“Natural immunity” is the trope du jour of the anti-vaccine world – they want us to believe that contracting a dangerous pathogen is somehow better than preventing that disease with a vaccine. Their pseudoscientific beliefs rely upon logical fallacies, a complete misunderstanding of how the immune system works, and a healthy dose of bad math.
In other words, the same old same old from our anti-vaxxer “friends.”
The purpose of this article is to discuss why natural immunity is a bogus concept when it comes to vaccines. I need to make one warning upfront – immunology is complicated and cannot be described in 1000 words or less. So, I’m going to do a lot of linking to good articles that describe various things about the immune system.
This new (for the USA) hexavalent vaccine is intended for intramuscular injection as a 3-dose series given at 2, 4, and 6 months of age. However, the initial dose may be given to infants as early as 6 weeks. The vaccine may be used to complete the hepatitis B immunization series. However, one additional dose of a pertussis-containing vaccine must be added to the 3-dose hexavalent vaccine schedule to complete the immunization against pertussis.
This vaccine will reduce the number of separate vaccinations from at least 4 down to 1. Reducing the number of times an infant needs to receive a shot is a benefit to the child, the parents, and the healthcare workers who perform the vaccinations.
Sanofi, Merck, and GSK have produced various formulations of this hexavalent vaccine outside of the USA since 2000. Merck and Sanofi submitted the application for this vaccine to the FDA in 2014 after completion of phase III clinical trials, which included over 1400 infants. The clinical trial showed that the new vaccine was equivalent, in terms of safety and effectiveness, to the older series of individual vaccines.
As discussed previously, spurious claims that hexavalent vaccines lack antigens and other nonsense have been debunked.
I am not sure why this vaccine took nearly two decades to reach the US market, but I’m sure someone in the anti-vaccine religion will invent some ridiculous conspiracy theory to say why. Nevertheless, this hexavalent vaccine is a very important addition to the list of vaccines available in the USA.
In spite of the FDA approval, the CDC’s Advisory Committee on Immunization Practices will need to review all of the data again before making a recommendation to change the US vaccination schedule. That will probably happen during the next couple of years.
This new hexavalent vaccine is a great benefit to preventing diseases that harm our children. I’m glad it’s coming to the USA.
One of the concerns about DTaP vaccine (for protection against diphtheria, tetanus, and pertussis or whooping cough) is that it is given at 2 months, and during that time, the infant is susceptible to whooping cough. A new clinical trial provides evidence that giving the monovalent pertussis vaccine at birth is both safe and can protect the infant until the first DTaP vaccination.
Of course, these outbreaks and epidemics have lead to the “blame game” from the antivaccination cult, because they have claimed that since A) most kids are vaccinated, and B) we’re having this outbreak, then C) either the vaccines are useless or are actually the cause of the outbreak. Seriously. They blame the vaccines.
Since this outbreak will undoubtedly lead to the typical antivaccine rhetoric about the whooping cough vaccines, DTaP or Tdap (which also protect against tetanus and diphtheria), I decided to search the internet to find the most popular vaccine denialist arguments regarding pertussis vaccinations–then debunk them. Hopefully, this will be useful for those who are observing what’s going on in Reno.
About two years ago, California’s governor, Jerry Brown, signed SB277 into law, which mandated that all school age children must have all vaccines appropriate for their age before they could enter private or public schools. The law nearly eliminated the ability to get personal belief exemptions (PBE), which allowed parents to object to vaccinations for almost any reason. The new law does allow for medical exemptions, that is, children who have some medical condition that contraindicates a vaccine may be exempted from these rules. As a result of this law, it was predicted that the California vaccine uptake for school age children would increase substantially, while reducing the incidence of vaccine preventable diseases.
Those of us who have been keen observers and supporters of SB277 were hoping for the best – that the vaccination rate in the state would show increases quickly. And it did.
Data released this week (pdf), from the California Department of Public Health, showed an exceptional increase in the percentage of California’s kindergarteners who were fully vaccinated (for their age group) – it rose from 92.8% to 95.6%. But, there’s even more astonishing data underneath that. With the advent of the new law, 97.3% of California’s kindergartners have received both MMR vaccinations, up from 94.5% in 2016 and 92.6% in 2014. The same was shown for diphtheria, tetanus and pertussis (whooping cough) vaccine – it went from 94.2% in 2015 to 96.9% in 2016. There should be cheering in the streets of California for the success of SB277.
The increase in vaccine uptake for all mandated vaccines is dramatic – not only does it show that SB277 has stemmed the overuse of personal belief exemptions that was slowly reducing California vaccine uptake, but it also has increased that uptake to levels far above historical. This graph illustrates how well the law has worked in a short period of time:
The best part of the law is that it’s increasing vaccine uptake in areas of the state where the overuse of PBEs was pushing the vaccination rate down. Most California’s counties have vaccination rates above 95%, which is considered the level at which the herd effect for measles vaccinations prevent the rapid spreading of the disease. Furthermore, only 4 relatively small counties in California have rates below 90%.
