More disease and death among the unvaccinated

Beginning on Friday after my post expressing amazement at something as rare as a 70° F temperature in January (at least around my neck of the woods), namely an actual provaccine article in the Huffington Post, a number of you began sending me links to a story that I find most disturbing, a mini-tsunami that continued all weekend. In fact, it's so disturbing that I kept procrastinating all weekend until I wasn't even sure I was going to write about it at all. But the comments kept coming, and I realized once again that, once one gains a reputation as a go-to blogger about a certain topic, there's actually a bit of an obligation involved. As hard as I still find to believe it, more people than I would have dreamt possible actually care what I think about certain issues. (Yes, it's pretty amazing, but there you go.)

Before I get into this story, you'll notice one thing that I haven't seen thus far (at least not as of late Sunday night, when I wrote this). I haven't seen, for example, anyone on the antivaccine blog Age of Autism acknowledging this story. I haven't seen one word there or on any of the other antivaccine sites that I monitor. Nothing from David Kirby on HuffPo. Nothing from Barbara Loe Fisher. No Dr. Jay "I'm not an antivaccinationist I just sound like one" Gordon showing up to say how exaggerated the story is. Nope. I've seen none of this.

Perhaps it's because this story, which appeared in the New York Times on Friday afternoon and was entitled Minn. Illnesses Worry CDC Officials:

ATLANTA (AP) -- Five Minnesota children have grown sick -- and one of them died -- from a germ that can cause meningitis, causing U.S. health officials to warn of the importance of a common childhood vaccine.

The Hib vaccine, which is given to babies, has succeeded in reducing U.S. cases of the bacterial illness to about only 20 a year in children younger than 5. But a cluster of five cases occurred in central Minnesota last year in young children. One child, who was 7 months old, died of meningitis in November.

No other states have reported such an increase. But Minnesota's disease surveillance is unusually good, so problems in other states could be developing, said Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention.

And what was the likely cause of this cluster of H. influenzae type B cases in Minnesota. If you've been reading this blog, I think you know the answer to that one:

Three of the five children -- including the dead child -- had not received any vaccine, due to a decision by their parents. But a shortage of Hib vaccine may also have contributed, CDC officials said.

That's right. Three of them were completely unvaccinated. Because I wanted to know more, I decided to look at the CDC's MMWR report that describes the incident:

During 2008 in Minnesota, five children aged 5 months to 3 years were reported with invasive Hib disease; one died (Table). The patients resided in five different counties in Minnesota and had no known relationship to each other. Three patients had received no vaccinations because of parent or guardian deferral or refusal. One child was aged 5 months and had received 2 doses of Hib PRP-TT vaccine in accordance with the primary series schedule. Another child had received 2 doses of Hib PRP-OMP vaccine, but no booster dose, per CDC recommendations during the shortage. Subsequent to Hib infection, this child was diagnosed with hypogammaglobulinemia. None of the five were enrolled in group child care. The five cases in 2008 were the most reported for 1 year from Minnesota since 1992, when 10 cases were reported (Figure 1).

I can guess what antivaccinationists would say about this. They'd pooh-pooh it, saying it was just five children, that it was a single cluster that may not mean anything. Sure, that's possible. But it's damned peculiar, don't you think, that every single one of these children were either completely unvaccinated against Hib , not completely vaccinated, or possibly immunosuppressed.

What worries me (and the CDC) is that this might be the proverbial "canary in the coalmine." As was pointed out in both reports, Minnesota has an unusually good disease surveillance and tracking system. Ironically, enough, it isn't just children whose parents refused to vaccinate their children who died, but a shortage of Hib vaccine may have contributed to the problem. Either way, there's a clear reason why the antivaccine contingent hasn't commented on this. Whether it was a shortage of vaccines or parents refusing vaccines that resulted in this cluster of Hib cases, the Minnesota experience over the last year is yet one more piece of evidence that vaccines prevent infectious disease and death. When viewed in the context of other evidence that the introduction of the plain polysaccharide vaccine in 1985 and the conjugate vaccine in 1988 resulted in a rapid and profound decrease in the incidence of Hib infection, 85% in Minnesota by 1993. Observation, history, and science show that incidence and death from infectious disease is inversely correlated to vaccination levels. When vaccination levels fall, be it from antivaccine sentiment or from parents refusing to vaccinate their children, infectious diseases formerly protected against inevitably return.

What's particularly disturbing about this incident is that it suggests how easily herd immunity can be compromised for Hib. If it were up to full protective levels, then even the children whose parents were foolish enough not to vaccinate them would have been protected. Take a look at this figure from the MMWR:

i-29181488492d2cff70252cd51a9cea34-m8e0123a1f2.gif

Notice that only 50% of the children have had all three doses.

Another factor to be considered is this from the MMWR:

The cases occurred during a Hib vaccine recall and continuing nationwide shortage that began in December 2007. The recall of certain lots of the two Hib-containing vaccines manufactured by Merck & Co., Inc. (West Point, Pennsylvania) and cessation of production of both vaccines left only one manufacturer of Hib vaccine in the United States (Sanofi Pasteur, Swiftwater, Pennsylvania) (2,3).

In other words, there were only two manufacturers of the Hib vaccine in the U.S., and all it took was a recall to get one of them to stop making the vaccine. Why is it that there are so few manufacturers of this and other vaccines? Could it possibly be because of the legal liability issues stoked by the antivaccine movement? Unfortunately, these days manufacturing common vaccines is a relatively low profit, high liability business activity. If I were CEO of a large pharmaceutical company, my fiduciary duty would make me wonder whether I should stop manufacturing vaccines too.

I hope this incident is just a blip, a one-year anomaly that will get better once Hib vaccine availability is back to where it was. I really do. The problem is, I fear that it's not. With increasing numbers of parents refusing to vaccinate, thanks to the lies of Jenny McCarthy and the antivaccine movement, I worry that all it now takes is a vaccine shortage to reveal the chinks in herd immunity.

I also worry that, thanks to antivaccinationists, that clusters and outbreaks of vaccine-preventable disease will be an increasing problem.

ADDENDUM: The Bad Astronomer noted this story.

