I live in San Diego, California, an area of the USA that is experiencing a preventable disease renaissance. I’ve been observing my friends take part in so-called “Facebook Challenges”. These challenges are typically to post a flower picture or maybe something you are grateful for every day for one month.
I decided to make up a challenge of my own, and one that I hope will have a positive impact, you are welcome to join me! Please share, like, or make your own posts! I am going to use this blog to document my research, as well as the questions, comments, and arguments that come my way over the next 45 days. Please send me any questions you have or topics you would like me to write about, and check back frequently for a “shot” of straight vaccine talk.
It may seem like “everyone” is questioning vaccines or attempting to space them out differently, but that is not true. 90% of kids in the USA are vaccinated on time. Which means 28 immunizations in the first two years of life to prevent 14 different diseases. It is this sheer number alone that frightens some parents.
In San Diego County alone in 2015, 45 infants under the age of 4 months contracted whooping cough. I have committed to writing about childhood vaccinations every day for 45 days to honor the 45 infants in San Diego County who contracted whooping cough last year due to low herd immunity.
However, I’m worried about my challenge. The danger in doing this is real- I might do more harm than good. We know that presenting clinical information to parents who are “vaccine hesitant” actually causes them to vaccinate less. In other words, somehow, presenting real clinical data actually strengthens their belief that they are being lied to by the “establishment”.
Did you know that immunizations are associated with cutting the risk of SIDS by one half (1/2!!)? On-time immunizations are an important part of SIDS prevention strategies. (2) Epidemiological evidence indicates infants immunized against diphtheria, pertussis and tetanus (DPT) are at decreased risk of sudden infant death syndrome (SIDS). Asymptomatic whooping cough and pyrogenic toxins of Staphylococcus aureus have been implicated in the etiology of SIDS. (3)
I would like to take this time to remind everyone, I am not an MD, none of this is medical advice, and of course, you should talk to your own doctor.
I am just discussing the EVIDENCE BASED recommendations. I am surprised by the positive response this experiment has generated, already, in just two days! A half a dozen people have messaged me to ask me to discuss the research behind questions that have been bugging them. One of those questions was: “If vaccinated kids are “safe” then why are those parents concerned about unvaccinated kids?”
This is a GREAT question! The “immunity” that you develop in response to vaccines, is only as good as your own immune system’s response to it. The effectiveness does not come from the vaccine, it comes from you. If your body creates a strong response to the vaccine then your immunity will be high. If you have a weak response then your immunity will be low, and you may still get the illness. That is why the effectiveness of vaccines can vary between people. Most childhood vaccines are nearly 100% effective. Nearly. For example: measles antibodies develop in approximately 98 percent of children vaccinated at 15 months or older. It is estimated that about 2–5 percent of children, who receive the vaccine at 12 months of age or younger or who only get one dose of MMR, fail to be protected.The CDC says that vaccine-induced immunity “appears to be long term and probably lifelong in most persons.” However, some studies show that immunity does not last forever. Measles is a terrifying disease. It is extremely almost 100% contagious (spread through the air, just from BREATHING, not coughing).
Diseases like measles exist in all inhabited continents and kill approximately 122,000 people every year — that’s 14 deaths every hour. What’s worse? Most of these people are children under five years old (see red dots on map above). There are studies that show measles outbreaks CAN AND DO occur in fully vaccinated populations. For example, an outbreak of measles in the spring of 1985 in Corpus Christi, Texas, occurred in a school where more than 99 percent of the students were fully vaccinated. (4,5,6)
Children, and adults that have not received “boosters” as well as the thousands and thousands of children who can’t get vaccinated for legitimate reasons; immuno-compromised (kids who have seizure disorders, kids who have had chemotherapy, kids who have allergies), are at risk from unvaccinated kids. I believe, we need to protect these people. It has been estimated that there are as many as 10 million “immuno compromised” people living in the USA.(7)
The BIGGEST worry for parents of vaccinated kids is simply that the vaccine schedule takes several years to fulfill. When your child is too young to get the vaccines, or when a series of spaced-out shots is needed to make him/her fully immune, that is when they will be at the most risk, and the least able to fight off getting a virus if they are exposed. Parents are usually the most worried when they have older kids going to school with unvaccinated kids, while they also have very young children at home.
Many parents are worried about the risk of seizures following vaccination.
Sometimes, fevers can cause a child to experience spasms or jerky movements called seizures. Seizures caused by fever are called “febrile seizures.” They are most common with fevers of 102°F (38.9°C) or higher, but they can also happen at lower body temperatures or when a fever is going down. Most febrile seizures last for less than one or two minutes.
