Properly evaluating vaccine mortality
The public’s concern about adverse events, especially death, immediately or soon after vaccinations is very disruptive to vaccine uptake, leading to increased morbidity and mortality of vaccine-preventable diseases. For example, a 2009 Japanese study that showed 107 deaths following H1N1 influenza A vaccination, assumed a causality between the vaccine and the deaths without any evaluation of background rates of of deaths, which would help indicate whether there was any significance to the death rate or even if its related to the vaccination.
Chen RT. Evaluation of vaccine safety after the events of 11 September 2001: role of cohort and case-control studies. Vaccine. 2004 May 7;22(15-16):2047-53. Review. PubMed PMID: 15121321.
It has been demonstrated that passively reported data, that is data that isn’t actively investigated by trained researchers, cannot be used to assess causality. In an active investigation, it was found that only 2 of the 107 deaths had an autopsy performed, and most of the others had other underlying diseases and conditions that were causally related to the mortality events. Furthermore, 15 million people were vaccinated with the H1N1 seasonal vaccine, and it would be expected that there would be >8000 deaths during the 20 days after vaccination using a crude mortality rate in Japan. Though it would still be a misuse of statistics, but there really is more evidence that the H1N1 vaccination lowered the death rate from 8000 to 107 post vaccination.
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Mandatory flu vaccinations cause healthcare workers to quit–a myth
One of the many myths of the vaccine denialism movement is that healthcare workers will quit if there is a mandatory vaccination, usually the flu. Many of the healthcare worker vaccine deniers base their opposition to vaccines based on thoroughly debunked lies about vaccinations. Their invented opposition to vaccines is in direction contradiction to their obligation to protect the health of patients. However, more and more healthcare systems are mandating the flu vaccine for their employees.
A four-year analysis of mandatory influenza (flu) vaccinations, which are a condition of employment at Loyola University Health System in Chicago, IL, showed no statistical increase in voluntary terminations of employees. In the first year of Loyola’s mandatory policy (2009-10 flu season), 99.2% of employees received the vaccine, 0.7% (yes, 0.7%) were exempted for religious/medical reasons, and 0.1% refused vaccination and chose to terminate employment with Loyola. In 2012, the last year of the study, the vaccination uptake rate at Loyola remained steady: 98.7% were vaccinated, 1.2% were exempted and 0.06% refused vaccination.
According to Dr. Jorge Parada, study author and professor of medicine at Loyola University Chicago Stritch School of Medicine, reported that ”in reality our numbers were even better than that, of the 5 persons who refused vaccination in the mandatory period, 3 were unpaid volunteers, who later reconsidered, received vaccine and returned to Loyola. The two other persons were part-time staff, each with only 10% time commitment at Loyola…truly reflecting a 0.002 vaccine refusal rate” reports Parada. The study showed that, over the course of four years, less than 15 staff, including volunteers, out of approximately 8,000 healthcare workers in the system, chose termination over vaccination. Loyola has sustained a 99 percent compliance average since adopting the mandatory flu vaccination protocol four years ago.
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Religious exemptions to vaccines elevates whooping cough rates
©Centers for Disease Control and Prevention, 2012
According to a new study published in Pediatrics, the number of New York state parents who skipped at least one required vaccine for religious reasons has increased over the past decade. And New York counties that had this increase in religious exemptions to vaccinations also had more whooping cough (Bordetella pertussis, or simply pertussis) cases, even among children that had been fully vaccinated.
For this study, the researchers tracked data from the New York State Department of Health on both religious exemptions and new whooping cough cases. Children were reported as having a religious exemption if they had been allowed to skip at least one required vaccine for non-medical reasons.
The key results from the study were:
- The overall state annual mean rate of religious exemptions increased significantly from 0.23 % in 2000 to 0.45% in 2011, almost doubling the rate over the decade.
- The prevalence of religious exemptions varied greatly among counties with no obvious trends, although all of the counties around New York City showed large increases in religious exemptions.
- Counties with mean religious exemption rates of >1% reported a higher incidence of pertussis. For counties with higher exemption rates, the rate of pertussis was 33 per 100,000 compared to counties with lower exemption rates, which had a pertussis infection rate of 20 per 100,000. The researchers determined that this difference was statistically significant.
- In addition, the risk of pertussis among vaccinated children living in counties with high exemption rate increased with increase of exemption rate among exempted children, also statistically significant.
