Vaccines

[Aemon Stark]

So, in the U.S. Politics thread, the idea was raised that a parent of a child in a family with a history of autoimmune disease might not want to vaccinate their child, at least not at the child's current age, which I believe was 2 years old.

I get that the whole "autism is caused by vaccines" thing has no empirical support, on its face. I don't understand why we are so dismissive of ANY danger from vaccines, though - or, in particular, the way we vaccinate.

Isn't there some validity to the idea that exposure to a couple dozen different vaccines over a short period of time might be unnecessarily dangerous? That the degree of autoimmune response provoked when this is done might cause irreversible damage due to an overactive autoimmune response that destroys healthy cells? Why does the link between vaccines and Gulf War Syndrome get some respect if we're so dismissive of the idea that vaccines might be problematic? Why are people hostile to the idea that maybe we could vaccinate better? I've read one suggestion in the literature that children not be given more than one vaccine every dix months. Is that really a totally crazy idea that deserves nothing but scorn?

Some people may have more of a reaction that others, but if so the vaccine schedule can certainly be spaced out. However, some points must be made:

1) Vaccines do not induce an "autoimmune" response.

2) That an immune response is stimulated by a vaccine does NOT imply that "bystander" or "healthy" cells are destroyed.

3) Public health and infectious disease specialists and pediatricians have modified vaccine schedules over time and the use adjuvants and novel vaccine formulations

4) We are exposed to thousands upon thousands of antigens everyday and our immune systems are amply capable of handling them.

5) Vaccines are nothing more than targeted introduction of antigens belonging to pathogens. The closer the vaccine's antigen mix is to the original pathogen, the stronger the immune response and the more effective the vaccine, but so-called "live" vaccines carry the risk of actual infection in those who have significant immune deficiencies or are otherwise immunosuppressed. However, "killed" whole organism vaccines and subunit vaccines are also less effective and so we have adjuvants - like the dread thimerosol - to enhance the immune response and gain greater effectiveness. Adjuvants are NOT preservatives in general.

http://www.discovery...s-of-the-adult/

That's just one example. The reason aluminum is added to vaccines is to act as an adjuvant - adding it provokes a stronger stimulation of the immune system. It's not like it's thought to be an inert delivery mechanism or something.

So are you suggesting that this study is some sort of gold standard of evidence? As near as I can tell they are describing the immunopathology of a certain condition, and the assertions of connections to autoimmune diseases, GBS in particular, are out of date. The major problem, of course, is that if indeed infectious agents play a role in the pathogenesis of autoimmune disease, there is no indication (and, in fact, it seems much less likely) that vaccines which invariably stimulate a lesser immune response would convey a higher risk of subsequent disease.

From UpToDate ("Pathogenesis of Guillain-Barré syndrome in adults"):

Influenza vaccination — In the United States, an increased risk of GBS was associated with the swine influenza vaccine in 1976, although the severity of the risk has been controversial [30,36]. Subsequently, no increased risk was observed up to 1991. Other data suggest that influenza vaccination is associated with a low or negligible risk of GBS.

• Individuals who received either the 1992-1993 or 1993-1994 influenza vaccinations were not at significantly increased risk for GBS, but combining the two seasons suggested that influenza vaccination resulted in approximately one additional case of GBS per million patients inoculated [37]. This risk appears to be substantially less than the overall health risk posed by naturally occurring influenza. The annual reporting rate of GBS following influenza vaccination in adults declined significantly from 1996-1997 through 2002-2003 in the US [38]. Nevertheless, the long onset interval for post vaccination GBS compared with other post vaccination adverse events (median 13 days versus one day, respectively) is consistent with a possible causal association between GBS and influenza vaccine.
  
