Tag: vaccine myths

We Don’t Know How To Talk About Vaccines

There is a dirty little secret about vaccines that people don’t seem to like to talk about.

No, it’s not about toxins or autism.

“Our systematic review did not reveal any convincing evidence on effective interventions to address parental vaccine hesitancy and refusal. We found a large number of studies that evaluated interventions for increasing immunization coverage rates such as the use of reminder/recall systems, parent, community-wide, and provider-based education and incentives as well as the effect of government and school immunization policies.

However, very few intervention studies measured outcomes linked to vaccine refusal such as vaccination rates in refusing parents, intent to vaccinate, or change in attitudes toward vaccines.

Most of the studies included in the analysis were observational studies that were either under-powered or provided indirect evidence.”

Sadaf et al on A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy

It’s that we don’t really know how to talk about vaccines to vaccine hesitant parents, at least not in a way that we know will consistently get them to vaccinate and protect their kids.

Understanding Studies About Vaccine Hesitancy

Sure, a lot of studies have been done about talking to vaccine hesitant parents.

We have all seen the headlines:

  • Study: You Can’t Change an Anti-Vaxxer’s Mind
  • Pro-vaccine messages can boost belief in MMR myths, study shows
  • UWA study shows attacking alternative medicines is not the answer to get parents to vaccinate kids
  • Training Doctors To Talk About Vaccines Fails To Sway Parents

Does that mean that you shouldn’t try to talk to vaccine hesitant parents?

Of course not.

“How providers initiate and pursue vaccine recommendations is associated with parental vaccine acceptance.”

Opel et al on The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits

Just understand that these headlines are usually about small studies, which if they were about treating a child with asthma or strep throat,  likely wouldn’t change how you do things.

Why do anti-vaccine websites still post misinformation about fake recommendations to stop breastfeeding?
Why do people continue to believe misinformation about fake recommendations to stop breastfeeding?

In one study that concluded that “physician-targeted communication intervention did not reduce maternal vaccine hesitancy or improve physician self-efficacy,” the physicians got a total of 45 minutes of training!

So they shouldn’t have so much influence about how you might talk to parents about vaccines that you throw up your hands at the thought of talking to a vaccine hesitant parent and won’t even think about learning how to use the CASE method, why presumptive language might work, or about vaccination-focused motivational interviewing techniques.

The bottom line is that no matter what the headlines say, we just haven’t found the best way to talk to vaccine-hesitant parents and help them overcome their cognitive biases. And until more studies are done, none of the existing studies about anti-vaccine myth-busting should likely overly influence how you do things.

“Physicians should aim for both parental satisfaction and a positive decision to vaccinate. Researchers must continue to develop conceptually clear, evidence-informed, and practically implementable approaches to parental vaccine hesitancy, and agencies need to commit to supporting the evidence base. Billions of dollars fund the research and development of vaccines to ensure their efficacy and safety. There needs to be a proportional commitment to the “R&D” of vaccine acceptance because vaccines are only effective if people willingly take them up.”

Leask et al on Physician Communication With Vaccine-Hesitant Parents: The Start, Not the End, of the Story

If you spend any time talking to vaccine hesitant parents, especially those who are on the fence, you quickly learn that many are eager to get good information about vaccines and all want to do what is best for their kids.

It’s just hard for many of them to do what is best when their decisions are getting influenced by vaccine scare videos and many of the 100s of myths about vaccines that are out there.

“…while the drivers of vaccine hesitancy are well documented, effective intervention strategies for addressing the issue are sorely lacking. Here, we argue that this may be because existing strategies have been guided more by intuition than by insights from psychology and by the erroneous assumption that humans act rationally.”

Rossen et al on Going with the Grain of Cognition: Applying Insights from Psychology to Build Support for Childhood Vaccination

So while we need more studies on the best ways to talk to vaccine hesitant parents, don’t dismiss all of the ways that might be effective, such as:

It is also important to become familiar with the myths and anti-vaccine talking points that may be scaring your patients away from getting vaccinated on time.

Why is this important?

If a parent is concerned about glyphosate, you might not sound too convincing telling them not to worry if you don’t even know what glyphosate is.

What to Know About Vaccine Hesitancy Studies

While we learn better ways to talk about vaccines, so that vaccine-hesitant parents can more easily understand that vaccines are safe and necessary, don’t dismiss current strategies because of small studies and attention grabbing headlines.

