Tag: HHE

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

 

Pertussis Outbreaks

Like measles and mumps, pertussis, or whooping cough, is another vaccine-preventable disease that has been increasing in recent years.

Pre-Vaccine Era Pertussis Outbreaks

Pertussis has been known since at least the Middle Ages, although the bacteria that causes pertussis, Bordetella pertussis, wasn’t discovered until 1906.

Like measles, pertussis was a top killer of young children in the pre-vaccine era.
Like measles, pertussis was a top killer of young children in the pre-vaccine era.

That discovery led to the later development of the first pertussis vaccines, but before then, pertussis was a big killer, with epidemic cycles every 2 to 5 years.

During one of these cycles in the United States, from 1926 to 1930, there were:

  • 909,705 cases, and
  • 36,013 deaths

Unfortunately, even natural infection doesn’t provide life-long immunity, so adults would get pertussis and give it to susceptible kids, who were most likely to die during these epidemics.

But even in non-epidemic years, a lot of folks got pertussis. The number of reported cases ranged from “just” 161,799 in 1928 to 202,210 in 1926. And during one of the biggest years, 1934, there were 265,269 cases!

Post-Vaccine Era Pertussis Outbreaks

That changed in the vaccine era.

The first pertussis vaccines were developed in the 1930s and became more widely used in the 1940s when it was combined into the whole-cell DTP vaccine.

This was replaced with the acellular DTaP vaccine in 1997, with the Tdap vaccine being added to the vaccine schedule in 2006.

These vaccines helped to greatly reduce how many people got pertussis and how many people died from pertussis:

  • 1940 – 183,866 cases
  • 1950 – 120,718 cases and 1, 118 deaths
  • 1960 – 14,809 cases and 118 deaths
  • 1970 – 4,249 cases and 12 deaths
  • 1980 – 1,730 cases and 11 deaths
  • 1990 – 4,570 cases and 12 deaths
  • 2000 – 7,867 cases and 12 deaths
  • 2010 – 27,550 cases and 26 deaths

They never eradicated pertussis though, and as you can see, recently, pertussis cases have started to rise again.

Is it a coincidence that whooping cough came back as more folks began to skip and delay vaccines for their kids?
Is it a coincidence that whooping cough came back as more folks began to skip and delay vaccines for their kids?

In 2012, there were 48,277 cases of pertussis in the United States, the most since 1950, when we had 68,687 cases. Unfortunately, with the rise in cases, we are also seeing the tragic consequences of this disease – 20 deaths in 2012, mostly infants under age 3 months.

Pertussis cases remained steady, but high, in 2013 and 2014, at around 30,000 cases in the United States.

In California, pertussis reached epidemic levels. The California Department of Public Health reported at least 11,114 cases in 2014 – the highest numbers of pertussis cases in the state in 70 years!

And as expected with the rise in cases, there were 3 pertussis related deaths in California that year – all infants who had contracted pertussis when they were less than 8 weeks old. Two of the infants became sick in 2013, but the third, a 5-week-old baby, got infected in 2014.

Another baby, only 25 days old died in early 2015, but will be counted as the 2nd death of 2014 since that is when the illness started. About 383 patients, mostly infants who are less than 4 months old, were hospitalized in California that year, including 80 who required intensive care. And according to the California Department of Public Health, about 82% of the cases in infants were born to mothers who did not receive a dose of Tdap during their third trimester of pregnancy.

What’s happened since then?

Pertussis cases are continuing to fall each year! In fact, with about 16,000 cases in the United States, 2017 may have ended with the lowest number of pertussis cases since 2008.

Still, with just 1,830 pertussis cases in California in 2016, there were two deaths – both infants who were younger than 3 months of age when they got sick. And there was at least one death in 2017, with similar rates of disease, although reports are still preliminary.

Why So Many Pertussis Outbreaks?

Ever since a 2010 California pertussis outbreak, in which there were 9,154 cases of pertussis, the most in 63 years, and 10 infants died, many people, especially parents, began wondering why we were seeing more pertussis these days.

Is it because the pertussis vaccines simply don’t work, as the anti-vaccine movement would have you think?

