Comparing effectiveness of two types of pertussis vaccines
Over the past year or so, there have been several outbreaks of whooping cough (Bordetella pertussis), including one that reached epidemic levels in Washington state, which has been considered one of the worst pertussis outbreaks in the USA during the past several decades. The disease lead to 18 infant deaths from whooping cough during 2012.
The original DTP vaccine (diphtheria, tetanus and pertussis) became available in the USA in 1948 and was critical to dropping the number of cases of whooping cough from 260,000 in 1934 to less than a few thousand per year in the 1990′s. The original vaccine contained what was called “whole-cell” pertussis, which includes all of the antigens of the pertussis bacterium, partially because it wasn’t understood (and to some extent still not fully understood) which antigens on the bacteria actually induce the proper immune response to have the body destroy a pertussis infection.
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Flu during pregnancy is associated with bipolar disorder in children
A recent article published in a leading psychiatry journal, JAMA Psychiatry, has shown that pregnant mothers’ exposure to the influenza (flu) was associated with a nearly 4X increase in risk to their child eventually developing bipolar disorder in adulthood. These findings add to mounting evidence of possible shared underlying causes and illness processes with schizophrenia, which some studies have also linked to prenatal exposure to influenza. Bipolar disorder, historically called manic depressive disorder, is a mood disorder where the sufferer can experience episodes of a frenzied state known as mania (or hypomania), typically alternating with episodes of depression. It can be treated with medications and psychotherapy (especially cognitive therapy), but more difficult cases require the individual to be voluntarily or involuntarily institutionalized until the mood changes can be reduced or eliminated.
Updated: make religious vaccine exemptions more difficult to obtain
A recent report indicated that US state legislatures are beginning to pass laws that make it more difficult for parents to obtain so-called personal exemptions to vaccinations before children attend public schools. According to the author, Tara Haelle, “Each US state sets its own vaccination policies, and most will not generally allow children to attend public school unless they have been vaccinated against diphtheria, tetanus and pertussis (whooping cough); hepatitis B; the Haemophilus influenzae bacterium; measles, mumps and rubella; polio; and varicella (chicken pox).” In general, most states require that students meet the Centers for Disease Control and Prevention schedule (pdf) for children between 0 and 6 years old, which is set by the Advisory Committee on Immunization Practices.
All states allow legitimate medical exemptions from the immunization schedule before a child enters school, because of certain medical conditions that might make vaccinations problematic for young children. Some of these medical issues are: allergies to some of the components in the vaccines, immunocompromised conditions, family history of seizures, and other issues outlined in the General Recommendations on Immunization of the Advisory Committee on Immunization Practices. These medical exemptions are extremely rare, but are very important. A licensed medical doctor is the only one that should provide this exemption.
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Consequences of not vaccinating–Report 5
A baby died in Florida from whooping cough (Bordetella pertussis) last week. According to the report, “officials said the family chose not to vaccinate their child. Some parents are choosing not to fully vaccinate their children because they worry there is a link between the vaccinations and autism.” Of course, there is no evidence that vaccines cause autism.
Let’s place the blame for this death right where it belongs, right at the feet of Mr. Andy Wakefield, the de-licensed physician, who caused the drop in MMR vaccine uptake through his fraudulent claim that MMR caused autism. Wakefield is a horrible excuse for a human being, and probably should take responsibility for this and many other deaths that resulted from his fraudulent and retracted study claiming that vaccines cause autism.
Parents have a moral obligation to vaccinate their children.
We have a moral responsibility for the health of our children and this has to dominate any other belief systems we hold. Even worse, by not vaccinating children, we are putting other people’s children at risk, as well as our own. If another child dies of measles, or whooping cough, or meningitis, and was infected by our own, non-vaccinated child, are we partly responsible?
And they should start by ignoring Wakefield’s lies. Because vaccines would have saved this baby’s life.
Use the Science-based Vaccine Search Engine.
Key citations:
- Retraction–Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 2010 Feb 6;375(9713):445. doi: 10.1016/S0140-6736(10)60175-4. PubMed PMID: 20137807.
- Carrillo-Marquez M, White L. Current controversies in childhood vaccination. S D Med. 2013;Spec no:46-51. Review. PubMed PMID: 23444591.
Vaccines saves lives–HPV scientific evidence part 2
© Copyright CSL, 2013. All Rights Reserved.
