Tag: correlation

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

Mistaking Subsequence for Consequence

Most parents understand that vaccines are safe, with few risks, and necessary, but some are still scared to get their kids vaccinated and protected.

Some even get anxious at the idea of going to their next visit to their pediatrician, because it might mean their baby is going to get shots.

Why?

They have likely heard some of those vaccine injury stories and got to thinking – how could all of those parents be wrong?

Mistaking Subsequence for Consequence

It’s easy to make a hasty judgement about something.

We jump to conclusions and try to link things together when they occur at about the same time as each other.

It is incident to physicians, I am afraid, beyond all other men, to mistake subsequence for consequence.

That’s because we often mistake subsequence (the state of following something) for consequence (a result of an action).

For example, developing multiple sclerosis (the consequence) six weeks after (subsequent) getting a vaccine, doesn’t mean that the vaccine caused you to develop multiple sclerosis.

Although the source of the quote on subsequence and consequence is Dr. Samuel Johnson, an 18th century writer, it got new life when Justice Jeremy Stuart-Smith used it in a DTP vaccine trial verdict.

“Where given effects, such as serious neurological disease or permanent brain damage, occur with or without pertussis vaccination, it is only possible to assess whether the vaccine is a cause, or more precisely a risk factor, when the background incidence of the disease is taken into account. The question therefore is, does the effect occur more often after pertussis vaccination than could be expected by chance?”

Sir Jeremy Stuart-Smith

What about chance and coincidences?

Instead of thinking that things could simply be the result of chance or a coincidence, we typically want more of an explanation when something happens, and sometimes, we simply want someone or something to blame.

“Establishing or disproving cause and effect, particularly for events of major consequence, proved difficult. Although the original allegations of causation were largely anecdotal and based on the fallacious assumption that subsequences and consequences were synonymous, they raised great concern and stimulated the search for an improved vaccine.”

Vaccines (Seventh Edition)

That leads us to fallacious thinking – post hoc ergo propter hoc (after this, therefore, because of this).

It shouldn’t though.

“Most of you will have heard the maxim “correlation does not imply causation.” Just because two variables have a statistical relationship with each other does not mean that one is responsible for the other. For instance, ice cream sales and forest fires are correlated because both occur more often in the summer heat. But there is no causation; you don’t light a patch of the Montana brush on fire when you buy a pint of Haagan-Dazs.”

Nate Silver

Remember, “correlation does not imply causation.”

Because polio outbreaks often came in summer months, some folks thought the virus must be spread at swimming pools, so they were often closed. It didn't help... Correlation did not equal causation.
Because polio outbreaks often came in summer months, some folks thought the virus must be spread at swimming pools, so they were often closed. It didn’t help… Correlation did not equal causation.

That maxim becomes easier to understand when you see all of the things that correlate together, like ice cream sales and forest fires, but once you think about them, there is no way that one could cause the other.

  • the consumption of high fructose corn syrup and deaths caused by lightning
  • the divorce rate in Maine and the per capita consumption of margarine
  • autism rates and organic food sales
  • autism rates and Jenny McCarthy‘s popularity?!?

Correlation does not imply causation.

“It is incident to physicians, I am afraid, beyond all other men, to mistake subsequence for consequence.”

Dr Samuel Johnson

Fortunately, it is not as “incident to” (likely to happen to) physicians these days to “mistake subsequence for consequence.”

There are certainly some vaccine friendly pediatricians who pander to the fears of parents and push so-called alternative, non-standard, parent-selected, delayed protection vaccine schedules, who seem to believe in anecdotal evidence above all else, but most doctors understand that vaccines are safe and necessary.

They also know that because correlation can sometimes equal causation, we don’t ignore possible vaccine injuries. And that’s why we have strong vaccine safety systems that can detect and warn us of true vaccine risks.

More on Mistaking Subsequence for Consequence

If It’s Vaccines, Then Why Are There Autistic Kids Who Are Unvaccinated?

