Diphtheria in Canada

A lot of people were surprised by the news of a case of diphtheria in Canada this past week.

Some folks were quick to blame the anti-vaccine movement, assuming it was in an unvaccinated child.

News soon came that the child was vaccinated!

“I’ve always been on top of that, I’m a firm believer in immunizations.”

Mother of 10-year-old with diphtheria

What happened next?

Anti-vaccine folks began using the fact that he was vaccinated, but still developed diphtheria, as some kind of proof that vaccines don’t work.

The Case of Diphtheria in Canada

They are wrong.

The diphtheria vaccines have worked very well to control and eliminate diphtheria from Canada, just like it has in the United States.

Diphtheria has become rare since the pre-vaccine era.
Diphtheria has become rare since the pre-vaccine era.

So how did a vaccinated child in Canada get diphtheria?

It’s simple.

He has cutaneous diphtheria, not respiratory diphtheria.

What’s the difference?

“Extensive membrane production and organ damage are caused by local and systemic actions of a potent exotoxin produced by toxigenic strains of C. diphtheriae. A cutaneous form of diphtheria commonly occurs in warmer climates or tropical countries.”

Vaccines Seventh Edition

Cutaneous diphtheria occurs on your skin. It is usually caused by non-toxigenic strains of Corynebacterium diphtheriae.

On the other hand, respiratory diphtheria is usually caused by toxigenic strains of Corynebacterium diphtheriae.

Diphtheria strikes unprotected children.The diphtheria vaccine (the ‘D’ in DTaP and Tdap), a toxoid vaccine, covers toxigenic strains. More specifically, it covers the toxin that is produced by toxigenic strains of Corynebacterium diphtheriae. It is this toxin that produces the pseudomembrane that is characteristic of diphtheria.

It was the formation of this pseudomembrane in a child’s airway that gave diphtheria the nickname of the “strangling angel.”

So why the fuss over this case in Canada? They likely don’t yet know if it is a toxigenic strain. If it is, then it could be a source of respiratory diphtheria.

But remember, even if these kids developed an infection with the toxigenic strain of Corynebacterium diphtheriae, those that are fully vaccinated likely wouldn’t develop respiratory diphtheria. Again, it is the toxin that the bacteria produces that cause the symptoms of diphtheria. The vaccine protects against that toxin.

For example, when an intentionally unvaccinated 6-year-old in Spain was hospitalized with severe diphtheria symptoms a few years ago, although many of his friends also got infected, non of them actually developed symptoms because they were all vaccinated.

Diphtheria Is Still Around

Diphtheria is DeadlyTragically though, especially since diphtheria is still endemic in many countries, we are starting to see occasional lethal cases of diphtheria in many more countries where it was previously under control:

  • at least 7 diphtheria deaths in Venezuela this past year
  • a family that became infected in South Africa in which at least one child died (August 2017)
  • an unvaccinated 3-year-old who died in Belgium (2016)
  • a 22-year-old unvaccinated women who died in Australia (2011)

It is even more tragic that diphtheria is not under control in so many more countries.

In 2016, the WHO reported that there were just over 7,000 cases of diphtheria worldwide. While that is down from the 30,000 cases and 3,000 deaths in 2000, thanks to improved vaccination rates, there is still work to be done.

And as this recent case in Canada shows, diphtheria is still around in many more places than we would like to imagine.

Get educated. Vaccines are necessary.

What to Know About Diphtheria in Canada

The case of cutaneous diphtheria in Canada is a good reminder that vaccines are still necessary.

More on Diphtheria in Canada

But If It Wasn’t the Vaccines…

Do you know why some folks still think vaccines are associated with autism?

It is simply because we can’t tell them what does cause autism.

“In the absence of a specific etiology for ASDs, and a tendency among parents of children with a disability to feel a strong sense of guilt, it is not surprising that parents attempt to form their own explanations for the disorder in order to cope with the diagnosis.”

Mercer et al on Parental perspectives on the causes of an autism spectrum disorder in their children

So if we don’t have another answer – then it must be vaccines.

That helps explain a lot of vaccine injury stories too.

For example, doctors often can’t tell you why your child has allergies, asthma, Celiac disease, diabetes, eczema, multiple sclerosis, POTS, SIDS, or thyroid problems, etc., which makes some people look to the mistaken theory that they were triggered by vaccines.