More on Vaccine Hesitancy Studies

 

Vaccines and the HAZMAT Team Myth

Do unused vaccines need to be disposed of as hazardous waste?

If you drop a vaccine vial and it breaks, do you need to call in a HAZMAT team to clean it up?

If a HAZMAT team shows up a pediatricians office, it is probably because someone got sick from fumes - from burned popcorn...
If a HAZMAT team shows up a pediatricians office, it is probably because someone got sick from fumes – from burned popcorn… Photo by Kathy Nellis Chastney

Have you heard any of these anti-vaccine myths?

Would you be scared to vaccinate your kids if you had?

Vaccines and the HAZMAT Team Myth

While spilling elemental or metallic mercury, like by breaking a mercury filled glass thermometer (about 500mg of mercury), could release dangerous mercury vapors that need to be cleaned up carefully, vaccines never contained this type of elemental mercury that could vaporize like that.

And the amount of thimerosal or ethylmercury that used to be contained in vaccines, before it was removed beginning in 2000, was very small, even in multi-dose vial of vaccines.

Believe it or not, kids used to play with metallic mercury...
Believe it or not, kids used to play with metallic mercury… Photo by Bionerd (CC BY 3.0)

While you should be concerned if you drop a fluorescent light bulb in front of your kids, you don’t have to be if someone drops a vaccine vial.

And that being said, you don’t have to call a HAZMAT team if you break a CFL or other mercury containing light bulb, even though they might contain about 4,000mcg of mercury. As a precaution, you just let the room air out for out 10 minutes and then you carefully clean it up.

You don’t even have to call a HAZMAT team if you break a mercury thermometer, which can contain up to about 500,000mcg of mercury! Just let the area air out and then follow instructions to carefully clean it up.

How much mercury is in a typical multi-dose vaccine vial?

None.

But those that still contain thimerosal can contain up to 250mcg of ethylmercury per 10 dose vial. That’s about 6% of the amount of mercury that is in the light bulb (and 0.05% of the amount in the thermometer) and it is mixed with other ingredients, so you don’t have to worry about it being released as a mercury vapor.

And since you don’t have to call a HAZMAT team for the much larger quantities of metallic mercury in light bulbs and thermometers, why would you ever think you would have to for vaccine vials, which don’t even contain metallic mercury that can become a vapor that you can inhale?!?

Vaccines as Hazardous Waste

But if you don’t need a HAZMAT team, then how do you get rid of unused vaccines?

“In general, most empty vaccine vials are not considered hazardous or pharmaceutical waste and do not require disposal in a biomedical waste container. However, requirements for medical waste disposal are regulated by state environmental agencies so you should contact your immunization program or state environmental agency to ensure that your disposal procedures are in compliance with state and federal regulations.”

CDC on Vaccine Storage and Handling

It depends.

Still, most can be thrown away as medical waste.

Those that contain a preservative, like thimerosal, usually need to be thrown away in a hazardous waste container and disposed of through a hazardous waste disposal company.

Hazardous waste? Wait, doesn’t that mean HAZMAT?

No, but that’s where the myth likely comes from. Remember, you’re not supposed to throw out old CFLs in the trash either.

In the real world, most unused vaccines that are expired are simply returned to the manufacturer.

While having to deal with a hazardous waste disposal company sounds like a big deal, it is important to remember that almost all vaccines are now preservative free. The flu shot may still contain thimerosal, but the great majority,  at least 130 million doses, were preservative free this year.

So, few pediatricians likely have to deal with vaccines with preservatives or hazardous waste disposal companies. And hopefully they don’t have any old mercury thermometers lying around either.

That just leaves these myths about vaccines which never seem to go away…

What to Know About Vaccines and the HAZMAT Team Myth

Having to call a HAZMAT team to clean up after a broken vaccine vial is another myth about vaccines that is simply meant to scare you away from vaccinating and protecting your kids.

More on Vaccines and the HAZMAT Team Myth

Expert Statements on Vaccines and Autism

All of the organizations that help autistic people agree that there is no association between vaccines and autism.
All of the organizations that help autistic people agree that there is no association between vaccines and autism.

Some parents are still confused about who they should listen to for advice about vaccines and autism.

Is there any controversy or a real debate going on about whether vaccines are associated with autism?

What do the experts say?

They say that vaccines are not associated with autism.

