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Vaccine Safety

What Is Thimerosal and Why Are Some People Worried About it?

By April 14, 2016 3 Comments
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“I don’t wanna put mercury in my baby, Doc; it’s poison.”  After Robert DeNiro’s anti-vaccination massive misstep Tuesday, I’m yet again, dreading hearing these words.

This is where, as a pediatrician, I grit my teeth (sorry, dentists).  I know that when I parent tells me this,  that science has lost another battle with fear in the race to inform families first. Since the race has been lost, I know I’m going to have to work from behind to get this child protected from deadly diseases.

There will likely be a lot of questions for me.  Questions based on faulty premises and that question my integrity as a doctor, as a dad and as a person.  I will put my pride aside and try to help these parents make the right choice for their kid.

I will explain that thimerosal is not mercury (although it contains very small amounts of it).

I will explain that even though there was no evidence that thimerosal was harmful, that it was removed from early childhood vaccines in 2001.

I will try to communicate with evidence-based information.

I will bring up the fact that Andy Wakefield, the man behind the current anti-vaccine movement and the movement has had his medical license revoked after the General Medical Council in the UK found he committed professional misconduct and acted dishonestly and irresponsibly. I will remind them that they don’t know many people that sleep in iron lungs because of Salk’s polio vaccine.

Reluctantly, I may even have to go into my personal life and divulge that my entire household (my wife, two girls and I) is fully vaccinated. These things may or may not sway the family.The conversation may end in an awkward stalemate. There could be a conversion that occurs over months.

I hope not, though, “because deadly diseases ain’t waitin’ on you to decide.” I get colloquial once we’re all good friends.

Sometimes people change their hearts and minds right away when I reassure them; those conversations are more fun, but I am usually wary of the spurious information that is just outside the hospital doors, or sometimes in the room with me on their smart phones.  I know once I’m done talking to them, there’s a whole lot of noise outside waiting to undo what I just did.

Robert DeNiro Appeared on NBC's Today Show on Tuesday

Robert De Niro Appeared on NBC’s Today Show on Tuesday

Like Tuesday, during The Interview Heard Around the Internet, when one of the greatest (the greatest?) screen actors of all time went full anti-science on the Today Show. Robert DeNiro, in explaining why he regrets the pulling of the movie “Vaxxed: from cover-up to catastrophe” from his Tribeca Film Festival, made some dangerously inaccurate statements about vaccines and autism.

In case you missed the discussions from a few weeks ago, here’s the skinny: Big-time festival announces the screening of a pro-disease (or, anti-vaccination) motion picture, the scientific community loses our collective mind and lets them know it’s a dangerous choice, Big-time festival pulls the movie, anti-vaxxers go up in arms. The science community was FINE with this result (you know, the support of actual scientific fact), even tentatively giddy.

Bobby D pulled no punches in his NBC interview, citing most of the tried-and-true tropes of the antivax movement: he stated that vaccine science is not “settled,” claimed “overnight” changes in children after immunizations, talked about mercury in vaccines and even gave the ol’ “I’m not anti-vaccine” speech, which is pretty much only said by people that are.

I’d love to make a reference to the classic “Just when I thought I was out, they pull me back in”… but that was Pacino’s line.

As a parent, if someone told you the nonsense that De Niro spouted on the Today Show, it would sound terrifying. No one wants to cause harm to their own child (or someone else’s). As a doctor I can tell you I’ve dedicated my life to helping parents keep their kids safe.  I don’t want to see your kid hurt either.  So let me break down De Niro’s claims starting with thimerosal.

The reality is that if De Niro got his information from better sources and actually talked to real scientists he’d know that a lot of what he just said isn’t true. He’d know that thimerosal hasn’t been in early childhood vaccines for 15 years, and he’d know that it was never in the MMR vaccine, the one that his boy Andy Wakefield falsely claims causes autism.

He’d also know that thimerosal is a mercury-based substance used in multi-dose vials of vaccines as preservative. It kills bacteria and prevents the growth of fungus in the vial, to help keep it sterile and safe for injection. It’s also a substance found in tattoo ink in concentrations thousands of times higher than what is found in vaccines. The compound breaks down into ethylmercury, half of which is broken down and rendered “ineffective” by the body in about a week. Then, we poop it out!

