Tag: alternative vaccine schedules

Why Are Vaccine Schedules Different in Each Country?

Anti-vaccine folks often point in differences in the immunization schedules in various countries to try and make a case that some countries do things better than others.

Is that true?

Why Are Vaccine Schedules Different in Each Country?

The ACIP and CDC set the immunization schedule in the United States, but it shouldn’t be surprising that other countries have their own systems to set their schedules.

Each country vaccinates according to their own needs, so none of their schedules are wrong, even though they are all a little different.
Each country vaccinates according to their own needs, so none of their schedules are wrong, even though they are all a little different.

And no, just because they are all a little different, that doesn’t mean that any are wrong.

That’s easy to understand once you do just a little research on how these immunization schedules are set up.

The WHO immunization schedule.
The WHO immunization schedule.

The WHO immunization schedule is set by the Strategic Advisory Group of Experts (SAGE) on Immunization.

WHO vaccine position paper development is "a complex, rigorous, multifaceted process."
WHO vaccine position paper development is “a complex, rigorous, multifaceted process.”

It’s basically a summary of WHO position papers.

The WHO recommendations help other countries develop optimal immunization schedules.

The Communicable Diseases Act in Sweden regulates the 13 factors that the Public Health Agency of Sweden must account for when proposing changes in the national vaccination programme to the Government.
The Communicable Diseases Act in Sweden regulates the 13 factors that the Public Health Agency of Sweden must account for when proposing changes in the national vaccination programme to the Government. 

Many countries also have their own National Immunization Technical Advisory Group that sets their immunization schedule.

So their immunization schedule is right for their country, even if it doesn’t match the United States schedule.

Australia’s Vaccine Schedule

In Australia, for example, the National Immunisation Program (NIP) Schedule is set by National Immunisation Committee (NIC), which reports to the Australian Health Protection Principal Committee (AHPPC) of the Australian Health Ministers Advisory Council (AHMAC) through the Communicable Diseases Network Australia (CDNA).

The Australian Technical Advisory Group on Immunisation (ATAGI) also provides technical advice on the operation of the National Immunisation Program.

Combination vaccines mean infants in Australia get fewer shots, but the same number of vaccines.
Combination vaccines mean infants in Australia get fewer shots, but the same number of vaccines.

Notice any differences between Australia’s vaccine schedule and the US schedule?

  • they give the routine second dose of MMR earlier, at 18 months
  • they don’t give a second dose of the chickenpox vaccine
  • they give the routine first dose of the meningococcal vaccine earlier, at 12 months
  • the hepatitis A and flu vaccines are only given to high risk kids

While there are some minor differences, it is fairly similar to the US immunization schedule.

“There is a legislative requirement for all vaccines provided under the NIP or the PBS to undergo a thorough and objective assessment process.”

National Immunisation Strategy for Australia

Why the earlier dose of meningococcal vaccine?

This is a good example of why immunization schedules vary between countries.

“The notification rate for meningococcal disease to the National Notifiable Diseases Surveillance System peaked at 4.3 per 100 000 in 2002 and declined to 0.4 per 100 000 in 2013.”

Meningococcal disease

Meningococcal disease incidence rates in the United States were much lower, about 0.6 per 100,000, when they started giving meningococcal vaccines in Australia (2001).

The UK Vaccine Schedule

But aren’t the immunization schedules from other countries supposed to be a lot different from the US schedule?

Let’s look at another…

The Joint Committee on Vaccination and Immunisation (JCVI) advises UK health departments on immunisation.
The Joint Committee on Vaccination and Immunisation (JCVI) advises UK health departments on immunisation.

It’s not the easiest schedule to read, but you should notice that vaccines for hepatitis A and chickenpox are missing, but younger children get extra meningococcal shots.

You may also have noticed yet another dosage schedule for the Prevnar 13 vaccine.

While the United States gives a three dose primary series and a booster, many other countries give either a three dose primary series alone or a two dose primary series with a booster.

“A large and growing body of evidence from immunogenicity studies, as well as clinical trials and observational studies of carriage, pneumonia and invasive disease, has been systematically reviewed; these data indicate that schedules of 3 or 4 doses all work well, and that the differences between these regimens are subtle, especially in a mature program in which coverage is high and indirect (herd) effects help enhance protection provided directly by a vaccine schedule.”

