Vaccine Safety

This is part 2, continued from Vaccines

There are two main concerns about the safety of vaccines:  the MMR vaccine, and the preservative thimerosal.

MMR

For years, there has been some controversy surrounding the MMR vaccine.  Responsible parents don’t want to hurt their kids, so if the vaccine causes health problems, we don’t want to subject our kids to it.

In 1998, a respected medical journal, The Lancet, published a paper suggesting a possible link between the MMR vaccine and autism.  Then in 2004, The Lancet published a retraction by ten of the paper’s thirteen authors – a retraction because those authors wanted to make it clear that there was not evidence that the vaccine was unsafe and people were misinterpreting the small study’s write-up.

In 2010, the entire paper was retracted.  It simply is not true that the MMR vaccine causes autism.  Both the “research” and paper were fraudulent.  For some truly shocking information, read How the case against the MMR vaccine was fixed and Wakefield’s article linking MMR vaccine and autism was fraudulent.

The MMR vaccine, like any medication, can have side effects.

• 1 in 6 kids get a temporary fever
• 1 in 20 will get a temporary mild rash
• on rare occasions, kids will experience mild swelling of the neck/cheeks about a week after getting the vaccine
• 1 in 3000 kids will have seizures due to fever (vs. 3-6 in the same sized group who will die from the disease)
• some people have joint pain due to the vaccine; it is temporary
• 1 in 30,000 people have a temporary low platelet count due to the vaccine
• Less than one in a million people vaccinated experience a severe allergic reaction due to the vaccine

The alternative is much scarier.  Survivors blind, fighting pneumonia, maybe sterile; hundreds of thousands of children dead.

Thimerosal

The MMR vaccine isn’t the only safety question regarding childhood immunizations.  The other big issue is that of preservatives, mainly thimerosal.

Obviously it doesn’t help to prevent a given disease (diphtheria, for example), only to have the patient die of a different infection because the medicine was contaminated.  If a doctor’s office has a vial that holds twenty doses, then twenty different times a needle will be inserted into the vial and a dose drawn out.  In a perfect world, this would always remain sterile; here in the real world, as a safeguard to keep fungi and bacteria from growing in vaccines, small amounts of an antiseptic/preservative were added.

When very few vaccines were available, this wasn’t a significant problem because kids got very little of that preservative.  As more and more vaccines became available, the amount of preservative given to young children increased.  People became concerned that the accumulated doses might be harmful.  The evidence appears to say no, but to err on the side of caution, pharmaceutical companies were asked to stop using this preservative.  Some vaccines contain only trace amounts, others have none.  For those vaccines that still contain small amounts of this preservative, patients can specifically request thimerosal-free vaccines (single-dose vials as opposed to multi-dose vials).

A look at the data on individual vaccines shows that the vaccines are much safer than the diseases.

• Hib
• Hepatitis A - my two oldest have had this vaccine, the younger ones have not
• Hepatitis B 
• Chickenpox - since I’ve never had chickenpox, I made sure my kids got this vaccine
• Pneumococcal 
• Meningococcal
• Rubella (German Measles) – part of the MMR vaccine
• Mumps - I remember having mumps as a child, and am happy to spare my kids the experience
• Measles
• HPV - no matter how confident I am in my kids’ ability to make good choices, there are no guarantees that a person’s future spouse will have always made good choices 
• Diphtheria
• Pertussis
• Tetanus
• Rotavirus - this is new; none of my kids have had this vaccine

For more information:

• Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children
• Retraction of an Interpretation
• Authors reject interpretation linking autism and MMR vaccine
• Lancet retracts Wakefield’s MMR paper
• How Safe Are Vaccines?
• Immunization Vaccine Safety
• Thimerosal in Vaccines
• Thimerosal in Vaccines Q and A
• Immunization Schedules

Written for a friend who asked my opinion on vaccines. 
Possibly one more vaccine post in the works, but that’s not going to be the focus of this blog.

