What Happens When You Research the Disease?

We know how anti-vaccine folks think.

Anti-vaccine math…

And now we know how they do their research…

How Anti-Vaccine Folks Research Disease

If you’re like me, you are probably wondering why they picked 2016 as the year to research.

Why look just at 2016?

And, there you see it.

In the past 6 years, 2016 was the year with the fewest cases of measles. Why not choose 2017 or 2018 to do their research?

But let’s look at 2016, even though the information isn’t complete:

  • 86 cases
  • cases in 19 states, including Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon, Tennessee, Texas, and Utah
  • a large outbreak in Arizona (31 cases) linked to a private detention center and all that is known is that 7 of 9 staff members who got measles had received at least one dose of MMR, and 3 had received their dose very recently
  • a large outbreak in Shelby County, Tennessee, at least 7 cases, including 6 unvaccinated and one partially vaccinated child
  • a large measles outbreak (17 cases) in Los Angeles County and Santa Barbara County that was linked to the Los Angeles Orthodox Jewish community
  • two cases in Colorado, including an unvaccinated toddler and an unvaccinated adult – outbreaks which cost at least $68,192 to control

And of th cases in 2016, it seems that just 16% were vaccinated.

What about the claim that 26% were vaccinated?

That wasn’t 26% of the total number of cases, but rather 26% of the cases among US residents.

So if you do the math, that’s just 14 cases that were vaccinated, and out of 86 cases, that’s really just 16%. And a lot of those cases are skewed by the one outbreak at the detention center, in which they may have only received one dose of MMR and nearly half may have gotten vaccinated after the caught had already started!

What about the claim that “the odds of dying from the measles are like 0.00000013%” using numbers “before the vaccine was introduced in 1963?”

“Before a vaccine became available in 1963, measles was a rite of passage among American children. A red rash would spread over their bodies. They would develop a high fever. Severe cases could cause blindness or brain damage, or even death.”

CDC says measles almost eliminated in U.S.

In the pre-vaccine era, your odds of getting measles were very high. Remember, everyone eventually got measles.

And looking at statistics of reported measles cases and reported measles deaths, we know that death occurred in about 1 to 3 in every 1,000 reported cases.

So everyone got measles, but not everyone survived having measles.

Even if you use a more liberal count of 1 death in 10,000 cases, when all kids get measles, that’s a lot of deaths. Remember, about 450 people used to die with measles each year.

What about your odds of dying with measles now?

If you are fully vaccinated, then they are extremely low.

They are pretty low if you are unvaccinated too, in most cases, because you are benefiting from herd immunity and the fact that most folks around you are vaccinated, reducing your risk of being exposed to measles. Still, the risk is much higher than most anti-vaccine folks expect, because they often make the mistake of using the entire population of the United States in their calculations. They should instead just use the folks who are unvaccinated and susceptible, a much smaller number.

Want to increase your risk?

  • travel out of the country
  • hang out in a cluster with other unvaccinated people
  • stay unvaccinated

The odds aren’t in your favor to avoid measles if you are unvaccinated. Eventually, your luck might run out.

Starting to see the mistakes anti-vaccine folks make when they say they have done their research?

“How do they know how many people would have gotten measles and how many of them would have died?!?”

It’s not rocket science.

It’s epidemiology.

“We constructed a state-space model with population and immunisation coverage estimates and reported surveillance data to estimate annual national measles cases, distributed across age classes. We estimated deaths by applying age-specific and country-specific case-fatality ratios to estimated cases in each age-country class.”

Simons et al on Assessment of the 2010 global measles mortality reduction goal: results from a model of surveillance data.

Unfortunately, after years of improvements, measles deaths increased in 2017. And they will continue to increase, as our risk of getting measles continues to increase if folks don’t get vaccinated and protected.

Lastly, why does it “sound like millions of people would have died without the measles vaccine?”

Maybe because millions of people died in previous years, before they were vaccinated and protected.

Indeed, do your research, but you will find that vaccine-preventable diseases aren’t as mild as anti-vaccine folks believe. That’s why it is important to get vaccinated and protected.

More on Researching Vaccine-Preventable Disease

How Do You Get Caught up If You Have Never Been Vaccinated?

Why would someone have never gotten any vaccines and need to catch up?

Getting caught up on your vaccines is easy.
Getting caught up on your vaccines is easy.

The usual story is that a child’s vaccines were delayed or skipped for some reason, typically over fears of anti-vaccine propaganda.

You can always get caught up though, right?

Well, not always…

Tragically, kids can get sick and catch these vaccine-preventable diseases before they have time to get vaccinated and protected. You can wait too long to get vaccinated!

