Author: Vincent Iannelli, MD

Learn the Risks of Falling for Anti-Vaccine Propaganda

If you are on the fence or hesitant to vaccinate your kids, it might not be easy to recognize that the vaccine information that you get on some sites is pure propaganda.

That’s unfortunate, because you can’t make an informed choice about vaccines if you are basing that decision on misinformation.

Learn the Risks of Falling for Anti-Vaccine Propaganda

Take the infographic about the number of vaccine doses children in the United States normally get.Learn the risks of following bad advice about vaccines.

It is designed into making you think that kids get 72 doses of vaccines, scaring you and trying to reinforce the myth that kids get too many vaccines.

Have you seen and fallen for that trick? Did you ever think to actually count the total vaccine doses they list? As you can see above, it doesn’t come out to 72 doses

But why do  they do it? If they really think their “vaccines contain toxic chemicals” argument is convincing, then would it matter if the number of vaccine doses was 11 or 53 or 72? Why inflate it to make it wound scarier?

Still, however you want to count the number of doses of vaccines kids get today, one thing is crystal clear –  they get protection from more vaccine-preventable diseases.

In 1983, kids may have only have gotten 11 doses of vaccines, but many still died from Hib pneumonia and meningitis, epiglotitis (Hib), pneumococcal pneumonia and meningitis, hepatitis A, hepatitis B, rotavirus, chicken pox, and meningococcemia, etc.

“for those trained in pediatrics in the 1970s, Hib (Haemophilus influenzae type b) was a horror.”

Walter Orenstein, MD

Today, unless you decide to skip or delay your child’s vaccines, they are protected from these diseases.

What about the flu? Kids still die with the flu, but it is important to keep in mind that most kids who die with the flu are unvaccinated.

That’s why it is important to get your kids vaccinated. Don’t take the risk of following bad advice.

What to Know About Learning the Risks of Anti-Vaccine Propaganda

It is important to to learn the risks of falling for anti-vaccine propaganda – leaving your kids unvaccinated, unprotected, and at risk for vaccine-preventable diseases.

More on Learning the Risks of Anti-Vaccine Propaganda

Do Kids Really Get 72 Doses of Vaccines?

Most parents vaccinate their kids according to the recommended immunization schedule.

They know that’s the best way to keep them protected.

Do Kids Really Get 72 Doses of Vaccines?

Saying kids get 72 doses of vaccines is a propaganda too to scare parents.
Saying kids get 72 doses of vaccines is a propaganda tool to scare parents.

While kids do get more vaccines than their parents did, that’s only because we have more vaccines available to protect them from more now vaccine-preventable diseases.

Do they get their kids 72 doses of vaccines?

That sounds like a lot…

It sounds like a lot because it is an inflated number that is meant to scare parents.

Kids today do routinely get:

  • 13 vaccines, including 5 doses of DTaP, 4 doses of IPV (polio), 3 or 4 doses of hepatitis B, 3 or 4 doses of Hib (the number of doses depends on the vaccine brand used), 4 doses of Prevnar, 2 or 3 doses of rotavirus (the number of doses depends on the vaccine brand used), 2 doses of MMR, 2 doses of Varivax (chicken pox), 2 doses of hepatitis A, 1 doses of Tdap, 2 or 3 doses of HPV (the number of doses depends on the age you start the vaccine series), 2 doses of MCV4 (meningococcal vaccine), and yearly influenza vaccines
  • protection against 16 vaccine-preventable diseases, including diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, chicken pox, pneumococcal disease, hepatitis A, hepatitis B, meningococcal disease, HPV, rotavirus, Hib, and flu
  • about 28 doses of those vaccines by age two years (with yearly flu shots)
  • about 35 doses of those vaccines by age five years (with yearly flu shots)
  • as few as 23 individual shots by age five years if your child is getting combination vaccines, like Pediarix or Pentacel and Kinrix or Quadracel and Proquad
  • about 54 doses of those vaccines by age 18 years, with a third of that coming from yearly flu vaccines

How do you get a number like 72?

