Tag: pre-vaccine era

Why Do We Only Fear Vaccine Preventable Diseases?

How many diseases can be prevented with vaccines?

Would you believe that there are about 29 vaccine-preventable diseases, from adenovirus and anthrax to typhoid fever and yellow fever?

That’s a lot more than the 16 that kids today routinely get vaccinated against

Diseases That Are Not Vaccine Preventable

Whether you think about 16 or 29 vaccine-preventable diseases, they are a drop in the pocket when you think about all of the diseases that can’t be prevented with a vaccine.

Just consider all of the viruses and bacteria that can get you sick during cold and flu season:

  • group A Streptococci – strep throat and scarlet fever
  • Human metapneumovirus (HMPV) – bronchiolitis, colds, and viral pneumonia
  • Human parainfluenza viruses (HPIVs) – bronchiolitis, bronchitis, colds, croup, or viral pneumonia
  • norovirus – diarrhea and vomiting
  • respiratory adenovirus – bronchitis, colds, croup, viral pneumonia, pink eye, and diarrhea
  • Respiratory syncytial virus (RSV) – wheezing and bronchiolitis in younger children, but colds in older kids and adults
  • rhinovirus – the classic common cold
  • rotavirus – diarrhea and vomiting, was much more common in the pre-vaccine era
  • seasonal coronavirus – colds, bronchitis, and viral pneumonia
  • Streptococcus pneumoniae – ear infections, meningitis, sinus infections, and pneumonia

In addition to the flu, only rotavirus and Streptococcus pneumoniae (pneumococcal vaccines) are vaccine preventable.

And there are still thousands of other diseases that aren’t vaccine preventable, including African trypanosomiasis, Chagas disease, Chikungunya, Cytomegalovirus (CMV), Dengue fever, Ebola, Herpes Zoster, HIV, Hookworm disease, Leishmaniasis, Malaria, Schistosomiasis, and Zika, some of the most deadly diseases around.

Why Do We Only Fear Vaccine-Preventable Diseases?

So is it true that we only fear vaccine-preventable diseases and that’s why folks get vaccinated?

“Why aren’t you walking around concerned about leprosy every day? Why aren’t you concerned about someone from another country bringing leprosy into Australia or the US and somehow exposing all of our most vulnerable to this illness? I’ll tell you why. Because there’s no vaccine for leprosy. You are afraid of what we vaccinate for because these illnesses are hyped up all of the time. It’s propaganda. You are told what to fear, so they can then sell you an alleged solution.
The only diseases we fear are the ones that a vaccine has been developed and marketed for. We never feared measles and mumps in the early 20th century… Because its what the media tells us to do.”

Learn the Risk – Why aren’t we afraid of all diseases?

Did you know that there actually is a vaccine for leprosy? Don’t expect it to be added to our immunization schedule any time soon or to increase your fears about leprosy, as leprosy is not highly contagious and it can be cured.

Forget about leprosy though… If folks didn’t fear measles and mumps in the early 20th century, before we had vaccines to control these diseases, then why did epidemics so often lead to newspaper headlines, quarantines, and school closings?

Quarantines were routine in the pre-vaccine era.
Quarantines were routine in the pre-vaccine era.

And if we only fear diseases that a vaccine has been developed and marketed for, then why are so many parents afraid of RSV and herpes?

How many new parents won’t even let family members kiss their newborns because they are worried about herpes, even if they don’t have a cold sore? How many parents get panicked if they hear RSV, which can cause severe disease in high risk babies, but typically only causes cold symptoms in most others.

Anyway, fear doesn’t drive most of us to vaccinate and protect our kids. We just understand that vaccines are safe and necessary and that getting vaccinated is a smart decision.

It is the diseases that aren’t vaccine preventable that might scare us a little bit…

What to Know About Fearing Vaccine-Preventable Diseases

Anti-vaccine folks push propaganda to make parents afraid of vaccines and to scare them away from vaccinating and protecting their kids. The idea that we are only afraid of vaccine preventable diseases is a good example.

More on Fearing Vaccine Preventable Diseases

The Hospital Rock Engravings of Farmington, Connecticut

Vaccines are a lot safer than they used to be in the old days.

No, I’m not talking about the “crude brew” that was the original DTP vaccine.

