Tag: allergic reactions

How Often Do Severe Events Occur After Vaccines?

Most of us understand that vaccine reactions are usually mild. While severe events can occur after vaccines, they are very rare.

“That measles infections can cause neurologic side effects on rare occasions is known, but the complication rate for vaccinations is low. After infectious measles encephalitis, risk of an autistic regression has occurred in 1/1000 to 1/10,000 cases. If the trend toward delaying vaccination continues because parents remain misinformed about the MMR, the number of children with neurologic complications of measles or rubella will increase. ”

Chez et al on Immunizations, Immunology, and Autism

Unfortunately, being worried about severe reactions sometimes scares parents away from vaccinating and protecting their kids.

How Often Do Severe Events Occur After Vaccines?

Hopefully, realizing just how rare these severe reactions are will help more parents understand that all of the benefits of vaccines (very big) truly do outweigh the risks (very small).

How often do severe events occur after MMR vaccines?
How often do severe events occur after MMR vaccines?

So how often do these events occur?

Are there any statistics?

Using the MMR vaccine information statement as an example, we see that it lists the following severe events:

  • deafness – which is so rare to be associated with MMR that it is hard to tell whether they are caused by the vaccine
  • long-term seizures, coma, or lowered consciousness – which is so rare to be associated with MMR that it is hard to tell whether they are caused by the vaccine
  • brain damage – which is so rare to be associated with MMR that it is hard to tell whether they are caused by the vaccine
  • severe allergic reaction – which occurs in less than 1 out of a million doses
  • serious injury or death – which is so rare to be associated with MMR that it is hard to tell whether they are caused by the vaccine

Wait.

Why can’t we tell if these problems are caused by the vaccine?

In some cases, the association is based on a few case reports.

“With respect to the recent claims of deaths caused by MMR vaccine, drawing broad cause and effect conclusions between vaccination and deaths based on spontaneous reports to VAERS, some of which might be anecdotal or second hand, is not a scientifically valid practice. In fact, a review of the VAERS data reveals that many of the death reports for MMR vaccine involved children with serious preexisting medical conditions or were likely unrelated to vaccination (e.g., accidents). These complete VAERS reports and any accompanying medical records, autopsy reports and death certificates have been reviewed in depth by FDA and CDC physicians and no concerning patterns have emerged that would suggest a causal relationship with the MMR vaccine and death.”

Miller et al on Deaths following vaccination: What does the evidence show?

Mostly though, these type of severe events just occur so rarely after getting vaccinated.

“As for vaccines causing death, again so few deaths can plausibly be attributed to vaccines that it is hard to assess the risk statistically.”

WHO on Six common misconceptions about immunization

At a rate of less than 1 in a million doses, it gets hard to know if something was really caused by the vaccine or if it was just a coincidence, as you don’t have a lot of cases to compare with each other.

Still, it should be reassuring that even if they were caused by the vaccine, these serious events are extremely rare.

Vaccines are safe, with few risks.

More on How Often Severe Events Occur After Vaccines

Did a Top Cancer Scientist Suddenly Die After Getting a Yellow Fever Vaccination?

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:

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.

That we are having to talk about it because anti-vaccine folks are using his death to push their idea that vaccines aren’t safe is unconscionable.

More on Yellow Fever Vaccine Deaths

Can You Really Get a Flu Shot If You Are Allergic to Eggs?

Are you still worried about your child’s egg allergy and getting them a flu vaccine?

Everyone needs a flu shot. When will you get yours?
Everyone needs a flu shot. Even kids with egg allergies. Photo by Gabriel Saldana (CC BY-SA 2.0)

That’s not surprising, as we once warned people about residual egg proteins in flu vaccines and the possibility of immediate hypersensitivity reactions in those with severe egg allergies.

Flu Vaccines and Egg Allergies

Of course, that advice has now changed, even though most flu vaccines are still prepared in chicken eggs.

“Recent studies have shown that even individuals with confirmed egg allergy can safely receive the flu vaccine. The Joint Task Force on Practice Parameters of the American Academy of Allergy Asthma and Immunology and the American College of Allergy Asthma and Immunology as well as the American Academy of Pediatrics state that no special precautions are required for the administration of influenza vaccine to egg-allergic patients no matter how severe the egg allergy.”