Of course, the answer isn’t that these are vaccine-induced diseases.

It simply demonstrates the limits of medical technology. Even if we don’t know what does cause many of these diseases, in almost all cases, it has been shown that they are not associated with vaccines.

Limits of 21st Century Medical Technology

Even in the 21st Century, science and medicine don’t have all of the answers.

And sometimes the answers are there, but are misinterpreted.

For example, the National Association of Medical Examiners makes the following distinctions on a medical certificate between manner of death:

  • Natural — “due solely or nearly totally to disease and/or the aging process.”
  • Accident — “there is little or no evidence that the injury or poisoning occurred with intent to harm or cause death. In essence, the fatal outcome was unintentional.”
  • Suicide — “results from an injury or poisoning as a result of an intentional, self-inflicted act committed to do self-harm or cause the death of one’s self.”
  • Homicide — “occurs when death results from…an injury or poisoning or from… a volitional act committed by another person to cause fear, harm, or death. Intent to cause death is a common element but is not required for classification as homicide.”
  • Could not be determined — “used when the information pointing to one manner of death is no more compelling than one or more other competing manners of death when all available information is considered.”
  • Pending investigation — “used when determination of manner depends on further information”

Why is this important to know?

Because many people confuse a natural cause of death as meaning that there was nothing wrong. That’s actually the opposite of what it means! A natural cause of death in a child means that they died because of a disease or condition.

Which disease or condition?

What was the underlying or immediate cause of death in these cases?

Limits and Uncertainty in Medicine

That’s where the limits of modern medicine and modern medical technology come in…

Maybe technology will change the future of healthcare – hopefully for the better, but there are still many things it can’t do.

Sure, we have indexed or mapped the entire human genome, but we still can’t often tell you why your child has a cough or runny nose, has developmental delays, or didn’t make it out of the PICU.

“…finding an underlying diagnosis for many conditions can be a very long and frustrating experience. A diagnosis can take as many as five years, and occasionally may never happen, especially with rare conditions. In addition, some experts say that between 30 to 40 percent of children with special needs do not have an exact diagnosis.”

NIH on Learning About An Undiagnosed Condition in a Child

Everyone wants answers when a child is sick or has unexplained signs and symptoms, especially when a child dies.

Unfortunately, while it may not get talked about often enough, there are many limits to modern medicine. There is often some uncertainty too.

“…when parents perceive greater uncertainty, they perceive less control over their child’s condition.”

Madeo et al on Factors Associated with Perceived Uncertainty among Parents of Children with Undiagnosed Medical Conditions

Just because futuristic medical tools like Tricorders are on the way doesn't mean that we will have all of the answers.
Just because futuristic medical tools like Tricorders are on the way doesn’t mean that we will have all of the answers.

Doctors don’t know everything.

The best doctors are the ones that actually know that they don’t know everything.

But just because they don’t know everything, that doesn’t mean that they don’t know anything.

For example, not knowing what does cause autism doesn’t mean that we don’t know many of the things that aren’t linked to autism.

And it certainly doesn’t mean that you should use this an excuse to blame vaccines or to skip or delay any vaccines. Continuing to try and associate vaccines with autism doesn’t just frighten parents and leave kids unprotected, it hurts autistic families.

What to Know About Uncertainty in Medicine

While there is much uncertainty in modern medicine and doctors don’t have all of the answers, there is no evidence that vaccines are associated with autism.

More on Uncertainty in Medicine

The Vaccine-Friendly Plan Book Review

The Vaccine-Friendly Plan is the latest book about vaccines that claims to offer a “safe and effective approach to immunity and health.”

What’s the problem with it?

In addition to the fact that there doesn’t seem to be any evidence in the book to support that any of its ideas are indeed safe or effective, the book pushes just about every anti-vaccine talking point out there today.

Misinformation in The Vaccine-Friendly Plan

If you want to skip or delay some of your child’s vaccines and are looking for something to help you feel better about your decision, then this is the book for you.

While Dr. Thomas and Jennifer Margulis talk about providing balanced information, it was right after he stated that “I realized we had poisoned a generation of children with a mercury-derived preservative called thimerosal” and then goes on to talk about how kids are overvaccinated.

