Tag: DPT

A Shot at the Dark – DPT vs DTaP

Everyone knows that the DPT vaccine caused a lot of vaccine injuries, right?

“I got interested in the topic of vaccines way back in medical school. A friend of mine convinced me to read a book about vaccines, and it ended up being a very anti-vaccine book. It was all about an old vaccine called the DTP vaccine that we don’t use anymore. But the book talked a lot about the risks and the dangers of that vaccine. The author of that book was calling for that vaccine to no longer be used.

A number of years later, it turns out that they did discover that vaccine was causing a lot of very severe, life-threatening, even fatal side effects, so they did end up taking that vaccine off the market.

So it kind of opened my eyes to the fact that there are some very severe, fortunately very rare, side effects to vaccines, and I wanted to learn more about this issue. I started reading a lot more books.”

Bob Sears, MD on The Vaccine War

After all, it was after reports of those vaccine injuries, including seizures and encephalitis, that led to:

  • lawsuits and many pharmaceutical companies to stop making vaccines
  • the DPT: Vaccine Roulette special airing on TV
  • Barbara Loe Fisher, believing that her child was damaged by the DPT vaccine, forming the Dissatisfied Parents Together organization (she later changed the name to the National Vaccine Information Center), and writing the book DPT: A Shot in the Dark (this is the anti-vaccine book that Bob Sears is talking about above)
  • the National Vaccine Injury Compensation Act passing in 1986, creating the National Vaccine Injury Compensation Program and the Vaccine Court
  • the DTaP vaccine replacing the DTP vaccine

But were those reports true?

And did they ever really discover that the DPT “vaccine was causing a lot of very severe, life-threatening, even fatal side effects,” which led to them “taking that vaccine off the market” as Dr. Bob said?

A Shot at the Dark

It is easy to think that they were true, as we don’t use the DTP vaccine anymore.

But was it ever “taken off the market?”

“During the period of transition from use of whole-cell DTP to DTaP, whole-cell DTP is an acceptable alternative to DTaP for any of the five doses. For the first four doses, whole-cell DTP combined with Hib vaccine (DTP-Hib vaccine) is an acceptable alternative to DTaP and Hib vaccine administered at separate sites.”

ACIP on Pertussis Vaccination: Use of Acellular Pertussis Vaccines Among Infants and Young Children Recommendations of the Advisory Committee on Immunization Practices

No, it was replaced by a newer vaccine – DTaP.

And actually, it is still used in some parts of the world.

The whole-cell DTP vaccine did cause more side effects than the newer DTaP vaccine, but we are talking about relatively mild side effects, like local reactions, pain, and fever. And while that it is good, it comes at a cost, a less effective vaccine.

What about epilepsy and encephalitis?

After all of the scare about the DPT vaccine, studies quickly showed that it didn't cause all of the bad side effects that folks say it did.
After all of the scare about the DPT vaccine, studies quickly showed that it didn’t cause all of the bad side effects that folks say it did.

One clue that the DTP vaccine didn’t cause many of the problems that were blamed on it, is that the same vaccine lawsuits that were succeeding in driving vaccine manufacturers out of business in the United States, were failing in the UK.

“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?”

Justice Jeremy Stuart-Smith

There is also the fact that many children who were originally thought to have been vaccine injured after their DPT vaccine are now known to have Dravet syndrome.

Without a diagnosis, Cossolotto said, she would probably still believe — erroneously — that the DPT shot caused Michaela’s illness. “I understand this is a genetic condition,” she said. “Having an answer does make a difference.”

Medical mystery: Seizures strike baby after routine vaccine

And then there are the reports and studies that found:

  • no association with brain injury, epilepsy, SIDS, or infantile spasms
  • no increased risk for serious neurological illness in the week after getting vaccinated with DPT
  • no increased risk for encephalopathy in the 90 days after receiving DTP and MMR vaccines
  • no difference in severe reactions after DPT vs DTaP, including encephalopathy, seizures, and allergic reactions

So no, the DPT vaccine was never really as dangerous as folks said or thought it was, despite what you might read or hear in anti-vaccine books or news reports.

What to Know About the Safety of the DPT Vaccine

Misconceptions about the risks and safety of the DPT vaccine created the modern anti-vaccine movement and unfortunately, continues to influence many people.

More on the Safety of the DPT Vaccine

 

There Is a New Treatment for an Old Vaccine Induced Disease

Mutation screening of the SCN1A gene can help diagnosis kids and adults with Dravet syndrome.
Mutation screening of the SCN1A gene can help diagnosis kids and adults with Dravet syndrome.

