ResearchBlogging.orgIn many ways, the anti-vaccine movement is highly mutable. However, this mutability is firmly based around keeping one thing utterly constant, and that one thing is vaccines. No matter what the evidence, no matter what the science, no matter how much observational, scientific, and epidemiological evidence is arrayed against them, to the relentlessly self-confident members of the anti-vaccine movement, it’s always about the vaccines. Always. Vaccines are always the root many human health problems, be they asthma, autoimmune diseases, autism, and chronic diseases of all types. Everything else is negotiable. For instance, back when Andrew Wakefield ignited a scare about the MMR vaccine by publishing a fraudulent case series linking the MMR to a new syndrome consisting of regressive autism and enterocolitis, it was the measles vaccine that caused this syndrome. Here in the U.S., it was the mercury in the thimerosal preservative that used to be used in many childhood vaccines until 2001 that was the cause of all evil. However, as scientists did more and more studies, testing vaccines to see if they were associated with an increased risk of autism and found zero, nada, zip association with either vaccines or the thimerosal preservative in vaccines, the anti-vaccine movement was nothing if not mutable. Before long, Jenny McCarthy was declaring that it was the “toxins” in vaccines that were causing autism, and Generation Rescue was asserting that children were getting “too many too soon.” Of course, as far as the anti-vaccine movement was concerned, the beauty of these ideas was (and is) that they are much harder to falsify scientifically because they are so much more vague.

Of late, the anti-vaccine movement has hit upon a new strategy. Specifically, they are demanding what they like to call a “vaxed versus unvaxed” study. Basically, their claim is that unvaccinated children are so much healthier than vaccinated children, and they think that such a study would prove it. Of course, they only hit on this message after making some rather embarrassing missteps. In particular, they didn’t seem to realize that a randomized, double blind study of vaccination according to the currently recommended schedule versus unvaccinated children was totally unethical. So, they figured out another angle. They acknowledge that a randomized trial of unvaccinated versus vaccinated children would not be feasible (although they appear not to be able to admit just how unethical it would be), and blithely suggest instead an epidemiological study of the vaccinated versus the unvaccinated without realizing just how horrendously difficult it would be to overcome the confounders that would plague such a study or that ethical considerations still require sound scientific justification for such a study. That’s why it’s so cute to see anti-vaccine loons trying to justify such a study.

All of which is why it’s pretty amusing that just such a study was recently reported in Germany. Can you guess what it found? Let’s just say that, to those of us who accept the science showing that vaccines do not cause autism, autoimmune diseases, asthma, and the like, the results were utterly unsurprising:

In their study, the authors compare the occurrence of infections and allergies in vaccinated and unvaccinated children and adolescents. These include bronchitis, eczema, colds, and gastrointestinal infections.

The evaluation showed that unvaccinated children and adolescents differ from their vaccinated peers merely in terms of the frequency of vaccine preventable diseases. These include pertussis, mumps, or measles. As expected, the risk of contracting these diseases is substantially lower in vaccinated children and adolescents.

Surprise, surprise! Unvaccinated kids differ from vaccinated kids only in having a much higher risk of vaccine-preventable disease! Who’da thunk it? But, as is my wont, I need to see the actual study, rather than a news report. So, as they say, let’s go to the tape. Unfortunately, the authors feel obligated to lay out exactly why they did their study:

The benefits, efficacy, and safety of protective vaccinations are widely scientifically proven. Furthermore, modern vaccines are well tolerated (4, 5). In spite of all this, some parents and doctors have reservations against vaccinations. The fear is that vaccinations overburden, stress, or weaken a child’s immune system and may therefore cause harm. As a result they think that vaccinated children are more prone to falling ill than non-vaccinated children. In addition, vaccinations are deemed to be responsible for the occurrence or increased incidence of other diseases, including chronic diseases (6, 7).

In other words, Generation Rescue, Dr. Jay Gordon, Jenny McCarthy, and others. They spread this misinformation.