• In a self-matched case control series from Ontario, Canada that identified 269 hospital admissions for GBS diagnosed within 42 weeks of receiving influenza vaccination, the estimated relative incidence of GBS during the primary risk interval (weeks two through seven after vaccination) compared with the control interval (weeks 20 through 43) was 1.45 (95% CI 1.05-1.99) [39]. However, a separate time-series analysis of 2173 hospitalized cases of GBS showed no statistically significant increase in hospitalizations for GBS after institution of the universal influenza vaccination program in 2000.
  
• A European case-control study of 105 patients with GBS matched to one or more controls found that the 2009 pandemic H1N1 influenza A vaccine did not increase the risk of GBS (adjusted odds ratio 1, 95% CI 0.3-2.7) [40]. The confidence interval indicated that the absolute effect of the vaccine could range from one avoided case to three excess cases of GBS per one million people who received the vaccination.
  
• In an analysis of 550 first-episode cases of GBS from 1995 to 2006 in a northern California healthcare database, a recurrent diagnosis of GBS was observed in 6 (1 percent) [41]. There were no cases of recurrent GBS among 107 patients who received influenza vaccination after the initial diagnosis of GBS, and none of the six individuals with recurrent GBS had any vaccine exposure in the two months prior to the onset of the second episode of GBS
  

Where are you finding these studies, by the way?

Here is another study: http://www.ncbi.nlm....pubmed/17114826. It's titled "Aluminum adjuvant linked to Gulf War illness induces motor neuron death in mice."

Animal experiments like this may be (1) underpowered and (2) without obvious relevance to, well, humans. I took a look at the article itself, and I'm not sure on the face of it whether it was adequately powered, and the outcome measures for "symptoms" are some set of behavioural tests where they comment on mice memory and anxiety.

I have no idea what to make of it, for the most part, except that the statistical analysis is not adequately documented or presented.

[Aemon Stark]

Meh, according to you guys there must of been thousands who died between the ages of 1 to 5 in the 60's and 70's. It's strange that I have no recollection of this. As I recall, the big concern was for young expectant mothers for measles, and adult men who hadn't gotten the mumps as children. I never got the measles, because I was probably vaccinated for it it 1963, not because there was an epidemic that year, but because the military told my mother that her kids should get the same vaccinations they were giving my father just before he was stationed overseas. Since my father was stationed to the far east 3 time before 1970, I was well vaccinated. I think 3 times for smallpox for instance.

So this idea 1 year olds need to be inoculated for all this stuff just boggles my mind. So produce the documentation that this is necessary before the age of 5 please. You want to support your position go ahead, because it seems to me that all you have done so far is pull shit out of your butts.

It's rather simple - at age 5, kids go to school, and anyone who has school age children or is exposed to them on a regular basis can tell you that they are reservoirs of viruses and infections.

And, to put it bluntly, diseases like polio, diptheria, pertussis, tetanus, Haemophilus and pneumococcal meningitis caused considerable mortality and morbidity in children and adults alike for thousands of years. Prevention of meningitis in particular has changed the face of acute care pediatrics - which is a good thing if you've ever participated on a septic workup for a neonate.

Of course, a better question would be to ask why we should not vaccinate before children attend school or daycare or whatever. The idea that you can "overwhelm" the "immature" immune systems of babies with dread vaccines is nothing more than a lay supposition.

[Seli]

One thing I don't enderstand is the vaccination scheduale, who does everyone one day old need a hep b shot? Why not wait, especailly for a disease with this type of transmission profile.

Probably because they don't know or are not allowed to know if the mother is Hep b positive. And birth is the one moment when the quite effective placental blood-blood barrier breaks down and cross-contamination is possible. A related injection is/was the rhesus jab all Rh- mothers got just after giving birth, which might have changed with the current options to check the child's blood type.

In the Netherlands the day0 Hep B injection is only given to babies when the mother is a carrier, but we do have different rules and regulations surrounding medical practices.