So much for balanced information…

But Dr. Thomas isn’t just worried about vaccines. He is also worried about Tylenol, that the chemicals in plastics are endocrine disruptors, GMOs, flame retardants, pesticides, fluoride, artificial sweeteners, chemical dyes, and all of the other toxins that other doctors and the CDC supposedly ignore.

What about the “science” that supports his ideas?

Sure, he is quick to cherry pick studies that support the ideas he likes and label them as “important studies” among “a growing body of evidence,” but if the studies don’t, then they are “a handful of poorly designed, anecdotal studies.”

We see a lot of other anti-vaccine propaganda techniques in the book too.

“Giving a quadruple live-virus vaccine to a toddler is a mistake. When a toddler catches an illness naturally, he does not catch all four at once. I have serious concerns about hitting the immune system of a twelve-month-old baby with four live viruses, even though they are weakened.”

Does Dr. Thomas understand how the immune system works or how many different things our immune systems get “hit” with each and every day? Children are exposed to a lot of live, unweakened viruses and other germs every day and fight them off just fine.

Dr. Thomas also routinely downplays the risks of vaccine-preventable diseases (they all seem to be easily treatable in his world), overstates the risks of vaccines (they all seem to be full of horrible poisons in his world), makes heavy use of anecdotes, repeatedly makes it sound like every other pediatrician is doing something wrong, and again, makes full use of anti-vaccine talking points to scare parents:

To see how silly his arguments are, consider that when talking about giving any amount of formula to a baby, he is quick to say that “Cow’s milk is for calves, human milk is for human babies.”

“I also know several strapping young people who drank bottles of raw goat’s milk (instead of store-bought formula) when their breastfeeding mothers needed to be away from them for several hours…”

Raw goat milk is for kids = baby goats. Don't give it to your baby!
Raw goat milk is for kids = baby goats. Don’t give it to your baby! Photo by Shannon McGee (CC BY-SA 2.0)
But what about goat milk?

Is it just for baby goats?

You won’t hear this from Dr. Thomas, but unless your ‘kid’ is a baby goat, don’t give him raw goat milk!

So what’s the take home message about Dr. Thomas and his book?

Despite his frequently using the word science in the book, the only “science” in The Vaccine-Friendly Plan is that it is full of pseudoscience.

You can even see this in his ideas about gluten sensitivity. Why do so many of his patients show a sensitivity to gluten? He uses an IgG food sensitivity test that most experts say is basically worthless.

Making a Case for Getting Vaccinated

Perhaps the only good thing about Dr. Paul Thomas’ book is that he makes some very good cases for why you should vaccinate your kids.

Wait, what?

His introduction starts off with the story of the death of his three-year-old playmate in Africa. Tragically, the child died of measles.

Like many other pediatricians, he also talks about “the miracle that the Hib vaccine was when it was introduced in 1985.”

“Then in 2012 I had about twenty children in my practice with pertussis: eighteen were school age kids, and two were infants. Interestingly, fifteen of the twenty were fully immunized for pertussis, and the other five were from the small group of families in my practice who refuse all vaccines.”

His story about pertussis in his practice is also very interesting, but not for the reason that Dr. Thomas believes.

Consider that most kids are vaccinated, even in Dr. Thomas’ practice, so the fact that 25% of the kids who got pertussis are unvaccinated means a very high attack rate among unvaccinated children. So even with the problems of waning immunity with the pertussis vaccine, you are still much better off to be vaccinated and protected, even if that protection isn’t perfect.

“Since I opened my practice in 2008, not a single child has received the rotavirus vaccine. I refuse to stock it. Yet only one child in seven years has been hospitalized for severe dehydration. The unvaccinated children in my practice either are not getting rotavirus, or the illness is so mild that it requires no intervention.”

And so much for vaccine choice. How can his patients make a decision to get vaccinated if he doesn’t even have the vaccine?!?

But why don’t they get rotavirus? It is not because the vaccine doesn’t work or isn’t necessary. It is actually called being a free-rider or hiding in the herd.

Like most vaccines, the rotavirus vaccine works and helps create community immunity.

The Most Dangerous Advice in The Vaccine-Friendly Plan

Unfortunately, the dangerous advice in this book extends well beyond repeatedly telling parents to “say no thank you” to multiple vaccines and to delay others.

