone like me that you are right and Raven is wrong, cites will be necessary.

Disease risk is in every official ACIP recommendation for each specific vaccine. Each includes disease age related data as well as serious outcome data.
ACIP sources on CDC website

Thanks. I'll take a look at those.

The bottom line in this equation is still risk benefit. I don't buy the premise vaccines impact the immune system as Raven does. But one can add 'potential harm' to the risk benefit assessment even though there is no evidence of any demonstrated harm. The known harm from the infections themselves still outweighs the potential but unseen risk to the immune system.

When you add uncertainty due to unknown potential harm into the equation, the risk/benefit assessment result may come out a bit differently. Depends on how you weight the uncertainty and how serious you think the potential harm might be.

The premise for the hypothesis is illogical

I have to disagree. It's quite clear that vaccines affect our immune system. That's why we give them. The question is, are there unintended consequences of giving so many vaccines to young children? I'm unaware of any studies that look at the cummulative effects of vaccines on children. If you know of any, I'd be interested to review them.

I hypothesize that acorns affect your immune system. We need to destroy all oak trees because they are weakening our immune systems. Hey, I could be just as right as the guy who hypothesizes it's not affecting your immune system.

Actually, we know that some people will have allergies, so it's reasonable to assume they can affect the immune system. It's quite a leap to go from there to destroying all oak trees, and I understand that some anti-vaxers make leaps that are equally as extreme. But Raven hasn't done that. Neither have I.

What's wrong with that picture besides its absurdity? There is no evidence of anyone's immune system suffering this imagined harm. We have had vaccines now for ~50 years. MMR and DPTs have been given to 80% give or take of the population born in the last 35 years. Do you see a problem? Do you see 35 year olds keeling over as their immune systems fail?

No, but I believe that there has been a rise in auto-immune diseases of all sorts over the same time period. Perhaps that is unrelated to mass vaccinations, but I don't find it a ludicrous hypothesis that they are connected.

And to think the immune system hasn't been well studied is ludicrous. Spend some time on a medical web site dealing with bone marrow transplants and see just how much research has been done on patients when we totally wipe out their immune system and grow it back. Take a look at the volumes of research on AIDS and see how much we know about the immune system. And in case you're thinking such research only looks at immune function pathology, that would not be correct. In order to see how things go wrong you must first see how things are supposed to go.

I haven't said the immune system hasn't been studied well. It has. But it's also an extremely complex system and there are aspects of it that are not well understood. There is much research being done and there may yet be a few surprises for us all regarding the effect of vaccinations both on individuals and on populations.

some drug companies have been over zealous with new drugs recently making overall trust in these companies harder to have.

Correct. There is now a lack of trust in new medications that will take years to overcome.

But, don't forget to look at vaccine use in other countries as well. Sometimes, like with hep B vaccine, the drugs are in use long before licensed in the USA. In fact, many drug companies don't get US licenses for their products because it is more rigorous than in many other countries. Which is OK in some cases but maybe not so in every case.

When there is a new drug, you have to weigh the benefit. You are making the same claim that these vaccine preventable diseases are "not one I consider a serious risk for my child". And why is it you believe this?

In some cases, such as CP, because the disease is typically quite mild prior to puberty. In other cases, such as Hep B, because the risk of my child actually getting the disease prior to becoming sexually active is extremely low. In both cases, the risk of a serious adverse consequence from the disease is low enough that I'm willing to accept the risk and wait until my child is older in order for the vaccine to be better evaluated and possibly improved. In point of fact, this has already happened with the Hep B vaccine, which is much safer now than it was when my son was a newborn.

So hopefully my frustration isn't coming through too harshly here.

Not too much. Thanks.

 

[Deus Ex Machina]

Beth

This example is illustrative of why I prefer to wait until a vaccine has been on the market for several years before agreeing to have my children vaccinated if the disease is not one I consider a serious risk for my child. Unexpected adverse consequences are NOT always going to be discovered in the trials and I don't consider the ACIP to be very quick in discovering, acknowledging or dealing with those problems. So I find waiting several years until I feel more confidence in their recommendations to be a reasonable strategy when the risk of the disease is small and the risk of adverse effects of the vaccine are still IMO uncertain.

