Tag: cherry picking

Did Gregory Poland Really Say That MMR Vaccines Can’t Prevent Measles Outbreaks?

One of the pillars of the anti-vaccine movement is their belief that vaccines don’t even work.

They even think that they have graphs to prove it! They don’t…

Did Gregory Poland Really Say That MMR Vaccines Can’t Prevent Measles Outbreaks?

To help them try and argue their point, they also seem to like to cherry pick and misuse quotes from real experts.

Anti-vaccine propaganda from Lawrence Solomon.
Is that what Dr. Poland said?

In 2012, Gregory Poland, the Editor-in-Chief of the journal Vaccine, did publish the article, The Re-Emergence of Measles in Developed Countries: Time to Develop the Next-Generation Measles Vaccines?

No where in the article does he say that the measles vaccine can’t prevent measles outbreaks.

He is just saying that since the vaccine isn’t 100% effective and because measles is so contagious, that it can’t prevent all measles outbreaks.

“Thus, measles outbreaks also occur even among highly vaccinated populations because of primary and secondary vaccine failure, which results in gradually larger pools of susceptible persons and outbreaks once measles is introduced.”

Poland et al on The Re-Emergence of Measles in Developed Countries: Time to Develop the Next-Generation Measles Vaccines?

And we likely won’t be able to eradicate measles with our current measles vaccine, “even though measles can be controlled, and even eliminated in some regions for defined periods of time.”

“Thus, while an excellent vaccine, a dilemma remains.”

Poland et al on The Re-Emergence of Measles in Developed Countries: Time to Develop the Next-Generation Measles Vaccines?

The dilemma is that measles is still around and that people who are too young to be vaccinated, too young to be fully vaccinated, and those with immune system problems who can’t be vaccinated sometimes get measles, in addition to folks who are intentionally unvaccinated.

With a better vaccine, fewer people would get caught up in outbreaks that are typically triggered by folks who are intentionally unvaccinated.

Remember, most outbreaks are traced back to someone who is unvaccinated. This is the person Dr. Poland is describing when he says “once measles is introduced,” as the endemic spread of measles has been eliminated in the United States. All cases are reintroduced from outside the country, typically when someone who is intentionally not vaccinated travels overseas and then returns with measles while they are still contagious.

“But he also said that sometimes people who oppose the vaccines will pick out one sentence in the scientific study and extrapolate it to mean things that it does not mean… He said that measles is the most contagious disease that we know, and yet we found that fear and ignorance is more so.”

Senator Carla Nelson on The Anti-vaxxers Might Wish that What was Lost had not been Found

Unfortunately, a better measles vaccine still won’t protect us from anti-vaccine propaganda.

Vaccines are safe, with few risks, and necessary. Get vaccinated and stop the outbreaks. You don’t have to wait for a new measles vaccine…

More on Did Gregory Poland Say That MMR Vaccines Can’t Prevent Measles Outbreaks?

Show Me the Vaccine Insert!

Have you ever wondered why anti-vaccine folks always ask about vaccine inserts?

It will soon be obvious that anti-vaccine folks don't really read vaccine inserts...
It will soon be obvious that anti-vaccine folks don’t really read vaccine inserts…

Would they really be happy if we handed them the entire vaccine insert before every visit?

Would they read the entire vaccine insert?

Which part of the vaccine insert do anti-vaccine even read?
Which part of the vaccine insert do anti-vaccine folks even read?

Or would they continue to only believe the parts that they think justify their decisions to leave their kids unvaccinated, unprotected, and at risk for getting life-threatening diseases?

Show Me the Vaccine Insert!

Let’s see what’s really in these package inserts…

“Measles, mumps, and rubella are three common childhood diseases, caused by measles virus, mumps virus (paramyxoviruses), and rubella virus (togavirus), respectively, that may be associated with serious complications and/or death. For example, pneumonia and encephalitis are caused by measles. Mumps is associated with aseptic meningitis, deafness and orchitis; and rubella during pregnancy may cause congenital rubella syndrome in the infants of infected mothers”

MMR II Package Insert

Wait a second!

How can anti-vaccine folks say that measles is a mild disease if the vaccine insert says that it “may be associated with serious complications and/or death.”

Have they really read this thing?

