Ask 8 Questions Before You Skip a Vaccine

As anti-vaccine folks get more attention because of the rise in outbreaks of vaccine-preventable disease, in addition to more folks getting vaccinated, we are seeing some of the leaders of the anti-vaccine movement get more vocal.

Are measles outbreaks a sign that the anti-vaccine movement is “winning?”

Meetings, dinners, rallies…

They are doing everything they can to get their misinformation and propaganda out so that you don’t vaccinate and protect your kids.

Ask 8 Questions Before You Skip a Vaccine

If you see any of these folks, ask them a few questions…

  1. If Andrew Wakefield was right, and the MMR vaccine is associated with autism, then why are you worried about thimerosal? The MMR vaccine never contained thimerosal…
  2. If Robert F. Kennedy, Jr is right, and it is all about thimerosal, then why are you worried about the MMR vaccine? The MMR vaccine never contained thimerosal…
  3. If you are worried about thimerosal and aluminum, then why are you worried about the MMR vaccine? Not only has it never contained thimerosal, as a live vaccine, but it has also never contained aluminum.
  4. If vaccines are associated with autism, then why don’t the counties with the highest immunization rates have the highest rates of autism?
  5. If better hygiene and sanitation got rid of vaccine-preventable diseases, then why didn’t it do it for all diseases at the same time? And why hasn’t it gotten rid of RSV, Ebola, Zika, HIV, Norovirus, and all of the diseases that we don’t have vaccines for?
  6. If measles is so mild, then during the measles epidemics from 1989 to 1991 in the United States, why were 11,000 people hospitalized and why did 123 people die?
  7. If you are concerned about vaccines that have a distant association with abortion, then why don’t you vaccinate your kids with all of the vaccines that don’t use WI-38 and MRC-5 cells lines?
  8. If your arguments are so solid, then why do you need to keep moving the goalposts (it’s autoimmune diseases they are worried about now, not autism) and why are they so easy to refute (vaccines aren’t associated with autoimmune diseases either)?

The answers will be predictable.

They will revolve around three basic core beliefs of the anti-vaccine movement.

  • The belief that vaccines are toxic, full of poison, and always cause damage and injuries.
  • The belief that vaccine-preventable diseases are mild and you are better off getting natural immunity.
  • The belief that vaccines don’t even work.

Is that what you believe?

Will you let those kinds of beliefs scare you away from vaccinating and protecting your kids?

Are you going to put our kids at risk because you believe those things?

Are you really making an informed choice to skip or delay a vaccine when all of the scary things that people are telling you about vaccines aren’t even true?

More on Questions to Ask Before You Skip a Vaccine


Does Getting the DTaP Vaccine Make You More Susceptible to Pertussis?

Wait, why would anyone think that getting vaccinated would make you more likely to get a vaccine-preventable disease?

Because there is a new pertussis outbreak in California and folks don’t understand how attack rates work…

Does Getting the DTaP Vaccine Make You More Susceptible to Pertussis?

We know that the latest pertussis vaccines aren’t the greatest, having issues with waning immunity.

They don’t actually make you more likely to get pertussis though, at least not relative to being unvaccinated.

“Because of linked-epitope suppression, all children who were primed by DTaP vaccines will be more susceptible to pertussis throughout their lifetimes, and there is no easy way to decrease this increased lifetime susceptibility.”

JD Cherry on The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future

What the above quote that anti-vaccine folks are misusing is actually saying is that kids who got DTaP vaccines will be more susceptible to pertussis compared to those who got DTwP, the older version of the vaccine. That’s what the whole article is about!

It is not that they will be more suspecptible to pertussis vs someone who was unvaccinated.

Dr. I: Anti-vax folks are misinterpreting that statement, not understanding that it means relative to kids who got DTwP. They think that you are saying that it is the DTaP vaccine itself that makes it more likely that a child will get pertussis, in general. Even relative to someone who is unvaccinated. I know it shouldn’t be necessary, but can you provide a simple quote to clarify this?

JDC: You are of course correct. I was asked to write-up the talk that I have given many times in the US and in many other countries. In the talk, right at the beginning, I mention that today there is 20 fold less pertussis than there was in the pre-vaccine era and that illness in vaccine failures is much less severe that illness in unvaccinated children. I also remember how wrong they were 30 years ago R/E alleged reactions to DTwP.

And if you read his latest article, The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future, especially if you read more than the abstract, you discover that’s what he is saying.

But what about linked-epitope suppression?

