DDP Newsletter November 2011, Volume XXIX, No. 6.
Public health officials are concerned that more parents are requesting exemptions from childhood vaccines. In some states, as many as 1 in 20 public school kindergartners have skipped one or more of the required immunizations (AP 11/29/11). The percentage of Arizona parents claiming a personal/religious exemption has increased from around 1% in 2000 to nearly 4% in 2011, according to a report by Karen Lewis, M.D., Medical Director, Arizona Immunization Program Office, at a Dec 8 meeting of the Maternal and Child Health Committee of the Arizona Medical Association (ArMA). Vaccine refusers tend to cluster geographically, increasing the likelihood of outbreaks. They tend to be more highly educated and in more affluent socioeconomic groups.
“They think they’re cable of doing research!” lamented a committee member.
After one safety concern is addressed, another tends to surface. “First it was pertussis, then measles, then thimerosal, and now it must be the adjuvants since thimerosal has been removed.”
Some advocate more restrictive laws, but Dr. Lewis thinks education is preferable. It was noted that after the Wakefield furor (see below), the message seems to be that “parents may have the right to refuse, but we have the right to protect ourselves against them.” This is the tactic exemplified in vaccine advocate Paul Offit’s book Deadly Choices: How the Anti-Vaccine Movement Threatens Us All. Parents of children affected by a vaccine-preventable disease give programs entitled “Ruining It for the Rest of Us.” They suggest sending the unvaccinated to “their own infectious diseases island.” [My review of this book is available at: http://www.jpands.org/vol16no3/bookreviews.pdf.]
“Education” or promotional efforts have not been particularly effective in increasing influenza immunization in health care workers. In one study, uptake was only 21.9% in the intervention group versus 21.0% in controls (J Pub Health Med 2001;23:346-3438). Generally rates hover at less than 50%. Based on CDC recommendations, some facilities or states are mandating flu vaccine for all workers, sometimes on pain of being fired. In Colorado, proposed rules permit only limited medical exemptions. As with second-hand smoke laws, the rationale is that people have the constitutional right to risk their own health, but not to impose risk on others.
VACCINES AND HEALTH
“A lot of people…should be held responsible” for four (4) measles deaths and hundreds of hospitalizations in the UK, Offit thinks, since an article in the Lancet by Andrew Wakefield M.D., and a dozen others suggested a possible link between MMR (measles-mumps-rubella) vaccine and autism, causing parents to decline the vaccine. The “bombshell” withdrawal of the allegedly fraudulent 1998 article might, Offit hopes, “ [end] the [autism] debate once-and-for-all” (CBSNews 2/4/10). [Wakefield’s presentation at the 2011 meeting of the Association of American Physicians and Surgeons (AAPS) may be viewed at http://www.youtube.com/watch?v=l67fWVrw8xU.]
Without mandates, advocates argue, U.S. chickenpox-related deaths, for example, might skyrocket from 66/y [1999–2001] back to the pre-vaccine level of 145/y.
As discussed in the January 2011 issue, an increasing number of vaccines has not been associated with overall good health. About 43% of U.S. children are said to have at least one of 20 chronic health conditions, not counting obesity, and 24% have some type of environmental or skin allergy (Acad Ped 2011;11:S22-S33). Food allergies affect about 6% of young children and 3% to 4% of adults. These result in some 317,000 visits each year to emergency rooms or physicians, and 9,500 hospital admissions (3.6 times as many in 2004-2006 as in 1998-2000). Food allergies cause 150 to 200 deaths per year, more than half caused by peanuts (www.AAAAI.org).
Peanut dust, like viruses, travels in the air, so sensitive persons can experience an anaphylactic response without actually eating a peanut. Schools are banning peanuts because of a problem that was virtually unheard of 50 years ago. Since vaccines, after all, stimulate the immune system, could we have exchanged the risk of infection during an outbreak for a need for constant vigilance against a ubiquitous antigen?
The CDC has never conducted a study of health outcomes in vaccinated versus unvaccinated persons. It has the Vaccine Adverse Event Reporting System (VAERS, www.vaers.hhs.gov), but it is likely that fewer than 10% of reactions are reported. Conditions developing months after a vaccine would not be noted. An internet survey, begun 10 years ago by a German homeopath Andreas Bachmair, contains more than 10,000 self-reports on the health of unvaccinated persons, compared with statistics from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The site began as www.impfschaden.info and has been translated into English www.vaccineinjury.info. Allergies are reported in 10.6% of unvaccinated persons vs. 22.9% in KiGGS; asthma/chronic bronchitis in 2.4% vs. 18%.
ABOUT THOSE ADJUVANTS
An adjuvant is a substance added to a vaccine to increase immunogenicity, and perhaps to decrease cost by reducing the amount of antigen needed. The classic Freund’s adjuvant (antigen immersed in mineral oil) is far too toxic to use in human vaccines. The only adjuvant approved for human use is alum, aluminum salts or gel, present in hepatitis A and B, diphtheria-tetanus-pertussis, Haemophilus influenzae b (Hib), human papilloma virus (HPV), and pneumococcal vaccines. The major use of oil-in-water emulsions has been in therapeutic cancer and HIV vaccines. Vaccines, may, however, use oils as “carriers.” Also, vaccine components—or contaminants—may act as adjuvants even if not intended to be such. Dr. Lewis told ArMA that one reason for pertussis outbreaks may be that the cleaner, safer acellular (DTaP) vaccine is less effective than the older, “dirty” whole-cell DTP that contained lots of bacterial fragments.
Vaccines can induce immunity to any vaccine component. To protect trade secrets, these may not all be listed on the label. They could include peanut oil (and trace bits of peanut protein), casein (milk protein), egg protein, soy peptone broth, calf serum, gelatin, neomycin, and other components of culture medium.
A speculation that I have not seen addressed is the induction of allergy to a substance that is not in the vaccine but to which the patient is simultaneously exposed. A friend reported that while mowing a field, his tractor ruptured a hydraulic line, and squirted oily fluid into his eyes. For years after that, he had severe hayfever on exposure to grass, which he had never before experienced. Mice were sensitized to peanuts by either intranasal or intragastric introduction of peanut protein together with cholera toxin as an adjuvant. A logical follow-up would be to feed common food allergens to animals on a day they were receiving a regular vaccine. Animals do have food allergies, and they get a lot of vaccines; are these connected? Should patients be on a hypoallergenic diet for a period of time while being immunized, especially with adjuvanted vaccine (and for how long)?
Instead of shaming parents—or firing health care workers—who raise vaccine safety concerns, physicians should be insisting on better safety studies and full disclosure.