If I come across a little peeved, please bear with me. This is not a hypothetical situation for me and my family.

In Denmark in the late 70's it was 'fashionable' to not immunize kids. In 1979 this resulted in a rubella outbreak and our unborn son was infected with devastating results.

I bring this up to emphasize the point that low or reduced take up of immunization can have consequences not just for one's self or one's own family - but for others.

 

[Beth]

Beth

If I come across a little peeved, please bear with me. This is not a hypothetical situation for me and my family.

In Denmark in the late 70's it was 'fashionable' to not immunize kids. In 1979 this resulted in a rubella outbreak and our unborn son was infected with devastating results.

I bring this up to emphasize the point that low or reduced take up of immunization can have consequences not just for one's self or one's own family - but for others.

Please accept my condolances for your son. Yes, such decisions do have an impact on others, just as every decision we make as individuals living within a society do. Every time I drive to the grocery store, I'm risking injuring or killing another human being via a car accident. Should I take such that small but miniscule risk into consideration when deciding to go to the grocery? What about the impact of the emissions on the atmosphere? Some people would argue yes, but I don't agree. In general, I just don't find this particular line of reasoning very convincing in regards to vaccinations either. I think the decision is best made based on the risk/benefit for a particular child, not the impact on society as a whole.

BTW, my children did get the MMR vaccination. Personally, I find the benefits of that particular vaccine easily outweight the risks.

 

[Capsid]

I have to disagree. It's quite clear that vaccines affect our immune system. That's why we give them. The question is, are there unintended consequences of giving so many vaccines to young children? I'm unaware of any studies that look at the cummulative effects of vaccines on children. If you know of any, I'd be interested to review them.

Here are two studies showing no increase in hospitalisations after childhood vaccinations and a protective effect against hospitalisations following MMR vaccination.

 

[Beth]

Here are two studies showing no increase in hospitalisations after childhood vaccinations and a protective effect against hospitalisations following MMR vaccination.

That's really interesting and I've not seen it before. However, it looks specifically at other infectious diseases and my concern in regards to unintended consequences (which I haven't previously stated) relates to the rate of auto-immune diseases which this study didn't address. Hopefully, such a study will be undertaken at some point. Thanks for the link.

ETA: Looking a little closer at the abstract, I realized that they did NOT look at the cummulative effect of the vaccinations, but computed the probability of a significant increase in adverse effects for each of 6 possible vaccines with each of 7 different infectious diseases. That's not the sort of study I've been hoping I could find regarding long-term effects of multiple vaccinations. Thanks anyway.

 

[Capsid]

That's really interesting and I've not seen it before. However, it looks specifically at other infectious diseases and my concern in regards to unintended consequences (which I haven't previously stated) relates to the rate of auto-immune diseases which this study didn't address. Hopefully, such a study will be undertaken at some point.

Studies have been done. Here is a meta analysis of some that addressed autoimmunity associated with viral vaccines. It concluded

Very few patients may develop some autoimmune diseases following viral vaccination (in particular - arthropathy, vasculitis, neurological dysfunction and thrombocytopenia). For the overwhelming majority of people, vaccines are safe and no evidence linking viral vaccines with type 1 diabetes, multiple sclerosis (MS) or inflammatory bowel disease can be found.

 

[Beth]

Studies have been done. Here is a meta analysis of some that addressed autoimmunity associated with viral vaccines. It concluded

This was interesting as well. Apparently there is some association with individual vaccines and auto-immune diseases. The abstract didn't give details of the relationship, only that the risk was 'small'. I'll try to review the entire article when I get a chance. This was a meta-analysis and it indicated that the studies being combined all looked at individual vaccines. I have yet to see one that looked for a cummulative effect of vaccinations.

THanks for the link.

 

[Capsid]

I have yet to see one that looked for a cummulative effect of vaccinations.

I didn't find any such study on PubMed. It's not something that would be anticipated given the way the immune system works IMO. The immune response occurs a short time after exposure to an antigen and there is selection of antigen recognition molecules and gene reshuffling to optimise that recognition. There is the capacity to recognise 10^12 different antigens. So exposure to cumulative antigens just kicks in another set of recognition which is independent of what has gone before. Otherwise, wouldn't we all be generating autoimmunity simply from the cumulative effect of everyday exposure to the thousands of different viral and bacterial antigens. Why would vaccines be different to these?