You can boost your count to make it look scarier by counting the DTaP, MMR, and Tdap vaccines as three separate vaccines each, even though they aren’t available as individual vaccines anymore.

To boost the Vaccine Doses for Children a bit more, they add pregnancy doses too.
To boost the Vaccine Doses for Children a bit more, they add pregnancy doses too.

This trick of anti-vaccine math quickly turns these 8 shots into “24 doses.”

It’s not a coincidence.

Anti-vaccine folks want to scare you into thinking that vaccines are full of toxins, that kids get too many vaccines, that we give many more vaccines than other countries, and that this is causing our kids to get sick.

Can an unvaccinated child really get tetanus after a toe nail injury?
Can an unvaccinated child really get tetanus after a toe nail injury? Photo by Petrus Rudolf de Jong (CC BY 3.0)

None of it is true.

At age four years, when your preschooler routinely gets their DTaP, IPV, MMR, and chicken pox shots before starting kindergarten, how many vaccines or doses do you think they got? Two, because they got Kinrix or Quadracel (DTaP/IPV combo) and Proquad (MMR/chickenpox combo)? Four, because they got separate shots? Or Eight, because you think you should count each component of each vaccine separately?

Know that even if you do want to count them separately, it really just means that with those two or four shots, your child got protection against eight different vaccine-preventable diseases – diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, and chicken pox.

Vaccine-preventable diseases that have not disappeared, something that the “72 doses” sites don’t ever warn you about.

What to Know About Anti-Vaccine Math

Many websites use anti-vaccine math to inflate vaccine dose numbers and scare parents away from vaccinating and protecting their kids.

More on Anti-Vaccine Math

Is Meningitis a Side Effect of Vaccines?

Most folks know that there are several meningitis vaccines.

Hib, Prevnar, MMR, and the meningococcal vaccines, for example, all protect folks against meningitis.

Is Meningitis a Side Effect of Vaccines?

So why would some people think that vaccines could actually cause meningitis?

Is meningitis listed on the package insert of any vaccines?
Is meningitis listed on the package insert of any vaccines?

Meningitis is listed as a possible adverse event in the package insert of some vaccines, but only in the section that includes spontaneously reported data from post-marketing experience, where it “may not be possible to reliably estimate their frequency or establish a causal relationship to vaccine exposure.”

It is just like when folks find autism or SIDS in a vaccine’s package insert and think that it is evidence that vaccines are associated with autism or SIDS.

SIDS and autism are listed in Tripedia package insert, but are not causally linked to the vaccine.
SIDS and autism are listed in Tripedia package insert, but are not causally linked to the vaccine.

It isn’t.

These adverse reactions are listed “because of the seriousness OR frequency of reporting.” They are not included because they are serious AND frequent, as some anti-vaccine sites like to proclaim.

How Could a Vaccine Cause Meningitis?

When you think about it, how could a vaccine actually cause someone to develop meningitis?

Why would you even think this is true?

Meningitis is typically caused by a virus, bacteria, parasite, or fungus, etc.

While a live virus vaccine might rarely be able to cause an infection, few of the meningitis vaccines are live virus vaccines. Prevnar, Hib and the meningococcal vaccines are all sub-unit vaccines. Since only a part of bacteria (antigens) is actually present in the vaccine, it is not possible for them to cause an infection.

What about the live virus vaccines, like MMR, chicken pox, and rotavirus?

Since these viral infections rarely cause meningitis, except for mumps, you wouldn’t expect the rare vaccine induced infection to cause meningitis either. A natural measles infection, for example, is more likely to cause encephalitis instead.

“…there is no evidence to link Jeryl Lynn mumps vaccine to aseptic meningitis.”

MMR Package Insert

What about the chicken pox vaccine? There is a case report of a vaccinated child who later developed shingles and meningitis, caused by vaccine strain chicken pox virus. He recovered fully and it is important to note that folks with natural chicken pox are thought to be even more likely to develop shingles, and they too can develop meningitis.