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I only know a little about Hib (and that's just because some colleagues were working on the epidemiology a few years ago), but isn't meningitis a relatively rare outcome? Isn't it more normal to just have a painful earache? IOW, is it likely that many more kids are being affected, but aren't being reported?

For some bizarre reason, MN is rife with antivax and antiscience psychos. I blame the winters. People are stuck inside and those who choose to spend it all in front of their computer will fall prey to pseudoscience (Generation Rescue and Age of Autism) if they also have a GoF mutation in the lemming gene.

This is very disturbing though not unexpected. Having been through two meningitis scares with my son, I cannot imagine how anyone would not do everything they could to avoid this for their children.

I posted a comment to the (moderated) Fisher blog, but I'm not exactly holding my breath.

By Wojciech Setlak (not verified) on 26 Jan 2009 #permalink

They are playing Russian Roulette with children's lives.

I'm sure the deafening silence of the anti-vaxxers is temporary until they figure out a way to rationalize how they are the victims of the MSM and Big Pharma. Just as a child and its mother can die because of HIV Denialism, these people will never accept their complicit responsibility in these deaths.

They are guilty of Woo Slaughter.

By mayhempix (not verified) on 26 Jan 2009 #permalink

Bob O'H--
You're confusing Hib (haemophilus influenza, type B) with non-typeable haemophilus influenza. Non-typeable causes the ear infections, is fairly common, but isn't covered by the vaccine. The true Hib, on the other hand, causes not only meningitis but also epiglottitis. The epiglottis--you know that flap in your throat sealing off your airway so you don't choke when you eat? Imagine it swelling up--now food won't go down your airway, but neither will air. Very bad stuff. Before the vaccine came out, Hib was the #1 cause of bacterial meningitis in kids. Now, it's almost unheard of. Which is an amazing testament to the effectiveness of the vaccine.
The key word is "almost." Some adults still carry the bacteria, albeit without any symptoms. Hence the recent outbreak in Minnesota.
On a related note, we pediatricians have been fearing exactly this sort of thing ever since the shortage started last year.

By Cynical Pediatrician (not verified) on 26 Jan 2009 #permalink

I can't help but think of the cectic comic...

What's infuriating are the discussions I've had with antivax parents online. The selfish claims that they have to do what's best for their child, and that they are happy to rely on the herd immunity others provide. A bit of game theory might be nice here - perhaps sit them down for a few rounds of prisoner's dilemma?

By Epinephrine (not verified) on 26 Jan 2009 #permalink

The comments on the Mommy Militia boards (mothering.com's crunch-granola group) are that the 7-monther was too young to get the vaccine anyway, so it's non non-vaccination that is the problem.

They don't seem to grasp that vaccinating older kids keeps them from bringing the infection to their baby brothers.

By Tsu Dho Nimh (not verified) on 26 Jan 2009 #permalink

They don't seem to grasp that vaccinating older kids keeps them from bringing the infection to their baby brothers.

And considering the social characteristics of antivaccine hysteria, unvaccinated families are likely to associate with one another, increasing the risk of an outbreak more than one might expect from overall vaccination statistics.

Well, I'm glad I didn't email this story to you, Orac, since so many other people did. I heard it on NPR on Saturday and my first thought actually was "Orac would want to hear about this."

Anecdote time: my grandmother's first child died from epiglottitis, probably from HiB (this would have been the mid 1950s). It's become so commonplace for children to survive infancy that I think most people don't really understand what it was like to assume that some of your children would die before they ever ha a chance to live. I've managed to experience a small amount of that resignation in the face of nature through my grandmother, and it's provided a much needed perspective when I consider the consequences of not vaccinating.

Bob Sears was quick to point out that two "fully vaccinated" children died as well (never mind that one was too young to have head more vaccines and the other had immune problems).

I had meningitis when I was a little girl. The actual pathogen was never isolated (through a screw-up at the hospital, which was extremely busy at the time, both samples of my CNS were lost en route to the lab, and they didn't want to put me through another spinal tap). But it could've been Hib, so I got to spend most of my two-week hospital stay in isolation. Yay. (Developed a phobia of the coal-fired power plant in St Paul, or at least its smokestack, which was clearly visible out my window. I can't really explain why it scared me so much, but it did, and I didn't know how to call the nurse to come close the drapes, so I just screamed until someone heard me through the airtight doors of my room.)

I cannot understand anyone willing to accept the risk of that sort of experience. Yeah, I lived, and with no long-term ill effects. But it took two weeks of intensive medical care and a lot of terror in order to achieve that, and I very nearly didn't make it.

I have done what's best for my children. I have made sure they are vaccinated, and you can be damn sure I got them the Hib vaccine.

By Calli Arcale (not verified) on 26 Jan 2009 #permalink

The comments on the Mommy Militia boards (mothering.com's crunch-granola group) are that the 7-monther was too young to get the vaccine anyway, so it's non non-vaccination that is the problem.

By age 7 months, the child should have had the primary series complete with three doses on board.
So he/she wasn't too young and once again, the Mommy Militia is misinformed, lying, or denying.

This is from Shirley's Wellness Cafe and appears to have been posted on the site prior to 2002.

http://www.shirleys-wellness-cafe.com/vaccines_phillips_myths.htm

"In Minnesota, a state epidemiologist concluded that the Hib vaccine increases the risk of illness when a study revealed that vaccinated children were five times more likely to contract meningitis than unvaccinated children."

"The author is "Alan Phillips is a 3rd year law student attending the University of North Carolina at Chapel Hill, and a co-founder and co-director of Citizens for Healthcare Freedom (CHF), a nonprofit corporation dedicated to raising vaccine awareness and advocating informed choice. Alan has a background in technical writing, writing assessment, childrenâs elementary education, freelance writing and investigative research on alternative health issues, and is known internationally for professional music performance and production. He holds a ministerial credential, and plans on practicing law in the Chapel Hill, NC area following admission to the bar in 2002."

He posted no link or source for that assertion.

The post he authored is a series of numbered Vaccination Myths". Here are a couple of examples of sub-headers:

VACCINATION TRUTH #3

"It is unclear what impact, if any, that vaccines had on 19th and 20th century infectious disease declines."

VACCINATION MYTH #4:
"Vaccination is based on sound immunization theory and practice..."

...or is it?