This older vaccine used more antigens than the DTaP vaccine that replaced it, so could cause more side effects. Even before that though, there was less oversight of vaccine manufacturers in the early 20th century. This could lead to vaccines that were contaminated or which simply didn’t work.

That certainly was a problem with the early smallpox vaccine, which is typically considered to be the most dangerous vaccine ever routinely used.

Variolation and Smallpox

But even before the smallpox vaccine was developed by Edward Jenner in 1796, we had variolation.

While the smallpox vaccine involved the cowpox virus, variolation actually infected someone with smallpox. The idea was to give the person a milder form by exposing them to a weaker, or attenuated, form of the virus.

They got this weakened virus from the smallpox scabs of someone who had already recovered and:

  • blowing dried smallpox scabs into their nose
  • applying pus from smallpox scabs to a small puncture wound on their skin

Variolation worked, giving the person immunity to smallpox – if they survived.

Unfortunately, about 1 to 3% of people who underwent variolation died.

And people who had recently undergone variolation could be contagious, leading to smallpox epidemics.

So why did folks undergo variolation if they had a chance of dying from the procedure?

It’s simple.

A natural smallpox infection was so much more deadly. Up to 30% of people who got smallpox died, and many people eventually got caught up in the regular smallpox epidemics that plagued people in the pre-vaccine era.

The Hospital Rock Engravings of Farmington, Connecticut

We don’t have to worry about smallpox anymore.

Well, not about natural smallpox infections, since smallpox was eradicated back in 1980.

And there are many other diseases that we get vaccinated against, with it being extremely easy to get that protection, especially compared to what folks did in the old days.

Do you know how far folks went to make variolation safer?

“Every year, thousands undergo this operation, and the French Ambassador says pleasantly, that they take the small-pox here by way of diversion, as they take the waters in other countries. There is no example of any one that has died in it, and you may believe I am well satisfied of the safety of this experiment, since I intend to try it on my dear little son. I am patriot enough to take the pains to bring this useful invention into fashion in England…”
Lady Mary Wortley Montagu On Small Pox in Turkey (1717)

They actually went to smallpox hospitals to get vaccinated, remaining in quarantine for up to three weeks so that they wouldn’t get others sick.

In Farmington, Connecticut, two doctors established the Todd-Wadsworth Smallpox Hospital and had a lot of success with variolation.

Patients were no longer starved before inoculation, and many had begun to doubt the efficacy and safety of vomiting, sweats, purges, mercurials (toxic mercury salts such as calomel), and bleeding which had previously weakened both inoculees and those who “took the pox in the natural way.”

Charles Leach, MD on Hospital Rock

There, up to 20 patients at a time stayed in quarantine to get variolated, as a smallpox epidemic hit nearby Boston.

Patients engraved their name on Hospital Rock in the late 1700s near Farmington.
Patients engraved their name on Hospital Rock in the late 1700s near Farmington. Photo by Keith Wilkens

Between 1792 and 1794, many who got variolated wrote their names on what is now known as Hospital Rock.

“Many have supposed that the names on this rock were those who had did of the small-pox, but this is a great mistake. Every name on the rock is that of a person who was living when the name was placed there. Norris Stanley lived to own ships which were captured in the war of 1812 by Algerian pirates and still later to receive from the United States an indeminity therefor amounting to a large sum.”

James Shepard on The Small Pox Hospital Rock

The nearby town of Durham seemed to go a different way.

Instead of an inoculation hospital, they had a pest house to quarantine folks with natural smallpox infections.

Adding to the history of smallpox in Connecticut – a smallpox burying ground in Guilford.

Why wasn’t variolation popular everywhere? Folks didn’t have to wait for the first vaccine for the anti-vaccine movement to get started.

What to Know About Smallpox and the Hospital Rock Engravings

Hundreds of people got safely inoculated against smallpox and left their names on Hospital Rock near Farmington, Connecticut just before Edward Jenner discovered the first smallpox vaccine.

More on the Hospital Rock Engravings

Grave Reminders of Life Before Vaccines

Need a reminder of just how serious vaccine preventable diseases can be?

Don’t remember the pre-vaccine era?

That could be why some folks are so quick to think that skipping or delaying vaccines is a safe option for their kids.

Vaccines are necessary.

Without them, we will see even more outbreaks of measles, mumps, and pertussis and kids will continue to die of rabies, tetanus, and other now vaccine-preventable diseases.

The South Park Cemetary was begun in 1891 during a diphtheria epidemic.
A diphtheria cemetery in Wyoming.