Febrile seizures can be frightening, but nearly all children who have a febrile seizure recover quickly. Febrile seizures do not cause any permanent harm and do not have any lasting effects.
Of course, if your child is prone to febrile seizures, they can have one regardless of whether the fever is a mild symptom of vaccination, or from acquiring say.. the actual chickenpox.
There are many genetic childhood seizure disorders which start in infancy, right around the time that vaccinations start to be administered, therefore, the two have become linked together in the minds of the public. For example, Dravet syndrome, (also known as Severe Myoclonic Epilepsy of Infancy (SMEI)), is a rare and catastrophic form of intractable epilepsy that begins in infancy, with an estimated incidence rate of 1:16,000 to 1:21,000.
Vaccinating children at the recommended age may prevent some febrile seizures by protecting children against measles, mumps, rubella, chickenpox, influenza, pneumococcal infections and other diseases that can cause fever and febrile seizures. A recent study (8) found no significant association between vaccination in the first year and acute seizure events regardless of the type of vaccine or whether the vaccine was received on time or delayed. However, in the second year of life, delay of the first MMR vaccine until 16 months of age or older resulted in 3 times greater risk for seizures in the 7 to 10 days after vaccination than if administration of MMR vaccine was on time.
This is the problem with science! Who can read the table above and decipher it, except a trained scientist? So to make it easier to understand – The IRR is the metric you are looking at (for MMR). Divide the 6.53 by 2.65, and you get nearly 3 times the risk.
Regardless of vaccination, young children are at their greatest risk for febrile seizures at ∼16 to 18 months of age (9,10). However, the data are clear, delaying vaccination not only puts your child and others at risk for getting and spreading disease, but also at a higher risk for seizures as well.
Vaccination during pregnancy is a powerful way to “close the gap” of time after birth, but before an infant can be vaccinated.
This post is part of a three day series that will also include discussions of flu and whooping cough vaccination during pregnancy. Many times these days we hear about people not vaccinating, but there are some really-really-really bright spots!! For example, the biggest maternal vaccination success story — on a global scale — is against tetanus (muscle spasms until you die (11).
Referred to in the Old Testament as the “seventh-day death,” neonatal tetanus strikes rapidly, killing newborns soon after birth. Tetanus occurs when a bacterium, Clostridium tetani, enters the body through an open wound or puncture. The bacterial spores are ubiquitous — they live in the soil, in animal dung, and in human feces. Birth and delivery is a particularly dangerous time for women and infants as there are ALWAYS open wounds (umbilical cord.. for example, or the dreaded episiotomy or tear between your vagina and anus) and feces everywhere due to unsanitary and unhygienic conditions in many places around the world where women deliver babies!!!
Tetanus is called the “silent killer” because so many of these women and newborns die at home, and both the births and the deaths go unreported.
In the USA, Tdap is often recommended (I will discuss why tomorrow!). To maximize the “maternal antibody response” and transfer across the placenta to the infant, optimal timing for Tdap administration is between 27 and 36 weeks of gestation. This is an “evidence based” recommendation, it is not arbitrary! (12)
More than one million people died each year from tetanus in the 1980s, about three-quarters of them, infants in the first month of life. Today, the toll of neonatal deaths has been reduced by over 90% and maternal and neonatal tetanus has been eliminated from all but 22 countries.
Large studies on use of the tetanus vaccination during pregnancy have not uncovered any clinically severe events (13, 14).
There are still 58 countries where tetanus is a public health problem, and there are plans to eliminate it in every one of them, except two.
Many people don’t think that “flu” is a big deal, and so they think, “why should I get the flu shot?” However, the flu season can be particularly dangerous, as pregnant women are at greater risk for coming down with the flu because of their lowered immune system. Not only that, but pregnant women have been shown to be at increased risk for morbidity and death too (15). A pregnant woman’s heart and lungs are already doing extra work handling the pregnancy, so a serious illness like the flu can put her in danger of developing complications like pneumonia. The flu has also been linked in previous studies with preterm labor and premature birth; and fever from the flu can lead to birth defects. The flu shot has been given to millions of pregnant women over many years. Flu shots have not been shown to cause harm to pregnant women or their babies. It is very important for pregnant women to get the flu shot.
Pregnancy is a dangerous time for women. Your fetus is comprised of your own, plus “foreign” non-self DNA. Normally, your immune system will do anything it can to kill off a foreign invader. But, you don’t want to mount an immune response against your baby during pregnancy. In fact, your immune response will be lowered, so that you can successfully carry your fetus to term. Pretty neat. except….. during flu season.