He’d know that in term of quantities, the amount of mercury given in a yearly flu vaccine is 25 micrograms (mu). The amount needed to kill 50% of living organisms (LD50) is 98 milligrams (mg) per kilogram (kg) of body weight. Remember, 1 milligram is equivalent to 1,000 micograms – so this means that, for a 10 kilogram (about 22 pound) child to have life-threatening effects, the child would need to have 980,000 micrograms of mercury. At one time.

He’d contrast this with methylmercury, which is found in tuna and industrial waste or elemental mercury which used to be found in old school thermometers (You may have even played with spheres of it as a kid if you’re an old fogey, like me). These are the types of mercury that we really worry about.  With methylmercury there are so many ways we are exposed and with elemental mercury we’re usually exposed to a lot when we’re exposed (like playing with broken thermometers).

Methylmercury is the one that makes us warn pregnant women about salmon intake.  Elemental mercury is the kind was used when making felt hats, giving the makers neurological damage centuries ago, i.e. The Mad Hatter. It takes about six weeks for the body to break this substance down to its ineffective state. In the meantime, the compound binds strongly to fat and neurological tissue; it finds its way to the brain, where it causes intellectual deficits.

This is why it’s important for people like De Niro to know the difference between mercury compounds, but he didn’t (or he doesn’t).

How did we get to this point? Why are parents distrusting of the scientists and physicians they chose, and continue to choose to listen to celebrities and snake oil salesmen?  Why are we still discussing something that’s not even in early childhood vaccines any more?  Why are we talking about “mercury” that was never even in the MMR vaccine to begin with?

I believe that three, nearly concurrent events happened almost twenty years ago that set this phenomenon in motion:

1) The FDA Modernization Act of 1997 required vaccine manufacturers to give detailed information to the government about all mercury-containing products. At the time, jabs for Hepatitis B, DTaP (diphtheria, tetanus and pertussis) and inactivated Polio had trace to small amounts of thimerosal (a mercury-based preservative) in their ingredients.

2) In 1998, Andrew Wakefield, a UK gastroenterologist published his infamous study in the Lancet that claimed a link between the MMR vaccine and autism (that’s since been retracted – more on that in a moment).

3) After vaccination rates declined because parents were so concerned about Wakefield’s study and lots of talk about thimerosal the CDC recommended the FDA order thimerosal removed from early childhood vaccines (except for the flu shot).  We’re still talking about this 15 years later, so pulling thimerosal from the vaccines didn’t work.

After the FDA Modernization Act, and widespread fears about autism following the paper published by Wakefield, there was quite a bit of public outcry for changes to be made in vaccines. In spite of good scientific evidence that there was no link between thimerosal and autism, government agencies and vaccine manufacturers decided to make all childhood vaccines thimerosal free. This decision placated some, but many pediatricians feel that it served as a capitulation to non-science. Thimerosal, at this point, only exists for children in certain flu vaccines. There is no thimerosal in the dose for children from 0 to 3 years-old.

In terms of Wakefield’s claim, his paper stating that a combined MMR vaccine was linked to autism was retracted in 2010 and his license to practice medicine was stripped in the same year. In the eyes of many health professionals, however, the damage had already been done. Vaccine rates dropped in several Western nations in the early 2000s, leading to multiple outbreaks of diseases that had been on a steady decline or even eradicated from some countries.

In spite of the overwhelming, worldwide, scientific evidence that vaccinations are safe and effective, claims of “toxins” and “poisonings” continue on the internet and at family gatherings. I won’t link to them here, but trust me. My job, as I see it, is to continue to fight the good fight against vaccine misinformation. The more people understand what we are giving their children, the more vaccine uptake and suffering prevented.

Yet we still have neighbors, family members, and very high-profile celebrities who are against or that “question” the safety of vaccinations. You know the ones: they show up on your Facebook timeline once a week with a story about “the medical industrial complex” or tell you that Big Pharma is out to make money by “making our kids zombies.” These folk often have a dubious story to share about a medical catastrophe or grand claims about medical marijuana curing cancer along the lines of “it also raised my cousin Scott from the dead.”

