Tag: hierarchy of evidence

Dr. Baker Says to Stop Worrying About Measles!

Are you worried about measles?

Are you less worried because a chiropracter on the Internet told you to stop worrying?

Dr. Baker Says to Stop Worrying About Measles!

I have no idea who “Dr” Baker really is, but let’s take a look at his copypasta “evidence” for why you shouldn’t worry about measles.

What’s missing from his list?

All of the studies that say that vaccines aren’t associated with autism!

The study, Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality, which found that measles had an affect on non-measles deaths (causing more of them) through “measles-induced immune damage.”

And lots of other evidence that says that the MMR vaccine is safe, effective, and necessary.

If you really don’t want to have to worry about measles, get your kids vaccinated and protected.

Unfortunately, some folks don’t have that option, as their kids might be too young to get vaccinated or might have a true medical contraindication to getting vaccinated.

They have to worry about measles, no matter what “Dr.” Baker says, mostly because of your unvaccinated kids…

More on Worrying about Measles

Does Getting a Flu Vaccine Increase Your Risk of Spreading the Flu or Getting Others Sick?

Have you heard the latest flu vaccine bombshell from anti-vaccine folks?

Like all other anti-vaccine bombshells, this one is a dud.
Like all other anti-vaccine bombshells, this one is a dud.

They think that they have evidence that flu vaccines spread the flu.

Does Getting a Flu Vaccine Increase Your Risk of Spreading the Flu or Getting Others Sick?

The latest anti-vaccine bombshell comes from Mike Adams, the Health Ranger, and is posted among a bunch of other articles that will have you scratching your head.

Did you know that Amazon’s Alexa is a ‘demon device,’ Apple is banning Christian apps in a war on Christianity, and that CHAOS is coming in the new year?

Not surprisingly, the “latest” anti-vaccine bombshell was a dud, even though it continues to be shared on the majority of anti-vaccine websites and Facebook groups.

What’s the problem?

Anti-vaccine folks are simply misinterpreting a small study, Infectious virus in exhaled breath of symptomatic seasonal influenza cases from a college community, from the Proceedings of the National Academy of Sciences.

Of course, that the study wasn’t a great anti-vaccine bombshell is easy to see if you actually read it.

Although the study did find an association between vaccination and greater fine-aerosol shedding for influenza A infections, if the flu vaccine really increases your risk for spreading the flu, then:

  • why wasn’t getting a flu vaccine associated with coarse-aerosol or nasopharyngeal shedding?
  • why wasn’t the association of vaccination and shedding significant for influenza B infections?

The answer is that because it was a small study, the finding about vaccination and shedding likely wasn’t really significant.

It wasn’t even what they were looking at in the study, which was instead trying to prove that you don’t have to cough and sneeze to spread the flu – simply breathing can spread infectious flu particles.

“Unvaccinated people are more likely to get the flu and transmit it to other people because they shed lots of virus into the nasal secretions into the air.”

Donald K. Milton

And as the authors of the study clarified, folks who aren’t sick because they got vaccinated and didn’t get the flu won’t shed and won’t get anyone else sick.

If anything, the study confirms just how hard it is to avoid folks sick with the flu and why everyone should get a flu vaccine each year.

And how hard it is to avoid anti-vaccine misinformation

After all, anti-vaccine folks could have done a little digging and found that a previous study about influenza virus aerosols, Exposure to Influenza Virus Aerosols During Routine Patient Care, didn’t find a statistically significant difference among folks who got a flu vaccine and how much flu virus they shed (emitters vs non-emitters). In fact, they found that a small percentage of these patients were superemitters, who “exceeded average influenza virus aerosol concentrations by multiple times.”

What’s that mean?

It’s just another reason to get vaccinated and protected. While you don’t want to be exposed to a superemitter and get the flu, you also don’t want to get the flu and become a superemitter, getting lots of other people sick.

More on Does Getting a Flu Vaccine Increase Your Risk of Spreading the Flu or Getting Others Sick?

