There is a concern that they were “substandard,” or that they might not work as well as they should.
That’s not good either though.
Getting a substandard vaccine might mean that you could get a disease that you thought you were vaccinated and protected against.
Still, since the scandal seems limited to a few companies (well, really just one company) and a few vaccines (just rabies and DTaP), it is very unlikely that many people in other countries have been affected.
“WHO assessed the national regulatory authorities in 2010 and 2014, and found that they met WHO criteria as a functional regulator for vaccines with a clear commitment to continual improvement. WHO welcomes the fact that China’s NDA continues to work with WHO’s Regulatory Systems Strengthening program, as it has been doing for nearly 20 years. While the current incident is clearly regrettable, the detection of this event by an unannounced inspection shows that the regulatory authority’s system of checks and balances to protect population health is working.”
WHO Statement on Rabies Incident in China
It is also important to realize that:
affected vaccines include 650,000 doses of DTaP vaccine, which were only sent to Chongqing and the provinces, of Shandong and Hebei. And while they initially passed testing for safety and efficacy before being released for distribution, later, routine testing found low titer testing in vaccines from two companies, Changchun Changsheng Life Sciences Ltd. and Wuhan Institute of Biological Products, who’s vaccines were recalled. Batch numbers have been published, so parents should be able to figure out if they got one of these vaccines.
problems with rabies vaccines from Changchun Changsheng Life Sciences Ltd. were discovered on a routine inspection and before the vaccine had been released for distribution. Unfortunately, the problem is that they made up production and inspection records, which is why at least 15 people from the company have been arrested. This is the scandal.
While some folks are concerned of more widespread problems, it is important to keep in mind that vaccines have been working in China. Despite these recent problems, China is polio-free and has “significantly reduced vaccine-preventable diseases such as measles, mumps, rubella, and hepatitis A and B among children.”
If there were a big problem with the effectiveness of their vaccines, they should be seeing more disease. And they aren’t.
And in places that are seeing more disease, like Europe, with their measles outbreaks and deaths, it is clearly unvaccinated folks that are getting sick.
“If you are unsure as to whether or not your child was vaccinated, the doctor can have their blood tested for antibodies to determine their immunity to certain diseases. However, these tests may not always be accurate, so the doctor may not be sure your child is truly protected. In some cases, doctors may prefer to revaccinate your child anyway for best protection. It is safe for your child to be revaccinated, even if your child received that vaccine in their birth country.”
CDC on Adoption and Vaccines
If you are still concerned about vaccines that your child may have gotten in China, either because you were living in China when your child was vaccinated or your child was adopted from China, remember that you can always have those vaccines repeated.
Until and if we get further guidance on this issue from the WHO, CDC, or AAP, neither seems to be necessary for what seems to be an isolated problem right now.
Update on the Vaccine Scandal in China
There have been a few updates since the initial news of the vaccine scandal in China, including that:
at least 10 officials with the State Food and Drug Administration and the State Drug Administration have been fired and 35 non-centrally-administered officials will be held accountable
an additional 247,200 DTaP vaccines from Changchun Changsheng Life Sciences Ltd. have been found to be substandard
And there are reports of some parents going to Hong Kong to get their kids vaccinated.
Vaccine Scandals in China
Tragically, these aren’t the first vaccine scandals in China.
there were reports of kids getting sick in 2016 in Shandong providence after getting vaccines that had not been stored properly
there were reports of kids getting sick in 2015 after getting expired vaccines in Henan province
in 2013, several infant deaths were blamed on hepatitis B vaccines, but they were later determined to be coincidental
And before that, in 2010, at least four children reportedly died in Shanxi province after getting what were said to be improperly stored vaccines.
While improperly stored vaccines could become contaminated, getting kids sick, it is unlikely that they would get sick from expired vaccines, which might just be less effective than newer vaccines.
What to Know About Vaccine Scandals in China
While it is horrible that anyone put profits before safety when it comes to keeping kids safe from vaccine-preventable disease, it would also be terrible to further use the China vaccine scandals to scare parents away from vaccinating and protecting their kids.
That’s one of the reasons that it is important for everyone to be vaccinated, so that herd immunity levels of protection can protect those who can’t get vaccines.
Vaccines After Cancer and Chemotherapy
But what happens after they complete their cancer treatments?
“The interval until immune reconstitution varies with the intensity and type of immunosuppressive therapy, radiation therapy, underlying disease, and other factors. Therefore, often it is not possible to make a definitive recommendation for an interval after cessation of immunosuppressive therapy when inactivated vaccines can be administered effectively or when live-virus vaccines can be administered safely and effectively.”
Red Book on Immunization in Immunocompromised Children
After they complete therapy for cancer, whether it is chemotherapy or a bone marrow transplant, many children need to get extra vaccines.