“The impact of measles, mumps, and rubella vaccination on the natural history of each disease in the United States can be quantified by comparing the maximum number of measles, mumps, and rubella cases reported in a given year prior to vaccine use to the number of cases of each disease reported in 1995. For measles, 894,134 cases reported in 1941 compared to 288 cases reported in 1995 resulted in a 99.97% decrease in reported cases; for mumps, 152,209 cases reported in 1968 compared to 840 cases reported in 1995 resulted in a 99.45% decrease in reported cases; and for rubella, 57,686 cases reported in 1969 compared to 200 cases reported in 1995 resulted in a 99.65% decrease”

MMR II Package Insert

Full stop!

How can they say vaccines don’t work when the package insert provides these stats showing it does and goes on to say that “M-M-R II is highly immunogenic and generally well tolerated.”

“The recommended age for primary vaccination is 12 to 15 months.”

MMR II Package Insert

Why are some of these folks delaying or skipping their child’s MMR vaccine? The package insert says to give it at 12 to 15 months!

“Individuals first vaccinated at 12 months of age or older should be revaccinated prior to elementary school entry.”

MMR II Package Insert

That’s the part of the package insert that says to give a second dose before kids enter kindergarten.

“There are no reports of transmission of live attenuated measles or mumps viruses from vaccinees to susceptible contacts.”

MMR II Package Insert

And that’s the part that says they can stop talking about shedding.

Maybe we should make anti-vaccine folks read these inserts…

“The following adverse reactions are listed in decreasing order of severity, without regard to causality, within each body system category and have been reported during clinical trials, with use of the marketed vaccine, or with use of monovalent or bivalent vaccine containing measles, mumps, or rubella:”

MMR II Package Insert

Do anti-vaccine folks understand that some of the things that are listed in the adverse reactions section of the package insert haven’t actually been proven to be caused by the vaccine? They are listed “without regard to causality.”

When you see them talk about SIDS and autism and package inserts, this is what they are talking about.

What about all of the “hidden” ingredients that are listed in the package insert?

Vaccine ingredients are not hard to find.

The ingredients that are so well hidden, they are listed right in the vaccine’s insert? Where does it mention all of the toxins that anti-vaccine folks are always talking about?

“…M-M-R II is highly immunogenic and generally well tolerated.”

MMR II Package Insert

The MMR vaccine works and it is safe.

It says so in the package insert.

Vaccinate your kids.

More on Vaccine Inserts

This Is the Modern Anti-Vaccine Movement

We often like to think that we know how anti-vaccine folks think.

They are just scared and trying to do the right thing for their kids, right? Just like all of the rest of us?

Maybe some of them…

This Is the Modern Anti-Vaccine Movement

Of course, you can’t group all anti-vaccine folks together, as many vaccine-hesitant or on-the-fence parents are truly just scared about the things they see and read about vaccines.

But they should know what they are getting into when they follow their favorite anti-vaccine hero, celebrity or Facebook group.

The modern anti-vaccine movement goes far deeper than worries about possible vaccine side effects.

Don’t believe me?

Hillary Simpson may not share the anti-Semitic views of one of her admins, but many of her followers do...
Hillary Simpson may not share the anti-Semitic views of one of her admins, but many of her followers do…

It is hopefully clear to everyone by now that the modern anti-vaccine movement:

Don’t believe me?

Why should this family have to come out and give an explanation for how their child died?
Why should this family have to come out and give an explanation for how their child died?

After a 4-month-old died of bacterial meningitis, anti-vaccine folks pushed the idea that it was a vaccine injury instead of an infection.

An anti-vaccine parenting group helping spread misinformation about this baby's death.
An anti-vaccine parenting group helped spread misinformation about this baby’s death.

And they push their views that everything is a vaccine injury on everyone, even though most folks understand that vaccines are not associated with SIDS, shaken baby syndrome, autism, and most other things.

There is no connection between vaccines and acute flaccid myelitis, no matter how hard anti-vaccine folks are trying to make one.
To be clear, there is no connection between vaccines and acute flaccid myelitis, no matter how hard anti-vaccine folks are trying to make one.

Award winning?

Please.

Sure, everyone and everything in anti-vaccine world is the very best, except if they are, then why are they trying so hard to convince you of that… So maybe you will agree with some of their more far-out claims, suggestions, and conspiracy theories?

Learn the risks of following bad advice. Are you really going to say no to chemotherapy if your child has cancer?
Learn the risks of following bad advice.

