Yes, although anti-vaccine folks needlessly worry about shedding when kids get routine childhood vaccines and even talk about a shedding season, with the smallpox vaccine, problems with shedding are really a thing.
Since the smallpox vaccine is a live virus vaccine and since it very commonly causes a skin reaction at the injection site, shedding can spread it to others. While that’s a good thing with some vaccines, like the oral polio vaccine, because it increases herd immunity, it isn’t with the smallpox vaccine.
If the weakened smallpox vaccine can cause a skin reaction on your arm where you got the shot, what is it going to do if it gets on a child’s skin that is irritated all over with eczema?
An 8-month-old boy with eczema vaccinatum. Photo by CDC/Arthur E. Kaye
It’s a good thing that we don’t routinely have to use the smallpox vaccine anymore.
“Because persons with eczema are deferred from vaccination, only a single, accidentally transmitted case of EV has been described in the medical literature since military vaccination was resumed in the United States in 2002.”
Children with mastocytosis have extra mast cells, a normal type of cell that we all have that release histamine and other chemicals when activated.
As you can imagine, having too many mast cells, which release too much histamine, isn’t a good thing.
What Causes Mastocytosis?
Mastocytosis, some forms of which have been known since 1869, is caused by spontaneous mutations that aren’t passed on to future generations (somatic mutations).
“Most forms of mastocytosis are caused by a mutation of the KIT gene on the 4q12 chromosome – a mutation that increases cellular reproduction. The c-KIT gene mutation creates an overgrowth of one cell line of mast cells.”
What is mastocytosis?
And the symptoms you have with mastocytosis depends on the type you have, which can include localized (solitary, maculopapular cutaneous, diffuse cutaneous) vs systemic mastocytosis.
“The severity of the symptoms associated with mastocytosis may vary from mild to life-threatening. In general, symptoms occurring in mastocytosis are mainly due to the release of chemicals from the mast cells and thus produce symptoms associated with an allergic reaction.”
Mastocytosis – Rare Disease Database
Localized mastocytosis is usually present at birth or early infancy.
Do Vaccines Cause Mastocytosis?
Since it is caused by spontaneous mutations and is often present at birth or early infancy, there is no reason to think that vaccines could cause mastocytosis.
Vaccines and Mastocytosis
That’s not to say that you shouldn’t think about vaccines if your child has mastocytosis.
Although almost anything can be a trigger for kids with mastocytosis, from insect stings, skin rubbing, antibiotics, aspirin, cough medications, exposure to heat or cold, and stress, there have been a few reports of vaccines being a trigger.
“In childhood, the risk for anaphylactic episodes was limited to children with extensive skin disease, but nonexistent for children with mastocytoma or limited macular lesions. This is in good agreement with the literature, where children with anaphylaxis were described as having clinically severe skin involvement of mastocytosis, although the levels of skin involvement were not given and tryptase concentrations not determined. Children with fatal anaphylaxis, described in three case reports, all had suffered from extensive blistering skin disease…”
Brockow et al on Anaphylaxis in patients with mastocytosis: a study on history, clinical features and risk factors in 120 patients.
It is important to note that these are kids with severe disease though and not the more typical type of localized disease that the average child will have.
An infant with diffuse cutaneous mastocytosis. Lange et al. (CC BY-NC 3.0)
It should also be noted that viral and bacterial infections with fever, some of which are vaccine preventable, can also be a trigger.
Still, if your child has extensive skin disease, your specialist will likely talk about premedication before vaccines and watching your child closely afterward in case they have an anaphylactic reaction.
Should they get fewer vaccines at a time?
Surprisingly, it depends on who you ask, but it should be noted that all of the discussions about vaccines are for kids with diffuse cutaneous mastocytosis (DCM), a rare form of cutaneous mastocytosis.
“Although patients with mastocytosis can be vaccinated according to the standard schedule, precautions to prevent MC activation and degranulation have been formulated by experts, particularly in cases of diffuse skin manifestations”
And none say to skip vaccines, although some say to use an alternative immunization schedule, getting one vaccine at a time perhaps, especially for the initial doses.
It should be clear that kids with mastocytosis can and should be vaccinated though and vaccines do not actually cause mastocytosis.
We are seeing many reports that Professor Martin Gore, an oncologist at London’s Royal Marsden Hospital for more than 35 years, died suddenly after getting a yellow fever vaccine.
Could that be true?
Could someone really die after getting a routine vaccination?
Did a Top Cancer Scientist Suddenly Die After Getting a Yellow Fever Vaccination?
Of course, it could be true.