In the UK, for example, 6 months after completing “standard antileukemia chemotherapy,” children get a booster dose of DTaP, IPV, Hib, MenC, and MMR.
Why just a single booster dose?
Because most kids can continue to get non-live vaccines on schedule while they are getting standard chemotherapy. They get a booster dose when they finish chemotherapy because those vaccine doses they got while receiving treatment might not be as effective as usual and typically don’t count as valid doses.
Of course, if they were missing any doses, then they might need extra doses to catch up too.
“Three months after cancer chemotherapy, patients should be vaccinated with inactivated vaccines and the live vaccines for varicella; measles, mumps, and rubella; and measles, mumps, and rubella-varicella according to the CDC annual schedule that is routinely indicated for immunocompetent persons.”
2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host
In contrast to those getting standard chemotherapy, if treatment involved a hematopoietic stem cell transplant (HSCT), then these children are essentially revaccinated:
beginning at 6 months after the HSCT, they should get 3 doses of DTaP if they are less than 7-years-old vs a dose of Tdap and 2 doses of Td if they are already 7-years-old
beginning at 3-6 months after the HSCT, they should get 3 doses of Prevnar
beginning at 6-12 months after the HSCT, they should get 3 doses of Hib
beginning at 6-12 months after the HSCT, they should get 3 doses of hepatitis B, followed by postvaccination anti-HBs titer testing
beginning at 6-12 months after the HSCT, they should get 3 doses of IPV
beginning at 6-12 months after the HSCT, they should get 2 doses of a meningocococcal vaccine (if they are already 11 to 18 years old)
beginning at 6-12 months after the HSCT, they should get 3 doses of HPV vaccine (if they are already 11 to 26 years old)
beginning at 12 months after the HSCT, one dose of the Pneumovax vaccine
beginning at 24 months after the HSCT, two doses of MMR
beginning at 24 months after the HSCT, two doses of the chicken pox vaccine
a yearly flu shot
Why not just check titers instead of repeating all of those vaccines?
“protective” concentrations or titers in this population may not be as valid as in healthy children, leaving open the question regarding what levels to use as the basis for revaccination. Furthermore, there are some vaccines for which no serological correlate of protection exists (e.g., pertussis) or for which, in routine practice, it is too difficult to have levels measured (e.g., polio).
Soonie R. Patel et al. on Revaccination of Children after Completion of Standard Chemotherapy for Acute Leukemia
In Canada, they used to check titers at 1, 3, and 5 years after the end of chemotherapy and just vaccinate when titers dropped, but they switched to giving all kids a booster dose, as it works better.
What will your child’s immunization look like after completing treatment for cancer?
Although the specific recommendations will come from your child’s treatment team, they will likely look something like the guidelines included here.
What to Know About Vaccines After Cancer and Chemotherapy
Kids often have to get revaccinated, or at least get booster doses of their vaccines, after completing treatment for cancer.
At least they do when you get the right vaccine at the right time and it is given properly. If an error is made, sometimes a vaccine dose needs to be repeated.
When a Vaccine Doesn’t Count and Needs to Be Repeated
While it would be unfortunate to have to repeat a vaccine dose, in most cases, if you didn’t, it would leave the child without full protection.
Why might a vaccine dose not count?
Although it doesn’t happen often, it is possible that:
the wrong vaccine was given
the vaccine was given too early, either before the next dose was due or when the child was too young. Although there is some leeway for when most vaccines can be given, there are still some specific rules to follow, especially the minimum time between doses, the earliest age you can get a dose, and the age requirement for booster doses. (sticking to the standard immunization schedule can help avoid these types of errors)
the vaccine was mixed improperly (many vaccines are now premixed, making this error less likely to occur)
part of the vaccine leaked out when it was being injected, which can happen when kids move, if they aren’t being held well as the shot is being given (rotavirus doses aren’t repeated if a child spits up though)
there is a range of recommended ages for most vaccines
there is a range of recommended ages for catch-up immunization, which is basically an accelerated immunization schedule, which is why infants can typically start getting their vaccines as early as age 6 weeks and get the first few sets as early as 4 weeks apart
Also, you typically have a grace period, during which early vaccine doses will still count.
“…administering a dose a few days earlier than the minimum interval or age is unlikely to have a substantially negative effect on the immune response to that dose. Known as the “grace period”, vaccine doses administered ≤4 days before the minimum interval or age are considered valid…”
AICP on Timing and Spacing of Immunobiologics
The grace period doesn’t count for the rabies vaccine and while it is an ACIP guideline, it might be superseded by local or state mandates. The grace period also can’t be used to shorten the interval between two live vaccines, which must be at least 28 days.
One last way to get away without repeating an invalid dose would be checking your child’s titers.
When Do You Repeat the Invalid Vaccine Dose?