Or is it because there are higher rates of unvaccinated kids these days and parents using alternative immunization schedules, instead of the standard immunization schedule from the CDC?

James Cherry, MD is an expert on pertussis and pertussis vaccines.
James Cherry, MD is an expert on pertussis and pertussis vaccines.

A commentary, Why Do Pertussis Vaccines Fail?, by James Cherry, MD, gave us some answers.

While the title of the article might have you think that all of the blame lies with the pertussis vaccines, that certainly isn’t the case. While there can be vaccine failures with the pertussis vaccines, just like any other vaccine, that doesn’t mean that the vaccine doesn’t work for most children.

One of the problems is that the DTaP vaccine likely isn’t as effective as the older DTP vaccine. So instead of efficacy of 84 to 85%, as was once believed, it is likely closer to just 71 to 78%.

Other issues, including waning immunity, the possibility of an incorrect balance of antigens in the vaccine that could create a blocking effect, and genetic changes in the B. pertussis bacteria, could also possibly lead to increased vaccine failure rates.

So it isn’t that the pertussis vaccines don’t work.

That should be easy to see when you look at the pertussis rates in California, when the highest rates by far were in infants less than 6 months of age (434 per 100,000 people). In contrast, children who were 6 months to 6 years old had a rate of only 62 per 100,000.

And the results of a study that were presented at the 49th annual meeting of the Infectious Diseases Society of America in Boston show just how important the pertussis vaccine is, as:

  • vaccine effectiveness was 98.1 percent among children who received their 5th dose within the past year
  • long term effectiveness – children who were five or more years past their last DTaP dose – was about 71 percent
  • children who had never received any doses of DTaP (unvaccinated children) faced odds of having whooping cough at least eight times higher than children who received all five doses

It is also important to note that the high rates seen in 2010 in California are still well below the rates that were seen in the pre-vaccination era, when the attack rate of pertussis in the United States was as high as 157 per 100,000 people, with about 200,000 cases a year.

What’s the answer?

“The present “resurgence of pertussis” is mainly due to greater awareness and the use of PCR for diagnosis. There are also many other factors which have contributed to the “resurgence.” New vaccines are clearly needed; with our present vaccines (DTaP and adolescent and adult formulated tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap)), if used correctly, severe pertussis and deaths in infants can be prevented.”

James D. Cherry, MD on The History of Pertussis (Whooping Cough); 1906 – 2015: Facts, Myths, and Misconceptions

It certainly isn’t for more kids to follow non-standard, parent-selected, delayed protection vaccine schedules or to simply skip vaccines all together. Since natural immunity isn’t going to keep newborns and infants from getting pertussis, the ages which are most at risk for life-threatening infections, they can catch pertussis from people around them, including those working on their natural immunity. Natural infections don’t even provide life-long protection against pertussis, as some people believe. That natural immunity wanes fairly quickly too.

Not Vaccinated? No Kisses!
Not Vaccinated? No Kisses!

The future of pertussis control is more likely going to be in maximizing our current vaccination program, including getting more teens and adults to get the Tdap vaccine, especially when women are pregnant.

That’s the best strategy, at least until new pertussis vaccines are developed. It provides a lot of benefits. According to the CDC, like with the flu vaccine, when you get a pertussis vaccine, in addition to protecting yourself and those people around you, “people who do catch whooping cough after being vaccinated are much less likely to be hospitalized or die from the disease.”

Unfortunately, not everyone has gotten the message. And because of waning immunity, children who aren’t vaccinated against pertussis can’t “hide in the herd” and rely on the rest of us who do vaccinate our children to provide them with protection. Instead, since they are at a higher risk, they get pertussis and get even more people sick.

This slogan, during a whooping cough epidemic, reminded parents to get their kids vaccinated now.
This slogan, during a whooping cough epidemic, reminded parents to get their kids vaccinated now.

In one study, Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children, researchers found that “vaccine refusers had a 23-fold increased risk for pertussis when compared with vaccine acceptors, and 11% of pertussis cases in the entire study population were attributed to vaccine refusal.” The highly contagious nature of pertussis then means every primary case is probably going to infect as many as 17 other people. That’s why it makes sense that higher rates of children using vaccine exemptions could be at least one of the factors in these outbreaks.