In “linked-epitope suppression,” memory B cells out-compete naive B cells for access to the Bordetella epitopes because they are more numerous and their receptors exhibit a higher antigen affinity. Linked-epitope suppression applies as the immune response to novel epitopes is suppressed by the strong response to initial components if they are introduced together.

JD Cherry on The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future

Basically, the DTwP vaccine included many more epitopes or targets for antibodies to bind to than the newer DTaP vaccine. That’s why it worked better. And you don’t get a good response to non-vaccine epitopes or antigens.

Still, you at least have some memory B cells and antibodies after getting the DTaP vaccine, which is why the idea that getting vaccinated makes you more susceptible to pertussis is silly. You are still protected, even if the protection isn’t perfect.

That’s why Dr. Cherry recommends that folks continue to get vaccinated and protected!

“We should be more vigilant than we have been in the past to recognize and treat pertussis in all age groups so that transmission to young infants is reduced. Most important (although not discussed in this review) is to ensure that all pregnant women receive the Tdap vaccine between 27 and 36 weeks’ gestation with each pregnancy. Also, we should consider routinely administering Tdap vaccine every 3 years to all adolescents and adults who were primed with a DTaP vaccine. This suggestion is contrary to that in the current Advisory Committee on Immunization Practices recommendations. However, from the data available, this approach could be expected to decrease the circulation of B pertussis in adolescents and adults. Also, Tdap should be administered to all adolescent and adults exposed to B pertussis during a school or other group outbreak.”

JD Cherry on The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future

He does recommend that we work on new pertussis vaccines though.

“Future cohorts would benefit from the development and use of live vaccines and less-reactogenic DTwP vaccines.”

JD Cherry on The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future

But why are we using a vaccine that doesn’t work as well as the previous vaccine we had?

“Despite the fact that in all but 2 of the efficacy trials the DTwP vaccines had greater efficacy than did the DTaP vaccines being studied, DTaP vaccines were licensed and used in many countries throughout the world; DTaP vaccines had replaced DTwP vaccines. The urgency to adopt DTaP vaccines was driven largely by antivaccine activist groups such as “Dissatisfied Parents Together.” During the rush to adopt DTaP vaccines and tetanus, diphtheria, acellular pertussis vaccines for adults (Tdap), much of the history relating to human pertussis was overlooked.”

JD Cherry on The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future

But the DTwP vaccines weren’t safe, right?

“The results of a number of controlled studies between 1979 and 2004 indicated that no risk of severe neurologic disease after DTwP vaccinations existed. It was noted by myself and Shields (a pediatric neurologist) that what was being called pertussis vaccine encephalopathy was not an encephalitis-like event but, instead, the first seizure or seizures of infantile epilepsy.”

JD Cherry on The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future

No, the cases of encephalopathy that were being reported were not caused by the DTwP vaccine. And neither did the DTwP vaccine cause SIDS, as was also reported at the time.

“Since 1997, the DTaP vaccination policy has created a cohort of people (the number of which is expanding yearly) who are more susceptible to repeated clinical illness with B pertussis infection than are DTwP-vaccinated children. There is no feasible way to make this cohort less susceptible.”

JD Cherry on The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future

And now, after helping create the current DTaP vaccination policy, anti-vaccine folks want to scare folks away from using the vaccine. Don’t let them. Don’t skip or delay this vaccine and leave your kids susceptible to getting diphtheria, tetanus, and pertussis.

More on Does Getting the DTaP Vaccine Make You More Susceptible to Pertussis?

Is the Japanese Encephalitis Vaccine the Stupidest Vaccine Known to Man?

You probably aren’t surprised to hear that Japanese encephalitis isn’t very common in the United States.

“Travelers who go to Asia are at risk for getting Japanese encephalitis (See map). For most travelers the risk is extremely low but depends on where you are going, the time of year, your planned activities, and the length of the trip. You are at higher risk if you are traveling to rural areas, will be outside frequently, or will be traveling for a long period of time”

Japanese Encephalitis

Fortunately, if you are one of those travelers who will be at risk, a Japanese encephalitis vaccine is available.

Is the Japanese Encephalitis Vaccine the Stupidest Vaccine Known to Man?

So how many people get Japanese encephalitis in the United States?

Del Bigtree thinks that it is stupid to have a vaccine against a disease that kills up to 20,400 in the world each year.
Del Bigtree thinks that it is stupid to have a vaccine against a disease that kills up to 20,400 in the world each year.

Not many, but that doesn’t mean it isn’t important to have a Japanese encephalitis vaccine if you need it, right?