Human papillomavirus (HPV) is a virus from the papillomavirus family that is capable of infecting humans. Like all papillomaviruses, HPVs establish productive infections only in keratinocytes of the skin or mucous membranes, making it easily transmitted sexually or through other intimate contact. While the majority of the known types of HPV cause no symptoms in most people, some types can cause warts (verrucae). HPV types 16 and 18 cause approximately 70% of cervical cancers, and cause most HPV-induced anal, vulvar, vaginal, and penile cancers. The HPV quadrivalent vaccine, also known as Gardasil (or Silgard in Europe), is marketed by Merck. The vaccine prevents the transmission of certain types of HPV, specifically types 6, 11, 16 and 18.
Consequences of not vaccinating–Report 4, meningitis and education
This is the fourth in a series of reports about actual consequences from not vaccinating against infectious diseases. The reports are all based on verifiable reports from health agencies and/or articles published in high impact peer-reviewed journals.
Bacterial meningitis is a usually severe inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. While most people with meningitis recover, it can cause serious complications, such as brain damage, hearing loss, or learning disabilities. For example, in the United States, about 4,100 cases of bacterial meningitis, including 500 deaths, occurred each year between 2003–2007.
There are several pathogens that can cause bacterial meningitis including Haemophilus influenzae (most often caused by type b, often called Hib), Streptococcus pneumoniae, group B Streptococcus, Listeria monocytogenes, and Neisseria meningitides. Depending on the pathogen, bacterial meningitis is highly contagious, especially among groups that are in enclosed areas such as schools, college dormitories and other such situations. There are other types of meningitis, viral, fungal, parasitic and non-infectious, but they are significantly different than bacterial meningitis, about which is the focus of this article.
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Consequences of not vaccinating–Report 3
If you don’t follow the news out of Wales on a regular basis, then you might not know that that there is an epidemic of measles in that part of the UK. According to Public Health-Wales, there have been 886 cases of measles from 1 November 2012 through 22 April 2013. This compares to around 0-3 cases per year in the late 90′s and early 00′s. The numbers have slowly risen to peak at 159 cases in 2009. The slow increase in number of measles cases correlates with the drop in MMR vaccine uptake to around 89% by age 5, far below the 95% level that Public Health-Wales has established for MMR vaccinations.
Measles (also called rubeola, not to be confused with rubella, or German measles) is a respiratory disease caused by the measles virus. Measles virus normally grows in the cells that line the back of the throat and lungs. Measles is spread through respiration (contact with fluids from an infected person’s nose and mouth, either directly or through aerosol transmission), and is highly contagious—90% of people without immunity sharing living space with an infected person will catch it. There is no specific treatment for the disease.
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Consequences of not vaccinating a child–Report 2
Angelina at five, just before onset of SSPE
I am creating a new series, “Consequences of not vaccinating a child”, documenting individual or large group cases, where children are specifically harmed by not being vaccinated. I first published this story in May 2012, but I thought it would be fitting to republish it now, along with some updates.
One of the memes of the vaccine denialists is that childhood diseases, like measles or whooping cough, are not dangerous. In fact, some parents have set up “pox parties” to deliberately expose their children to these diseases, because anti-vaccine lunatics believe (with all evidence against their beliefs, typical of any science denialist) that natural immunity is better than a vaccine induced immunity. Not only is that an Appeal to Nature fallacy, but it shows ignorance on how immunity occurs.
Measles (also called rubeola, not to be confused with rubella, or German measles) is a respiratory disease caused by the measles virus. Measles virus normally grows in the cells that line the back of the throat and lungs. Measles is spread through respiration (contact with fluids from an infected person’s nose and mouth, either directly or through aerosol transmission), and is highly contagious—90% of people without immunity sharing living space with an infected person will catch it. There is no specific treatment for the disease.
Even though vaccine denialists will claim that measles is not dangerous, not backed up with evidence, it is actually a fairly dangerous disease. According to the CDC, some of the complications of measles are:
About 30% of measles cases develop one or more complications, including:
- Pneumonia, which is the complication that is most often the cause of death in young children.
- Ear infections occur in about 1 in 10 measles cases and permanent loss of hearing can result.
- Diarrhea is reported in about 8% of cases.
These complications are more common among children under 5 years of age and adults over 20 years old (usually those with lapsed immunity).
Even in previously healthy children, measles can be a serious illness requiring hospitalization. As many as 1 out of every 20 children with measles gets pneumonia, and about 1 child in every 1,000 who get measles will develop encephalitis. (This is an inflammation of the brain that can lead to convulsions, and can leave the child deaf or mentally retarded.) For every 1,000 children who get measles, 1 or 2 will die from it. Measles also can make a pregnant woman have a miscarriage, give birth prematurely, or have a low-birth-weight baby.