More and more, experts are also stating that continuing to focus attention on vaccines is hurting autistic families.

And no, it’s not just one or two of them and it is not just your pediatrician…

Autism Science Foundation

“Multiple studies have been completed which investigated the measles, mumps and rubella vaccination in relation to autism. Researchers have also studied thimerosal, a mercury-based preservative, to see if it had any relation to autism. The results of studies are very clear; the data show no relationship between vaccines and autism.”

American Academy of Pediatrics

The American Academy of Pediatrics, an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists, has long advocated for the health and safety of our children.

“Claims that vaccines are linked to autism, or are unsafe when administered according to the recommended schedule, have been disproven by a robust body of medical literature. Delaying vaccines only leaves a child at risk of disease. Vaccines keep communities healthy, and protect some of the most vulnerable in our society, including the elderly, and children who are too young to be vaccinated or have compromised immune systems.”

The AAP has consistently emphasized the safety and importance of vaccines to help reassure parents who are scared by anti-vaccine misinformation.

Autistic Self-Advocacy Network

“Vaccinations do not cause autism – but the use of autism as a means of scaring parents from safeguarding their children from life-threatening illness demonstrates the depths of prejudice and fear that still surrounds our disability. Autism is not caused by vaccines – and Autistic Americans deserve better than a political rhetoric that suggests that we would be better off dead than disabled.”

Autism Society of America

“There is no known single cause for autism spectrum disorder, but it is generally accepted that it is caused by abnormalities in brain structure or function. Brain scans show differences in the shape and structure of the brain in children with autism compared to in neurotypical children. Researchers do not know the exact cause of autism but are investigating a number of theories, including the links among heredity, genetics and medical problems.”

Autism Women’s Network

“Vaccines do not cause autism. Neither does thimerosal.”

National Autistic Society

“In the light of concern around the continuing activities of anti-vaccine campaigners, including promotion of the film ‘Vaxxed’, we feel it’s important to restate that research has comprehensively shown that there is no link between autism and vaccines…

We believe that no further attention or research funding should be unnecessarily directed towards examining a link that has already been so comprehensively discredited. Instead, we should be focusing our efforts on improving the lives of the 700,000 autistic people in the UK and their families.”

Autistica

“The biggest myth of all is that vaccines, specifically the MMR vaccine, cause autism. The safety of vaccinations has been repeatedly tested across large groups of people. High quality research studies involving hundreds of thousands of people have consistently shown that vaccinations do not cause autism.”

Thinking Person’s Guide to Autism

“So I want to ask you to be careful about how you make your pro-vaccine arguments when autism is involved — because when we use our many many mountains of evidence in statements such as “there is NO evidence linking vaccines to autism” without adding the statement “and fear of autism hurts autistic people,” then we’re actually contributing to negative stereotypes about autism and autistic people, rather than furthering autistic people’s acceptance and inclusion in our society.”

American Medical Association

The American Medical Association, which was founded in 1847, has just over 240,000 members.

“Each year vaccines prevent an estimated 2.5 million deaths among children under age 5, according to the World Health Organization. The AMA adopted policy this week continuing its efforts to promote public understanding and confidence in the safety of vaccines in order to prevent resurgence in vaccine-preventable illnesses and deaths. The new policy specifically supports the rigorous scientific process undertaken by the Advisory Committee on Immunization Practices and its development of recommended immunization schedules for the nation. The policy also recognizes the substantial body of scientific evidence that has disproven a link between vaccines and autism.”

Centers for Disease Control and Prevention

“There is no link between vaccines and autism.”

March of Dimes

“The implication that vaccinations cause autism is irresponsible and counter productive,’ said Michael Katz, M.D., senior vice president for Research and Global Programs for the March of Dimes…

Although several carefully performed scientific studies have searched for a link between autism and the use of thimerosal in vaccines, no such link has been found.”

Autism Speaks

“Each family has a unique experience with an autism diagnosis, and for some it corresponds with the timing of their child’s vaccinations. At the same time, scientists have conducted extensive research over the last two decades to determine whether there is any link between childhood vaccinations and autism. The results of this research is clear: Vaccines do not cause autism.”