How Do You Get Caught up If You Have Never Been Vaccinated?

That’s why it is important to get caught up as soon as possible.

How does that work?

The first step is figuring out which vaccines you need, considering that:

  • rotavirus vaccines are only given up to age 9-months
  • Hib and Prevnar are typically only given up to age 5-years, unless someone has specific conditions that put them at high risk for disease, although Prevnar becomes routine again at age 65-years
  • the polio vaccine is typically only given up to age 18-years
  • the meningococcal vaccines (MenACWY and MenB) are routinely given to teens and young adults through age 16 to 23-years, but older high-risk adults can also be vaccinated if necessary
  • the HPV vaccines are routinely given up to age 26-years, although they are FDA approved to be given through age 45 years
  • hepatitis A vaccines are routinely given to children and teens, but are recommended for high-risk adults, including those who travel out of the country or just want to be protected
  • hepatitis B vaccines are routinely given to children and teens, but are recommended for high-risk adults, including those who travel out of the country or just want to be protected
  • the Pneumovax (PPSV23) and shingles vaccines are given to seniors
  • if you already had a natural case of chicken pox, while you won’t need to be vaccinated, some folks might need a varicella titer to confirm that they are immune

So, depending on your age when you are starting your catch-up, there may be some vaccines that you don’t need anymore.

Still, unless you have a contraindication, you will likely at least need:

  • a yearly flu vaccine
  • 1 to 2 doses (high risk groups) of MMR
  • 2 doses of the chicken pox vaccine (Varivax)
  • 1 dose of Tdap, followed by 2 doses of Td

What’s next?

Once you have an idea of which vaccines you need, you should schedule an appointment with your health care provider and get vaccinated and protected.

A local pharmacy or health department are other places that might offer vaccines to older teens and adults.

More on Getting Caught up on Vaccines

Why Would Vaccines Be Designed to Kill People?

If you are playing devil’s advocate with anti-vaccine folks, trying to figure out how they think, it isn’t a terrible question.

Remember, many anti-vaccine folks think that vaccines never work and that they always cause injuries – to everyone that gets them.

Why Would Vaccines Be Designed to Kill People?

We can start with Larry Cook‘s “answer,” which was in the form of another question:

“Why do doctors and medical examiners deny vaccine injury and death?”

Larry Cook

Wait, do doctors and medical examiners deny vaccine injury and death?

Uh, no they don’t.

They are often skeptical that each and everything that happens after someone gets a vaccine, even if it is months or years later, is a vaccine injury though. But we do know that although rare, vaccine injuries are real and can sometimes be life-threatening.

But why would vaccines actually be designed to kill people?

Makes sense, right?

  1. Make vaccines that kill people.
  2. ?
  3. Profit.

Actually, it doesn’t make any sense, does it?

Vaccine-preventable diseases kill people. In the pre-vaccine era, they killed a lot more people.

If you want to control the population or make life-long customers, why not just let them get smallpox, measles, chicken pox, hepatitis B, and HPV?

“Results revealed a significant negative relationship between anti-vaccine conspiracy beliefs and vaccination intentions. This effect was mediated by the perceived dangers of vaccines, and feelings of powerlessness, disillusionment and mistrust in authorities.”

Jolley et al on The Effects of Anti-Vaccine Conspiracy Theories on Vaccination Intentions

And if you wanted to do that, you could just push a lot of conspiracy theories about vaccines to scare folks away from getting vaccinated…

So, could bacteria and viruses be controlling the minds of these disease-friendly, influential anti-vaccine folks, helping to make sure people are intentionally unvaccinated, so that they can spread among us more easily?

Since I’m too skeptical to go down that rabbit hole, it is probably a safer bet to think that most are just doing it to sell supplements in their stores, get commissions from pushing online seminars, and ads from folks visiting their sites.

“Conspiracy beliefs are therefore associated with common motivations that drive intergroup conflict. Two social motivations in particular are relevant for conspiracy thinking. The first motivation is to uphold a strong ingroup identity, which increases perceivers’ sense‐making motivation when they believe their group is under threat by outside forces. That is, people worry about possible conspiracies only when they feel strongly connected with, and hence care about, the prospective victims of these conspiracies. The second social motivation is to protect against a coalition or outgroup suspected to be hostile”

van Prooijen et al on Belief in conspiracy theories: Basic principles of an emerging research domain

Will any of this help anti-vaccine folks see that these anti-vaccine conspiracy theories aren’t true?

Unfortunately, it probably won’t.

Like vaccine-injury stories, conspiracy theories are one of the things that hold up, and hold together, the modern anti-vaccine movement.