Consequences of not vaccinating a child–Report 1
Vaccine deniers love to say that many (and some say all) vaccine preventable diseases are not dangerous, so why even take a tiny risk of an adverse event with vaccines to prevent these innocuous, harmless diseases. The problem with that belief is that it is simply untrue.
The CDC reported last week about a previously healthy 15 year old girl in Ohio who died from a chickenpox (Varicella zoster virus), a disease that is generally prevented by the varicella vaccine. The adolescent girl was admitted to a hospital after three days of a rash consistent with chickenpox with the last day experiencing fever and shortness of breath. The young girls was started on antibiotics and antifungals, to treat any concurrent infections, but she died three weeks later. The girl was current (or close to current) on her other vaccinations, MMR, DTaP, and Hib, but lived in an area that with low uptake of varicella vaccinations. Because deaths from chickenpox are so rare (about 100 people die of chickenpox every year in the USA), but not unknown, the Ohio Department of Health undertook a thorough investigation and concluded that the girl died from chickenpox, and there were no other comorbidities, including leukemia (which might have suppressed her immune system).
The complications from chickenpox occur mostly in susceptible groups such as infants, pregnant women, and immunocompromised individuals. Some of the more serious complications are:
- dehydration
- pneumonia
- bleeding problems
- infection or inflammation of the brain (encephalitis, cerebellar ataxia)
- bacterial infections of the skin and soft tissues in children including Group A streptococcal infections
- blood stream infections (sepsis)
- toxic shock syndrome
- bone infections
- joint infections
It was very difficult to read the article. Most of the young girl’s organs failed, and she was in respiratory distress when she died. I cannot imagine being a parent watching what happened over three weeks while she was in the hospital. I can only imagine that the parents are beating themselves up over not having her vaccinated.
For those parents who are engaging in Pox Parties, where parents deliberately infect their children with flu, chickenpox and other vaccine-preventable diseases, understand that you might be putting your child at risk of dying. Please don’t do it.
Vaccines do save lives.
Use the Science-based Vaccine Search Engine.
Key citations:
- Centers for Disease Control and Prevention (CDC). Varicella death of an unvaccinated, previously healthy adolescent – ohio, 2009. MMWR Morb Mortal Wkly Rep. 2013 Apr 12;62:261-3. PubMed PMID: 23575238.
Vaccines saved lives–scientific evidence
There are many canards propagated by vaccine denialists to support their personal beliefs (or denialism) about the safety and effectiveness of vaccines. One of their more popular beliefs is that vaccines didn’t end many of the deadly diseases, but improved sanitation, healthcare, nutrition or magical fairies (also known as homeopathy) ended these diseases. There is even a subgroup of these believers who think that the CDC, historians, and everyone else is lying about the epidemics that existed prior to vaccinations–let’s call this group history deniers.
So, is there scientific evidence that vaccines actually ended these epidemics? Yes there is, and it’s unequivocal. Unless you want to deny history, and somehow all of the health care records and epidemiological information was faked.
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How vaccines saved millions of lives
Infographic: How People Died In The 20th Century
Over 5.2 billion people died in the 20th Century. Although the 20th Century ended a mere 13 years ago, from a statistics standpoint, we know we will probably die of different diseases (and other less natural causes) than our forebears. The causes of death evolve over time as medicine improves, science ameliorates risk, lifestyles change, environments shift, and politics reshape our world. British data journalist David McCandless (of Information is Beautiful) created this fascinating infographic based on a project, commissioned by the Wellcome Trust, a U.K. charity devoted to human health, called Death in the 20th Century, which shows us, graphically, the leading causes of mortality from 1900 to 2000, worldwide.
Some of the numbers are shocking. Humanity is the cause of nearly 1 billion (or just short of 20%) of the deaths in the 20th Century. These numbers include war, murders, religious intolerance, suicide, and other deadly crimes that humans perpetrate against one another. Maybe the 21st Century will knock that number down, though I doubt any of us are optimistic given the way this century has started.
But the most interest information is in the Infectious Disease section. Nearly 1.7 billion people have died from infectious diseases. Some of the more interesting numbers are:
- Diphtheria–0.76 million deaths
- Hepatitis B–12.7 million deaths
- Measles–96.7 million deaths
- Meningitis-21.9 million deaths
- Polio–0.13 million deaths
- Smallpox–400 million deaths (yes, 400 million)
- Tetanus–37.1 million deaths
- Whooping cough–38.1 million deaths
In the 21st Century, the numbers of deaths from these diseases will probably be in the few thousand worldwide. Why? Because of vaccines. Not better sanitation. Not better health care facilities. But because of vaccines.
