Answers To Frequently Asked Questions About Immunizations
Not surprisingly, many parents have the same questions about immunizations and they want answers to reassure themselves that they are doing the right thing for their kids by getting them vaccinated and protected.
“In POTS, the lightheadedness or fainting is also accompanied by a rapid increase in heartbeat of more than 30 beats per minute, or a heart rate that exceeds 120 beats per minute, within 10 minutes of rising.”
NIH Postural Tachycardia Syndrome Information Page
POTS or postural orthostatic tachycardia syndrome was first identified in the early 1990s and can cause many debilitating symptoms, such as dizziness, headaches, and fatigue.
“The term “POTS” was coined in 1993 by a team of researchers from Mayo Clinic, led by neurologist Dr. Philip Low. However, POTS is not a new illness; it has been known by other names throughout history, such as DaCosta’s Syndrome, Soldier’s Heart, Mitral Valve Prolapse Syndrome, Neurocirculatory Asthenia, Chronic Orthostatic Intolerance, Orthostatic Tachycardia and Postural Tachycardia Syndrome.”
Dysautonomia International on POTS
Well, we know that POTS is caused by a malfunction of the patient’s autonomic nervous system (dysautonomia), but we don’t know always know what causes or triggers that malfunction.
Sometimes we do though, as POTS has been associated with other types of dysautonomia, like Ehlers-Danlos Syndrome and Mast Cell Disorders.
And genetics may play a role in some people with POTS.
“Anyone at any age can develop POTS, but the majority of individuals affected (between 75 and 80 percent) are women between the ages of 15 to 50 years of age.”
NIH Postural Tachycardia Syndrome Information Page
As more people were becoming aware of POTS, some of them were getting vaccinated for HPV.
But that correlation certainly doesn’t mean that vaccines cause POTS.
“POTS is a condition that causes lightheadedness or fainting and a rapid increase in heartbeat upon standing. The cause is unknown, but doctors think POTS may be associated with a number of risk factors and syndromes, including: a recent viral illness, physical deconditioning, chronic fatigue syndrome and nervous system problems.”
In 2015, the European Medical Association confirmed evidence that HPV vaccines do not cause complex regional pain syndrome (CRPS) and postural orthostatic tachycardia syndrome (POTS)
A review of VAERS reports that “did not detect any unusual or unexpected reporting patterns that would suggest a safety problem” with HPV vaccination, including extra cases of POTS
A study in the UK using the MHRA’s Yellow Card passive surveillance scheme found no increase in reports of chronic fatigue syndromes following the introduction of Cervarix
A large, nationwide register-based study from Norway found no indication of increased risk of chronic fatigue syndrome/myalgic encephalomyelitis following HPV vaccination
A large cohort study of over 2 million young girls in France found no risk for autoimmune diseases (including neurological, rheumatological, hematological, endocrine, and gastro-intestinal disorders)
A large cohort study of girls in Sweden with pre-existing autoimmune diseases found that HPV vaccination was not associated with increased incidence of new-onset autoimmune disease (49 types of autoimmune diseases)
“There is currently no conclusive evidence to support a causal relationship between the HPV vaccine and POTS. It is of utmost importance to recognize that although temporal associations may be observed, conclusions of causality cannot be drawn from case reports and case series due to the small sample size and lack of control population inherent to this type of scientific literature. If POTS does develop after receiving the HPV vaccine, it would appear to do so in a small subset of individuals and would be difficult to distinguish from the normal prevalence and incidence of the disorder.”
Butts et al on Human Papillomavirus Vaccine and Postural Orthostatic Tachycardia Syndrome: A Review of Current Literature
What about other vaccines? Could they cause POTS?
While the focus has been on the HPV vaccines, an issue with other vaccines causing POTS would have been picked up with our current vaccine safety systems.
But why has the focus been on the HPV vaccines?
It is an easy association to notice, after all POTS begins to occur right around when the HPV vaccines are given (teen years) and the HPV vaccines are given in many different countries. Most other vaccines that we give to teens in the United States, including Tdap and the meningococcal vaccines, aren’t as widely used in other countries.
But remember, POTS isn’t a new diagnosis. That anti-vaccine groups are latching onto it to scare parents away from vaccinating and protecting their kids is.
