Category: History of Vaccines

Milestones Towards the Eradication of Polio

There is a lot more interest in polio these days, but not because we are close to eradicating this deadly disease, but rather because of the emergence of cases of acute flaccid myelitis (AFM).

Although the cases have a different cause, the symptoms of AFM are the same that we used to see during the outbreaks of polio that used to hit each summer in the pre-vaccine era.

Polio

Surprisingly, in most people, the poliovirus doesn’t actually cause any symptoms. They simply have an asymptomatic infection.

In some others, the poliovirus causes flu-like symptoms, including a fever, sore throat, nausea, and a headache – symptoms that last about 3 to 5 days.

Much more rarely, the poliovirus causes meningitis or paralysis.

It is these cases of paralytic polio that most people are aware of and that panicked parents during summers in the 1940s and 50s.

In addition to respiratory problems (think iron lungs), polio causes muscle atrophy.
In addition to respiratory problems (think iron lungs), polio causes muscle atrophy. (CC BY-NC 4.0)

After having flu-like symptoms, those kids who would develop paralytic polio can develop pain and then flaccid paralysis.

“The most severe form, paralytic poliomyelitis, which is seen in less than 1% of patients, presents as excruciating episodes of pain in back and lower limbs. In children, the disease may present in biphasic form—a period of prodrome followed by a brief symptom-free period of 7 to 10 days and then appearance of asymmetrical paralysis of limbs. Flaccid paralysis is the hallmark with loss of deep tendon reflexes eventually.”

Mehndirattta et al on Poliomyelitis Historical Facts, Epidemiology, and Current Challenges in Eradication

Of course, polio wasn’t always called polio.

Other names have included infantile spinal paralysis, infantile paralysis, Heine-Medin disease, poliomyelitis anterior acuta, and acute anterior poliomyelitis.

The first use of the name “polio” came from Adolph Kussmaul, with his use of the term poliomyelitis anterior acuta, which was derived from the Greek polios “grey” and myelos “marrow” and itis “inflammation.” It was because he knew that it was caused by inflammation of the spinal cord gray matter, even if he didn’t know why.

Polio History

Polio didn’t just suddenly appear in the middle of the 20th century though, it was likely around for ages.

That this Ancient Egyptian priest's leg is smaller than the other and he uses a staff to walk suggests that he could have had polio.
That one of this Ancient Egyptian priest’s legs is smaller than the other and he uses a staff to walk could suggest that he had polio.

In addition to an Egyptian funeral stele (a stone slab used as a monument) portraying Roma the Doorkeeper from 1500 BCE that suggests he had paralytic polio, archeologists have found evidence of polio in skeletons as far back as the Neolithic period.

A medical book from 1789 likely describes people with polio.
A medical book from 1789 likely describes people with polio.

Still, we don’t really know how long polio has been around and we don’t know why we began to see more cases in the mid-20th Century, although there are theories, including, ironically, about hygiene. While we often credit improved sanitation and hygiene for helping to reduce mortality from many diseases, some think that this actually set us up for polio outbreaks, as we were no longer exposed as infants, when we still had some maternal immunity.

The one thing that we do know is that we are on the verge of eradicating polio, as there are very cases now, in just a few countries.

Polio Timeline and Milestones

In addition to the more ancient discoveries about polio, there is a lot to learn about vaccines and vaccine-preventable diseases if we look at the major milestones of this important disease.

Although in the end it is a success story, the road to figuring out what caused polio symptoms and how polio could be prevented was very long.