Isolation hospitals and pest houses were commonly used to quarantine folks with smallpox.
Isolation hospitals and pest houses were commonly used to quarantine folks with smallpox and other now vaccine-preventable diseases.

Even mild smallpox, as depicted on this WHO Smallpox Recognition Card, included flu like symptoms, a few weeks of pustules, and then waiting for the lesions to scab over...
Even mild smallpox, as depicted on this WHO Smallpox Recognition Card, included flu like symptoms, a few weeks of pustules, and then waiting for the lesions to scab over…

People continued to die of smallpox well into the 20th century, even though an effective vaccine was developed in 1796.
People continued to die of smallpox well into the 20th century, even though an effective vaccine was developed in 1796.

In the pre-vaccine era, we had outbreaks of polio, and other, now vaccine-preventable diseases.
Outbreaks of polio would once isolate entire towns, as parents feared their kids would get sick too.

Fight Polio Poster
When was the last time you saw a child with polio?

Before wide use of the Hib and Prevnar vaccines, infants with fever would routinely get spinal taps and you would hope for clear fluid (cloudy fluid could be a sign of a bacterial infection).
Before wide use of the Hib and Prevnar vaccines, younger infants with fever would routinely need spinal taps and you would hope for clear fluid (cloudy fluid could be a sign of a Hib or Strep pneumo infection).

In the pre-vaccine era, Hib caused epiglottitis, meningitis, and pneumonia - all life-threatening diseases that are now prevented by the Hib vaccine.
In the pre-vaccine era, Hib caused epiglottitis, meningitis, and pneumonia – all life-threatening diseases that are now prevented by the Hib vaccine.

Before the 1990s, when the Hib vaccine available, hospitals had an epiglottitis team on call and always available.
Before the 1990s, when the Hib vaccine available, hospitals had an epiglottitis team on call and always available.

News of the Newark kids going to Paris to get Pasteur's rabies vaccine made the front page of the New York Times.
In 1885, several boys from Newark went all of the way to Paris to get Pasteur’s new rabies vaccine, as the disease had always been fatal up until that time.

Even if they survive, kids can lose fingers, toes, or even arms and legs to meningococcemia.
Even if they survive, kids can lose fingers, toes, or even arms and legs to meningococcemia.

Roald Dahl's daughter died of measles in 1962, the year before the development of the first measles vaccine.
Roald Dahl’s daughter died of measles in 1962, the year before the development of the first measles vaccine.

Nationwide, at least 123 people died in the United States during a large measles epidemic from 1989 to 1991, during a time that we had good sanitation, nutrition, and medical care.
Nationwide, at least 123 people died in the United States during large measles epidemics from 1989 to 1991, a time when we had good sanitation, nutrition, and medical care, but some folks weren’t vaccinated and we weren’t yet giving a second dose of MMR.

A papilloma caused by HPV on the vocal cords of a child with recurrent respiratory papillomatosis.
A papilloma caused by HPV on the vocal cords of a child with recurrent respiratory papillomatosis. (CC BY 4.0)

You don't have to go back to the pre-vaccine era to know that pertussis kills.
You don’t have to go back to the pre-vaccine era to know that pertussis kills. Ten infants died in 2010 in California from pertussis infections.

We should never forget what life was like before vaccines.

We should know that vaccine-preventable diseases were rarely mild, natural immunity comes at a cost, and that those who died from smallpox, diphtheria, measles, and polio aren’t around to talk about their experiences on Facebook (survivorship bias).

We should never forget that vaccine-preventable diseases were once big killers, and the only reason some folks have grown to fear the side effects of vaccines more than the diseases they prevent, is because we don’t see those diseases very much any more. If more people skip or delay getting vaccinated, we will though.

immunization-program-stages
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

Vaccines are safe and vaccines work.

Get vaccinated and protected.

Outbreaks of vaccine-preventable diseases belong in the past.

What to Know About Life Before Vaccines

Forgetting the pre-vaccine era and the benefits of vaccines makes folks susceptible to anti-vaccine talking points and scares them away from vaccinating and protecting their kids.

More on Remembering Life Before Vaccines

Do Your Kids Need a Mumps Booster Shot?

Traditionally, kids get vaccines to protect them against mumps when they are 12 to 15 months old (1st dose of MMR) and again before starting kindergarten (2nd dose of MMR).