National Association of Pediatric Nurse Practitioners

“Despite an abundance of evidence that there is no correlation between the vaccine and autism, the story noted in the movie has unfortunately made a lasting impact. It is the responsibility of pediatric-focused advanced practice registered nurses (APRNs) and colleagues to speak out against false information and educate patient families about vaccine safety and efficacy to prevent unnecessary and potentially fatal outbreaks.”

American Academy of Child and Adolescent Psychiatry

“Years ago, some people questioned whether the onset of characteristic symptoms of autism coincided with the timing of immunizations. Since then, multiple studies conducted in several different countries have demonstrated that there is no causal association between vaccines and autism. Neither vaccines nor their preservatives increase the rate of autism compared to unvaccinated children. Vaccines do not change the timing of autism symptoms, nor is there any effect on autism severity. Even in families at greater risk for autism, for example, where there is already a child with autism, there is no increase in the likelihood that the second child will have autism if he or she is vaccinated. Recent studies have also demonstrated that brain changes associated with autism risk most likely occur before birth and well before any immunizations are ever administered.”

World Health Organization

“Available epidemiological data show that there is no evidence of a link between measles-mumps-rubella (MMR) vaccine and autism spectrum disorders. Previous studies suggesting a causal link were found to be seriously flawed.

There is also no evidence to suggest that any other childhood vaccine may increase the risk of autism spectrum disorders. In addition, evidence reviews commissioned by WHO concluded that there was no association between the use of vaccine preservatives such as thiomersal and autism spectrum disorders.”

Institute of Medicine

“Based on a thorough review of clinical and epidemiological studies, neither the mercury-based vaccine preservative thimerosal nor the measles-mumps-rubella (MMR) vaccine are associated with autism… Furthermore, the hypotheses regarding how the MMR vaccine and thimerosal could trigger autism lack supporting evidence and are theoretical only .”

Child Neurology Foundation

“There are many myths linked to vaccines that this article hopes to have helped dispel. As discussed, any potential risk associated with vaccines administered to healthy children is small and outweighed by the risk of the naturally occurring disease. Maintenance of herd immunity and avoidance of vaccine exemptions are critical. Both of these practices disproportionately affect, at times with deadly consequences, our youngest and most vulnerable citizens.”

Canadian Paediatric Society

“Thus, the evidence is in, and the assessment of purported causality is clear. The MMR vaccine and immunization with thimerosal-containing vaccines are not causally associated with, nor are they a cause of, autism or ASD. There is mounting evidence that ASD has a strong genetic component – a very plausible cause for the disorder.”

European Centre for Disease Prevention and Control

“Autism is such a strong and emotive issue and something we all care about. However, the link made by one doctor to autism has been firmly discredited, and I can show you study after study that demonstrates that there is no link between the MMR vaccine and autism. Unfortunately, once a seed of doubt has been planted it tends to grow, and is fueled by sensational media and internet coverage that isn’t concerned with the facts. The real issue here is the very real risks from not being protected. I wish the voices of those who have been victims of not getting vaccinated could be heard more loudly and clearly.”

Robert Koch Institute

“There has been an ongoing debate in recent years whether autism, diabetes and even multiple sclerosis could be triggered by vaccinations. To date, there is no evidence for this and there are numerous studies that suggest that there is no link between vaccinations and these diseases.”

Hopefully it is clear that these position statements about vaccines and autism come from experts around the world, including many that directly take care of and support autistic families.

What to Know About Expert Statements on Vaccines and Autism

There is no debate and it is not a controversy – experts agree – vaccines are not associated with autism.

More on Expert Statements on Vaccines and Autism

 

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

Vaccines Are Made in China!

It shouldn’t be a secret that vaccines are made in China.

There are over 1.3 billion people in China, and no, they don’t import all of their vaccines from the United States.

Neither does India, for all of their 1.2 billion people.

For example, the Serum Institute of India Pvt. Ltd. makes many vaccines, including:

  • GeneVac-B – hepatitis B
  • Quadrovax – DTP-Hib combo
  • Pentavac – DTP-HepB-Hib combo
  • Tresivac – MMR
  • Poliovac – polio
  • Triple Antigen – DTP
  • MenAfriVac – meningococcal group A
At least 34 manufacturers make vaccines for use in China, like this Hib vaccine.
At least 34 manufacturers make vaccines for use in China, like this Hib vaccine.