  • Michael Underwood describes what is thought to be paralytic polio in his book A Treatise on the Diseases of Children, with General Directions for the Management of Infants from Birth  in a section on “Debility of the Lower Extremities” (1789)
  • first reported outbreak of polio in Worksop, England (1835)
  • Jacob von Heine, head of an orthopedic hospital in Germany, publishes a monograph that describes 29 cases of paralytic polio, and actually attributes the condition to inflammation of the anterior horns of the spinal cord, although the cause was still not known (1840)
  • first use of the term poliomyelitis by Adolph Kussmaul (1874)
  • Nils August Bergenholtz reports on an outbreak of paralytic polio in Sweden (1881)
  • Karl-Oskar Medin, a pediatrician who reported on a polio epidemic in Sweden (1887), later presents his findings at the Tenth International Conference in Berlin (1890)
  • the first major outbreak in the United States is documented in Rutland County, Vermont and causes 132 cases of paralysis and 18 deaths (1894)
  • Ivar Wickman tracks cases of polio during an epidemic in Sweden in 1905 and was the first to suggest that polio was contagious and that you could get it from “those afflicted with the abortive type” (1907)
  • although they don’t actually identify the poliovirus, Dr. Karl Landsteiner and Dr. Erwin Popper  identify that a virus causes polio when they inject material from the spinal cord of a child who had recently died with polio into the peritoneum of two monkeys, both of which soon developed paralytic polio (1908)
  • Simon Flexner, first discovers polio antibodies (1911), but unlike other researchers at the time, pushes the theory that polio was spread by the olfactory route, instead of the fecal-oral route, which was why we saw the development of nose sprays, etc., to try and prevent polio, none of which worked of course
  • a large polio epidemic in the United States causes at least 27,000 cases and 6,000 deaths (1916)
  • Philip Drinker and Louis Agassiz Shaw invent the first iron lung, the Drinker respirator (1929)
  • Frank M. Burnet and Jean Macnamara proposed that there were antigenically different strains of poliovirus (1931)
  • John R. Paul and James D. Trask help figure out how polio was spread by identifying the polio virus in human waste and sewage samples (1932)
  • Maurice Brodie and John Kolmer have unsuccessful field trials of early polio vaccines, including allergic reactions and vaccine induced polio because of poor attenuation (1935)
  • Sister Elizabeth Kenny establishes a clinic in Australia to treat polio survivors (1932) and later publishes her treatment recommendations, Infantile Paralysis and Cerebral Diplegia (1937)
  • the National Foundation for Infantile Paralysis is founded by FDR to stop polio (1937)
  • the first March of Dimes fundraisers to stop polio (1938)
  • Carl Kling found traces of the poliovirus in the Stockholm sewage system (1942)
  • the Sister Kenny Institute is built in Minneapolis, as her treatment methods become widely accepted after years of controversy (1942)
  • the U.S. Army Neurotropic Virus Commission, including Albert Sabin, gets a grant from the NFIP to study polio in North Africa (1943)
  • Isabel Morgan actually developed the first inactivated polio vaccine, but only tested it on monkeys (1949)
  • John Enders, with T. H. Weller and F. C. Robbins, received the Nobel Prize in 1954 for their work on the cultivation of the poliomyelitis viruses (1949)
  • David Bodian creates the monkey model using field isolates of poliovirus and with Jonas Salk, identifies the three poliovirus serotyes (1950s)
  • Hilary Koprowki develops the first oral, live polio vaccine, (1950) although Sabin’s vaccine eventually gets licensed because it is thought to be less neurovirulent in monkeys and undergoes more testing
  • there are 58,000 cases of paralytic polio in the United States (1952)
  • Renato Dulbecco, with Marguerite Vogt, successfully grows and purifies polio virus (1952)
  • the Polio Pioneers vaccine field trial, led by Thomas Francis Jr.,  that proves that Jonas Salk’s polio vaccine is safe and effective begins (1954)
  • Jonas Salk gets approval for his polio vaccine (1955)
  • improperly inactivated polio vaccine from Cutter Laboratories (Cutter Incident) causes 40,000 cases of polio, 200 cases of paralysis, and kills ten people (1955)
  • Albert Sabin develops the first live, oral polio vaccine, which replaced Jonas Salk’s inactivated polio vaccine (1961)
  • that polio survivors can develop new, late complications or post-polio syndrome begins to get reported (1969)
  • last endemic case of polio in the United States (1979)
  • the National Foundation for Infantile Paralysis officially changes its name to the March of Dimes Birth Defects Foundation (1979)
  • the World Health Assembly adopts a resolution for the worldwide eradication of polio by 2000 and the the Global Polio Eradication Initiative is launched (1988)
  • last imported case of polio in the United States (1993)
  • the WHO Region of the Americas is declared polio free (1994)
  • “last” case of VAPP that was acquired in the United States (1999)
  • wild poliovirus type 2 eradicated (1999)
  • the WHO Western Pacific Region is declared polio free (2000)
  • the United States switches back to using the an inactivated polio vaccine because of concerns over VAPP (2000)
  • the WHO European Region is declared polio free (2002)
  • outbreak of vaccine derived polio among a group of unvaccinated Amish in Minnesota (2005)
  • last case of VAPP that was acquired outside the United States, an unvaccinated 22-year-old U.S. college student who became infected with polio vaccine virus while traveling in Costa Rica in a university-sponsored study-abroad program (2005)
  • last case of VAPP, a patient with a long-standing combined immunodeficiency who was probably infected in the late 1990s (2009)
  • seasonal reports of acute flaccid myelitis in the late summer and early fall, which might be caused by a non-polio enterovirus, are reminiscent of polio epidemics in the early part of the 20th century (2014)
  • Bob Sears says that it is okay to delay the polio vaccine on his alternative vaccine schedule because “we don’t have polio in the United States” (2015)
  • a global switch from trivalent OPV to bivalent OPV in routine immunization programs (2016)
  • polio remains endemic in just three countries, Afghanistan, Nigeria, and Pakistan (2018)