Many children who once developed seizures after getting a pertussis containing vaccine were thought to have a vaccine injury.

In fact, HHE and seizures from DPT were once table injuries.

Since then, many of those children have been found to have Dravet syndrome, which is not a vaccine injury or vaccine induced disease. Dravet syndrome includes children who develop severe, fever-related seizures before their first birthday.

First described by Dr. Charlotte Dravet in 1978, using mutation screening of the SCN1A gene, in 2006, Dr. Samuel Berkovic found that many adults had Dravet syndrome too.

“We present here the cases of 5 children who presented for epilepsy care with presumed parental diagnoses of alleged vaccine encephalopathy caused by pertussis vaccinations in infancy. Their conditions were all rediagnosed years later, with the support of genetic testing, as Dravet syndrome.”

Reyes et al on Alleged cases of vaccine encephalopathy rediagnosed years later as Dravet syndrome

Others soon replicated Berkovic’s work and found other children with the SCN1A mutation that causes Dravet syndrome. These children had hard to control seizures, developmental delays, and autism-like characteristics and included some with an “alleged vaccine encephalopathy.”

That they didn’t have a vaccine injury wasn’t a surprise to many people, as many of the early reports about the DPT vaccine and seizures were wrong. In 1973, Dr. John Wilson took to the media to scare parents because he had “seen too many children in whom there has been a very close association between a severe illness, with fits, unconsciousness, often focal neurological signs, and inoculation.” What followed was a drop in DPT vaccinations in many countries and vaccine lawsuits, even though his study was later found to be seriously flawed, with most having no link to the DPT vaccine.

“Although Dravet syndrome is a rare genetic epilepsy syndrome, 2.5% of reported seizures following vaccinations in the first year of life in our cohort occurred in children with this disorder.”

Verbeek on Prevalence of SCN1A-Related Dravet Syndrome among Children Reported with Seizures following Vaccination: A Population-Based Ten-Year Cohort Study

What’s the association between Dravet syndrome and vaccines?

Since infants with Dravet syndrome have febrile seizures, any fever can trigger those seizures. Of course, vaccines can cause fever. And so infants with Dravet syndrome who get a fever after their vaccines can have seizures. Even without getting vaccines, they will eventually have seizures, so skipping or delaying vaccines isn’t a good idea for these kids.

There Is a New Treatment for an Old Vaccine Induced Disease

Have you ever heard of Dravet syndrome?

Even though Dravet syndrome is now known to be at least twice as common as once thought – at about 1 in 15,000 children, many parents have still never heard of it.

“Multiple prolonged febrile seizures in an otherwise well child, usually starting by 8 months of age, are the early clinical hallmarks of Dravet syndrome. Other typical features of this devastating disorder include refractory and multiple seizure types after 12 months of age, including partial, myoclonic, atonic, and absence seizures, and developmental delays and motor impairment such as ataxia and spasticity.”

Wu et al on the Incidence of Dravet Syndrome in a US Population

If you have been locked into the idea that your child was vaccine injured or vaccine damaged after the DPT vaccine, then you have likely not have heard of Dravet syndrome.

Without a diagnosis, Cossolotto said, she would probably still believe — erroneously — that the DPT shot caused Michaela’s illness. “I understand this is a genetic condition,” she said. “Having an answer does make a difference.”

Medical mystery: Seizures strike baby after routine vaccine

That’s unfortunate, as there is a new treatment for Dravet syndrome that is showing a lot of promise. Although not a cure by any means, use of cannabidiol (CBD) oral solution has been shown to reduce seizures in children with Dravet syndrome.

And no, getting a prescription for cannabidiol oral solution from a neurologist is not the same as buying CBD oil, hemp oil, or CBD hemp oil on the internet. While they are all free of THC, you have no idea of the real concentration of CBD when you buy these substances on the internet. Also, hemp oil doesn’t even contain CBD, so won’t control seizures or do much of anything else.

“Previously, many children with severe epilepsy and intellectual disability did not receive a specific diagnosis; there was only limited ability to take the diagnosis further. With advances in clinical epileptology, genetics, and neuroimaging, specific forms of severe epilepsy that lead to progressive intellectual deterioration can be identified.”

Samuel Berkovic, MD on Cannabinoids for Epilepsy — Real Data, at Last

How would you know if your child has Dravet syndrome? Mutation screening of the SCN1A gene, something that is now routinely done for infants with repeated febrile seizures.