Basically, what the German investigators did was to examine data collected aas part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which was conducted from May 2003 to May 2006 by the Robert Koch Institute. The data collected were primarily from a standardized, computer-assisted personal interview of the parents, but diagnoses reported and vaccination status were verified through medical records. Results were compared between vaccinated and unvaccinated children, defined thusly:

Children and adolescents were defined as unvaccinated if at the time of the KiGGS survey no documentation existed for any vaccination against diphtheria, pertussis, tetanus, Haemophilus influenzae type b, hepatitis B, poliomyelitis, measles, mumps, or rubella. By contrast, children who had by then received at least one vaccination according to their vaccination card were categorized as vaccinated. Immigrant families were excluded from the analyses in order to avoid misclassification because of the often missing or incomplete vaccination documents.

On the basis of the KIGGS data, investigators concluded that approximately 0.7% of nonimmigrant children and adolescents in Germany are completely unvaccinated. This is in line with estimates I have seen for the percentage of children in the U.S. who are completely unvaccinated, although this population is more difficult to ascertain in the U.S., at least on a national level. In any case, there was a vaccination card available for 13,453 children aged 1 through 17. Out of this group, for 94 children no evidence of vaccination could be found. Consistent with results in the U.S., the unvaccinated children tended to be from families of higher socioeconomic status. Less relevant, unvaccinated children tended to live in older German states than in the new German states.

Otherwise, the children in both groups were very similar, except in one way. This graph in Figure 1 tells the tale.

i-c7ed88b7f634f2efb173053889959fd9-Figure1.jpg

Basically, unvaccinated children had a much higher prevalence of vaccine-preventable infectious disease. The results were significant for pertussis, measles, and mumps, as described in the text:

The proportion of children and adolescents who had had pertussis, measles, mumps, and/or rubella was much higher in unvaccinated children than in those who had been vaccinated against the respective disease to a sufficient extent. For pertussis, the lifetime prevalence in unvaccinated subjects was 15.8% (95% CI 8.5 to 27.6, n = 11), in those with sufficient vaccination cover only 2.3% (95% CI 2.0 to 2.8), n = 184). For measles, the lifetime prevalence was 15.0 (95% CI 7.7 to 27.4, n = 10) in unvaccinated subjects and 5.2% (95% CI 4.7 to 5.8, n = 431) in sufficiently vaccinated ones. For mumps, the lifetime prevalence in unvaccinated subjects was 9.6% (95% CI 4.2 to 20.2, n = 7) and in vaccinated ones, 3.1% (95% CI 2.6 to 3.7, n = 305). For rubella, the lifetime prevalence was 17.0% (95% CI 9.4 to 29.0, n = 11) for unvaccinated subjects and 6.8% (95% CI 6.0 to 7.6, n = 642) for vaccinated ones. Differentiated stratified analyses confirmed the described higher proportions of subjects with the respective disease among unvaccinated subjects for boys and girls and for different age groups (data not shown).

It was at this point that the authors included an interesting control. One might imagine that if, for some reason, there were differences in infectious disease prevalence in general between the two groups, there might be differences in diseases against which we do not or cannot vaccinate, such as colds. What the investigators found was that there was no difference in the number of infections between vaccinated and unvaccinated children in any of the age groups studied:

i-26f07b9c33d4bf3040a674d38050dcfe-Figure2.jpg

In other words, as expected, the only difference in prevalence observed was in diseases for which vaccines make a difference, and those diseases were much less prevalent among vaccinated children than among unvaccinated children.

