With all the noise about whooping cough (sorry…) I thought it would be helpful to provide quick links to our main articles on the topic.
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Why? Because they questioned a WHO (World Health Organization) diktat in favor of universal Hib vaccination in India.
Sorry, but this is getting ridiculous. Anyone, at any time who raises any concern about the safety, efficacy, or appropriateness of any vaccine is now called anti-vaccine.
Here is a potted history of the recent outbreak of name-calling.
In the July 2010 issue of the Indian Journal of Medical Research this editorial appeared: Introducing pentavalent vaccine in the EPI in India: A counsel for caution.
The latest WHO position paper on Hib says ‘Hib vaccine should be included in all routine immunization programmes. This suggests that Hib vaccine should be included in the immunization programme universally, irrespective of an individual country’s disease burden, not withstanding of natural immunity attained within the country against the disease, and not taking into account the rights of sovereign States to decide how they use their limited resources. The mandate and wisdom of issuing such a directive, for a disease that has little potential of becoming a pandemic, needs to be questioned.
The editorial reviews the available data and on the basis of the science, questions the need for the Hib vaccine in India.
In response to this thoughtful challenge to the WHO policy on Hib, a news commentary was published in the BMJ (British Medical Journal) which called the concerned doctors an “anti-vaccine lobby.” This article, which is unreferenced, claims:
The Hib organism, which can cause severe bacterial meningitis and pneumonia, is estimated to kill more than 370 000 children worldwide each year, GAVI said. Nearly 20% of these deaths occur in India.
In response to the BMJ article, a rapid response was published in the online version of the BMJ by eight members of the supposed “lobby”
The doctors wrote:
The thrust for including Hib vaccine in India is based on 2 arguments. The first is that there is anecdotal evidence of the existence of Hib disease and Hib meningitis in India and that Hib meningitis may lead to long term morbidity. The second argument is that the well-to-do parents sometimes buy Hib vaccine in the open market to vaccinate their children. The Government of India must therefore provide it free for the poor, on the grounds of equity and fair play (2).
The problem with the anecdotal reports is that they do not specify the size of the universe from which the samples are drawn and public health policies cannot be based on these figures without a denominator. The many systematic surveys done to look at the magnitude of the problem of Hib disease in India have nearly always shown that the incidence of Hib disease is much lower than what was projected for India. Most of these studies have been funded by the WHO and these have been reviewed recently in an open access journal (3).
So, we have the BMJ calling names and publishing an unreferenced attack claiming high numbers of deaths from Hib, while the supposed anti-vaccine lobby provides carefully referenced information debunking the claims.
The pro-vaccine lobby has plumbed to new depths.
When it comes to third world medicine we almost invariably hear from the WHO about the successes of massive vaccination programs. If you look into the recent agenda for the World Health Assembly  you will find pandemic influenza vaccines at the top of the technical matters, and in the status section, the eradication of Poliomyelitis is at the top of that section. What is glaringly absent is a discussion of the pervasive double standards in research ethics, health-care safety and professional rigor that exist in the developing world. The WHO and its medical partners won’t talk about it publicly because when you look at the numbers, it is directly implicated in the suffering and ultimate death of millions of people in the developing world. That is what we’ll cover in this piece.
It is well known that needle re-use can be a major cause of virus transmission. In 2000, a WHO press release states:
Unsafe Injection practices have serious large-scale consequences…”unsafe injection practices throughout the world result in millions of infections which may lead to serious disease and death. Each year over-use of injections and re-use of dirty syringes and needles combine to cause an estimated 8 – 18 million hepatitis B virus infections, 2.3-4.7 million hepatitis C virus infections and 80,000 – 160,000 infections with HIV/AIDS worldwide. 
That same press release uses an epidemic of Hepatitis C that occurred from Schistosomiasis treatment in Egypt. Notably absent is any discussion of the massive immunization campaigns waged throughout the third world coincident with the massive epidemics of HIV and other infectious diseases. However, someone there must be aware of the potential problem because the press release states the following at the end:
In addition, to ensure the safety of immunization injections, WHO, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), and the International Federation of the Red Cross and Red Crescent Societies (IFRC) have recently called for the exclusive use of auto-disable (AD) syringes for immunization by the end of 2003.