Do Vaccines Cause Bell’s Palsy?

We don’t usually know what causes Bell’s Palsy, so that makes it a perfect candidate for some people to think it’s a vaccine injury.

Mercola cites a study that looked at VAERS reports, so none of the cases were verified to see if they were actually caused by a vaccine. And he fails to mention all of the real studies that found no association between vaccines and Bell's Palsy!
Mercola cites a study that looked at VAERS reports, so none of the cases were verified to see if they were actually caused by a vaccine. And he fails to mention all of the real studies that found no association between vaccines and Bell’s Palsy!

And for anti-vaccine folks to use in their propaganda to scare you away from vaccinating and protecting your kids.

What Causes Bell’s Palsy?

Although we may not always know what causes it, Bell’s Palsy is fairly easy to diagnose.

“Bell’s palsy is a nerve problem that affects the muscles of your face. It causes weakness or partial paralysis of the muscles on one side of your face. With Bell’s palsy, your eyelid may not close properly and your smile may seem uneven.”

What Is Bell’s Palsy?

So what causes it?

“Bell’s palsy occurs when the nerve that controls the facial muscles is swollen, inflamed, or compressed, resulting in facial weakness or paralysis. Exactly what causes this damage, however, is unknown.”

Bell’s Palsy Fact Sheet

Most experts think that Bell’s Palsy is caused by a viral infection, which leads to swelling and inflammation of the facial nerve. That’s likely why steroids and antiviral medications, like acyclovir, are often helpful treatments.

“The prognosis for individuals with Bell’s palsy is generally very good. The extent of nerve damage determines the extent of recovery. Improvement is gradual and recovery times vary. With or without treatment, most individuals begin to get better within 2 weeks after the initial onset of symptoms and most recover completely, returning to normal function within 3 to 6 months.”

Bell’s Palsy Fact Sheet

Fortunately, most people with Bell’s Palsy, which mainly affects adults, get better.

Do Vaccines Cause Bell’s Palsy?

Bell’s Palsy was first described by Sir Charles Bell in 1821.

There are reported cases before that though, with the earliest by Cornelis Stalpart van der Wiel (1620-1702) from The Hague, The Netherlands in 1683.

And no, we didn’t have any vaccines in 1683.

That’s not to say that vaccines couldn’t cause Bell’s Palsy.

One vaccine, an inactivated intranasal influenza vaccine that was only used in Switzerland during the 2000-01 flu season, was associated with an increased risk of Bell’s Palsy.

Why? It was likely because of the enzymatically active Escherichia coli Heat Labile Toxin (LT) adjuvant that was used in the vaccine, which is not something you find in any of the vaccines we now use.

While you might find an occasional case report about a vaccine and Bell’s Palsy, remember that a case report published about one patient isn’t strong evidence that it wasn’t a coincidence.

It should be reassuring to everyone that plenty of studies have been done confirming that other vaccines we use do not cause Bell’s Palsy. And even in the case of that flu vaccine, the association was quickly discovered and the vaccine was discontinued.

In fact, since vaccines, especially the chicken pox vaccine and Tdap, can prevent infections that actually cause Bell’s Palsy, if you are worried about Bell’s Palsy, get vaccinated!

More on Bell’s Palsy?

Diagnosing Vaccine Injuries

Vaccines are often described as one of the greatest public health achievements of the 20th century.

That great benefit also leaves no doubt for most people that getting vaccinated and fully protected far outweighs the very small risks that vaccines might have.

Vaccine Injuries vs Vaccine Side Effects

Vaccines can certainly have side effects.

Fever, pain at the injection site, and redness and swelling where the shot was given are all common, mild problems that can be associated with almost any vaccine.

Some vaccines might also commonly cause fussiness, tiredness or poor appetite, and vomiting within 1 to 3 days of getting the vaccine. Others can cause a rash, headache, or muscle and joint pain for a few days.

Even syncope or fainting can commonly occur within 15 minutes of teens getting a vaccine.

