Tag: passive immunity

Risks and Benefits of Vaccines – Anti-Vax Edition

Anti-vax folks like to say that they are doing their research, even collecting that research into handy binders. And they like to think that they are looking at both the risks and benefits of vaccines when they make their decision to skip or delay their child’s vaccines.

When anti-vax folks look at the risks and benefits of vaccines, they see lots of risks and few benefits.

Like their research, their method of considering the risks and benefits of vaccines is very flawed…

Risks and Benefits of Vaccines – Anti-Vax Edition

What’s the first thing you notice when you look at Ashley Everly‘s chart?

She doesn’t have a column for when a child Should Be Vaccinated!

Although there are no optional vaccines, there are some situations in which getting vaccinated and protected is truly essential, including:

a child bitten by a dog, coyote, or bat with rabies
a completely unvaccinated teen who gets a deep puncture wound while playing in a field
a baby born to a mother with hepatitis B
an unvaccinated older teen living in a dorm on a college campus where there is an ongoing outbreak of meningococcemia
a preschooler with a cochlear implant
an unvaccinated 1st grader who’s sibling is starting chemotherapy for leukemia
unvaccinated kids traveling out of the country to parts of the world where vaccine-preventable diseases are still endemic
a child with asplenia

Does she really think that the benefits of the rabies vaccine don’t outweigh the risks? Does she understand what happens if you get rabies, even if your child has access to nutritious food, clean drinking water, and emergency medical care?

Who Should Not Be Vaccinated?

What else is wrong with Ashley Everly‘s risk and benefit chart?

Most of the things on her list of who should not be vaccinated are not true contraindications.

Of course, the one about having a “previous vaccine injury or serious reaction” would likely be a reason to not get that vaccine again, as long as the injury or reaction was really caused by the vaccine.

Are there situations in which the potential benefit of vaccination might not outweigh the vaccines risks?

“Events or conditions listed as precautions should be reviewed carefully. Benefits of and risks for administering a specific vaccine to a person under these circumstances should be considered. If the risk from the vaccine is believed to outweigh the benefit, the vaccine should not be administered. If the benefit of vaccination is believed to outweigh the risk, the vaccine should be administered. Whether and when to administer DTaP to children with proven or suspected underlying neurologic disorders should be decided on a case-by-case basis.”
ACIP Contraindications and Precautions

Those situations are called precautions.

Fortunately, most are temporary, such as having a “moderate or severe acute illness with or without fever.”

These precautions do not include having a family history of cancer or autoimmune disease.

When Vaccination May Be Unnecessary

Are there any situations in which vaccination may be unnecessary?

There are a few, including:

when a disease is eradicated
when you aren’t at risk to get a disease and there is little risk that there will be an outbreak in your community or a return if folks stop vaccinating – that’s why we don’t routinely vaccinate against yellow fever, cholera, and typhoid fever, etc. in the United States
when you get sick and develop natural immunity

Vaccination is still necessary if a child’s mother is breastfeeding (which doesn’t protect against most vaccine-preventable diseases), has natural immunity to wild type infections (passive immunity quickly wears off), and even if the child has access to nutritious food and clean drinking water.

Nearly two months in the ICU vs getting a tetanus shot… How do the risks and benefits stack up now?

And yes, getting vaccinated and protected is even necessary if a child has access to emergency medical care.

What to Know About the Risks and Benefits of Vaccines

While you should certainly consider the risks and benefits of getting vaccinated, understand that vaccines are safe, with few risks, and very necessary.

Wakefield’s Mutating Measles and Natural Herd Immunity

Andrew Wakefield is back and warning folks about “mutant measles” and our loss of natural herd immunity.

Of course, that isn’t what is causing our record breaking measles outbreaks.

Natural Herd Immunity

Why is he talking about measles this time, besides a new propaganda film he is already pushing?

“We are in a time now when obviously anti-vaxxers are getting blamed for these measles outbreaks here in this country – the biggest measles outbreak since they declared measles to be eradicated from America. But what you had to say was really interesting. First, the only deaths I’ve seen really specifically have been the stewardess in Israel. We hear about she died. She got the measles but she was vaccinated. There was a child, a young man in Europe. He died after having measles. He was vaccinated… What’s happening? Why is the news not talking about how these were vaccinated individuals? What’s happening with measles?”
Del Bigtree on WAKEFIELD’S WARNING: “MEASLES IS MUTATING”

He is looking to play the blame game. Measles cases are on the rise and while they aren’t all due to vaccine hesitancy, many are. And that has left anti-vaccine folks looking to shift the blame elsewhere.

