The usual talking point from folks who are anti-vax is that vaccine-preventable diseases are mild. Some even go so far to say that they are good for you! It isn’t too often that these folks admit that these diseases, from measles and polio to chickenpox, do indeed kill people.
No, chickenpox doesn’t kill 1 in 100 people, but that doesn’t mean that people don’t die with chickenpox, especially if they are unvaccinated and unprotected.
Did Bobby Kennedy Admit That Chickenpox Kills People?
“Chickenpox can reactivate as shingles when an adult’s immunity wanes or is not boosted by periodic exposure to children with chickenpox. CDCs clinical studies predicted that widespread vaccination would double shingles rates among adults and children and precipitate a shingles epidemic. “
While it is true that chickenpox can reactivate as shingles, a bonus of getting vaccinated and protected with the chickenpox vaccine is that it actually decreases your risk of developing shingles later in life!
And those countries that didn’t vaccinate and protect their kids with the chickenpox vaccine, because they thought it might cause a later shingles epidemic if fewer kids were sick and boosting the immunity of adults who had already had chickenpox still saw a rise in shingles cases.
That’s probably why many of those countries are now considering adding the chickenpox vaccine to their schedule.
“…chickenpox presents as a mild rash and slight fever and confers lifetime immunity to chickenpox and significant protection against shingles, heart disease, atopic diseases, and cancers including glioma, brain, and spinal tumors. “
“Merck’s vaccine is only 60% effective after 5 years, leaving adults vulnerable to shingles.”
Actually, it has been found that one dose of the chickenpox vaccine is 100% effective at preventing severe disease!
So why do we get two doses?
“This study confirmed that varicella vaccine is effective at preventing chicken pox, with no waning noted over a 14-year period. One dose provided excellent protection against moderate to severe disease, and most cases occurred shortly after the cohort was vaccinated. The study data also suggest that varicella vaccination may reduce the risks of HZ in vaccinated children.”
Baxter et al on Long-term effectiveness of varicella vaccine: a 14-Year, prospective cohort study.
So their immunization schedule is right for their country, even if it doesn’t match the United States schedule.
Australia’s Vaccine Schedule
In Australia, for example, the National Immunisation Program (NIP) Schedule is set by National Immunisation Committee (NIC), which reports to the Australian Health Protection Principal Committee (AHPPC) of the Australian Health Ministers Advisory Council (AHMAC) through the Communicable Diseases Network Australia (CDNA).
Notice any differences between Australia’s vaccine schedule and the US schedule?
they give the routine second dose of MMR earlier, at 18 months
they don’t give a second dose of the chickenpox vaccine
they give the routine first dose of the meningococcal vaccine earlier, at 12 months
the hepatitis A and flu vaccines are only given to high risk kids
While there are some minor differences, it is fairly similar to the US immunization schedule.
“There is a legislative requirement for all vaccines provided under the NIP or the PBS to undergo a thorough and objective assessment process.”
National Immunisation Strategy for Australia
Why the earlier dose of meningococcal vaccine?
This is a good example of why immunization schedules vary between countries.
“The notification rate for meningococcal disease to the National Notifiable Diseases Surveillance System peaked at 4.3 per 100 000 in 2002 and declined to 0.4 per 100 000 in 2013.”
Meningococcal disease incidence rates in the United States were much lower, about 0.6 per 100,000, when they started giving meningococcal vaccines in Australia (2001).
The UK Vaccine Schedule
But aren’t the immunization schedules from other countries supposed to be a lot different from the US schedule?
Let’s look at another…
It’s not the easiest schedule to read, but you should notice that vaccines for hepatitis A and chickenpox are missing, but younger children get extra meningococcal shots.
You may also have noticed yet another dosage schedule for the Prevnar 13 vaccine.
While the United States gives a three dose primary series and a booster, many other countries give either a three dose primary series alone or a two dose primary series with a booster.
“A large and growing body of evidence from immunogenicity studies, as well as clinical trials and observational studies of carriage, pneumonia and invasive disease, has been systematically reviewed; these data indicate that schedules of 3 or 4 doses all work well, and that the differences between these regimens are subtle, especially in a mature program in which coverage is high and indirect (herd) effects help enhance protection provided directly by a vaccine schedule.”
Whitney et al on Dosing schedules for pneumococcal conjugate vaccine: considerations for policy makers.
That doesn’t mean that they are all guessing at the dose! All of these schedules are well studied and in this case, there isn’t much difference.
There are even studies that suggest giving only one primary dose, combined with one booster dose might work, but only in areas where pneumococcal disease is already well controlled and infants would be protected by indirect herd immunity.
But that doesn’t mean that other schedules would work just as well too. For example, giving the doses later or on a slower schedule would not be better.
Infants are most at risk for many of these diseases, especially Hib and pneumococcal disease, when they are young and delaying when infants get vaccinated simply leaves them unprotected and at risk to get sick for a longer period of time. You also want infants to be protected by the time they lose the passive protection they get from their maternal antibodies.
What about the chickenpox vaccine?
While the UK has not added the chickenpox vaccine to their schedule because their models predicted an increase in cases of shingles (which has happened anyway) with a decrease in exogenous boosting (the theory that exposure to chickenpox lowers your risk of shingles), they are now looking at this again.
“This study confirms that severe complications of varicella, including death, continue to occur in the UK and Ireland.”
Cameron et al on Severe complications of chickenpox in hospitalised children in the UK and Ireland
Mostly it has been said that the chickenpox vaccine isn’t on the schedule because they have not thought it to be cost effective.
Iceland’s Vaccine Schedule
When anti-vaccine folks talk about immunization schedules from other countries, they aren’t usually talking about the UK or Australia though.