Whitney et al on Dosing schedules for pneumococcal conjugate vaccine: considerations for policy makers.

That doesn’t mean that they are all guessing at the dose! All of these schedules are well studied and in this case, there isn’t much difference.

There are even studies that suggest giving only one primary dose, combined with one booster dose might work, but only in areas where pneumococcal disease is already well controlled and infants would be protected by indirect herd immunity.

But that doesn’t mean that other schedules would work just as well too. For example, giving the doses later or on a slower schedule would not be better.

Why not?

Infants are most at risk for many of these diseases, especially Hib and pneumococcal disease, when they are young and delaying when infants get vaccinated simply leaves them unprotected and at risk to get sick for a longer period of time. You also want infants to be protected by the time they lose the passive protection they get from their maternal antibodies.

What about the chickenpox vaccine?

Will the UK get the chickenpox vaccine soon?

While the UK has not added the chickenpox vaccine to their schedule because their models predicted an increase in cases of shingles (which has happened anyway) with a decrease in exogenous boosting (the theory that exposure to chickenpox lowers your risk of shingles), they are now looking at this again.

“This study confirms that severe complications of varicella, including death, continue to occur in the UK and Ireland.”

Cameron et al on Severe complications of chickenpox in hospitalised children in the UK and Ireland

Mostly it has been said that the chickenpox vaccine isn’t on the schedule because they have not thought it to be cost effective.

Iceland’s Vaccine Schedule

When anti-vaccine folks talk about immunization schedules from other countries, they aren’t usually talking about the UK or Australia though.

They are talking about Iceland, the country that they believe gives far fewer vaccines than the United States.

You thought they gave even fewer vaccines in Iceland, didn't you?
You thought they gave even fewer vaccines in Iceland, didn’t you?

Vaccines for flu, chickenpox, hepatitis A, and hepatitis B and also available for those who are considered high risk.

Extra vaccines are available for high risk kids.

Want to follow Iceland’s immunization schedule?

Then you should move to Iceland.

Hopefully you are starting to see that immunization schedules are different in each country because each country has different rates of disease, different populations, and different healthcare systems.

Iceland is a small country (338,349 people), with high vaccination rates, and universal health care. Compare that to the United States, with 327,200,000 people, clusters of unvaccinated people, and lots of people without health care.

It should be easy to see that what works in one country might not work in the other…

Vaccine Schedule Comparison by Country

What about other countries?

Austria’s immunization schedule for 2019 includes all of the same vaccines as the US schedule, plus the vaccine for Japanese encephalitis (if high risk).
Austria’s immunization schedule for 2019 includes all of the same vaccines as the US schedule, plus the vaccine for Japanese encephalitis (if high risk).

On the immunization schedule in Austria, the columns in red are for vaccines that are recommended and free. The blue columns are also recommended, but they aren’t free.

The chickenpox vaccine was just added to Japan's routine vaccine schedule, but they still don't give the combined MMR vaccine. They do still have autistic kids, so does that finally prove that the MMR vaccine is not associated with autism?
The chickenpox vaccine was just added to Japan’s routine vaccine schedule, but they still don’t give the combined MMR vaccine. They do still have autistic kids, so does that finally prove that the MMR vaccine is not associated with autism?

Japan has two separate schedules – the routine schedule for everyone (in dark blue above) and the voluntary schedule, with extra vaccines. Note that the primary series of infant vaccines are given at 2, 3, and 4 months.

The latest vaccine schedule in Germany.
The latest vaccine schedule in Germany.

Germany also gives their primary series of infant vaccines at 2, 3, and 4 months.

In contrast to the 16 diseases that kids in the US are vaccinated against, Sweden uses vaccines for just 9.
In contrast to the 16 diseases that kids in the US are vaccinated against, Sweden uses vaccines for just 9.

Sweden is the other country that anti-vaccine folks like to talk about a lot. Mostly because they think that Sweden recently banned mandatory vaccination. They didn’t.

And note that kids in Sweden can get vaccinated at school!

The Norwegian immunization program makes heavy use of combination vaccines.
The Norwegian immunization program makes heavy use of combination vaccines.

Norway is studying adding chickenpox and Shingles vaccines to their schedule.

Switzerland now offers a few optional vaccines for folks who want them, including the meningococcal vaccine, HPV vaccines for boys, and the shingles vaccine for seniors.
Switzerland now offers a few optional vaccines for folks who want them, including the meningococcal vaccine, HPV vaccines for boys, and the shingles vaccine for seniors.