Although vaccines are very safe, they are not 100% risk free. And tragically, they do very rarely have life-threatening side effects.
To be fair, we don’t know the full story about what happened to Prof Gore, but the media reports do say that he suffered total organ failure shortly after getting his yellow fever vaccine.
What we don’t know is how shortly after getting the vaccine or if there is any evidence for another cause for his having organ failure.
Still, although most side effects are mild, it is reported that the yellow fever vaccine, which has been available for more than 80 years, can rarely cause:
internal organ dysfunction or failure – yellow fever vaccine-associated viscerotropic disease (YEL-AVD)
How rarely?
About 1 in 55,000 for severe allergic reactions, 1 in 125,000 for severe nervous system reactions, and 1 in 250,000 for life-threatening severe illness with organ failure.
And the risks are likely higher if you are older than age 60 years, although YEL-AND and YEL-AVD are not reported to happen with booster doses of the yellow fever vaccine.
“People aged ≥60 years may be at increased risk for serious adverse events (serious disease or, very rarely, death) following vaccination, compared with younger persons. This is particularly true if they are receiving their first yellow fever vaccination. Travelers aged ≥60 years should discuss with their healthcare provider the risks and benefits of the vaccine given their travel plans.”
Yellow Fever Frequently Asked Questions
Why would you get the yellow fever vaccine if you were older than aged 60 years and you knew there was a higher risk of severe side effects?
Yellow fever itself is a life threatening disease without a cure and a case fatality rate of up to 50%, and again, YEL-AVD is not common, occurring in about 0.4/100,000 doses.
So you would typically want to get vaccinated if you were traveling to an area where yellow fever was a risk.
“Since January 2018, 10 travel-related cases of yellow fever, including four deaths, have been reported in international travelers returning from Brazil. None of the 10 travelers had received yellow fever vaccination.”
Fatal Yellow Fever in Travelers to Brazil, 2018
In addition to outbreaks, yellow fever is still endemic in forty-seven countries in Africa and Central and South America, leading to 170,000 severe cases and 60,000 deaths in recent years, including some deaths in unvaccinated travelers returning from these areas. Did you read about these deaths in the paper?
Although it is not on the routine immunization schedule, if you are traveling somewhere and yellow fever is a risk, you should get a yellow fever vaccine.
Professor Gore’s death, at age 67, is a tragedy, no matter the cause.
Not surprisingly, a lot of things that get blamed as being caused by flu vaccines are not actually side effects.
Did you actually get the flu in the days or weeks after your flu vaccine?
That’s not a side effect of your flu vaccine. Neither the inactivated flu shot, nor the attenuated FluMist can actually cause a flu infection.
Did you get a little sore at the site where you got your flu shot?
That’s a common side effect to getting a flu shot.
So is having some redness and swelling at the site, all of which begin soon after getting the shot and go away in a few days. You can also get a headache, fever, nausea, and muscle aches or signs and symptoms of an allergic reaction.
Do you have a runny nose or a cough? Side effects of the nasal spray flu vaccine can include a few days of runny nose, wheezing, headache, vomiting, muscle aches, fever, sore throat and cough.
Again, a bad cough and cold after a flu shot isn’t a side effect of the vaccine though.
If you found out you were pregnant shortly after getting a flu shot, you wouldn’t think they were associated, would you?
What about narcolepsy?
“An increased risk of narcolepsy was found following vaccination with Pandemrix, a monovalent 2009 H1N1 influenza vaccine that was used in several European countries during the H1N1 influenza pandemic.”
Narcolepsy Following Pandemrix Influenza Vaccination in Europe
Although the focus has been on the Pandemrix flu vaccine as a trigger for narcolepsy in some countries (the vaccine wasn’t used in the United States), interestingly, several countries that weren’t using the vaccine also saw a spike in narcolepsy cases as the 2009 H1N1 pandemic hit.
Doctors and pharmacies rarely give away flu shots for free. They might not charge a copay sometimes because they are getting paid by your insurance company!
What about all of the reports of severe reactions and deaths after getting a flu shot that you might hear about? In addition to vaccine injury stories, those reports are to VAERS and typically are not causally related to getting a vaccine.
Why are there so many reports to VAERS and the NVICP about flu vaccines? Since 2006, over 1.6 trillion doses of flu vaccine have been distributed in the United States, which equals about the total of all other vaccines we use.
What Are the Side Effects of This Year’s Flu Shot
Even when folks understand that flu vaccines don’t typically cause serious side effects, the question always comes up whether or not this year’s flu shot is causing more side effects than usual.