Finally, the investigators examined the hypothesis that vaccines increase the risk of allergies and immune system dysfunction by looking at atopic disorders. The authors examined the prevalence of three conditions, bronchial asthma, atopic eczema, and allergic rhinoconjunctivitis. Just like the case for diseases not currently vaccinated against, there was no difference in prevalence found between vaccinated and unvaccinated children, strongly suggesting that vaccines do not cause atopic disorders. This evidence is, of course, consistent with previous studies that have similarly failed to find evidence that vaccines increase the risk of asthma and other atopic disorders. Overall, this study is a near slam dunk against the idea that vaccines are in any way associated with atopic diseases, including this part:

In addition to atopic disorders, we further compared diseases–such as obstructive bronchitis, pneumonia and otitis media, heart disease, anemia, epilepsy, and attention deficit hyperactivity disorder (ADHD)–in unvaccinated and vaccinated subjects. No relevant differences in the lifetime prevalences were found, neither for different age groups nor between girls and boys. Schneeweiß et al. conducted a comprehensive literature review of vaccine safety, the central part of which was the evaluation of vaccine critical arguments on the basis of the current state of scientific knowledge. None of the hypotheses were found to be valid (5).

Let me repeat this again. None of the hypotheses were found to be valid.

It is true that, as large as it is, this study is relatively small given the low percentage of completely unvaccinated children. This made subgroup analysis impossible for some measures and limited the power of the analysis due to low numbers of unvaccinated children in several of the categories. After all, there were only 94 unvaccinated children, which makes it impossible to compare autism and ASD prevalence with the vaccinated cohort, because the expected prevalence of autism is only approximately 1 in 100 anyway. That means that on average roughly one autistic child would be expected in such a cohort. To look at differences in autism prevalence between the groups, many times more than 13,000 subjects would be needed, which would be a hugely expensive study, particularly if medical records and vaccination cards were reviewed for every child. This study also bolsters what I said before by showing how difficult it would be to do such a “vaxed versus unvaxed” study with sufficient subjects to provide adequate statistical power to detect even fairly large differences in prevalence. For diseases and conditions sufficiently prevalent to allow the detection of differences in the sample size the investigators had, though, there was no evidence of differences in conditions commonly blamed on vaccines between vaccinated and unvaccinated children. Certainly, this study provides no support for doing a larger study. For it to do that, there would have to be a hint of a whiff of an association between vaccinated status and the atopic diseases examined or the risk of infectious diseases not prevented by vaccines. There wasn’t. If I were on an IRB, and someone proposed doing a larger study, this German study would be an argument that there is inadequate scientific justification to do a larger study, particularly in light of other studies like this, this, and this, which suggest that early vaccination might actually be protective against atopic diseases.

The wandering band of anti-vaccine propagandists over at, for example, Age of Autism say again and again that they want a “vaxed versus unvaxed” study. Indeed, after the recent Supreme Court decision in Bruesewitz v. Wyeth upholding the primacy of the Vaccine Court in disbursing compensation to children injured by vaccines, AoA seems to have lost what’s left of its mind, posting multiple times about it as though it were some grave injustice and their rights had been completely stripped away. Add to that the picture of Barbara Loe Fisher comparing the anti-vaccine movement to Winston Churchill facing down Hitler, and the picture remains truly nauseating.

Be that as it may, I’d like to finish by offering our “friends” in the anti-vaccine movement a bit of advice. You keep saying you want the government to fund a “vaxed versus unvaxed” study. You keep repeating it until you’re blue in the face. Based on this German study, you might want to be a bit more careful. In other words, be careful what you wish for. You just might get it. And, based on this study and the vast preponderance of evidence, if that study you so fervently wish for is well-designed and conducted properly, you probably won’t like the results.

But why worry? If a “vaxed versus unvaxed” study is negative, the anti-vaccine movements will just ignore it. It’s what they do.

REFERENCE:

Schmitz, R; Poethko-Müller, C; Reiter, S; Schlaud, M (2011). Vaccination Status and Health in Children and Adolescents: Findings of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) Dtsch Arztebl Int, 108 (7), 99-104

Comments

  1. #1 herr doktor bimler
    March 14, 2011

    What about an ERV?
    Then it’s a standard part of the human genome that we all have, and you might as well call it a genetic or a genetic / environmental cause.