The bottom line is that if someone has meningitis, even if they were recently vaccinated, you shouldn’t be blaming the vaccines.

Like they do with VAERS reports, misusing package inserts is a common method that anti-vaccine folks use to scare parents away from vaccinating and protecting their kids.

What to Know About Meningitis and Vaccine Package Inserts

Although included in some vaccine package inserts, except for rare circumstances with some live virus vaccines, none actually claim that vaccines cause meningitis.

More on Meningitis and Vaccine Package Inserts

How the Anti-Vaccine Movement Takes Advantage of Dead Children and Their Parents

It is bad enough that folks in the anti-vaccine movement use propaganda to scare parents away from vaccinating and protecting their kids.

“The anti-vaccine argument is wrong in both the scientific and moral sense.”
Sarah Kurchak on Here’s How the Anti-Vaccination Movement Hurts Autistic People

Many people also think that the anti-vaccine message is anti-autism.

How the Anti-Vaccine Movement Takes Advantage of Dead Children and Their Parents

But just when you thought that they couldn’t go any lower, folks in the anti-vaccine movement find new ways to demonstrate their lacks of morals.

As a physician, I assure you this story isn’t believable at any level. In my opinion, the “health officials” are conjuring meningitis fairy tales about an “unvaccinated” boogeyman to cover for the much more probable cause of this child’s death: VACCINES.

The much more likely cause is right in front of us: “The child had just received his 4-month-old vaccinations two days beforehand.”

Jim Meehan

What is Dr. Jim Meehan talking about?

A four-month-old who recently died of bacterial meningitis in Chesterfield County, Virginia.

“Notice that THREE of the vaccines given at 4 months are for organisms capable of invading the brain and causing MENINGITIS. Rotavirus is a live virus vaccine capable of shedding from recently vaccinated children. The vaccine pre-clinical trials lacked placebo controls and were associated with infant deaths.

It doesn’t take my medical degree to understand how flimsy are the claims in this story.”

Jim Meehan

While rotavirus is a live virus vaccine, rotavirus rarely causes central nervous system disease. And he died of bacterial meningitis. It shouldn’t take a medical degree to know that rotavirus is a virus, not a bacteria.

While two of the other vaccines routinely given at four months do actually protect you from meningitis, both Prevnar and Hib are sub-unit vaccines, so can’t actually cause disease. Unfortunately, at four months, he would have been only partially protected against Prevnar and Hib, having only received two of four dosages of those vaccines.

“They expect the general public to be ignorant of the fact that we can actually measure the presence of the meningitis causing organisms for which there are vaccines: Haemophilus influenzae, Pneumococcus, and Meningococcus. So, where are the tests that confirm the presence of one of these “vaccine preventable” organisms?! Where’s the spinal tap/CSF pathology report?

As hard as it is for a grieving family to conceive of an autopsy, I pray the family demands a confirmation of the farcical cause of death being contrived in this case.”

Jim Meehan

Has Jim Meehan heard of HIPAA?

Does he read any of the other messages when he is writing his own comments about this family?

Why should this family have to come out and give an explanation for how their child died?
Why should this family have to come out and give an explanation for how their child died?

Is Jim Meehan really a doctor? It shouldn’t take a medical degree to understand that carriers of a disease don’t usually have symptoms of the disease.

“Again, from the article: “Health care officials told Dempsey they BELIEVE an unvaccinated person was carrying meningitis and Killy happened to come into contact with that person.”

They “believe”…give me a break. It should have said, “they made-up a story to cover for the real cause.”

SECOND, people don’t walk around with meningitis. They lay in their beds in a dark room and writhe in pain.

THIRD, the likelihood that an unvaccinated individual was walking around with meningitis is vanishingly small. To even list that in the top 100 options of a differential diagnosis is pure fiction.

FOURTH, where is this hypothetical unvaccinated meningitis shedding “patient zero?” He or she would have been so obviously sick that there is no way new parents would not remember the likely suspect…unless the suspect never existed.”