So it should be clear, that despite what some folks think, polio wasn’t conquered overnight. And Salk and Sabin obviously had a lot of help, although those are the names we most commonly hear connected with polio eradication.

“Until poliovirus transmission is interrupted in these countries, all countries remain at risk of importation of polio, especially vulnerable countries with weak public health and immunization services and travel or trade links to endemic countries.”

Global Polio Eradication Initiative on Endemic Countries

And to be clear, polio hasn’t yet been conquered.

There is still some work to do unless we want to see cases of polio and paralytic polio return.

That’s why it is important that you don’t skip your child’s vaccines, even for diseases that we don’t have in the United States anymore.

More on the History of Polio

Recognizing Old Vaccine Scars

Do you have a scar on your arm and you aren’t sure why it is there?

Having a smallpox vaccine scar makes you a part of history.
Having a smallpox vaccine scar makes you a part of history.

Is it from the smallpox vaccine?

Recognizing Old Vaccine Scars

Classically, there are two vaccines that can leave a scar – the ones that protect us against smallpox and tuberculosis.

“BCG scar is a surrogate marker of vaccination and an important index in the vaccination program.”

Dhanawade et al on Scar formation and tuberculin conversion following BCG vaccination in infants: A prospective cohort study

And there are a few easy ways to tell if you have a smallpox scar.

When were you born? Remember, the smallpox vaccine hasn’t been used in the United States since the early 1970s and its use stopped everywhere in 1986.

And where were you born?

The BCG (bacille Calmette-Guerin) vaccine, on the other hand, is still in use in many countries, and is given at birth to prevent tuberculosis disease, including meningitis and disseminated tuberculosis. It isn’t routinely used in the United States though “because of the low risk of infection with Mycobacterium tuberculosis, the variable effectiveness of the vaccine against adult pulmonary TB, and the vaccine’s potential interference with tuberculin skin test reactivity.”

Do you have a vaccine scar on your arm?
Do you have a vaccine scar on your arm? Photo by Earl Hershfield

In general though:

  • the BCG vaccine scar has a raised center
  • the smallpox vaccine scar is depressed, with lines that radiate to the edges

Complicating matters is the fact that you can have multiple scars from each vaccine…

“In 1972, the National Advisory Committee on Immunization in Canada recommended that routine immunization of infants for smallpox be stopped. Very few Canadians born after 1972 have been immunized against smallpox. Those, like me, who were immunized prior to that date have little or no immunity left. Nothing, but a small scar as testimony to a grand global achievement.”

Diane Kelsall on A Small Scar

Do you have any vaccine scars?

More on Recognizing Old Vaccine Scars

What Ever Happened to the Lyme Disease Vaccine?

A Lyme disease vaccine, LYMErix, was approved by the FDA in 1998.

Unfortunately, the manufacturer stopped making it a few years later.

What Ever Happened to the Lyme Disease Vaccine?