More on Why Would Vaccines Be Designed to Kill People?

How Often Should You Do Vaccine Titer Testing?

We sometimes hear about folks doing vaccine titer testing.

A vaccine titer is a blood test that can determine whether or not you are immune to a disease after you get a vaccine.

While that sounds good, after all, why not check and be sure, it has downsides. Chief among them is that the results aren’t always accurate.

That’s right. You can sometimes have a negative titer test, but still be immune because of memory B cells and the anamnestic response.

How Often Should You Do Vaccine Titer Testing?

So how often should you do vaccine titer testing?

It depends, but most folks might never have it done!

Why not?

Vaccines work very well, so you would typically not need to routinely check and confirm that you are immune after being vaccinated. And, this is also important, the vaccine titer tests don’t always work that well, titer testing isn’t available for all vaccines (you can’t do titer testing for Hib and pertussis), and the testing can be expensive.

So we usually just do the testing (a quantitative titer) for folks that are in high risk situations, including:

  • pregnancy – rubella titer only (HBsAg is also done, but that’s not a vaccine titer test, but rather to see if you are chronically infected with hepatitis B)
  • healthcare workers – anti-HBs (antibody to the hepatitis B surface antigen to confirm immunity after being vaccinated)
  • students in nursing school and medical school, etc. – anti-HBs
  • children and adults exposed in an outbreak – measles, chicken pox, mumps, etc., but only if we are unsure if they were previously vaccinated and protected
  • after a needlestick injury, etc. – to confirm immunity to hepatitis B
  • babies born to a mother with hepatitis B – to confirm that their hepatitis B vaccine worked

Vaccine titer testing might also be done for:

  • internationally adopted children – to confirm that they are immune if we unsure about all of the vaccines the child got in other countries
  • children and adults with lost vaccine records – to confirm that they are immune, since we are unsure about all of the vaccines they got
  • evaluation of children and adults with immune system problems – to help identify what immune system problems they might have – typically involves checking pneumococcal titers, giving Prevnar, and then checking pneumococcal titers again
  • people at continuous or frequent risk for rabies – rabies titer testing every 6 months to 2 years
  • patients with inflammatory bowel disease, before starting immunosuppressive therapy – hepatitis A and hepatitis B titers, as they might be at increased risk for hepatitis

While checking titers is easy, it is sometimes harder to know what to do with the results you get.

Of all of these different titers, only one tells you that you are immune due to vaccination.
Of all of these different titers, only one tells you that you are immune due to vaccination.

It is especially important to know that:

  • most people don’t need to have their titers checked routinely if they are not in one of the high-risk groups noted above
  • it isn’t practical to get titers tested as a method of potentially skipping one or more doses of your child’s vaccines, after all, if the titer is negative, then you are still going to have to get vaccinated
  • a healthcare provider with a negative measles titer after two doses of the MMR vaccine does not need another dose of vaccine
  • a healthcare provider who has anti-HBs <10 mIU/mL (negative titer) after three doses of the hepatitis B vaccine should get another dose of vaccine and repeat testing in 1 to 2 months – if still <10 mIU/mL, they should then get two more doses of hepatitis B vaccine (for a total of 6 doses) and repeat testing. If still negative, these documented nonresponders will need HBIG as post-exposure prophylaxis for any future hepatitis B exposures, but no further doses of hepatitis B vaccine.
  • vaccinated women of childbearing age who have received one or two doses of rubella-containing vaccine and have rubella serum IgG levels that is not clearly positive should be administered one additional dose of MMR vaccine, with a maximum of three doses, and should not be tested again
  • postvaccination titer testing is not recommended after the chicken pox vaccine
  • in addition to not being able to test titers for pertussis and Hib immunity, it is becoming difficult to test poliovirus type 2 titers, as the test uses a live virus that isn’t routinely available anymore (type 2 polio has been eradicated)

Still think you need vaccine titer testing?

More on Vaccine Titer Testing

Is H1N1 Flu Back This Year?

You remember H1N1 flu, right?

Is it back this year?

Is H1N1 Flu Back This Year?

While H1N1 seems to be the most frequently identified influenza virus type this year, in reality, since causing the “swine flu” pandemic in 2009, this strain of flu virus never really went away.

It instead became a seasonal flu virus strains.

So it is back again this year, but just like it was back during the 2013-14 and 2015-16 flu seasons.

Is that good news or bad news?

In general, it’s good news, as “flu vaccines provide better protection against influenza B or influenza A (H1N1) viruses than against influenza A (H3N2) viruses.”