“Now correct me if I’m wrong, but no one seems to be complaining of the fact that we have two vaccines that injured have injury rates adverse events of over 100 people. Nine serious adverse events. When the disease itself has only infected 12 human beings in 24 years.

That means that both of these vaccines are six times more dangerous than the disease itself, yet no one on this panel seems to want to discuss that. I imagine that you all will pass whatever it is the Japanese encephalitis next – the stupidest vaccine known to man.

Remember 12 people infected in America – 4 million people visiting the Asia every single year – 24 years – 12 people been infected, and yet we are having this conversation. It is clear that this is a money making operation for the vaccine maker and has nothing to do with actual safety.”

Del Bigtree at the ACIP Meeting

Del’s rant was in response to the Advisory Committee on Immunization Practices discussing Japanese encephalitis vaccines…

It is clear that he doesn’t understand how any of this works, so let’s correct him, since he did ask.

First things first.

Why does he think that only 12 people have been infected with Japanese encephalitis in the United States?

“In the United States, in 25-year period following licensure of JE vaccine in 1992, 12 travel-associated cases reported (< 1 case per year)”

Review of Japanese encephalitis (JE) and JE Vaccine Work Group plans

That’s actually the data from the ACIP JE Vaccine Work Group…

Japanese encephalitis is more common in Asia, where it is endemic in 24 countries in the WHO South-East Asia and Western Pacific regions.

Still, since it isn’t on the list of National Notifiable Conditions, it is possible that a low number of cases have been reported to the CDC because few of the cases actually get reported.

It is also possible that there are few cases because folks who are high risk now get vaccinated and protected. Rates were higher in the pre-vaccine era.

But there is also the fact that most travelers are not at risk to get Japanese encephalitis, so maybe there really have only been 12 cases.

“However, given the large numbers of travelers to Asia (>5.5 million U.S. travelers entered JE-endemic countries in 2004), the low risk for JE for most travelers to Asia, and the high cost of JE-VC ($400–$500 per 2-dose primary series), providing JE vaccine to all travelers to Asia likely would not be cost-effective. In addition, for some travelers with lower risk itineraries, even a low probability of vaccine-related serious adverse events might be higher than the risk for disease. Therefore, JE vaccine should be targeted to travelers who, on the basis of their planned travel itinerary and activities, are at higher risk for disease.”

Use of Japanese Encephalitis Vaccine in Children: Recommendations of the Advisory Committee on Immunization Practices, 2013

That doesn’t mean that we shouldn’t have these vaccines or that this is all part of a money-making operation, does it?

If it was a “money-making operation,” wouldn’t the ACIP recommend the Japanese encephalitis vaccines for all travelers?

Or to make even more money, wouldn’t they just add it to the routine immunization schedule and recommended it for all children?

“Travelers to JE-endemic countries should be advised of the risks for JE disease and the importance of personal protective measures to reduce the risk for mosquito bites. For some travelers who will be in a higher-risk setting based on season, location, duration, and activities, JE vaccine can further reduce the risk for infection. JE vaccine is recommended for travelers who plan to spend a month or longer in endemic areas during the JE virus transmission season.”

Use of Japanese Encephalitis Vaccine in Children: Recommendations of the Advisory Committee on Immunization Practices, 2013

Instead, they make recommendations, even with the latest updates, that virtually guarantees a very low market for the vaccine.

But if the disease isn’t common, why have a vaccine at all?

“Although symptomatic Japanese encephalitis (JE) is rare, the case-fatality rate among those with encephalitis can be as high as 30%. Permanent neurologic or psychiatric sequelae can occur in 30%–50% of those with encephalitis.”

Japanese encephalitis

Japanese encephalitis is deadly!

There have been at least 5 deaths, including 2 children, among just 12 cases (if Del's stats are right).
There have been at least 5 Japanese encephalitis deaths, including 2 children, among just 12 cases (if Del’s stats are right).

And since the Japanese encephalitis vaccines are safe, with few risks (Del is talking about VAERS reports when he talks about vaccine injury rates), why wouldn’t you get vaccinated and protected if you were going to be at risk?

“No safety concerns to date in post-licensure surveillance.”

Review of Japanese encephalitis (JE) and JE Vaccine Work Group plans

After all, there is nothing stupid about wanting to reduce your risk of getting sick and dying.

More on Japanese Encephalitis


Alternative Names for Vaccine Preventable Diseases

You know all of the names – measles, mumps, rubella, diphtheria, whooping cough, etc.

But do you know why they used to call 10-day measles?

And which disease causes a 100-day cough?

