Tag: VAPP

Are Fewer Than 1% of Vaccine Injuries Reported to VAERS?

It is a common anti-vaccine argument that fewer than 1% of vaccine injuries are reported to VAERS.

I've found that fewer than 1% of anti-vaccine signs are true...
I’ve found that fewer than 1% of anti-vaccine signs are true…

They even think that they have evidence from Harvard to support their claim!

Are Fewer Than 1% of Vaccine Injuries Reported to VAERS?

Do they?

Are fewer than 1% of vaccine injuries reported to VAERS?

It has long been suspected that reports to VAERS are under-reported, as it is a passive reporting system.

The original claims for under-reporting to VAERS were based on an old study about drug reactions and were not specific to vaccines though.

Is that the Harvard study?

Nope.

“Restructuring at CDC and consequent delays in terms of decision making have made it challenging despite best efforts to move forward with discussions regarding the evaluation of ESP:VAERS performance in a randomized trial and comparison of ESP:VAERS performance to existing VAERS and Vaccine Safety Datalink data. However, Preliminary data were collected and analyzed and this initiative has been presented at a number of national symposia.”

Electronic Support for Public Health–Vaccine Adverse Event Reporting System (ESP:VAERS)

They are talking about a report, Electronic Support for Public Health–Vaccine Adverse Event Reporting System (ESP:VAERS), that was conducted at Harvard Pilgrim Health Care, Inc.

“Preliminary data were collected from June 2006 through October 2009 on 715,000 patients, and 1.4 million doses (of 45 different vaccines) were given to 376,452 individuals. Of these doses, 35,570 possible reactions (2.6 percent of vaccinations) were identified.”

Electronic Support for Public Health–Vaccine Adverse Event Reporting System (ESP:VAERS)

It is very important to note that all the study found is that all possible reactions, including minor reactions, like pain and fever, are not common.

They didn’t actually finish the report to see how commonly those reactions were reported to VAERS.

But we already know that more serious reactions are reported to VAERS much more routinely.

“Sensitivities ranged from 72% for poliomyelitis after the oral poliovirus vaccine to less than 1% for rash and thrombocytopenia after the MMR vaccine.”

Rosenthal et al on The reporting sensitivities of two passive surveillance systems for vaccine adverse events

And there has even been a more recent report, Advanced Clinical Decision Support for Vaccine Adverse Event Detection and Reporting, which also used an ESP-VAERS system, that found great improvements in reporting of adverse events to VAERS.

Even more importantly, even with it’s limitations, VAERS works!

“Despite its limitations, VAERS effectively detected a possible problem soon after introduction of RRV-TV in the United States.”

Lynn R. Zanardi, et al on Intussusception Among Recipients of Rotavirus Vaccine: Reports to the Vaccine Adverse Event Reporting System

Although it would be ideal to have even more reports sent to VAERS, time and again, we have seen that VAERS works.

“On November 23, 2010, the combination of the coding term “febrile convulsion” and the Fluzone(®) TIV product exceeded a predetermined threshold in the VAERS database. By December 10, we confirmed 43 reports of febrile seizure following TIV in children aged 6-23 months. Clinical features of most reports were consistent with typical uncomplicated febrile seizures, and all children recovered. Further epidemiologic assessment of a possible association between TIV and febrile seizures was undertaken in a separate, population-based vaccine safety monitoring system.”

Leroy et al on Febrile seizures after 2010-2011 influenza vaccine in young children, United States: a vaccine safety signal from the vaccine adverse event reporting system.

As we have seen, for VAERS to work, we don’t need all side effects and reactions to be reported.

“VAERS is primarily a safety signal detection and hypothesis generating system. Generally, VAERS data cannot be used to determine if a vaccine caused an adverse event. VAERS data interpreted alone or out of context can lead to erroneous conclusions about cause and effect as well as the risk of adverse events occurring following vaccination.”

Shimabukuro et al on Safety monitoring in the Vaccine Adverse Event Reporting System (VAERS).

Also, VAERS is not the only safety system that we have to make sure that our vaccines are safe.