And the there is this:

"Do you have a vaccine exemption legal issue or question click here to email Alan Phillips or call 919-960-5172 NC. He is one of only a handful of attorneys in the U.S. with a focus on vaccine legal exemptions. See his article Vaccine Religious Exemption."

and this:

INTRODUCTORY VACCINE PRESENTATIONS

"Citizens for Healthcare Freedom Director Alan Phillips conducts introductory lectures on the vaccine controversy. Presentations are designed to complement and supplement the information in this article. To sponsor a presentation in your home, office, local library, etc., write to CHF Lectures, P.O. Box 62282, Durham, NC 27715-2282, or email lawpapa@nc.rr.com.

ALSO AVAILABLE:

Alan has researched and written on several vaccine legal issues, including vaccine exemptions (with a focus on religious exemption federal case law), the National Vaccine Injury Compensation Program, and the shaken-baby-syndrome/vaccine injury connection: the documented instances in which parents and caretakers are convicted of child abuse, but later the damage is shown to have been caused by a vaccine injury."

Here is his site on vaccination avoidance:
http://www.vaccinerights.com/?hop=wellcafe

I called Allan and asked him if he knew about the death in MN. He replied that he had heard something maybe about a child dying but IMHO was feigning ignorance. I explained the report to him. When I read his quote back to him and then asked if he felt any responsibility he started with "But what about the 10,000 deaths caused by..." I cut him off and stated he was avoiding my question... he hung up.

I called him back and he told me that Shirley's Wellness Cafe was not his site and they could publish anything they wanted. I told him, yes, but that it was still his quote or does he deny it, and if not did he feel had any responsibility for the death? He started off about some other "expert". I again interrupted that he was avoiding the question. He then told me that he was a lawyer and if I wanted a consultation it would cost me $140/hr to which I replied are you also a doctor? and he hung up again.

By mayhempix (not verified) on 26 Jan 2009 #permalink

Also this from Alan Philip's website:

"COST: Alan Phillips' vaccine exemption consultations usually run about an hour and are modestly priced. If a Legal Opinion Letter or Affidavit is requested or required, there is an additional charge. Alan offers a sliding scale for low-income individuals and families--cost need never prevent you from getting the help you desire."

This guy is charging people to help them avoid legally mandated vaccinations.

By mayhempix (not verified) on 26 Jan 2009 #permalink

IMO there's no question that McCarthy/Gordon/Kirby/Wakefield/etc. are ethically responsible for this death. Reckless endangerment murder seems the closest fit.

Too bad the legal system doesn't see things that way.

mayhempix said "I called Allan and asked him if he knew about the death in MN..... I told him, yes, but that it was still his quote or does he deny it, and if not did he feel had any responsibility for the death? He started off about some other "expert". I again interrupted that he was avoiding the question. He then told me that he was a lawyer and if I wanted a consultation it would cost me $140/hr to which I replied are you also a doctor? and he hung up again."

Here is where Allan Phillips old "Vaccination Myth" website is analyzed:
http://www.pathguy.com/antiimmu.htm

It has this to say in reference to how he uses data:
"[Link now down.] The main feature of this inflammatory site is heavy referencing to the scientific literature. Someone who does not have the time to check the scientific references could be impressed.....
The author of "Dispelling Vaccine Myths" has NO refereed data to document his obviously false claim that immunization has not led to a reduction in the diseases for which it is administered."

Again, this is an example of why you should not go to a lawyer for medical advice.

The Mommy Militia is in full blown denial. At least one discussion thread on the Mothering forums has been removed for "review" aka deleted because it is inconvenient. The rest of them are nitpicking irrelevant details or plain out ignoring the case.

The local forums have no mention of it at all. In fact most of the local anti-vaxers haven't made much of an appearance at all, probably hoping it will blow over before they have to explain it.

The case is simple, not vaccinating that child resulted in their death. End of story.

It's full damage control mode because they depend on fear to convince the average parent (most of their audience). This is real and it is convincing to anyone that isn't a conspiracy nutcase. Not vaxing just became alot scarier than it was before for a whole lot of people.

Pondering this: if a child were too young to get the MMR shot (under one year old) and became infected and died because of such a anti-vaccine community infection, would it be plausible to take those non-vaccinating parents to court for a wrongful death suit? (Excuse my horrid run-on sentence/word salad!) Knowing negligence that directly leads to death seems exactly what this sort of lawsuit is intended to address. I'd kind of love to see this happen. (Well, except for the whole blameless dead baby aspect, of course.) I just have no idea what can reach these people, but at least it would publicize the real consequences of their choices. Thanks for the post, Orac.

Only 1 child died not 5 though 5 were reported as having it (which means that the other 4 were ill enough to take to a doctor/hospital and have possibly suffered permanent damage [or will die in the not too distant future, this disease does not always kill quickly]).

The scary statement in the report to my mind is

"Among children aged 7 months, 3-dose primary Hib series coverage was 46.5%"

You probably can do that (I've been hoping for something like that to happen) but the problem is: Money
You need someone directly hurt to file (aka the parents) and you need the guilty to have enough money to cover a verdict. Otherwise no lawyer will touch it, unless the suing parents are willing to pay for a (financially) useless lawsuit. And in that case, the guilty might just not fight the lawsuit but file for bankruptcy, which doesn't help the cause much; a default judgment in first instance civil court is not going to be much of a precedent.

Mu said:
"...and you need the guilty to have enough money to cover a verdict."

I hear Jenny McCarthy just came into a wad of cash. JB also has some deep pockets. The real question is where did the parents get their "education" about vaccination?

I wonder how anti-vaxers will fare when they play the part of cold, heartless cretin that caused the death of children?

Question from a lay person. All the articles on this mentioned the child who was immuno-suppressed but had had the full course of vaccinations. What does that mean? I get that it means that he or she was susceptible despite the vaccine, but how does that work?

By WonderingWilla (not verified) on 26 Jan 2009 #permalink

Sorry to spam the blog, but I put this link under another entry and it may be better here. Besides I totally effed up the spelling of thimerosal in the other post.

MSNBC has an interesting article on vaccine safety here: http://www.msnbc.msn.com/id/28854955/

The article discusses a long term Italian study that addresses the thimerosal to autism (non)link.

mayhempix,

People like this Phillips bastard are the most execrable of a contemptible lot (I like the word execrable, so sue me, oh wait, Phillips is a lawyer, nevermind).