Although they only use a two dose primary series, Switzerland gives many of the same vaccines as the United States.

The 2018 vaccination schedule in the Netherlands. New additions in 2020 will be the rotavirus vaccine or high risk infants, Tdap in pregnancy, and MenACWY for teens.
The 2018 vaccination schedule in the Netherlands. New additions in 2020 will be the rotavirus vaccine or high risk infants, Tdap in pregnancy, and MenACWY for teens.

Are you surprised to see that infants in Denmark get more vaccines before they turn 12 month old than infants in the United States and an extra set by four months?

While most vaccines are free, you can pay extra to get vaccines that are already on the United States schedule in most other countries.
While most vaccines are free, you can pay extra to get vaccines that are already on the United States schedule in most other countries.

Even if they aren’t routine in other countries, all of the same vaccines that are offered in the United States, including vaccines to protect kids against rotavirus, chickenpox, and hepatitis A, are available in most other countries.

Vaccination schedule for children and adolescents in Israel.
Vaccination schedule for children and adolescents in Israel.

The latest immunization schedule in Israel includes hepatitis B, DTaP, polio, pneumococcal, rotavirus, MMR, chickenpox, HPV, and flu vaccines.

The 2019 Immunization Schedule for South Korea includes almost all of the US vaccines, plus BCG and Japanese encephalitis vaccines.
The 2019 Immunization Schedule for South Korea includes almost all of the US vaccines, plus BCG and Japanese encephalitis vaccines.

What’s missing in South Korea’s immunization schedule? Meningococcal vaccines. But they do have some that we don’t give in the United States.

What don’t these different immunization schedules influence? Prevalence rates of autism, SIDS, and other things that scare parents away from vaccinating and protecting their kids.

The One Wrong Way to Give Vaccines

Since the immunization schedules from all of these countries are just a little bit different, does that support the idea that an individualized approach to vaccinating kids is a good idea?

There is no science and nothing that says altering any vaccine schedule is a safer or more effective way to do things.
There is no science and nothing that says altering any vaccine schedule is a safer or more effective way to do things.

Of course not!

"Later and slower" is not part of any immunization plan.
“Later and slower” is not part of any immunization plan.

In many countries, even if they are missing protection against a few diseases that we routinely vaccinate against in the United States, many get their vaccines earlier! And all start by three months and don’t split up the schedule to just give one or two vaccines at a time.

Everyone knows that later and slower just leaves kids unprotected for longer periods of time. More risks. No extra benefits.

More on Vaccine Schedules Around the World

Who’s Who in the Anti-Vaccine Movement – 2019 Edition

We know that there will always be some folks who won’t vaccinate their kids.

“Although many may characterize all individuals who eschew vaccines as “anti-vaccine” or “vaccine deniers,” in reality, there is a broad spectrum of individuals who choose not to have themselves or their children vaccinated.”

Tara C Smith on Vaccine Rejection and Hesitancy: A Review and Call to Action 

Who are these people?

Who’s Who in the Anti-Vaccine Movement – 2019 Edition

We used to conveniently call them anti-vaccine, but that doesn’t really work.

Well, it still does, as long as you understand who you are talking about.

The thing is, the folks who don’t vaccinate their kids exist on a spectrum, from those who just need a little extra reassurance (the worrieds) or a lot of extra reassurance (parents who are on the fence or vaccine-hesitant), to vaccine refusers (will likely vaccinate during an outbreak, etc.) and deniers who likely aren’t vaccinating their kids in any circumstance and who might try to persuade others to avoid vaccines too – the vocal vaccine deniers.

So you don’t really want to bunch them all up one big anti-vaccine group, especially when you are typically talking about the vocal vaccine deniers, many of whom believe that they have a child who was injured or damaged by a vaccine.

We are still missing some folks though…

No, I’m not talking about those who like to claim that they are pro-safe vaccines, pro-choice vaccines, or vaccine skeptics, just because they don’t want to be labeled as being anti-vaccine.

Bob Sears appeared on Fox & Friends in 2010 for the segment "Vaccines: A Bad Combination?"
Remember when Bob Sears appeared on Fox & Friends in 2010 for the segment “Vaccines: A Bad Combination?”

We need to talk about the:

These are the folks who push misinformation about vaccines that scares parents away from vaccinating and protecting their kids.