Other vaccine side effects can include persistent crying, nodules at the injection site, limb swelling, and febrile seizures, etc.

These are well known vaccine side effects that are often minor and temporary though.

Is It a Vaccine Injury?

Although the term is typically associated with the anti-vaccine movement, as they tend to think everything is a vaccine injury, it is important to understand that vaccine injuries, although rare, are indeed real.

After all, vaccines are not 100% safe.

In addition to the milder side effects listed above, vaccines can very rarely cause more serious types of adverse events or injuries, including:

  • life threatening allergic reactions
  • brachial neuritis (shoulder pain and then weakness) following a tetanus containing vaccine
  • encephalopathy/encephalitis following a measles, mumps, or rubella, or pertussis containing vaccine
  • chronic arthritis following a rubella containing vaccine
  • thrombocytopenic purpura (ITP) following a measles containing vaccine
  • vaccine-strain measles viral infection in an immunodeficient recipient following a measles containing vaccine
  • intussusception – following a rotavirus vaccine
  • shoulder injury related to vaccine administration – SIRVA

Keep in mind that some of these are just table injuries and are not necessarily proven as being caused by vaccines.

And while vaccines are associated with some serious adverse events, the research is clear that vaccines are not associated with autism, SIDS, and shaken baby syndrome, type 1 diabetes, multiple sclerosis, inflammatory bowel disease, or other so-called vaccine induced diseases.

Or Is It Just a Coincidence?

Dr. Samuel Johnson once said that “It is incident to physicians, I am afraid, beyond all other men, to mistake subsequence for consequence.”

How does this apply to diagnosing vaccine injuries?

Too often we forget that just because one event is subsequent (happens after) another, it does not mean that it was a consequence (was caused by) the first event. It is another way of saying that correlation does not imply causation.

This is also highlighted by missed vaccine stories, events that would surely be blamed on a vaccine injury, except that a vaccine was never actually given for one reason or another.

Most pediatricians have these types of missed vaccine stories, such as:

  • an infant who begins vomiting on the way home from a well appointment and is diagnosed with intussusception (9 month old visit and didn’t get any vaccines)
  • a 4 year old who developed encephalitis just one week after his well check up (no vaccines – DTP had been deferred to his 5 year old visit)
  • a 2 month old who died of SIDS on the night of his scheduled well child visit (no vaccines as they had forgotten to go to the appointment)
  • a 4 month old who had a seizure at his well child visit (no vaccines were given yet as they were still being drawn up)

Or they have kids who begin to have symptoms or are diagnosed with a condition right around the time of a check up when they would routinely get one or more vaccines, but haven’t yet. From diabetes and POTS to transverse myelitis, some parents would have blamed their child’s vaccines if they had actually been vaccinated at that time and subsequently got diagnosed.

My own son started getting migraines when he was 12 years old and about to start 7th grade. Should I blame his headaches on his middle school booster shots? While it would be convenient, it is more likely that genetics are to blame. I started getting migraines at about the same age, and he began getting them just before he got his booster shots.

Diagnosing Vaccine Injuries

How do you know if your child had a true vaccine injury?

Does the reaction fit into the vaccine injury type AND “time period for first symptom or manifestation of onset or of significant aggravation after vaccine administration” as described in the NVICP vaccine injury tables?

That time period, also known as a risk interval, is when “individuals are considered at risk for the development of a certain adverse event following immunization (AEFI) potentially caused by the vaccine.”

For example, did your child develop an anaphylactic reaction within four hours of getting the DTaP vaccine? While a reaction 14 hours after the vaccine would be much less likely to be caused by the vaccine, if it occurred within 4 hours, that could certainly be a vaccine injury.

How about a child who developed thrombocytopenic purpura 90 days after getting his MMR vaccine? That is unlikely to be a vaccine injury, as the MMR vaccine typically causes TTP within 7 to 30 days.