“The 2009 H1N1 influenza virus (referred to as “swine flu” early on) was first detected in people in the United States in April 2009. This virus was originally referred to as “swine flu” because laboratory testing showed that its gene segments were similar to influenza viruses that were most recently identified in and known to circulate among pigs. CDC believes that this virus resulted from reassortment, a process through which two or more influenza viruses can swap genetic information by infecting a single human or animal host. When reassortment does occur, the virus that emerges will have some gene segments from each of the infecting parent viruses and may have different characteristics than either of the parental viruses, just as children may exhibit unique characteristics that are like both of their parents. In this case, the reassortment appears most likely to have occurred between influenza viruses circulating in North American pig herds and among Eurasian pig herds. Reassortment of influenza viruses can result in abrupt, major changes in influenza viruses, also known as “antigenic shift.” When shift happens, most people have little or no protection against the new influenza virus that results.”

Origin of 2009 H1N1 Flu (Swine Flu): Questions and Answers

The only reason we were so concerned about this strain of H1N1 in 2009 was because it was new.

Still, even in a good year, it is important to remember that a lot of people die with the flu, including a lot of kids. And most of them are unvaccinated.

So while it might be interesting to talk about which flu virus strain is going around, just remember that your best protection against that strain is a yearly flu vaccine.

More on H1N1 Flu

Do Vaccines Cause Mastocytosis?

Children with mastocytosis have extra mast cells, a normal type of cell that we all have that release histamine and other chemicals when activated.

As you can imagine, having too many mast cells, which release too much histamine, isn’t a good thing.

What Causes Mastocytosis?

Mastocytosis, some forms of which have been known since 1869, is caused by spontaneous mutations that aren’t passed on to future generations (somatic mutations).

“Most forms of mastocytosis are caused by a mutation of the KIT gene on the 4q12 chromosome – a mutation that increases cellular reproduction. The c-KIT gene mutation creates an overgrowth of one cell line of mast cells.”

What is mastocytosis?

And the symptoms you have with mastocytosis depends on the type you have, which can include localized (solitary, maculopapular cutaneous, diffuse cutaneous) vs systemic mastocytosis.

“The severity of the symptoms associated with mastocytosis may vary from mild to life-threatening. In general, symptoms occurring in mastocytosis are mainly due to the release of chemicals from the mast cells and thus produce symptoms associated with an allergic reaction.”

Mastocytosis – Rare Disease Database

Localized mastocytosis is usually present at birth or early infancy.

Do Vaccines Cause Mastocytosis?

Since it is caused by spontaneous mutations and is often present at birth or early infancy, there is no reason to think that vaccines could cause mastocytosis.

Vaccines and Mastocytosis

That’s not to say that you shouldn’t think about vaccines if your child has mastocytosis.

Although almost anything can be a trigger for kids with mastocytosis, from insect stings, skin rubbing, antibiotics, aspirin, cough medications, exposure to heat or cold, and stress, there have been a few reports of vaccines being a trigger.

“In childhood, the risk for anaphylactic episodes was limited to children with extensive skin disease, but nonexistent for children with mastocytoma or limited macular lesions. This is in good agreement with the literature, where children with anaphylaxis were described as having clinically severe skin involvement of mastocytosis, although the levels of skin involvement were not given and tryptase concentrations not determined. Children with fatal anaphylaxis, described in three case reports, all had suffered from extensive blistering skin disease…”

Brockow et al on Anaphylaxis in patients with mastocytosis: a study on history, clinical features and risk factors in 120 patients.

It is important to note that these are kids with severe disease though and not the more typical type of localized disease that the average child will have.

An infant with diffuse cutaneous mastocytosis. Lange et al. (CC BY-NC 3.0)
An infant with diffuse cutaneous mastocytosis. Lange et al. (CC BY-NC 3.0)

It should also be noted that viral and bacterial infections with fever, some of which are vaccine preventable, can also be a trigger.

Still, if your child has extensive skin disease, your specialist will likely talk about premedication before vaccines and watching your child closely afterward in case they have an anaphylactic reaction.

Should they get fewer vaccines at a time?

Surprisingly, it depends on who you ask, but it should be noted that all of the discussions about vaccines are for kids with diffuse cutaneous mastocytosis (DCM), a rare form of cutaneous mastocytosis.

“Although patients with mastocytosis can be vaccinated according to the standard schedule, precautions to prevent MC activation and degranulation have been formulated by experts, particularly in cases of diffuse skin manifestations”

And none say to skip vaccines, although some say to use an alternative immunization schedule, getting one vaccine at a time perhaps, especially for the initial doses.

