Tag: vaccines work

The Myth That Polio Only Went Away Because They Changed the Way It Was Diagnosed

Have you heard this one?

“Before the vaccine was developed, the diagnosis of polio required 24 or more hours of paralysis. After the vaccine release, the diagnosis changed to at least 60 days of paralysis. As you can imagine, cases of polio dropped significantly.”

So that’s why polio went away?

It wasn’t the vaccine?

The Myth That Polio Went Away Because They Changed the Diagnostic Criteria

In 1952, there were 21,000 cases of paralytic polio in the United States.

But were there really?

Didn’t they change the way they diagnosed polio a few years later, right after the first polio vaccines came out, making it less likely that folks would be diagnosed with polio?

The original diagnostic criteria for polio came from the World Health Organization and included:

“Signs and symptoms of nonparalytic poliomyelitis with the addition of partial or complete paralysis of one or more muscle groups, detected on two examinations at least 24 hours apart.”

It changed in 1955 to include residual paralysis 10 to 20 days after onset of illness and again 50 to 70 days after onset.

Why?

“In the past children’s paralysis was often not correctly diagnosed as polio. Stool samples need to be analyzed to be able to distinguish paralytic symptoms from Guillain-Barré Syndrome, transverse myelitis, or traumatic neuritis.”

Polio – Data Quality and Measurement

But you coulld’t just use stool samples, as many kids might have recently had non-paralytic polio, and could test positive for polio (false positive test), but have another reason to have paralysis.

“Isolation of poliovirus is helpful but not necessary to confirm a case of paralytic poliomyelitis, and isolation of poliovirus itself does not confirm diagnosis.”

Alexander et al. on Vaccine Policy Changes and Epidemiology of Poliomyelitis in the United States

Since polio causes residual paralysis, the new diagnostic criteria helped to make sure that kids were diagnosed correctly.

Did We Overestimate the Number of Kids with Polio?

Some folks think that since we changed the criteria, we overestimated the number of kids with polio in the years before the vaccine came out.

Most of this idea seems to come from a panel discussion in 1960 by critics of the original polio vaccine, The Present Status of Polio Vaccines, including two, Dr. Herald R. Cox and Dr. Herman Kleinman, who were working on a competing live-virus vaccine.

None in the group were arguing against vaccines, or even really, that the Salk polio vaccine didn’t work at all though. They just didn’t think that it was effective as some folks thought.

“I’ve talked long enough. The only other thing I can say is that the live poliovirus vaccine is coming. It takes time. The one thing I am sure of in this life is that the truth always wins out.”

Dr. Herald R. Cox on The Present Status of Polio Vaccines

Dr. Cox did talk a lot about the oral polio vaccine. He talked about successful trials in Minneapolis, Nicaragua, Finland, West Germany, France, Spain, Canada, Japan, and Costa Rica, etc.

When anti-vaccine folks cherry pick quotes from The Present Status of Polio Vaccines discussion panel, they seem to leave out all of the stuff about how well the oral polio vaccine works.

That’s how they work to scare parents and hope that their anti-vaccine myths and misinformation can win out over the truth that vaccines work and that they are safe and necessary.

“Since nothing is available, there seems to be no alternative but to push the use of it. I don’t think we should do so in ignorance, nor too complacently, believing that as long as we have something partially effective there is no need to have something better.”

Dr. Bernard Greenberg on The Present Status of Polio Vaccines

And of course, they did, fairly soon, switch to something better – the Sabin live-virus oral polio vaccine.

Interestingly, using the idea that we changed the diagnostic criteria to make polio go away in an argument about vaccines is known as the Greenberg Gambit.

It tells you something about anti-vaccine arguments, that these folks are misinterpreting something someone said about vaccines almost 60 years ago.

In pushing the idea that polio hasn’t been eliminated, but rather just redefined, they also miss that:

But isn’t polio still around and just renamed as transverse myelitis, Guillain-Barré syndrome (GBS), and aseptic meningitis?