Jim Meehan

In this case, with a meningococcal infection, which is what the infant is thought to have, about 10% of people are carriers, asymptomatically having the Neisseria meningitidis bacteria in their nose or throat.

In the United States, we have two types of meningococcal vaccines, neither of which is routinely given to infants:

  • Menactra and Menveo – meningococcal conjugate vaccines that protect against serogroups A, C, W, Y and first given when kids are 11 to 12 years old, with a booster at age 16 years.
  • Bexsero and Trumenba – meningococcal conjugate vaccines that only  protect against serogroup B and can be given to kids at increased risk and teens and young adults who want to reduce their risk of getting MenB disease

The only other possibility, since they mentioned that exposed people received antibiotics, would be the Hib bacteria.

“In the prevaccine era, Hib could be isolated from the nasopharynx of 0.5%–3% of normal infants and children but was not common in adults.”

CDC on the Epidemiology and Prevention of Vaccine-Preventable Diseases

Again, these carriers can be contagious, even though they don’t have any symptoms.

“It’s likely that these “health officials” are covering for the pharmaceutical/vaccine industry that pays them so well. It’s “health officials” like this that for decades have pretended that sudden unexplained infant death syndrome (SUIDS), not only has no explanation, but it couldn’t possibly be related to the injection of neurotoxic doses of aluminum into the bodies of tiny baby humans. They can ignore the clustering of infant deaths that occurs around the same times that CDC recommends multiple (5-13) vaccines at one visit, but I won’t.”

Jim Meehan

Why is a family that just lost their child getting harassed by anti-vaccine folks?

This is the modern anti-vaccine movement.
This is the modern anti-vaccine movement.

One clue is that Jim Meehan is pushing the idea that there is a Big Pharma conspiracy behind this child’s death.

An anti-vaccine parenting group helping spread misinformation about this baby's death.
An anti-vaccine parenting group helping spread misinformation about this baby’s death.

And there are many anti-vaccine parenting groups that are helping spread his message around.

Of course, this isn’t the first time this has happened.

Anti-vaccine folks routinely hound parents who die of SIDS and shaken baby syndrome, working to convince them that vaccines caused their deaths.

Even infants who die of vitamin K deficiency bleeding because they skipped their baby’s vitamin K shot all of a sudden have a vaccine injury.

They turn every story of a child’s death or disability into a vaccine injury story.

Shame on them all.

More on the Vultures of the Anti-Vaccine Movement

Vaccination Tragedies are Rare

Vaccines work to prevent at least 2 to 3 million deaths each year worldwide.

Tragically, either because of errors or contamination, vaccines can sometimes actually cause people to get sick.

This can happen when health workers:

  • use a reconstituted vaccine after six hours – live vaccines can quickly become contaminated if they are kept and used for too long a time
  • mixup diluents – in addition to using the wrong diluent vaccination tragedies can occur when a dangerous medication is used instead of a vaccine’s standard diluent
  • improperly handle vaccines – breaking the cold chain
  • a vaccine is given to someone with a true medical contraindication

Fortunately, these situations are rare.

History of Vaccination Tragedies

With billions of doses of vaccines being given each year, it is likely not surprising that we see some problems. But when many of those vaccines are being given to kids, even one mishap, especially if it leads to life-threatening complications, is too many.

That’s why many safe guards have been put in place in the manufacturer and distribution of modern vaccines, so that we don’t see these types of vaccine tragedies:

  • the Cutter Incident, when, in 1955, at least 56 people developed polio and 5 children died after being vaccinated with inactivated polio vaccine that was poorly manufactured by Cutter Laboratories and still contained live polio virus
  • hepatitis-contaminated yellow fever vaccines – some lots of yellow fever vaccines used in the military in 1942 were unintentionally contaminated with the hepatitis B virus
  • the Lubeck Disaster – 75 children died and others got tuberculosis in 1929 Germany after there was a mixup between the BCG vaccine and the strain of Mycobacterium tuberculosis that causes tuberculosis. The BCG vaccine was supposed to be made with a weakened strain of Mycobacterium bovis bacteria instead.
  • the Bundaberg incident – 12 children died in Australia in 1928 after being given contaminated diphtheria vaccine from a multidose vial without preservative
  • tetanus contaminated smallpox vaccine in the 1890s and early 20th century

Although vaccines are much safer now, some rare incidents still occur.

