Tag: delaying vaccines

We Know What Happens If We Stop Vaccinating

It’s no surprise.

If we stop vaccinating, diseases that are now vaccine preventable will come back.

How do we know?

Because it has happened already.

We Know What Happens If We Stop Vaccinating

It has happened a lot, actually.

Remember when Sweden stopped using the DPT vaccine?

Between 1979 and 1996, Sweden suspended vaccination against pertussis because of concerns about the DPT vaccine.

And what happened?

“In 1979, the Swedish medical society abandoned whole-cell pertussis vaccine and decided to wait for a new, safer, more effective vaccine – a strategy that was soon adopted as national policy. During 1980-83, annual incidence for children aged 0–4 years increased to 3370 per 100000, with rates of serious complications approaching global rates. In subsequent years, Sweden reported more than 10000 cases annually with an incidence exceeding 100 per 100000, comparable to rates reported in some developing countries.”
Ganarosa et al on Impact of anti-vaccine movements on pertussis control: the untold story.

Pertussis came back.

In fact, endemic pertussis came back.

“Our evaluation of pertussis in the unimmunized child population gave an answer to the question of whether pertussis nowadays is a harmless disease which does not demand general vaccination. The present situation regarding pertussis in Sweden and the low efficacy of the antimicrobial treatment indicate an urgent need to prevent the disease by general vaccination as soon as a safe and effective vaccine is available.”
Romanus et al on Pertussis in Sweden after the cessation of general immunization in 1979.

Of course, they already had a safe and effective vaccine at the time. All of the claims against the whole cell pertussis vaccine ended up being untrue.

The same thing happened when Japan stopped using the MMR vaccine.

“Due directly to these gaps in ‘herd’ immunization resulting from politicized transitions in vaccination policy by the government, there were outbreaks of rubella with 17,050 cases reported between the years of 2012 and 2014, and 45 cases of congenital rubella syndrome reported to the National Epidemiological Surveillance of Infectious Diseases from week 1, 2012 to week 40, 2014.”
Yusuke Tanaka on History repeats itself in Japan: Failure to learn from rubella epidemic leads to failure to provide the HPV vaccine

What happened in Ukraine when immunization rates dropped in the 1990s? There were 17,387 cases of diphtheria and 646 deaths from 1992 to 1997. Also high, were cases of measles (over 23,000 cases in 1993) and pertussis (almost 7,000 cases in 1993).

Remember the measles outbreaks that spread across Europe in 2010 to 11, leading to about 30,000 cases of measles each year, and at least 28 deaths?

That should have been enough to warn folks, but it didn’t.

Things are much worse now, with over 120 measles deaths in Europe over the past few years.

More recently, in Venezuela, shortages of most things have led to ongoing epidemics of measles and diphtheria, a “potential for reemergence of poliomyelitis,” and a risk to neighboring countries.

“Officials say the low coverage rate and widespread transmission of the virus is due to many factors, including transport costs for those in rural areas, a high number of people with weakened immune systems, such people living with HIV and tuberculosis – and vaccine refusal.”
Ukraine: Red Cross deployed to help contain largest measles outbreak in Europe in four years

And once again, there are measles outbreaks in Ukraine. This time, they have spread to many other countries, fueling outbreaks in Israel and the United States.

We know what happens if we stop vaccinating. Get vaccinated and stop the outbreaks.

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

How Often Should You Do Vaccine Titer Testing?

We sometimes hear about folks doing vaccine titer testing.

A vaccine titer is a blood test that can determine whether or not you are immune to a disease after you get a vaccine.

While that sounds good, after all, why not check and be sure, it has downsides. Chief among them is that the results aren’t always accurate.

That’s right. You can sometimes have a negative titer test, but still be immune because of memory B cells and the anamnestic response.

How Often Should You Do Vaccine Titer Testing?

So how often should you do vaccine titer testing?

It depends, but most folks might never have it done!

Why not?

Vaccines work very well, so you would typically not need to routinely check and confirm that you are immune after being vaccinated. And, this is also important, the vaccine titer tests don’t always work that well, titer testing isn’t available for all vaccines (you can’t do titer testing for Hib and pertussis), and the testing can be expensive.

So we usually just do the testing (a quantitative titer) for folks that are in high risk situations, including:

pregnancy – rubella titer only (HBsAg is also done, but that’s not a vaccine titer test, but rather to see if you are chronically infected with hepatitis B)
healthcare workers – anti-HBs (antibody to the hepatitis B surface antigen to confirm immunity after being vaccinated)
students in nursing school and medical school, etc. – anti-HBs
children and adults exposed in an outbreak – measles, chicken pox, mumps, etc., but only if we are unsure if they were previously vaccinated and protected
after a needlestick injury, etc. – to confirm immunity to hepatitis B
babies born to a mother with hepatitis B – to confirm that their hepatitis B vaccine worked

Vaccine titer testing might also be done for:

internationally adopted children – to confirm that they are immune if we unsure about all of the vaccines the child got in other countries
children and adults with lost vaccine records – to confirm that they are immune, since we are unsure about all of the vaccines they got
evaluation of children and adults with immune system problems – to help identify what immune system problems they might have – typically involves checking pneumococcal titers, giving Prevnar, and then checking pneumococcal titers again
people at continuous or frequent risk for rabies – rabies titer testing every 6 months to 2 years
patients with inflammatory bowel disease, before starting immunosuppressive therapy – hepatitis A and hepatitis B titers, as they might be at increased risk for hepatitis

While checking titers is easy, it is sometimes harder to know what to do with the results you get.