They seem to be proliferating and we’re seeing these diseases come back: an intentionally unvaccinated child recently died of diptheria in Spain, the first case seen there since the 1980s.  Then there was the measles outbreak that began in Disneyland last year, largely fueled by families that had refused to vaccinate their children.

While unrelated scientifically (do I need to repeat myself, MMR vaccines never had thimerosal as an ingredient), these three events became the bedrock of the modern anti-vaccination movement. The headlines falsely claiming that vaccines cause autism spread quickly throughout the Western world, and vaccine rates plummeted.  Once it’s out there you can’t get the genie back in the bottle.

The reality is that vaccine programs have been heralded as the greatest medical innovation of the last hundred years. We have drastically decreased deaths from vaccine preventable diseases. Even cervical cancer is getting its butt kicked. We need to keep it that way.

Editor’s Note 2.16.17 | This post was updated to better reflect the difference between the historic uses of elemental mercury.

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Categories: Disability + Disability Advocacy, Infectious Disease + Vaccines, Science 101 + Mythbusting

Two Months After Whooping Cough: An Update from Tara Hills and Her Family

By and June 16, 2015 4 Comments
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We’ve received a lot of questions from our readers about the status of Tara Hills, the formerly anti-vax mother whose 7 children caught whooping cough, just a week before their updated vaccination schedule was supposed to begin. It’s been a couple of months since we’ve posted an update, so we interviewed Tara this week.

Read more about Tara’s story:
Learning the Hard Way: My Journey from #AntiVaxx to Science – April 8, 2015
Whooping Cough is so Rotten, That We Couldn’t Post the Video – April 9, 2015
With 7 Kids in Recovery from Whooping Cough, Tara Hills Answers Your Questions – April 15, 2015

Here’s what she told told us:

So first up, even though it’s more than two months later we still get emails and messages asking about how your kids are doing now. How is everyone doing post whooping cough?

I’m touched that 2 months later people around the world care enough to ask about our family. Really touched. Physically everyone is well. The 7 kids responded to the antibiotic treatment and turned a corner within days. That cough is awful though and has lingered in our youngest. It can linger up to 12 weeks so we’re hoping it goes away soon. Mercifully no one went into respiratory distress so we don’t expect long-term damage.

Emotionally the kids are fine and life is normal again. I’m another story. I still think of this everyday. Painful reminders, what ifs, gratitude, self-consciousness as strangers say they ‘know me’. Many, many lessons learned the hard way.

How about how the medical community in Ottawa responded to you during and after the crisis? Did you feel any judgement from your doctor, the hospital or public health agencies?

They were excellent. We were assigned a nurse from Ottawa Public Health from day 1 when the results came back positive. She was our go-to through and after the crisis. She worked with us (over the phone) step by step, was very calm, helpful, and professional. We were in great hands.

Something which shocked Julia and Leslie was that other parents seemed to be understanding and supportive of you online, but both the pro-science and anti-vaccine communities seemed to have harsh words for you but for different reasons. Have you lost any friends in either camp due to your post?

Our story hitting international news was shocking and surreal. I was willing to ‘speak into the microphone’ even though I felt sick in front of such a huge audience. But we stood by our core message and still do. I stayed away from news comment feeds because I was too involved and overwhelmed with everything. It was all so “out there” so the harsh words didn’t affect me. Closer to home, all our key relationships were fine. Some friendships were strained temporarily and only 1 was lost, mostly due to disagreements with how I handled what was a very difficult situation for our family.

It was hard to hear the harsh judgement from the pro-science community. We thought they’d embrace us with open arms. We had already learned our lesson and booked the catch-up appointments. We expected the anti-vaccine community to react harshly to us, but to have the pro-science community rub our faces in a pile of shame was disgustingly unhelpful in advancing their cause. Some asked “what if it had been polio?” I know! Don’t you think I KNOW? That’s exactly why we shared our story and withstood the firestorm from every angle.

WC TimelineWere there any misconceptions that bothered you?

Some people have said that whopping cough is no biggie so they “aren’t convinced” or alarmed enough to reconsider examining the vaccine issue much less get their kids or themselves vaccinated. For most of our kids it wasn’t a nightmare, but it was awful for the youngest ones. The two youngest would cough so hard they threw up, none of us slept that week.