The advice to “decline vaccines” during pregnancy has to be right up there with the most dangerous advice in his book, but you be the judge…

“It depends on the medication, but the short answer is that it’s best to avoid all over the counter and prescription medications during pregnancy.”

Unbelievably, Dr. Thomas really seems to say that pregnant mothers should try to stop their antidepressants because “women respond differently to pregnancy hormones and some who struggle with mental health issues find the high estrogen and progesterone of pregnancy actually improve mood and mental health.”

He also thinks that it is “reasonable” to skip your baby’s vitamin K shot because of “worrisome ingredients,” like polysorbate 80 and aluminum.

“If bilirubin levels remain extremely high – above 20 – for over a week or two, some of the bilirubin can enter the brain, where it can cause permanent brain damage called kernicterus.”

Hopefully most parents are aware that you don’t want to wait “a week or two” to seek treatment if you baby’s jaundice level is above 20.

And hopefully most parents also understand that:

  • the cutoff for fever in newborns is 100.4°F (38°C) or higher, not 100.6°F (38.4°C)
  • co-sleeping and letting your baby sleep on your chest are not safe things to do
  • skipping an evaluation and antibiotics when mom is GBS positive after delivery and she develops a fever (possible chorioamnionitis) is not a safe thing for baby, especially if mom already skipped getting antibiotics during her delivery  – it’s called gambling that the baby won’t develop early-onset invasive group B streptococcal disease. Several studies have found very high numbers of newborns in this situation with positive blood cultures, even though they had no symptoms.
  • if your pediatrician recommends that your child needs treatment for congenital hip dysplasia (which is actually now called Developmental Dysplasia of the Hip), then you should probably listen, instead of hoping it goes away on its own by wearing “your baby on your front or back with his legs splayed.”
  • you shouldn’t put your baby in direct sunlight without sunscreen for ten to fifteen minutes every day
  • there is no need to routinely check your baby’s vitamin D level – just give a supplement if you are exclusively breastfeeding
  • until polio is eradicated, the risk of getting polio is higher than zero and that all of his unvaccinated kids are at risk even if they don’t travel outside the US, like the outbreak among the Amish in 2005
  • children die from meningococcal disease because it is a severe and terrible disease that progresses very quickly, not because “we pediatricians – so quick to intervene in other, unnecessary ways – fail to listen to a worried mother, dismiss her concerns as “hysterical,” and send a sick child home…” In one study, “Most children had only non-specific symptoms in the first 4-6 h, but were close to death by 24 h.”
  • preschoolers do not need to routinely take 2,000IU of vitamin D each day – the current recommendation is 600IU if they are not getting enough from the foods they are eating and drinking and 2,000IU only if they have been diagnosed with a vitamin D deficiency
  • about 4,200 women die of cervical cancer in the United States each year, something Dr. Thomas fails to mention when he says that “some strains of HPV can lead to slow-growing, highly treatable cancers.”

Although the whole book is dangerous, these are serious errors that can harm kids, and it is unbelievable that Penguin Random House would publish this book as a Medical/Parenting book. After all, this is the same company that published NeuroTribes!

Conspiracy Theories in The Vaccine-Friendly Plan

No good anti-vaccine book would be complete without some good old conspiracy theories.

Dr. Thomas doesn’t disappoint!

“It took me years to realize something I still wish were not true but which you cannot ignore if you want to have a healthy baby in America today: Our government officials and a handful of well-positioned M.D.’s who advise them have ignored some of the most important peer-reviewed studies and most relevant scientific information about immunity and health, both during pregnancy and throughout infancy.”

Dr. Paul Thomas

What else has he got?