He works to protect child abusers and child killers with pseudoscience that claims that babies shaken to the point of injury or death was caused by vaccines. Antivax claims that are made to scare people into not vaccinating their kids.

And the trail of slime doesn't end there, either. One of the proponents of this disgusting lie is the ass who gave the late Christine Maggiore plausible deniability that she didn't infect her daughter with HIV.

Crank magnetism at its worst.

I'm pissed.

By Robster, FCD (not verified) on 26 Jan 2009 #permalink

Question from a lay person. All the articles on this mentioned the child who was immuno-suppressed but had had the full course of vaccinations. What does that mean? I get that it means that he or she was susceptible despite the vaccine, but how does that work?

I don't know much more than you do, but I'll give it a try : there are immune cells (part of the "adaptive" immune system) that are designed to fit a particular pathogen and counteract it. This means you've got tons of those cells, all of them slightly different. When you get an infection, those that happen to "fit" that pathogen multiply and mount an immune defense against it. If you survive, those that fit best will leave a few "memory cells" behind, so that if ever that pathogen ever comes back the memory cells react immediately by producing massive amounts of the cells that worked last time, thus getting rid of the pathogen before it actually makes trouble.

Vaccination is an exercise in creating those memory cells without the whole "getting the disease in the first place" thing.

Given this, if you're immunosuppressed you've got a problem with your immune system in the first place and whatever's affecting your ordinary immune cells will also be affecting the memory cells, so they won't be much help in mounting a defense.

In other words, there were only two manufacturers of the Hib vaccine in the U.S., and all it took was a recall to get one of them to stop making the vaccine.

One thing that's always amused/puzzled me about anti-vaccine people is the claim that vaccines are pushed by Big Pharma, although (please correct me if I'm wrong) I've heard vaccines are the least profitable activity for pharmaceutical companies.
Hey, I've got a lot of problems with Big Pharma, but if so vaccines would be one area where they're actually being good guys.

By Caravelle (not verified) on 26 Jan 2009 #permalink

ababa, unfortunately it would be very hard to sue the true culprits (JMc and Co); while they are the instigators and provide the moral support for the non-vaccinating parents, the causal link would be a real problem. Same as you can't sue someone who gave an inflammatory speech for the damage in the riots afterward (unless they were stupid enough to actually ask for rioting).

It's going to take an epidemic to get it through the uneducated but fearful masses collective head that vaccines are a necessity for public health.

As a recovered magical-thinker and former denialist, the PR problem here is daunting. You have the "worried well" who are living in a fear-based delusion where quacks offer pseudoscientific answers for terrible diseases. These are not stupid people, they're scared and the quacks are saying what they want to hear. I can scarcely believe the things I once used to accept because I wanted them to be true. It took several personal experiences of illness and loss to snap me out of my own fear and into reality. It was liberating, and as an advertising exec, I'm pondering how to reach those who think of medical professionals and scientists as cold, calculating schills for "Big Pharma" (as I once did). Any other creatives out there interested? rebelmacaque@gmail.com

By Pareidolius (not verified) on 26 Jan 2009 #permalink

WonderingWilla, possibly the child had Common Variable Immunodeficiency, in which one of a number of genetic defects affects levels of immunoglobulin, which is one of the first lines of defense against bacterial infection.

Fact remains, any way the antivaxers try to spin it, a seven month old child has died from meningitis. This would have been prevented had the parents not refused vaccination. I hope someone, somewhere forgives them.

As the CDC say in their MMWR article:

"Before development of Hib conjugate vaccines, Hib was the most common cause of bacterial meningitis in children aged <5 years. Since implementation of the Hib conjugate vaccine immunization program in the United States in the early 1990s, the incidence of Hib disease has declined from a peak of 41 cases per 100,000 children aged <5 years in 1987 to approximately 0.11 cases per 100,000 in 2007 (3,5). As with other bacterial diseases in which acquisition of carriage is necessary for development of invasive disease, reductions in asymptomatic carriage and transmission are substantial contributors to the reduction in Hib disease achieved through vaccination programs (6--8). This herd immunity provided by high vaccination coverage provides additional protection both for fully vaccinated and undervaccinated persons (6--8)."

Whoops, that should read like this (formating was upset by the CDC's use of a "less than" sign)

"Before development of Hib conjugate vaccines, Hib was the most common cause of bacterial meningitis in children aged under 5 years. Since implementation of the Hib conjugate vaccine immunization program in the United States in the early 1990s, the incidence of Hib disease has declined from a peak of 41 cases per 100,000 children aged under 5 years in 1987 to approximately 0.11 cases per 100,000 in 2007 (3,5). As with other bacterial diseases in which acquisition of carriage is necessary for development of invasive disease, reductions in asymptomatic carriage and transmission are substantial contributors to the reduction in Hib disease achieved through vaccination programs (6--8). This herd immunity provided by high vaccination coverage provides additional protection both for fully vaccinated and undervaccinated persons (6--8)."

Pink Book says this:

In 1998â2000, approximately 44% of children younger than 5 years of age with confirmed invasive Hib disease were younger than 6 months of age and too young to have completed a three-dose primary vaccination series. Fifty-six percent were age 6 months or older and were eligible to have completed the primary vaccination series. Of these age-eligible children, 68% were either incompletely vaccinated (fewer than 3 doses) or their vaccination status was unknown. 32% of children aged 6â59 months with confirmed type b disease had received three or more doses of Hib vaccine, including 22 who had received a booster dose 14 or more days before onset of their illness. The cause of Hib vaccine failure in these children is not known.

http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/hib-508.pdf

This sugests that a third of children with invasive HiB were primary vaccine failures. All the more important then to have good herd immunity, or possibly to look for more immunogenic vaccines.

Whoops, I meant a third of children of vaccinatable age with invasive HiB were primary vaccine failures.

Orac wrote;
"As hard as I still find to believe it, more people than I would have dreamt possible actually care what I think about certain issues. (Yes, it's pretty amazing, but there you go.)"