Although Lyme disease is caused by a bacterial infection, the bacteria is transmitted to people through tick bites. Not surprisingly, the original Lyme disease vaccine didn’t attack ticks, it attacked the Borrelia burgdorferi bacteria in those ticks, before they could cause an infection.

A new Lyme disease vaccine would be welcomed in the 14 states where the majority of Lyme disease cases are reported.
A new Lyme disease vaccine would be welcomed in the 14 states where the majority of Lyme disease cases are reported.

After three doses, LYMErix was found to be 78% effective at preventing Lyme disease.

Unfortunately, unverified reports of vaccine side effects, especially arthritis, were hyped by the media and anti-vaccine groups and led folks to avoid the vaccine.

In their article, “Concerns Grow Over Reactions To Lyme Shots,” The New York Times even gave equal time to doctors from the International Lyme and Associated Diseases Society, who push the idea that folks need treatment for chronic Lyme disease.

Another vaccine, ImuLyme, didn’t even bother applying for FDA licensure at the time.

“In 2002, in response to low vaccine uptake, public concern about adverse effects, and class action lawsuits, SmithKline Beecham withdrew the vaccine from the market despite the fact that both pre- and post-licensure safety data showed no difference in the incidence of chronic arthritis between those who received the vaccine and those who had not.”

The History of the Lyme Disease Vaccine

Interestingly, a more current article in The New York Times, “Lyme Disease Is Spreading Fast. Why Isn’t There a Vaccine?,” doesn’t mention the media’s role in bringing down the vaccine.

“But the company took it off the market less than four years later, citing low sales, amid lawsuits from patients who said the vaccine caused severe arthritis and other symptoms… The high cost of the vaccine and confusion over who should get it and how many doses were needed didn’t help its prospects.”

Lyme Disease Is Spreading Fast. Why Isn’t There a Vaccine?

And that’s likely why we continue to see false balance in their reporting, as we see them interview a group who is “skeptical about the new vaccine.”

A new vaccine that hasn’t even made it into phase II trials yet!

“Whatever you think about Andrew Wakefield, the real villains of the MMR scandal are the media.”

Ben Goldacre on The MMR story that wasn’t

The media’s role in scaring folks about vaccines isn’t new.

Unfortunately, the impact of the media on the anti-vaccine movement has been felt far beyond Andrew Wakefield, the MMR vaccine and measles outbreaks.

“As we ask how to weigh public health benefits of interventions against potential risks (notably incurred by identifiable individuals), the LYMErix case illustrates that media focus and swings of public opinion can pre-empt the scientific weighing of risks and benefits in determining success or failure.”

The Lyme vaccine: a cautionary tale

Hopefully, folks have learned their lesson though. How many people have developed Lyme disease since LYMErix was withdrawn from the market? After all, Lyme disease should still be a vaccine-preventable disease.

More on the Lyme Disease Vaccine

Who is Alexander Langmuir?

Alexander Langmuir is typically described as a hero or titan of public health.

Then why do some folks think he was against the flu and measles vaccines?

Who is Alexander Langmuir?

Dr. Alexander Langmuir has been called the father of infectious disease epidemiology.

Why?

In 1949, he established the CDC’s Epidemiology Program. Actually, at the time, the CDC was still called the Communicable Disease Center.

Dr. Alexander Langmuir and his Polio Surveillance Unit at the EIS in 1955.
Dr. Alexander Langmuir and his Polio Surveillance Unit at the EIS in 1955.

Dr. Langmuir, as Chief Epidemiologist at CDC for 21 years, also:

  • founded the Epidemic Intelligence Service (EIS)
  • instituted a malaria surveillance system
  • established national disease surveillance system for the United States
  • was involved in resolving the Cutter incident
  • brought the Morbidity and Mortality Weekly Report to CDC
  • investigated the swine influenza virus vaccine incident, when it was thought that some people developed GBS after getting the new swine flu vaccine in 1976

His work saved the lives of hundreds of thousands of people.

Don't believe any propaganda or quotes without sources attributed to Alexander Langmuir.
Don’t believe any propaganda or quotes without sources attributed to Dr. Alexander Langmuir.

Did he ever tell folks to not get a flu shot?

Was he ever concerned about mercury in flu shots?

