Category: Vaccine Safety

Do Vaccines Cause Psoriasis?

Even with all of the so-called vaccine-induced diseases that anti-vaccine folks come up with, few people likely think that vaccines cause psoriasis.

Bob Sears is being investigated by the California Medical Board for giving these medical exemptions because he thinks vaccines cause psoriasis.
Bob Sears is being investigated by the California Medical Board for giving these medical exemptions. Were they legitimate?

Some do though…

Do Vaccines Cause Psoriasis?

Bob Sears thinks that these kids shouldn’t be vaccinated because “vaccines can trigger psoriasis or make existing psoriasis worse.”

Dr. Bob did his research and thinks that vaccines are a risk to cause lifelong psoriasis.
Dr. Bob did his research and thinks that vaccines are a risk to cause lifelong psoriasis.

He even provided a list of studies that he thinks support his case.

“Nevertheless, the likely very low incidence of psoriasis following vaccination emphasizes the safe profile and the relevance of vaccination strategies in psoriasis patients, especially in candidates for immunosuppressive treatments.”

Sbidian et al on National survey of psoriasis flares after 2009 monovalent H1N1/seasonal vaccines.

Do they?

“The risk of psoriasis was also increased in subjects who reported a history of a recent infectious episode. The analysis by individual diagnosis pointed to acute pharyngitis as the disease with the strongest association and the only one providing statistically significant results…”

Naldi et al on Family history of psoriasis, stressful life events, and recent infectious disease are risk factors for a first episode of acute guttate psoriasis: results of a case-control study

Let’s see, although I’m not sure he actually read more than the abstracts or understands that guttate psoriasis isn’t the same as plaque psoriasis

  1. Possible Triggering Effect of Influenza Vaccination on Psoriasis – a small group of patients (36) either had an exacerbation of their psoriasis, or new onset of psoriasis (7), within a couple of weeks to months after getting a flu shot.
  2. Psoriasis triggered by tetanus-diphtheria vaccination – a case report of a 50-year-old with chronic psoriasis for 6 years who developed an exacerbation a week after getting a tetanus booster.
  3. Psoriatic skin lesions induced by BCG vaccination – a case report of a 6-month-old who developed a BCG-induced tuberculid-like eruption accompanied by psoriatic skin changes one month after vaccination. They went away without treatment within 3 months.
  4. Guttate psoriasis-like lesions following BCG vaccination – a case report of a 7-year-old who developed guttate psoriasis-like lesions one week after his BCG vaccination. He was treated with steroid creams and the rash went away within three weeks.
  5. New Onset Guttate Psoriasis Following Pandemic H1N1 Influenza Vaccination – a case report of a 26-year-old who developed guttate psoriasis after getting a flu shot. Her rash went away within three weeks.
  6. National survey of psoriasis flares after 2009 monovalent H1N1/seasonal vaccines – a small group of patients (10) who either developed new onset psoriasis or had an exacerbation after getting a flu shot.
  7. Psoriasis vaccinalis; report of two cases, one following B.C.G. vaccination and one following vaccination against influenza – from 1955, two case reports of psoriasis after BCG vaccine and the flu shot.
  8. Family history of psoriasis, stressful life events, and recent infectious disease are risk factors for a first episode of acute guttate psoriasis: results of a case-control study – a case control study that “confirmed that recent pharyngeal infection is a risk factor for guttate psoriasis. It also documented the strong association between guttate psoriasis and a family history of psoriasis. Finally, the study added evidence to the belief that stressful life events may represent risk factors for the onset of psoriasis.” The study doesn’t mention vaccines, but does remind us that “it has been estimated that only one third of cases of guttate psoriasis progress to chronic plaque psoriasis, whereas a history of guttate psoriasis is not frequent in patients with psoriasis.”
  9. Genetic background of psoriasisdoesn’t mention vaccines.

So, none of Bob’s studies were in children, they are mostly about flu shots and the BCG vaccine (which isn’t used in the United States), they are mostly case reports (low on the hierarchy of evidence), and a few don’t mention vaccines…

And most aren’t about chronic psoriasis!