Apparently the Dutch system also only uses 4 repeats of 2 individual jabs in the first year, but one of those is a mixed one against (in its current form) Diphtheria, Pertussis, Tetanus, Polio, Haemophilus influenzae type b, Hepatitus b (where the first four are the traditional mix and the known killers), with the second jab just against Pneumococcal infection. MMR is a single jab at 14 months, combined with a meningococcus jab. (source in Dutch)

So no chickenpox yet, as far as I can tell

[RWHamel]

It's rather simple - at age 5, kids go to school, and anyone who has school age children or is exposed to them on a regular basis can tell you that they are reservoirs of viruses and infections.

And, to put it bluntly, diseases like polio, diptheria, pertussis, tetanus, Haemophilus and pneumococcal meningitis caused considerable mortality and morbidity in children and adults alike for thousands of years. Prevention of meningitis in particular has changed the face of acute care pediatrics - which is a good thing if you've ever participated on a septic workup for a neonate.

Of course, a better question would be to ask why we should not vaccinate before children attend school or daycare or whatever. The idea that you can "overwhelm" the "immature" immune systems of babies with dread vaccines is nothing more than a lay supposition.

So why not give the vaccinations at age 5 like I said if you read what I wrote. Why do it to 1 year olds?????????

[Aemon Stark]

One year olds are no less susceptible. And their immune systems are NOT anywhere near as fragile as you seem to be implying.

Why NOT protect children as early as possible?

There may indeed come a time when we no longer need vaccinate against polio, to take on example - the same cannot be said of H. flu, pneumococcus, or tetanus.

[RWHamel]

One year olds are no less susceptible. And their immune systems are NOT anywhere near as fragile as you seem to be implying.

Why NOT protect children as early as possible?

There may indeed come a time when we no longer need vaccinate against polio, to take on example - the same cannot be said of H. flu, pneumococcus, or tetanus.

So back up your position. If what you say is true, then the statistical data for newborns to 5 years should have a higher mortality for those diseases in the 1960's/1970's than currently. It should easily be demonstrated. Instead all I get is this evasive glib remarks about how the babies immune system can handle this. No proof. Just that I should accept this as fact. No evidence, and if this is the same rational that was used to get us here, then it's reckless.

[Aemon Stark]

So back up your position. If what you say is true, then the statistical data for newborns to 5 years should have a higher mortality for those diseases in the 1960's/1970's than currently. It should easily be demonstrated. Instead all I get is this evasive glib remarks about how the babies immune system can handle this. No proof. Just that I should accept this as fact. No evidence, and if this is the same rational that was used to get us here, then it's reckless.

You think I'm going to do some kind of exhaustive search of the epidemiology literature to satisfy your questioning?

But since I have UpToDate open already:

Excerpt from "Microbiology, epidemiology, and treatment of Haemophilus influenzae":

EPIDEMIOLOGY — By 18 months of age, one-third of children have had H. influenzae nasopharyngeal colonization with both typeable and nontypeable H. influenzae [7,15]. Carriage rates in households or day care centers with an index case can exceed 60 percent [8,16]. Colonization can persist for months, and intercurrent upper respiratory infection may promote invasive disease as well as enhance spread among close contacts [9,15,17-19]. Simultaneous colonization by multiple strains is common, and longitudinal monitoring demonstrates that colonization is a dynamic process, with a turnover of individual strains over time [19].

Since the introduction of Hib conjugate vaccines the incidence of invasive disease cause by H. influenzae in the United States has decreased dramatically. During 1989-2008, 7559 cases of H. influenzae disease were reported in the United States; the estimated mean annual incidence was 1.62 per 100,000 population and 15 percent of cases were fatal [20]. A considerable burden of non-Hib disease is still present in the oldest and youngest age groups. The largest burden of disease among children occurred in infants <1 year; many of these cases occurred during the first month of life in preterm or low-birth weight infants.