And with cases on the rise, we are also seeing measles deaths on the rise. Which has to make you think, has Del Bigtree really only heard of two measles deaths? After all, there have been over a hundred in Europe, including eight measles deaths in Italy alone.

“I guess the question comes down to that poor air stewardess. Did she die because she was vaccinated? That’s a really big question.”
Andrew Wakefield on WAKEFIELD’S WARNING: “MEASLES IS MUTATING”

Is that really even a question?

A 43-year-old mother of three, died four months after getting measles while working as a flight attendant for El Al, getting exposed on a flight from New York and Israel.

She died because someone exposed her to measles, a life-threatening disease.

“It really is a question of who is to blame, who’s really to blame for the resurgence of measles around the world. Is it those they label anti-vaxxers or is it in fact those responsible for vaccination?”
Andrew Wakefield on WAKEFIELD’S WARNING: “MEASLES IS MUTATING”

Hmm, who’s to blame for the outbreaks. Anti-vaxxers or those vaccinating and protecting folks…

Guess who Wakefield is blaming?

“I’ve been studying measles since 1990. It’s something I know something about. As I got into it… I suddenly realized what the problem was and I also realized that they, on the other side, the vaccinologists, the industry, the smart ones, know it. And it’s their greatest fear.”
Andrew Wakefield on WAKEFIELD’S WARNING: “MEASLES IS MUTATING”

So what did Wakefield figure out?

This is the consequence of better hygiene, sanitation, and nutrition in the first part of the century and vaccines later on.

He talks about natural herd immunity, shows mortality graphs, and goes on about how measles is most serious in those under one and adults, but is a “trivial disease” in children.

“Nature has constrained the age of exposure to the majority of people getting measles when they are children, because that’s when they can get it safely.”
Andrew Wakefield on WAKEFIELD’S WARNING: “MEASLES IS MUTATING”

So by vaccinating people, he argues that we have interrupted the protection you get from natural infections. Adults don’t have lifetime immunity from their childhood infections and infants don’t have the passive immunity they get from their mothers, protecting them when they are most at risk.

He goes so far as to say that measles deaths would have “declined to zero” if we had never vaccinated!

What’s the problem with his theory?

Typical mortality graphs that anti-vax folks use don't tell the whole story... — Typical mortality graphs that anti-vax folks use don’t tell the whole story…

Well, for one thing, why didn’t natural herd immunity protect folks from dying with measles in the early 1900s? Or in the 1950s, when we still had 400 deaths a year in the United States?

Why didn’t natural herd immunity get rid of smallpox or any other disease?

And if we go back to the pre-vaccine era, when everyone got measles, what happens to all those with immune system problems who will almost certainly die if they get exposed to measles? These are the people who rely on herd immunity now, but they will be at big risk in this natural herd immunity model, because it means that millions of kids get measles every year.

Give Another Dose…

What do Wakefield and Del think that our answer will be to the measles outbreaks?

“The only answer they have is to give another dose, and give another dose, and give another dose.”
Andrew Wakefield on WAKEFIELD’S WARNING: “MEASLES IS MUTATING”

Of course, there are no calls to give “one more in college” and “two more MMR in adulthood” for measles protection as Del Bigtree claims.

In fact, two doses are very effective protection against measles.

“We report a screen of plasma donors confirming that widespread use of childhood measles vaccination since 1963 resulted in a decrease in average measles virus antibody titers among plasma donors, which is reflected in intravenous immunoglobulins (IVIGs).”
Modrof et al on Measles Virus Neutralizing Antibodies in Intravenous Immunoglobulins: Is an Increase by Revaccination of Plasma Donors Possible?

And no, the paper Wakefield talked about doesn’t prove that the MMR vaccine doesn’t work.

“With the success of the measles vaccination program and the ongoing World Health Organization efforts to eliminate and ultimately eradicate measles worldwide, a replacement of the measles virus antibody titer as a functional potency requirement for IVIG seems inevitable in the long term.”
Modrof et al on Measles Virus Neutralizing Antibodies in Intravenous Immunoglobulins: Is an Increase by Revaccination of Plasma Donors Possible?