And there are over 34 vaccine manufacturers in China, including:

  • Chengdu Institute of Biological Products Co., Ltd
  • Hualan Biolgical Bacterin Co., Ltd
  • Jilin Brother Biotech Co., Ltd
  • Wuhan Institute of Biological Products
  • Lanzhouz Institute of Biological Products

These vaccine manufacturers in China, a mix of state run, private, and international joint ventures, help produce the vaccines used in China’s immunization program.

Some US vaccine companies even have vaccine manufacturing plants in China and other countries, but they make vaccines that are used in nearby parts of the world.

For example, Merck recently opened a new vaccine plant in Hangzhou, China to make vaccines to be used in the Asia Pacific region.

Should We Be Concerned About Vaccines Made in China?

If you are getting vaccinated in China, then you likely want to know more about where and how your vaccines are made. Everyone else should probably be wondering why anti-vaccine folks make such a fuss about this.

In addition to implying that vaccines are made under unsafe conditions, much of this anti-vaccine propaganda includes racist themes.

Parents who are concerned should understand that the United States doesn’t get any vaccines from China or India, or from Brazil, Cuba, Indonesia, or Russia for that matter.

The concern, of course, would be that it might be hard to test and verify these vaccines if they were.

“Following approval, FDA also carefully monitors the quality of vaccines—all manufactured lots must pass tests before they can be used. And as with all manufacturers of medical products, vaccine manufacturers must follow strict manufacturing standards. In addition, FDA conducts routine inspections of manufacturing sites.”

FDA on How does FDA assess the safety of vaccines?

Instead, vaccines that are used in the United States are made by:

  • Emergent Biosolutions – USA – Anthrax vaccine
  • ID Biomedical Corp – Canada – Fluvaval
  • GSK Vaccines – based in Belgium, but vaccines are made in Belgium (Boostrix, Cervarix, Energix-B, Havrix, Hiberix, Infanrix, MenHibrix, Kinrix, Pediarix, Rotarix), Germany (Boostrix, Fluarix, Infanrix, Kinrix, Pediarix, Rabavert), and Italy (Bexsero, Menveo)
  • MedImmune – USA – FluMist
  • Merck – USA – BCG, Gardasil9, MMRII, PedvaxHIB, PneumoVax23, ProQuad, RecombivaxHB, RotaTeq, Vaqta, Varivax, Zostavax are made at Merck’s vaccine manufacturing plants in West Point, Pennsylvania, Elkton, Virginia, and Durham, North Carolina
  • PaxVax – USA – their Vivotif typhoid vaccine is made in Thörishaus, Switzerland
  • Pfizer – USA – (Prevnar, Trumenba)
  • Protein Sciences Corporation – USA – Flublok
  • Sanofi Pasteur – Canada (Adacel, Daptacel, Pentacel), France (IPOL, Pentacel), USA (Menactra, YF-Vax, ),
  • Seqirus – USA – Afluria, Flucelvax, Fluvirin
  • Valneva (Intercell USA) -their  Japanese encephalitis vaccine (IXIARO) is made in Livingston, Scotland, UK
  • Valneva Sweden AB – their Dukoral cholera vaccine is made in Solna, Sweden

A little competition in the vaccine industry wouldn’t be a horrible thing though.

Vaccines are expensive

They are safe, but expensive. Necessary too.

What to Know About Vaccines Made in China

Although plenty of vaccines are made in China, the vaccines that are used in the United States are not, although anti-vaccine folks use this as a talking point to scare parents away from vaccinating and protecting their kids.

For More Information on Vaccine Manufacturer Sites:

Diphtheria in Canada

A lot of people were surprised by the news of a case of diphtheria in Canada this past week.

Some folks were quick to blame the anti-vaccine movement, assuming it was in an unvaccinated child.

News soon came that the child was vaccinated!

“I’ve always been on top of that, I’m a firm believer in immunizations.”

Mother of 10-year-old with diphtheria

What happened next?

Anti-vaccine folks began using the fact that he was vaccinated, but still developed diphtheria, as some kind of proof that vaccines don’t work.

The Case of Diphtheria in Canada

They are wrong.

The diphtheria vaccines have worked very well to control and eliminate diphtheria from Canada, just like it has in the United States.

Diphtheria has become rare since the pre-vaccine era.
Diphtheria has become rare since the pre-vaccine era.

So how did a vaccinated child in Canada get diphtheria?

It’s simple.

He has cutaneous diphtheria, not respiratory diphtheria.

What’s the difference?

