Tag: hierarchy of evidence

Can Vaccines Cause Arthritis?

Many people think that vaccines can cause arthritis.

Vaccines and Arthritis

That’s not surprising, as there are many case reports associating vaccines and arthritis.

Arthritis is even listed as an adverse reaction in the package insert for the MMR vaccine.

While rubella vaccines can cause arthritis, so can a rubella infection.
While rubella vaccines can cause arthritis, so can a rubella infection.

And chronic arthritis is also listed as a table injury for vaccines containing the rubella virus.

Can Vaccines Cause Arthritis?

So that means that vaccines cause arthritis, right?

Actually, no, it doesn’t. At least not the type of arthritis that most people associate with the term arthritis.

Wait, what does that mean?

Vaccines do not cause juvenile arthritis or rheumatoid arthritis, for example.

“Rubella-containing vaccines (e.g. MMR) can cause mild, acute, transient arthralgia or arthritis, rarely in children but very commonly in certain adult women (between 10-25% of adult female vaccinees without preexisting rubella immunity), usually beginning 1-3 weeks after vaccination and then persisting up to 3 weeks. Other vaccines currently routinely recommended to the general population in the U.S. have not been shown to cause chronic arthralgia or arthritis.”

Do Vaccines Cause Arthralgia or Arthritis?

While rubella-containing vaccines can cause arthritis, it is a mild type of arthritis that is usually temporary, lasting about two days.

“Postpubertal females should be informed of the frequent occurrence of generally self-limited arthralgia and/or arthritis beginning 2 to 4 weeks after vaccination.”

MMR-II Package Insert

It is also rare in children.

And it also occurs after a natural rubella infection. In fact, up to 70% of adult women with rubella develop arthralgia or arthritis.

Of course, arthritis isn’t the rubella complication that we worry about…

During the rubella epidemic in the United States just before the rubella vaccine was developed, there were 2,000 cases of encephalitis, 11,250 therapeutic or spontaneous abortions, 2,100 neonatal deaths, and 20,000 babies born with congenital rubella syndrome.

Vaccines for Arthritis

Except for temporary arthritis after the rubella vaccine, not only do vaccines not cause arthritis, it is recommended that people with chronic arthritis get vaccinated.

“Keeping up with your vaccinations is always a smart move, but getting immunized is especially important when you have an autoimmune disease like rheumatoid arthritis (RA). Both RA and the medicines you take to treat it can increase your risk for infections.”

RA & Vaccinations

And one day, we might even have therapeutic vaccines for arthritis!

Rheumavax completed a phase I clinical trial in Australia a few years ago. That led to the development of a new drug, DEN-181, that is now in phase 1 trials.

What to Know About Vaccines Causing Arthritis

Rubella containing vaccines can cause mild, temporary arthritis, but mostly in postpubertal females and less commonly than after a natural rubella infection.

More on Vaccines and Arthritis

More Vaccinated vs Unvaccinated Studies

Anti-vaccine folks continue to call for vaccinated vs unvaccinated studies.

A vaccinated vs unvaccinated study that anti-vaccine folks don't talk about...
A vaccinated vs unvaccinated study that anti-vaccine folks don’t talk about…

Not surprisingly, they ignore all of the studies that have already been done.

More Vaccinated vs Unvaccinated Studies

Listening to these anti-vaccine folks, you would actually think that the only vaccinated vs unvaccinated “study” that has ever been done is the survey about homeschoolers that they always talk about…

That leaves out a lot of other vaccinated vs unvaccinated studies, including:

Do we need even more studies on vaccinated vs unvaccinated children?

We already know that unvaccinated kids get sick more and they have more severe disease. Who is going to approve of or want to do a study that only puts kids at risk to get a vaccine-preventable disease?

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

More on Vaccinated vs Unvaccinated Studies

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 psoriasis – doesn’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

The Dunning-Kruger Awards

Bob Sears posted his pic wearing Mickey Mouse ears a month before the big Disneyland measles outbreak...
This was posted a month before the big Disneyland measles outbreak…

Most folks understand, or think they understand, the Dunning-Kruger effect.

“Poor performers—and we are all poor performers at some things—fail to see the flaws in their thinking or the answers they lack.”

We Are All Confident Idiots

Not surprisingly, there are plenty of great examples of the Dunning-Kruger effect among vocal vaccine deniers.

The Dunning-Kruger Awards

But who leads the pack?

Smarter than the entire New York Public Health Department?

I don’t think so…

Yes, Forrest Maready, who came up with the Crooked Face Theory of vaccine injury, now considers himself to be an expert on polio.

Robert F. Kennedy, Jr. thinks that he is cursed with too much knowledge about vaccines…

Kelly Brogan, a holistic psychiatrist, got her case study published in the Advances in Mind-Body Medicine journal. History making? That’s about as history making as her vaccine paper that was published in the journal, Alternative Therapies in Health and Medicine.

Full stop. There is a lot of good information on the Internet, but most folks who say they did their research about vaccines on Google choose “to accept only information that supports his or her position, and ignores or dismisses information in conflict with it.”

Will Jim Meehan ever understand vaccines better?

Will anyone that listens to these folks?

Don't let Goop's mistake become your mistake.

Gwyneth Paltrow and Goop made one mistake – thinking that they could give health advice.

The creator of the PEACH anti-vaccine safety manual that has been distributed in Orthodox Jewish communities spent years gathering anti-vaccine propaganda...
The creator of the PEACH anti-vaccine safety manual that has been distributed in Orthodox Jewish communities spent years gathering anti-vaccine propaganda…

While the average pediatrician doesn’t actively investigate vaccine safety, do you know who does? Real scientists and researchers…

Whether they put all of the anti-vaccine propaganda they gather into a binder or a vaccine guide on the Internet, these folks are simply misinformed about vaccines.

Don’t look to them to help get you educated about vaccines.

Dunning Kruger Awards