The next question that comes up after you realize that you have to repeat a dose of a vaccine is when should you repeat it?
give the correct vaccine as soon as possible if the problem was that the wrong vaccine was given
repeat the dose as soon as possible if the problem was an expired, improperly stored, or a dose that had leaked out
if the dose was given too early, then you need to wait for the appropriate interval or when your child is old enough to get the dose. Keep in mind that when you repeat the dose, you would generally restart counting your interval from the invalid dose, not from the previous dose. That’s because the invalid dose might interfere with mounting a good immune response.
Well, there have been studies warning people about giving Tylenol before vaccines. It had nothing to do with side effects though. They suggested that a vaccine might be less effective if the child got Tylenol before his vaccines. It is important to note that they never really found that the vaccines didn’t work as well, as all of the kids in the study still had protective levels of antibodies, they were just a little lower than kids who didn’t get Tylenol.
Other studies have found the same effect if Tylenol was given after a child got his vaccines. Although interestingly, other studies have found that giving Tylenol after vaccines does not affect antibody titers.
“Antibody titres to diphtheria and tetanus toxoids and pertussis bacteria of the placebo (n = 25) and acetaminophen (n = 34) groups did not differ significantly from each other. It is concluded that acetaminophen in a single dose schedule is ineffective in decreasing post-vaccination fever and other symptoms.”
Uhari et al on Effect of prophylactic acetaminophen administration on reaction to DTP vaccination
The only thing that this had to do with side effects though, is that the kids who got Tylenol had a little less fever.
What about the association of MMR, Tylenol and autism? Although one study did suggest that to be true, the study, a parental survey, was found to be “fatally flawed.”
Can I Give My Kids Tylenol When They Have Their Vaccines?
So, can you give your kids Tylenol when they get their vaccines?
The better question is, should you give your kids Tylenol either before or after they get their vaccines?
Notwithstanding the very small chance that giving Tylenol might cause decreased immunogenicity (lower antibody production) if you give it before your kids get their vaccines, since there is a good chance that they won’t have any pain or fever and won’t even need any Tylenol, then why give it?
Skip the “just in case” dose and wait and see if they even need it.
What about afterwards?
If your kids have pain or fever and are uncomfortable, then you should likely give them something for pain or fever control, such as an age appropriate dose of either acetaminophen or ibuprofen. Will that cause lower antibody production? Maybe. Will that mean that their vaccines won’t work. That’s doubtful. It certainly won’t lead to increased side effects though, unless they a reaction to the dose of Tylenol itself.
Should you give a pain or fever reducer after a vaccine “just in case?” Again, there is a good chance that your kids might not need it, so it is likely better to wait and see if they do, instead of giving a dose automatically after their shots.
There is even some evidence that giving acetaminophen or ibuprofen before vaccines, or as a routine dose right after, especially with booster shots, doesn’t really prevent side effects that well anyway. They work better if given on an as needed basis instead, and these kinds of doses are less likely to be associated with decreased antibody production.
What to Know About Tylenol and Vaccines
Giving a pain or fever reducer either before or after your child’s vaccinations likely won’t affect how it works, but since it often isn’t necessary, it is likely best to only given one, like Tylenol or Motrin, if it is really needed.
And that brings up to a few very easy ways to avoid getting quarantined during an outbreak:
make sure you are always up-to-date on all of your vaccines
if you think that you have natural immunity (already had the disease) or were vaccinated, but don’t have your immunization records, then getting a titer test might keep you out of quarantine if you can prove that you are immune
“Persons who continue to be exempted from or who refuse measles vaccination should be excluded from the school, child care, or other institutions until 21 days after rash onset in the last case of measles.”
Manual for the Surveillance of Vaccine-Preventable Diseases
That’s right, especially in the case of measles, you can often avoid being quarantined if you simply get vaccinated.
Why are quarantines important?
Can’t you just isolate yourself if you get sick?
The problem with that strategy is that you are often contagious before you develop symptoms. That’s especially true of measles, when you likely won’t even realize that you have measles until you get the measles rash, after having a high fever for three to five days. That’s why people with measles are often seen at clinics and emergency rooms multiple times, exposing many people, before they are finally diagnosed. It is the classic signs of a rash with continued fever that helps to make the diagnosis.
Without quarantines of unvaccinated people, especially those who are known exposures to other cases, today’s outbreaks would be even bigger and harder to control.
If you don’t want to take the risk of being quarantined and missing weeks or months of school or work, then don’t take the risk of being unvaccinated. Tragically, that’s not the only risk you take when you skip or delay your vaccines. In addition to getting sick, you also risk getting others sick, including those who didn’t have a choice about getting vaccinated yet.
What to Know About Avoiding Quarantines During an Outbreak
The easiest way to avoid getting caught up in a quarantine for a vaccine-preventable disease is to simply make sure your kids are up-to-date on all of their vaccines.