Do Your Kids Need a Mumps Booster Shot?

Routine use of the mumps vaccine, which was first licensed in 1967, has helped to greatly reduce the incidence of mumps cases from pre-vaccine era levels.

Outbreaks of mumps the last few years have led to calls for a third dose of MMR in some situations though.

mumps-booster
During an outbreak, universities make sure students are up-to-date with their MMR vaccines.

Does that mean that your kids will need a third dose of the MMR vaccine?

Probably not.

“Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine to improve protection against mumps disease and related complications.”

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak

Is there a mumps outbreak in your area?

While that is the main reason to get a third dose of MMR, simply being near an outbreak still doesn’t mean an extra vaccine is necessary.

“In the setting of an identified mumps outbreak, public health authorities should define target groups at increased risk for mumps during the outbreak, determine whether vaccination of at-risk persons is indicated, and provide recommendations for vaccination to health care providers.”

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak

Your local or state health department will decide which folks need a third dose of MMR in an outbreak situation.

“Persons at increased risk for acquiring mumps are those who are more likely to have prolonged or intense exposure to droplets or saliva from a person infected with mumps, such as through close contact or sharing of drinks or utensils.”

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak

Why not just give everyone a third dose of MMR?

The issue with the mumps vaccine is waning immunity, so it isn’t known how long an extra dose would last, and that’s why at this time, the only recommendation is to give an extra dose during outbreaks.

If you are still unsure about needing a third dose of MMR, ask your pediatrician, school health clinic, or local health department, especially if you have heard about local mumps cases.

What to Know About the Mumps Booster Shot

A third dose of MMR is recommended for some people at high risk to get mumps in an outbreak situation.

More on the Mumps Booster Shot

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

How Many People Die in the USA Every Year from Being Vaccinated?

We know that vaccines work to save lives from vaccine-preventable disease.

If you are at all hesitant about vaccines and are doing your research, you have likely come across the myth that vaccines are more dangerous than the diseases they protect us against though.

This is only because most people don’t remember the pre-vaccine era when measles, polio, small pox, and diphtheria, etc., were big killers. So even though vaccine side effects are about the same as they always have been, they can become a much bigger focus for some people because they don’t see any of the mortality or morbidity from the diseases that the vaccines have gotten so good at preventing.

immunization-program-stages
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

It is at this crossover point that anti-vaccine folks are able to get away with pushing myths, such as like more people die from the MMR vaccine than from measles.

They don’t.

How Many People Die in the USA Every Year from Being Vaccinated?

Although vaccines are not perfectly safe, it is extremely rare for a vaccine reaction to be deadly.

“As for vaccines causing death, again so few deaths can plausibly be attributed to vaccines that it is hard to assess the risk statistically.”

WHO on Six common misconceptions about immunization

So why do anti-vaccine folks think that they are more common than they really are?

That’s an easy question to answer.

“Differentiation between coincidence and causality is of utmost importance in this respect. This is not always easy, especially when an event is rare and background rates are not available.”

Heininger on A risk-benefit analysis of vaccination

They often believe than anything and everything that happens after someone is vaccinated, even if it is weeks or months later, must have been caused by the vaccine. This discounts that fact that most people have a basic risk, often called the background rate, for developing these conditions that can coincide with getting vaccinated. It also explains why they believe in so many so-called vaccine induced diseases.

Another reason is that they also misuse VAERS reports when talking about vaccine deaths.

“In a review of reports of death following vaccination submitted to the Vaccine Adverse Event Reporting System (VAERS) from the early 1990s, the Institute of Medicine concluded that most were coincidental, not causally associated.”

Moro et al on Deaths Reported to the Vaccine Adverse Event Reporting System, United States, 1997–2013

Not surprisingly though, studies have shown that most of the deaths in VAERS are not actually related to vaccines.

In fact, most of the things that anti-vaccine folks blame on vaccines, including things you see in many of their vaccine-injury stories, are not related to vaccines.

How Many People Die in the USA Every Year from Vaccine-Preventable Diseases?

Fortunately, most people are vaccinated, and deaths from  vaccine preventable diseases are tremendously below what they were in the pre-vaccine era.

Most people will be surprised to know that they aren’t zero though.

People do still get vaccine-preventable diseases in the United States.

And tragically, people do still die of vaccine-preventable diseases in the United States.