And in the 21st Century, as more vaccines are developed and brought to market, many of these infectious diseases will be less of a problem.
Vaccines saves lives. Literally hundreds of millions of lives.
Use the Science-based Vaccine Search Engine.
CDC: 90 percent of children who died from flu not vaccinated
The 2012-2013 flu season is beginning to wind down from a moderately severe season. Sadly, according to the CDC, 105 children died this season from the flu. And a preliminary review of the data by the CDC found that 90% of those children who died were not vaccinated for this season’s flu. In case that wasn’t clear, over 90 children died from influenza, a vaccine-preventable disease.
This review by the CDC indicated that 60 percent of deaths occurred in children who were at high risk of developing serious flu-related complications, but 40 percent of the children, who had died, had no recognized chronic health problems. The proportions of pediatric deaths occurring in children who were unvaccinated and those who had high-risk conditions are similar to what the CDC has observed in previous flu seasons.
Earlier this flu season, the CDC had strongly recommended that children get the flu vaccine, and those who had never been vaccinated for the flu before, get two doses of the vaccine. And despite the various myths about the flu vaccine, it is extremely effective, it will not give a child the flu, and it has an incredibly high safety profile.
Many of us who discuss medicine know that every medical procedure involves a risk and a benefit. With the flu vaccine, there are few risks, and even those are minor. But the benefit is immense for children. Saving lives. And in my view of the world, saving even one life, one child, is worth it. Parents who don’t give the flu vaccine to their children put them at a small, but significant risk of severe complications to the flu, up to and including death. Maybe next year someone will read this article, and think, “I want to save my child’s life.” I can only hope.
Visit the Science-based Vaccine Search Engine.
Key citations:
- Centers for Disease Control and Prevention (CDC). Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)–United States, 2012-13 influenza season. MMWR Morb Mortal Wkly Rep. 2012 Aug 17;61(32):613-8. PubMed PMID: 22895385.
- Centers for Disease Control and Prevention. CDC Reports About 90 Percent of Children Who Died From Flu This Season Not Vaccinated. March 22, 2013.
Survey identifies reasons for not vaccinating teens
Vaccines are one of the most important and crucial aspects for the long-term health of babies and young children. Except for a tiny, and irresponsible, minority of individuals who are opposed to vaccinations, greater than 95% of children are fully vaccinated for most vaccine preventable diseases by kindergarten. Unfortunately, a recently published article in Pediatrics provided evidence that teens are not keeping up with vaccinations that are critical to avoid infections from serious, and deadly, diseases. The study examines how vaccination rates have changed over the three year study period, and some of the reasons why they are not getting vaccinated.
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I get an email about Gardasil
I get lots of email about my articles that are published here. Sometimes, it’s about grammar or spelling (and the grammar KGB can be uncivil at times). Sometimes, it’s compliments or questions about what I’ve written. Rarely, they’re rude and usually include quite immature comments about the location of my head. However, I recently received an email that is more or less polite, but is filled with so many errors and logical fallacies, that I thought it should be critiqued publicly.
Here are my point-by-point comments about the email:
I stumbled across your blog and could not believe what I was reading about the safety of Gardasil. As a mother of a Gardasil injured daughter, your profuse endorsement made me skeptical. I want to begin by saying I am not anti-vaccine; I am anti-Gardasil.
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Flu vaccinations and work
HPV–early vaccination maximizes effectiveness
HPV protesters in Texas.
Human papillomavirus (HPV) is a virus from the papillomavirus family that is capable of infecting humans. Like all papillomaviruses, HPVs establish productive infections only in keratinocytes of the skin or mucous membranes, making it easily transmitted sexually or through other intimate contact. While the majority of the known types of HPV cause no symptoms in most people, some types can cause warts (verrucae). HPV types 16 and 18 cause approximately 70% of cervical cancers, and cause most HPV-induced anal, vulvar, vaginal, and penile cancers. The HPV quadrivalent vaccine, also known as Gardasil (or Silgard in Europe), is marketed by Merck. The vaccine prevents the transmission of certain types of HPV, specifically types 6, 11, 16 and 18.
Although the safety of HPV vaccine has been thoroughly vetted for safety in studies with large cohorts, the long time period (up to decades) from infection to a diagnosis of an HPV-related cancer has left questions about how to maximize effectiveness of the vaccine which required further research.