“Extensive membrane production and organ damage are caused by local and systemic actions of a potent exotoxin produced by toxigenic strains of C. diphtheriae. A cutaneous form of diphtheria commonly occurs in warmer climates or tropical countries.”

Vaccines Seventh Edition

Cutaneous diphtheria occurs on your skin. It is usually caused by non-toxigenic strains of Corynebacterium diphtheriae.

On the other hand, respiratory diphtheria is usually caused by toxigenic strains of Corynebacterium diphtheriae.

Diphtheria strikes unprotected children.The diphtheria vaccine (the ‘D’ in DTaP and Tdap), a toxoid vaccine, covers toxigenic strains. More specifically, it covers the toxin that is produced by toxigenic strains of Corynebacterium diphtheriae. It is this toxin that produces the pseudomembrane that is characteristic of diphtheria.

It was the formation of this pseudomembrane in a child’s airway that gave diphtheria the nickname of the “strangling angel.”

So why the fuss over this case in Canada? They likely don’t yet know if it is a toxigenic strain. If it is, then it could be a source of respiratory diphtheria.

But remember, even if these kids developed an infection with the toxigenic strain of Corynebacterium diphtheriae, those that are fully vaccinated likely wouldn’t develop respiratory diphtheria. Again, it is the toxin that the bacteria produces that cause the symptoms of diphtheria. The vaccine protects against that toxin.

For example, when an intentionally unvaccinated 6-year-old in Spain was hospitalized with severe diphtheria symptoms a few years ago, although many of his friends also got infected, non of them actually developed symptoms because they were all vaccinated.

Diphtheria Is Still Around

Diphtheria is DeadlyTragically though, especially since diphtheria is still endemic in many countries, we are starting to see occasional lethal cases of diphtheria in many more countries where it was previously under control:

  • at least 7 diphtheria deaths in Venezuela this past year
  • a family that became infected in South Africa in which at least one child died (August 2017)
  • an unvaccinated 3-year-old who died in Belgium (2016)
  • a 22-year-old unvaccinated women who died in Australia (2011)

It is even more tragic that diphtheria is not under control in so many more countries.

In 2016, the WHO reported that there were just over 7,000 cases of diphtheria worldwide. While that is down from the 30,000 cases and 3,000 deaths in 2000, thanks to improved vaccination rates, there is still work to be done.

And as this recent case in Canada shows, diphtheria is still around in many more places than we would like to imagine.

Get educated. Vaccines are necessary.

What to Know About Diphtheria in Canada

The case of cutaneous diphtheria in Canada is a good reminder that vaccines are still necessary.

More on Diphtheria in Canada

The Vaccine-Friendly Plan Book Review

The Vaccine-Friendly Plan is the latest book about vaccines that claims to offer a “safe and effective approach to immunity and health.”

What’s the problem with it?

In addition to the fact that there doesn’t seem to be any evidence in the book to support that any of its ideas are indeed safe or effective, the book pushes just about every anti-vaccine talking point out there today.

Misinformation in The Vaccine-Friendly Plan

If you want to skip or delay some of your child’s vaccines and are looking for something to help you feel better about your decision, then this is the book for you.

While Dr. Thomas and Jennifer Margulis talk about providing balanced information, it was right after he stated that “I realized we had poisoned a generation of children with a mercury-derived preservative called thimerosal” and then goes on to talk about how kids are overvaccinated.

So much for balanced information…

But Dr. Thomas isn’t just worried about vaccines. He is also worried about Tylenol, that the chemicals in plastics are endocrine disruptors, GMOs, flame retardants, pesticides, fluoride, artificial sweeteners, chemical dyes, and all of the other toxins that other doctors and the CDC supposedly ignore.

What about the “science” that supports his ideas?

Sure, he is quick to cherry pick studies that support the ideas he likes and label them as “important studies” among “a growing body of evidence,” but if the studies don’t, then they are “a handful of poorly designed, anecdotal studies.”

We see a lot of other anti-vaccine propaganda techniques in the book too.

“Giving a quadruple live-virus vaccine to a toddler is a mistake. When a toddler catches an illness naturally, he does not catch all four at once. I have serious concerns about hitting the immune system of a twelve-month-old baby with four live viruses, even though they are weakened.”

Does Dr. Thomas understand how the immune system works or how many different things our immune systems get “hit” with each and every day? Children are exposed to a lot of live, unweakened viruses and other germs every day and fight them off just fine.