Egg Allergy and the Flu Vaccine

In fact, it began to change in 2011, when we got the recommendation that it was okay to give flu shots to people with egg allergies, if they only get hives as their reaction. It was still recommended that those with more severe allergic reactions to eggs “be referred to a physician with expertise in the management of allergic conditions for further risk assessment before receipt of vaccine.”

Before that, we would sometimes do skin testing on high risk egg allergic kids, desensitization, or regular chemoprophylaxis.

In 2013, the recommendation changed so that those with severe allergic reactions to eggs should get their flu shot “by a physician with experience in the recognition and management of severe allergic conditions.”

The recommendations were again modified in 2016, removing the recommendation that egg-allergic flu vaccine recipients be observed for 30 minutes and that those with severe egg allergies “should be vaccinated in an inpatient or outpatient medical setting (including but not necessarily limited to hospitals, clinics, health departments, and physician offices), under the supervision of a health care provider who is able to recognize and manage severe allergic conditions.”

Why the changing advice?

It’s because severe allergic reactions to vaccine are rare (in a million doses rare). And even in the flu vaccines that still use eggs, almost all of the egg protein is removed from the final vaccine. So that residual amount of egg protein is unlikely to trigger an allergic reaction. And that’s what we saw as the recommendations were slowly changed year after year.

Getting a Flu Shot When You Are Allergic to Eggs

And that’s why we have our current recommendations:

  • Those with a history of egg allergy who only get hives can get any age-appropriate flu vaccine.
  • Those with a history of egg allergy who have severe reactions, including angioedema, respiratory distress, lightheadedness, recurrent emesis, or who required epinephrine or another emergency medical interventions, can still get any age-appropriate flu vaccine, but they should get it in an inpatient or outpatient medical setting (such as a hospital, clinic, health department, or physician’s office). And the vaccine administration should be supervised by a health care provider who is able to recognize and manage severe allergic reactions.
  • Those who can eat eggs without reaction can get any age-appropriate flu vaccine.

Do you still have to be observed after getting your flu vaccine if you have an egg allergy?

No postvaccination observation period is recommended specifically for egg-allergic persons.

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season

Nope. But that’s likely because although they are rare, reactions might not occur right away.

So yes, you can and you should get a flu vaccine if you are allergic to eggs.

More on Flu Vaccines and Egg Allergies

 

Why Are We More Careful About Introducing Baby Food Than Giving Vaccines?

The rules about introducing baby food have changed a lot over the years.

Believe it or not, instead of rice cereal, when your baby is ready for solid foods, you can now give her fruits, veggies, meat, or even peanut butter. That’s right, infants can have peanut butter!

baby boy cake child
Let them eat cake, but don’t let that be your baby’s first food… Photo by Henley Design Studio on Pexels.com

In fact, if your baby has eczema, your pediatrician will likely encourage you to introduce peanut butter early, by four to six months, as a way to hopefully avoid peanut allergies later in life.

Why Are We More Careful About Introducing Baby Food Than Giving Vaccines?

Those are some big changes, aren’t they.

Still, a lot of other things stayed the same, including that parents should:

  • wait until at least four months, and often until six months, before they think about starting solid foods
  • only give one new food at a time

So while there are few restrictions on which foods to give now (still no honey before age 12 months and no choke foods), you still want to introduce one new food every three or four days to watch for a reaction.

Why is that different than for vaccines?

It’s because reactions to foods are more common, especially non-allergic type reactions (diarrhea, gas, and fussiness, etc), but also because there is basically no risk to delaying the introduction of new foods by this slow method.

There is also no real benefit to going much faster. Do you really want to introduce your baby to multiple new foods a day?

In addition to allergies and intolerances, there is another type of reaction you are watching for too – your baby simply not liking the food. For example, if one of your baby’s first foods is an apple, strawberry, beet combo puree and he spits it out at the first taste, how are you going to know which flavor he didn’t like? Isn’t it better to go through all of the single ingredient first foods before mixing them up?

Now if you did the same thing with vaccines, your baby would be getting a shot every four days! And it would leave them unprotected for a lot longer period of time.

Considering that serious vaccine reactions are rare, it is easy to understand that there is no benefit to only giving one vaccine at a time and we recommend that folks stick to the standard immunization schedule.

What to Know About Giving Vaccines and Introducing Baby Food

Although it is like comparing peas with peach mango and oatmeal cereal, stick to your pediatricians advice about vaccines and introducing baby food.

More on Giving Vaccines and Introducing Baby Food