The increase in whooping cough rates is particularly troubling since unvaccinated children not only put themselves at risk, but also those who have been vaccinated (as result of the lower effectiveness of the currently available pertussis vaccine). Also, as the exemption rate increases and there is a lower than expected effectiveness of the vaccine, the herd immunity becomes weaker.
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Big Pharma supports the antivaccine movement–the real conspiracy
One of the ongoing memes, beliefs and fabrications of the vaccine deniers is somehow, somewhere, in some Big Pharma boardroom, a group of men in suits choose the next vaccine in some magical way, and foist it upon the world just to make billions of dollars. And while magically concocting the vaccine brew, these pharmaceutical execs ignore ethics and morals just to make a profit on hapless victims worldwide.
The vaccine deniers pollute the internet with their screeds about the profits of vaccines. One of them said, “measles expert Offit has already made millions of dollars profit from his ties to vaccines and the measles MMR vaccine maker Merck.” Using a childish ad hominem, the article calls him, Dr. Paul “For Profit” Offit. Seriously, that’s how you’re going to “prove” that vaccines are a Big Pharma conspiracy?
You can find whole threads of tedious commentary about vaccine profits on any typical anti-vaccine forum. One of the more illogical claims is that “maybe vax companies see vaccines as more of an investment? Break mostly even on what the vaxes cost to make and sell, but make a bank load of money on treating all the chronic problems they cause!” Of course, that would be a business strategy that would be laughed out of the secret Big Pharma boardroom, because they know that vaccines don’t cause chronic problems. The vaccines prevent it.
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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.
Water fluoridation-an update
This is an update of an article from 30 January 2013 to include recent studies about the efficacy of fluoridation.
Water fluoridation is a controversy that just doesn’t seem to go away, despite the overwhelming evidence of successfully reducing the rate of cavities in children (and adults), while also having little or weak evidence that there are any risks. When I was a kid, I remember controversies about fluoridating water. But I just hated dentists, so to my young, immature scientific mind, if fluoridation kept me from the dentist, that was a good thing!
Today, fluoridated water has become ubiquitous in the USA and many other countries. Unless you drink bottled or filtered water, or avoid fluoride toothpastes (or mouthwashes), most children and adults get an adequate level of fluoride to maintain good dental health. I actually thought that the fluoridation controversy had passed into history with rotary phones, the Soviet Union, and the slide rule.
Yes, there are groups that still fight against water fluoridation, and there are many people who think that fluoridation is bad.
The John Birch Society, a right wing conspiracy group that I thought had passed into history, still considers water fluoridation to be mass medicine and once thought of it as a communist plot to poison Americans (see Schneider & Lilienfeld, 2011). Ironically, on the opposed side of the political spectrum, leftists, like the UK’s Green Party, are opposed to fluoridation because of the mass medicine idea, a concern occasionally expressed by antivaccine proponents. So it’s really not a right or left political issue. It seems to be, like many medical issues (for example, vaccinations), a matter of good science versus bad science (or even no science).
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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.
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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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.
Water fluoridation-the 47 millionth blog post on the issue
When I was a kid (probably 6 or 7), there was a big controversy in our community whether the water would be fluoridated or not. Now, I was just becoming fascinated by science, medicine, health, and sports at that time, so I tried to figure out what was happening. To my ears and adolescent brain, the argument boiled down to no fluoridation (which meant cavities and visits to the dentist) vs. fluoridation (which was a communist conspiracy). Scary choices. Though Nazi dentists were also plenty scary.
But I grew up, and fluoridation because more common. Water systems are mostly fluoridated (unless you drink bottled water). And fluoride is in toothpaste and various mouthwashes. I thought the fluoridation controversy had passed into history with rotary phones, Soviets, and the slide rule.
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Tamiflu-does it work
According to the CDC, this year’s flu season is pretty serious in the USA. Current data, shows that about 4.6% of patient visits to health care providers are for influenza like illnesses (ILI). Thirty states and New York City are now reporting high ILI activity; an increase from 24 states last week. Additionally, 10 states are reporting moderate levels of ILI activity. Forty-eight states reported widespread geographic influenza activity for the week of January 6-12, 2013. This increased from 47 states in the previous week.
Although there has been a slight drop-off in ILI visits over the past couple of weeks since the peak in early January, the CDC continues to identify this season as a “moderately severe” one, and supplies in some areas have tight supplies of the flu vaccine.
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The 2012-13 flu season getting deadlier
The CDC is reporting that influenza activity continues to increase in the United States and most of the country is now observing high levels of influenza-like-illness (ILI). ILI reports are approaching levels that usually seen during moderately severe flu seasons. Of course, the CDC continues to recommend vaccinations for the flu, and antiviral treatment if appropriate.