Dr. Thomas also routinely downplays the risks of vaccine-preventable diseases (they all seem to be easily treatable in his world), overstates the risks of vaccines (they all seem to be full of horrible poisons in his world), makes heavy use of anecdotes, repeatedly makes it sound like every other pediatrician is doing something wrong, and again, makes full use of anti-vaccine talking points to scare parents:

To see how silly his arguments are, consider that when talking about giving any amount of formula to a baby, he is quick to say that “Cow’s milk is for calves, human milk is for human babies.”

“I also know several strapping young people who drank bottles of raw goat’s milk (instead of store-bought formula) when their breastfeeding mothers needed to be away from them for several hours…”

Raw goat milk is for kids = baby goats. Don't give it to your baby!
Raw goat milk is for kids = baby goats. Don’t give it to your baby! Photo by Shannon McGee (CC BY-SA 2.0)
But what about goat milk?

Is it just for baby goats?

You won’t hear this from Dr. Thomas, but unless your ‘kid’ is a baby goat, don’t give him raw goat milk!

So what’s the take home message about Dr. Thomas and his book?

Despite his frequently using the word science in the book, the only “science” in The Vaccine-Friendly Plan is that it is full of pseudoscience.

You can even see this in his ideas about gluten sensitivity. Why do so many of his patients show a sensitivity to gluten? He uses an IgG food sensitivity test that most experts say is basically worthless.

Making a Case for Getting Vaccinated

Perhaps the only good thing about Dr. Paul Thomas’ book is that he makes some very good cases for why you should vaccinate your kids.

Wait, what?

His introduction starts off with the story of the death of his three-year-old playmate in Africa. Tragically, the child died of measles.

Like many other pediatricians, he also talks about “the miracle that the Hib vaccine was when it was introduced in 1985.”

“Then in 2012 I had about twenty children in my practice with pertussis: eighteen were school age kids, and two were infants. Interestingly, fifteen of the twenty were fully immunized for pertussis, and the other five were from the small group of families in my practice who refuse all vaccines.”

His story about pertussis in his practice is also very interesting, but not for the reason that Dr. Thomas believes.

Consider that most kids are vaccinated, even in Dr. Thomas’ practice, so the fact that 25% of the kids who got pertussis are unvaccinated means a very high attack rate among unvaccinated children. So even with the problems of waning immunity with the pertussis vaccine, you are still much better off to be vaccinated and protected, even if that protection isn’t perfect.

“Since I opened my practice in 2008, not a single child has received the rotavirus vaccine. I refuse to stock it. Yet only one child in seven years has been hospitalized for severe dehydration. The unvaccinated children in my practice either are not getting rotavirus, or the illness is so mild that it requires no intervention.”

And so much for vaccine choice. How can his patients make a decision to get vaccinated if he doesn’t even have the vaccine?!?

But why don’t they get rotavirus? It is not because the vaccine doesn’t work or isn’t necessary. It is actually called being a free-rider or hiding in the herd.

Like most vaccines, the rotavirus vaccine works and helps create community immunity.

The Most Dangerous Advice in The Vaccine-Friendly Plan

Unfortunately, the dangerous advice in this book extends well beyond repeatedly telling parents to “say no thank you” to multiple vaccines and to delay others.

The advice to “decline vaccines” during pregnancy has to be right up there with the most dangerous advice in his book, but you be the judge…

“It depends on the medication, but the short answer is that it’s best to avoid all over the counter and prescription medications during pregnancy.”

Unbelievably, Dr. Thomas really seems to say that pregnant mothers should try to stop their antidepressants because “women respond differently to pregnancy hormones and some who struggle with mental health issues find the high estrogen and progesterone of pregnancy actually improve mood and mental health.”

He also thinks that it is “reasonable” to skip your baby’s vitamin K shot because of “worrisome ingredients,” like polysorbate 80 and aluminum.

“If bilirubin levels remain extremely high – above 20 – for over a week or two, some of the bilirubin can enter the brain, where it can cause permanent brain damage called kernicterus.”

Hopefully most parents are aware that you don’t want to wait “a week or two” to seek treatment if you baby’s jaundice level is above 20.