  2. #2 Prometheus
    March 14, 2011

    The Analyst (#167) asks:

    “Am I the only one that thinks Autism looks like a retrovirus?”

    No, there are a number of people claiming that autism is caused by XMRV. However, none of those people appear to know anything about retroviruses.

    I’m curious – what is it about autism that looks like a retrovirus? Is it the progressive nature of the disability? Is it the tumors resulting from retroviral integration? What exactly about autism looks like a retroviral infection?

    I’m quite serious – I can’t see it, so it’s obviously something I’m missing.

    Prometheus

  3. #3 Antaeus Feldspar
    March 14, 2011

    No, there are a number of people claiming that autism is caused by XMRV. However, none of those people appear to know anything about retroviruses.

    It’s actually looking less likely that XMRV has anything to do with chronic fatigue syndrome, the association which brought XMRV to public attention to begin with. At least that’s the impression I’m getting.

  4. #4 herr doktor bimler
    March 14, 2011

    what is it about autism that looks like a retrovirus?
    The elevated level of reverse-transcriptase activity that no-one’s reporting.

  5. #5 Prometheus
    March 16, 2011

    For that matter, I’d like to know which kind of retrovirus “The Analyst” thinks autism looks like.

    This sort of comment – like Th1Th2’s immunological ravings – is proof positive that the commenter knows nothing about the topic on which they are opining. It’s like hearing someone claiming to be a sports expert waxing eloquent about “home-runs” and “base hits” while discussing football (either type): you know immediately that they are fake.

    Prometheus

  6. #6 Todd W.
    March 16, 2011

    Slightly off-topic, but related, I’ve got some posts up discussing the ethics/legalities of a prospective, randomized, placebo-controlled vax vs. unvax study over at Harpocrates Speaks. Here is the list of posts so far. I have one more planned. Parts 1 and 2 are background material, part 3 applies some ethical considerations and part 4 (up tomorrow) will talk about legalities. Okay. Done with the shameless plug. I beg all of your indulgence.

  7. #7 Calli Arcale
    March 16, 2011

    XMRV — I thought I remember reading recently that there’s some controversy over whether it’s even a real virus at all, much less causing massive epidemics of seemingly unrelated chronic conditions.

    Ah yes, that was over at ERV’s blog:
    http://scienceblogs.com/erv/2011/02/xmrv_lab_contaminant.php

  8. #8 ERV
    March 16, 2011

    Because there’s no reason why a virus should affect identical twins significantly more than ordinary siblings.

    What about an ERV?

    ERVs–>disease are not the result of genetics. The diseases they are involved with are not associated with the genes, but disregulation of the genes via disregulation of epigenetic control. Thus, identical twins and non-identical twins and siblings raised in the same household are all at the same risk-level. Its the common environment, not the common genetics.

    And thanks for the links, guys 😛 XMRVs got jack to do with anything.

  9. #9 The Analyst
    March 17, 2011

    Thus, identical twins and non-identical twins and siblings raised in the same household are all at the same risk-level. Its the common environment, not the common genetics.

    False.

  10. #10 The Analyst
    March 17, 2011

    For that matter, I’d like to know which kind of retrovirus “The Analyst” thinks autism looks like.

    I never claimed to know which kind, and never claimed to know it was a retrovirus. If I knew these things, I’d probably be rolling in money.

    But you seem to already know that it couldn’t be a retrovirus or ERV.

    What do you think causes the immune dysfunction, oxidative stress (amongst many other things) present in autism?

    I don’t have the answer, but do you?

  11. #11 Calli Arcale
    March 17, 2011

    The Analyst — what makes you think immune dysfunction and oxidative stress are obligate features of autism rather than just things that happen to sometimes exist in the same person?

    I mean, when you say “present in autism,” that seems to imply you believe them to be features of autism rather than comorbid conditions. I have heard you mention this before, but have not heard it anywhere else apart from certain dubious sources who seem ill-equipped to explain what they mean. You seem to be more knowledgable than them, so I think you’re my best chance of finding out if there is any meat to this. You might also want to be more specific; what precisely do you mean by “immune dysfunction” and what do you mean by “oxidative stress”? They seem rather vague categories without more context.