We know quite reliably that the WHO knew years prior to this press release (2003) that medical practices in the developing world were problematic. As Gisselquist outlines in his 2009 article  the WHO was quietly giving UN employees the following advice in 1991.
take special precautions to avoid HIV transmission via blood . . . If you are not carrying your own needles and syringes, avoid having injections unless they are absolutely necessary . . . Avoid tattooing and ear-piercing. Avoid any procedures that pierce the skin, such as acupuncture and dental work, unless they are genuinely necessary. Before submitting to any treatment that may give an entry point to HIV, ask whether the instruments to be used have been properly sterilized.
“Just because you need a third dose doesn’t mean the two dose schedule is having issues or anything”
Filed under: CDC Watch, News, Opinion, Parents' Pages, Vaccine/Disease Analysis
Because of continued spread, health authorities working with communities in Orange County are giving schoolchildren a third dose of the MMR vaccine. Gallagher says it will be two or three months before it’s known whether the effort succeeded.
Why do they need a third dose?
The infections happened despite high coverage with the measles-mumps-rubella (MMR) vaccine. Among patients ages 7 to 18 — the age group that had the most cases — 85% of patients had received the two recommended MMR vaccine doses.
This doesn’t mean the MMR vaccine isn’t working, says epidemiologist Kathleen Gallagher, DSc, MPH, the CDC’s team leader for measles, mumps, and rubella.
“Two doses of mumps vaccine is believed to be 90% to 95% effective,” Gallagher tells WebMD. “But that means people can still get mumps. If the vaccine is 90% effective and 100 people are exposed to mumps, 10 will get the disease.”
If we imagine that mumps is being sprinkled from the sky and spread evenly throughout the population, then yes, one out of ten vaccinated people would catch mumps if the vaccine was, indeed, 90% effective, or one out of twenty if it were 95% effective. But if the vaccine creates “herd immunity” then the disease shouldn’t be able to jump from vaccinated person to vaccinated person to vaccinated person. Read more
While it’s too soon to be sure, influenza numbers are dropping and the season may be coming to an early close. The CDC has these numbers:
During week 51 (December 20-26, 2009), influenza activity decreased slightly in the U.S.
154 (3.9%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
Translation: of thousands of tested cases of “might be flu”, 154 turned out to really be flu, only 3.9% of the total specimens tested. Lots of sneezing and coughing out there, and not an insubstantial number of hospitalizations and deaths for “influenza-like-illness and pneumonia” , but no influenza viruses are the main cause at this point.
2009 H1N1 virus did turn out to be more dangerous to children than the typical yearly influenza virus: the CDC received 225 reports of deaths this year, 130 last year, 88 in 2007 and 78 in 2006.
The breakdown by age:
Since August 30, 2009, CDC has received 225 reports of influenza-associated pediatric deaths that occurred during the current influenza season (42 deaths in children less than 2 years old, 25 deaths in children 2-4 years old, 83 deaths in children 5-11 years old, and 75 deaths in children 12-17 years old).
How likely was a child under 2 to die from H1N1 based on these numbers?
Live births in 2007: 4,317,000, minus 29,000 infant deaths, gives us a starting number of 4,288,000. The number of births has been going up every year for the last few years, so if we assume the same number in 2008 we are erring on the side of caution. We’ve got a total of roughly 8,576,000 children in the U.S. under the age of two. Forty-two of those children died this year as a result of H1N1, according to the CDC. This means that one child out of every 204,190 died from 2009 H1N1 according to the reported number of cases.
Are the reported number of cases reflective of the true burden of illness? Probably not entirely, but in November, CBS news reported that:
It’s a little counter intuitive,” Frieden said, “but the best way to estimate the total burden of illness is not to count the cases, but to estimate them based on the best available science.”
However, Ashton pointed out, things are very different when reporting pediatric flu deaths. She said states are required to document each case with the CDC, and every week the updated numbers are an accurate reflection of the entire country.
The numbers of pediatric deaths from 2009 H1N1 are based, therefore, on actual case counts in the U.S., during 2009.
Infants and toddlers were one of the groups recommended for the 2009 H1N1 vaccine. However, if saving the maximum number of lives is our goal, then there are several other causes of death in infants and toddlers which we feel should be addressed with a vigor to match the actual death and injury rates for each category.
Among 1- to 4-year-old children, injuries accounted for 42 percent of all deaths, followed by deaths due to congenital malformations (birth defects), malignant neoplasms (cancer), homicide, and diseases of the heart.
