Tag: case reports

Should I Blame the Vaccine If I’m Sick and I Just Got Vaccinated?

We all know the saying, correlation equals causation, right?

So if you get an MMR vaccine and get the measles a week later, it has to be the vaccine, right?

Should I Blame the Vaccine If I’m Sick and I Just Got Vaccinated?

Actually, no.

“Correlation does not imply causation.”

Although it would be very easy to blame the vaccine, if you keep in mind that the saying is actually “correlation does not imply causation,” maybe you will do a little investigating and see if something else is to blame.

Some things to consider and ask yourself:

  1. Do I really have measles? Remember that it is not uncommon to develop a fever and a rash about 7 to 12 days after getting an MMR vaccine. This is a very common, mild vaccine reaction. It doesn’t mean that you have measles or even a mild case of the measles.
  2. Was I recently exposed to someone with measles? If you were vaccinated because you were exposed to measles during an outbreak, then there is a good chance that the vaccine hasn’t had a chance to work yet and you actually developed measles from being exposed to the wild virus.
  3. Do I have the wild type or a vaccine strain of measles? Testing can be done to tell which strain of measles you have and to see if it is a wild type or vaccine strain.

Are there any examples of folks having wild type disease if they get sick shortly after being vaccinated?

Not surprisingly, there are a lot of these types of examples.

“Vaccine strains are poorly or not transmissible and prompt differentiation between wild-type and vaccine strains allows for optimal management and public health action.”

Pabbaraju et al on Simultaneous Detection and Differentiation between Wild-Type and Vaccine Measles Viruses by a Multiplex Real-Time Reverse Transcription-PCR Assay

What about examples of folks getting sick with vaccine strain measles and other diseases? Not so many.

The clinical diagnosis could just as easily have been wild type measles and not a vaccine strain, as there was a lot of measles in the the UK in 1988.
The clinical diagnosis could just as easily have been wild type measles, as there was a lot of measles in the the UK in 1988.

Most of the published examples are case reports without evidence of a vaccine strain.

What about the kid in Canada that got measles after her MMR vaccine?

“We describe a case of vaccine-associated measles in a two-year-old patient from British Columbia, Canada, in October 2013, who received her first dose of measles-containing vaccine 37 days prior to onset of prodromal symptoms.”

Murti et al on Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013.

She had symptoms of measles and a vaccine strain and was reported as “the first case of MMR vaccine-associated measles.” Well, at least the first case that occurred so long after getting vaccinated. Still, they note that “clinically significant vaccine-associated illness is rare.”

What about all of the people in California and Michigan who supposedly had vaccine-strain measles?

This is not vaccine strain measles! It is people with a rash or fever after being vaccinated. They don't have measles though.
This is not vaccine strain measles! It is people with a rash or fever after being vaccinated. They don’t have measles though.

Anti-vaccine folks made that up!

When It’s a Wild-Type Virus

What’s the most obvious evidence against the idea that vaccines and shedding are responsible for causing outbreaks?

For one thing, despite the recent uptick, cases of vaccine-preventable diseases are way down from the pre-vaccine era. That’s not what you would expect if vaccine-induced disease was common or if contacts of those who were recently vaccinated could easily get sick from shedding.

And we have evidence against vaccine induced disease.

When kids get chicken pox shortly after being vaccinated, they often have a wild strain. They don’t have breakthrough chicken pox.

“All of 57 vaccinees with breakthrough varicella, clinically diagnosed on the basis of a generalized maculopapular or vesicular rash, in which there was amplifiable DNA [corrected], had wild-type VZV infection based on analysis of viral DNA. “

LaRussa on Viral strain identification in varicella vaccinees with disseminated rashes.

Same thing with measles.

Want to avoid these situations in which you could get a wild strain of a vaccine-preventable disease?

Don’t skip or delay your child’s vaccines!

More On Wild-Type and Vaccine Measles Viruses

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

Do Vaccines Cause Psoriasis?

Even with all of the so-called vaccine-induced diseases that anti-vaccine folks come up with, few people likely think that vaccines cause psoriasis.

Bob Sears is being investigated by the California Medical Board for giving these medical exemptions because he thinks vaccines cause psoriasis.
Bob Sears is being investigated by the California Medical Board for giving these medical exemptions. Were they legitimate?

Some do though…

Do Vaccines Cause Psoriasis?

Bob Sears thinks that these kids shouldn’t be vaccinated because “vaccines can trigger psoriasis or make existing psoriasis worse.”

Dr. Bob did his research and thinks that vaccines are a risk to cause lifelong psoriasis.
Dr. Bob did his research and thinks that vaccines are a risk to cause lifelong psoriasis.

He even provided a list of studies that he thinks support his case.