Fifteen infants died and 75 children got sick in Syria in 2014 after they received a neuromuscular blocking agent, atracurium, instead of the measles vaccine they were supposed to get. How? The measles vaccine that was being used is mixed with a diluent, but instead of using the proper diluent, the health worker unintentionally used a bottle of atracurium instead.

In 2015, at least two kids died and 29 got sick in Chiapas, Mexico, among 52 children who were vaccinated. The children were reportedly given a BCG vaccine, the rotavirus vaccine, and/or a hepatitis B vaccine that day. However, the only vaccine that all of the sick children received in common was the hepatitis B vaccine. Since 130,000 doses from the same batch of vaccines had been given in the area, it was not thought to be a manufacturing problem or widespread issue. It was instead bacterial contamination of hepatitis B vaccine vials at that one clinic.

Fifteen children died in 2017 in a village in South Sudan after a poorly trained team that wasn’t adhering to WHO immunization safety standards used the same syringe to reconstitute measles vaccines over a four day period. They also didn’t keep the vaccine vials refrigerated.

“A single reconstitution syringe was used for multiple vaccine vials for the entire four days of the campaign instead of being discarded after single use. The reuse of the reconstitution syringe causes it to become contaminated which in turn contaminates the measles vaccine vials and infects the vaccinated children.”

Statement regarding findings of joint investigation of 15 deaths of children in Nachodokopele village, Kapoeta East County in South Sudan

As you can imagine, the conditions that led to these tragedies aren’t present when most kids get vaccinated.

Even in developing countries, most children get vaccinated by people adhering to WHO immunization safety standards. Why did they happened then? Both Syria and South Sudan have been rocked by war for years, leading to a breakdown in the ability to provide routine health care, even as basic as getting kids vaccinated. And Comunidad La Pimienta, Simojovel, Chiapas is a very poor part of southern Mexico.

These kinds of tragedies aren’t going to happen at your pediatrician’s office, as they don’t even have drugs like atracurium.

What Happened in Samoa?

Two toddlers died after being vaccinated at Safotu Hospital in Samoa.
Two toddlers died after being vaccinated at Safotu Hospital in Samoa.

In Samoa, four years after the deaths of the children in Syria, we are once again hearing about reports of deaths after kids were vaccinated with the MMR vaccine.

Two children in Samoa, both one-year-olds, died within minutes  of being vaccinated on the same day in the same hospital on the island of Savai’i.

Not surprisingly, as health officials investigate the cause, use of the MMR vaccine had been suspended in Samoa.

So what happened?

“Until the investigations have been completed and reported on we cannot say what did happen.

However, given the batch of vaccine involved had been in use in that country since August last year, and given the same batch of vaccine has been used in South American countries and the Caribbean island nations without incident, it seems unlikely that there was anything wrong with the vaccine.

The reports from the parents of the children affected on Friday indicate the reactions occurred within minutes after vaccination. This would preclude a response to the vaccine viruses as this takes at least a week. While anaphylaxis occurs within minutes and can be fatal when not treated the odds of seeing this twice in a day at the same place, given a chance of 1 in a million doses, is literally astronomical.”

Dr. Helen Petousis Harrison on What happened in Samoa?

Since it happened so quickly, it sounds like it could have been a mix-up with the diluent, as happened in Syria. A five dose vial of MMR is used in Samoa, which means that unlike premixed vaccines, it does have to be mixed with a diluent.

What about contamination? It is known that vaccine vials can be contaminated with Staphylococcus bacteria if they are mishandled. Although Staphylococcus bacteria can directly cause infections, they can also release a toxin that can cause toxic shock syndrome (TSS).