If you think that your child has had a vaccine injury, be sure to talk to your pediatrician. You should also report any vaccine reaction to Vaccine Adverse Event Reporting System (VAERS) and if you truly believe that your child has been injured by a vaccine, you can file a claim with the National Vaccine Injury Compensation Program (VICP).

“You may file a claim if you received a vaccine covered by the VICP and believe that you have been injured by this vaccine.”

What You Need to Know About the National Vaccine Injury Compensation Program (VICP)

How will your pediatrician figure out if it is a vaccine injury? Among the things that they will consider when evaluating a reaction after a vaccine will be the answers to some key questions, including:

  • Is there any evidence that something else caused the reaction? While getting a vaccine could cause an anaphylactic reaction, so could the fact that your child just eat a peanut butter and jelly sandwich.
  • Is there a known causal association between the reaction and the vaccine?
  • Is there strong evidence against a causal association between the reaction and the vaccine?
  • Is there a laboratory test that implicates the vaccine as a cause of the reaction?
  • If the reaction is an infection, did it have a vaccine or wild type origin?

Your pediatrician will also consider other factors when making a decision, including whether other patients were affected (might implicate a contaminated vaccine), and will make sure that the original diagnosis is correct.

Being able to answer all of these questions often puts pediatricians in the unique position of correctly evaluating potential vaccine injuries. There is even a standardized algorithm that can help your pediatrician collect and interpret all of the data they will get when evaluating a possible vaccine injury.

Another algorithm can help evaluate and manage suspected allergic reactions, including immediate or type 1 hypersensitivity reactions and delayed type 3 hypersensitivity reactions. If the reaction is consistent with an allergic reaction and additional doses of the vaccine are still needed, possible next steps in this algorithm include serologic testing for immunity and skin testing with the vaccine or vaccine components.

For extra help, your pediatrician can consult an allergist or immunologist before considering giving your child another vaccine, if necessary. Experts at the Clinical Immunization Safety Assessment (CISA) are also available for consults about suspected vaccine injuries.

Over-Diagnosing Vaccine Injuries

In addition to vaccine side effects and vaccine injuries, it is much more common for children and adults to develop health problems and symptoms after getting a vaccine that have nothing to do with the vaccine. These are events, sometimes tragic, that would have happened even if they had not been vaccinated.

Anytime we see a post about vaccines and SIDS, we know what happened, an anti-vaccine Facebook group is taking advantage of a grieving family.
Anytime we see a post about vaccines and SIDS, we know what happened, an anti-vaccine Facebook group is taking advantage of a grieving family.

Despite the evidence against it, some parents may still think that their child has been injured or damaged by a vaccine, especially if they:

  • believe all of the vaccine injury stories they hear on the Internet
  • misuse vaccine package inserts
  • believe that VAERS reports have all been confirmed to be true
  • think that vaccine injuries can occur months or years after getting a vaccine
  • find a case report in PubMed and think that is convincing evidence of causality, even though it is really nothing more than a glorified anecdote
  • have found their way into a Facebook group where folks think vaccines always injure kids
  • go to a homeopath, chiropractor, or holistic practitioner who told them the child was injured

For example, studies have repeatedly shown that “vaccination does not increase the overall risk of sudden infant death (SIDS),” and that “the risk of SIDS in vaccinated cases and controls is neither increased nor reduced during the early post-vaccination period.”

What should you do if you really think that your child has a vaccine injury?
Just what a parent needs when their baby dies of SIDS, someone to reach out and tell them it was because they had him vaccinated… 

So a VAERS report of SIDS on the night that an infant received his 4 month vaccines, while tragic, would likely not end up being classified as a true vaccine injury.

Neither should a case report or package insert about SIDS influence your thinking about SIDS being associated with a vaccine injury.

Still, it is easy to understand why many like to blame vaccines.

Vaccines are an easy target, especially as most vaccine-preventable diseases are under fairly good control compared to the pre-vaccine era. And in some cases of SIDS, a new case of diabetes, or the sudden death of an older child, etc., it may happen soon after the child was vaccinated, and that correlation is hard to ignore for some folks.