A recent study analyzed 58,008 births in Western Australia between April 2012 and December 2013. Among the women, 8.8 percent had received the flu vaccine, and 377 stillbirths occurred at a rate of 5.0 per 100,000 pregnancy days for women who did not get the vaccine and 3.0 per 100,000 days for women who received the vaccine.
Overall, stillbirth was 51 percent less likely among vaccinated mothers, as opposed to unvaccinated mothers, with the largest reduction in stillbirths coming just after flu season ended (16).
The Narrative Inquiry in Bioethics (published by Johns Hopkins University Press) is looking for parents to share their story on why they are vaccinating. The call for papers can be found here (http://www.nibjournal.org/…/documen…/Vaccine_Call-9-1-16.pdf), and it includes specifics on what the journal is looking for. Selected articles will be published in the issue, but they might publish more of the stories online. This is a unique opportunity to share your story and why vaccines matter to you.
1) Effective Messages in Vaccine Promotion: A Randomized Trial Pediatrics, April 2014, VOLUME 133 / ISSUE 4, Brendan Nyhan, Jason Reifler, Sean Richey, Gary L. Freed
2) Do immunisations reduce the risk for SIDS? A meta-analysis.Vaccine. 2007 Jun 21;25(26):4875–9. Epub 2007 Mar 16, Vennemann MM1, Höffgen M, Bajanowski T, Hense HW, Mitchell EA.
3) The protective effect of immunisation against diphtheria, pertussis and tetanus (DPT) in relation to sudden infant death syndrome. FEMS Immunol Med Microbiol. 1999 Aug 1;25(1–2):183–92. Essery SD1, Raza MW, Zorgani A, MacKenzie DA, James VS, Weir DM, Busuttil A, Hallam N, Blackwell C.
4) Measles Outbreak in a Fully Immunized Secondary-School Population. Gustabson TL, Lievens AW, Brunell PA, et al. N Engl J Med. 1987 Mar 26;316(13):771–4.
5) Infection on Maintaining Immunity Against Measles in Vaccinated Children in West Africa. Whittle HC, Aaby P, Samb B, et al. Effect of SubclinicalThe Lancet. Jan. 9, 1999. Vol 353, Issue 9147, pp 98–102.
6) CDC.gov. Measles Outbreak among Vaccinated High School Students — Illinois. MMWR. June 22, 1984. 33(24);349–51. Online. (Accessed March 2012).
7) Expected Adverse Events in a Mass Smallpox Vaccination Campaign. Effective Clinical Practice, March/April 2002, Alex R. Kemper, MD, MPH, MS, Matthew M. Davis, MD, MAPP, Gary L. Freed, MD, MPH.
8) Timely versus delayed early childhood vaccination and seizures. Hambidge SJ1, Newcomer SR2, Narwaney KJ2, Glanz JM3, Daley MF4, Xu S2, Shoup JA2, Rowhani-Rahbar A5, Klein NP6, Lee GM7, Nelson JC8, Lugg M9, Naleway AL10, Nordin JD11, Weintraub E12, DeStefano F12.
9) Febrile seizures: an update. Waruiru C, Appleton R, .Arch Dis Child. 2004;89(8): 751–756 35.
10) Childhood febrile seizures: overview and implications. Jones T, Jacobsen SJ., Int J Med Sci. 2007;4(2):110– 114
12) Preventing infant pertussis: a decision analysis comparing prenatal vaccination to cocooning. Terranella A, Asay G, Messonnier M, Clark T, Liang J. Presented at the 49th Infectious Diseases Society of America Annual Meeting, Boston, MA; October 20–23, 2011.
13) Neonatal tetanus in New Guinea. Effect of active immunization in pregnancy. Schofield FD, Tucker VM, Westbrook GR. Br Med J 1961;2:785–9.
14) Newell, KW, Dueñas Lehmann, Leblanc DR, Garces Osoria N. The use of toxoid for the prevention of tetanus neonatorum. Final report of a double-blind controlled field trial. Bull World Health Organ 1966;35:863–71.
15) Effects of influenza on pregnant women and infants. Rasmussen SA1, Jamieson DJ, Uyeki TM.Am J Obstet Gynecol. 2012 Sep;207(3 Suppl):S3–8. doi: 10.1016/j.ajog.2012.06.068. Epub 2012 Jul 9.
16) Seasonal Trivalent Influenza Vaccination During Pregnancy and the Incidence of Stillbirth: Population-Based Retrospective Cohort Study. Annette K. Regan, Hannah C. Moore, Nicholas de Klerk, Saad B. Omer, Geoffrey Shellam, Donna B. Mak, and Paul V. Effler