Considering that Dr. Langmuir died in 1993, before folks became concerned about thimerosal in vaccines, that’s unlikely. That’s especially so considering that the only place you can find these types of quotes are on anti-vaccine websites.

Still, Langmuir was critical of flu shots.

“From this appraisal of the experience in the past three and one-half years, it is apparent that progress in the control of influenza has not been impressive.”

Langmuir et al. on The Epidemiological Basis For The Control Of Influenza

He didn’t think that they worked well enough. Or more importantly, he didn’t think we had enough information about how well they worked.

“Our information regarding the occurrence of influenza is largely qualitative. Schools close, absenteeism increases, medical services become taxed, virus isolations and serological identifications are made in great numbers, and daily accounts appear in our newspapers and on television. We know we have an epidemic and we know its specific cause, but we have few quantitative measures of incidence, age- and sex-specific attack rates, and character and severity of complications. Further- more, we have only crude data regarding mortality. We do not know what proportion of excess deaths occurs among reasonably active and productive citizens in contrast to deaths among persons who are already invalids suffering from severely debilitating pre-existing disease. Despite this serious deficiency we base our recommendations for vaccine use largely on mortality experience. We undertake major efforts to produce influenza vaccine in large amounts, but we have no meaningful information regarding its actual distribution. We do not know to what extent it actually reaches persons at highest risk.”

Langmuir et al. on A Critical Evaluation of Influenza Surveillance

But he wasn’t anti-vaccine.

And he never said that flu shots weren’t safe.

“The availability of potent and effective measles vaccines, which have been tested extensively over the past 4 years, provides the basis for the eradication of measles in any community that will raise its immune thresholds to readily attainable levels.”

Langmuir et al. on Epidemiologic Basis For Eradication Of Measles In 1967

And concerning all that he did in the field of public health, he is certainly not someone that anti-vaccine folks should be quoting.

More on Alexander Langmuir

Does Congress Really Agree About Vaccines?

Believe it or not, Congress has a lot to do with whether or not folks get vaccinated.

“As Members of Congress, we have a critical role to play in supporting the availability and use of vaccines to protect Americans from deadly disease.”

Sens. Lamar Alexander et al Dear Colleague Letter

We saw what happened in the mid-1980s when Federal funding for vaccine programs went down – we got measles outbreaks.

Congress and Vaccines

But it isn’t just that members of Congress have their fingers on the purse strings.

Over the years, while the great majority of lawmakers do agree that vaccines work and that they are safe and necessary, a few have created unnecessary fear about vaccines and have likely scared parents away from vaccinating and protecting their kids.

Remember when Michele Bachmann went on the Today Show with Matt Lauer and told her HPV vaccine story?
Remember when Michele Bachmann went on the Today Show with Matt Lauer and told her HPV vaccine story?

And then there are the Congressional hearings…

Remember Dan Burton?

The former Republican member of the U.S. House of Representatives from Indiana (1983-2013) has been described as being “antivaccine through and through” and “organized quackery’s best friend in Congress.”

Dan Burton held over 20 Congressional hearings trying to prove that there was a link between vaccines and autism.

Because he thinks that his grandson developed autism from vaccines, Dan Burton continues to believe that vaccines are associated with autism.
Because he thinks that his grandson developed autism from vaccines, Dan Burton continues to believe that vaccines are associated with autism.

Hearings that gave a high profile platform to Andrew Wakefield and are best described as:

“carefully choreographed to generate as much negative feeling toward the vaccination system as possible.”

Arthur Allen on Vaccine The Controversial Story of Medicine’s Greatest Lifesaver

Who replaced Dan Burton?

It seems to be U.S. Congressman Bill Posey (R-FL), who has been described as “vying to take over the title of the most antivaccine legislator in the U.S. Congress since Dan Burton retired.”

He got a little help from Rep. Darrell Issa, who conducted a meeting of the Subcommittee of Government Operations in 2014, Examining the Federal Response to Autism Spectrum Disorders.