  • the polio vaccines didn’t eliminate polio in the US, instead, it could have been “chlorinating water in public swimming pools” – it wasn’t
  • “severe reactions to the HPV vaccine are actually much more common than parents are being told” – they aren’t, even Diane Harper says the HPV vaccines are safe
  • rotavirus deaths in the pre-vaccine era are “inaccurate and misleading” because they are estimated numbers “based on a retrospective study that looked at morbidity associated with diarrheal disease between 1968 and 1991,” – except that Dr. Thomas looked at the wrong study. The estimates for hospitalizations and deaths in the pre-vaccine era come from a different study that looked at “Hospitalizations and Deaths from Diarrhea and Rotavirus among Children <5 Years of Age in the United States, 1993–2003.” Oops.
  • most flu-like illnesses are not really the flu, which “makes it impossible to distinguish influenza infections from other viruses,” unless you go to his office, where he tests kids for the flu – except that using the influenza-like illness (ILI) case definition has a high positive predictive value during flu season and many doctors and hospitals also do rapid flu testing

Do you really believe that it was the chlorine in swimming pools that eliminated polio in the United States? Or that he has found a magic way to avoid autism by drinking filtered water, avoiding GMOs, eating organic, whole foods, and following a non-standard, parent-selected, delayed protection vaccine schedule?

What to Know About The Vaccine-Friendly Plan

The Vaccine-Friendly Plan is a dangerous book that not only panders to parent’s fears about vaccines, it goes out of its way to increase those fears by pushing misinformation, telling parents to skip and delay vaccines, and giving other unsafe pediatric and parenting advice.

The only reason to pick it up is because you are looking for some confirmation bias to make you feel better about a decision to not vaccinate your child. If you read it because you were on the fence about vaccines, please consider doing a little more research.

More on The Vaccine-Friendly Plan

Vaccines and the Risk of Intussusception

Many people first heard the term intussusception after it became associated with Rotashield, the first rotavirus vaccine, back in 1999.

What is Intussusception?

Intussusception is a type of intestinal blockage that occurs when one part of a child’s intestine in pulled into or slides into another.

This leads to younger children, typically between the ages of 3 months and 3 years, developing colicky abdominal pain (severe pain that comes and goes) and loose stools that are filled with blood and mucous.

Fortunately, if caught early, it can be both diagnosed and treated with an air contrast enema.

Do Rotavirus Vaccines Cause Intussusception?

Intussusception in children is not a new condition. In fact, Samuel Mitchel reported treating children with intussusception as early as 1838!

So what causes intussusception?

Surprisingly, in most cases, we just don’t know why kids get intussusception.

We do know that it occurs in about 1 in 100,000 US infants, with about 2,000 cases being diagnosed and treated each year.

“There is also a small risk of intussusception from rotavirus vaccination, usually within a week after the first or second dose. This additional risk is estimated to range from about 1 in 20,000 to 1 in 100,000 US infants who get rotavirus vaccine.”

CDC on Questions & Answers about Intussusception and Rotavirus Vaccine

And we know that getting a rotavirus vaccine adds a small extra risk for intussusception.

The association was found by looking at reports to VAERS and studies by the FDA’s Post-licensure Rapid Immunization Safety Monitoring System (PRISM).

And it is not just the original Rotashield vaccine, which was withdrawn, but the rotavirus vaccines that we now use that have also been linked to intussusception. The difference is that the risk is much less with the newer rotavirus vaccines.

“Given the magnitude of declines in rotavirus disease compared with this small increase in intussusception, the benefits of rotavirus vaccination outweigh the increase risk of intussusception.”

Tate et al on Intussusception Rates Before and After the Introduction of Rotavirus Vaccine

This small risk must also be viewed against the many benefits of the rotavirus vaccines.

“Rotavirus is the leading cause of severe gastroenteritis among young children worldwide, and was estimated to account for approximately one-third of the estimated 578,000 deaths from childhood gastroenteritis and more than 2 million hospitalizations and 25 million outpatient clinic visits among children <5 years of age each year in the pre-vaccine era.”

Parashar et al on Value of post-licensure data on benefits and risks of vaccination to inform vaccine policy: The example of rotavirus vaccines

Rotavirus vaccines are associated with a very small risk of intussusception, but that is not a good reason to miss the benefits of this vaccine.
Rotavirus vaccines are associated with a very small risk of intussusception, but that is not a good reason to miss the benefits of this vaccine. Photo by Vincent Iannelli, MD

It is also still not clear if the rotavirus vaccines actually “trigger” intussusception or if they simply cause it to occur earlier in infants that would have gotten it anyway. That’s because while the latest studies have found excess cases shortly after the first dose of vaccine, studies looking at intussusception trends “have not consistently demonstrated an overall increase in rates post-vaccination.” So there were the same number of total cases, even with the few extra cases right after the kids were vaccinated.