Being one that sent you a CNN version of the article about the Minn. outbreak, I am hoping that possibly an individual (or individuals) of professional qualification within the medical profession would eventually get air-time to start bitch slapping (sorry couldn't help it) some of these Univeristy of Google attention seekers that the media continues to give air time and media print to.

I am a staunch freedom of speech advocate, but this is getting to the "yelling fire in a crowded theater" stage of the freedom of speech argument. It is long overdue for public service announcements.

I am afraid that the power of mere suggestion is beginning to manifest itself as a precurser to the disease statistic.

As the saying goes, a lot of people are going to have to die before....

By Uncle Dave (not verified) on 26 Jan 2009 #permalink

I have read that some anti-vaccination people have concerns about serotype replacement related to the HiB and the pneumoccoal vaccines. Can you comment on this? Particularly, I have seen these studies:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=344485

http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&list_uids=17516405&c…

http://www.journals.uchicago.edu/doi/abs/10.1086/511861

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_ui…

Also, I have read that one reason people do not want to get the HiB vaccine is because it has been linked to an increase in Type 1 Diabetes.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1116914

I would be interested in your views on these studies. Thanks!

I don't think the meningitis vaccine was around early enough for my son to have had it. Is there any point in getting it for him as a young adult? That should help the herd immunity.

I've a graph on one of my articles that shows the rates for meningitis caused by serotypes C and B. One vaccine was developed before the other, and you can see that one strain of the disease dropped while the other continued as usual until the second vaccine was developed. If outside causes were reducing the rates of disease, this pattern would not appear.

In other news, pneumonia vaccine reduces the risk of heart attack.

Interesting that "kathy" did not post the link of the diabetes study that is criticized the comments to the editor which is here:
http://www.ncbi.nlm.nih.gov/pubmed/10221937
It concludes there is no statistical increase in child diabetes after the introduction of the vaccine. Also, one of the rebuttals even ends with this statement: "... diabetes induced by the vaccine may be avoided by starting vaccination a few weeks earlier."

I wonder why the anti-vaxxers aren't recommending parents just start the vaccine a few weeks earlier as a precautionary measure? At least then a child wouldn't have died.

There are so many other factors that the increase of child diabetes can be attributed to, the main culprit being increased intakes of sugar, that this is the same as "If my dog peed on a fire hydrant and then I got a flat tire, I better not let my dog pee on fire hydrants."

As usual the alarmists react "Yeah, but what if it's true!!!????" even though one comment they post concludes that even if it is true it's probably just a matter of starting vaccinations a few weeks earlier.

As far as the increase of flu in adults is concerned:

"Conclusions.In Illinois, the incidence of invasive H. influenzae disease increased from 1996 to 2004, and its epidemiological characteristics changed from a disease predominantly found in children and dominated by serotype b to a disease predominantly found in adults and dominated by nontypeable strains."

The adults did not receive the vaccine when they were children so the vaccine did not directly cause the increase in Nontypeable H. flu, nor did it increase children's susceptibility to the disease. I know that alarmists will claim they never said that but the way it is presented to concerned parents who feel pressured not vaccinate their children it leaves a distinct impression that it does. Anti-vaxxers operate on fear motivated by ignorance. And even if it turns out to be the case that the disease is morphing because of the vaccine then as an adult I would certainly choose to protect my child with the vaccination and take my chances when I am over 65 because (quoting the Illinois study posted):

"During January 1996âDecember 2004... the incidence of disease increased from 0.4 to 1.0 cases per 100,000 persons, including an increase of incidence in adults aged 65 years from 1.1 to 3.9 cases per 100,000 persons. Nontypeable H. influenzae disease accounted for the greatest proportion of cases (35.8%â61.5%) in all but 1 age group. Overall, the caseâfatality rate was 12.7%, with the highest rate observed in persons aged 65 years (20.6%)."

Meaning that at best my chances of getting sick with a Nontypeable H. flu after 65 went from approximately 1 to 2 in 100,000 and my chances of dying went up to about 1 in 1,000,000.

What if vaccination causes autism??!!!!
What if vaccination causes child diabetes??!!!!
What if vaccination increases adult flu??!!!!
What if someday we find something??!!!!

Definitely not vaccinating has killed a child
and added to the Woo Slaughter death count.

By mayhempix (not verified) on 27 Jan 2009 #permalink

Monado said "I don't think the meningitis vaccine was around early enough for my son to have had it. Is there any point in getting it for him as a young adult? That should help the herd immunity."

Not the Hib, it is only given to babies. They are the most vulnerable from the meningitis and their breathing being cut off from epiglottitis (see the sixth comment, it is by Cynical Pediatrician, for a description). You might be thinking of another meningitis vaccine for a different bacteria:
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/mening-508.pdf

Young adults who are going to college should get that, plus updated their tetanus booster with the Tdap, plus get an influenza vaccine if necessary (my insurance only pays for the latter up to age 18).

"kathy" didn't post the other link because she hadn't seen it. So there are two studies- one says that diabetes isn't linked, and one says it is. Does anyone know if any others have been completed?

I'm still curious about your response to the serotype replacement studies. Just trying to learn something - no agenda.

Also, when I look at this chart from the CDC, it doesn't appear that there has been any significant decreases in Haemophilus reported since the vaccine was introduced. Is this because while HiB is decreasing, other types of Hi are becoming more common? http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/G/cases&…

No one in this world wants to avoid vaccinations.

But mercury in your vaccine a dozen times over?

Vaccines at One Day old?

Repeat vaccines for same illness every month or every year for life?

And from Italy everyone says its fine but ONE autism case out of 1 400 is RISKY.

My vaccines came at 5, 10 and 13 that's years not MONTHS and the safety record then? That was ONE vaccine and you are IMMUNE for life.

One Adverse Event in 50 million for those vaccines.

Gardasil now claims more than 30 dead and thats for USA in less than 2 years.

What's the safety record here?

By John Fryer (not verified) on 27 Jan 2009 #permalink

And yet another fact free posting from John Fryer.

Please tell us, John Fryer, how much mercury is in the Hib vaccine? Also tell us when the doses are?

kathy said "Is this because while HiB is decreasing, other types of Hi are becoming more common? "

It is because they did not officially start reporting Hib until AFTER the vaccine was introduced. It did not become a reportable disease until the 1990s, and the first vaccine for it was introduced in the 1980's.