The other thing that folks should understand? Most reports to VAERS are not actually vaccine injuries…

More on the Percentage of Reports to VAERS

How Long Do Side Effects of Immunizations Last?

Immunizations are safe, but they can have some risks and side effects.

Vaccine side effects can be reported to VAERS online or using a downloadable form.
Vaccine adverse events can be reported to VAERS online or using a downloadable form.

Fortunately, most are fairly mild, like pain and fever.

How Long Do Side Effects of Immunizations Last?

And most vaccine side effects go away quickly.

For example, fever and fussiness, two of the most common vaccine reactions, typically only lasts a day or two.

Others can last a little longer, but still usually go away on their own:

  • when kids get a rash after their MMR vaccine, it might last three or four days
  • even when kids get swelling of an entire arm or leg after the DTaP shot is given, it might last for 1–7 days
  • pain at the injection site typically only lasts a few days
  • shoulder injury related to vaccine administration (SIRVA) can last months and sometimes doesn’t go away
  • arthritis after a rubella containing vaccine, which mostly occurs in adults, typically only lasts a few days
  • febrile seizures are usually brief and rarely lead to non-febrile seizures
  • immune thrombocytopenic purpura (ITP) after a measles containing vaccine resolves in two weeks to six months, typically without any treatment
  • intussusception after a rotavirus vaccine resolves with treatment, either an air contrast enema or surgery
  • Guillain-Barré Syndrome after a seasonal flu vaccine, which is very rare, resolves in the majority of people over a period of years

Do any have more long lasting effects?

VAPP or vaccine-associated paralytic polio after the oral polio vaccine might not resolve. Fortunately, it only occurs in about 1 in every 1.27 million children receiving their first dose of OPV. It is even less common after bOPV, which is oral polio vaccine that is now being used. And won’t happen at all once we stop using oral polio vaccines.

Encephalitis or encephalopathy after a pertussis or a measles, mumps, and rubella virus containing vaccine might also lead to long lasting effects.

And some, like anaphylaxis, are life-threatening.

Fortunately, most long-term vaccine studies have shown that immunizations are safe, rarely causing severe reactions, and don’t have many long term side effects.

What to Know About How Long Immunization Side Effects Last

Most vaccine side effects are mild and only last a few days.

More on Immunization Side Effects

What Is the Morbidity/Mortality Rate of the Polio Vaccine vs the Wild Virus?

Some anti-vaccine folks still think that the risks of vaccines are far greater than the risks of the vaccine-preventable diseases they keep you from getting.

As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks.
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

They aren’t, but you can kind of understand why they might think that with a disease like polio, when they might never actually have known anyone to have the disease.

What Is the Morbidity/Mortality Rate of the Polio Vaccine vs the Wild Virus?

Still, even though polio is under good control and close to being eradicated, the risk/benefit ratio clearly favors getting vaccinated and protected.

That’s because the polio vaccines are very safe and if we stopped vaccinating, polio could come back.

In fact, morbidity/mortality from polio vaccines are decreasing, as we are using much less oral polio vaccine (OPV) in the transition (OPV cessation) to just using inactivated polio vaccine (IPV).

“Over the past ten years, more than 10 billion doses of OPV have been given to nearly three billion children worldwide. More than 16 million cases of polio have been prevented, and the disease has been reduced by more than 99%. It is the appropriate vaccine through which to achieve global polio eradication.”

OPV Cessation

And while most developed countries already use IPV, those that are still using OPV recently switched from a trivalent (tOPV) to a bivalent (bOPV) form of OPV. We could do this because type 2 poliovirus has already been eradicated (2015)!

Of course, the issue with the OPV vaccines is that they rarely cause vaccine-associated paralytic polio (VAPP) and circulating vaccine-derived polioviruses (cVDPV).

Fortunately, this is even less common with bOPV.

As this chart from the WHO shows, polio vaccines are very safe.
As this chart from the WHO shows, polio vaccines are very safe.

So morbidity (getting sick)/mortality (dying) from polio vaccines is low.