According to Dr. Joe Bresee, Chief of the Epidemiology and Prevention Branch in CDC’s Influenza Division, “While we can’t say for certain how severe this season will be, we can say that a lot of people are getting sick with influenza and we are getting reports of severe illness and hospitalizations. Anyone who has not already been vaccinated should do so now. And it’s important to remember that people who have severe influenza illness, or who are at high risk of serious influenza-related complications, should get treated with influenza antiviral medications if they get flu symptoms regardless of whether or not they got vaccinated. Also, you don’t need to wait for a positive laboratory test to start taking antivirals.”
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A child dies from the flu in Maine
Yesterday, I wrote about the CDC reports regarding pediatric deaths from the flu. Those were just numbers, but there are real kids and real parents of those kids who constitute those numbers.
The Maine Public Broadcasting Network (MPBN) reported about the death of an elementary school child from the flu. The child was healthy, so it wasn’t that the flu increased some risk factor because of an underlying disease.
According to Maine’s CDC Director, Dr. Sheila Pinette, pediatric flu deaths are not common in the state. She stated that flu can be fatal in people who are elderly or have a compromised health status, but this elementary school child was believed to be healthy. Dr. Pinette wants everyone to get vaccinated against the flu, unless the vaccine is medically contraindicated (which is very very rare). According to the MPBN article, “that’s an expansion from previous CDC recommendations that focused on the young, the elderly, and health care workers.”
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Pediatric flu vaccination–it saves children’s lives
If you have any reluctance about having your children receive their annual flu vaccination, look at the chart below:
Children die from the flu virus–282 innocent children died from the flu in 2009-10, 122 in 2010-11, 34 in 2011-12. So far this flu season, 6 children have died. The number varies from highs during pandemic years, such as in 2009-10, and lower in non-pandemic years.
The CDC predicts that 2012-13 could be serious, and the current flu vaccine protects against 3 subtypes of the seasonal flu in North America:
- A/California/7/2009 (H1N1)-like
- A/Victoria/361/2011 (H3N2)-like
- B/Wisconsin/1/2010-like
There are no valid excuses for avoiding a flu vaccination. Just in case you believe the myths about the flu vaccine, they’re not true. The vaccine does not itself cause the flu. The vaccine is safe for pregnant women. And most of the other myths have been solidly debunked.
Get a flu vaccination for your kids. Because Vaccines Save Lives.
Key citations
- Centers for Disease Control and Prevention. 2012-2013 Influenza Season Week 49 ending December 8, 2012.
- Centers for Disease Control and Prevention. Final estimates for 2009–10 Seasonal Influenza and Influenza A (H1N1) 2009 Monovalent Vaccination Coverage – United States, August 2009 through May, 2010.
- 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). Misconceptions about Seasonal Influenza and Influenza Vaccines.
West Virginia tough on vaccine exemptions
The state of West Virginia (WV) has one of the toughest child vaccination regulations in the United States, not allowing any religious exemptions to vaccinations required before attending school. Only Mississippi has regulations this strict for allowable exemptions. Of course, as I have written, religious exemptions have been abused by vaccine deniers by creating “fake” religions so that parents’ antivaccination beliefs will be recognized by the state. In fact, only medical exemptions are accepted by the state (pdf), and their standards on who can meet the medical exemption are quite tough.
Flu during pregnancy linked with increased risk of autism
Autism Spectrum Disorders (ASD) appear to be an increasing medical issue in the United States. According to the Centers for Disease Control and Prevention, ASD is diagnosed in approximately 1 in 88 children, and are reported to occur in all racial, ethnic, and socioeconomic groups. ASD refers to a broad range of symptoms, from mild social awkwardness to mental retardation, repetitive behaviors and an inability to communicate. The CDC states that diagnosing ASD can be difficult, because there are no medical tests, such as a genetic or blood test, that can provide a definitive diagnosis. Physicians make a diagnosis through observation of a child’s behavior and development.
Medical science agrees that the increase in diagnosis is not only a result of better diagnostic standards, but also because there appears to be more children who are actually developing autism. Unfortunately, science has not uncovered the cause. Genetics are a critical factor, for example, since it has been shown that if one twin has autism there is a high likelihood that the other twin will also develop ASD. But are there other factors?
Science-based vaccine search engine
I have updated this website with a new science-based vaccine search engine powered by Google™. It basically searches about 200 websites that are science oriented (usually providing peer-reviewed articles, or links to those articles) and focused on vaccines. You can find it by clicking on the menu bar, and going to Vaccine FAQ’s.