Alternative Names for Vaccine Preventable Diseases

Back in the day, when these diseases were more common, they used much more descriptive terms and nicknames, in addition to their official names.

Why was measles known as 10-day measles?

Because there was also a 3-day measles!

MeaslesRubella
10-day measles3-day measles
red measlesGerman measles
rubeola

Unfortunately, 10-day measles made you feel miserable for 10 days!

Although a vaccine was available, it took a little more time to get measles under better control.

Can you guess which disease was known to cause a 100-day cough?

That’s right, it’s whooping cough or pertussis.

“I honestly felt like it was never going to go away. The doctor told me it was 100 day cough, so I was counting the days while Googling to see if there was anything that could help. I tried everything, you name it, I tried it, and nothing worked. It came to 120 days and I couldn’t understand why it wasn’t gone. I then researched and found that babies take longer to get over whooping cough.”

Fern’s Story – Whooping Cough

Fortunately, the cough doesn’t typically last that long if you are vaccinated and still get pertussis.

What do they call rabies?

Mad dog disease.

But that’s an easy one.

Which disease was known as “the Strangling Angel?”

“The breathing became much more difficult, with a kind of rattling stertor, as if the patient was actually strangling, the voice being exceeding hoarse and hollow, exactly resembling that from venereal ulcers in the fauces. This noise, in speaking and breathing, was so peculiar, that any person in the least conversant with the disease might easily know it by this odd noise; from whence, indeed, the Spanish physicians gave it the name of garrotillo, expressing the noise such make as are strangling with a rope.”

Edward Headlam Greenhow on Diphtheria

How about “The Crippler?”

Fight Polio Poster
Polio, also known as infantile paralysis, was known as “The Crippler.”

The “Speckled Monster?”

Even mild smallpox, as depicted on this WHO Smallpox Recognition Card, included flu like symptoms, a few weeks of pustules, and then waiting for the lesions to scab over...
Even mild smallpox, as depicted on this WHO Smallpox Recognition Card, included flu like symptoms, a few weeks of pustules, and then waiting for the lesions to scab over…

We forget these names, because we don’t see these diseases anymore.

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

Walter Orenstein

Do you remember that measles was called a “harmless killer?”

Be sure to think about how these now vaccine-preventable diseases got their nicknames before you think about skipping or delaying your child’s vaccines.

More on Alternative Names for Vaccine Preventable Diseases

Choose to Stop Spreading Anti-Vaccine Propaganda

You have a choice.

Right now.

You can continue to share and spread anti-vaccine propaganda, helping scare other folks away from vaccinating and protecting their kids, or you can stop.

Choose to Stop Spreading Anti-Vaccine Propaganda

Why is the above meme anti-vaccine propaganda?

For one thing, there aren’t 200 vaccines in the pipeline!

There are actually very few new vaccines being developed that have any chance of making it onto the immunization schedule anytime soon. Many of the so-called vaccines in the pipeline are either not for infectious diseases (many are therapeutic vaccines for cancer!) or are for the same disease.

Even more importantly though, removing non-medical vaccine exemptions, which are often abused, doesn’t force anyone to vaccinate their kids.

Vaccine mandates are laws about getting vaccinated to attend daycare and school, etc. You still have a choice if you don’t want to get vaccinated.

What’s the problem that some folks have?

They don’t like their choices!

They want to be able to skip or delay their child’s vaccines and be able to send them to daycare or school.

“…the increased risk of disease in the pediatric population, in part because of increasing rates of vaccine refusal and in some circumstances more rapid loss of immunity, increases potential exposure of immunodeficient children.”

Medical Advisory Committee of the Immune Deficiency Foundation

And they want to take away everyone else’s choice to decrease their risk of getting a vaccine-preventable disease.

You don’t have a right to do that though!

Are you still spreading anti-vaccine propaganda?

Then you are part of the problem. You just don’t realize it yet.

And you are the reason that rates of vaccine-preventable diseases are going up and why Legislators are having to tighten the rules to prevent exemption abuse.

More on Choosing to Stop Spreading Anti-Vaccine Propaganda

Bob Sears on Hiding in the Herd

How do some intentionally unvaccinated kids get away without getting sick?

Mandatory vaccination laws still don't mean forced vaccination.
Mandatory vaccination laws still don’t mean forced vaccination.

How does a pediatrician get away without seeing kids harmed by vaccine-preventable diseases?

