Whooping Cough – Lies, Damn Lies and Statistics

According to the CDC (2002)

However, since the early 1980s, reported pertussis incidence has increased cyclically with peaks occurring every 3–4 years.

And yet  whooping cough increases are being described as though they are a new problem. Here is an example, one of many:

Whooping cough cases have outright ballooned in Washington; state health authorities actually declared epidemic status earlier this year, there has been a 13-fold increase in diagnoses since 2011.

Washington — though home to a lot of highly-educated, tech savvy people — is also the epicenter of the U.S. anti-vaccination movement. Over the last few decades, more and more parents there have opted out of inoculating their kids against preventable illnesses. As some 90 percent of any population must be inoculated for vaccines to work — AKA “herd immunity” — many are blaming Washington’s anti-vax camp for spurring the disease’s spread. Read more

Review: The average cost of measles cases and adverse events following vaccination in industrialised countries

One of our readers posted a comment asking us: “Can you tease out some facts in this study?” We think we could probably write several papers discussing the issues surrounding this study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC128813/ but we will provide a brief summary because a study such as this isn’t worth spending an inordinate amount of time on.

We are going to make a few opening caveats:

1) Some of us believe that measles might be the only vaccine that is justifiable on a large population basis and that is only because there is some evidence that measles can have a relatively high (still low on an absolute basis) rate of serious side effects in some populations.
2) Cost justification studies (such as this) are usually based on a house of cards, and are only as good as the data that underlies the layers of assumptions made in the model.
3) Cost justification studies that are used to support mass vaccination mandates almost invariably turn out to be wrong due to underestimating the cost of the vaccine program and side-effects and overestimating the effectiveness of the vaccines.
4) These studies are often misleading because they are usually sensitive to a few key assumptions and they normalize everything to a dollar value. Here is a sample problem with normalizing everything to a dollar value: let us imagine we have two different vaccines that we want to give to 1 million people. In the testing, 50% of the people suffered 3 days of mild illness causing missed work with no long term effects from vaccine A. 1 person died from vaccine B with no one else suffering any ill effects. The cost of vaccine A would be far higher in almost any financial model, and yet clearly we would much rather fall mildly ill for 3 days rather than risk a 1 in a million chance of dying.

This particular study is interesting in that it is not actually performing a cost comparison or justification. It is only trying to set the cost of a measles case and the cost of a measles vaccine reaction. In order to judge the likelihood of bias in a study, a quick check on the authors reveals that although there are no direct conflicts of interest declared, several of them work for organizations which were desperate to defend the MMR vaccine in the wake of the Wakefield papers from around that time period. There is nothing wrong with that, but it provides context for the timing, content, and potential bias’ of the study. Read more

Lessons from H1N1: How Partial Immunity Can Kill You

December 20, 2010 by · 1 Comment
Filed under: News, Vaccine Science, Vaccine/Disease Analysis 

We are now in the thick of the influenza season, and it is a true shame that the emphasis on vaccines against the flu has drowned out any mainstream discussion much less headlines for  an important study recently released in Nature about the 2009 H1N1 influenza virus: Severe pandemic 2009 H1N1 influenza disease due to pathogenic immune complexes [1]. The press release is worth reading.

There are a few initial things that make this study worth noting:
1) It is not funded by the industrial/governmental health care complex
2) It is short, concise, and doesn’t draw any reaching conclusions
3) It furthers our understanding of the 2009 H1N1 Flu by doing a rigorous scientific follow-up of real cases.

The last point is a refreshing change as one of the best ways to learn something is to examine the medical outcomes for real people and this is something we don’t see very often from our medical authorities. The study itself does not address vaccines but the findings have important implications for mass influenza vaccination policies. Read more

Tuberculosis Vaccine Use Based on “Blind Faith”

November 8, 2010 by · 6 Comments
Filed under: Vaccine Science, Vaccine/Disease Analysis, WHO Watch 

UK is planning to introduce the BCG vaccine for all newborns in London because of a resurgence of the disease. The article states:

Health experts believe the threshold at which routine immunisation is required — 40 cases per 100,000 — has been reached across the capital. Current policy has been to offer vaccination to children who are born abroad or whose parents are born abroad. [1]

Why is it that Spain and the U.S. have never used the vaccine and yet have a very low incidence of TB?

The BCG vaccine is the most widely used vaccines of all, as well as the most controversial. The first BCG vaccine trial resulted in a huge disaster which seriously marred its reputation.

The Lubeck disaster will remain a landmark in the history of immunization. In the summer of 1930, in Lubeck, Germany, 240 infants were vaccinated with BCG; 72 of the vaccinated infants developed tuberculosis and died….

Nevertheless, the disaster had done much to harm public acceptance of the vaccine, and mass vaccination of children was only reinstated after 1932, when new and safer production techniques were implemented. Its efficacy has been found to range from 0-80%. [2] Read more

Polio: Causes and Effects Part II

October 10, 2010 by · 15 Comments
Filed under: Vaccine Myths, Vaccine/Disease Analysis 

Cut a hole in the immune system?

During the first half of the 20th century, every parent and child feared the word “polio”. In an epidemic, it attacked male and female, black and white, from rural communities to suburbia. Most people understood that a virus caused polio, but no one knew where the virus came from or how victims would fare. Often, the virus entered the body, created mild, flu-like symptoms, and left it virtually unscathed. Even though, in any community, most people would never get paralysed, pictures of iron lungs and braces would silently ask the question, “Will you be next?”  If, rather than immunity, a person got paralytic polio, the  outcome of conventional medical treatment might be some sort of deformity, or for the worst bulbar polio cases, weeks or a lifetime in an iron lung, or death.  Everyone knew certain aspects of the polio virus: It was highly contagious; struck without warning and preferred children and young adults; and the medical profession could offer neither prevention or cure. [1]

In 1954 a newspaper article quoted a study published in the prestigious Journal of the American Medical Association:

Analysis of the data suggested that the absence of tonsils and adenoids, regardless of the time of their removal in relation to the onset of poliomyelitis, increased the risk that the bulbar form of the disease would develop. [2] Read more

Polio: Causes and Effects, Part I

September 7, 2010 by · 12 Comments
Filed under: Vaccine Science, Vaccine/Disease Analysis 

We saw in our first [1] blog on polio that infection with this virus was common, but paralytic polio was rare. In our second [2] article we reviewed the history of polio and the significant number of cases of paralysis from other causes which were blamed on polio. In the third [3] article we looked at one of the explanations for the rise of paralytic polio in advanced countries and the collapse of this explanation as polio increased in developing countries.

With polio, is there one cause, the virus, and one effect, paralysis? Obviously not, as the results of infection with the polio virus range from absolutely nothing to death. In this series we are going to review some of the factors which, combined with the presence of the virus, can move the situation from no symptoms and no problems, to paralysis.

A characteristic of infection with polio is the length of time it takes to clear the virus from the body and create immunity to polio.

…the interval between initiation of infection and appearance of CNS signs may be as long as several weeks, which accounts for the great variation in the incubation period of the disease. [4]

CNS means inflammation of the central nervous system. Someone can be carrying around a happily multiplying polio virus in the nose, throat and gut system, and other non-neural areas of the body, for a period of weeks without having any symptoms to indicate that the virus is there. “Non-symptomatic response” to polio virus exposure, results in eventual clearing of the virus from the system, permanent immunity to that strain of polio, and is the normal bodily response to the polio virus.

However, if something occurs during the several weeks of polio virus carriage which opens up access to the central nervous system to the virus, then the polio moves from asymptomatic to paralytic. There is a list of provokers which cause polio to invade the CNS.   Today we are going to consider one cause which we can credit to the medical profession. Read more

A Pox on the Taxpayer

 

A handful of countries recommend the chickenpox (varicella) vaccine for all children and an even smaller group have a chickenpox booster on the schedule. The US leads the pack of countries with a 2 shot schedule, and following along are Ecuador, Saudi Arabia, Germany, Greece, and part of Australia.

Some countries give the shot to adolescents, others offer it to members of “risk groups”… and a few have a one-shot schedule for toddlers: Canada, Costa Rica, Uruguay, Cyprus, Latvia, and Korea. A grand total of 26 countries offer the shot in one way or another. [1]

The US was the first country to recommend the shot for all toddlers, in 1996 :

…. empiric data on medical utilization and costs of work-loss resulting from varicella were used. The results of this study, which were determined using an estimated cost of $35 per dose of vaccine and $5 for vaccine administration, indicated a savings of $5.40 for each dollar spent on routine vaccination of preschool-age children when direct and indirect costs were considered. When only direct medical costs were considered, the benefit-cost ratio was 0.90:1. [2] (emphases added)

But it turned out that a single shot of varicella vaccine didn’t work to suppress chickenpox.

…varicella outbreaks have regularly been observed in populations with high vaccination coverage and are the cause of sizable disease and economic impact for public health departments and the US health system overall. To further reduce varicella disease burden, a routine 2-dose varicella vaccination recommendation was approved by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) in June 2006 (first dose for children 12–15 months of age, second dose for children 4–6 years of age) . [3]

The single-shot regimen showed a narrow margin of benefit only when placed alongside income lost by parents staying home to care for sick children.

But when the one-shot program failed, the ACIP came up with another cost/benefit justification for the second shot where the evidence….

….included ongoing disease burden and varicella-zoster virus transmission, including transmission from breakthrough cases to high-risk persons that may lead to severe disease and even death (CDC, unpublished data); partial or complete susceptibility in 1-dose vaccine recipients as they become adults; the burden on public health agencies due to varicella outbreaks in highly vaccinated school settings, which have proven disruptive to society and costly to control; and the increased immunity and disease protection from a second dose. Overall, the 2-dose strategy still provides very high cost savings (>$0.9 billion from societal perspective). [3] (emphases added)

So the ACIP justifications for adding a second dose, used the consequences of their decision to recommend the first dose of varicella vaccine. These ingenious calculations created a bigger cost savings than their first round! Read more

Polio and Sanitation

KHAGARIA: On the sandy banks of Kosi river in north Bihar, a quiet crowd of several hundred people is waiting in the sizzling morning sun. A speck appears in the pale blue summer sky, rapidly growing in size — its a gleaming white helicopter. Within seconds it is hovering above the opposite bank, amidst the cornfields.

The crowd is awestruck at the monstrous machine as it settles down in billowing clouds of sand. Out comes the man everybody has been waiting to see — Bill Gates.

Bill Gates has come to find out why polio eradication is failing in Bihar. He asks questions about immunization strategies and tries to figure out what sort of technical problems are blocking universal vaccine delivery.

People complain of lack of basic health facilities…There are only 49 auxilliary nurse and midwives under the PHC, against a sanctioned strength of 76…So, the delivery of basic health services is itself a distant dream…The villagers hope against hope. Isn’t the spread of polio linked to lack of sanitation and basic health facilities? Gates acknowledges this fact but says that it is for the government to do the needful. “We are concentrating on the eradication of polio, which is achievable through vaccines,” he says. [1]

Polio epidemics first appeared in the mid-nineteenth century. Many doctors and scientists struggled with the mystery: why, as living conditions improved, did incidents of paralysis increase? Out of all the changes that came with modernity, improved sanitation was chosen as the change which caused polio to turn from a mild illness to one that left death and permanent damage in its wake.  Here is an excellent example  from a 2007 medical article which summarizes the concept:

Prior to the 20th century, virtually all children were infected with PV while still protected by maternal antibodies. In the 1900s, following the industrial revolution of the late 18th and early 19th centuries, improved sanitation practices led to an increase in the age at which children first encountered the virus, such that at exposure children were no longer protected by maternal antibodies. Consequently, epidemics of poliomyelitis surfaced . [2] Read more

Polio and Acute Flaccid Paralysis

In post one of this series on polio, a term was introduced: “Acute Flaccid Paralysis”. [1]

Acute Flaccid Paralysis is a term which applies to the exact clinical symptoms you would expect to see from poliovirus infection, but which are not necessarily caused by polioviruses. Paralytic polio is actually considered a sub-category in the broad umbrella of acute flaccid paralysis. See pages 300-312 [1] for a chart and summary of many other causes of AFP, a few of which are: Guillaine-Barre syndrome, Cytomegalovirus polyradiculomyelopathy, Acute transverse myelitis, Lyme borreliosis, nonpolio enterovirus and Toxic myopathies.

For many years the medical profession assumed that when they saw paralysis with a particular cluster of symptoms, it was poliomyelitis. The 1954 Francis Trials of the Salk vaccine [2] triggered a reconsideration of this assumption, and a major change in the diagnostic criteria.

How were polio cases counted in 1954?

In 1954 most health departments worked with the WHO definition:

“…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.” [3, p. 88]

How were polio cases counted in 1955?

In 1955 the criteria were changed to conform more closely to the definition used in the 1954 field trials: residual paralysis was determined 10 to 20 days after onset of illness and again 50 to 70 days after onset. [3, p. 88]

Thus, simply by changes in diagnostic criteria, the number of paralytic cases was predetermined to decrease in 1955-1957, whether or not any vaccine was used. At the same time, the number of nonparalytic cases was bound to increase because any case of poliomyelitis-like disease which could not be classified as paralytic poliomyelitis according to the new criteria was classified as nonparalytic poliomyelitis. Many of these cases, although reported as such, were not non-paralytic poliomyelitis. [3, p. 88] (emphasis added)

It was after the SALK vaccine was introduced, when fully vaccinated people continued to get “polio”, that doctors started looking a lot more carefully at the viruses in individuals. Many viruses were found to cause paralysis, for example coxsackie B, enterovirus 71, etc. Read more

Polio 2010

Poliovirus

Over the next few weeks, Inside Vaccines will be taking a closer look at Poliomyelitis infections, exploring aspects of the history of poliomyelitis; describing environmental factors that increase the incidence of paralytic polio; considering the history and efficacy of the vaccines used against polio; and finally, exploring the campaign to eradicate polio.
First, let’s look at some basic information.

When most people think of poliomyelitis, they think of children who had lameness and leg deformities, with their legs in braces, or lying in iron lungs (old-style breathing machines, or ventilators) because they couldn’t breathe. Most people link all paralysis and lameness solely to a group of viruses called POLIOMYELITIS. The World Health Organization describes polio:

Polio is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours. The virus enters the body through the mouth and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized. [1]

Now for a more accurate picture of exactly what “poliomyelitis” is.

The poliomyelitis viruses fall within a class of viruses called “human enteroviruses” [2]. Polioviruses belong to the viral family Picornaviridae [3]. There are three types: 1 Brunhilde; 2 Lansing; and 3 Leon.   Amongst these types there are hundreds of different strains. Type 1 is considered the most serious virus, followed by type 2.

Technically, a person can “get” poliomyelitis 3 times, since the types do not give cross protection to each other, but in practice, having clinical polio three times is very rare.

How is poliomyelitis virus transmitted?

Poliomyelitis is transmitted by person-to-person spread through fecal-oral and oral-oral routes, or occasionally by a common vehicle (e.g., water, milk). [4]

What happens when people are exposed to polioviruses?

When non-immune persons are exposed to wild poliovirus, inapparent infection is the most frequent outcome (72 percent). [4]

Most people won’t even be aware that they were sick. Read more

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