Explaining the Correlation of Psoriasis After Vaccines

Is there anything that might explain the case reports that do show an association between vaccines and psoriasis flares?

“Psoriasis can appear in areas of the skin that have been injured or traumatized. This is called the Koebner [KEB-ner] phenomenon. Vaccinations, sunburns and scratches can all trigger a Koebner response. The Koebner phenomenon can be treated if it is caught early enough.”

National Psoriasis Association on Causes and Triggers

Experts also talk about Th1- and Th17-predominant immunologic responses of flu shots and the BCG vaccine’s Th17 activity. It is known that Th17 cells play a role in psoriasis.

Are there any other studies about vaccines and psoriasis that Dr. Bob left out?

  1. Yellow fever vaccine used in a psoriatic arthritis patient treated with methotrexate: a case report – “A case of yellow fever vaccine used in a 27-year-old Slovenian male with psoriatic arthritis during treatment with methotrexate is described. We demonstrate a positive case, since there were no adverse effects in concurrent administration of yellow fever vaccine and methotrexate.”
  2. Live attenuated varicella vaccine: A new effective adjuvant weapon in the battlefield against severe resistant psoriasis, a pilot randomized controlled trial – a study of 35 patients which found that the “use of chickenpox vaccine with low-dose cyclosporine seems to have value for the treatment of resistant psoriasis.”
  3. [Psoriasis is no obstacle to smallpox vaccination] – (I haven’t found the full article yet, but the title is intriguing, since eczema is a contraindication to getting the smallpox vaccine…)
  4. Factors associated with 2009 monovalent H1N1 vaccine coverage: a cross sectional study of 1,308 patients with psoriasis in France – mentions that more than twice as many people with psoriasis in France got a flu shot than the general population.
  5. Immune response to pneumococcus and tetanus toxoid in patients with moderate-to-severe psoriasis following long-term ustekinumab use – vaccines work when you have psoriasis!
  6. From the Medical Board of the National Psoriasis Foundation: monitoring and vaccinations in patients treated with biologics for psoriasis – addresses vaccination practices for folks with psoriasis.
  7. Challenges in the treatment of psoriasis with biologics: vaccination, history of malignancy, human immunodeficiency virus (HIV) infection, and pediatric psoriasis – actually talks about how UNDERVACCINATION is a challenge in treating kids with psoriasis, as you might have to interrupt therapy to get them caught up!
  8. Vaccinations in patients with immune-mediated inflammatory diseases – is very clear that the “Clinical evidence indicates that immunization of IMID patients does not increase clinical or laboratory parameters of disease activity. Live vaccines are contraindicated in immunocompromized individuals, but non-live vaccines can safely be given.”

The bottom line is that experts that treat people with psoriasis recommend that they be fully vaccinated.

“Psoriasis is a treatable, chronic dermatosis. The very low absolute risk of new-onset or relapsed psoriasis following influenza vaccination should not change its universal recommendation, particularly for patients with psoriasis on immunosuppressive therapy. We present this case to highlight clinical manifestations of this rare association.”

Shi et al on Widespread psoriasis flare following influenza vaccination

There is even talk of development of a vaccine to treat psoriasis!

It should be clear that neither psoriasis nor a family history of psoriasis should be a reason to get a medical exemption for vaccines.

More on Vaccines and Psoriasis

Which Countries Have a Vaccine Injury Compensation Program?

Vaccines are safe, effective, have few risks, and are obviously necessary.

They aren’t perfect though, which is why “the National Vaccine Injury Compensation Program (VICP) may provide financial compensation to individuals who file a petition and are found to have been injured by a VICP-covered vaccine.”

But the NVICP is only in the United States.

Which Countries Have a Vaccine Injury Compensation Program?

What do other countries do?

The United States isn't the only country with a vaccine injury compensation program. We weren't even the first to have such a system.