At least it is hard to ignore and easy to be influenced by anti-vaccine folks if you don’t understand the background rate of these diseases – or the fact that a certain number of children will be affected no matter what, and because many kids get vaccinated, it is only a matter of chance that the two get correlated together. 

Vaccines are safe.

They don’t typically cause serious vaccine injuries.

If you do think that your child has a vaccine injury, talk to your pediatrician. Don’t get diagnosed in a Facebook forum…

More on Diagnosing Vaccine Injuries

Do Vaccines Cause Strabismus?

Vaccines can do a lot of things.

They can prevent you from getting a life-threatening disease, sometimes even after you have been exposed. And if you do get sick when vaccinated, the vaccine can often help to make sure the disease isn’t as severe as it might have been if you were unvaccinated. They can also keep you from getting sick and exposing others, including those who are at extra risk for severe disease.

Vaccines also get blamed for doing a lot of other things, namely for causing vaccine injuries.

These types of vaccine injury stories often scare other parents away from vaccinating and protecting their kids.
These types of vaccine injury stories often scare other parents away from vaccinating and protecting their kids.

While, of course, vaccines aren’t risk free, they don’t actually cause most of the bad things you read about on the Internet.

What Causes Strabismus?

Strabismus isn’t a disease. It is simply a term that describes a misalignment of your child’s eyes.

“At birth, an infant’s eyes cannot always focus directly on objects. They may appear to move quite independently at first, sometimes crossing, and sometimes wandering outward. But by the age of three to four months, an infant’s eyes should have the ability to focus on small objects and the eyes should be straight or parallel. A six-month-old infant should be able to focus on both distant and near objects.”

Prevent Blindness America on Is Strabismus Present at Birth?

To be more specific, children with strabismus can have:

  • esotropia – the eye turns inward
  • exotropia – the eye turns outward
  • hyertropia – the eye turns upward
  • hypotropia – the eye turns downward

And we get especially concerned when strabismus leads to amblyopia – decreased vision in the affected eye.

Some specific things that cause strabismus include:

  • third nerve (III) palsy
  • fourth nerve (IV) palsy – superior oblique muscle
  • sixth nerve (VI) palsy – lateral rectus muscle
  • Brown syndrome
  • Duane syndrome

Often, we don’t know why kids have strabismus, although it is thought that at least 50% of them are born with it, even if it isn’t recognized until they are older.

“Most strabismus is the result of an abnormality of the neuromuscular (including brain) control of eye movement. Our understanding of these control centers in the brain remains incomplete. Less commonly, a problem with the actual eye muscle may cause strabismus.”

AAPOS on What causes strabismus?

Kids with cerebral palsy, Down syndrome, hydrocephalus, and brain tumors are thought to be at higher risk for developing strabismus.

Do Vaccines Cause Strabismus?

And because we don’t always know what causes strabismus, that leads some folks to want to blame vaccines.

Interestingly, one study, Prevalence of Amblyopia and Strabismus in White and African-American Children Aged 6 through 71 Months: The Baltimore Pediatric Eye Disease Study, found that strabismus was rare in infants and that while higher in older kids, “there was no clear trend for increasing or decreasing prevalence after age 12 months.”

If strabismus was caused by vaccines, wouldn’t you expect to see more infants with strabismus and a consistent rise in cases as kids continued to get vaccines until they go to kindergarten?

Do any studies support the idea that vaccines do cause strabismus?

No.

There are a few case reports, but it is important to remember that a case report is basically a gloried anecdote. It is not the kind of high quality evidence you really want if you are trying to make a case trying to prove causality.

The biggest evidence against vaccines causing strabismus?

Strabismus isn’t new.

The first cases were reported over 3500 years ago and the first surgical repairs were being done in the early 19th Century.

So why do some folks think that strabismus is a vaccine injury? Mostly it is because some folks think that everything is a vaccine injury.