Also, it is thought that wild type rotavirus infections can also trigger intussusception, so the rotavirus vaccines might prevent those cases.

Most importantly though, remember that even if the rotavirus vaccines cause an extra 35 to 100 hospitalizations a year because of intussusception, they are preventing up to 70,000 hospitalizations from severe rotavirus diarrheal disease that occurred in the pre-vaccine era. The vaccines are also preventing about 20-60 deaths from rotavirus disease, while intussusception is rarely life-threatening.

If you are on the fence about vaccines, worry about intussusception is not a good reason to skip or delay your child’s vaccines.

What to Know About Vaccines and Intussusception

Because of a small risk of intussusception, parents should be aware of the symptoms and signs of intussusception and that they may appear six to eight days after an infant’s first dose of rotavirus vaccine.

More on Vaccines and Intussusception

The Value and Cost Savings of Getting Vaccinated

We often hear a lot about the benefits of vaccines.

Even the schools were closed in San Antonio when polio came to Texas in 1946.
How much would it cost to close all of the schools in a big city today?

Well, most of us do.

But can getting vaccinated really help save us money?

Cost Savings of Getting Vaccinated

Vaccines are expensive, so it probably doesn’t make a lot of sense to many people that saving money is one of the big benefits of getting vaccinated.

That’s just because vaccines work so well.

“Analyses showed that routine childhood immunization among members of the 2009 US birth cohort will prevent ∼42 000 early deaths and 20 million cases of disease, with net savings of $13.5 billion in direct costs and $68.8 billion in total societal costs, respectively.”

Zhou et al on Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009

Few of us remember the pre-vaccine era when there were polio and diphtheria hospitals and “pest houses” at the edge of town.

We don’t remember when outbreaks of vaccine-preventable diseases would close schools and these diseases were more deadly, not because they were more severe, but simply because they were more common.

Costs Associated With Getting Sick

If we don’t remember these diseases and outbreaks, we certainly don’t remember how much it cost to control and treat them.

We should though.

Just look at how much it costs to control the recent measles outbreaks that continue to plague us.

“The estimated total number of personnel hours for the 16 outbreaks ranged from 42,635 to 83,133 and the corresponding total estimated costs for the public response accrued to local and state public health departments ranged from $2.7 million to $5.3 million US dollars.”

Ortega-Sanchez on The economic burden of sixteen measles outbreaks on United States public health departments in 2011

Not including the direct costs for outpatient visits and inpatient care, recent outbreaks have cost anywhere from $3,000 to $50,000 per case to contain. Why the difference? Localized outbreaks, like in a church group or among a single family, will be easier and less expensive to contain, as they will likely involve fewer contacts to track down to see if they were exposed and are already vaccinated.

Again, these costs don’t include the costs of going to your doctor or the ER because your child is sick, getting hospitalized, or lab tests, etc.

It also doesn’t include the costs associated with living under quarantine, which is happening in many of the recent outbreaks.

Getting sick is expensive.

How much is a liver transplant?

How much does it cost to treat someone with cervical cancer?

How much does it take to care for a child with congenital rubella syndrome?

How do anti-vax folks usually counter this important message?

They typically say that taking care of a vaccine-injured child is expensive too. While that can be true, the problem is with their idea of what constitutes a vaccine injury. While vaccines are not 100% safe and they can rarely cause serious or even life-threatening reactions, most of what they describe as vaccine-induced diseases, from autism to SIDS, are not actually associated with vaccines.

The Value of Vaccination

So yes, getting vaccinated is cost effective.

“Cost-effectiveness analysis has become a standard method to use in estimating how much value an intervention offers relative to its costs, and it has become an influential element in decision making. However, the application of cost-effectiveness analysis to vaccination programs fails to capture the full contribution such a program offers to the community. Recent literature has highlighted how cost-effectiveness analysis can neglect the broader economic impact of vaccines.”

Luyten et al on The Social Value Of Vaccination Programs: Beyond Cost- Effectiveness

The value of getting vaccinated goes way beyond saving money though.

Most of the ways this has been studied in the past still leaves out a lot of important things, including:

  • increased productivity later in life following vaccination
  • improved cognitive and educational outcomes
  • community-level health gains through herd effects
  • prevention of antibiotic resistance
  • vaccination-related benefits to macroeconomic factors and political stability
  • furthering moral, social, and ethical aims

Why are these important?