“Okay. Let’s stop it right there. Because every time we have ever talked about doing one of those studies, some idiot in the media says I am suggesting that children intentionally don’t get vaccinated. And I don’t know that anybody ever has ever proposed that. But there are plenty of children whose parents will not allow them to be vaccinated. There are plenty of cultures where children are not vaccinated. And there are other reasons children are not vaccinated. And there are children who take large doses of vaccination, and children whose parents decide to have them take one vaccination at a time to avoid thimerosal. And I have not been able to ascertain that there has actually been a legitimate study done that wasn’t tainted by the touch of the international colossal scumbag Poul Thorsen.”

Rep. Bill Posey questioning NIH Director Thomas R. Insel, M.D. in the Congressional hearing on Examining the Federal Response to Autism Spectrum Disorders

Who else might be joining him?

Since the verbal evidence she hears says kids are getting too many vaccines, Rep Maloney asks the CDC Director why we can't just space out the vaccines kids get...
Since the verbal evidence she hears says kids are getting too many vaccines, Rep Maloney asks the CDC Director why we can’t just space out the vaccines kids get…

There is Rep. Carolyn Maloney (D-NY).

Maloney also spoke at a 2012 hearing planned by Rep. Darrell Issa (R-CA) on the federal response to rising autism rates.

“Are you looking at vaccination? Is that part of your studies? I have a question. Are you looking at vaccination? Are you having a study on vaccination and the fact that they’re cramming them down and having kids have nine at one time. Is that a cause? Do you have any studies on vaccination?”

Rep. Carolyn Maloney (D-NY) in a hearing on Rising Autism Rates

Rep. Carolyn Maloney was also a co-sponsor of Rep. Bill Posey’s 2015 Vaccine Safety Study Act bill, which called for “a comprehensive study comparing total health outcomes, including risk of autism, in vaccinated populations in the United States with such outcomes in unvaccinated populations in the United States, and for other purposes,” even though many experts have long pointed out the problems with using intentionally unvaccinated folks as a comparison group.

But Rep Maloney got her start long before Bill Posey ever came to Congress…

In 2006, in response to a series of articles by Dan Olmstead, who later created the website, Age of Autism, Rep Maloney held a briefing at the National Press Club where she proposed the Comprehensive Study of Autism Epidemic Act of 2006, a bill that sounds awfully similar to Posey’s Vaccine Safety Study Act.

Rep. John Duncan (R-TN) was another co-sponsor.

But we shouldn’t forget Rep. Dave Weldon MD (R-Fl), who introduced the Mercury-Free Vaccines Act of 2004 and the Vaccine Safety and Public Confidence Assurance Act of 2007. Weldon also sent a number of letters to Julie Gerberding questioning a study about thimerosal by Thomas Verstraeten, a study that was investigated and cleared by Senator Mike Enzi (R-WY) and the Senate Health, Education, Labor and Pensions (HELP) Committee in 2005. Because he was a doctor, Rep. Burton also had Weldon do a lot of the questioning during his hearings.

And there is also Rep. Christopher Smith (R-NJ), who was a cosponsor when  Maloney reintroduced the Vaccine Safety and Public Confidence Assurance Act in 2009.

Not surprisingly, many of these members of Congress have been getting donations from anti-vaccine organizations.

Henry Waxman was a featured speaker at the 2015 AAP Legislative Conference.
Henry Waxman was a featured speaker at the 2015 AAP Legislative Conference.

In contrast to all of the folks above, there was Rep. Henry A Waxman (D-CA), who retired after 40 years in Congress, but not before:

  • fighting back against Dan Burton’s misinformation in his hearings about vaccines
  • introducing the Vaccine Access and Supply Act of 2005
  • authoring the stand-alone Vaccines for Children legislation that was included in the Omnibus Budget Reconciliation Act of 1993 that created the Vaccines for Children (VFC) Program
  • introducing the National Childhood Vaccine Injury Act of 1986

But his work on vaccines has probably been the most low-profile thing that Waxman did, which is why he is often described as “one of the most important Congressman ever.”

You’ll never hear that said about Dan Burton, Bill Posey, Dave Weldon, or Carolyn Maloney…

More on Congress and Vaccines

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

The Catholic Church and Vaccines

We hear a lot about the Catholic Church and vaccines.