What to Know About Vaccines and POTS
There is no evidence that vaccines, especially the HPV vaccines, cause POTS.
Most people understand that measles can be deadly.
“Measles is a highly contagious, serious disease caused by a virus. Before the introduction of measles vaccine in 1963 and widespread vaccination, major epidemics occurred approximately every 2–3 years and measles caused an estimated 2.6 million deaths each year.”
WHO Measles Fact Sheet
In the United States alone, in the pre-vaccine era, “an average of 549,000 measles cases and 495 measles deaths were reported annually.”
That roughly translates into about one death for every 1,000 cases, or a case-fatality rate of about 0.1%.
That’s in line with the typical case-fatality rate of measles of 0.1 to 0.2%.
Just How Deadly Is Measles?
Not surprisingly, many others have reported a similar case-fatality rate for measles.
Because of a 1989 report that said that “Before measles vaccine was available, more than 400,000 measles cases were reported each year in the United States. However, since virtually all children acquired measles, the true number of cases probably exceeded 4 million per year (i.e., the entire birth cohort).”
Their idea is that if there were more cases (i.e., the entire birth cohort), then even if almost 500 people died each year, the extra cases would make the death rate lower.
There are a lot of problems with that reasoning though…
For one thing, 500 people dying each year of a now vaccine-preventable disease is a lot of people, no matter how you to frame it!
And the traditional stat about the measles fatality rate clearly mentions that this is about reported cases.
You can’t change the number of measles cases to a theoretical number, the entire birth cohort, and keep the number of deaths based on the number of reported cases, and think that you are still talking about the same thing. What if deaths from measles were under-reported too?
“Death from measles was reported in approximately 0.2% of the cases in the United States from 1985 through 1992.”
CDC Pink Book
And there are plenty of more recent statistics, when far fewer people were getting measles, that show a similar case fatality rate.
What Is the Measles Fatality Rate?
How else do we know that The Physicians for Informed Consent is misinforming people?
“…any parent who has seen his small child suffer even for a few days with persistent fever of 105 F, with hacking cough and delirium, wants to see this prevented…”
Alexander D Langmuir, MD on the Medical Importance of Measles
Their measles ‘information’ sheet, made by folks who have likely never treated a child with measles, say that “most measles cases are benign.”
That’s a bit different than Dr. Langmuir’s 1962 account of how the typical child suffered with measles and why he welcomed the new measles vaccine.
“Nevertheless, a resurgence of measles occurred during 1989–1991, again demonstrating the serious medical burden of the disease. More than 55,000 cases, 123 deaths, and 11,000 hospitalizations were reported”
Orenstein et al on Measles Elimination in the United States
What was the case fatality rate during the measles outbreaks in the late 1980s?
It was a little over 0.2%. Did we again under-count cases or was the case-fatality rate so high because most of the cases were in younger, preschool age children?
Anyway, whether the case fatality rate is 1 in 1,000 or 1 in 10,000 (the UK lists their measles case fatality rate at 1 in 5,000), it doesn’t mean that someone will die when you hit case number 1,000, 5,000, or 10,000. It could be the 1st case in an outbreak or the 15,000th.
Measles can be deadly. That’s why most of us choose to have our kids vaccinated and protected.
Do you know how many people had measles in the 2013 outbreak in Brooklyn when a pregnant woman developed measles and had a miscarriage? The outbreak that was started by an unvaccinated teenager included a total of 58 cases.
How about the 2015 outbreak in Clallam County, Washington in which an immunocompromised woman died of pneumonia due to measles? There were only five other cases, almost all unvaccinated.
And in many European countries last year, many of the deaths are in countries with few cases. When the 17-year-old unvaccinated girl in Portugal died, there were just 31 cases. In Switzerland, a vaccinated man with leukemia died in an outbreak with just 69 cases. There were only 163 cases when an unvaccinated 10-month-old died in Bulgaria. And there were fewer than 1,000 cases in Germany when a partially vaccinated mother of three children died.
