Effect Measure

When it comes to vaccinations, a high degree of safety is one of the paramount issues. This is because even a small risk, like one in a million, when multiplied by tens of millions will produce tens or more of adverse events. The trade-off, of course, is the prevention of the disease the vaccine is directed against. Unlike a therapeutic drug, when a vaccine works, nothing happens. When there is a side effect, a previously well person becomes sick from the vaccine itself. This becomes a tricky problem in public health education. The recent scare in Israel with influenza vaccine illustrates what can happen. The Israelis are now saying the sudden deaths within days of vaccination in high risk elderly was not due to the vaccine, but that is both difficult to demonstrate conclusively and sometimes not persuasive to people, whatever the truth of the matter. After all, there is a clear temporal relationship between the vaccination and the event in their eyes which has a great deal of cogency.

Vaccinating children has all these problems and more. Concern about the next generation is probably hardwired into our behavior (it is evoloutionarily advantageous), so emotions run even higher. The publicity over autism and measles-mumps-rubella (MMR) vaccinations is a case in point. MMR and many other vaccines have a mercury-based preservative in them when packaged in multiple doses. Since mercury in some forms is a known neurotoxin, the thought that the mysterious affliction of autism might be related to this ubiquitous childhood exposure was plausible and interesting and a study or two seem to indicate such a relationship. But intense focus on possibility has shown that this is not a cause of autism after all (we have consulted some of the world’s top autism and mercury experts whose expertise and concern for children’s health we have a great deal of confidence in), but the damage to childhood vaccination programs has been severe. The recent outbreak of mumps in the US has been blamed on an index case imported from the UK, where vaccination rates dropped following the autism scare.

Children, like adults, are a risk for severe complications of influenza, so vaccinating them is an important public health measure. CDC estimates around 90 under 5 year old children die yearly of influenza and many more become seriously ill. Even when they don’t become severely ill, circulation of the virus in school age children may be one of the important drivers for influenza in adults. As influenza season is upon us once again and the threat of a pandemic looms, CDC reports the largest study of side effects in babies and toddlers.

Researchers studied 45,000 U.S. children and found almost no side effects requiring medical treatment during the six weeks after the youngsters were vaccinated.

[snip]

Researchers found a few more cases of mild nausea and diarrhea than expected within the first two weeks after the shot, but the numbers were extremely low considering the thousands of children studied: 13 cases.

After their flu shots, the children were less likely to get treated for upper respiratory tract and ear infections. That could have been because parents felt reassured that the symptoms were not signs of flu, said study co-author Dr. Simon Hambidge, an investigator at Kaiser Permanente Colorado’s clinical research unit. (AP)

The paper is in the current issue of the Journal of the American Medical Association (subscription only). About half of the 19 authors reported some financial ties with vaccine makers. The senior author works for a large HMO (Kaiser Permanente). Since their stake is in seeing reduced morbidity, we think bias against finding side effects is unlikely.

This is a data point in the risk benefit equation for childhood immunization. It tips to the benefit side.

Comments

  1. #1 william
    October 26, 2006

    http://medamericaresearch.org/
    “CDC estimates around 90 under 5 year old children die yearly of influenza”
    First, of course children must be vaccinated against this disease. Second, what does the above quote mean. It means very few children die of Influenza A.
    Third, please for a moment remove all the medical dogma you have accumulated in your mind, and open it up to new concepts.If not, you will let that dogma blind you to what may be reality regarding our lack of knowledge regarding H5N1.
    Influenza A usually does not kill people. And it is very difficult to become infected by H5N1, no matter how hard you try. Millions have been exposed to H5N1, but very few have become infected. Why is this?
    Dr. Lawrence Broxmeyer, at the above referenced site, in referring to the Spanish Flu epidemic of 1918,says:”Influenza A could have been an innocent passenger virus in 1918,as Barr-Epstein and Cytomegalovirus were in Aids.”
    And in explaining the death of thousands of pigs in Haskell Kansas in 1918, says:
    “The lethal pig epidemic that began in Kansas just prior to the first human outbreaks was a disease of avian and human tuberculosis genetically combined through mycobacteriophage interchange, with the pig susceptible to both, as its involuntary living culture medium.”
    A mutant stain of TB may have caused the 1918 epidemic.
    And now a new mutant strain of TB may cause a new pandemic, as all effort is concentrated on stopping H5N1. A human disaster, based on false medical dogma, may be about to kill millions.