Science-based vaccine search engine.
By the way. Vaccines Save Lives.
Repeated contact with mumps may overwhelm immunization
A recent study, published in The New England Journal of Medicine, concluded that after an intense face-to-face educational technique, used among Orthodox Jews, apparently led to an outbreak of mumps in 2009 and 2010, despite high vaccination rates in the group. In a one-year period, from June 28, 2009, through June 27, 2010, 3,502 cases of mumps were reported in New Jersey, New York City and New York’s Orange and Rockland counties. The study examined 1,648 of those cases, 97% were Orthodox Jews, and found 89% had received two doses of the vaccine and 8% received one dose, a relatively high rate of vaccination.
Many of the individuals attended a religious school where they practiced an intense training technique called chavruta, which involves close contact with a partner across a narrow table. Partners change frequently, and he discussion is often loud and may involve shouting since a larger group may be close to each other, all trying to make an argument or point. This prolonged contact overwhelmed the immunity, from the mumps vaccination (part of the MMR vaccine), for individuals. The study did find high rates of two-dose coverage reduced the severity of the disease and the transmission to people in settings of less exposure. Also, the study found that mumps did not spread outside of the Orthodox Jewish community in the area, further supporting the overall effectiveness of the mumps vaccine in the broader community.
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CDC recommends pertussis vaccination for all pregnant women
On October 24, 2012, the Centers for Disease Control and Prevention recommended that “providers of prenatal care implement a Tdap immunization (Tdap or DTaP vaccine) program for all pregnant women. Health-care personnel should administer a dose of Tdap during each pregnancy irrespective of the patient’s prior history of receiving Tdap. If not administered during pregnancy, Tdap should be administered immediately postpartum.” This recommendation is based upon the Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts that develops recommendations on how to use vaccines to control diseases in the United States, guidelines, published Fall 2011, for whooping cough(Bordetella pertussis).
ACIP reviewed published and unpublished data from VAERS, Sanofi Pasteur (Adacel) and GlaxoSmithKline (Boostrix) pregnancy registries, and two small studies here and here. ACIP concluded “that available data from these studies did not suggest any elevated frequency or unusual patterns of adverse events in pregnant women who received Tdap and that the few serious adverse events reported were unlikely to have been caused by the vaccine.” In addition, both tetanus and diphtheria toxoids (together) and tetanus toxoid (alone) vaccines have been used worldwide in pregnant women to prevent neonatal tetanus without negative effects. The ACIP concluded that administration of the pertussis vaccine after 20 weeks of pregnancy was preferred to minimize any risk of a low percentage adverse event.
According to the CDC, only about 3% of pregnant women receive the vaccination. However, the CDC believes if the new recommendations are implemented, there would be a 33 percent reduction in cases, a 38 percent reduction in hospitalizations and a 49 percent reduction in deaths from whooping cough.
Vaccines Saves Lives.
Use the Science-based Vaccine Search Engine.
Key citations:
- Centers for Disease Control and Prevention. CDC Advisory Committee for Immunization Practices Recommends Tdap Immunization for Pregnant Women. October 24, 2012.
- Centers for Disease Control and Prevention (CDC). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged <12 months — Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. 2011 Oct 21;60(41):1424-6. PubMed PMID: 22012116.
- Czeizel AE, Rockenbauer M. Tetanus toxoid and congenital abnormalities. Int J Gynaecol Obstet. 1999 Mar;64(3):253-8. PubMed PMID: 10366047.
- Gall SA, Myers J, Pichichero M. Maternal immunization with tetanus-diphtheria-pertussis vaccine: effect on maternal and neonatal serum antibody levels. Am J Obstet Gynecol. 2011 Apr;204(4):334.e1-5. Epub 2011 Jan 26. PubMed PMID: 21272845.
- Talbot EA, Brown KH, Kirkland KB, Baughman AL, Halperin SA, Broder KR. The safety of immunizing with tetanus-diphtheria-acellular pertussis vaccine (Tdap) less than 2 years following previous tetanus vaccination: Experience during a mass vaccination campaign of healthcare personnel during a respiratory illness outbreak. Vaccine. 2010 Nov 23;28(50):8001-7. Epub 2010 Sep 25. PubMed PMID: 20875487.
State legislatures making vaccine exemptions more difficult to obtain
Outstanding news. Tara Haelle reported in Nature News & Comment 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 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, 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.
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