In fact, several studies, including, Geographic Clustering of Nonmedical Exemptions to School Immunization Requirements and Associations With Geographic Clustering of Pertussis, found that “geographic pockets of vaccine refusal are associated with the risk of pertussis outbreaks in the whole community.”

Get educated. Vaccines are safe and as you can see with the rise in outbreaks, vaccines are necessary.

What to Know About Pertussis Outbreaks

Many factors are responsible for the rise in pertussis outbreaks in recent years, but it is clear that being unvaccinated and unprotected put you at greatest risk for getting pertussis and passing it on to others.

More on Pertussis Outbreaks

Precautions vs Contraindications When Vaccinating Your Kids

Believe it or not, there are some anti-vaccine folks who believe that all vaccines are dangerous and unnecessary. And they believe that pediatricians push vaccines on kids in all situations, using a one-size-fits-all kind of immunization schedule.

Of course, neither is true.

Vaccines are safe and necessary.

There are some true medical contraindications and precautions to getting vaccinated though. Still, it is important to remember that even more things are simply “conditions incorrectly perceived as contraindications to vaccination.”

Contraindications To Vaccinating Your Kids

There are actually some good reasons to delay or skip one or a few of your child’s vaccines, but only in some very specific situations.

These very specific situations are called contraindications and are what count as medical exemptions.

“A vaccine should not be administered when a contraindication is present; for example, MMR vaccine should not be administered to severely immunocompromised persons.”

CDC on Vaccine Contraindications and Precautions

Fortunately, there are not that many of these contraindications, they are usually specific to just one or a few vaccines, and they are usually, but not always, temporary.

That’s why it would be really unusual to get a true permanent medical exemption for all vaccines. Even if you had a severe allergy to a vaccine that contained yeast, latex, or gelatin, since vaccines contain different ingredients, you would very likely be able to safely get the others.

Remember, your doctor can’t, or at least shouldn’t, just make up contraindications and exemptions to help you avoid getting your kids vaccinated and help you keep them in school.

“I do not believe vaccines had anything to do with my child’s autism. I never noticed any change in his speech, behavior or development with vaccines. I believe the protection and benefits of vaccines far outweigh the risks!”

Michele Han, MD, FAAP

Autism, for example, has been shown to not be associated with vaccines, so it is not a contraindication to getting vaccinated. That’s why many parents vaccinate and protect their autistic kids!

Precautions To Vaccinating Your Kids

In addition to contraindications to getting vaccinated, there is an accompanying list of  precautions.

“A precaution is a condition in a recipient that might increase the risk for a serious adverse reaction, might cause diagnostic confusion, or might compromise the ability of the vaccine to produce immunity (e.g., administering measles vaccine to a person with passive immunity to measles from a blood transfusion administered up to 7 months prior). A person might experience a more severe reaction to the vaccine than would have otherwise been expected; however, the risk for this happening is less than the risk expected with a contraindication. 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

Again, we are fortunate that most of the conditions that are listed as precautions are temporary.

The vaccine information sheet that you get with each vaccine will list contraindications and precautions on who should not get the vaccine.
The vaccine information sheet that you get with each vaccine will list contraindications and precautions on who should not get the vaccine.

In fact, the most common is having a “moderate or severe acute illness with or without fever.”

Don’t want to get your child vaccinated when he or she has a severe illness?

Don’t worry.

Your pediatrician usually doesn’t want to vaccinate your child in that situation either.

It is easy enough to wait a few days or a week to get vaccinated, when the illness has passed, keeping in mind that a “mild acute illness with or without fever” is neither a precaution nor a contraindication to getting vaccinated. So you can still get your child their recommended vaccines if they just have a cold, stomach bug, or ear infection, etc.

What to Know About Precautions and Contraindications to Vaccines

Although there are some true medical exemptions or contraindications and precautions to getting vaccinated, most are vaccine specific and many are temporary, so they shouldn’t keep you from getting your child at least mostly vaccinated and protected.

More on Precautions and Contraindications to 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