California state Senator Richard Pan (D-Sacramento), who is also a pediatrician and who was one of the primary supporters of SB277, tweeted out “Great News.” Obviously he’s ecstatic with this data on California vaccine uptake across the state.
Dr. Pan was interviewed by the Los Angeles Times, and said,
Measles certainly hasn’t gone away. We need to be sure to have our immunization levels high enough. The fact that this class and the state overall has now achieved this level is one further step to restore the community immunity we had before.
He also noted that the data shows the significant increase in very young children, kindergartners. He mentioned that there are still significant number of older children who are not vaccinated because of the lax requirements in previous vaccine laws, which made PBEs very easy to get. SB277 also requires 7th graders to be completely up-t0-date on their vaccines, so all children should eventually be caught up with their vaccines. Unfortunately, many students who have passed that 7th grade vaccination checkpoint may be insufficiently vaccinated. Or not vaccinated at all.
The University of California (UC) system has stated that it will require vaccines for all new enrollees at its 10 campuses (along with the UC Hastings College of Law which has decided to comply with the UC requirements). Like the state law, it eliminates all personal belief exemptions, but does allow medical ones. Eventually, this mandate will cover the over 230,000 students in the system.
There are reasons to cheer all of this news out of California regarding immunization rates. But that’s just one state, albeit the largest and arguably the most influential state in the country. Other than California, only two other states have laws that have eliminated personal belief exemptions for immunizations – Mississippi and West Virginia, both of which have high vaccine uptake. And the easy availability of personal belief exemptions have lead many states to have vaccination rates of the MMR vaccine that are far below the 95% target. This graphic shows which states have significant deviations from the 95% standard for MMR vaccine (thanks to BuzzFeedNews):
Sadly, it may not be possible for a lot of states to copy California’s success with vaccines. One of the worst performing states for the MMR vaccine is Colorado, and, according to BuzzFeed News,
Vaccine advocates in Colorado are envious of their counterparts in California. “We are watching California very closely, and kudos to them for getting that bill through,” Stephanie Wasserman, executive director of the Colorado Children’s Immunization Coalition, told BuzzFeed News.
She believes it would be very difficult to enact similar legislation in Colorado, which has libertarian conservatives who reject government mandates on vaccines, as well as liberal enclaves like Boulder where many parents seek out alternative health care and see vaccines as a tool of Big Pharma.
Libertarian conservatives and liberals on the same side of the fence on vaccines? The problem with both groups is that they ignore the health of children just to be “politically virtuous” about vaccines. Except they are scientifically and medically wrong.
So let’s give an ovation for hard working politicians of California, who decided that the health of the state’s children was the paramount consideration for vaccinations. Dr. Pan and many other state legislators decided that the most effective way of increasing the California vaccine uptake was to reduce the availability of personal belief exemptions. And they were right – California’s immunization rate has increased appreciably because of SB277.
The issues with the pertussis vaccine waning effectiveness has been circulating for several years. There have been a number of well-designed studies that have provided evidence of the issues with the pertussis component of the DTaP or Tdap vaccine (which also provides immunization against tetanus and diphtheria, both dangerous diseases).
According to current research, individuals who have been vaccinated against whooping cough (Bordetella pertussis), with either the DTaP (version for usually for children) or Tdap vaccine, lose protection against whooping cough in some time period after being vaccinated.
A new article, published in Pediatrics, written by Nicola P Klein et al., examined children who received the Tdap vaccine in the Kaiser Permanente Northern California (KPNC) health care plan, a vertically integrated managed care system which closely tracks patients after vaccination. Their data provide important information about the strategies for the vaccine going forward.
1 or 2 in 100 (1.6%) will have convulsions (violent, uncontrolled shaking)
Two thirds (67%) will have apnea (slowed or stopped breathing)
1 in 300 (0.4%) will have encephalopathy (disease of the brain)
1 or 2 in 100 (1.6%) will die
Whooping cough can be easily prevented by the DTaP or Tdap vaccines (which also protect against tetanus and diphtheria). The vaccines can be given to infants as early as 6 weeks to 2 months old.
As with all medical procedures, there are some adverse effects with the pertussis vaccines. Moderate adverse effects from the vaccine occur in about 1 in 10,000 (or even fewer) injections. The most severe effects, which may or may not be causally related to the vaccine since the rate is so low, are in the range of 1 out of a million doses.
Editor’s note: This article was originally published in January 2015. It has been revised to include information from a recent Australian Federal Court ruling that imposed fines upon the homeopaths.
On December 22, 2014 an Australian Federal Court ruled that Homeopathy Plus! Pty Ltd, LTD, and its creator and director, Ms. Frances Sheffield, engaged in misleading conduct in trade or commerce in making claims against the whooping cough vaccine and in support of homeopathic remedies as an alternative – or a second line of defense – for preventing whooping cough.
There are many canards propagated by the vaccine deniers to support their personal beliefs (really, 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. They reject the scientific and historical evidence that vaccines saved lives – amazing.