If you look at the CDC Appendix G, the "NR" in the Haemophilis column means "Not Reported".

There are estimates in the literature, usually on research done with transmission in day cares. If you found Appendix G of the CDC Pink Book, I can assume you know how to look for the literature in PubMed.

Sadly we do live in a real world and I see that if you go to a USA hospital 20 years ago you would have no chance of MRSA.

Ten years ago there where 2 000 cases of MRSA.

This year there are 400 000 cases of MRSA.

That is illness that resists modern drugs and the infection and is picked up after entering hospital.

In the vaccine world for kids we search for one victim and immunise everybody a dozen times over.

Why not vaccinate for hospital infections and we are then saving hundreds of thousands of lives.

Risks are relative and there are MAJOR concerns not least is to get back to the safe vaccines of yester year. And proper monitoring of events.

In Europe they use not vaccines but HYGIENE and eliminate MRSA TOTALLY from hospitals.

There are a dozen ways to halt infection and vaccines are but ONE method.

We need to look at the broad picture and not focus too closely on minor problems. The hib business is not the least bit clear with this illness being rare a long time ago and then becoming a BIG menace. Even today it looks as if despite vaccine efforts it is difficult to see if vaccines are making headway or keeping numbers of hib up. But before lots of vaccines there wasn't a hib problem.

My own view would be to tackle illness one at a time and get rid of them. Measles would be the first as it is so similar to smallpox that it is certain it can be eliminated if the determination was there as for small pox. By having hundreds of vaccines it is like the plate spinning game and the whole lot is likely to come down on you. When you regulated 10 vaccines they were regulated. I don't think CDC has the capability to monitor 300 different vaccines from half a dozen different companies.

By John Fryer (not verified) on 27 Jan 2009 #permalink

I assume that Mr. Fryer is without his tinfoil hat today.

By Joseph C. (not verified) on 27 Jan 2009 #permalink

I assume that Mr. Fryer is without his tinfoil hat today

He stopped wearing it when he foudn out that the "tinfoil" was actually aluminum, a dreaded "heavy metal".

By Militant Agnostic (not verified) on 27 Jan 2009 #permalink

John Fryer,

Mercury isn't in childhood vaccines anymore, or hadn't you heard? So that isn't it. Vaccines don't cause autism, so your suggestion of 1 in 1400 risk for Italy is a meaningless claim.

On the other hand, we have several genetic risk factors identified as linked to autism.

Evidence vs lack of evidence.

By Robster, FCD (not verified) on 27 Jan 2009 #permalink

In Europe they use not vaccines but HYGIENE and eliminate MRSA TOTALLY from hospitals

Um, what? There is no vaccine for MRSA. And I sincerely doubt that Europe is 100% MRSA free.

John Fryer,
Hygiene is useful for preventing or containing MRSA (and other maladies), vaccines are useful for preventing a myriad of diseases. What was your point exactly?

Mr. Fryer comments:


"In Europe they use not vaccines but HYGIENE and eliminate MRSA TOTALLY from hospitals."

As was already mentioned, there is no vaccine for MRSA (although there is work on using viruses to eradicate it).

Secondly, it took me all of 15 seconds on PubMed to find a number of articles describing the problems of hospital- and community-acquired MRSA in Spain, Italy, Norway, England, Germany and France. I realize that not everybody considers Norway to be part of Europe, but the other countries are indisputably part of the EU.

How many times will we have to correct Mr. Fryer before he starts doing his own fact-checking? Is he even concerned about what is and is not true? Or does he simply make up stories that fit his delusional perception of the world in the hopes that someone who knows less than he will be persuaded?

Prometheus

Just trying to learn something - no agenda.

With my past experience with christian proselytisers and creationists, it's difficult to read this and not immediately conclude "Liar!". That's the problem with religous types of every stripe - the continual lies. You get a tiny bit cynical after a while.

I worked health policy for the Senate, and I struggled to get a law practice going (unsuccessfully). It really does pain me to see lawyers who appear to be making a living on unethical behavior. Mayhempix said:

. . . then told me that he was a lawyer . . .

And so, your next three telephone calls were to the North Carolina Bar Association to ask them to investigate, and to the North Carolina attorney general's office to inform them of a guy practicing medicine without a license, and to the North Carolina medical licensing authority with the same info, yes?

If rationalists were able to spin like the anti-vaxers, wouldn't the headline be "60% of child deaths due to lack of vaccinations?" Or, "8 out of 10 children who die from infection were not vaccinated?"

No, no, that's not what the research says. No, we shouldn't succumb to the same scare tactics. But could someone devise an appropriate, scary headline for the 30-second response, and the 2-second headline? Think of all the lives that might be saved.

As was already mentioned, there is no vaccine for MRSA (although there is work on using viruses to eradicate it).

Ooh, neat.

From the scary mothering.com forums, in response to a poster who said that she was now considering getting the Hib vaccine for her 3 kids:

"The child that died of hib it's sad, but how did the family live? What was their diet like? Was the child neglected? Abused? We don't know any of that.
And you simply go by the mainstream thinking that this child could have been saved by a vaccine. Yet you know NOTHING about that child or its living conditions including diet. Gosh they sure know how to rattle our chains. Don't they?

Don't feed into their fear mongering agenda. Think of how healthy your kids are and believe in their immune system. You don't know what long term damage you could cause with any vaccine. Why start messing with something that we were never even intended to worry about and to mess with.

Our bodies have all the natural juices to keep us healthy and if needed to heal us. We just have to give it that chance."

Absolutely disgusting, as far as I'm concerned. If someone died of a vaccine-preventable disease, it's obviously their fault, for not living a healthy lifestyle. I see this "blame the victim" mentality all of the time on this disgusting forum.

Paul- I didn't realize I came off as a proselytizer/creationist. I am just a new mother trying to make sense of all of this and have been looking for a balance of both pro-vax and anti-vax opinions. For the record- I believe/hope that all mothers are just trying to do what is best for their children. And also for the record, I am not actually anti-vax but again just trying to learn.

Our bodies have all the natural juices to keep us healthy and if needed to heal us. We just have to give it that chance.

My brain felt like it was being spaghettified as I read this. Those words are a black hole of stupid. Didn't science discharge the four humors theory some time ago?