Our story was illustrative of a vaccine-preventable illness sweeping through one family. That’s why I shared our story in that context. Some people online dismissed it and acted like the whole thing was one big stay-cation for our family. That truly shocked me. I couldn’t believe that after hearing the sounds of our children struggling to breath through coughing fits they would dismiss the risk to infants. It was beyond shocking.

Waiting to make sure our 5-month-old niece and 2 immune-compromised family members were going to be okay was indescribable. I had so much guilt and fear, there are no words to describe the waiting to hear if our infant niece was hospitalized or worse, all because of us.

For me one of the most shocking things was people alleging there were ‘holes’ in my story and that I was a paid actress. Even more bizarre is that some people alleged that I was covering up a more scandalous truth. Are you kidding me? I would have given anything for our family to not have gone through what we did!

When you changed your minds about vaccines do you think (honestly) there was anything anyone could have said to you to change your mind?

Maybe? How they approached me would have made a huge difference. Respectfully validating and addressing versus sarcastically dismissing my concerns and questions would have made a difference. Building our trust through caring, patient dialogue would have helped. Just talking to me at all like an intelligent caring person would have helped.

If someone had said in a genuinely kind tone. “Tara, you are a great mom who loves her kids dearly. I know there is so much confusion about vaccines. I care about you and want to help you make a informed decision you feel really confident in. Would you be willing to share some of your concerns with me so we could go through them one by one? In the end it’s your decision. I want to make sure you are totally confident in your decision since it’s so important.” I would like to think I would have stepped willingly into that kind of conversation. There was no threat or attack that would trigger defensiveness.

It’s hard to talk to loved ones about vaccines. Hopefully our sharing will help people have those talks in a constructive way, guide them to a starting point they can relate to, and maybe help save some lives.

You said in an earlier post that the Disneyland measles outbreak was part of what contributed to your rethinking of your anti-vaccination stance. When you finally began your new wave of research, can you clarify how that happened, and how did you look for and find your information?

It had been building for some time. Seeing the hatred and fear towards people who didn’t vaccinate (like us) was alarming. I knew if push came to shove, and we lost the freedom to choose, we would have to be rock solid certain of our stance. So in February, I came out of the anti-vax closet by posting on my personal Facebook wall that I was that mom. That I felt caught between a horrible rock and terrible place. That somehow no matter how much I searched for solid answers I’d never really know. That it would boil down to a coin toss with our kids’ health in the balance. So I set out to prove we were right NOT to vaccinate. I had my kids’ health at stake and my pride to defend. So I started reading anti-vaccine books, publications, and popular sites to bolster my position. But I knew a fair trial demanded I listen to both sides. A public health advocate (The Scientific Parent’s Leslie Waghorn) suggested I list my key concerns/questions, and offered to go through them with me one by one. She disarmed my defensive posture by validating that it was okay to ask questions and even better to seek solid answers. Turns out that all my concerns boiled down to only a few key questions, which I addressed in my first Q&A.

Were your older children aware of your decision to stop vaccinating, and if so how did you talk to them about your decision to resume vaccination?

Our oldest (10) and I had discussed it back in February or March when she saw me doing a lot of research and reading about vaccines. So she had the backstory when the pertussis hit our family. I talked to her using an analogy of imaginary kids playing at our park. It went like this: What if after playing Johnny, Suzy came along and whispered “don’t play with Johnny. His family is dirty and will make your family sick!” What should you do? Just believe her words or go check her story to see if it’s true? How could you know for sure? Then I bridged to the vaccine issue, shared our story from when she was little, how all the Suzys were talking and we got scared and confused. We froze when we should have dug deeper for solid answers. A painful life lesson I hope our children will not repeat.

Do you have any advice for parents who are skeptical about vaccines or have questions?

That I commend them for taking the time and effort to focus on this vital part of parenting! To make sure to consider their biases and check their sources carefully and to not cherry-pick the information they like best. They should also talk to their doctors before making any decisions about vaccines. Our doctor was very understanding when we said we wanted to catch the kids up on their vaccines. We didn’t consult him before we stopped vaccinating because we were afraid of being judged or worse. I now wish I’d talked to him because he was very understanding.