Considering how quickly these children got died though (within minutes), it isn’t likely that the vaccines became contaminated with Staphylococcus toxins. There have been reports of TSS following vaccination in the past, usually with vaccines that don’t use preservatives, but symptoms typically develop over four to 24 hours.

“This particular vaccine batch lot arrived to Samoa in August 2017 and has been in use since then. The same vaccine batch lot used in Samoa is also in use in a number of South American and Caribbean countries (Belize, Ecuador, St. Vincent, Trinidad Tobago, Chile, Aruba, Dutch Antilles, St. Kitts & Nevis and Cuba) with no reports of adverse events from those countries.”

Government of Samoa – Ministry of Health Press Statement

Could this be related to what happened to two other children in Samoa who had died after getting their MMR vaccines?

Almost certainly not. Those children, siblings, died years earlier, one in 2015 and the other in 2017. Neither died immediately after being vaccinated and there are reports that they may have had some kind of an immunodeficiency syndrome that contributed to their deaths.

“A number of media outlets are already covering these tragic events, speculating on the cause of death before the investigation is completed, and the stories have been picked up by the anti-vaccination movement.”

Government of Samoa – Ministry of Health Press Statement

That some folks would use these rare tragedies to scare parents from vaccinating and protecting their kids is shameful. But that’s the modern anti-vaccine movement

What to Know About Vaccination Tragedies

Kids shouldn’t get sick or die after getting vaccinated. Fortunately, they rarely do, except in extreme circumstances that can make it more likely for errors to occur.

More on Vaccination Tragedies

Avoiding the Most Common Vaccine Errors

Although it would be great if mistakes never ever happened, the best we can do is to understand that mistakes do sometimes happen and take steps to avoid them.

How can we avoid mistakes and errors about vaccines?

Avoiding Vaccine Errors

It can help to:

  • understand the 7 Rights of vaccine administration, including that you give the Right vaccine to the Right patient at the Right time by the Right route at the Right injection site and then follow it with the Right documentation
  • use a screening checklist to help avoid giving vaccines that are contraindicated
  • double check vaccines that look alike or have names that sound like, such as DTaP and Tdap
  • double check expiration dates
  • make sure you aren’t giving live vaccines within 28 days of each other, unless they are given at the same time
  • make sure you aren’t giving the wrong dosage amount for the patient’s age, as some vaccines have different formulations depending on the age of the patient, including flu shots, hepatitis A, and hepatitis B vaccines
  • be careful so that you don’t give a combination vaccine, such as Pediarix, Pentacel, Kinrix, Quadracel, or ProQuad, inappropriately

That we are have a 4-day grace period does help avoid the need to revaccinate some kids when vaccines are given a little too early.

“With the exception of rabies vaccine, ACIP allows a grace period of 4 days (i.e., vaccine doses administered up to 4 days before the recommended minimum interval or age can be counted as valid). However, if a dose was administered 5 or more days earlier than the recommended minimum interval between doses, it is not valid and must be repeated. The repeat dose should be spaced after the invalid dose by the recommended minimum interval.”

Ask the Experts About Scheduling Vaccines

In many cases, as long as vaccine doses were administered less than or equal to 4 days before the minimum interval or age, then they can still be counted and are considered valid.

Common Vaccine Errors

It’s easier than you think to prevent vaccine errors.

Especially if there are more than one child in the room getting vaccines, either the tray itself or the vaccines should be labeled with each child's name so that they don't get the wrong vaccines.
Especially if there is more than one child in the room getting vaccines, either the tray itself or the vaccines should be labeled with each child’s name so that they don’t get the wrong vaccines. Photo by Vincent Iannelli, MD

When are you most likely to make a vaccine error?

When you are doing something that isn’t routine, which most commonly happens when folks delay or skip some vaccines and are now playing catch-up.