Let’s do the math.

Using the adjusted numbers in the The Present Status of Polio Vaccines discussion, there were at about 6,000 cases of paralytic polio in the United States in 1959.

While 3,000 to 6,000 people in the United States develop Guillain-Barré syndrome each year, the risk increases with age, and it is rare in young kids. Remember, paralytic polio mostly affected younger children, typically those under age 5 years.

“Transverse myelitis can affect people of any age, gender, or race. It does not appear to be genetic or run in families. A peak in incidence rates (the number of new cases per year) appears to occur between 10 and 19 years and 30 and 39 years.”

Transverse Myelitis Fact Sheet

Similarly, transverse myelitis is uncommon in younger children, and there are even fewer cases, about 1,400 a year.

What about aseptic meningitis? That doesn’t usually cause paralysis.

So do the math.

You aren’t going to find that many kids (remember, the incidence was 5-7 per 1,000) under age 5 years who really have “polio,” but instead, because of a worldwide conspiracy about vaccines, are getting diagnosed with transverse myelitis, Guillain-Barré syndrome (GBS), or aseptic meningitis instead.

Anyway, kids with acute flaccid paralysis are thoroughly tested to make sure they don’t have polio. And both transverse myelitis and Guillain-Barré syndrome have different signs and symptoms from paralytic polio. Unlike polio, which as asymmetric muscle atrophy, the atrophy in transverse myelitis and Guillain-Barré syndrome is symmetrical. Also, unlike those other conditions that cause AFP, with polio, nerve conduction velocity tests and electromyography testing will be abnormal. Plus, polio typically starts with a fever. The other conditions don’t.  So while these conditions might all be included in a differential diagnosis for someone with AFP, they are not usually that hard to distinguish.

“Each case of AFP should be followed by a diagnosis to find its cause. Within 14 days of the onset of AFP two stool samples should be collected 24 to 48 hours apart and need to be sent to a GPEI accredited laboratory to be tested for the poliovirus.”

Polio – Data Quality and Measurement

But why be so strict on following up on every case of AFP?

It’s very simple.

If you miss a case of polio, then it could lead to many more cases of polio. And that would tmake it very hard to eradicate polio in an area.

If anything, until the establishment of the Global Polio Eradication Initiative (GPEI) in 1988, it is thought that cases of polio and paralytic polio were greatly underestimated in many parts of the world!

And now polio is almost eradicated.

“DR. SABIN: Let us agree, at least, that things are not being brushed aside. Let us say that we might disagree on the extent to which certain things have received study. But I hope that Dr. Bodian realizes that nobody is brushing things aside. I would not have taken the trouble of spending several months studying viremia with different strains in chimpanzees and human volunteers, and viremia produced by certain low temperature mutants to correlate it with their invasive capacity, if I were merely brushing it aside.”

Live Polio Vaccines – Papers Presented and Discussions Held at the First International Conference on Live Poliovirus Vaccines

There is no conspiracy.

Think about it.

If they redefined how paralytic polio was diagnosed in 1955 as part of a conspiracy to make it look like the polio vaccines were working, then why did the number of cases continue to drop into the 1960s?

Shouldn’t they have just dropped in 1955 and then stayed at the same lower level?

After the switch to the Sabin vaccine, polio was on its way to being eliminated in the United States.
After the switch to the Sabin vaccine, polio was on its way to being eliminated in the United States, although there was an uptick in 1959, before we made the switch.

And why don’t any of the folks with other conditions that cause paralysis, like transverse myelitis and Guillain-Barré syndrome (GBS) ever have polio virus in their system when they are tested?

Also, if the renaming theory explains why the polio vaccine didn’t work, then why do anti-vaccine folks also need to push misinformation about DDT and polio?

What to Know About Polio Myths and Conspiracies

The near eradication of polio from the world is one of the big success stories of the modern era, just as those who push the idea that has all been faked is a snapshot of society at one of our low points.