H. influenzae serotype b — H. influenzae is an exclusively human pathogen; it is transmitted from person to person via airborne droplets and direct contact with respiratory secretions [1]. Prior to the routine use of H. influenzae serotype b (Hib) conjugate vaccines in infants, invasive Hib was the leading cause of bacterial meningitis in children; 85 percent of these infections occurred in children under five years of age [21]. Hib was also a leading cause of epiglottitis, pneumonia, empyema, pericarditis, bacteremia, and septic arthritis. Clinical manifestations of invasive Hib infections reflect the organism's capacity for vascular invasion and establishing metastatic foci of infection including meningitis, septic arthritis, osteomyelitis and cellulitis [14].

Prior to routine vaccination, the incidence of invasive Hib disease varied from 67 to 130 cases per 100,000 children under five years per year, and the incidence of Hib meningitis was 40 to 69 cases per 100,000 children per year. This incidence was equivalent to approximately 25,000 cases of acquired invasive Hib annually in the United States, or invasive infection in 1 per 200 children in the first five years of life [22]. Some populations at increased risk had incidence up to four times this rate.

Before widespread immunization, the secondary attack rate among children who were household contacts of an index case was 0.3 percent, which is 500-fold higher than the age-adjusted risk in the general population [19]. This risk of secondary infection increased inversely with age; children under four years of age were at greatest risk, and clinical disease was most likely in the first 30 days after exposure to the index case [23-29].

However, the widespread use of conjugate Hib vaccines in infancy has resulted in a dramatic decline in invasive Hib disease in children to one case or less per 100,000 [4,30]. The incidence of invasive disease among individuals over five years of age has been stable at approximately 0.5 per 100,000 population.

Hib immunization has reduced carriage (and presumably transmission) and facilitated herd immunity. This reduction in carriage seems to be influenced by number and type of Hib immunizations as well as time post immunization. Consequently, the differences in immunization schedules internationally may result in differing carriage and disease patterns. In England, following a period of time when only infant Hib vaccination was practiced (without a toddler booster), there was waning immunity and some recurrence of Hib disease among toddlers. Investigators found that the point prevalence of Hib carriage among 855 British children ages 6 to 16 during this period (between 1999 and 2003) remained high (4 percent) [31].

The global burden of Hib disease is substantial; worldwide Hib caused about 8.13 million serious illnesses worldwide in 2000, with 371,000 deaths [32]. This is almost entirely vaccine preventable; expanded use of the Hib vaccine could reduce pneumonia, meningitis and mortality among children.

And if that's not enough for you, well, do your own research.

[Lord O' Bones]

They don't do the same kind of thing that the Gulf war vaccinations do. In addition, the GW ones were for things like Anthrax

After 8 injections and almost 20 years I am still waiting for my deleterious side effects.

What a rip-off.

[Robin Of House Hill]

I agree. I've been vaccinated for things I'm not even sure of the names of, with no adverse effects. The way I see it, if a child is vaccinated there is a remote possibility of some adverse effect which would harm the child. If the child is not vaccinated, there is a chance the child may suffer an adverse effect...contracting the disease the vaccine would have prevented, plus the child would become an agent of the contagion and spread the disease to others. Don't vaccinate the child and he/she becomes a potential biological weapon.

[RWHamel]

So when I look at a case study for Hiberix, and note that there 2 serious events out of the 1,008 test subjects I should then expect 198 to 199 serious events per 100,000 inoculations, correct. Wonderful. You don't happen to work for Glaxo Smith Kline?

[RWHamel]

I'm glad you two are OK. I have an uncle who was a hard hat diver in the Navy, who is in his 80's, and has been a chain smoker his entire adult life with no cancer or heart disease So by your logic, and that anecdotal evidence, I should conclude that smoking cigarettes is not bad for you.

[Aemon Stark]

So when I look at a case study for Hiberix, and note that there 2 serious events out of the 1,008 test subjects I should then expect 198 to 199 serious events per 100,000 inoculations, correct. Wonderful. You don't happen to work for Glaxo Smith Kline?

And you are finding this where? And a case study with 1,008 test subjects? Testing what? Under what criteria? What kind of adverse events were these?