That’s actually not unreasonable, even when you consider that the biggest change in most flu vaccines from year to year is the strain of flu viruses they include, and not any of the other ingredients.
In addition to the Pandemrix flu vaccine, in 2010, the use of one brand of flu vaccines in Australia was suspended because they were causing more side effects (fever and febrile seizures) in young children than expected.
“The studies flesh out preliminary findings from CSL in June 2012, which said that the manufacturing process retained more virus component than that of other manufacturers and that the 2010 virus components triggered an excessive immune response in some young kids.”
CSL studies shed light on 2010 flu vaccine seizures
People with Guillain-Barré syndrome develop the rapid onset of muscle weakness and then paralysis. They may also have numbness and a loss of reflexes.
Unlike some other conditions that cause weakness and paralysis, GBS is a symmetrical, ascending paralysis – it starts in your toes and fingers and moves up your legs and arms.
What Causes Guillain-Barré Syndrome?
If you want to avoid GBS, skip raw milk, not your vaccines. (CC BY 2.0)
GBS is an autoimmune disorder and often starts after a viral or bacterial infection, especially one that causes diarrhea or a respiratory illness.
One of the biggest risk factors is a previous Campylobacter jejuni infection, that is often linked to drinking raw milk, eating undercooked food, drinking untreated water, or from contact with the pet feces.
In less half of cases, no specific cause is found.
Fortunately, although progress can be slow, many people with GBS recover.
“On very rare occasions, they may develop GBS in the days or weeks after getting a vaccination.”
CDC on Guillain-Barré syndrome and Flu Vaccine
It is not common though.
For example, the increased risk of GBS after getting a flu vaccine is thought to be on the order of about one in a million – in adults.
Flu vaccines have not been shown to cause GBS in children.
“The risk of GBS is 4–7 times higher after influenza infection than after influenza vaccine. The risk of getting GBS after influenza vaccine is rare enough that it cannot be accurately measured, but a risk as high as one case of GBS per 1 million doses of flu vaccine cannot be reliably excluded.”
Poland et al on Influenza vaccine, Guillain–Barré syndrome, and chasing zero
It is also important to keep in mind that you are far more likely to get GBS after a natural flu infection than after the vaccine, plus the flu vaccine has many other benefits.
What about other vaccines?
“In this large retrospective study, we did not find evidence of an increased risk of GBS following vaccinations of any kind, including influenza vaccination.”
Baxter et al on Lack of association of Guillain-Barré syndrome with vaccinations
No other vaccines that are currently being used routinely have been associated with Guillain-Barré syndrome.
In fact, many studies do not even find an association between GBS and the flu vaccine.
What to Know About Guillain-Barré Syndrome and Vaccines
Guillain-Barré Syndrome may be associated with the flu vaccine in adults in about 1 in a million cases, but does not occur with any other vaccines, and occurs far more commonly after a natural flu infection.
petechia and/or purpura – caused by temporary thrombocytopenia (low platelet count) in about one out of every 30,000 to 40,000 doses of vaccine given
And then there is the rash that up to 5% or people get about 7 to 10 days after their dose of MMR – a mild vaccine reaction that goes away on its own without treatment.
Most importantly, the presence of this measles-like rash does not mean that your child has actually gotten measles from the vaccine.
How do we know?
For one thing, the MMR vaccine is made with an attenuated or weakened form of the measles virus, so it can’t actually cause full-blown measles, unless maybe a child has a severe immune system problem.
Also, there is no viremia after vaccination.
“There are no reports of isolation of vaccine virus from blood in normal humans.”
Plotkin’s Vaccines
It is also important to note that “person-to-person transmission of vaccine virus has never been documented.”
And kids who get a rash after their MMR vaccine are not considered to be contagious. At most, you would expect them to shed the weakened vaccine virus, but they don’t.
What’s causing this measles-like rash then?
Like the fever, it is thought to be a delayed immune response to the live, attenuated virus in the vaccine.
When the Rash Really is Measles
Are there any situations in which a child gets a rash after their MMR vaccine and it could really be measles?
Sure.
An infant with wild type measles hospitalized during a measles outbreak in the Philippines in which 110 people died. Photo by Jim Goodson, M.P.H.
Your child could have been exposed to wild type measles right around the time they got vaccinated, and then went on to develop regular measles.
While getting a measles vaccine within 72 hours of exposure (post-exposure prophylaxis) can reduce your chance of getting measles, it isn’t a perfect strategy.
Or your child could have been vaccinated and been one of the few people for whom the vaccine failed to work. So their rash, again, would be from a wild type strain of measles that they were exposed to and not from the shot.