Natural juices? This brings me back to General Ripper's "precious bodily fluids" from Dr. Strangelove. Vaccines, apparently, are trying to sap and impurify all our natural juices.

By Joseph C. (not verified) on 28 Jan 2009 #permalink

Kathy - it's hard, being a new mother and learning all this stuff. If you have time to read, get "Autism's False Prophets" by Dr Paul Offit. It's really a quick read and very informative. Not "heavy" reading, so perfect for a new mom (I remember those days....)

There is autism in my family. (Even prior to vaccines). So I have been very interested in the subject.

Disclaimer: My children are fully vaccinated. (They chose for themselves to have the HPV vaccine.) However, we lived through chickenpox (pre-vaccine) and my eldest had a lot of severe pain and suffering as she had the disease very severely. She nearly required hospitalization. I was giving a 5 year old narcotics for the pain! I would have preferred the short lived pain of a vaccine and possibly milder case, if she caught it at all. (Oh..and her sister who had a milder case, has almost NO antibodies to chickenpox. She got the vaccine before leaving for college for the protection).

Marni said "From the scary mothering.com forums,"

There is a reason I spell the name of that place: sMothering

"wanting to learn"=anti-vaxer pretending to be neutral

Don't insult my intelligence. If that makes you mad, then tough.

By anonimouse (not verified) on 28 Jan 2009 #permalink

"And so, your next three telephone calls were to the North Carolina Bar Association to ask them to investigate, and to the North Carolina attorney general's office to inform them of a guy practicing medicine without a license, and to the North Carolina medical licensing authority with the same info, yes?"
Posted by: Ed Darrell | January 28, 2009 5:10 AM

Umm... no. Not being a lawyer I would have no idea what determines "practicing medicine without a license". And having posted here I would assume if Orac had any perception that it was, he would be in a much better position than I to make that determination. And as much as I wish they could shut him down and charge him, I do find it difficult to believe that Phillip's is because as a lawyer I would bet he's very careful not to cross that line. He's offering a "service" to help those who wish to avoid the vaccinations, not advising them from a medical point of view that they should.

BTW did you make those 3 calls? By the arrogant dismissive tone of your post it would seem that you are positively sure Phillip's is "practicing medicine without a license".

I'm just saying...

By mayhempix (not verified) on 28 Jan 2009 #permalink

""kathy" didn't post the other link because she hadn't seen it"

So "kathy", that means you somehow found the comments to the editor about the Hib study without ever going to the subject of the comments? As a "neutral" mom did you just stumble upon them? And weren't you even curious what they were referring to...? The link to the study was at the top of the page and was clearly denoted as such... that's how I found it. It would seem that if you were truly "looking for a balance of both pro-vax and anti-vax opinions" you would have clicked the link and read the report.

Why do I have the suspicion you were just posting info you were fed by other anti-vaxxers without doing any real objective research on your own?

Neutral my ass.

By mayhempix (not verified) on 28 Jan 2009 #permalink

Going back to kathy's original question and the link she published, the table shows cases and death rates for ALL Haemophilus species (I believe there are five or six), not just Haemophilus influenzae type b. The vaccine is targeted just to type b, not any other type. I don't remember enough microbiology to know the prevalence of the other serotypes of H. flu and if a decrease in type b would bring down all cases in general. I do remember that there are encapsulated and non-encapsulated types with Hib being encapsulated which seems to be related to its virulence.

Kathy, read Dr. Offit's book. Vaccines are the one thing in medicine, the one aspect of my practice, that has done more to reduce morbidity and mortality than anything else. They truly prove that an ounce of prevention is worth a pound of cure.

gaiainc - Yes, the "B" strain is encapsulated (has a polysaccaride coating)

Young children do not have the ability to make antibodies to polysaccharide and are, therefore, more susceptible to encapsulated bacteria. ... and the best way to keep them from encountering the HiB is to have the surrounding people vaccinated.

By Tsu Dho Nimh (not verified) on 28 Jan 2009 #permalink

hey,
im just replying to the main post of this stream of craziness... i didnt read them all ... who has time?
anyway,
i just wanna say,,,, isnt it the parent's right to choose not to vaccinate their child in the first place..
my main point is this,,, can u gaurantee me that my child will not get autism or die from a sever allergic reaction to one of these vaccines???
also,, can you gaurantee me that he will NOT get any of these illnesses if he is?? I dont think so....
Sooo... I also wanna know what is it to these parents of Vaccinated kids....the unvaccinated ones are the ones that could catch something ... not them right?????
that is really beside the point...it is not just mercury/autism debate.. it is all the toxins that poison our children before they are even 2 yrs...
what is wrong with these Dr's that wont treat unvaccinated kids... do they not need to see the DR?
check ups.. etc?
if anybody has a prolem with my not vaccinating MY child..
convince me that they will NOT get the disease they are vaccinated against and really convince me that they wont get autism or other side effects including death!!!

my main point is this,,, can u gaurantee me that my child will not get autism or die from a sever allergic reaction to one of these vaccines???

I can't guarantee that your child won't get autism, but I can guarantee as much as science can that if your child does get autism it won't have been from the vaccines. As for the chance of a severe allergic reaction, that is incredibly rare but not zero. You should read this:

http://scienceblogs.com/insolence/2006/09/vaccines_and_relative_risks_1…

Clearly you do not understand the concept of relative risks.

Sooo... I also wanna know what is it to these parents of Vaccinated kids....the unvaccinated ones are the ones that could catch something ... not them right?????
that is really beside the point...it is not just mercury/autism debate.. it is all the toxins that poison our children before they are even 2 yrs...

Lame use of the "toxins" gambit. In other words, you're dead wrong and not particularly coherent in making your case.

what is wrong with these Dr's that wont treat unvaccinated kids... do they not need to see the DR?

Because unvaccinated children pose a danger to the other children in the waiting room, some of whom can't be vaccinated for various reasons and some of whom are too young to have gotten all of their vaccines yet.

kim said (poorly): "i just wanna say,,,, isnt it the parent's right to choose not to vaccinate their child in the first place..
my main point is this,,, can u gaurantee me that my child will not get autism or die from a sever allergic reaction to one of these vaccines???
also,, can you gaurantee me that he will NOT get any of these illnesses if he is?? I dont think so...."