“Nevertheless, the likely very low incidence of psoriasis following vaccination emphasizes the safe profile and the relevance of vaccination strategies in psoriasis patients, especially in candidates for immunosuppressive treatments.”

Sbidian et al on National survey of psoriasis flares after 2009 monovalent H1N1/seasonal vaccines.

Do they?

“The risk of psoriasis was also increased in subjects who reported a history of a recent infectious episode. The analysis by individual diagnosis pointed to acute pharyngitis as the disease with the strongest association and the only one providing statistically significant results…”

Naldi et al on Family history of psoriasis, stressful life events, and recent infectious disease are risk factors for a first episode of acute guttate psoriasis: results of a case-control study

Let’s see, although I’m not sure he actually read more than the abstracts or understands that guttate psoriasis isn’t the same as plaque psoriasis

  1. Possible Triggering Effect of Influenza Vaccination on Psoriasis – a small group of patients (36) either had an exacerbation of their psoriasis, or new onset of psoriasis (7), within a couple of weeks to months after getting a flu shot.
  2. Psoriasis triggered by tetanus-diphtheria vaccination – a case report of a 50-year-old with chronic psoriasis for 6 years who developed an exacerbation a week after getting a tetanus booster.
  3. Psoriatic skin lesions induced by BCG vaccination – a case report of a 6-month-old who developed a BCG-induced tuberculid-like eruption accompanied by psoriatic skin changes one month after vaccination. They went away without treatment within 3 months.
  4. Guttate psoriasis-like lesions following BCG vaccination – a case report of a 7-year-old who developed guttate psoriasis-like lesions one week after his BCG vaccination. He was treated with steroid creams and the rash went away within three weeks.
  5. New Onset Guttate Psoriasis Following Pandemic H1N1 Influenza Vaccination – a case report of a 26-year-old who developed guttate psoriasis after getting a flu shot. Her rash went away within three weeks.
  6. National survey of psoriasis flares after 2009 monovalent H1N1/seasonal vaccines – a small group of patients (10) who either developed new onset psoriasis or had an exacerbation after getting a flu shot.
  7. Psoriasis vaccinalis; report of two cases, one following B.C.G. vaccination and one following vaccination against influenza – from 1955, two case reports of psoriasis after BCG vaccine and the flu shot.
  8. Family history of psoriasis, stressful life events, and recent infectious disease are risk factors for a first episode of acute guttate psoriasis: results of a case-control study – a case control study that “confirmed that recent pharyngeal infection is a risk factor for guttate psoriasis. It also documented the strong association between guttate psoriasis and a family history of psoriasis. Finally, the study added evidence to the belief that stressful life events may represent risk factors for the onset of psoriasis.” The study doesn’t mention vaccines, but does remind us that “it has been estimated that only one third of cases of guttate psoriasis progress to chronic plaque psoriasis, whereas a history of guttate psoriasis is not frequent in patients with psoriasis.”
  9. Genetic background of psoriasisdoesn’t mention vaccines.

So, none of Bob’s studies were in children, they are mostly about flu shots and the BCG vaccine (which isn’t used in the United States), they are mostly case reports (low on the hierarchy of evidence), and a few don’t mention vaccines…

And most aren’t about chronic psoriasis!

Explaining the Correlation of Psoriasis After Vaccines

Is there anything that might explain the case reports that do show an association between vaccines and psoriasis flares?

“Psoriasis can appear in areas of the skin that have been injured or traumatized. This is called the Koebner [KEB-ner] phenomenon. Vaccinations, sunburns and scratches can all trigger a Koebner response. The Koebner phenomenon can be treated if it is caught early enough.”

National Psoriasis Association on Causes and Triggers

Experts also talk about Th1- and Th17-predominant immunologic responses of flu shots and the BCG vaccine’s Th17 activity. It is known that Th17 cells play a role in psoriasis.

Are there any other studies about vaccines and psoriasis that Dr. Bob left out?