Is mutation screening of the SCN1A gene to test for Dravet syndrome something your MAPS doctor would suggest for your older child?

What to Know About Getting Diagnosed and Treating Dravet Syndrome

Children with Dravet syndrome were once misdiagnosed as having a vaccine encephalopathy and may have some new hope in having resistant seizures treated with cannabidiol oral solution.

More on Getting Diagnosed and Treating Dravet Syndrome

 

Recommendations for Reporting About Vaccines

Historically, the media has played a huge role in pushing vaccine misinformation and scaring parents away from vaccinating and protecting their kids.

“The media created the MMR hoax, and they maintained it diligently for 10 years.”

Dr. Ben Goldacre Bad Science

Even before Andy Wakefield and his MMR hoax, the media helped fuel pertussis outbreaks by pushing the flawed research of John Wilson, which led to lawsuits against DPT vaccines and a big drop in vaccination rates.

None of it was true and the lawsuits failed, but the consequence was still that many unvaccinated kids died.

Bob Sears appeared on Fox & Friends in 2010 for the segment "Vaccines: A Bad Combination?"
Bob Sears appearing on Fox & Friends in 2010 for the segment “Vaccines: A Bad Combination?” is a great example of false balance.

Many others in the media have done a great job in promoting myths and fake controversies about vaccines and have used false balance in their interviews and articles to scare parents.

Fortunately, things have gotten better over the years.

Important Points for Reporting About Vaccines

Still, despite what some folks might think, health journalists aren’t going to get in trouble for reporting about vaccines.

They are going to hear about it if they do a bad job though.

“…it is important to recognise that the balance of media reporting does not necessarily reflect the balance of the argument among the involved professionals – by this is meant that equal weighting might be given by the media (and thus the lay community) to those for and against the vaccine although opponents of vaccination might be a very small number, as for example happened with both pertussis and MMR.”

David Baxter on Opposition to Vaccination and Immunisation the UK Experience – from Smallpox to MMR

Remember, the way that health journalists cover vaccines and vaccine-preventable diseases can influence the behavior of people, either helping them understand that vaccines are safe and necessary, putting them on-the-fence about vaccines, or scarring them away from getting vaccinated and protected.

So be careful when reporting about vaccines, as it gives you the opportunity to correct many of myths that scare people, while educating folks about the topic you are covering.

You should also:

Are you ready to cover your next story about vaccines or the next measles outbreak?

What to Know About Reporting on Vaccines

The way that health journalists cover vaccines and vaccine-preventable disease outbreaks can influence the behavior of people, either helping them understand that vaccines are safe and necessary, putting them on-the-fence about vaccines, or scarring them away from getting vaccinated and protected.

More on Reporting about Vaccines

What Are Hypotonic-Hyporesponsive Episodes?

Just about any side effect after a vaccine can be scary for parents.

What if your child suddenly became limp, wasn’t responsive, and was pale?

That would be scary for any parent.

What Are Hypotonic-Hyporesponsive Episodes?

But that’s just what can happen when a child has a hypotonic–hyporesponsive episode (HHE).

“A hypotonic-hyporesponsive episode (HHE) is the sudden onset of hypotonia, hyporesponsiveness, and pallor or cyanosis that occurs within 48 hours after childhood immunizations.”

DuVernoy et al on Hypotonic-hyporesponsive episodes reported to the Vaccine Adverse Event Reporting System (VAERS), 1996-1998

These types of episodes were once thought to happen once for every 1,750 DTP vaccines given.

HHE is much more rare since we switched to a new pertussis vaccine.
HHE is much rarer since we switched to a new pertussis vaccine.

Fortunately, although they certainly do sound scary, the episodes stop on their own and  don’t cause any permanent harm.

Hypotonic-hyporesponsive episodes were even removed as table injuries after DTP back in 1995. It is not that HHE can’t occur after DTP, DTaP, or other vaccines, but rather that HHE doesn’t then cause any permanent neurological damage to the child.

And it is rare for kids to have a second episode, so they can continue to get vaccinated. HHE is not a good reason to skip or delay all of your child’s vaccines. While not a contraindication to getting vaccinated, having an episode of HHE “within 48 hours after receiving a previous dose of DTP/DTaP,” is listed as a precaution to getting another dose of DTaP or Tdap though.

“In general, vaccinations should be deferred when a precaution is present. However, a vaccination might be indicated in the presence of a precaution if the benefit of protection from the vaccine outweighs the risk for an adverse reaction.”