Can you tell the difference if someone has measles from the vaccine or from a wild type strain?
Sure.
“During outbreaks, measles vaccine is administered to help control the outbreak, and in these situations, vaccine reactions may be mistakenly classified as measles cases.”
CDC on Genetic Analysis of Measles Viruses
You just have to test the measles strain to see if it is the wild type virus or a vaccine strain.
Does It Matter If It Is the MMR Vaccine or Measles?
About now, you are probably wondering why it matters knowing if a child’s rash is caused by measles or the MMR vaccine, right?
For one thing, if a parent thinks a vaccine gave their child measles, then they might not want to get vaccinated again. They will especially think twice about getting another MMR.
Also, if a child really does have full-blown, wild type measles and you simply blame their MMR vaccine, then you might miss someone else in the community that exposed the child to measles. And that’s why some outbreaks are hard to stop.
Lastly, if you simply blame the vaccine, you might miss something else that is causing the child to be sick.
Need an example?
During the 2010 measles outbreaks in Canada, a 15-month-old develop a rash, fever, and other symptoms 12 days after getting their MMR vaccine. Did the have measles, a vaccine reaction, or something else?
Turns out that he had scarlet fever.
The child tested positive for Streptococcus pyogenes (group A streptococcus), the bacteria that causes strep throat and scarlet fever. He also tested positive for vaccine strain measles. He did not have the wild strain of measles, and in fact, did not have measles at all.
Again, he had scarlet fever and it was just a coincidence that he had recently received an MMR vaccine.
But isn’t there another case report from Canada that does prove that you can get full-blown measles from the MMR vaccine? While there is such a case report, it is hardly proof of anything.
“It is possible that the case’s symptoms were not measles-vaccine-related but an inter-current illness confounding the presentation.”
Murti et al on Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013
The problem with the case?
For one thing, the child already had high levels of IgG antibodies at the time he had the rash, which developed 37 days after he got his vaccine.
“The two-fold rise between acute and convalescent measles-specific IgG suggests the vaccine-mediated immune response had been underway prior to the onset of symptoms.”
Murti et al on Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013
This was neither a typical reaction nor a typical case. And it very well might not have been measles. If it was, it was a very rare exception to the rule that rashes after the MMR vaccine aren’t full-blown measles.
What to Know About Rashes After the MMR Vaccine
The rash that your child can get after their MMR vaccine is not a sign that they have developed full-blown measles, instead, it is a mild vaccine reaction that will quickly go away without any treatment.
Just about any side effect after a vaccine can be scary for parents.
What if your child suddenly became limp, wasn’t responsive, and was pale?
That would be scary for any parent.
What Are Hypotonic-Hyporesponsive Episodes?
But that’s just what can happen when a child has a hypotonic–hyporesponsive episode (HHE).
“A hypotonic-hyporesponsive episode (HHE) is the sudden onset of hypotonia, hyporesponsiveness, and pallor or cyanosis that occurs within 48 hours after childhood immunizations.”
DuVernoy et al on Hypotonic-hyporesponsive episodes reported to the Vaccine Adverse Event Reporting System (VAERS), 1996-1998
These types of episodes were once thought to happen once for every 1,750 DTP vaccines given.
HHE is much rarer since we switched to a new pertussis vaccine.
Fortunately, although they certainly do sound scary, the episodes stop on their own and don’t cause any permanent harm.
Hypotonic-hyporesponsive episodes were even removed as table injuries after DTP back in 1995. It is not that HHE can’t occur after DTP, DTaP, or other vaccines, but rather that HHE doesn’t then cause any permanent neurological damage to the child.
And it is rare for kids to have a second episode, so they can continue to get vaccinated. HHE is not a good reason to skip or delay all of your child’s vaccines. While not a contraindication to getting vaccinated, having an episode of HHE “within 48 hours after receiving a previous dose of DTP/DTaP,” is listed as a precaution to getting another dose of DTaP or Tdap though.
“In general, vaccinations should be deferred when a precaution is present. However, a vaccination might be indicated in the presence of a precaution if the benefit of protection from the vaccine outweighs the risk for an adverse reaction.”
CDC on Vaccine Contraindications and Precautions
Also, HHE has become even more rare since we switched to using DTaP, instead of the older DTP vaccine. So being worried about HHE is definitely not a good reason to skip or delay any vaccines.
What to Know About Hypotonic-Hyporesponsive Episodes
Hypotonic-hyporesponsive episodes were more common after the older DTP vaccines, but still didn’t cause any long term problems and aren’t a good reason to skip or delay your child’s vaccines.