Or to give some comparative numbers:
More than 16,500 lives could be saved each year in the United States alone if our under-5 mortality rate was the same as Iceland. If the U.S. rate of under-5 mortality was similar to that of France, Germany and Italy (all 4 per 1,000 live births), over 12,000 child lives could be spared.
The causes of child deaths in the industrialized world differ dramatically from those in developing countries. In the developing world, over half of under-5 deaths are caused by pneumonia, diarrhea or newborn conditions. In the industrialized world, these problems rarely lead to death. Children’s deaths are most likely the result of injury suffered in traffic accidents, intentional harm, drowning, falling, fire and poisoning.
Mumps outbreaks are occurring in highly vaccinated populations and this has led to differences in opinion amongst scientists around the efficacy of the vaccine, with various mechanisms of failure being put forward. It has been suggested that the number of vaccinated young adults (18-24 yrs) who contracted mumps in the US in 2006 form a small percentage of the overall vaccinated population. The fact that 84% were vaccinated with two doses is reduced to a minor detail when numbers are crunched in the “right” way. However, this is not the view of all scientists. There is concern as to why highly vaccinated populations are having mumps outbreaks. By choosing to avoid the issue, essentially ignoring the reason why young adults who have been vaccinated twice with the MMR are coming down with mumps, the evidence on the real efficacy of mass vaccination against a benign childhood disease is not discussed. Read more
Filed under: News, Parents' Pages, Vaccine Science, Vaccine/Disease Analysis, WHO Watch
It’s that time of year again! Having spent last summer consulting the avian set on what’s hot in influenza, the pharmaceutical company has whipped up a fresh batch of flu vaccine, and now they need to move the merchandise! Fortunately, the CDC is happy to help with sales, by expanding the recommendation to ever more age groups. The Advisory Committee on Immunization Policy currently recommends the vaccine for all children aged 6 months to eighteen years. There is just one slight issue that might concern some parents. Peer-reviewed research in The Archives of Pediatric and Adolescent Medicine, Vol. 162 No. 10, October 2008,1 demonstrates that the vaccine is not effective under age 5!
An inherent assumption of expanded vaccination recommendations is that the vaccine is efficacious in preventing clinical influenza disease. Although studies have documented immune responses following 2 doses of inactivated influenza vaccine as well as vaccine efficacy for culture-confirmed disease in randomized clinical trials, surprisingly little information exists regarding influenza vaccine effectiveness (VE) among young children receiving vaccine in routine health care settings.
Where Do They Find These Scary Statistics? Part II: Gross Estimation–Diphtheria Statistics Defy Reality
Filed under: CDC Watch, News, Vaccine Science, Vaccine/Disease Analysis
Top graph from page 423 of The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century.
Lower graph from page 208 of Trends in Diphtheria Mortality.
Filed under: CDC Watch, News, Vaccine Science, Vaccine/Disease Analysis
Dr. Gerberding of the CDC
Remember Hannah Poling? The head of the CDC, dressed in a very nice pink suit, appeared on TV and discussed Hannah’s case. In one of her appearances she said something like this: “Vaccines prevent 33,000 deaths a year in the United States.” Just to make sure I had the statement right, I searched for the phrase and found it again, from CNN, this time in print.
Today, through immunizations given in the first two years of life, we can protect children from 16 diseases, preventing 33,000 deaths and 14 million illnesses per year.
A few searches made it clear that this is a very popular statistic. A variety of news stories included the information that vaccines prevent 33,000 deaths a year in the United States. This is an interesting number to anyone who knows a bit about the history of infectious diseases. I decided to dig deeper.
My next find was this chart, which is on a the web-site of an organization called Every Child by Two. The chart provides morbidity (incidence) and mortality (deaths) for each disease. How in the world would someone be able to calculate (for example) the exact number of cases of diphtheria which would occur and the exact number of deaths which would follow? Amazing! There must be some truly extraordinary scientific research underlying these numbers, don’t you think? Read more
“Being a carrier of MRSA has increased a lot, especially among school-aged kids,” said Lyn Finelli, chief of influenza surveillance at the CDC. “And being colonized may put them at risk for a severe staph aureus infection when they get the flu.”
This particular news story blames the problem on antibiotic overuse, and, of course, recommends the flu vaccine to save children from this dangerous situation. Read more