The article actually talks about how successful the MMR vaccine is and just says that folks who are vaccinated don’t get the extra high levels of antibodies needed to make IVIG, which is used to treat people who are exposed to measles.

That doesn’t mean their vaccine didn’t work though. Many studies have demonstrated an amnestic response after measles vaccination, meaning that antibodies levels rise with any exposure to wild measles virus.

Mutating Measles

Little that Andrew Wakefield or Del Bigtree say in their video on mutating measles is true.

When he finally gets to actually talking about mutating measles, it is about a paper describing a new D4 subgenotype of measles.

Most measles outbreaks are now caused by B3 and D8 measles strains.

A strain for which antigenic shift might have led to resistance to vaccine induced protection, but fortunately, one that is rarely found.

And it isn’t what’s causing our measles outbreaks.

Remember, most people who get measles are unvaccinated.

“It’s that certainty that makes them so dangerous.”
Andrew Wakefield on WAKEFIELD’S WARNING: “MEASLES IS MUTATING”

Why is Wakefield so certain he is right?

“This is why, when that air hostess, got her vaccine, which she was probably promised, her mother was promised that it would give her protection for life, and it didn’t. She was susceptible again as an adult when it was more serious. So measles vaccination had made what was increasingly a trivial disease in children a much, much more dangerous disease. So who’s responsible for the resurgence of measles? Who’s responsible for the death of that girl?
Andrew Wakefield on WAKEFIELD’S WARNING: “MEASLES IS MUTATING”

Who does he blame for bringing measles back?

Wakefield blames the vaccinologists…

Who's really to blame for low immunization rates and continuing outbreaks? — Who’s really to blame for low immunization rates and continuing outbreaks?

How many people still blame Wakefield?

“So the adult population of this country is completely unprotected from measles virus unless you have had a natural infection. Boosting it with vaccination is not going to make any difference and that is an incredibly worrying situation.”
Andrew Wakefield on WAKEFIELD’S WARNING: “MEASLES IS MUTATING”

Just remember, the measles vaccine is very effective, especially when you get two doses. Most of the people who are getting measles are unvaccinated, either intentionally or because of lack of access.

And measles is hardly a trivial disease.

Neither is listening to this kind of anti-vaccine propaganda.

Is the MMR Safe for 6-Month-Old Babies?

Most parents understand that the first dose of the MMR vaccine is routinely given to children when they are 12 to 15 months old, at least in the United States.

In some other countries, the first dose is routinely given as early as 8 to 9-months of age.

And in high-risk situations, the MMR can safely be given to infants as early as age 6-months.

Is the MMR Safe for 6 Month Old Babies?

An early MMR, is that safe?

This type of pure anti-vaccine propaganda is what caused the measles outbreaks in New York in the first place... — This type of pure anti-vaccine propaganda is what caused the measles outbreaks in New York in the first place…

Yes, it is safe.

What about the package insert?

“Local health authorities may recommend measles vaccination of infants between 6 to 12 months of age in outbreak situations. This population may fail to respond to the components of the vaccine. Safety and effectiveness of mumps and rubella vaccine in infants less than 12 months of age have not been established. The younger the infant, the lower the likelihood of seroconversion (see CLINICAL PHARMACOLOGY). Such infants should receive a second dose of M-M-R II between 12 to 15 months of age followed by revaccination at elementary school entry.”
MMR II Package Insert

The package insert says to give infants who get an early dose another dose when they are 12 to 15 months old! It doesn’t say to not protect these babies!

But what about the idea that the safety and effectiveness of MMR hasn’t been proven for infants under 12 months of age?

In general, the package insert is only going to list studies that the manufacturer used to get FDA approval for their vaccine. Since it is an off-label recommendation of the ACIP, they would not include the studies that show that an early MMR is safe and effective.

“In conclusion, this study indicated that the MMR was well tolerated and immunogenic against measles, mumps and rubella with schedule of first dose both at 8 months and 12 months age. Our findings strongly supported that two doses of MMR can be introduced by replacing the first dose of MR in current EPI with MMR at 8 months age and the second dose at 18 months in China.”
He et al on Similar immunogenicity of measles-mumps-rubella (MMR) vaccine administrated at 8 months versus 12 months age in children.