Vaccines

Everyone wants what’s best for their children.  We dress our kids warmly, teach them to wash their hands, and tell them not to eat slugs or lick the handle of the grocery store’s shopping cart.  We feel awful when they’re sick, and wish there was something we could do to reduce their chances of ever contracting another disease.

There is something we can do.  Vaccinations are one way to help keep kids healthy, and they’re far less costly than dealing with disease.

Smallpox
Smallpox is considered by some to be the most deadly of all diseases in history.  Up to 35% of people who caught smallpox died from their illness.  The pox left scars on those who survived, and many people were blinded by the disease.  Today, however, we are lucky because the fight to eradicate smallpox was so successful that it’s no longer considered necessary to give this vaccine to children.*  With diligent vaccination programs, we can eradicate other diseases, too.

Measles
Imagine a disease so feared and so deadly that parents don’t name their babies.  Only after a child has gotten the disease and been lucky enough to survive will the child be named.  That’s true of measles in some parts of the world.  According to the World Health Organization, measles is the leading cause of vaccine-preventable death in young children.  Hundreds of thousands of people die every year.  Survivors can experience complications such as blindness, brain swelling, ear infection, pneumonia, and sterility.  All this can be prevented with a simple vaccine.  One dose is given at age 12-15 months, and a second dose is recommended around age 4-6. 

Is the vaccine effective?  Consider this graph:
 

Vaccine efforts around the world have seen similar results.  WHO reports that in 2000, 733,000 died from measles.  By 2008, that number had decreased to 164,000.    In 2009-2010, unfortunately, vaccines were down again and measles cases rose dramatically.  When a disease isn’t seen as a threat, people don’t always see the need to have their children immunized.  In the U.S., the measles vaccine is combined to protect against measles, mumps, and rubella all in a single shot.

Polio
I’ve written about this recently.  People can die from polio.  Complications can be terrible for survivors.  Although this disease is no longer common, we live in a small world.  There have been recent cases of a single unvaccinated traveller contracting polio while on vacation, then returning home before symptoms developed and unknowingly spreading this contagious disease to others in the community.  Prevention is simple with a series of four vaccination shots, given at ages 2 months, 4 months, 6-18 months, and 4-6 years.

Diphtheria
Think of the Roaring ’20s:  flappers and happy times after the conclusion of the first World War.  Sadly, life isn’t wasn’t always as pictured in the movies; in that decade, the United States also saw 13,000-15,000 deaths per year from diphtheria.  It’s a terrible disease.  We tend to forget, but most people have heard at least a little about diphtheria; some of the traditions seen in the Iditarod are in commemoration of the 1925 serum run to Nome - a race against time due to a diphtheria outbreak.  Thanks to vaccines, we no longer need to fear this deadly disease. 

Whooping Cough (Pertussis)
Some people think that since this disease is worst in infants, adults don’t need to worry about it.  Not true.  Adults with whooping cough spread the disease to others, including infants.  Last year in California, a number of babies died because they hadn’t been vaccinated yet.  That horrible cough must have been terrifying for the parents to hear, knowing there was nothing they could do to help their babies.

I have a friend who had whooping cough as an adult a few years ago, and can testify that it’s no picnic for an adult to have the disease.  Childhood vaccinations against whooping cough do not last forever.  Boosters are required.  Pertussis is one of three diseases included in a single vaccine (the other two being diphtheria and tetanus).  The children’s vaccine is called DTaP (or DTP), and the adult boosters are called Tdap).

 ***

The goal of these (and other) vaccines is to give children a longer, healthier life.  Vaccines work.  They prevent disease and save thousands of lives every year.  The question is, though, do they cause other problems?  Are vaccines safe?

Safety—>

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*The smallpox vaccine is still given to soldiers headed overseas.  It is also given to people exposed to monkeypox.   Read about smallpox & George Washington here.  

Is the Polio Vaccine Safe?

Dumbfounded.

That’s the only word to describe it.