And hopefully most parents also understand that:

  • the cutoff for fever in newborns is 100.4°F (38°C) or higher, not 100.6°F (38.4°C)
  • co-sleeping and letting your baby sleep on your chest are not safe things to do
  • skipping an evaluation and antibiotics when mom is GBS positive after delivery and she develops a fever (possible chorioamnionitis) is not a safe thing for baby, especially if mom already skipped getting antibiotics during her delivery  – it’s called gambling that the baby won’t develop early-onset invasive group B streptococcal disease. Several studies have found very high numbers of newborns in this situation with positive blood cultures, even though they had no symptoms.
  • if your pediatrician recommends that your child needs treatment for congenital hip dysplasia (which is actually now called Developmental Dysplasia of the Hip), then you should probably listen, instead of hoping it goes away on its own by wearing “your baby on your front or back with his legs splayed.”
  • you shouldn’t put your baby in direct sunlight without sunscreen for ten to fifteen minutes every day
  • there is no need to routinely check your baby’s vitamin D level – just give a supplement if you are exclusively breastfeeding
  • until polio is eradicated, the risk of getting polio is higher than zero and that all of his unvaccinated kids are at risk even if they don’t travel outside the US, like the outbreak among the Amish in 2005
  • children die from meningococcal disease because it is a severe and terrible disease that progresses very quickly, not because “we pediatricians – so quick to intervene in other, unnecessary ways – fail to listen to a worried mother, dismiss her concerns as “hysterical,” and send a sick child home…” In one study, “Most children had only non-specific symptoms in the first 4-6 h, but were close to death by 24 h.”
  • preschoolers do not need to routinely take 2,000IU of vitamin D each day – the current recommendation is 600IU if they are not getting enough from the foods they are eating and drinking and 2,000IU only if they have been diagnosed with a vitamin D deficiency
  • about 4,200 women die of cervical cancer in the United States each year, something Dr. Thomas fails to mention when he says that “some strains of HPV can lead to slow-growing, highly treatable cancers.”

Although the whole book is dangerous, these are serious errors that can harm kids, and it is unbelievable that Penguin Random House would publish this book as a Medical/Parenting book. After all, this is the same company that published NeuroTribes!

Conspiracy Theories in The Vaccine-Friendly Plan

No good anti-vaccine book would be complete without some good old conspiracy theories.

Dr. Thomas doesn’t disappoint!

“It took me years to realize something I still wish were not true but which you cannot ignore if you want to have a healthy baby in America today: Our government officials and a handful of well-positioned M.D.’s who advise them have ignored some of the most important peer-reviewed studies and most relevant scientific information about immunity and health, both during pregnancy and throughout infancy.”

Dr. Paul Thomas

What else has he got?

  • the polio vaccines didn’t eliminate polio in the US, instead, it could have been “chlorinating water in public swimming pools” – it wasn’t
  • “severe reactions to the HPV vaccine are actually much more common than parents are being told” – they aren’t, even Diane Harper says the HPV vaccines are safe
  • rotavirus deaths in the pre-vaccine era are “inaccurate and misleading” because they are estimated numbers “based on a retrospective study that looked at morbidity associated with diarrheal disease between 1968 and 1991,” – except that Dr. Thomas looked at the wrong study. The estimates for hospitalizations and deaths in the pre-vaccine era come from a different study that looked at “Hospitalizations and Deaths from Diarrhea and Rotavirus among Children <5 Years of Age in the United States, 1993–2003.” Oops.
  • most flu-like illnesses are not really the flu, which “makes it impossible to distinguish influenza infections from other viruses,” unless you go to his office, where he tests kids for the flu – except that using the influenza-like illness (ILI) case definition has a high positive predictive value during flu season and many doctors and hospitals also do rapid flu testing

Do you really believe that it was the chlorine in swimming pools that eliminated polio in the United States? Or that he has found a magic way to avoid autism by drinking filtered water, avoiding GMOs, eating organic, whole foods, and following a non-standard, parent-selected, delayed protection vaccine schedule?

What to Know About The Vaccine-Friendly Plan

The Vaccine-Friendly Plan is a dangerous book that not only panders to parent’s fears about vaccines, it goes out of its way to increase those fears by pushing misinformation, telling parents to skip and delay vaccines, and giving other unsafe pediatric and parenting advice.

The only reason to pick it up is because you are looking for some confirmation bias to make you feel better about a decision to not vaccinate your child. If you read it because you were on the fence about vaccines, please consider doing a little more research.

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