 

– Edited by Leslie Waghorn and Julia Bennett

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Categories: Infectious Disease + Vaccines

There’s Actually a Scientific Reason Behind Being #antivaxx

By February 24, 2015 No Comments
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In just under 10 minutes, Hank Green of YouTube’s famous SciShow gives the most scientific (while easily understandable) explanation of why people opt out of vaccines. His video follows the thinking of Nobel Prize winner Daniel Kahneman who claims that “[p]eople are much more afraid of their children dying from a vaccine than they are from a child dying of an illness that spreads naturally. If something would happen to their child after being vaccinated, their decision becomes a focus of enormous regret.”

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Categories: Infectious Disease + Vaccines, Science 101 + Mythbusting

How I Accidentally Started an Anti-Vaxx Myth in the Name of Science

By February 17, 2015 1 Comment
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I’m an infectious disease researcher and the mother of two children, so I’m usually the first person friends and family turn to whenever a disease is in the news. Since the Disneyland measles outbreak, I’ve responded to a lot of myths and misinformation from concerned parents.

As a mother I understand what it’s like to to want to arm yourself with as much information as possible to protect your children.  As an infectious disease researcher it’s frustrating to see people without knowledge of virology nor immunology misconstrue science, or simply ignore it, and spread dangerous misinformation.

A new anti-vaxx myth has surfaced which seems to have been developed as a result of my recent post “Disneyland Measles Outbreak is Due to Measles”, which discussed the measles genotype responsible for this outbreak. The post was a response to another circulating myth that the measles strain is unknown and could be the strain found in the vaccine. It seems my post was then misconstrued and has become the basis of yet another anti-vax myth.

The new myth goes like this: since the measles strain in the MMR vaccine is genotype A, the vaccine doesn’t protect against the strain of the measles responsible for the Disneyland outbreak, which is genotype B3. This is not true and I want you to know how and why it’s not true.  The MMR vaccine does provide cross-protective coverage for wild-type measles strains such as B3.

Before I get into the how and why, though, I want to define some terms:

  • RNA: Ribonucleic Acid are strings of nucleic acid, similar to DNA, that acts as a messenger of genetic information.
  • Genotype: The small differences within a specific region in the RNA or DNA of a species of microorganism.
  • Antigen: A protein on the surface of a virus or bacteria that provokes an immune system response.
  • Serotype: The same species of microorganism such as virus or bacteria that can be further divided into sub-groups based upon their surface antigens.
  • Epitope: The very specific part of the antigen which antibodies attach to.
  • Strain: A generic term to refer to subgroups of a virus or bacteria that include the above variables.

When a physician suspects a patient has the measles they take a sample from the patient through a throat or nasal swab and send it to be genetically sequenced.  Epidemiologists use two genes within the measles  virus to determine the virus’ genotype, specifically they look at regions of nucleotide sequences in the RNA called hemagglutinin (H) and nucleoprotein (N). This is where we get the labels genotype A and genotype B.

The measles virus has only one serotype which causes only one illness, unlike Human Papillomavirus which has dozens of serotypes and can cause different diseases.  This is why we see multiple serotypes included in the HPV vaccine and only one strain in each of the available measles vaccines which are all genotype A.  Additionally, Unlike other viruses, such as the flu, the genotypes within strains of the measles virus only vary ~12% at the nucleotide level.

For these reasons, studies including millions of individuals have shown that the genotype A strain in the measles vaccines available today produce the antibodies necessary to provide immunity to all strains of the measles.

Measles viruses recovered through testing are constantly monitored, analyzed and characterized to identify areas of the genome which may antigenically-drift.  The measles viruses currently circulating have also been tested against vaccine-derived antibodies to ensure vaccines will cross-protect against the numerous genotypes that have been detected in different parts of the world.

There are tests such as virus neutralisation assays that combine different measles viruses with serum samples (the antibody-rich fraction of blood) of people who have either been vaccinated or previously infected with wild-type measles to determine if antibody binding occurs to different measles genotypes.  A fluorescent tag is added in order to visualize a reaction and then the antibody-antigen complex is measured. Results of numerous studies demonstrate that vaccine-derived antibodies protect against many different measles genotypes:

One of the tools public health agencies such as the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) use to monitor and test the efficacy of the measles vaccines are antibodies called monoclonal antibodies (MAbs) and have found that between the vaccine strain (genotype A) and wild type measles viruses (genotypes B-D) the measles vaccines currently available offer protection against these strains.