They are talking about Iceland, the country that they believe gives far fewer vaccines than the United States.
Vaccines for flu, chickenpox, hepatitis A, and hepatitis B and also available for those who are considered high risk.
Want to follow Iceland’s immunization schedule?
Then you should move to Iceland.
Hopefully you are starting to see that immunization schedules are different in each country because each country has different rates of disease, different populations, and different healthcare systems.
Iceland is a small country (338,349 people), with high vaccination rates, and universal health care. Compare that to the United States, with 327,200,000 people, clusters of unvaccinated people, and lots of people without health care.
It should be easy to see that what works in one country might not work in the other…
Vaccine Schedule Comparison by Country
What about other countries?
On the immunization schedule in Austria, the columns in red are for vaccines that are recommended and free. The blue columns are also recommended, but they aren’t free.
Japan has two separate schedules – the routine schedule for everyone (in dark blue above) and the voluntary schedule, with extra vaccines. Note that the primary series of infant vaccines are given at 2, 3, and 4 months.
Germany also gives their primary series of infant vaccines at 2, 3, and 4 months.
Although they only use a two dose primary series, Switzerland gives many of the same vaccines as the United States.
Are you surprised to see that infants in Holland get more vaccines before they turn 12 month old than infants in the United States and an extra set by four months?
Even if they aren’t routine in other countries, all of the same vaccines that are offered in the United States, including vaccines to protect kids against rotavirus, chickenpox, and hepatitis A, are available in most other countries.
The latest immunization schedule in Israel includes hepatitis B, DTaP, polio, pneumococcal, rotavirus, MMR, chickenpox, HPV, and flu vaccines.
What’s missing in South Korea’s immunization schedule? Meningococcal vaccines. But they do have some that we don’t give in the United States.
What’s missing in Denmark?
Folks who don’t vaccinate their kids!
Denmark has very high immunization rates – over 97% for infants and toddlers!
What don’t these different immunization schedules influence?
Prevalence rates of autism, SIDS, and other things that scare parents away from vaccinating and protecting their kids.
The One Wrong Way to Give Vaccines
Since the immunization schedules from all of these countries are just a little bit different, does that support the idea that an individualized approach to vaccinating kids is a good idea?
Of course not!
In many countries, even if they are missing protection against a few diseases that we routinely vaccinate against in the United States, many get their vaccines earlier! And all start by three months and don’t split up the schedule to just give one or two vaccines at a time.
Everyone knows that later and slower just leaves kids unprotected for longer periods of time. More risks. No extra benefits.
Sherri Tenpenny wants us to stop calling chickenpox and measles diseases.
She thinks that we should call them infections instead…
Should I Stop Calling Chickenpox and Measles Diseases?
If you are like most people, you are probably thinking to yourself and maybe even shouting at your computer screen right now, “who cares what you call them, just get vaccinated and stop the outbreaks!”
Believe it or not, there is actually some precedent for changing the way we talk about diseases. While you may still refer to them as STDs, or sexually transmitted diseases out of habit, the prefererable term is actually STI, or sexually tranmistted infection.
Of course, this has nothing to do with Tenpenny’s reasoning.
“Why the change? The concept of ‘disease,’ as in STD, suggests a clear medical problem, usually some obvious signs or symptoms. But several of the most common STDs have no signs or symptoms in the majority of persons infected. Or they have mild signs and symptoms that can be easily overlooked. So the sexually transmitted virus or bacteria can be described as creating ‘infection,’ which may or may not result in ‘disease.’ This is true of chlamydia, gonorrhea, herpes, and human papillomavirus (HPV), to name a few.
For this reason, for some professionals and organizations the term ‘disease’ is being replaced by ‘infection.'”
ASHA on STDs/STIs
In fact, their definitions sound nothing like Tenpennys…
Unfortunately, many STIs, even if they aren’t causing symptoms and disease, can still be contagious.
Measles and chickenpox don’t do that. Although you can be contagious just before you start to have symptoms, you will very quickly develop symptoms.
It is true that some viruses and bacteria can lead to subclinical infections, in which you develop immunity without ever developing symptoms, but that doesn’t usually happen with measles and chicken pox.
Polio is one of the best examples of when it does happen. Remember, nearly 75% of kids who got polio never had any symptoms. Tragically, those symptoms could be severe in the small percentage who did.
If most adults aren’t immune because they haven’t been vaccinated or don’t get boosters, then since we aren’t seeing that many outbreaks, herd immunity itself must be a myth.
The thing is though, adults were either born in the pre-vaccine era and likely earned their natural immunity or were born in the vaccine era and are vaccinated and immune.
It is also important to understand that herd immunity is disease specific, so when we talk about herd immunity for measles, it doesn’t matter if everyone has herd immunity levels of protection against hepatitis A or Hib.
And adults do get a few boosters and some vaccines that are only recommended for adults, including the shingles vaccine.
In addition, some vaccines, like Hib and Prevnar, have indirect effects, protecting adults even though they aren’t vaccinated, because vaccinated kids are less likely to become infectious.
But back to the original question, how many adults are up to date on their immunizations?
“While modest gains occurred in vaccination coverage for pneumococcal, Tdap, hepatitis A (persons with chronic liver conditions), herpes zoster, and HPV vaccination, coverage did not improve for other vaccinations and many adults remained unvaccinated with recommended vaccines. “
Vaccination Coverage Among Adults in the United States, National Health Interview Survey, 2016
While most adults are immune to what were once common childhood diseases, like measles and mumps, because they were either vaccinated or had the disease naturally, many could do better with newer vaccines that weren’t available when they were kids.