  1. Yellow fever vaccine used in a psoriatic arthritis patient treated with methotrexate: a case report – “A case of yellow fever vaccine used in a 27-year-old Slovenian male with psoriatic arthritis during treatment with methotrexate is described. We demonstrate a positive case, since there were no adverse effects in concurrent administration of yellow fever vaccine and methotrexate.”
  2. Live attenuated varicella vaccine: A new effective adjuvant weapon in the battlefield against severe resistant psoriasis, a pilot randomized controlled trial – a study of 35 patients which found that the “use of chickenpox vaccine with low-dose cyclosporine seems to have value for the treatment of resistant psoriasis.”
  3. [Psoriasis is no obstacle to smallpox vaccination] – (I haven’t found the full article yet, but the title is intriguing, since eczema is a contraindication to getting the smallpox vaccine…)
  4. Factors associated with 2009 monovalent H1N1 vaccine coverage: a cross sectional study of 1,308 patients with psoriasis in France – mentions that more than twice as many people with psoriasis in France got a flu shot than the general population.
  5. Immune response to pneumococcus and tetanus toxoid in patients with moderate-to-severe psoriasis following long-term ustekinumab use – vaccines work when you have psoriasis!
  6. From the Medical Board of the National Psoriasis Foundation: monitoring and vaccinations in patients treated with biologics for psoriasis – addresses vaccination practices for folks with psoriasis.
  7. Challenges in the treatment of psoriasis with biologics: vaccination, history of malignancy, human immunodeficiency virus (HIV) infection, and pediatric psoriasis – actually talks about how UNDERVACCINATION is a challenge in treating kids with psoriasis, as you might have to interrupt therapy to get them caught up!
  8. Vaccinations in patients with immune-mediated inflammatory diseases – is very clear that the “Clinical evidence indicates that immunization of IMID patients does not increase clinical or laboratory parameters of disease activity. Live vaccines are contraindicated in immunocompromized individuals, but non-live vaccines can safely be given.”

The bottom line is that experts that treat people with psoriasis recommend that they be fully vaccinated.

“Psoriasis is a treatable, chronic dermatosis. The very low absolute risk of new-onset or relapsed psoriasis following influenza vaccination should not change its universal recommendation, particularly for patients with psoriasis on immunosuppressive therapy. We present this case to highlight clinical manifestations of this rare association.”

Shi et al on Widespread psoriasis flare following influenza vaccination

There is even talk of development of a vaccine to treat psoriasis!

It should be clear that neither psoriasis nor a family history of psoriasis should be a reason to get a medical exemption for vaccines.

More on Vaccines and Psoriasis

Can Vaccines Cause Rhabdomyolysis?

The urine is dark because of myoglobinuria secondary to muscle break down. Hemoglobinuria, from blood, is the other thing that makes urine dark.
The urine is dark because of myoglobinuria secondary to muscle break down. Hemoglobinuria, from blood, is the other thing that makes urine dark. Photo Kumar et al (CC BY-NC-SA 3.0 US).

You have probably never heard of rhabdomyolysis.

Children with rhabdomyolysis have severe muscle pain, muscle weakness, and dark urine.

It is classically caused by exercising too much (really overdoing it or exercising a lot more or a lot longer than you typically do) and damaging your muscles, leading to a breakdown of muscle cells and the release of creatine kinase, which in addition to muscle symptoms, can lead to kidney failure.

In addition to exercise, rhabdomyolysis can be caused by seizures, drugs, toxins, insect stings, snake bites, metabolic disorders, infections (viral myositis), and trauma.

“The most common causes of pediatric rhabdomyolysis were viral myositis (38%), trauma (26%), and connective tissue disease (5%).”

Mannix et al on Acute Pediatric Rhabdomyolysis: Causes and Rates of Renal Failure

Keep in mind that rhabdomyolysis is rare. You won’t confuse the aches and pains that most kids get, and which often get blamed on growing pains, with rhabdomyolysis. Although younger kids don’t always have dark urine when they have rhabdo, the pain and weakness is severe. Seek immediate medical attention if you think that your child might have rhabdomyolysis.

Can Vaccines Cause Rhabdomyolysis?

It is well known that rhabdomyolysis can be caused by infections.

“Rhabdomyolysis has been reported to be associated with a variety of viral infections, including influenza, [15,16] Coxsackie virus, human immunodeficiency virus (HIV), echovirus and cytomegalovirus [17]. In our series, the definite viral infection was identified in 5 patients (influenza type B in 4, Coxsackie A10 in 1)”

Chen et al on Clinical spectrum of rhabdomyolysis presented to pediatric emergency department

So if a natural influenza virus infection can cause rhabdomyolysis, does that mean that the flu vaccine can too? What about other vaccines?

Not necessarily, but there are a few case reports that associate vaccines with rhabdomyolysis.

“Influenza A infection has been described as a major viral cause of infection-induced rhabdomyolysis, but to date, only one reported case was described as having been induced by influenza vaccine.”

Callado et al on Rhabdomyolysis secondary to influenza A H1N1 vaccine resulting in acute kidney injury.

In several of the reports, patients already had chronic medical problems for which they were being treated. Still, no signal was found to suggest that the flu vaccine is a problem for these patients.

It is important to note that reports of post-vaccination rhabdomyolysis in healthy people are even rarer.

So while it is could be possible that vaccines are rarely associated with rhabdomyolysis, we know that many infections, including many vaccine-preventable diseases, are a more common cause.

Don’t skip or delay a vaccine because you might have heard that vaccines cause rhabdomyolysis.

Vaccines are safe, with few risks, and are obviously necessary.

More on Vaccines and Rhabdomyolysis