After all, it’s one thing to consider skipping or delaying your child’s vaccines when you think you can get away with hiding in the herd or to buy some essential oils and supplements, but are you really going to say no to chemotherapy if your child has cancer? Brandy Vaughan seems to think you should.

If there is a RISK, there must be a CHOICE.

Do you think it is okay to put infants who are too young to be vaccinated at risk for measles and other vaccine-preventable diseases because you don’t like the choices you have been given between getting your kids vaccinated and protected or keeping them out of school?

What about the parents of the kid who is being treated for cancer who gets exposed to chicken pox because someone else made the choice to not vaccinate their kid? Do you think that’s fair?

The modern anti-vaccine movement is only about choice when it is about their choices and doesn’t seem to care about the risks their unvaccinated kids pose to others.

Believe it or not, the modern anti-vaccine movement also equates getting vaccinated with rape…

Don’t believe me?

Meryl Dorey has also claimed that vaccination is rape.
Meryl Dorey has also claimed that vaccination is rape.

Do you agree?

What else do most folks in the modern anti-vaccine movement believe?

They believe that:

And of course, they believe that vaccine advocates are behind a big conspiracy, are lying to you, and are trying to force everyone to get vaccinated.

Is that what you believe?

Some nurses and doctors are refusing to get a flu shot and have to wear masks at work.
Some nurses and doctors are refusing to get a flu shot and have to wear masks at work.

Even though these and every other anti-vaccine point you have heard has already been refuted a thousand times already.

The RhoGAM shot helps prevent hemolytic disease of the newborn. It is not a vaccine and is not part of a Big Pharma profit ploy...
The RhoGAM shot helps prevent hemolytic disease of the newborn. It is not a vaccine and is not part of a Big Pharma profit ploy…

Do you believe in chemtrails or that Bill Gates has a plan to depopulate the world using vaccines?

“As a result, multiple breakouts of measles have occurred throughout different parts of the Western world, infecting dozens of patients and even causing deaths.”

Hussain et al on The Anti-vaccination Movement: A Regression in Modern Medicine

If you do, understand that you have been fooled by the propaganda of the modern anti-vaccine movement. If you don’t, understand that many of the folks in your anti-vaccine groups probably do.

More on the Modern Anti-Vaccine Movement

Is a Crooked Face a Sign of a Vaccine Injury?

Have you heard of the Crooked theory?

Is something really wrong with these Hollywood stars?
Does Zach Braff really have a crooked face?

If you haven’t, when you get done learning about it, the name is going to seem very ironic…

“Why do babies have lopsided smiles? Why are so many people’s eyes misaligned? What started as a simple search to understand this phenomenon turned into a two-year quest that uncovered hidden links between our crooked faces and some of the most puzzling diseases of our time.

From autism to Alzheimer’s and from chronic fatigue syndrome to Crohn’s disease, Crooked methodically goes through the most recent scientific research and connects the dots from the outbreak of metallic medicine in 1800s England to the eruption of neurological and autoimmune disorders so many are suffering from today.

If the theories put forth in this book are true, the convergence of metals, microbes and medicine that started two hundred years ago may have set humanity on a path of suffering that could make the deadliest epidemics in history pale in comparison. Thankfully, for the millions who are afflicted, who may have found nothing to explain the cause of their suffering — these same theories could also illuminate the path to healing and recovery.”

Forrest Maready on Crooked: Man-Made Disease Explained

Spoiler Alert – The “theories” put forth in his book are not true.

Are you crooked?

Forrest Maready might get asked that a lot these days for actually trying to sell a self-published book pushing the idea that he knows what causes everything “from autism to Alzheimer’s and from chronic fatigue syndrome to Crohn’s disease.”

Of course, he thinks that it is vaccines and aluminum.

“And that’s what makes this even worse. Not only is the theory completely false, it’s not even original!.”

Were We Crooked?

It isn’t.

This “theory” of “his” has been well debunked, ironically, by Maready himself!

Doesn't it look like many of these football players from 1899 had crooked faces?
Doesn’t it look like many of these football players from 1899 had crooked faces?

As others have pointed out, Forrest Maready debunked his own book when he posted old photographs of football players, claiming it proved that vaccines caused chronic traumatic encephalopathy.

Not only did many of the football players from the late 18th and early 19th century who played without helmets go on to develop chronic traumatic encephalopathy, if they didn’t die on the field, as you can see, many also had crooked faces!