CDC on Vaccine Contraindications and Precautions

Also, HHE has become even more rare since we switched to using DTaP, instead of the older DTP vaccine. So being worried about HHE is definitely not a good reason to skip or delay any vaccines.

What to Know About Hypotonic-Hyporesponsive Episodes

Hypotonic-hyporesponsive episodes were more common after the older DTP vaccines, but still didn’t cause any long term problems and aren’t a good reason to skip or delay your child’s vaccines.

More About Hypotonic-Hyporesponsive Episodes

Antigen Counts in Vaccines

Vaccines contain antigens from toxins, viruses, or bacteria that help your body produce antibodies to help prevent future infections.

Of course, we are all exposed to these types of antigens every day.

In fact, experts state that we are exposed to thousands, if not millions, of antigens each day.

Eating. Drinking. Breathing. Touching things. These every day actions all can introduce antigens from viruses, bacteria, parasites, and toxins, etc., into our bodies.

And even though kids get many more vaccines today, and are protected against many more vaccine-preventable diseases than they once were, they actually get far fewer antigens from those vaccines than they once did.

Newer vaccines have a fraction of the antigens that the older DPT and smallpox vaccines once did.

That’s why the popular “too many too soon” anti-vaccine myth shouldn’t scare you from getting your kids vaccinated and protected.

Vaccine Antigen Counts

If you are still stuck on the actual number of vaccines, it is important to “understand that the numbers of antigens given are actually much less than they used to be. This is because we are giving purer vaccines. Vaccines have been isolated down to just the proteins needed to produce protection.”

The antigens are the things in the vaccines that actually trigger the production of antibodies and include antibody-stimulating proteins and polysaccharides.

In 1960, kids got up to 3,217 different antigens from the smallpox, polio, diphtheria, tetanus and whole cell pertussis vaccine.

In 1980, even as MMR replaced the smallpox vaccine, the antigen count in the vaccines kids got was still up to 3,041.

Kids Today Get Purer Vaccines

Even with many more vaccines, the number of different antigens that children will get with today’s immunization schedule is much lower than just 35 or 55 years ago:

  • DTaP/Tdap – 7 antigens
  • MMR – 24 antigens
  • IPV – 15 antigens
  • Hib – 2 antigens
  • Varicella – 69 antigens
  • Prevnar13 – 14 antigens
  • hepatitis A – 4 antigens
  • hepatitis B – 1 antigens
  • MCV4 – 5 antigens
  • HPV9 – 9 antigens
  • rotavirus – 15 antigens
  • Flu – 12 antigens

That’s just 177 different antigens in 12 vaccines that protect children against 16 vaccine-preventable diseases.

That’s still less than the 200 antigens that were in the smallpox vaccine that kids got 100 years ago.

Even considering that kids get multiple doses of many of these vaccines, with today’s complete vaccine schedule, from birth to age 18, including yearly flu shots, they would get a combined total of just 653 antigens. That’s still much less than a single dose of the DTP vaccine that kids got until 1997, when it was replaced by the DTaP vaccine.

With the 1980 immunization schedule, kids got 5 doses of DTP, 4 doses of OPV, a dose of MMR, and a dose of Td, combining to a grand total of at least 15,096 antigens.

Immune System Response to These Antigens

Of course, this is not to say that kids were exposed to too many antigens in vaccines in the past.

“Current studies do not support the hypothesis that multiple vaccines overwhelm, weaken, or “use up” the immune system. On the contrary, young infants have an enormous capacity to respond to multiple vaccines, as well as to the many other challenges present in the environment. ”

Offit et al on Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System?

Looking at the antigen load of vaccines is simply another way to understand that kids don’t get too many vaccines too soon.

In fact, they get exposed to many more antigens from natural infections. A strep throat infection, for example, exposes kids to at least 25 to 50 antigens. That’s comparable to the antigens in the vaccines that infants get at their two month visit – the DTaP, IPV, HepB, Hib, and rotavirus vaccines combine to just 54 antigens.

But it is not just infections that lead to antigen exposures. Kids are exposed to 2,000 to 6,000 antigens every day and the “vaccines that children receive in the first two years of life are just a drop in the ocean when compared to the tens of thousands of environmental challenges that babies successfully manage every day.”

What to Know About Antigen Counts in Vaccines

Although kids get more vaccines today that their parents and grandparents, they get far fewer antigens from those vaccines.

More About Antigen Counts in Vaccines