It should be clear that kids with mastocytosis can and should be vaccinated though and vaccines do not actually cause mastocytosis.

More on Vaccines and Mastocytosis

Propaganda Busting Confirms Anti-vaccine Sites Photoshop Images

Spend a few minutes going through our list of anti-vaccine PRATTs, and you will quickly realize that they just push misinformation and propaganda.

Propaganda Busting Confirms Anti-vaccine Sites Photoshop Images

How easy is it to refute their claims?

Consider this “article” about measles outbreaks…

It shows an infant with chicken pox.

While that could be a simple mistake, it is actually a Photoshopped stock image of an infant with chicken pox that adds a big scary needle and syringe, that I guess is supposed to represent a vaccine.

Where's the syringe and needle?
Where’s the syringe and needle?

The thing is, neither the chicken pox nor MMR vaccine look like that and neither would be given with such a long needle!

In fact, that needle is about twice the size as any needle that would be used on an infant or toddler, which is why they had to Photoshop a separate photo of a big syringe and needle onto the infant with chicken pox.

It's just a stock image of a big syringe and needle...
It’s just a stock image of a big syringe and needle…

Now that you know that the photo is make-believe, you shouldn’t be surprised that their “article” is too.

This erroneous thinking has led the public, media and government alike to attribute the origin of measles outbreaks, such as the one reported at Disney in 2015 (and which lead to the passing of SB277 that year, stripping vaccine exemptions for all but medical reasons in California), to the non-vaccinated, even though 18% of the measles cases occurred in those who had been vaccinated against it — hardly the vaccine’s two-dose claimed “97% effectiveness.”

Government Research Confirms Measles Outbreaks Are Transmitted By The Vaccinated

By itself, the number of cases in an outbreak doesn’t exactly tell you a vaccine’s effectiveness. You also have to know something about how many people were vaccinated and unvaccinated and the attack rate, etc.

“Among the 110 California patients, 49 (45%) were unvaccinated; five (5%) had 1 dose of measles-containing vaccine, seven (6%) had 2 doses, one (1%) had 3 doses, 47 (43%) had unknown or undocumented vaccination status, and one (1%) had immunoglobulin G seropositivity documented, which indicates prior vaccination or measles infection at an undetermined time.”

Measles Outbreak — California, December 2014–February 2015

Anyway, in the Disneyland outbreak, if you do the math correctly, you can see that only 8 of 110 were fully vaccinated, or about 7%.

What does that tell you about vaccine effectiveness?

Not much!

Again, we don’t know how many vaccinated vs unvaccinated folks were exposed and didn’t get measles.

We can guess though…

Most folks are vaccinated, even in California. So the fact that only 7% of the people that got measles in the outbreak were fully vaccinated actually says quite a lot about how effective the MMR vaccine really is.

What about the idea that vaccinated people are starting outbreaks and spreading measles?

While the vast majority of measles outbreaks are in fact traced to someone who is unvaccinated, there was one outbreak in 2011 that was “started” by someone who was vaccinated.

“She had documentation of receipt of MMR vaccination at 3 years and 4 years of age. There was no travel during the incubation period and no known sick contacts. However, the index patient worked at a theater frequented by tourists.”

Outbreak of Measles Among Persons With Prior Evidence of Immunity, New York City, 2011

Since even the MMR vaccine isn’t 100% effective, is it really so surprising that occasionally, someone who received two doses of the vaccine could get measles and pass it to others, especially considering that around 220 people got measles in the United States that year?

“During 2011, a provisional total of 222 measles cases were reported from 31 states… Most patients were unvaccinated (65%) or had unknown vaccination status (21%). Of the 222, a total of 196 were U.S. residents. Of those U.S. residents who had measles, 166 were unvaccinated or had unknown vaccination status, 141 (85%) were eligible for MMR vaccination, 18 (11%) were too young for vaccination, six (4%) were born before 1957 and presumed immune, and one (1%) had previous laboratory evidence of presumptive immunity to measles.”

Measles — United States, 2011

Is the MMR vaccine a failure because there were some still some outbreaks in the 1980s, before we started to give kids a second dose? The attack rate in many of these school outbreaks, in which many kids had one dose of MMR, was still only about 2 to 3%.

It is safe to blame a failure to vaccinate and intentionally unvaccinated kids for most of the recent measles outbreaks.

Is the MMR vaccine a failure because we still have outbreaks among intentionally unvaccinated kids and every once in a while, in someone who is fully vaccinated who gets caught up in an outbreak?

Of course not!

It is easy to do a little research, consider what disease rates looked like in the pre-vaccine era, and know that vaccines work and that they are necessary.

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