  12. #12 AntiVaccine
    March 18, 2011

    The study leaves out a very critical piece of data in undergoing potentially risking biological tinkering.

    The actual outcome of the infected and the prognosis long term post infection. the result of the infections rate aren;t suprising for such a small sample group. No vaccine is 100% effective and no population is 100% suceptiable particularlly to something as common and mundane as measales mumps rubella. All of which self resolve with nero zero complications in most case. Mumps being the one to be concerned about however if cuaght during adolsecents but even the study data only really shows a very small decline in infection rates. Extroplated without fuzzy math its a 6% reduction in infection. Hardly worth noting or consider in light of efficacy. If anything this study prove how rampantly ineffective vaccines actually are and how resistant the population is at large to common viral infections.

    Its doesn;t make the case of the OP if the data is examined with a critical eye.

    the data would mean more if both sample group were equally sized and I am fiarly sure the results would be more evenly divided amongst the 2 groups at such a point.

  13. #13 Chris
    March 18, 2011

    Oh, I see why you are “AntiVaccine”, it has something to do with your lack of reading ability. You obviously did not understand why the pool of totally unvaccinated persons was so small.

  14. #14 Prometheus
    March 18, 2011

    “AntiVaccine” appears to claim that the Schmitz et al (2011) study showed only a small decrease in vaccine-preventable diseases in the vaccinated group:

    “…even the study data only really shows a very small decline in infection rates. Extroplated without fuzzy math its a 6% reduction in infection.”

    The “real” numbers from Schmitz et al 2011:

    Pertussis: unvaccinated 11%; vaccinated 1.8%
    Measles: unvaccinated 11%; vaccinated 4.3%
    Mumps: unvaccinated 7.5%; vaccinated 3.1%
    Rubella: unvaccinated 12%; vaccinated 7.0% *

    *not a statistically significant difference.

    I can’t see how this works out to a “6% reduction in infection” unless “AntiVaccine” is making the common error of subtracting one percentage from another.

    Truly, this was the only area in the study where the unvacinated children “outshone” the vaccinated children: their significantly higher incidence of vaccine-preventable diseases. If you’re anti-vaccine, I’d think you’d want to revel in this; “Yay! Unvaccinated kids rule!**”

    ** in getting vaccine-preventable diseases

    After all, isn’t that what the anti-vaccinistas are always claiming – that “natural” immunity is so much better that we’d all be healthier if we got our immunity the “old-fashioned way”? And, if 2 per 1,000 kids who get measles end up with permanent brain injury (a known, well-documented complication of measles, as opposed to autism, which hasn’t been shown to be associated with vaccines), well, that’s just the cost of being “natural”, right?

    Sheesh.

    Prometheus

  15. #15 Composer99
    March 18, 2011

    TheAnalyst @ 209:

    {Citation needed.}

  16. #16 SM69
    March 18, 2011

    Looking at the material and method of the paper:

    1- By contrast, children who had by then received at least one vaccination according to their vaccination card were categorized as vaccinated.

    One vaccine only? This hardly is a true vaccinated representative population.

    2- n=94 (unvaccinated) versus n=13359 (vaccinated at least once)- You must be kidding.

    3- Table 2 does not seem to fit with the statistical conclusions reached.

    4- Dr Schlaud was the lead investigator of an epidemiological study of deaths in children aged 2–24 months (TOKEN Study) in 2004–2009, which was jointly funded by the Federal Ministry of Health, the Paul Ehrlich-Institute, Sanofi Pasteur, and Glaxo Smith Kline.

  17. #17 SM69
    March 18, 2011

    Looking at the material and method of the paper:

    1- By contrast, children who had by then received at least one vaccination according to their vaccination card were categorized as vaccinated.