Before 8 months, an early MMR isn’t likely to be as effective as giving it later. That’s because some maternal antibodies might linger in a baby’s system and can interfere with the vaccine working, even after six months. How many antibodies and how much interference?

It’s almost impossible to tell for any one child, but the risk that this maternal protection has begun to wear off and these infants are at risk to develop measles is too great. That’s the reason that they get an early MMR, even though we know it won’t be as effective as a dose given later and we know it will have to be repeated.

Is this early dose safe?

“This review did not identify any major safety concerns. These findings may facilitate discussions about the risks and benefits of vaccinating infants who are potentially exposed to this life-threatening disease.”
Woo et al on Adverse Events After MMR or MMRV Vaccine in Infants Under Nine Months Old

Of course! Although the complications of measles can be serious, even deadly, we aren’t going to recommend something that is even worse.

“Early MMR vaccination is well tolerated, with the lowest AE frequencies found in infants aged 6-8 months. It is a safe intervention for protecting young infants against measles.”
van der Maas et al on Tolerability of Early Measles-Mumps-Rubella Vaccination in Infants Aged 6-14 Months During a Measles Outbreak in The Netherlands in 2013-2014.

So an early MMR is safe, with few risks, and is likely effective at preventing measles.

And by now you know what’s not safe. That’s right, getting measles.

What Is a Vaccine?

You know what a vaccine is, right?

The word vaccine comes from the vaccinia virus that was in the original smallpox vaccine. — The word vaccine comes from the *vaccinia* virus that was in the original smallpox vaccine.

The flu shot you get each year is a vaccine.

Vaccine: A product that stimulates a person’s immune system to produce immunity to a specific disease, protecting the person from that disease. Vaccines are usually administered through needle injections, but can also be administered by mouth or sprayed into the nose.
Immunization: The Basics

The smallpox shot that Edward Jenner developed was a vaccine.

Vaccine Definitions

While that is an easy enough definition to understand, that there are many different types of vaccines does make it a little more complicated.

There are:

Live-attenuated vaccines – made from a weakened or attenuated form of a virus or bacteria
Inactivated vaccines – made from a killed form of virus or bacteria
Subunit, recombinant, polysaccharide, and conjugate vaccines – made from only specific pieces of a virus or bacteria
Toxoid vaccines – made to target a toxin that a bacteria makes and not the bacteria itself

And of course all of these types of vaccines work to produce immunity to specific diseases – vaccination.

Immunization: A process by which a person becomes protected against a disease through vaccination. This term is often used interchangeably with vaccination or inoculation.
Immunization: The Basics

What other definitions are important to know when you talk about vaccines?

active immunity – immunity that you get from having a disease (natural immunity) or getting a vaccine and making antibodies
adjuvant – a substance that helps boost your body’s immune response to a vaccine so that you can use a minimum amount of antigen, reducing side effects
antibodies – protective proteins that you make against antigens
antigens – specific substances (can be part of a virus or bacteria) that trigger an immune response
attenuation – a virus or bacteria that is made less potent, so that it can produce an immune response without causing disease
elimination – getting rid of a disease in a specific area
endemic – the baseline level of disease in an area
eradication – getting rid of a disease everywhere (smallpox)
epidemic – an increase in the number of cases of a disease over a large geographic area
herd immunity – when enough people in a community are protected and have immunity, so that disease is unlikely to spread
immunity – protection against a disease
incubation period – how long it takes to develop symptoms after you are exposed to a disease
outbreak – an increase in the number of cases of a disease over a small geographic area
pandemic – an increase in the number of cases of a disease over several countries or continents
passive immunity – temporary immunity that you get after being given antibodies, either via a shot of immunoglobulin or a mother’s antibodies are transferred to her baby through her placenta
placebo – classically defined as “a comparator in a vaccine trial that does not include the antigen under study”
quarantine – isolating someone so that they don’t get others sick
titer – an antibody count that can often be used to predict immunity

Got all of that?

So what about variolation, the process that was used before Jenner developed his smallpox vaccine? Was that also a vaccine?

It did produce immunity to smallpox, which is the basic definition of a vaccine, but still, variolation is typically concerned an immunization technique and not a vaccine.

VAXOPEDIA

Risks and Benefits of Vaccines – Anti-Vax Edition