“Vaccination has greatly reduced the burden of infectious diseases. Only clean water, also considered to be a basic human right, performs better. Paradoxically, a vociferous antivaccine lobby thrives today in spite of the undeniable success of vaccination programmes against formerly fearsome diseases that are now rare in developed countries.”

Andre et al on Vaccination greatly reduces disease, disability, death and inequity worldwide

If you are making a decision to get vaccinated vs. trying to hide in the herd, you want to have all of the information about the benefits of vaccines, not just about the risks, or what you might think are risks.

Vaccines Are Expensive

Although getting vaccinated is certainly cost-effective, that doesn’t erase the fact that vaccines are expensive.

If they weren’t so expensive, then we likely still wouldn’t have so many deaths from vaccine-preventable diseases in the developing world, where the problem is access to vaccines, not vaccine-hesitant parents.

“We conclude that the vaccination portion of the business model for primary care pediatric practices that serve private-pay patients results in little or no profit from vaccine delivery. When losses from vaccinating publicly insured children are included, most practices lose money.”

Coleman on Net Financial Gain or Loss From Vaccination in Pediatric Medical Practices

Parents should also be aware that vaccines are expensive for the average pediatrician too, who no matter what anti-vax folks may claim about bonuses, aren’t making much or any money on vaccinating kids.

And because vaccines work, pediatricians also don’t make as much money when vaccinated kids don’t get diarrhea and dehydration that is prevented by the rotavirus vaccine, recurrent ear infections that are prevented by Prevnar, or a high fever from measles, etc., all things that would typically trigger one or more office visits.

It should be clear that the only reason that pediatricians “push vaccines” is because they are one of the greatest achievements in public health.

A great achievement at a great value.

What to Know About the Cost Savings of Getting Vaccinated

There is no question that there is great value in getting fully vaccinated on time and that getting immunized is a very cost effective way to keep kids healthy.

More on the Cost Savings of Getting Vaccinated

What Is Cherry Picking?

Everyone has heard of cherry picking.

If you are talking about vaccines, this probably isn’t that kind of cherry picking though.

What Is Cherry Picking?

Have you ever been to a cherry orchard?

“Pick only the cherries that are fully red (or whatever color they are supposed to be when ripe!). Part the leaves with your hands to look for hidden cherries ready for harvest.”

Cherry Picking Tips and Facts

Cherries don’t continue to ripen off the tree, so you want to pick them at exactly the right time. Not too early and not too late.

So when you go cherry picking, you are looking for the perfect cherries.

That’s what folks do when they go cherry picking for just the right information to fit their beliefs, but ignore any and all other information that might prove them wrong.

“Whatever one might think about Andrew Wakefield, he was just one man: the MMR autism scare has been driven for a decade now by a media that over-emphasises marginal views, misrepresenting and cherry picking research data to suit its cause. As the Observer scandal makes clear, there is no sign that this will stop.”

Ben Goldacre on MMR: the scare stories are back

It shouldn’t come as a surprise that most anti-vaccine folks are very good at cherry picking.

A cherry picker isn't going to save you from a bad argument.
D’oh! A cherry picker isn’t going to save you from a bad argument.

Someone is cherry picking when they:

  • uses only one or a few out-of-context quotes that seem to support their argument, but ignores the rest of the article or study that doesn’t
  • talks about the one study that supports their position, but ‘forgets’ to mention the ten that don’t
  • mentions a few years of data that support their argument, but leave out the years that don’t

Need a good example?

Have you ever heard someone say that the package insert for Tripedia vaccine proves a link to autism?

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

This is classic cherry picking because they are ignoring all of the other information in the package insert, all of the other package inserts that don’t list autism as an adverse reaction, and all of the other evidence that autism is not associated with vaccines! It is also a bad argument against vaccines because they don’t explain why it is in the package insert.

How can you easily spot when someone is cherry picking?

You have to get educated and do your own research.

What to Know About Cherry Picking

Cherry picking occurs when someone chooses to use just the right information to fit their beliefs, but ignores any and all other information that might prove them wrong.

More on Cherry Picking

Vaccine Injury Stories That Scare Parents

It is not uncommon to hear about parents having ‘panic attacks’ over the idea of vaccinating their kids.