For example, in 2015:

  • there were at least 37 cases of perinatal hepatitis B infections
  • five infants and children less than age 5 years died of rotavirus disease
  • a 14-month-old died of Hib meningitis
  • an infant died of pneumococcal meningitis
  • a 3-year-old with congenital rubella syndrome died
  • at least two teens died of meningococcal meningitis
  • a woman in Washington died of measles – the immunosuppressed women was exposed to an outbreak in Clallam County that mostly included intentionally unvaccinated kids
  • 85 kids died of the flu

Of course, worldwide, especially in developing countries, the number of deaths are much higher, which is a good reminder of what would happen if more of us stopped vaccinating!

And it is an even better reminder that you have to look at the number of deaths from vaccine-preventable diseases today in the context that most people are vaccinated and protected.

If you are truly looking at a risk vs benefit analysis of whether or not to get vaccinated, it is still the great benefit of avoiding vaccine preventable diseases vs the very small risks of getting vaccinated that you should think about.

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

It is also the small risks of getting vaccinated vs the much greater risk of going back to the pre-vaccine era if you decided to skip or delay any vaccines.

It is not that you have been scared into thinking that the risks of  vaccines outweigh their benefits.

“Millions of vaccinations are given to children and adults in the United States each year. Serious adverse reactions are rare. However, because of the high volume of use, coincidental adverse events including deaths, that are temporally associated with vaccination, do occur. When death occurs shortly following vaccination, loved ones and others might naturally question whether it was related to vaccination. A large body of evidence supports the safety of vaccines, and multiple studies and scientific reviews have found no association between vaccination and deaths except in rare cases.”

Miller et al on Deaths following vaccination: What does the evidence show?

It is not that the risk of getting a vaccine preventable disease is low because you might be able to get away with hiding in the herd.

It is not that the risk of getting a vaccine preventable disease is low because you are counting on everyone else in the world to get vaccinated and eliminate or eradicate the disease and your risk.

If too many parents who are on the fence start believing that their kids have zero risk of getting polio and other vaccine-preventable diseases and continue to skip or delay vaccines, then boom, we are back to the days when outbreaks would close schools and kids would suffer from the devastating effects of these diseases.

Even the schools were closed in San Antonio when polio came to Texas in 1946.
Even the schools were closed in San Antonio when polio came to Texas in 1946.

While anti-vaccine folks won’t have such an easy time convincing people that these diseases are mild anymore, none of us want to wait for more outbreaks to occur before folks get the message that vaccines are safe and necessary.

What to Know About Vaccine Deaths

Despite what anti-vaccine folks would have you believe as they try to scare you away from vaccinating and protecting your kids, vaccines are safe and necessary and vaccine deaths are very rare.

More on Vaccine Deaths

Four Generations of Vaccines and Vaccine Preventable Diseases

This image that has been floating around the Internets conveys a lot of information, both about vaccines and vaccine-preventable diseases. And about the propaganda being pushed by the anti-vaccine movement.

Four generations of vaccines or vaccine misinformation?
Four generations of vaccines or vaccine misinformation?

A lot has changed over the last four generations…

Four Generations of Vaccine Preventable Diseases

In the United States, we have seen:

  • 1949 – the last smallpox outbreak
  • 1970s – the last outbreak of respiratory diphtheria
  • 1979 – endemic polio was declared eliminated
  • 1979 – smallpox was declared eradicated
  • 2000 – endemic measles was declared eliminated
  • 2000- neonatal tetanus was declared eliminated
  • 2004 – endemic rubella and congenital rubella syndrome were declared eliminated
  • 2009 – endemic respiratory diphtheria was declared eliminated

But there hasn’t been as much change as some folks think.

Four Generations of Vaccines

For one thing, kids don’t get 69 vaccines today as part of the recommended immunization schedule.

We don’t even have 69 vaccines available to give children today!

And while 200+ vaccines are being tested or are in the “pipeline,” very few will end up on the childhood immunization schedule. For example, many of these are therapeutic vaccines to treat cancer, allergies, and other conditions. And a lot of the other pipeline vaccines are for the same infectious disease, including 36 vaccines being tested to prevent or treat HIV and 25 to prevent the flu.

So how many vaccines do kids actually get?

Kids today routinely get 13 vaccines to protect them from 16 vaccine-preventable diseases. More than 13 vaccines are available, but some aren’t used in the United States and some are only used in special situations or for high risk kids.