You will likely be surprised to know that many have their own vaccine injury compensation programs, including:

  1. Germany ( year of introduction – 1961)
  2. France (1963)
  3. Japan (1970)
  4. Switzerland (1970)
  5. Denmark (1972)
  6. Austria (1973)
  7. New Zealand (1974)
  8. Sweden (1978)
  9. UK Vaccine Damage Payments Unit (1979)
  10. Finland (1984)
  11. Government of Québec Vaccine Injury Compensation Program (1985)
  12. United States NVICP (1988)
  13. Taiwan (1988)
  14. Italy (1992)
  15. Korea National Vaccine Injury Compensation Program (1994)
  16. Norway (1995)
  17. Iceland (2001)
  18. Slovenia (2004)
  19. Hungary (2005)

Does this prove that vaccines are dangerous?

“Vaccines are extremely safe and harm is rare. World-wide, more than 30,000 vaccine doses are delivered per second through routine immunization programs, which,in turn, prevent an estimated 2 million to 3 million deaths annually. The occurrence of serious adverse events, such as those that result in death, threaten life, require inpatient hospitalization, or result in significant disability, are rare (eg, <1 adverse event occurs per 10 million doses for tetanus toxoid vaccines, 1-2 adverse events per 1 million doses for inactivated influenza vaccine, and none for hepatitis A).”

Halabi et al on A Global Vaccine Injury Compensation System

Of course not!

Remember, payouts from these programs, compared to the number of doses of vaccines given, are rare.

Should all countries have a compensation program?

“The most important justification, however, is an ethical argument from justice and equity: introduction of a vaccine injury compensation scheme acknowledges the unique situation that routine childhood immunization is a public health measure, given and accepted in good faith, that may occasionally damage the recipient.”

David Isaacs on Should Australia introduce a vaccine injury compensation scheme?

Sure.

People shouldn’t have to fight for compensation for the rare circumstance for when a true vaccine injury does occur.

More on International Vaccine Injury Compensation Programs

Why Can’t You Give Blood After Getting a Vaccine?

If you are like most people, you have heard so much anti-vaccine misinformation that you figure it is safe to assume that everything these folks say isn’t true.

Yes, go research shedding

If you are a true skeptic, you will still do your research on any new claims just to make sure.

Why Can’t You Give Blood After Getting a Vaccine?

Although you may not have heard of any restrictions on donating blood after getting vaccinated before, it makes sense once you think of it.

You actually have to wait:

  • for up to 8 weeks after getting the smallpox vaccine
  • for up to 4 weeks after getting the MMR (because of the rubella component), chickenpox, and Zostavax vaccines.
  • for up to 3 weeks after getting the hepatitis B vaccine
  • for up to 2 weeks after getting the measles, mumps, oral polio, or yellow fever vaccines

If you notice that these are almost all live vaccines, it becomes very easy to see why you can’t donate blood shortly after being vaccinated.

Blood donation is “Acceptable if you were vaccinated for influenza, tetanus or meningitis, providing you are symptom-free and fever-free. Includes the Tdap vaccine. Acceptable if you received an HPV Vaccine (example, Gardasil).”

American Red Cross Eligibility Criteria: Alphabetical

Live vaccines can create a temporary viremia (virus particles in the blood), which could then be transferred to someone else in donated blood.

Could you get an infection this way?

Probably not.

Remember, you would only be getting the attenuated or weakened vaccine virus strain and even then, it would be a very small amount. If the person getting the vaccine doesn’t get sick from getting the vaccine, why would someone who was getting a much smaller dose through a blood donation.

Still, there is a theoretical risk, especially if the person who received the blood donation had an immunodeficiency, so people aren’t supposed to donate blood shortly after getting these vaccines.

But what about the hepatitis B vaccine. It isn’t a live virus vaccine.

The risk with this vaccine is that a very recently vaccinated donor might test positive for HBsAg (this only happens temporarily), leading the donation center to actually think that they had a hepatitis B infection, disqualifying them from ever donating blood again.