Crooked faces, brain damage because they didn't wear helmets, and death from now vaccine preventable diseases - life was tough in the old days.
Crooked faces, brain damage because they didn’t wear helmets, and death from now vaccine preventable diseases – life was tough in the old days.

As early as the 1920s, after first being noticed in boxers, it was quickly discovered that CTE could also occur in football players. And again, many of the folks in these pics have crooked faces!

“All people have asymmetric faces. When one looks closely, these differences become more apparent.”

AAP on Children with Facial Asymmetry

It is hopefully obvious that the crooked face theory is all about cherry picking and confirmation bias. And that some folks think that everything and anything is a vaccine injury.

That this appears to be a credible theory by anti-vaccine folks says a lot about the modern anti-vaccine movement and why some folks don’t vaccinate their kids.

Don’t believe it.

Vaccines are safe and necessary and won’t make your child’s face look crooked.

More on the Crooked Face Theory

 

The Myth That Polio Only Went Away Because They Changed the Way It Was Diagnosed

Have you heard this one?

“Before the vaccine was developed, the diagnosis of polio required 24 or more hours of paralysis. After the vaccine release, the diagnosis changed to at least 60 days of paralysis. As you can imagine, cases of polio dropped significantly.”

So that’s why polio went away?

It wasn’t the vaccine?

The Myth That Polio Went Away Because They Changed the Diagnostic Criteria

In 1952, there were 21,000 cases of paralytic polio in the United States.

But were there really?

Didn’t they change the way they diagnosed polio a few years later, right after the first polio vaccines came out, making it less likely that folks would be diagnosed with polio?

The original diagnostic criteria for polio came from the World Health Organization and included:

“Signs and symptoms of nonparalytic poliomyelitis with the addition of partial or complete paralysis of one or more muscle groups, detected on two examinations at least 24 hours apart.”

It changed in 1955 to include residual paralysis 10 to 20 days after onset of illness and again 50 to 70 days after onset.

Why?

“In the past children’s paralysis was often not correctly diagnosed as polio. Stool samples need to be analyzed to be able to distinguish paralytic symptoms from Guillain-Barré Syndrome, transverse myelitis, or traumatic neuritis.”

Polio – Data Quality and Measurement

But you coulld’t just use stool samples, as many kids might have recently had non-paralytic polio, and could test positive for polio (false positive test), but have another reason to have paralysis.

“Isolation of poliovirus is helpful but not necessary to confirm a case of paralytic poliomyelitis, and isolation of poliovirus itself does not confirm diagnosis.”

Alexander et al. on Vaccine Policy Changes and Epidemiology of Poliomyelitis in the United States

Since polio causes residual paralysis, the new diagnostic criteria helped to make sure that kids were diagnosed correctly.

Did We Overestimate the Number of Kids with Polio?

Some folks think that since we changed the criteria, we overestimated the number of kids with polio in the years before the vaccine came out.

Most of this idea seems to come from a panel discussion in 1960 by critics of the original polio vaccine, The Present Status of Polio Vaccines, including two, Dr. Herald R. Cox and Dr. Herman Kleinman, who were working on a competing live-virus vaccine.

None in the group were arguing against vaccines, or even really, that the Salk polio vaccine didn’t work at all though. They just didn’t think that it was effective as some folks thought.

“I’ve talked long enough. The only other thing I can say is that the live poliovirus vaccine is coming. It takes time. The one thing I am sure of in this life is that the truth always wins out.”

Dr. Herald R. Cox on The Present Status of Polio Vaccines

Dr. Cox did talk a lot about the oral polio vaccine. He talked about successful trials in Minneapolis, Nicaragua, Finland, West Germany, France, Spain, Canada, Japan, and Costa Rica, etc.

When anti-vaccine folks cherry pick quotes from The Present Status of Polio Vaccines discussion panel, they seem to leave out all of the stuff about how well the oral polio vaccine works.

That’s how they work to scare parents and hope that their anti-vaccine myths and misinformation can win out over the truth that vaccines work and that they are safe and necessary.

“Since nothing is available, there seems to be no alternative but to push the use of it. I don’t think we should do so in ignorance, nor too complacently, believing that as long as we have something partially effective there is no need to have something better.”

Dr. Bernard Greenberg on The Present Status of Polio Vaccines

And of course, they did, fairly soon, switch to something better – the Sabin live-virus oral polio vaccine.

Interestingly, using the idea that we changed the diagnostic criteria to make polio go away in an argument about vaccines is known as the Greenberg Gambit.

It tells you something about anti-vaccine arguments, that these folks are misinterpreting something someone said about vaccines almost 60 years ago.

In pushing the idea that polio hasn’t been eliminated, but rather just redefined, they also miss that:

But isn’t polio still around and just renamed as transverse myelitis, Guillain-Barré syndrome (GBS), and aseptic meningitis?

Let’s do the math.

Using the adjusted numbers in the The Present Status of Polio Vaccines discussion, there were at about 6,000 cases of paralytic polio in the United States in 1959.

While 3,000 to 6,000 people in the United States develop Guillain-Barré syndrome each year, the risk increases with age, and it is rare in young kids. Remember, paralytic polio mostly affected younger children, typically those under age 5 years.

“Transverse myelitis can affect people of any age, gender, or race. It does not appear to be genetic or run in families. A peak in incidence rates (the number of new cases per year) appears to occur between 10 and 19 years and 30 and 39 years.”

Transverse Myelitis Fact Sheet

Similarly, transverse myelitis is uncommon in younger children, and there are even fewer cases, about 1,400 a year.

What about aseptic meningitis? That doesn’t usually cause paralysis.

So do the math.

You aren’t going to find that many kids (remember, the incidence was 5-7 per 1,000) under age 5 years who really have “polio,” but instead, because of a worldwide conspiracy about vaccines, are getting diagnosed with transverse myelitis, Guillain-Barré syndrome (GBS), or aseptic meningitis instead.

Anyway, kids with acute flaccid paralysis are thoroughly tested to make sure they don’t have polio. And both transverse myelitis and Guillain-Barré syndrome have different signs and symptoms from paralytic polio. Unlike polio, which as asymmetric muscle atrophy, the atrophy in transverse myelitis and Guillain-Barré syndrome is symmetrical. Also, unlike those other conditions that cause AFP, with polio, nerve conduction velocity tests and electromyography testing will be abnormal. Plus, polio typically starts with a fever. The other conditions don’t.  So while these conditions might all be included in a differential diagnosis for someone with AFP, they are not usually that hard to distinguish.

“Each case of AFP should be followed by a diagnosis to find its cause. Within 14 days of the onset of AFP two stool samples should be collected 24 to 48 hours apart and need to be sent to a GPEI accredited laboratory to be tested for the poliovirus.”

Polio – Data Quality and Measurement

But why be so strict on following up on every case of AFP?

It’s very simple.

If you miss a case of polio, then it could lead to many more cases of polio. And that would tmake it very hard to eradicate polio in an area.

If anything, until the establishment of the Global Polio Eradication Initiative (GPEI) in 1988, it is thought that cases of polio and paralytic polio were greatly underestimated in many parts of the world!

And now polio is almost eradicated.

“DR. SABIN: Let us agree, at least, that things are not being brushed aside. Let us say that we might disagree on the extent to which certain things have received study. But I hope that Dr. Bodian realizes that nobody is brushing things aside. I would not have taken the trouble of spending several months studying viremia with different strains in chimpanzees and human volunteers, and viremia produced by certain low temperature mutants to correlate it with their invasive capacity, if I were merely brushing it aside.”

Live Polio Vaccines – Papers Presented and Discussions Held at the First International Conference on Live Poliovirus Vaccines

There is no conspiracy.

Think about it.

If they redefined how paralytic polio was diagnosed in 1955 as part of a conspiracy to make it look like the polio vaccines were working, then why did the number of cases continue to drop into the 1960s?

Shouldn’t they have just dropped in 1955 and then stayed at the same lower level?

After the switch to the Sabin vaccine, polio was on its way to being eliminated in the United States.
After the switch to the Sabin vaccine, polio was on its way to being eliminated in the United States, although there was an uptick in 1959, before we made the switch.

And why don’t any of the folks with other conditions that cause paralysis, like transverse myelitis and Guillain-Barré syndrome (GBS) ever have polio virus in their system when they are tested?

Also, if the renaming theory explains why the polio vaccine didn’t work, then why do anti-vaccine folks also need to push misinformation about DDT and polio?

What to Know About Polio Myths and Conspiracies

The near eradication of polio from the world is one of the big success stories of the modern era, just as those who push the idea that has all been faked is a snapshot of society at one of our low points.

More on Polio Myths and Conspiracies

Can Vaccinated Children Be Asymptomatic Carriers of Pertussis?

Why do anti-vaccine folks like to talk about baboons so much?

“Did you know that a study showed that baboons injected with whooping cough vaccine became infected with whooping cough anyway – and silently spread the disease to other baboons for 35 days?”

Anti-vaccine Meme

Is it because baboons are used in the study of vaccines?

That’s part of it, at least when they can find a study where they can cherry pick the results to suit their needs.

The Baboon Study

Like most anti-vaccine talking points, this one about baboons, has some truth to it.

An adult male baboon.
An adult male baboon. Photo by Elizabeth Miller

There was a baboon study with the pertussis vaccine and it found that previously vaccinated baboons could develop asymptomatic carriage of the pertussis bacteria after they were intentionally infected.

Here is where it is important to note that an infection is different than a disease.

The example that many people are familiar with is tuberculosis. It is common to have a TB infection without any signs or symptoms and to not feel sick. The only reason we know that they have TB is because they had a positive TB test.

Unfortunately, about 5 to 10% of these people with TB infections can eventually develop TB disease, with coughing, weight loss, night sweats, fever, and chest pain, etc.

It is kind of the same with the baboons in the study. Twenty-four hours after two previously vaccinated baboons were inoculated with pertussis bacteria in the back of their nose and trachea, an unvaccinated baboon was put in each of their cages.

The vaccinated baboons continued to have pertussis bacteria in their noses, which the researchers had put there, for up to 35 days. And they were able to eventually pass the pertussis bacteria to the unvaccinated baboons in their cages. Vaccinated baboons also became infected or colonized after they were put in a cage with an intentionally infected unvaccinated baboon.

“…animals did not cough and showed no reduction of activity, loss of appetite, or other outward signs of disease.”

Warfel et al on Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model

The vaccinated baboons were infected, but they never did develop symptoms of pertussis.

What Does The Baboon Study Mean?

One thing that is for sure – the baboon study found that the pertussis vaccines work. Only unvaccinated baboons got sick with pertussis.

But does this study explain our current outbreaks of pertussis?

Are vaccinated people becoming colonized and then getting others sick?

I guess it is possible, but we are not baboons in a cage with other baboons. How would we spread a respiratory disease, even if we did become colonized with the bacteria, if we don’t have symptoms?

It may explain part of our outbreaks though.

If vaccinated people do commonly become colonized with pertussis bacteria, then they might very well test positive for pertussis even though they don’t have symptomatic pertussis disease. So when they develop a cold or bronchitis and are found to have a positive pertussis test, then couldn’t that test just indicate that they have a pertussis infection and not disease, even though something else is actually causing their symptoms?

That’s what we think happens with strep carriers, right?

That’s kind of what the baboon study found. All of the baboons tested positive, but only the unvaccinated baboons had symptomatic pertussis disease.

“Baboons vaccinated with wP vaccines exhibit a level of protection that is intermediate between convalescent animals and aP-vaccinated animals. They exhibit no outwards signs of disease and are initially colonized to the same high level as aP-vaccinated animals but clear the infection more rapidly.”

Pinto et al on Pertussis disease and transmission and host responses: insights from the baboon model of pertussis.

It is interesting to note that the baboon study also found that baboons who had received whole cell pertussis vaccines also became carriers. They just didn’t stay carriers for as long as the baboons who got the newer acellular pertussis vaccine. But since they were still carriers, if asymptomatic transmission is such a big problem, wouldn’t it have been a big problem back in the day when everyone got whole cell pertussis vaccines?

The Debate Over Asymptomatic Carriage

Most vaccines prevent the spread of disease.

Do the pertussis vaccines?

Most folks still think so.

“The baboon model pioneered by Warfel et al. is without question a game-changer, shedding light on the impact of vaccination on disease and infection. However, the view it affords is clearer with respect to immunity and pathology than with respect to transmission. We point out that the extrapolation of the possibility of transmission from vaccinated baboons in the laboratory to the probability of transmission from vaccinated humans in the population is unwarranted. More work is needed to elucidate the relative transmissibility of infections in vaccinated vs. unvaccinated hosts. The evidence adduced above suggests, however, that vaccination with aP must have a strong effect on transmission as well as disease.”