Of all of these different titers, only one tells you that you are immune due to vaccination.

It is especially important to know that:

most people don’t need to have their titers checked routinely if they are not in one of the high-risk groups noted above
it isn’t practical to get titers tested as a method of potentially skipping one or more doses of your child’s vaccines, after all, if the titer is negative, then you are still going to have to get vaccinated
a healthcare provider with a negative measles titer after two doses of the MMR vaccine does not need another dose of vaccine
a healthcare provider who has anti-HBs <10 mIU/mL (negative titer) after three doses of the hepatitis B vaccine should get another dose of vaccine and repeat testing in 1 to 2 months – if still <10 mIU/mL, they should then get two more doses of hepatitis B vaccine (for a total of 6 doses) and repeat testing. If still negative, these documented nonresponders will need HBIG as post-exposure prophylaxis for any future hepatitis B exposures, but no further doses of hepatitis B vaccine.
vaccinated women of childbearing age who have received one or two doses of rubella-containing vaccine and have rubella serum IgG levels that is not clearly positive should be administered one additional dose of MMR vaccine, with a maximum of three doses, and should not be tested again
postvaccination titer testing is not recommended after the chicken pox vaccine
in addition to not being able to test titers for pertussis and Hib immunity, it is becoming difficult to test poliovirus type 2 titers, as the test uses a live virus that isn’t routinely available anymore (type 2 polio has been eradicated)

Still think you need vaccine titer testing?

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)

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.

How Do You Provide Informed Consent to Vaccination?

When you take your child to their pediatrician, you expect to be given all of the information you need to help you make good decisions about their care.

Whether it is about an antibiotic to treat an ear infection, the need for an MRI if your child is having severe headaches, or weaning off an asthma medication, etc., you deserve to be well informed of the risks and benefits of any and all procedures they have.

How Do You Provide Informed Consent to Vaccination?

Of course, informed consent also applies to vaccinations.

It's not an "informed consent form," but the Vaccine Information Statement can help you get informed consent before getting vaccines. — It’s not an “informed consent form,” but the Vaccine Information Statement can help you get informed consent before getting vaccines.

How do you provide informed consent to vaccination?

Provide the latest edition of the appropriate Vaccine Information Statement (VIS) before a vaccination is given. Although these aren’t actually “informed consent forms,” they are required to be given by federal law and because “cover both benefits and risks associated with vaccinations, they provide enough information that anyone reading them should be adequately informed”
Give parents/guardians the chance to take the VIS home to review later.
Answer any questions about the vaccine that their child is about to get.

Hopefully you always get informed consent before your child is vaccinated.

You should also get informed consent before skipping or delaying any of your child’s vaccines, as it risks their getting a life-threatening vaccine-preventable disease and puts others at risk, all without any extra benefit.

“At trial, the parent and physician both acknowledged that the vaccine was recommended, but the parent stated that the risk of death wasn’t mentioned during the discussion.”
Document ‘informed refusal’ just as you would informed consent

Believe it or not, a pediatrician in California was successfully sued after a parent refused to vaccinate their child with Prevnar and their infant died of pneumococcal sepsis, which the vaccine could have prevented.

Although they realized that their pediatrician had recommended the vaccine and they refused it, they claimed that they didn’t realize that their baby could die without it. He did…

Myths About Informed Consent and Vaccines

Not surprisingly, many folks get the idea of informed consent to vaccination wrong.

For one thing, unless it is required by state law, no one has to sign a consent form before getting vaccinated. Many pediatricians and clinics do have you sign that you received the VIS, although federal law does not require this signature.

And informed consent doesn’t come from reading a vaccine’s package insert, as the parts pushed by anti-vaccine folks are just things included from voluntary reports and have not actually been proven to be caused by the vaccine.

“Now that case one is settled, I can go back to being loud and proud about my belief that every single patient should receive complete informed consent prior to vaccinations. This two-year period of silence has been tough. I will not rest until every single family has been given access to full, complete, objective, and un-doctored information that makes every parent fully aware of the risks they accept if they don’t vaccinate their child, and all the risks they take if they do vaccinate their child. Period. And I will fight against mandatory vaccination laws until they are no more. When every single person on this planet has access to informed consent, and can make a free choice, I will then be able to say my work is done.”
Dr. Bob Sears

When Dr. Bob talks about vaccines, do you think he mentions the parents who skipped the Prevnar vaccine and then successfully sued their pediatrician for not warning them that their baby would die?

Dr. Bob Sears actually reassured parents that measles wasn't deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe - another well-nourished population with lower vaccination rates than the U.S. — Dr. Bob Sears actually reassured parents that measles wasn’t deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe – another well-nourished population with lower vaccination rates than the U.S.

Overstating the side effects and risks of getting vaccinated, rarely or ever mentioning the benefits of vaccines, and underestimating the complications and risks of life-threatening vaccine-preventable diseases isn’t informed consent.

It is actually misinformed consent.

It is propaganda.

It is a tool that some folks use to scare you away from making the right decision to vaccinate and protect your kids.

Parents deserve informed consent about vaccines. Unfortunately, that’s not what they are getting from the modern anti-vaccine movement.

VAXOPEDIA

We Know What Happens If We Stop Vaccinating

We Know What Happens If We Stop Vaccinating

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How Often Should You Do Vaccine Titer Testing?

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