Also, looking at historical immunization schedules, it is clear that folks in the 1940s and 50s didn’t get just two vaccines.

schedule1940s
A schedule of immunizations from a 1948 AAP Round Table Discussion on the Practical and Immunological Aspects of Pediatric Immunizations

Did some kids really get annual tetanus and typhoid vaccine boosters back then?

It’s possible, after all, by the 1930s, we did have individual vaccines against diphtheria, tetanus, pertussis, typhoid, and smallpox.

This was followed by:

  • 1948 – the individual diphtheria, tetanus, and pertussis vaccines become combined in a single DTP vaccine
  • 1955 – first polio vaccine – IPV
  • 1962 – change to oral polio vaccine – OPV
  • 1963-68 – first measles vaccines
  • 1967 – first mumps vaccine
  • 1969 – first rubella vaccine
  • 1971 – the individual measles, mumps, and rubella vaccines become combined in a single MMR vaccine
  • 1972 – routine vaccination with smallpox vaccines end in the US

The next big change was the addition of the Hib vaccine to the schedule in 1985.

“…for those trained in pediatrics in the 1970s, Hib (Haemophilus influenzae type b) was a horror.”

Walter Orenstein, MD

This was followed in 1989, with the addition of the hepatitis B vaccine, expanded age ranges for Hib, and the start of the switch to DTaP.

By 2000, kids got protection against 11 vaccine-preventable diseases, and routinely got the DTaP, MMR, IPV, Hib, chicken pox, Prevnar, hepatitis B, and Td vaccines.

Over the years, vaccines and protection against rotavirus, hepatitis A, meningococcal bacteria, HPV, and a yearly flu shot were added to the schedule.

We still haven’t gotten to 69 vaccines though.

Looking at the latest immunization schedule from the CDC and AAP, it should be clear that kids don't get 69 vaccines.
Looking at the latest immunization schedule from the CDC and AAP, it should be clear that kids don’t get 69 vaccines.

Kids today do routinely get:

  • 13 vaccines, including DTaP, IPV (polio), hepatitis B, Hib, Prevnar 13, rotavirus, MMR, Varivax (chicken pox), hepatitis A, Tdap, HPV, MCV 4 (meningococcal vaccine), and influenza
  • protection against 16 vaccine-preventable diseases, including diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, chicken pox, pneumococcal disease, hepatitis A, hepatitis B, meningococcal disease, HPV, rotavirus, Hib, and flu
  • about 28 doses of those vaccines by age two years
  • about 35 doses of those vaccines by age five years
  • as few as 23 individual shots by age five years if your child is getting combination vaccines, like Pediarix or Pentacel and Kinrix or Quadracel and Proquad
  • about 54 doses of those vaccines by age 18 years, with a third of that coming from yearly flu shots

How do you get a number like 69?

You can boost your count to make it look scarier by counting the DTaP, MMR, and Tdap vaccines as three separate vaccines each (even though they aren’t available as individual vaccines anymore). That quickly turns 8 shots into “24 vaccines.”

And that’s fine – as long as you are consistent. You can’t count them each as three vaccines today, but just as one when mom, grandma and great-grandma got them. If you are counting individual components of those vaccines, then great-grandma didn’t just get two vaccines, especially when you consider that she almost certainly would have gotten multiple doses of the DPT vaccine.

Paradoxically, even more antigens have been taken off the schedule with the removal of the smallpox and DPT vaccines. In 1960, kids got exposed to 3,217 different antigens from the smallpox, polio, diphtheria, tetanus and whole cell pertussis vaccines. All of today’s vaccines on the schedule expose them to just 177 different antigens!

Why does that matter? It is the antigens that are stimulating the immune system, so if you were really concerned about a number, that would be the one to look at.

More Vaccines Equal More Protection

Of course, the number of vaccines kids get and how they have increased over time is very important. But not in they way anti-vaccine folks like to think.

It is important because kids today are protected against and don’t have to worry about the consequences of many more life-threatening diseases, like bacterial meningitis (Hib and the pneumococcal bacteria), epiglottitis (Hib), liver failure and liver cancer (hepatitis B), severe dehydration (rotavirus), and cervical cancer (HPV), etc.

If you think kids get too many vaccines today, then you have no idea what things were like in the pre-vaccine era.

More on The Evolving Immunization Schedule