Oh, and by the way:

Interests declared: none.

[RWHamel]

I'm looking here on the FDA's website.

[Aemon Stark]

It is absolutely impossible to assess what happened in either of those two cases without more information. In any case, this vaccine has been used for years, and if the rate of serious adverse events were as high as 0.2% we'd see a whole lot such events.

[IheartTesla]

FFS. You cant extrapolate 2 out of a 1000 to the general populace based on a single study.

I thought with all the exposure to all the political polls out there people would have figured out what kinds of error margins there are in sample sizes of 1000 (edit: and with the variable of interest as well)

I mean, its great we are in this post-Englightenment period where everyone can read anything about everything, but lets get other tools in hand as well to understand what we read.

[Lord O' Bones]

I'm glad you two are OK. I have an uncle who was a hard hat diver in the Navy, who is in his 80's, and has been a chain smoker his entire adult life with no cancer or heart disease So by your logic, and that anecdotal evidence, I should conclude that smoking cigarettes is not bad for you.

Why not? You seem perfectly sanguine about believing the least likely result.

Question everything important. Educate yourself as much as you can. But at some point you should recognize that you're leaving responsibility corner and entering paranoia square.

Also, still waiting on my promised mesothelioma.

[Merentha]

Look, RWHamel moved the goalposts over here now! Wait, now they've moved again.

Oh, also, just because you weren't aware of measles outbreaks doesn't mean there weren't any: From the CDC website:

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). In 1994, every dollar spent to purchase measles-containing vaccine saved $10.30 in direct medical costs and $3.20 in indirect societal costs (7).

That should be more closely related to what you're looking for than the HiB one, but its also worth mentioning that wild type polio has effectively been eliminated, as has smallpox, both thanks to vaccines. Mumps and rubella show similar patterns to measles. They're wildly successful. We went from 500 000 cases per year to 89 (in a good year). And that's with a population that almost doubled in that time frame. Fucking. Phenomenal.

[The Iceman of the North]

That should be more closely related to what you're looking for than the HiB one, but its also worth mentioning that wild type polio has effectively been eliminated, as has smallpox, both thanks to vaccines. Mumps and rubella show similar patterns to measles. They're wildly successful. We went from 500 000 cases per year to 89 (in a good year). And that's with a population that almost doubled in that time frame. Fucking. Phenomenal.

But RHW don't remember those deaths, so those hardly counts, right?

[Nukelavee]

I was born in '68, and I can remember quite a few kids I knew (related, school, friends) missing school, etc, due to chicken pox, measles, and mumps. Actually, my youngest sister still has scars from chicken pox.

I don't see near the number of kids laid up with those diseases now, Hamel, so.. seems like it was more common then, as opposed to now.

On the other hand, I've trained my immune system to convert pesky pathogens into sweet sweet calories.

[Guest Raidne]

Ix - thanks. That's what I'd like to be talking about - the compliance risks vs. risks of multiple vaccinations. Since the risks of latter seem to only apply to some people - and not very many - and the risks of the former apply to everyone, there's a good ethical discussion there to have about fairness to the individual vs. the greater good.

Merentha - Thanks for providing some further commentary on the data - MOST of the committee's findings were negative. That's not surprising to me - I always assumed most anti-vaccers were nuts also. What's surprising to me is that some of the findings were NOT negative, but nobody really talks about that out of fear of giving the anti-vaccers ammo that they can unscientifically use to support a wholly unjustified broader agenda. So, in the end, the public debate has little to do with the truth on either side and people who may belong to the small, affected group justifiably feel dismissed and align themselves with the anti-vaccers causing further distortion.

Aemon, I'm not hiding my sources. They are all linked. Go read them if you want to know more about them - that's why the links are there. Surely you don't want to rely on my summary if you have all of this relevant expertise? If you posted a case on something in a thread about a law, I'd read it, not ask you where it was from and what it meant because you wouldn't really know.