More Myths About Measles
The Physicians for Informed Consent pushes a lot of other myths and misinformation about measles:
about using vitamin A to treat measles – where this works, in developing countries, untreated measles has a case fatality ratio of 5 to 40% because of malnutrition! It isn’t usually thought to be very helpful in an industrial country without malnutrition. And no, simply having a picky eater or one who eats a lot of junk food doesn’t mean that he will be helped by vitamin A if he gets measles
about using immunoglobulin to treat measles – the MMR vaccine and immune globulin can be used for post-exposure prophylaxis, but it is not a treatment once you have measles!
they misuse VAERS data to try and say the MMR vaccine is more dangerous than getting measles
The Physicians for Informed Consent even talks about benefits of getting measles, but somehow leaves out any talk about the risk of getting SSPE after a natural measles infection.
What else do they leave out? The idea that people who survive a measles infection can have some immunosuppression for up to two to three years! This measles-induced immune damage puts them at risk of dying from other diseases and helps explain why kids who are vaccinated against measles are also less likely to die from other childhood infections.
They even published a press release claiming that they “recently reported in “The BMJ” that every year about 5,700 U.S. children suffer seizures from the measles, mumps and rubella (MMR) vaccine.”
Their report? It was a “letter to the editor” that anyone can submit online…
According to the CDC, from 2006 to 2016, at least 3,153,876,236 doses of vaccines were distributed in the United States. These are the vaccines that are covered by the National Vaccine Injury Compensation Program, such as DTaP, MMR, Hepatitis A and B, HPV, and flu, etc.
That’s over 286 million doses each year!
How about worldwide?
That’s harder to know, but consider that the World Health Organization reports that 85% of infants worldwide, or almost 100 million infants, get at least:
3 doses of DTP
3 doses of hepatitis B
at least one doses of measles
3 doses of polio
Plus, an increasing number are getting vaccines to protect them against Hib, pneumococcal disease, rotavirus, HPV, meningitis A, mumps, rubella, tetanus, and yellow fever.
“UNICEF supplies vaccines reaching 45 per cent of the world’s children under five years old as part of its commitment to improving child survival.”
How many vaccine doses are we talking about?
A lot. UNICEF alone buys 2.8 billion doses of vaccines each year! Those vaccines are then distributed to children in over 100 countries.
Vaccine-Preventable Disease Statistics
As impressive as the number of vaccines that are given each year are the numbers about what happens when we give vaccines:
there are 2 to 3 million fewer deaths in the world each year because people are vaccinated and protected
in developing countries, every $1 spent on vaccines provides $16 in direct benefits, but that goes up to $44 when you take “into account the broader economic impact of illness”
for children born in the United States during “1994–2013, routine childhood immunization was estimated to prevent 322 million illnesses (averaging 4.1 illnesses per child) and 21 million hospitalizations (0.27 per child) over the course of their lifetimes and avert 732,000 premature deaths from vaccine-preventable illnesses,” and it also “will potentially avert $402 billion in direct costs and $1.5 trillion in societal costs because of illnesses prevented”
only two countries continue to have wild polio – Afghanistan and Pakistan – and together, they only had 21 cases in 2017
A lot happened in regards to vaccines when Reagan was President. After all, he was the President who signed the National Childhood Vaccine Injury Act (NCVIA) of 1986, which created VAERS and the NVICP!
What else happened?
“…the Reagan Administration starved the Federal program for childhood immunization…”
The Shame of Measles
That’s right, Federal support for vaccine programs reached a low point during Reagan’s years in office, as rates of children living in poverty and without health insurance also increased.
That’s not a good mix!
“During the Reagan years, the price of vaccine went up and Federal funding for childhood immunization went down.”
So even if Federal funding for vaccines had stayed the same, it would essentially have been a big cut!
“Measles is a wholly preventable disease, and it was almost eradicated from the country in 1983, when only 1,497 cases were reported. But by 1990, after Federal budget cuts and the end of the Government’s monitoring of immunization programs, more than 30,000 cases of measles and more than 60 deaths were reported.”
Panel Ties Measles Epidemic to Breakdown in Health System
All of this followed President Jimmy Carter’s National Childhood Immunization Initiative in 1977, which reached its goal of immunizing over 90% of children!
Not surprisingly, this followed a growth in federal grants from $5 million to $35 million towards state immunization budgets. Yes, it costs money to get kids vaccinated and protected. But don’t forget that it costs even more money to control outbreaks once they start.