Specifically, the CDC and the WHO have found that the current measles vaccines offer protection against measles genotype, B3 the strain responsible for the Disneyland outbreak.

It is frustrating to know that a post I intended to inform and educate parents has been used to fuel a myth that may put their children at risk.  If any further evidence was needed to support that the MMR vaccine is effective against the Disneyland measles outbreak, which has sickened 121 people to date (dozens more reported), only 7% of those infected had received two doses of the MMR vaccine.  If the MMR and MMRV vaccines were ineffective against genotype B3 we would see many more people with both doses of the vaccine test positive for the measles.

Measles is one of the most infectious diseases we know of and this interactive infographic demonstrates how measles can spread in variable susceptible populations.  If the vaccine did not proffer cross-protection, there would be tens of thousands of cases to date.  Help me save lives and It is a public health imperative that parents have accurate information in order to feel confident that the available measles vaccine do work and have an excellent safety profile.

 


Resources:
Science Mom. Disneyland Measles Outbreak is Due to The Measles.  JustTheVax.Blogspot.com. January 28, 2015. Retrieved February 16, 2015.

The RNA Society. What is RNA? Retrieved February 16, 2015.

Blamaire, J. Genotype and Phenotype Definitions. City University New York. 2000. Retrieved February 16, 2015.

National Institutes of Health. Antigen Definition. Medline Plus. August 11, 2013. Retrieved February 16, 2015.

Centers for Disease Control and Prevention. Serotypes and the Importance of Serotyping Salmonella. April 8, 2014. Retrieved February 16, 2015.

Medicinenet.com. Epitope Definition. June 16, 2012. Retrieved February 16, 2015.

Wikipedia. Strain (biology). Retrieved February 16, 2015.

Centers for Disease Control and Prevention. Specimens for Detection of Measles RNA by RT–PCR or Virus Isolation. November 3, 2014. Retrieved February 16, 2015.

Centers for Disease Control and Prevention. Genetic Analysis of Measles Viruses. November 3, 2014. Retrieved February 16, 2015.

“Wild-type measles viruses have been divided into distinct genetic groups, referred to as genotypes, based on the nucleotide sequences of their hemagglutinin (H) and nucleoprotein (N) genes, which are the most variable genes on the viral genome.

The 450 nucleotides encoding the carboxy-terminal 150 amino acids of the nucleoprotein has up to 12% nucleotide variation between genotypes. The 450 nucleotides that encode the carboxy-terminal region of the nucleoprotein (N–450) are required for determination of the genotype. The measles genotyping protocol is available from CDC.”

World Health Organization. Measles. March 11, 2013. Retrieved February 16, 2015.

“Many of the attenuated strains in use are derived from the Edmonston strain isolated in 1954, including the Schwartz, the Edmonston-Zagreb, and the Moraten strains. Other strains which are not derived from Edmonston strain include the CAM-70, TD 97, Leningrad-16, and Shanghai 191 (Ji-191) strains.”

Growdon, W. B., & Del Carmen, M. (2008). Human Papillomavirus-Related Gynecologic Neoplasms: Screening and Prevention. Reviews in Obstetrics and Gynecology, 1(4), 154–161.

Centers for Disease Control and Prevention. Serologic Testing for Measles in Low Prevalence Setting. November 3, 2014. Retrieved February 16, 2015.

Tamin, A., Rota, P., Wang, Z. et al., Antigenic Analysis Of Current Wild Type And Vaccine Strains Of Measles Virus. Journal of Infectious Diseases. (1994) 170 (4): 795-801.doi: 10.1093/infdis/170.4.795

“The serum samples from recently vaccinated persons neutralized both the Moraten and Chicago-I viruses equally well (table 1): There was a <2-fold difference in neutralization titers. In contrast, serum samples from persons with a recent wild type infection were able to detect antigenic differences between the viruses. Sera in this set had neutralization titers against Chicago-l that were 4-8 times higher (average, 5.1) than the titers against the vaccine strain.”

