Tag: live vaccines

Are More Polio Cases Now Being Caused by the Vaccine Than by Wild Polio Viruses?

Why would people think that more polio cases are now being caused by the vaccine than by wild polio viruses?

More polio cases are now being caused by the vaccine than by wild polio viruses.

Well, it’s true…

Are More Polio Cases Now Being Caused by the Vaccine Than by Wild Polio Viruses?

Wait, what?

“It is no exaggeration to describe it as a crisis. Even worse, looking more widely at the current state of polio eradication, the crisis has three peaks: the first is the level of wild polioviruses in Pakistan; the second is the way that the escalating restrictions in access in Afghanistan have created a huge immunity gap; and the third peak is the widespread occurrence of vaccine-derived polioviruses.”

Independent Monitoring Board 17th Report

Yes, as we are getting close to eradicating polio, we had been seeing fewer and fewer cases of wild polio in the world.

“In rare cases, the live virus in oral polio vaccine can mutate into a form capable of sparking new outbreaks.”

Report raises concern about rare polio cases caused by oral vaccine

And we have been seeing more cases of vaccine-derived polio, which is rarely caused by the oral polio vaccine.

Fortunately, something that most folks miss is that the polio vaccine protects against both wild polio and vaccine-derived polio.

“As recently as 30 years ago, wild poliovirus paralysed more than 350,000 children in more than 125 countries every year. In 2018 there were fewer than 30 reported cases in just two countries – Afghanistan and Pakistan.”

“Zero polio transmission and health for all”, WHO Director-General gives new year’s wish to the people of Afghanistan and Pakistan

And of course, if we weren’t using these polio vaccines, while that would solve the problem of vaccine associated polio, we would simply be seeing lots more wild polio.

More polio cases are now being caused by the vaccine than by wild polio viruses.

Even though cases of wild polio are up this year, after years of decline, they are still tremendously below what they were in the pre-vaccine era.

Remember, we are comparing about 300 cases of wild and vaccine-derived polio that we see today with more than 300,000 of wild polio that we used to see!

“Global efforts to immunise children with the oral polio vaccine (OPV) have reduced wild poliovirus cases by 99.9% since 1988.”

Fact Sheet: Vaccine-Derived Poliovirus

And even those 300 cases of wild and vaccine-derived polio cases can be eliminated if more kids get vaccinated.

“Today, global leaders convened at the Reaching the Last Mile (RLM) Forum in Abu Dhabi to affirm their commitment to eradicate polio and pledge US$2.6 billion as part of the first phase of the funding needed to implement the Global Polio Eradication Initiative’s Polio Endgame Strategy 2019-2023.”

Global leaders pledge US $2.6 billion to eradicate polio at the Reaching the Last Mile forum in Abu Dhabi

And we will get those kids vaccinated.

“Fourthly, rumours and deliberate social media seeding of misinformation about the polio vaccine has had a big impact on refusal rates. Fifthly, organised boycotts of the Polio Programme to gain political concessions have reduced some communities’ acceptance of the polio vaccine.”

Independent Monitoring Board 17th Report

And we will eradicate polio.

More on Polio Eradication

Getting Vaccinated to Protect Those Who Can’t Get the Vaccines

Most people get vaccinated because those vaccines have the direct benefit of reducing their risk of getting a life-threatening vaccine preventable disease. Protecting those who can’t get vaccines is a secondary benefit.

Should you get vaccinated to protect those who can't get the vaccines?
Does rationalizing your decision in anti-vax Facebook groups help you feel better that you are putting kids with cancer at greater risk to get sick?

A secondary benefit that anti-vax folks go to great lengths to convince themselves isn’t real and justify their decision to leave their kids unvaccinated and unprotected..

Getting Vaccinated to Protect Those Who Can’t Get the Vaccines

Of course, none of their explanations really hold water.

None of the vaccines that are routinely used on the CDC immunization schedule are a risk if you are around kids with cancer or other immunodeficiencies, except for FluMist and those with severe issues, like being in a bone marrow transplant unit.

One of the biggest misconceptions though, is that in getting vaccinated, parents are putting their own kids at great risk to protect someone else.

Don't set your kid on fire to keep mine warm!
Don’t set your kid on fire to keep mine warm!

Of course, that’s not true.

Remember, vaccines are safe, with few risks.

That why the analogy of setting their own kids on fire to keep others warm doesn’t make any sense.

After all, unlike vaccinating their own child, setting their child on fire offers them no benefit!