“Immunization policy during the Carter Administration demonstrated that when both an administration and key congressional actors viewed immunization as a priority and made sufficient funds available to support the public health delivery system and its infrastructure, coverage levels would continue to rise and disease levels continue to decline.”
Johnson et al on Federal immunization policy and funding: A history of responding to crises
Unfortunately, the coverage levels and growth during the Carter administration weren’t sustained for very long after Reagan took office in 1981.
As can be expected, neither were declines in rates of measles.
Instead, we eventually saw big outbreaks of measles across the United States. From 1989 to 1991, at least 123 people died among 55,000 cases, with another 11,000 hospitalized.
“The measles outbreak of 1989–1991 exposed many incorrect assumptions behind the belief that low levels of coverage were sufficient to control the transmission of infectious disease. The changing demographics of society, the mixing of young children in day care settings, new patterns of health care delivery, high rates of uninsured children, and the shrinking size and morale of health departments all fostered circumstances in which disease transmission occurred within major metropolitan areas even though disease reports were low, and state health officials believed statewide immunization coverage was at acceptable levels.”
Calling the Shots: Immunization Finance Policies and Practices
How did it get fixed?
President George HW Bush announced his own immunization action plan to raise vaccinated rates, and we once again put more Federal money into our immunization programs.
Immunization rates went up and the outbreaks stopped.
The President and the Children
Outbreaks that didn’t have to happen.
A 1987 op-ed in the New York Times warned about was coming and how to prevent it…
“Each dollar spent to immunize young children saves $10 in later medical costs. Yet in 1985, one of four children between ages 1 and 4 was not immunized for rubella, mumps, polio or measles and 13 percent lacked immunization for diphtheria, tetanus and pertussis. Congress would increase funding by about $20 million, enough to immunize 600,000 more youngsters.”
The Reagan administration didn’t listen.
Are we headed for something similar in the years ahead?
the Children’s Health Insurance Program (CHIP) expired on September 30 and it has yet to be reauthorized
the short-term CHIP “fix” took $750 million cut from the Prevention and Public Health Fund, which provides 40% of the total funding for the CDC’s immunization program
the Section 317 Immunization Program was already slated for a big drop in President Trump’s FY 2018 Budget
So we may have fewer kids with insurance and less money for immunization programs.
When did we last see that scenario?
Take Action and remind Congress and our President of the “critical role” they play in protecting our children and that they should #PutKidsFirst.
“As Members of Congress, we have a critical role to play in supporting the availability and use of vaccines to protect Americans from deadly disease.”
Sens. Lamar Alexander et al Dear Colleague Letter
“Supporting the availability and use of vaccines” does not mean decreasing funding for vaccine programs!
And protecting “Americans from deadly disease” certainly does not mean having fewer people covered on insurance plans.
What to Know About Ronald Reagan’s Vaccine Policy
Ronald Reagan essentially starved the Federal program for childhood immunization, which led to lower vaccine rates and deadly outbreaks of measles. Let’s not allow history to repeat itself.
It is mostly because they think that anything bad that happens after someone is vaccinated, even if it is weeks or months later, must have been caused by the vaccine.
“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
Of course, this discounts that fact that most people have a basic risk, often called the background rate, for developing most of these very same conditions, and they can just coincide with getting vaccinated.
Put more simply, the “reaction” would have happened whether or not they had been vaccinated.
“…when a number of well-controlled studies were conducted during the 1980s, the investigators found, nearly unanimously, that the number of SIDS deaths temporally associated with DTP vaccination was within the range expected to occur by chance. In other words, the SIDS deaths would have occurred even if no vaccinations had been given.”
WHO on Six Common Misconceptions About Immunization
That doesn’t mean that everything automatically gets blamed on coincidence though.
Is It a Vaccine Reaction?
When trying to determine if a child has had a vaccine reaction, experts typically go through a series of questions, looking at the evidence for and against :
How soon after the vaccine was given did the reaction occur? Was it minutes, hours, days, weeks, months, or years later?
Is there any evidence that something else could have caused the reaction?
Is there a known causal relation between the reaction and the vaccine?
Is there evidence that the vaccine does not have a causal association with the reaction?
Do any lab tests support the idea that it was a vaccine reaction?
Why is it important to consider these and other questions?
Because most of us are very good at jumping to conclusions, are quick to place blame, and like to know the reasons for why things happen.