Who's to blame for low immunization rates and continuing outbreaks?
Who’s to blame for low immunization rates and continuing outbreaks?

Do you know who I’m talking about it? Have you noticed that these folks never seem to face any consequences?

Who else do we need to talk about?

I remember speaking with my mother about vaccines, and at one point in our discussion, she claimed a link existed between vaccines and autism. In response, I presented evidence from the CDC which claimed directly in large bold letters, “There is no link between vaccines and autism.” Within the same article from the CDC on their official website, extensive evidence and studies from the Institute of Medicine (IOM) were cited. Most would assume when confronted with such strong proof, there would be serious consideration that your views are incorrect. This was not the case for my mother, as her only response was, “that’s what they want you to think.”

Ethan Lindenberger

There are also the folks who are pushing an anti-science agenda, making you think that mainstream doctors are bad and that anything holistic and natural must be good. Until the damage these folks are doing is seriously addressed, it won’t matter if we get a few anti-vaccine folks off of Amazon, Facebook and Pinterest.

Learn to be more skeptical. Do real research. Vaccinate your kids.

More on Who’s Who in the Anti-Vaccine Movement – 2019 Edition

Do Vaccines Cause Mastocytosis?

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)
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.

More on Vaccines and Mastocytosis

Is the La Leche League Anti-Vaccine?

Why would anyone think that the La Leche League, an organization who’s mission is to support breastfeeding, might be against vaccines?

“Many parents have questions about the compatibility of vaccines and breastfeeding. Your healthcare provider can address any questions that come up for you.”

la leche league international on Vaccines

They certainly don’t make any strong statements supporting vaccines…

“The LLLI Health Advisory Council suggests families discuss the pros and cons of influenza vaccines with their health care practitioners.”

la leche league international on Influenza

The cons of influenza vaccines?

What are those exactly? That the protection babies get from their mother’s pregnancy flu shot doesn’t last until they go to college?

What’s the greatest evidence that they might not support vaccines? I mean, besides anti-vaccine La Leache League leaders who actively say that they are against vaccines?

Bob Sears is giving two lectures  on vaccines at an upcoming La Leche League breastfeeding conference.
What exactly will Bob Sears be talking about during his two lectures on vaccines at this upcoming La Leche League breastfeeding conference?

Bob Sears is giving two lectures on vaccines at an upcoming La Leche League breastfeeding conference.

Will he really discuss the benefits of vaccines for pregnant and post-partum mothers and their families?

“Dr. Bob Sears, a renowned Dana Point pediatrician who has been sought out by parents who wish to opt out of the state’s mandatory vaccine requirements, has been placed on probation for 35 months by the Medical Board of California.”

Dr. Bob Sears, renowned vaccine skeptic, placed on probation for exempting child from all vaccinations

And considering that he nearly lost his medical license over giving an improper vaccine exemption, what can we really expect from his talk on California’s vaccine law?

“Remember that La Leche League is exclusively focused on breastfeeding support and has no stance on vaccinations.”

La Leche League USA

No stance on vaccinations?

Actually, with bringing Dr. Bob to their conference, it seems like they made a very clear stance…

“Nursing also allows your baby to give germs to you so that your immune system can respond and can synthesize antibodies! This means that if your baby has come in contact with something which you have not, (s)he will pass these germs to you at the next nursing; during that feeding, your body will start to manufacture antibodies for that particular germ. By the time the next feeding arrives, your entire immune system will be working to provide immunities for you and your baby. If you are exposed to any bacteria or viruses, your body will be making antibodies against them and these will be in your milk.”

Can Breastfeeding Prevent Illnesses?

And they have also done a good job of making it sound like breastfeeding infants don’t need vaccines.

They do!

While breastfeeding is great, it is not a substitute for getting vaccinated. In fact, antibodies in breast milk will not protect a baby against most vaccine-preventable diseases.

If the La Leche League truly wants to support what’s best for kids, they should move away from pushing non-evidence based therapies, especially craniosacral therapy and referrals to chiropractors for breastfeeding problems, and they should take a stand supporting vaccines.

The La Leche League is on this list of other organizations that speak out against vaccines.
The La Leche League is on this list of other organizations that speak out against vaccines.

Then maybe they wouldn’t appear on any lists from the NVIC.

More on Vaccines and the La Leche League