The Catholic Church teaches that it is lawful to get vaccinated to protect
The Catholic Church teaches that it is lawful to get vaccinated to protect “our children, public health, and the common good.” The National Catholic Bioethics Center

Maybe it is because Pope Francis led a polio vaccine campaign when he visited Mexico.

Pope Francis helped launch a polio vaccine campaign when he visited Mexico in 2016.
Pope Francis helped launch a polio vaccine campaign when he visited Mexico in 2016.

Or because Pope Francis thanked members of the Rotary International during an Audience at the Vatican, where the Pope “emphasized the importance of vaccinations against polio and urged Rotary to continue.”

History of the Catholic Church and Vaccines

Pope Francis isn’t the first Pope to promote vaccination.

Way back in the early 1800s, Pope Pius VII said the smallpox vaccine was “a precious discovery which ought to be a new motive for human gratitude to Omnipotence.”

But wasn’t there an anti-vaccine pope too?

Some claimed that Pope Leo XII had said that “Whoever allows himself to be vaccinated ceases to be a child of God. Smallpox is a judgment of God, the vaccination is a challenge toward heaven.

He didn’t say it though – the anti-vax edict from the Pope was imaginary!

There was no anti-vaccine pope.

Endorsement of vaccination by the Catholic Church had started long before the smallpox vaccine. As early as the 1720s, Jesuits were inoculating Indians in the Amazon against smallpox.

Other noteworthy events in the history of the Catholic Church related to vaccines include:

  • 1757 – Pope Benedict XIV was inoculated against smallpox
  • 1780s – introduction of public vaccinations by the archbishop of Bamberg, Germany
  • 1821 – Council of Vaccination
  • 1800s – priests routinely led processions of people to get vaccinated against smallpox
  • 1862 – Catholic missionaries vaccinated the Quwutsun in the Pacific Northwest

Sean Phillips, in examining the records of the Osler Library, has also found “a story of close cooperation between clergy and the state from the earliest stages of the vaccine in France…” That was important, because when smallpox epidemics were raging, the clergy functioned “as a conduit between the medical community and the majority of cities, towns, and communes in France throughout the nineteenth century.”

Vaccines and Abortion

Of course, one of the main reasons that vaccines and the Catholic Church comes up at all is because of abortion.

The Pontifical Academy for Life reaffirmed the "lawfulness" of using vaccines to protect children and those around them.
The Pontifical Academy for Life reaffirmed the “lawfulness” of using vaccines to protect children and those around them.

What does abortion have to do with vaccines?

While much of what you hear about abortion and vaccines isn’t true, some of it is:

  • Vaccines do not contain aborted fetal tissue.
  • Some vaccines are made in cell lines that originated from fetuses that were aborted over 40 years ago.
  • These vaccines are made in descendent cells from either the WI-38 and MRC-5 cell lines, which have been duplicated over and over again and are grown independently. So, “it is important to note that descendent cells are not the cells of the aborted child.”
  • The descendent cells don’t remain in the final vaccine after it has been purified.

It should be clear now why they say that these vaccines are said to have a “distant association with abortion.”

“For its part, Catholic social teaching entails a duty to vaccinate in order to protect the vulnerable.”

Paul J. Carson on Catholic Social Teaching and the Duty to Vaccinate

And why it is said that Catholics are “morally free to use the vaccine regardless of its historical association with abortion” and that “it should be obvious that vaccine use in these cases does not contribute directly to the practice of abortion since the reasons for having an abortion are not related to vaccine preparation.”

“Since there is no Catholic teaching that the use of these vaccines is sinful, schools cannot allow Catholic parents to claim a religious exemption from the requirement of immunization.”

National Catholic Bioethics Center on Vaccines and Exemptions Granted by Schools

Catholics can seek an alternative vaccine when available and “register a complaint with the manufacturer of the products as an acceptable form of conscientious objection,” but the The National Catholic Bioethics Center states that “there is no moral obligation to register such a complaint in order to use these vaccines.”

Not only are we morally free to get vaccinated and vaccinate our kids, but the National Catholic Bioethics Center says that parents actually “have a moral obligation to protect the life and health of their children and those around them.”

What to Know About the Catholic Church and Vaccines

From measles to HPV, the Catholic Church recommends that your family be vaccinated and protected.

More About the Catholic Church and Vaccines

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