In addition to the tips above, remember that:

  • the first dose of the rotavirus vaccines must be given by 15 weeks
  • the rotavirus vaccine series must be completed by 8 months (32 weeks)
  • ProQuad, the MMR and chicken pox combination vaccine, is not licensed for kids who are older than 12 years, although if a teen or adult did get ProQuad, it could be considered an off-label dose and could still count.
  • Kinrix and Quadracel, the DTaP and polio combination vaccines are only licensed for the 5th dose of DTaP and 4th dose of polio in children who are 4 to 6 years old, so wouldn’t be appropriate for an 18-month-old, even if he needs both (DTaP and polio) vaccines. Earlier doses can sometimes count as off-label doses though.
  • the combination vaccines Pediarix and Pentacel are only licensed up through age six years, but don’t necessarily need to be repeated if given to older kids.
  • children and adolescent’s get a pediatric dose (0.5ml) of the hepatitis A vaccine, while older teens, who are at least 19-years-old, get an adult (1.0ml) dose. Since most kids get vaccinated when they are younger, many pediatricians may not have the adult version of the hepatitis A or even realize that there is a different version.
  • children and adolescent’s get a pediatric dose (0.5ml) of the hepatitis B vaccine, while older teens, who are at least 20-years-old, get an adult (1.0ml) dose. Since most kids get vaccinated when they are younger, many pediatricians may not have the adult version of the hepatitis B vaccine or even realize that there is a different version.

Most importantly, even when giving vaccines on schedule, be sure to triple check everything. This is especially important if multiple kids in the same room are getting immunizations.

Also remember that vaccine errors should be reported to the ISMP National Vaccine Errors Reporting Program (VERP) or VAERS, with the correct dose repeated if necessary.

What to Know About Common Vaccine Errors

Although none of these vaccine errors are very common (hundreds of millions of doses of vaccines are given in the United States each year), understanding which ones occur the most often can help to make sure that they don’t happen in your office.

More on Common Vaccine Errors

Can Vaccinated Children Be Asymptomatic Carriers of Pertussis?

Why do anti-vaccine folks like to talk about baboons so much?

“Did you know that a study showed that baboons injected with whooping cough vaccine became infected with whooping cough anyway – and silently spread the disease to other baboons for 35 days?”

Anti-vaccine Meme

Is it because baboons are used in the study of vaccines?

That’s part of it, at least when they can find a study where they can cherry pick the results to suit their needs.

The Baboon Study

Like most anti-vaccine talking points, this one about baboons, has some truth to it.

An adult male baboon.
An adult male baboon. Photo by Elizabeth Miller

There was a baboon study with the pertussis vaccine and it found that previously vaccinated baboons could develop asymptomatic carriage of the pertussis bacteria after they were intentionally infected.

Here is where it is important to note that an infection is different than a disease.

The example that many people are familiar with is tuberculosis. It is common to have a TB infection without any signs or symptoms and to not feel sick. The only reason we know that they have TB is because they had a positive TB test.

Unfortunately, about 5 to 10% of these people with TB infections can eventually develop TB disease, with coughing, weight loss, night sweats, fever, and chest pain, etc.

It is kind of the same with the baboons in the study. Twenty-four hours after two previously vaccinated baboons were inoculated with pertussis bacteria in the back of their nose and trachea, an unvaccinated baboon was put in each of their cages.

The vaccinated baboons continued to have pertussis bacteria in their noses, which the researchers had put there, for up to 35 days. And they were able to eventually pass the pertussis bacteria to the unvaccinated baboons in their cages. Vaccinated baboons also became infected or colonized after they were put in a cage with an intentionally infected unvaccinated baboon.

“…animals did not cough and showed no reduction of activity, loss of appetite, or other outward signs of disease.”

Warfel et al on Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model

The vaccinated baboons were infected, but they never did develop symptoms of pertussis.

What Does The Baboon Study Mean?

One thing that is for sure – the baboon study found that the pertussis vaccines work. Only unvaccinated baboons got sick with pertussis.

But does this study explain our current outbreaks of pertussis?

Are vaccinated people becoming colonized and then getting others sick?