 

[kellyb]

There is this one study.
Not sure what to make of it considering it's just one study, though.

http://www.ncbi.nlm.nih.gov/entrez/..._uids=16387585&query_hl=5&itool=pubmed_docsum

Children having received measles, mumps, and rubella vaccination showed an increased risk of rhinoconjunctivitis, whereas measles infection was associated with a lower risk of IgE-mediated eczema. CONCLUSION: Certain features of the anthroposophic lifestyle, such as restrictive use of antibiotics and antipyretics, are associated with a reduced risk of allergic disease in children.

ETA:
And really, measles is scarier than eczema, anyway.

 

[Skeptic Ginger]

There is this one study.
Not sure what to make of it considering it's just one study, though.

http://www.ncbi.nlm.nih.gov/entrez/..._uids=16387585&query_hl=5&itool=pubmed_docsum

Children having received measles, mumps, and rubella vaccination showed an increased risk of rhinoconjunctivitis, whereas measles infection was associated with a lower risk of IgE-mediated eczema. CONCLUSION: Certain features of the anthroposophic lifestyle, such as restrictive use of antibiotics and antipyretics, are associated with a reduced risk of allergic disease in children.

ETA:
And really, measles is scarier than eczema, anyway.

The abstract doesn't mention if anything else was evaluated that wasn't noted in the abstract. More information might be in the full article.

One has to look at the characteristics of the experimental group and the control group to make a judgment about other variables that still need sorting out. There've been numerous hypotheses to explain the increase in asthma. This research concludes, "Certain features of the anthroposophic lifestyle, such as restrictive use of antibiotics and antipyretics, are associated with a reduced risk of allergic disease in children." You cannot say more than that from this information alone.

What is stated is that the attenuated viruses in an MMR may have some specific effect on developing allergies. So it could be something very specific to one vaccine virus strain. If anything, not seeing any killed vaccine association with allergies, (provided they looked at those but left it out of the abstract), one might conclude that killed vaccines did not have an effect. I don't know how they might have separated the other vaccine variables unless they had kids who only had MMRs and not other vaccines. This is one of those abstracts that doesn't have enough information.

Live vaccines, OTOH, are just that, viral infections. There is no difference in your immune response to a live vaccine than to an infection except severity and the fact it is a different strain.

 

[Skeptic Ginger]

I have a bit to say about your post that followed mine, Beth, and I have a few more details of Raven's to yet address. But I haven't yet had time. Two things I gather, you are not convinced of disease risk within certain situations (kids' age and health?), and, you are concerned about vaccines having some different effect on the immune system. I will go back to Ravens post on that as I do not agree but want to see exactly what her information was.

As to the susceptibility of serious disease for a healthy child, that information is again, not hard to find. Vaccines are less risk. That can be verified. but there is more here in decision making.

Everything has risk. The greatest risks to children in the USA are motor vehicle accidents followed by drowning, and then other accidents including burns I believe. But infectious disease is in the top 10 and climbing because of increasing antibiotic resistance.

So what does that mean? It means seat belts and air bags get my first attention. Water safety and the smoke alarm gets my second attention. I also do the easy things, batteries and seat belts are easy. Living the perfect lifestyle for health is a lot harder. We accept risk all the time.

The question here comes down to deciding about giving our kids vaccinations. And to do that we look at risks of vaccinating and risks of not vaccinating. Taking that motor vehicle example, why is it so many people don't bother with the simplest effort of putting on a seatbelt? Most of the time they just don't feel at risk. Yet it is so obvious anyone in a car is at risk. Then there are a few who have some mistaken belief seat belts will trap them in an accident making seat belts as far as they believe, less safe than not using them. The data is clear, seat belts save lives. Yet they chose to take some obscure source of information over the readily available scientific information.

One way or another they find a reason to believe the seat belts are dangerous. There are parallels here with the anti-vaccination beliefs some people hold. You mention fear of some connection of vaccines to autoimmune disorders. But there is no evidence whatsoever of any connection. In fact, there's more evidence viral infections may be involved in some of those diseases. There is some evidence infection and inflammation might play a role in cardiac disease. We know some viruses do cause cancer.