And they should understand that the one and only reason that their kids don’t get more vaccine-preventable diseases in this dog eat dog world is because the vast majority of us vaccinate and protect our kids.

Herd immunity is indeed real. In addition to protecting those who can’t be vaccinated, it protects the free-riders, those who just don’t want to get vaccinated.

What about the idea that it is unrealistic for folks who are immunocompromised to expect that they can lead normal lives and avoid infections?

You can't avoid all risks of infection, but why not avoid those that you can?

While it is true that there are other infections out there besides those that are vaccine-preventable, wouldn’t you want to at least reduce those risks that you can?

But could it be, as much as they seem to believe in shedding, that they think they are being altruistic in not vaccinating their kids?

Anti-vax folks are all about the shedding...
Anti-vax folks are all about the shedding

They aren’t.

In most cases, there are no restrictions on vaccinating people who have contact with those with immune system problems.

What about the idea that vaccines cause cancer?

Vaccines prevent cancer!
Vaccines prevent cancer!

That isn’t true. In fact, there are several vaccines that prevent cancer!

What other misconceptions do they have?

Most of the reasons folks use to avoid vaccines have been refuted a thousand times.
Most of the reasons folks use to avoid vaccines have been refuted a thousand times.

Let’s look at those last few issues…

  • vaccines are not associated with autism
  • vaccines aren’t perfect, but they do work very well
  • vaccines do help those with immune system problems, sometimes directly and more often because of herd immunity
  • people who have cancer are often vaccinated before they have chemo, but that protection gets wiped out during treatment and they can’t get caught up until after they have completed all of their treatments
  • kids with cancer might get some vaccines, but typically don’t get live vaccines

What about the idea that your unvaccinated child isn’t sick, so can’t get anyone else sick?

While that is a very common argument among anti-vax parents, it is very important that if your child is unvaccinated, then they are at much greater risk to catch a vaccine-preventable disease. And since you are often contagious even before you show symptoms, they might unknowingly expose many other people before they even realize that they are sick.

Hopefully you now understand it was never really a question.

That's why you get vaccinated, to protect those who can't get the vaccines!

Vaccinate and protect your kids.

If you don’t, in addition to putting them at risk to get sick, you put everyone around them at risk, including some who are at very high risk for severe complications from vaccine preventable diseases.

More on Risks from Unvaccinated Kids

Who Are the Medically Fragile Children?

As SB 276 becomes law in California, one thing we have been hearing about from some folks is how it will affect medically fragile children.

No one is coming to take the medical exemptions from medically fragile children.
No one is coming to take the medical exemptions from medically fragile children…

Will SB 276 or vaccine laws in other states take away the medical exemptions from medically fragile children?

Of course not!

Who Are the Medically Fragile Children?

The first thing to understand is that when folks like Rob Schneider talk about medically fragile children, they are using the term differently than when medical professionals and most parents do.

“Medically fragile” means having an acute or chronic health problem which requires therapeutic intervention and skilled nursing care during all or part of the day. Medically fragile problems include, but are not limited to, HIV disease, severe lung disease requiring oxygen, severe lung disease requiring ventilator or tracheostomy care, complicated spina bifida, heart disease, malignancy, asthmatic exacerbations, cystic fibrosis exacerbations, neuromuscular disease, encephalopathies, and seizure disorders.

2005 California Health and Safety Code Sections 1760-1761.8 FACILITIES HEALTH AND SAFETY CODE SECTION 1760-1761.8

The medically fragile kids as defined by the California Health and Safety Code, who require skilled nursing care, are not typically the kids who are getting routine medical exemptions.

Sure, some of them might need one. A child with severe HIV disease or a malignancy being treated with chemotherapy would likely get a medical exemption for live vaccines, etc.

A child with an acute encephalopathy or uncontrolled seizures would also qualify for a medical exemption.

And since vaccines aren’t 100% risk free, there might be some kids with a vaccine injury among these medically fragile kids. It is likely not a high number though, as severe reactions to vaccines are very rare.

“CMC {children with medical complexity} are likely increasing in prevalence because of increased survival rates of infants born prematurely, those born with various congenital anomalies, and/or those with chronic conditions, as well as improved treatments for acute illnesses in fields such as intensive care and oncology.”

Cohen et al on Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives

In most other cases, medically fragile kids wouldn’t need a medical exemption and would greatly benefit from being vaccinated and protected!

They would also greatly benefit if everyone around them was vaccinated and protected, especially if they did have a medical exemption.

Again, no one is coming to take their necessary medical exemptions if they have one though.

More on Medically Fragile Children

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 psoriasisdoesn’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