We don’t like to think that things are just caused by coincidence.
Post hoc ergo propter hoc (after this, therefore, because of this).
We are especially good at linking events and often automatically assume that one thing caused another simply because it occurred afterwards.
It is incident to physicians, I am afraid, beyond all other men, to mistake subsequence for consequence.
Dr Samuel Johnson
But we also know that correlation does not imply causation. And because of the great benefits of vaccines, it is important to find strong evidence for a correlation before we blame vaccines for a reaction.
Too often though, the opposite happens. Despite strong evidence against a correlation, parents and some pediatricians still blame vaccines for many things, from SIDS and encephalitis to autism.
Background Rates vs Vaccine Reactions
Although anti-vaccine folks are always calling for vaccinated vs unvaccinated studies to further prove that vaccines are indeed safe, much of that work is already done by looking at the observed rate of possible reactions and comparing them to the background rate of reactions and conditions.
We often know how many people are expected to develop certain conditions, from seizures and type 1 diabetes mellitus to acute transverse myelitis and juvenile and rheumatoid arthritis.
“On the basis of the reviewed data, if a cohort of 10 million individuals was vaccinated in the UK, 21.5 cases of Guillain-Barré syndrome and 5.75 cases of sudden death would be expected to occur within 6 weeks of vaccination as coincident background cases. In female vaccinees in the USA, 86.3 cases of optic neuritis per 10 million population would be expected within 6 weeks of vaccination. 397 per 1 million vaccinated pregnant women would be predicted to have a spontaneous abortion within 1 day of vaccination.”
Black et al on Importance of background rates of disease in assessment of vaccine safety during mass immunisation with pandemic H1N1 influenza vaccines
Intussusception is a good example of this.
This might surprise some folks, but we diagnosed and treated kids with intussusception well before the first rotavirus vaccines were ever introduced. And then, it was only after the risk of intussusception after vaccination exceeded the background rate that experts were able to determine that there was an issue.
“Knowledge of the background incidence rates of possible adverse events is a crucial part of assessing possible vaccine safety concerns. It allows for a rapid observed vs expected analysis and helps to distinguish legitimate safety concerns from events that are temporally associated with but not necessarily caused by vaccination.”
Gadroen et al on Baseline incidence of intussusception in early childhood before rotavirus vaccine introduction, the Netherlands, January 2008 to December 2012
Fortunately, studies have never found an increased risk above the background rate for SIDS, non-febrile seizures, and other things that anti-vaccine folks often blame on vaccines. So when these things happen on the same day or one or two days after getting vaccinated, it almost certainly truly is a coincidence. It would have happened even if your child had not been vaccinated, just like we see these things happen in the days before a child was due to get their vaccines.
For example, using background incidence rates in Danish children, one study found that if you vaccinated a million children with a new flu vaccine, you could expect that naturally, after seven days, you would see:
facial nerve palsy – one case
seizures – 36 cases
multiple sclerosis – one case
type 1 diabetes – three cases
juvenile and rheumatoid arthritis – three cases
After six weeks, those numbers of course go up. In addition to 4 kids developing MS, 20 develop diabetes, 19 develop arthritis, and 218 have seizures, and there would have been at least two deaths of unknown cause.
Would you blame the flu shot for these things?
What flu shot?
This was a “hypothetical vaccine cohort” that used 30 years of data from the Danish healthcare system to figure out background rates of each condition.
“In addition, the expected number of deaths in Japan following an estimated 15 million doses of H1N1 vaccine administered would be >8000 deaths during the 20 days following vaccination, based on the crude mortality rate.”
McCarthy et al on Mortality Rates and Cause-of-Death Patterns in a Vaccinated Population
Looking at background rates is especially helpful when folks report about vaccine deaths.
Using the Japan example that McCarthy studied, if they had looked at background rates, then all of a sudden, the 107 deaths they found after 15 million doses of H1N1 vaccine were given in 2009 would not have been so alarming. Background rates would have predicted a much, much higher number of deaths to naturally occur in that time period simply based on crude mortality rates.
Vaccines are safe and many of the things that folks think are vaccine reactions can be explained by looking at the background rates for these conditions and understanding that they would have happened anyway.
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.
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.
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
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.
“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.
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.