    One vaccine only? This hardly is a true vaccinated representative population.

    2- n=94 (unvaccinated) versus n=13359 (vaccinated at least once)- You must be kidding.

    3- Table 2 does not seem to fit with the statistical conclusions reached.

    4- Dr Schlaud was the lead investigator of an epidemiological study of deaths in children aged 2–24 months (TOKEN Study) in 2004–2009, which was jointly funded by the Federal Ministry of Health, the Paul Ehrlich-Institute, Sanofi Pasteur, and Glaxo Smith Kline.

  18. #18 SM69
    March 18, 2011

    Looking at the material and method of the paper:

    1- By contrast, children who had by then received at least one vaccination according to their vaccination card were categorized as vaccinated.

    One vaccine only? This hardly is a true vaccinated representative population.

    2- n=94 (unvaccinated) versus n=13359 (vaccinated at least once)- You must be kidding.

    3- Table 2 does not seem to fit with the statistical conclusions reached.

    4- Dr Schlaud was the lead investigator of an epidemiological study of deaths in children aged 2–24 months (TOKEN Study) in 2004–2009, which was jointly funded by the Federal Ministry of Health, the Paul Ehrlich-Institute, Sanofi Pasteur, and Glaxo Smith Kline.

  19. #19 Zed
    March 18, 2011

    Looking at the material and method of the paper:

    1- By contrast, children who had by then received at least one vaccination according to their vaccination card were categorized as vaccinated.

    One vaccine only? This hardly is a true vaccinated representative population.

    2- n=94 (unvaccinated) versus n=13359 (vaccinated at least once)- You must be kidding.

    3- Table 2 does not seem to fit with the statistical conclusions reached.

    4- Dr Schlaud was the lead investigator of an epidemiological study of deaths in children aged 2–24 months (TOKEN Study) in 2004–2009, which was jointly funded by the Federal Ministry of Health, the Paul Ehrlich-Institute, Sanofi Pasteur, and Glaxo Smith Kline.

  20. #20 Composer99
    March 18, 2011

    SM69:

    Kindly elaborate on your objections, preferably with reference to principles & techniques of statistical analysis to support your position.

    In particular, your objection #4 seems to be little more than an ad hominem (of the sort I suggested might happen back on comment #41) fallacy. If this study was conducted with sufficient rigour then it is of little moment who funded some 2004-2009 study. Likewise, if this study was conducted poorly, sloppily, etc. then it is of little moment who funded some 2004-2009 study.

  21. #21 Beamup
    March 18, 2011

    1. Shift goalposts much? When dose-response studies are done, the reaction is “dose doesn’t matter, one is enough, you have to do it completely unvaccinated vs. everyone else!” Then when that’s done, all of a sudden the number matters again.

    2. 94 is smaller than ideal, but all available. The fact that it’s so much smaller than 13359 is not a problem in the least. Think about it – if you want to claim that it would be better if the numbers were more equal, you are necessarily claiming that throwing away data makes results more reliable.

    3. Details are required when making such a statement.

    4. So?

  22. #22 MD1970
    December 8, 2011

    Orac’s minions-
    Suggest you read @116 from@SCR-

  23. #23 novalox
    December 8, 2011

    @md1970

    Suggest that you stop necroing old posts, idiot.

  24. #24 Professor Blackheart - Epidemiology
    December 9, 2011

    Here’s an unvaccinated – vaccinated study.

    “When DTP was first introduced into Guinea-Bissau, despite the absence of herd immunity, mortality was 5.1 deaths per 100 person-years among children who did not receive DTP but 11.3 deaths per 100 person-years among children who did receive DTP”

    That’s not to hard to understand is it ?

  25. #25 David Lipschitz
    February 11, 2012

    I don’t understand this line “Consistent with results in the U.S., the unvaccinated children tended to be from families of higher socioeconomic status.” Why are rich people not vaccinating their children? Do they hear something at Davos that the rest of us don’t have access to?

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