There were only 31 cases of wild polio in 2018, in Afghanistan and Pakistan, and an additional 102 cases of cVDPV in 7 countries.

What about morbidity/mortality from polio?

“As recently as 30 years ago, wild poliovirus paralysed more than 350 000 children in more than 125 countries every year. In 2018 there were fewer than 30 reported cases in just two countries – Afghanistan and Pakistan.”

“Zero polio transmission and health for all”, WHO Director-General gives new year’s wish to the people of Afghanistan and Pakistan

With a 99.9% drop in polio cases since 1998, your risk of getting polio in most parts of the world is very low, but you still have to consider both the morbidity/mortality of polio in the pre-vaccine era and the risk of polio returning if we stop vaccinating before it is eradicated.

What about the idea that you don’t have to worry about polio because only 1% of kids with polio developed paralysis?

“The mortality rate for acute paralytic polio ranges from 5–15%.”

Disease factsheet about poliomyelitis

Well, when everyone gets polio, even 1% is a lot.

With such a safe vaccine, why put your kids at risk of getting polio?

Do you even understand what the risks are?

No, it isn’t just the risk of wild polio in Afghanistan and Pakistan.

Since the oral polio vaccines shed, if you are unvaccinated, in addition to the risk of wild polio, there is a small risk of getting circulating vaccine-derived polioviruses (cVDPV) if you are not vaccinated and protected. No, it is not a big risk, as there were only 102 cases of cVDPV in 7 countries in 2018, but it isn’t zero either.

And the other big risk is that if enough folks stop getting vaccinated, taking their chances hiding in the herd, polio will come back and our chance to eradicate another vaccine-preventable disease will fail.

More on the Morbidity and Mortality Rates of Polio

Why Do We Still Vaccinate If Polio Has Been Eliminated?

It’s true, polio has been eliminated in the United States.

Are these folks serious with this anti-vaccine nonsense?
Are these folks serious with this anti-vaccine nonsense?

But that doesn’t mean that we can stop vaccinating kids against polio yet.

Why Do We Still Vaccinate If Polio Has Been Eliminated?

For one thing, the last polio case in the United States was a lot more recent than 40 years ago.

What happened 40 years ago?

That was when we had the last endemic case of polio in the United States, in 1979. After that, in addition to cases of VAPP, there were at least 6 cases of imported paralytic poliomyelitis. In fact, the last case of wild polio in the United States was in 1993, just 26 years ago.

And just ten years ago, in 2009, was the very last case of VAPP, a patient with a long-standing combined immunodeficiency who was probably infected in the late 1990s, even though she didn’t develop paralysis until years later.

But still, why couldn’t we stop vaccinating against polio in the United States, even though polio isn’t eradicated yet? After all, we stopped using the smallpox vaccine in 1972, before smallpox was declared eradicated (1980).

While that is true, smallpox isn’t as contagious as polio and there hadn’t been a case of smallpox in the United States for over 30 years when we stopped using the vaccine.

Until wild polio is eradicated and the oral polio vaccine isn’t used anymore (OPV switch), we must continue to vaccinate against polio to prevent new outbreaks.

That is the polio eradication and endgame strategic plan.

Over the next few years, the world will hopefully switch to using just the injectable form of the polio vaccines, which eliminates the risk of VAPP.

But if we are so close, why not just stop vaccinating in those parts of the world that don’t have polio?

Because we are so close to eradicating polio.

Why take the risk of polio spreading from one of the remaining endemic countries, paralyzing kids, and putting eradication efforts further behind?

Should we stop vaccinating kids because anti-vaccine folks are pushing misinformation about DDT, renamed diseases, or vaccine induced diseases?

Of course not!

Vaccines are safe, effective, and necessary.

Let’s continue the work and eradicate polio, once and for all!

And for the record – we don’t pump “kids full of polio” when we give them a polio vaccine. The polio shot is an inactivated vaccine, so doesn’t contain live polio virus.

More on Why Do We Still Vaccinate If Polio Has Been Eliminated?