“…many parents are inundated with horror stories of vaccine dangers, all designed to eat away at them emotionally while the medical and scientific communities have mounted their characteristic response by sharing the facts, the data, and all of the reliable peer-reviewed and well-cited research to show that vaccines are safe and effective.”

Federman on Understanding Vaccines: A Public Imperative

Or simply becoming anxious over an upcoming appointment for routine immunizations or to get caught up on vaccines.

What’s fueling all of this anxiety?

Vaccine Injury Stories That Scare Parents

Some of it is likely from the vaccine injury stories that they read  or videos they watch.

As parents get better at spotting the myths and misinformation behind the anti-vaccine movement, we are seeing more and more vaccine injury stories pop up to scare them.

“…recognizes the importance of examples—testimonials and stories—that are the lifeblood of vaccine-hesitant beliefs.”

Nathan Rodriguez on Vaccine-Hesitant Justifications

Vaccine injury stories aren’t new though.

These types of anecdotal stories were very popular when folks used to think that the DPT vaccine was causing a lot of side effects. It wasn’t though. And it was soon proven that the DPT vaccine didn’t cause SIDS, encephalitis, non-febrile seizures, and many other things it was supposed to have caused.

“Anecdotes – about a new miracle cure, a drug that is not being made available on the NHS, or the side effects of treatment, or some environmental hazard – sell product. Data, on the other hand, which take us towards the truth about these things, are less popular. Anecdotes, however many times they are multiplied, do not point the way to reliable knowledge. As the aphorism says, “The plural of anecdote is not data”.”

Raymond Tallis on Anecdotes, data and the curse of the media case study.

That anecdotes “sell” better than data may be one reason why you see them so often on anti-vaccine websites. Another is that they simply don’t have any good data to use as evidence!

Are Vaccine Injury Stories True?

Vaccines are not 100% safe, so there is no doubt that some vaccine injury stories are true.

There is also no doubt that what many people perceive to be vaccine injuries have actually been proven to not be caused by vaccines, from allergies and eczema to autism and MS.

“In the absence of a specific etiology for ASDs, and a tendency among parents of children with a disability to feel a strong sense of guilt, it is not surprising that parents attempt to form their own explanations for the disorder in order to cope with the diagnosis.”

Mercer et al on Parental perspectives on the causes of an autism spectrum disorder in their children

Also keep in mind that in addition to the many so-called vaccine induced diseases, there are many historical vaccine injury stories that have been shown to be untrue:

  • the first deaf Miss America did not have a vaccine injury
  • Johnnie Kinnear supposedly began having seizures 7 hours after getting a DPT vaccine, when he was 14-months-old, but medical records actually shown that his seizures started 5 months after he received his vaccines
  • Dravet syndrome now explains many severe seizures associated with vaccinations

And at least one of Wakefield’s own followers – a mother who claimed that the MMR vaccine caused her son’s autism, was “dismissed as a manipulative liar” by a court in the UK.

Vaccine Injury Stories are Dangerous

Do vaccine injury stories have a purpose? They might help a parent cope with a diagnosis in the short term, but vaccine injury stories are dangerous in so many ways.

We have seen how they create anxiety for many parents, which can scare them away from vaccinating and protecting their kids from life-threatening vaccine-preventable diseases.

What else can they do?

Driving a wedge between parents and pediatricians does not help autistic kids.
Driving a wedge between parents and pediatricians does not help autistic kids.

They can certainly build up mistrust towards pediatricians and other health professionals. That is one way that the anti-vaccine movement continues to hurt autistic families. They also can lead parents to think that their “vaccine injured” child is “damaged” in some way.

And they push parents towards dangerous, unproven, unnecessary, and expensive alternative treatments. It shouldn’t be a surprise that many of the sites and forums that push vaccine injury stories also promote a lot of dangerous advice.

From recommending goat milk for your baby and skipping your baby’s vitamin K shot to various kinds of detoxing “treatments,” these are not the folks you want to trust with the health of your child.

What to Know About Vaccine Injury Stories

Vaccine injury stories prey on the fears of parents, help drive a wedge between them and their pediatricians, and are considered by many experts to be the lifeblood of the anti-vaccine movement.

More on Vaccine Injury Stories