I assume you are not a native English speaker. I would suggest that you get a native speaker with an at least high school education to explain what Orac wrote above, and what follows:

Actually, no one guarantee anything. No one has claimed that vaccines are 100% effective nor 100% safe, but they are a safer bet than getting the actual diseases.

Yes, there is a risk of something happening after getting a vaccine (usually a sore arm and perhaps a slight fever), but there is no real science that connects vaccines with autism.

Also, there are people who cannot get the vaccine, and need to be protected by herd immunity (have someone explain that to you). One person was my son as an infant... due to a history of neonatal seizures he could not be vaccinated for pertussis, at the same time that there was a pertussis epidemic in our county (I had to be very careful who he came into contact with --- over a dozen American babies die from pertussis each year, and that is increasing). That was also about the same time over 120 Americans died from measles.

Another case are these boys:
http://www.timesonline.co.uk/tol/news/uk/article1055533.ece

Please have someone help you read the article, and then come back and tell us why those two boys deserved what happened to them.

I would also suggest you read this article, Dr. Crislip has a much clearer explanation of the vaccine versus disease risks... no wait, you would be better with his podcast, no need to worry about reading anything:
http://www.quackcast.com/spodcasts/files/48f9db861d8a83f764792aa4b77990…

Actually, I thought Kim was an English speaker, just one with that annoying online e.e. cummings penchant plus stream of consciousness meandering that drives me nuts.

I was trying to be nice, but in a snarky way.

Its sad to see you unconcious beings stabbing each other with your words. Ignorance is the cause of all disease, including the herd disease that has plagued this planet for thousands of years. It is rare to encounter a person who is logic enough to see with their own eyes what is happening in the world. Your Governments rule over you like a Shepard with his flock. Stop following. Think for yourself. My body vibrates at a frequency that is not condusive to support any disease, so I am exempt from your comments. I only have on thing to say. You need no doctors, only a strong mind, and a strong body. You are your own healer.

Wow, jason, were you spending almost an entire year to compose that word salad?

So how many Hertz are your body vibrations?

Wow. I bet nobody is going to believe this but I am simply on a fact finding mission as I have 4 week old puppies to vaccinate. All of my 5 children have had all of the recommended vaccines with apparently no ill effects. However I have two nephews with autism spectrum disorders. It strikes me how radical and antagonistic both the pro vaxers and anti vaxers are towards each other. Isn't it possible that there is merit on both sides of this issue?

@Barbara

First, I recommend that you find a more recent article on which to post your comment, rather than one almost a year old.

Second, it depends on how you define "merit". If you mean "earnest desire to protect one's children", then yeah. If you mean "facts and reality", then no.

Barbara -- I'd ask a vet for advice about what vaccines to give. At the very least, make sure your puppies receive those vaccines required by law, in particular rabies or distemper. There are two risks to not vaccinating against these diseases. One is that the diseases are invariably fatal, and there is no herd immunity since they are endemic in wild animals. The other is that if your dogs ever bite anyone, and you cannot prove they are current on their vaccines, the authorities may require that they be tested for rabies. Rabies can only be conclusively diagnosed after death, so a dog who bites someone can get a death sentence if they're not vaccinated. May not be fair, but it's how it is.

In general, the veterinary vaccines are very safe, and they've got them more combined than human ones now, which is very handy. (Less total shots, and also less expense for you. You may even be able to buy the vaccines and administer them yourself, which saves more money still.)

Now, it is true that there is antagonism on both sides. However, it's not true that when you see two people with differing opinions, the truth lies in the middle. This is a common belief, but not true. At best, it's a guideline, to look for the truth in the middle. Also, note the name of this website. There is far more anti-vax antigonism than pro-vax, but this site is called Respectful Insolence -- you get a lot more pro-vax irritation here than you would see out in the world at large, mostly because the posts here concentrate on the worst of the worst of the antivaxxers. So it's not a fair sample.

Maybe you could give your specific concerns and questions and people here can try and address them? At this point, I'm not really clear what your concerns are with respect to your puppies. My general advice is to vaccinate them.

By Calli Arcale (not verified) on 10 Feb 2011 #permalink

Thanks for your responses. I am definitely going to vaccinate
My puppies. However I wont, for convenience sake, give the 5,6,or more vaccines in one shot. It makes perfect sense to me not for bombard them with all thes virurlants at the same time. Yes it means more shots but this makes sense to me. This is the middle ground for me. And I won't revaccinate them every year either, just as we don't do that to ourselves. Except for rabies... I'll follow the law.

Barbara, check your local laws. I believe we only have to do rabies once every two years.

Thanks for your responses. I am definitely going to vaccinate
My puppies. However I wont, for convenience sake, give the 5,6,or more vaccines in one shot. It makes perfect sense to me not for bombard them with all thes virurlants at the same time. Yes it means more shots but this makes sense to me. This is the middle ground for me. And I won't revaccinate them every year either, just as we don't do that to ourselves. Except for rabies... I'll follow the law.

Thanks for your responses. I am definitely going to vaccinate
My puppies. However I wont, for convenience sake, give the 5,6,or more vaccines in one shot. It makes perfect sense to me not for bombard them with all thes virurlants at the same time. Yes it means more shots but this makes sense to me. This is the middle ground for me. And I won't revaccinate them every year either, just as we don't do that to ourselves. Except for rabies... I'll follow the law.

Thanks for your responses. I am definitely going to vaccinate
My puppies. However I wont, for convenience sake, give the 5,6,or more vaccines in one shot. It makes perfect sense to me not for bombard them with all thes virurlants at the same time. Yes it means more shots but this makes sense to me. This is the middle ground for me. And I won't revaccinate them every year either, just as we don't do that to ourselves. Except for rabies... I'll follow the law.

Thanks for your responses. I am definitely going to vaccinate
My puppies. However I wont, for convenience sake, give the 5,6,or more vaccines in one shot. It makes perfect sense to me not for bombard them with all thes virurlants at the same time. Yes it means more shots but this makes sense to me. This is the middle ground for me. And I won't revaccinate them every year either, just as we don't do that to ourselves. Except for rabies... I'll follow the law.