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Slight risk of Guillain-Barré syndrome after H1N1 flu vaccination
The H1N1 influenza pandemic of 2009 was the second pandemic in recent history that resulted from the H1N1 influenza virus, also known as the swine flu. The first one, known as the 1918 flu pandemic, killed over 50 million people, or about 1-3% of the world’s population at the time. The 2009 pandemic, though not as serious as the one in 1918, probably killed over 500 thousand people worldwide. In the United States, the CDC estimated that between 43 and 89 million people were infected with the 2009 H1N1 flu. They also estimated that of those, about 200-400 thousand were hospitalized, and approximately 12,470 died. The only reason the pandemic wasn’t worse was probably as a result of an effective H1N1 vaccine along with a broad effort to vaccinate those at highest risk of complications.
Along with the vaccination program, comprehensive safety surveillance was initiated to monitor for adverse events. This program identified a small increase in Guillain-Barré syndrome following the H1N1 vaccination. In paper published this week, researchers did a meta-analysis of the data from the monitoring program to quantify the level of risk.
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Waning whooping cough immunity after DTaP–a new analysis
Despite the fact that over 95% of kindergarteners in the United States are properly vaccinated against whooping cough(Bordetella pertussis) with the DTaP vaccine, there are persistent reports that the rates of whooping cough have risen during the past few years. Several outbreaks, along with an outright epidemic in Washington state, seemed to indicate that the vaccine’s effectiveness is waning faster than expected.
A recently published study in Pediatrics evaluates reports of increased rates of pertussis in the six years after receipt of the fifth (of five) DTaP doses. These reports suggest that waning of immunity to pertussis from DTaP is occurring before the recommended booster age of 11 to 12 years. The researchers tracked more than 400,000 Minnesota and Oregon children using immunization records and state health department whooping cough data. All of those children were born between 1998 and 2003 and received the recommended series of five DTaP shots, the final one usually given at 4-6 years old.
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Measles outbreak in South Wales, UK
Public Health Wales has reported an outbreak of almost 190 reported cases of measles in South Wales since November 2012. They are focusing their investigation in Swansea and Neath Port Talbot, where 189 cases have been confirmed. Cases have been notified in 32 secondary and primary schools and nurseries across the area, with 20 cases notified in the last week alone.
According to Dr Marion Lyons, Director of Health Protection for Public Health Wales, stated that “people most at risk of catching measles are children of school age who have not had two doses of MMR. We estimate that there are more than 8,500 school age children at risk of measles in the ABMU area at present due to their MMR status. Children should have their immunisation record, including MMR status, checked at the beginning of primary and secondary school and on leaving secondary school. We cannot emphasise enough that measles is an illness that can kill, or leave patients with permanent complications including severe brain damage, and the only protection is two doses of the MMR vaccination.”
The only protection against measles is the MMR vaccination. There are no other methods to protect a child from measles, other than isolation in a bubble against an outbreak. And despite the fraudulent claims of Mr. Andrew Wakefield and his acolytes, minions, and disciples, the MMR vaccine is safe and effective. And it does not cause autism.
Measles is just so contagious, that one unvaccinated child with the infection can pass it to nearly anyone that lacks immunity to the disease. An infected child can walk into a pediatrician’s office, where there may be infants who are too young for the vaccination, and pass it to them. Measles is not just a simple disease with a few red spots on your skin. It can lead to more serious complications like encephalitis and corneal scarring. In fact, complications are more frequent and severe in older teenagers and young adults (even if healthy), so the need for vaccination has significant benefits even if you’re an adult.
In general, about 30% of children who contract measles develop a more serious complication such as diarrhea, ear infections (leading to deafness) and pneumonia. About 5% of cases require hospitalization from pneumonia, about 1 in 1000 will contract encephalitis, and 1-2 out of a 1000 who get measles dies. Measles kills over 1 million children per year. And these risks are about the same for adults who contract the disease.
Many children are unvaccinated in South Wales. Maybe it’s because they believe the false information promoted by Wakefield and other vaccine deniers. Maybe they forgot to update or complete the vaccination series. Maybe they can’t afford the vaccine (though I don’t think that’s an issue in the UK’s public health system.) It’s the lack of immunized children that have caused this outbreak. Hopefully, parents will see the scientific truth and protect their children.
Vaccines Save Lives.
Early 2013 estimates of flu vaccine effectiveness–an analysis
This week, the Centers for Disease Control and Prevention (CDC) issued an interim report on the effectiveness of this season’s flu vaccine in the United States. Because these reports will be cherry picked for data by vaccine denialists (and may cause vaccine supporters to worry about their support of this particular vaccine), I want to look at the data carefully, and make sure we understand what is exactly reported.