  2. #2 william
    October 26, 2006

    I forgot to mention, you will probably say TB is not a problem. Just give the patient antibiotics. In other words, there is a magic pill.
    Is there really? Jama recently published a article, and so did Nature Magazine. Guess what. Extreme drug resistant TB, (XDR-TB), is almost impossible to cure, is an epidemic in eastern europe, one person becomes infected with TB in the world every second, and hospital workers and patients in South African hospitals are being infected by XDR-TB. And out of 60 patients that died of XDR-TB recently in South Africa, 14 were healthy adults, with supposedly strong immune systems. The other 44 had HIV.
    The Nature article says it may be impossible to contain this epidemic. And the cost of treatment is 100,000 pounds per patient in the UK. And only a few nations have the tests required to detect this disease. So in Africa, there is no way to know who has it and who does not.
    And one doctor who is a TB specialist in South Africa, referring to patients infectted with XDR-TB, said: “If patients develop immunity to capreomycin and para amino salicylic acid), nothing else is left.”
    New drugs for TB will not reach the market until 2015, at the earliest.
    Sorry for such long posts. I will now stop.

  3. #3 revere
    October 26, 2006

    william: this is not a new idea, nor is it particularly well supported by the evidence. People have considered this and rejected it. It is a fringe idea for a good reason.

    TB is a major public health problem throughout the world. I have been infected with TB. It is a major killer. I do not take TB for granted nor is it easy to treat. I do not dismiss it as a disease. That is not the issue.

  4. #4 Tom DVM
    October 26, 2006

    Revere. Unfortunately, Epidemiology may have over-stepped its bounds in the past fifteen years.

    In my opinion, epidemiology is now a ‘guns for hire’ profession. Just like in the past you could make accounting numbers say anything you wanted, now you can buy a study to say anything. In other words, Epidemiology has become a standard strategy for a wide variety of companies.

    Extrapolations are now made without it seems any ethical consideration for isolating the variables.

    Ex. Smokers die five years earlier than the rest of the population due to bowel cancers. Did they not consider the fact that a smoker might drink more alcohol and eat more fried foods…nope.

    …and then there are those studies, funded by beer and liquor companies etc. that have directly resulted in an astounding demand for this now…’health food’.

    I am surprised that ethical epidemiologists haven’t spoken out.

  5. #5 revere
    October 26, 2006

    Tom: It is routine to adjust for the kind of confounders you mention, so I don’t know what you are referring to. I’ll try posting on Epi 101 to explain some of this as I think it is not well understood. Right now I am in Europe and having posting difficulties so we’ll have to see what happens.

  6. #6 william
    October 27, 2006

    Revere,
    Thank you for explaining that this is a fringe idea, and that it has been rejected.

  7. #7 Thinlina
    October 31, 2006

    My godchild got a MMR vaccine and went unconscious for eight hours. Doctors said it can’t be the vaccine. Now we’re just hoping to see her developmental milestones.

    Of course vaccines are good. But going around claiming that vaccines do not harm is stupid and hippocrate.

  8. #8 Heraldblog
    November 19, 2006

    There has never been thimerosal in MMR vaccine.

  9. #9 revere
    November 19, 2006

    Heraldblog: You are correct. This was an error on our part. Table of vaccines with thimerosol here. Thank you for pointing out this error.

  10. #10 tony m
    December 13, 2006

    Revere
    Fringe idea? Rejected? By whom? Kudos to william l for having the insight to see through the smoke and mirrors of H5N1 before it is too late.