Does any of this mean that vaccines aren’t safe?

Of course not!

Just consider some of the other restrictions on donating blood:

  • You are not eligible to ever donate if you ever tested positive for hepatitis B, even if you were never sick.
  • You must wait 12 months after your last contact if you were exposed to someone with hepatitis B and you want to donate blood.
  • If you are unvaccinated, you must wait at least 4 weeks after being exposed to someone with measles.

So yes, that means that you will be much more likely to be eligible to donate blood if you are fully vaccinated and protected.

More on Donating Blood After Getting Vaccinated

What Is the Morbidity/Mortality Rate of the Polio Vaccine vs the Wild Virus?

Some anti-vaccine folks still think that the risks of vaccines are far greater than the risks of the vaccine-preventable diseases they keep you from getting.

As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks.
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

They aren’t, but you can kind of understand why they might think that with a disease like polio, when they might never actually have known anyone to have the disease.

What Is the Morbidity/Mortality Rate of the Polio Vaccine vs the Wild Virus?

Still, even though polio is under good control and close to being eradicated, the risk/benefit ratio clearly favors getting vaccinated and protected.

That’s because the polio vaccines are very safe and if we stopped vaccinating, polio could come back.

In fact, morbidity/mortality from polio vaccines are decreasing, as we are using much less oral polio vaccine (OPV) in the transition (OPV cessation) to just using inactivated polio vaccine (IPV).

“Over the past ten years, more than 10 billion doses of OPV have been given to nearly three billion children worldwide. More than 16 million cases of polio have been prevented, and the disease has been reduced by more than 99%. It is the appropriate vaccine through which to achieve global polio eradication.”

OPV Cessation

And while most developed countries already use IPV, those that are still using OPV recently switched from a trivalent (tOPV) to a bivalent (bOPV) form of OPV. We could do this because type 2 poliovirus has already been eradicated (2015)!

Of course, the issue with the OPV vaccines is that they rarely cause vaccine-associated paralytic polio (VAPP) and circulating vaccine-derived polioviruses (cVDPV).

Fortunately, this is even less common with bOPV.

As this chart from the WHO shows, polio vaccines are very safe.
As this chart from the WHO shows, polio vaccines are very safe.

So morbidity (getting sick)/mortality (dying) from polio vaccines is low.

There were only 31 cases of wild polio in 2018, in Afghanistan and Pakistan, and an additional 102 cases of cVDPV in 7 countries.

What about morbidity/mortality from polio?

“As recently as 30 years ago, wild poliovirus paralysed more than 350 000 children in more than 125 countries every year. In 2018 there were fewer than 30 reported cases in just two countries – Afghanistan and Pakistan.”

“Zero polio transmission and health for all”, WHO Director-General gives new year’s wish to the people of Afghanistan and Pakistan

With a 99.9% drop in polio cases since 1998, your risk of getting polio in most parts of the world is very low, but you still have to consider both the morbidity/mortality of polio in the pre-vaccine era and the risk of polio returning if we stop vaccinating before it is eradicated.

What about the idea that you don’t have to worry about polio because only 1% of kids with polio developed paralysis?

“The mortality rate for acute paralytic polio ranges from 5–15%.”

Disease factsheet about poliomyelitis

Well, when everyone gets polio, even 1% is a lot.

With such a safe vaccine, why put your kids at risk of getting polio?

Do you even understand what the risks are?

No, it isn’t just the risk of wild polio in Afghanistan and Pakistan.

Since the oral polio vaccines shed, if you are unvaccinated, in addition to the risk of wild polio, there is a small risk of getting circulating vaccine-derived polioviruses (cVDPV) if you are not vaccinated and protected. No, it is not a big risk, as there were only 102 cases of cVDPV in 7 countries in 2018, but it isn’t zero either.

And the other big risk is that if enough folks stop getting vaccinated, taking their chances hiding in the herd, polio will come back and our chance to eradicate another vaccine-preventable disease will fail.

More on the Morbidity and Mortality Rates of Polio