More on Polio Myths and Conspiracies

Has the United States’ Infant Mortality Rate Ranking Been Dropping as We Vaccinate More Kids?

Of all of the myths about vaccines that confuse and scare some parents, those about infant mortality rates can be especially hard to easily put aside.

After all, why doesn’t the United States rank better for infant mortality rates since most parents do vaccinate and protect their kids?

Vaccines and Infant Mortality Rates

That’s actually fairly easy to answer.

“Globally, the infant mortality rate has decreased from an estimated rate of 64.8 deaths per 1000 live births in 1990 to 30.5 deaths per 1000 live births in 2016.”

WHO on Infant Mortality Situation and Trends

Vaccine-preventable diseases don’t have much effect on infant mortality rates in the United States these days.

What does?

  • birth defects
  • premature births
  • SIDS
  • maternal complications of pregnancy
  • injuries

Think about it… If vaccines did increase infant mortality rates, then why would infant mortality rates be dropping as we vaccinate more kids?

Has the United States’ Infant Mortality Rate Ranking Been Dropping as We Vaccinate More Kids?

The Wisconsin Coalition for Informed Vaccination is pushing myths about SIDS and vaccines.
The Wisconsin Coalition for Informed Vaccination is pushing myths about infant mortality rates and vaccines.

Do you know what has been dropping?

The infant mortality rate.

In fact, infant mortality rates continue to drop and are now at their lowest levels ever.

While it is good news that the rate is dropping, most folks think they can be better.

For one thing, some states, like Mississippi, Louisiana, Alabama, Arkansas, and West Virginia, etc., have much higher infant mortality rates than others. Why? Much of those differences, can be explained by socio-economic factors. That’s also though to explain much of the differences in infant mortality rates between the U.S. and other developed countries, most of which have universal health care.

New Jersey, although they have ranked high for autism rates, has lower than average rates of infant mortality.
New Jersey, although they have ranked high for autism rates, has lower than average rates of infant mortality.

Another big difference is that many countries count infant mortality rates using different criteria than the United States.

For example, it is estimated that at least 40% of the differences between infant mortality rates in the United States and other countries is due to those countries not counting extremely preterm births among their statistics.

But why has the United States’ infant mortality ranking fallen relative to other developed nations?

Most European Countries had much higher infant mortality rates than the US in the 1960s and 70s, which affected relative rankings, even as all countries saw infant mortality rates fall.
OECD data shows that most European Countries have historically had much higher infant mortality rates than the US, which have affected relative rankings, even as all countries have seen infant mortality rates fall.

Although anti-vaccine groups try to tie this to ‘routine vaccination,’ it is easy to see that other countries have historically had much higher infant mortality rates than the United States. As they have caught up, the United States’ ranking has dropped relative to theirs, even though all have seen infant mortality rates drop.

Infant Mortality Rates in the Pre-Vaccine Era

But if you really want to understand the relationship of vaccines to infant mortality rates, you just have to look back to the pre-vaccine era. Back then, now vaccine-preventable diseases did have a big effect on infant mortality rates in the United States and elsewhere.

In 1910, for example, the most common causes of death for infants under 1 year were:

  1. diarrhea and enteritis
  2. premature birth
  3. congenital debility
  4. bronchopneumonia
  5. pneumonia
  6. malformations
  7. bronchitis
  8. convulsions
  9. injuries at birth
  10. whooping cough
  11. tuberculosis
  12. meningitis
  13. measles
  14. accident
  15. diphtheria

Although advances in modern medicine would help decrease the mortality from many of those diseases, it was vaccines that truly worked to make sure they were no longer a big part of our infant mortality statistics.

How will we continue to decrease our infant mortality rates?

Most experts think that it will require better access to health care for all members of society.

What to Know About Infant Mortality Rate Rankings

Infant mortality rates are not linked to vaccines.