Although we know that vaccines aren’t associated with autism, anti-vaccine folks can’t let go of the idea.

Paul Thomas misses the one thing his data is telling him...
Paul Thomas misses the one thing his data is telling him…

So how do they explain all of the autistic kids who are unvaccinated?

If It’s Vaccines, Then Why Are There Autistic Kids Who Are Unvaccinated?

Of course, anti-vaccine folks have a ready answer – it’s vaccines, but it’s not just vaccines.

I guess that’s how they explain the fact that there are so many autistic adults too! Well, actually no. Most anti-vaccine folks are surprised when you point out that there are so many autistic adults, as it doesn’t fit in with their idea that autism is new and caused by kids getting more vaccines than they used to.

Well, I guess mostly caused by giving so many more vaccines than we used to – there are also the autistic kids who were never vaccinated.

How do they explain those kids having autism?

Like their competing theories about how vaccines are associated with autism (it’s the MMR vaccine, no it’s thimerosal, no it’s glyphosate contaminating vaccines, etc.), they have a lot of ideas about how everything else causes autism. From fluoride and chlorine to acetaminophen and aluminum-lined containers, plus mercury, arsenic, aspartame, MSG, and the vaccines your child’s great-grandmother received – they think that just about anything and everything can cause autism. Or at least anything that they think they can sell you a treatment for, such as their supplements, special diet plans, or other “cures.”

Makes you wonder why they still focus on vaccines…

But they do, even as more studies have shown that vaccines are not associated with autism. And since vaccines don’t cause autism, it shouldn’t be surprising that there are unvaccinated children with autism. The only reason there aren’t more is that most parents vaccinate their children, so, of course, most autistic children are going to be vaccinated.

Another reason is that some parents stop vaccinating their kids once they have an autistic child. But since vaccines aren’t associated with autism, which is highly genetic and inheritable, younger unvaccinated siblings born after older siblings were diagnosed often still develop autism.

Now if vaccines didn’t cause autism in these unvaccinated kids, why would anyone still think that they caused autism in their older siblings?

“I must admit that it was through conversations with a coworker that I began to suspect something might be wrong with my youngest son. It concerned me so much that I started looking for information online. I read some of the stories and they sounded similar to what I was experiencing with my son – with the symptoms, the regression and the age at which it all started to become apparent.”

Lara’s Story: Growing Up Anti-Vaccine

Unlike some other stories you might read online, Lara’s story is about her unvaccinated autistic child.

She isn’t alone. You only have to look at personal stories and posts in parenting forums to see that there are many cases of autism among unvaccinated and partially vaccinated children:

  • “It is highly likely my 4-year-old son is autistic. And he is completely 100 percent vaccine-free. And I am just at a total loss.”
  • “I have unvaxxed kids on the spectrum, and my friend does as well.”
  • “A good friend’s son is autistic. He is totally non-vaxxed.”
  • “I seriously delayed vaccinating my son, so had very few vaxxes at the time he was diagnosed”
  • “We have autism in our unvaxxed children”
  • “I know two little boys who are both autistic, completely non-vaxxed”
  • “I have two unvaccinated children who are on the autism spectrum and have never vaccinated any of my children.”
  • “I am not sure what caused my son’s autism, but autistic he is. He is completely unvaxxed as we stopped vaxxing 10 years ago.”
  • “I have a 10 year old daughter with autism spectrum disorder… My daughter has never had a vaccine, a decision I made shortly after she was born, after much research.”

Unfortunately, while realizing that unvaccinated children can develop autism does help some parents move away from anti-vaccine myths and conspiracy theories, others get pushed deeper into the idea that it is just about toxins. It is not uncommon for some of these parents to blame vaccines they got while pregnant or even before they became pregnant, Rhogam shots, or mercury fillings in their teeth, etc.

Fortunately, most don’t though.

Take Juniper Russo, for example.

She “was afraid of autism, of chemicals, of pharmaceutical companies, of pills, of needles” when she had her baby. She just knew that vaccines caused autism when she first visited her pediatrician after her baby was born and knew all of the anti-vaccine talking points. She also later began to realize that her completely unvaccinated daughter had significant developmental delays. Instead of continuing to believe that vaccines cause autism, Ms. Russo understood that she “could no longer deny three things: she was developmentally different, she needed to be vaccinated, and vaccines had nothing to do with her differences.”

And she understands that her autistic child isn’t damaged, as hard as folks in the anti-vaccine movement still try to push the idea that she is.

More on Autistic Kids Who Are Unvaccinated

What Are the Side Effects of the Flu Vaccine?

Like other vaccines, flu vaccines can have side effects.

Fortunately, most of those side effects are mild.

What Are the Side Effects of the Flu Vaccine?

Not surprisingly, a lot of things that get blamed as being caused by flu vaccines are not actually side effects.

Did you actually get the flu in the days or weeks after your flu vaccine?

That’s not a side effect of your flu vaccine. Neither the inactivated flu shot, nor the attenuated FluMist can actually cause a flu infection.

Did you get a little sore at the site where you got your flu shot?

That’s a common side effect to getting a flu shot.

So is having some redness and swelling at the site, all of which begin soon after getting the shot and go away in a few days. You can also get a headache, fever, nausea, and muscle aches or signs and symptoms of an allergic reaction.

Do you have a runny nose or a cough? Side effects of the nasal spray flu vaccine can include a few days of runny nose, wheezing, headache, vomiting, muscle aches, fever, sore throat and cough.

Again, a bad cough and cold after a flu shot isn’t a side effect of the vaccine though.

Remember, correlation does not imply causation.

If you found out you were pregnant shortly after getting a flu shot, you wouldn’t think they were associated, would you?

What about narcolepsy?

“An increased risk of narcolepsy was found following vaccination with Pandemrix, a monovalent 2009 H1N1 influenza vaccine that was used in several European countries during the H1N1 influenza pandemic.”

Narcolepsy Following Pandemrix Influenza Vaccination in Europe

Although the focus has been on the Pandemrix flu vaccine as a trigger for narcolepsy in some countries (the vaccine wasn’t used in the United States), interestingly, several countries that weren’t using the vaccine also saw a spike in narcolepsy cases as the 2009 H1N1 pandemic hit.

Doctors and pharmacies rarely give away flu shots for free. They might not charge a copay sometimes because they are getting paid by your insurance company!
Doctors and pharmacies rarely give away flu shots for free. They might not charge a copay sometimes because they are getting paid by your insurance company!

What about all of the reports of severe reactions and deaths after getting a flu shot that you might hear about? In addition to vaccine injury stories, those reports are to VAERS and typically are not causally related to getting a vaccine.

Why are there so many reports to VAERS and the NVICP about flu vaccines? Since 2006, over 1.6 trillion doses of flu vaccine have been distributed in the United States, which equals about the total of all other vaccines we use.

What Are the Side Effects of This Year’s Flu Shot

Even when folks understand that flu vaccines don’t typically cause serious side effects, the question always comes up whether or not this year’s flu shot is causing more side effects than usual.

That’s actually not unreasonable, even when you consider that the biggest change in most flu vaccines from year to year is the strain of flu viruses they include, and not any of the other ingredients.

In addition to the Pandemrix flu vaccine, in 2010, the use of one brand of flu vaccines in Australia was suspended because they were causing more side effects (fever and febrile seizures) in young children than expected.

“The studies flesh out preliminary findings from CSL in June 2012, which said that the manufacturing process retained more virus component than that of other manufacturers and that the 2010 virus components triggered an excessive immune response in some young kids.”

CSL studies shed light on 2010 flu vaccine seizures

So are there any more side effects this year?

No, there is no evidence of increased side effects from this year’s flu vaccines

More on Flu Vaccine Side Effects