MedPage Today posted an article this morning titled Polio Days.  As anecdotal evidence that vaccines are becoming a victim of their own success, a doctor shared this:

“Today people have forgotten about polio. I gave a talk not long ago to a group of young parents who were somewhat skeptical about immunizations, and when I mentioned polio, one of them asked me why I was talking about a shirt — as in Polo. She had never heard of polio,” Schaffner recalled.

How is someone in the U.S. managing to walk through life so clueless as to never hear of polio?  Not in health class.  Not in history class.  Not from a doctor.  Not from looking at a vaccine record.  Never.

Let me tell you about Barbara, the third child in a family of four beautiful girls.  Among her many talents, she played guitar.  In their teens and early 20′s Barbara and her sisters sang on the radio.  They were good.  Life went by.  Barbara, young and in love, got married and planned to raise a big family of her own.  Then she got sick.  Very, very sick.  Barbara contracted polio. 

Her life’s dreams shattered.  No more guitar; she couldn’t move her arms.  No more singing; her voice allowed no more than a tiny squeak.  No more husband; “for better, for worse, in sickness and in health” didn’t mean he wanted to spend the rest of his life caring for an invalid.

Some might say Barbara was one of the lucky ones.  She lived.  She didn’t need a machine to breathe for her.  After spending a long time in a rehabilitation hospital, she gained a little movement in her hands and wrists.  Not a lot, but enough to do a few things.  After an aide changed the bags attached to tubes in various orifices of her body, bathed her, got her dressed, set her in her wheelchair, combed her hair, and pushed her to breakfast, she could feed herself.

Eating wasn’t how you or I might feed ourselves.  Someone else would prepare the food, fill her plate, cut everything into bites, and position the plate in front of her.  With a fork securely taped to a long, heavily padded knitting needle, Barbara was able to move her wrist just enough to stab a bite and maneuver it to her mouth.  Unable to lift a glass or move her body to reach a straw, she’d wait for a drink until someone was available to help.

After breakfast, when she was lucky, someone would have time to brush her teeth for her.  If someone would push her up to a high table and position a book where she could see it (not too close, because her neck wouldn’t bend down), and hand her a pencil, she could use the pencil eraser to turn pages and do a little reading until someone pushed her to lunch.  Then dinner.  Then undressed her and put her to bed.  Day in, day out.

That’s polio.

It’s not a shirt.  Polio is devastating. 

Before the introduction of a vaccine in 1955, approximately 1,000 people a year died from polio.  Many more continued to live, paralyzed and confined to a wheelchair.  Due to vaccination efforts, wild polio in the U.S. was conquered by 1979.  In 1999 the U.S. eliminated the OPV vaccine and switched entirely to the inactivated vaccine (IPV), solving the problem of vaccine-induced disease.  Since then, the only cases of polio seen in the United States have been attributed to unvaccinated travelers contracting the disease in another country and bringing it back here (then passing it on to others in their community).

The only caveat is that people who have had an anaphylactic allergic reaction to streptomycin, polymyxin B, or neomycin should not get the polio shot, since it contains minute amounts of antibiotic to prevent bacterial growth in the vaccine.  Anaphylactic allergy to latex is not currently listed as a contraindication to the vaccine.

Back when OPV was used (in the 60′s and 70′s), there was a very small chance of contracting polio from the vaccine – but not necessarily the child.  Parents whose children were vaccinated were instructed to keep the baby away from elderly people for six weeks because they might not have immunity (8-10 people per year contracted polio this way).  That is no longer the case.  People do not get polio from the inactivated vaccine.  There are no documented side effects from IPV.  The only little glitch is the possibility of pain at the injection site – easily solved.

For more information about the polio vaccine:

• Traveler’s Health – Yellow Book
• Smithsonian
• Patient Stories 
• CDC Pink Book
• NNii
• Q&A
• CDC Vaccine Information Sheet

Barbara was my grandmother’s sister.
There is no way my children will be given the chance to contract a vaccine-preventable disease.  Especially polio.