I guess it is possible, but we are not baboons in a cage with other baboons. How would we spread a respiratory disease, even if we did become colonized with the bacteria, if we don’t have symptoms?

It may explain part of our outbreaks though.

If vaccinated people do commonly become colonized with pertussis bacteria, then they might very well test positive for pertussis even though they don’t have symptomatic pertussis disease. So when they develop a cold or bronchitis and are found to have a positive pertussis test, then couldn’t that test just indicate that they have a pertussis infection and not disease, even though something else is actually causing their symptoms?

That’s what we think happens with strep carriers, right?

That’s kind of what the baboon study found. All of the baboons tested positive, but only the unvaccinated baboons had symptomatic pertussis disease.

“Baboons vaccinated with wP vaccines exhibit a level of protection that is intermediate between convalescent animals and aP-vaccinated animals. They exhibit no outwards signs of disease and are initially colonized to the same high level as aP-vaccinated animals but clear the infection more rapidly.”

Pinto et al on Pertussis disease and transmission and host responses: insights from the baboon model of pertussis.

It is interesting to note that the baboon study also found that baboons who had received whole cell pertussis vaccines also became carriers. They just didn’t stay carriers for as long as the baboons who got the newer acellular pertussis vaccine. But since they were still carriers, if asymptomatic transmission is such a big problem, wouldn’t it have been a big problem back in the day when everyone got whole cell pertussis vaccines?

The Debate Over Asymptomatic Carriage

Most vaccines prevent the spread of disease.

Do the pertussis vaccines?

Most folks still think so.

“The baboon model pioneered by Warfel et al. is without question a game-changer, shedding light on the impact of vaccination on disease and infection. However, the view it affords is clearer with respect to immunity and pathology than with respect to transmission. We point out that the extrapolation of the possibility of transmission from vaccinated baboons in the laboratory to the probability of transmission from vaccinated humans in the population is unwarranted. More work is needed to elucidate the relative transmissibility of infections in vaccinated vs. unvaccinated hosts. The evidence adduced above suggests, however, that vaccination with aP must have a strong effect on transmission as well as disease.”

Matthieu Domenech de Cellès et al on Epidemiological evidence for herd immunity induced by acellular pertussis vaccines

Even the author of the baboon study has said that “We agree that these data should not be directly extrapolated to pertussis transmission in humans. Although baboons are >96% genetically similar to humans, there are likely differences in how the species respond to vaccination and infection. We also agree that aP-vaccinated infected people are likely less efficient at transmitting pertussis compared with unvaccinated infected people, although it is not clear to what extent.”

Others think that asymptomatic carriage of pertussis might behind a lot of our recent outbreaks. Or at least what helps them grow so large.

Still, it is important to remember that unvaccinated folks do play a role in these outbreaks too. In a pertussis outbreak at a Florida preschool, in which most kids were vaccinated, the outbreak was started by a vaccine-exempt toddler.

And we have seen this in many other areas and it has been confirmed by many studies. Whatever else is contributing to pertussis outbreaks, like waning immunity, they are also associated with vaccine refusal.

“Counties with higher exemption rates had higher rates of reported pertussis among exempted and vaccinated children when compared with the low-exemption counties.”

Imdad et al. on Religious exemptions for immunization and risk of pertussis in New York State, 2000-2011.

But what if the DTaP and Tdap vaccines do cause folks to be asymptomatic carriers?

Even if that is true, understand that these vaccines don’t actually infect you, making you a carrier. They just might not prevent you from becoming a carrier if you are exposed to someone else with pertussis. While that might be a good reason to develop a new and better pertussis vaccine, it certainly isn’t a reason to skip or delay your child’s vaccines now.

Remember that even with our current outbreaks, rates of pertussis were much higher in the pre-vaccine era.

What to Know About Vaccines and Asymptomatic Carriers of Pertussis

The role of asymptomatic carriers and pertussis is controversial, but it certainly isn’t a reason to skip or delay your child’s vaccines.

More on the Vaccines and Asymptomatic Carriers of Pertussis