More Infant Mortality Rate Rankings

What Are the Benefits of the Flu Shot?

So that flu shot you got isn’t going to be 100% effective this year…

That doesn’t mean that you didn’t make a great decision getting your family vaccinated and protected! Or that you shouldn’t still take the time to go out and get a flu shot if you haven’t yet.

The flu vaccine works, even if it isn’t perfect.

Benefits of the Flu Shot

The benefits of the flu shot go far beyond just avoiding the flu.
The benefits of the flu shot go far beyond simply helping you avoid the flu. Most flu related deaths in children are in those who are unvaccinated.

What good is the flu shot if it doesn’t completely eliminate your risk of catching the flu?

How about the simple fact that even if doesn’t completely eliminate that risk 100%, a flu shot does decrease your risk of getting sick with the flu?

But it doesn’t end there.

Other benefits of a yearly flu shot include that it can:

  • reduce the risk of flu-associated death in children with underlying high-risk medical conditions by just over half (51%)
  • reduce the risk of flu-associated death in healthy children by just over two thirds (65%) – this is important, because despite what most people believe, many of the kids who die with the flu each year don’t have any underlying health problems
  • reduce how sick you get, even if you do get the flu, reducing “deaths, intensive care unit (ICU) admissions, ICU length of stay, and overall duration of hospitalization among hospitalized flu patients.”
  • reduce the risk of the babies getting hospitalized in their first 6 months when pregnant moms got a flu shot
  • reduce asthma attacks leading to emergency visits and/or hospitalizations in people with asthma

Getting vaccinated can also reduce the risk that you get sick with the flu and get someone else sick.

Considering all of these benefits, it is hard to imagine why anyone wouldn’t get a flu shot, even in year’s when it might just be 60% or even 40% effective.

I mean, it isn’t like the flu shot is actually going to give you the flu or anything…

Have you gotten your flu shot yet this flu season?

What to Know About the Benefits of the Flu Shot

In addition to helping you avoid getting sick with the flu, getting a yearly flu shot has many other indirect benefits, so that even if you get the flu, it can help you avoid getting really sick and ending up in the hospital, ICU, or getting so sick that you don’t survive.

More on the Benefits of the Flu Shot

Updated February 17, 2018

Diphtheria in Canada

Breaking News – there is a new case of diphtheria in Canada (June 2018), and no, according to health officials, this one is not cutaneous diphtheria.

A lot of people were surprised by the news of a case of diphtheria in Canada last year.

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 more and more lethal cases of diphtheria, including cases in many more countries where it was previously under control:

  • at least 142 diphtheria deaths in Venezuela since 2016, among about 1,602 cases
  • at least 85 deaths in Yemen, among about 1,584 cases since 2017
  • at least six deaths among Rohingya refugees in Bangladesh
  • at least two cases of diphtheria in Ukraine
  • 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

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

More on Diphtheria in Canada

Updated on June 25, 2018

Efficacy vs Effectiveness of Vaccines

According to the CDC:

Vaccine efficacy and vaccine effectiveness measure the proportionate reduction in cases among vaccinated persons.

But what’s the difference between vaccine efficacy and effectiveness?

Vaccine efficacy is used when a study is carried out under ideal conditions, for example, during a clinical trial.

Vaccine effectiveness is used when a study is carried out under typical field (that is, less than perfectly controlled) conditions.

Postlicensure studies can often help figure out vaccine effectiveness. For example, the study “Varicella Vaccine Effectiveness in the US Vaccination Program: A Review,” that appeared in The Journal of Infectious Diseases in 2008 “reviewed the results of postlicensure studies of varicella vaccine effectiveness and compared these results with those of prelicensure efficacy trials.”

That study of the chicken pox vaccine found that “the estimates of effectiveness are lower than the prelicensure efficacy,” although several studies found the vaccine “100% effective in preventing combined moderate and severe varicella.”

For More Information On Efficacy vs Effectiveness of Vaccines: