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

Sisyphus and the Conjugate Vaccines

January 31, 2008 by · 1 Comment
Filed under: Vaccine/Disease Analysis 

sisyphus1.jpg

As a punishment from the gods, Sisyphus was compelled to roll a huge rock up a steep hill, but before he reached the top of the hill, the rock always escaped him and he had to begin again. The maddening nature of the punishment was reserved for Sisyphus due to the mortal’s hubristic belief that his cleverness surpassed that of Zeus.

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In September, the AP reported that Prevnar…

“A vaccine that has dramatically curbed pneumonia and other serious illnesses in children is having an unfortunate effect: promoting new superbugs that cause ear infections.”
http://www.msnbc.msn.com/id/20825107/

I always wonder who actually writes these science stories you see in the media.

Yes, the emerging serotypes cause ear infections and other mild illnesses, but they also cause various deadly forms of invasive disease. It’s a phenomenon called “serotype replacement” (or “replacement disease” in other circumstances) and so far all of the conjugate vaccines (Hib, Prevnar, Menactra) have done this in some form or fashion. The vaccines work extremely well against vaccine-included serotypes of streptococcus pneumoniae, but they work so well that they also prevent asymptomatic carriage of these normally commensal organisms.

And that is a problem.

For example, from The Lancet:

“FINDINGS: We noted no reduction of AOM episodes in the pneumococcal vaccine group compared with controls (intention-to-treat analysis: rate ratio 1.25, 95% CI 0.99-1.57). Although nasopharyngeal carriage of pneumococci of serotypes included in the conjugate-vaccine was greatly reduced after pneumococcal vaccinations, immediate and complete replacement by non-vaccine pneumococcal serotypes took place.”
Read more

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