There are risks with vaccines and there is new information sometimes about old drugs that reveal a hazard not always known. No one wants to take a vaccine that does more harm than good.

The information available about vaccine preventable diseases is as clear as the vehicle accident data. There is no slant in the data provided by the ACIP anymore than there is a slant in the data that wearing your seat belt is safer than not wearing it. The ACIP puts everything that goes into their recommendations in the report for all to see and judge for themselves. If it were invalid, other health care researchers would be pointing it out in mass.

ON that, I'll sign off but will address more of the specifics hopefully tomorrow.

 

[Beth]

I didn't find any such study on PubMed.

I'm not surprised. I'm never heard of such a study either.

It's not something that would be anticipated given the way the immune system works IMO. The immune response occurs a short time after exposure to an antigen and there is selection of antigen recognition molecules and gene reshuffling to optimise that recognition. There is the capacity to recognise 10^12 different antigens. So exposure to cumulative antigens just kicks in another set of recognition which is independent of what has gone before. Otherwise, wouldn't we all be generating autoimmunity simply from the cumulative effect of everyday exposure to the thousands of different viral and bacterial antigens. Why would vaccines be different to these?

All I can say is that I don't find it an unreasonable hypothesis that as the number of childhood vaccines routinely given goes up, they could have a cummulative effect on the immune system and that such an effect is going undetected since no one has ever looked for it. The assumption is made that there isn't any. Maybe that's correct, but it's an assumption, not a known fact.

 

[Beth]

I have a bit to say about your post that followed mine, Beth, and I have a few more details of Raven's to yet address. But I haven't yet had time. Two things I gather, you are not convinced of disease risk within certain situations (kids' age and health?),

I also consider family history with the disease and such things as potential for harm due to unknown effects.

and, you are concerned about vaccines having some different effect on the immune system. I will go back to Ravens post on that as I do not agree but want to see exactly what her information was.

Please don't feel obliged. Capsid has been looking, but come to the same conclusion I have. There are no studies that have investigated cummulative impact of vaccinations on auto-immune diseases. It is an entirely unknown risk, although there are some studies that indicate some vaccines are associated with a slight increase in risk of some auto-immune diseases.

As to the susceptibility of serious disease for a healthy child, that information is again, not hard to find. Vaccines are less risk. That can be verified. but there is more here in decision making.

It can be verified that individual vaccines are less risk for most people. Family history does come into play in evaluating risk for an individual. In addition, there is the unknown factor of cummulative effects

Everything has risk.

There are risks with vaccines and there is new information sometimes about old drugs that reveal a hazard not always known. No one wants to take a vaccine that does more harm than good.

The information available about vaccine preventable diseases is as clear as the vehicle accident data. There is no slant in the data provided by the ACIP anymore than there is a slant in the data that wearing your seat belt is safer than not wearing it. The ACIP puts everything that goes into their recommendations in the report for all to see and judge for themselves. If it were invalid, other health care researchers would be pointing it out in mass.

Yes, everything has risks. Vaccines have risks. Not vaccinating has risks. I'm a professional statistician. I'm reasonably good at evaluating probabilities and make risk/benefit decisions. I make my choices based on the information I have at hand and considering the unknowns as well - of which there are always some. I also consider our personal situation and family history to round out the evaluation of the risk, something that the ACIP recommendations cannot take into account.

The ACIP makes their recommendations for a population as a whole and publishes their reasoning in their reports. Among other considerations, they make assumptions regarding the average person that may or may not apply to me and my children. I can look at their reasoning and say, 'that doesn't fit my family' and arrive at a different decision that they have. In addition, they have made mistakes in the past. That means I add a factor of uncertainty in deciding whether to follow their decisions.

I find that for a few diseases the risk of the disease is sufficiently low that I'm more comfortable accepting the risk of non-vaccination than accepting the unknown risks of the vaccinations (particularly for newer vaccines) and the unknown risk of any cummulative effect of getting so many vaccines. I can wait to see if any problems are discovered and corrected. Then I can get either get my children vaccinated at an older age (as I did with Chicken Pox for my daughter) or skip it entirely as I find appropriate. As I pointed out regarding the Hep B vaccine, it is already much safer now than it was when my son was a newborn.