More on Strabismus


Do Vaccines Cause HSP?

Have you ever heard of HSP?

Children with Henoch-Schonlein purpura (HSP) typically have a purplish rash (purpura), joint pain and swelling (arthritis), and severe stomach pains. They can also have blood in their urine (hematuria).

Palpable purpura in a toddler with HSP, likely after a Mycoplasma pneumoniae infection.
Palpable purpura in a toddler with HSP, likely after a Mycoplasma pneumoniae infection. (CC BY-NC-SA 4.0)

While those can all be very scary symptoms, fortunately, they typically go away without any treatment.

What Causes HSP?

HSP, also known as IgA Vasculitis, is an autoimmune reaction.

“Henoch-Schönlein purpura is caused by an abnormal immune system response in which the body’s immune system attacks the body’s own cells and organs.”

What is Henoch-Schönlein purpura (HSP)?

We don’t know why some kids have this abnormal immune reaction.

We do know that it most commonly occurs after a viral upper respiratory tract infection, although other infections, including chickenpox, measles, and hepatitis, can also trigger HSP.

Do Vaccines Cause HSP?

HSP has been associated with almost anything, from medications and foods, to insect bites and exposure to cold weather, so it is not surprising that some folks would think that vaccines could be a trigger too.

There are even some case reports of children developing HSP after receiving a vaccine. It is important to remember that a case report is basically a gloried anecdote though. It is not the kind of high quality evidence you really want if you are trying to make a case trying to prove causality.

One small study did suggest an increased risk following the MMR vaccine, but it only looked at hospitalized children with HSP. And of 288 hospitalized children with HSP, only eight had received a recent vaccine.

A more robust study, Vaccination and Risk of Childhood IgA Vasculitis, recently found that common childhood vaccines did not significantly increase the risk of HSP.

What to Know About Vaccines and HSP

Since some vaccine-preventable diseases can cause Henoch-Schönlein purpura, there is no evidence that vaccines can cause HSP beyond isolated case reports, and the most recent evidence shows that vaccines do not cause HSP, parents should vaccinate their kids, even if they have had a previous episode of HSP.

More on Vaccines and HSP

The BMJ Asks If Injections Are Part of the “Mystery” of Acute Flaccid Myelitis/AFM…

Yes, the BMJ, formally the British Medical Journal, just published a piece, Are injections part of the “mystery” of acute flaccid myelitis/AFM? Is the CDC interested in finding out?

Those familiar with the BMJ understand that this is not a real editorial or article though.

It is one of their Rapid responses to another article – basically a letter to the editor. Unfortunately, some folks use these Rapid responses as evidence for their anti-vaccine talking points and arguments.

The BMJ Asks If Injections Are Part of the “Mystery” of Acute Flaccid Myelitis/AFM…

We know vaccines are not associated with AFM.

It is no mystery that AFM isn’t associated with vaccines – experts review patient vaccination records.
It is no mystery that AFM isn’t associated with vaccines – experts review patient vaccination records.

The AFM patient summary form asks for a vaccination record and current studies have found no association with recent vaccines.

“They also say that they are continuing to investigate the possibility of an association, but the AFM Patient Summary Forms that they supply to US state health departments contain no questions about injections or vaccinations.”

Allan S. Cunningham on Are injections part of the “mystery” of acute flaccid myelitis/AFM? Is the CDC interested in finding out?

We know that vaccines are not associated with AFM.

“According to patients’ vaccination records, all but one had been vaccinated according to Advisory Committee on Immunization Practices recommendations. The median interval between receipt of the last vaccination and onset of neurologic symptoms was 1.9 years (range = approximately 2 months–7 years).”

Acute Flaccid Myelitis Among Children — Washington, September–November 2016

But it is understandable that some folks are still trying hard to push the idea that vaccines are associated with AFM, as to some of them, everything is a vaccine injury.

What is really baffling though, is why does BMJ give them a platform to spread their wild ideas and misinformation?

More on the BMJ