Bob Sears on Hiding in the Herd

Most folks know the answer

“And in my 20 years of pediatric practice, I have never once seen a child seriously harmed by a vaccine-targeted infection. Oh sure, I’ve seen kids get sick. And they all get better. And this is in a practice where most of my patients don’t vaccinate (or don’t anymore after one child suffers). So if anyone should be seeing kids get harmed from infections, it should be me, right? But not even one. “

Bob Sears

There are a few simple reasons that all of Dr. Bob’s intentionally unvaccinated kids all get better when they get sick.

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)

For one thing, vaccine-preventable diseases don’t kill every single person that gets them! Even in the pre-vaccine era, most kids did recover. Tragically though, not all did. And not all did without complications.

That’s why we say that you have to earn your natural immunity.

Even more importantly though, since most other parents vaccinate their kids, his intentionally unvaccinated kids are simply at less risk to get a vaccine-preventable disease.

They are hiding in the herd – free-riding and benefiting from the herd immunity that’s provided by those of us who do vaccinate and protect our kids.

Mostly though, Dr. Bob has been lucky.

185 kids, mostly unvaccinated, died with the flu last year.
185 kids, mostly unvaccinated, died with the flu last year.

And so have his patients.

They are especially lucky that more folks don’t listen to him and instead understand that vaccines are safe, with few risks.

“Here’s the thing…it doesn’t matter if vaccines played a role in reducing the incidence of certain diseases in industrialized nations 60 years ago. Yep, I said it. ***Decades have passed and we’re STILL vaccinating like we are in a developing country and it’s the year 1900.***”

Melissa Floyd

Remember, it wasn’t that long ago that kids were dying from Hib meningititis, Hib epiglotittis, pneumococcal disease, meningococcal disease, hepatitis B, and rotavirus. You don’t have to go back 60 years or all of the way to 1900!

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

And that so many people do get vaccinated is the only thing keeping these diseases from coming back at even higher numbers.

Even Dr. Bob used to know that…

More on Bob Sears on Hiding in the Herd

Who Needs an MMR Vaccine?

The MMR vaccine protects people against measles, mumps, and rubella.

It has been available since 1971, first as a single dose, then with a second dose added to the immunization schedule in 1990.

Who Needs an MMR Vaccine?

With the rise in measles cases and outbreaks, you might be wondering if you need an extra dose of the MMR vaccine.

Are you fully vaccinated and protected against measles?

Have you had one dose or two doses of the MMR vaccine?

Are you traveling out of the country or do you have any other risk factors for getting measles?

Did you get one of the original, inactivated measles vaccines that were used between 1963 and 1967, before the live vaccine became available? If you did, or you aren’t sure which vaccine you got at that time, you likely aren’t fully protected and need another dose.

Vaccine preventable diseases are just a plane ride away.
Vaccine preventable diseases are just a plane ride away.

In general, adults who have had two doses of MMR are considered to be fully vaccinated. You do not need to check your titers and you do not need another dose for measles protection.

You are also likely protected if you were born before 1957, as most people had measles back then, in the pre-vaccine era.

Confusing matters a bit, some adults who were born before the recommendation to get a second dose might still be considered fully vaccinated if they are not high risk.

What makes someone high risk?

  • traveling out of the country!
  • working in healthcare
  • being a student in college or other post-high school educational institution
  • living with someone who has a compromised immune system
  • people with HIV infection

So to be considered fully vaccinated and protected against measles, these high risk adults should have two doses of MMR.

What about kids?

If following the immunization schedule, kids will get two doses of MMR, with the first dose at age 12-15 months and a second dose when they are 4-6 years old.

There are situations in which they should get an early dose of MMR though, including:

  • infants 6 through 11 months of age who are traveling out of the United States should receive one dose of MMR vaccine, a dose that will have to be repeated when they are 12 months old.
  • children 1 to 3 years of age and older who are traveling out of the United States should receive two doses of MMR vaccine (instead of waiting to get the second dose when they are 4-6 years old), separated by at least 28 days. This second dose doesn’t have to be repeated.

Being exposed to measles or simply getting caught up in an outbreak might be another reason for young children to get an early first or second dose of MMR and for adults to get caught up.

What if you aren’t traveling out of the country, but are traveling to an area inside the United States that is experiencing a large outbreak of measles?

To help control their large outbreak, kids in Rockland County should get their MMR doses early.
To help control their large outbreak, kids in Rockland County should get their MMR doses early.

If you can’t delay your travel plans, check the local health department recommendations, and talk to your pediatrician if your child needs an early MMR.

The MMR vaccine is safe, with few risks.

Having measles isn’t.

More on Getting the MMR Vaccine