Matthieu Domenech de Cellès et al on Epidemiological evidence for herd immunity induced by acellular pertussis vaccines

Even the author of the baboon study has said that “We agree that these data should not be directly extrapolated to pertussis transmission in humans. Although baboons are >96% genetically similar to humans, there are likely differences in how the species respond to vaccination and infection. We also agree that aP-vaccinated infected people are likely less efficient at transmitting pertussis compared with unvaccinated infected people, although it is not clear to what extent.”

Others think that asymptomatic carriage of pertussis might behind a lot of our recent outbreaks. Or at least what helps them grow so large.

Still, it is important to remember that unvaccinated folks do play a role in these outbreaks too. In a pertussis outbreak at a Florida preschool, in which most kids were vaccinated, the outbreak was started by a vaccine-exempt toddler.

And we have seen this in many other areas and it has been confirmed by many studies. Whatever else is contributing to pertussis outbreaks, like waning immunity, they are also associated with vaccine refusal.

“Counties with higher exemption rates had higher rates of reported pertussis among exempted and vaccinated children when compared with the low-exemption counties.”

Imdad et al. on Religious exemptions for immunization and risk of pertussis in New York State, 2000-2011.

But what if the DTaP and Tdap vaccines do cause folks to be asymptomatic carriers?

Even if that is true, understand that these vaccines don’t actually infect you, making you a carrier. They just might not prevent you from becoming a carrier if you are exposed to someone else with pertussis. While that might be a good reason to develop a new and better pertussis vaccine, it certainly isn’t a reason to skip or delay your child’s vaccines now.

Remember that even with our current outbreaks, rates of pertussis were much higher in the pre-vaccine era.

What to Know About Vaccines and Asymptomatic Carriers of Pertussis

The role of asymptomatic carriers and pertussis is controversial, but it certainly isn’t a reason to skip or delay your child’s vaccines.

More on the Vaccines and Asymptomatic Carriers of Pertussis

Hierarchy of Evidence and Vaccine Papers

Evidence is evidence, right?

Nope.

There is a hierarchy of evidence, from weakest to strongest, that help folks make decisions about science and medicine.

That’s why you can’t just search Google or PubMed, read abstracts, and say that you have done your research.

Hierarchy of Evidence

For any study, you have to review and judge the quality of the evidence it provides.

A meta-analysis with over 1.2 million kids found that vaccines were not associated with autism, while Wakefield's retracted case series included only 12 children.
A meta-analysis with over 1.2 million kids found that vaccines were not associated with autism, while Wakefield’s retracted case series included only 12 children.

Is it a case report (a glorified anecdote), case series, or animal study (lowest quality evidence)?

Or a systemic review or meta-analyses (highest quality evidence)?

“The first and earliest principle of evidence-based medicine indicated that a hierarchy of evidence exists. Not all evidence is the same. This principle became well known in the early 1990s as practising physicians learnt basic clinical epidemiology skills and started to appraise and apply evidence to their practice. Since evidence was described as a hierarchy, a compelling rationale for a pyramid was made.”

Murad et al. on the New Evidence Pyramid

What about case control studies, cohort studies, and randomized controlled trials?

They lie somewhere in between on the hierarchy of evidence scale or pyramid.

And there are other factors to consider when judging the reliability of a study.

“Ultimately, the interpretation of the medical literature requires not only the understanding of the strengths and limitations of different study designs but also an appreciation for the circumstances in which the traditional hierarchy does not apply and integration of complementary information derived from various study designs is needed.”

Ho et al. on Evaluating the Evidence

For example, you might also have to take into account the sample size of the study.

A study can be underpowered if it doesn’t have enough subjects. Unfortunately, even an underpowered study will give you results. They likely won’t be statistically significant results, but folks don’t always realize that.

Even a meta-analysis, usually considered to be at the top of the hierarchy of evidence pyramid, can have problems that make their results less useful, such as not using appropriate inclusion criteria when selecting studies and leaving out important studies.

All in all, there are many factors to look at when reading a medical paper and considering if the results are valid and should influence what you do and how you think. This is especially true when looking at low quality vaccine papers, many of which the anti-vaccine movement uses to scare people, even though they are often poorly designed, and several of which have been retracted.

What to Know About the Hierarchy of Evidence

Learning about the hierarchy of evidence can help you better evaluate medical studies and vaccine papers and understand that there is more to doing your research about vaccines than searching PubMed and reading abstracts.

More on the Hierarchy of Evidence