Bankamp, B., Takeda, M., Zhang, Y. Genetic Characterization of Measles Vaccine Strains. Journal of Infectious Diseases. (2011) 204 (suppl 1):S533-S548.doi: 10.1093/infdis/jir097

“On the basis of the sequences of their N and H genes, MeVs can be assigned to 1 of 23 genotypes and 1 provisional genotype [11, 12]. All vaccine strains and their wild-type progenitors are assigned to genotype A. Experiments with monoclonal antibodies have defined antigenic differences between the H proteins of genotype A vaccines and the H proteins of wild-type viruses grouped in other genotypes [62, 188, 189]. However, there is only 1 serotype for measles, and serum samples from vaccines neutralize viruses from a wide range of genotypes, albeit with different neutralization titers [188, 190] More importantly, despite the presence of different endemic genotypes, vaccination programs with standard measles vaccines have been successful in every country where they were performed adequately [191193]. Suboptimal seroconversion after vaccination is likely the result of inadequate coverage; improper administration, transport, or storage of vaccine; or age of the vaccine recipients [194196].”

Centers for Disease Control and Prevention. Measles Outbreak — California, December 201–February 2015. Early Release. Morbidity and Mortality Weekly Report. February 13, 2015. Retrieved February 16, 2015.

Centers for Disease Control and Prevention & World Health Organization. History and Epidemiology of Global Smallpox Eradication. Slides 16-1. Retrieved February 16, 2015.

Harris, R., Popovich, N., Powell, K. Watch how the measles outbreak spreads when kids get vaccinated – and when they don’t. The Guardian. February 5, 2015. Retrieved February 16, 2015.

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Categories: Infectious Disease + Vaccines, Science 101 + Mythbusting

Does HPV Vaccine Gardasil Really Have A Dark Side?

By February 9, 2015 No Comments
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In their story on the purported devastating side-effects of the HPV vaccine, Gardasil, the Toronto Star’s David Bruser and Jesse McLean buried the lead. In both the print and video amplifier, the message “in the cases discussed in this story, it is the opinion of a doctor or patient that a particular drug has caused a side effect. There is no proof the vaccine caused a death, illness or hospitalization,” [emphasis mine] was buried either at or towards the end.

I’m usually a fan of the Star’s reporting, a good friend is a former reporter and editor with the paper, so I was shocked to see the specious connections made by the Star’s team about a life-saving vaccine. The Star’s story arrives in the midst of a national dialogue on the safety, efficacy and necessity of vaccines, which makes it all the more crucial to fact check the story’s claims.

If Gardasil carries with it a risk higher than reward I would be the first to say it needs to be pulled, but the data does not bear this out. But multiple studies (Chao, et al., 2012; Arnheim-Dahlström, et al., 2013; and CDC MMWR Weekly July 26, 2013 / 62(29);591-595) involving literally millions of subjects have shown no increased incidence of autoimmune disorders post vaccination with either variation of the HPV vaccine.

A crucial error in the story is Bruser and McLean’s misinterpretation (misrepresentation? misunderstanding?) of the Vaccine Adverse Event Reporting System (VAERS). In the simplest of terms VAERS is quantitative input, not qualitative output. Anyone can, and is encouraged to, report an injury to VAERS that they believe to be caused by a vaccine. Reporting a suspected injury to VAERS is not the same as a confirmed causal relationship.

The stories told by the girls and their mothers in the Star piece are heartbreaking, and I do not doubt these girls suffered debilitating illnesses. But what’s crucial to the story is whether or not those illnesses were caused by the Gardasil vaccine.

In one story, there may be a clear connection, however, the connection speaks not to the safety of the vaccine but rather to importance of vaccine safety communication. The article and video highlights the story of Kaitlyn, a teenage girl given the shot even though she told the nurses(s) she was allergic to a key component in the vaccine. If the nurse(s) did ignore Kaitlyn’s warnings and gave her the shot anyways, this does not imply an issue with the safety of the vaccine. It does imply that our health care professionals need to better educated about the components and contraindications for each vaccine.


Resources:
Chao, C., Klein, N. P., Velicer, C. M., Sy, L. S., Slezak, J. M., Takhar, H., Ackerson, B., Cheetham, T. C., Hansen, J., Deosaransingh, K., Emery, M., Liaw, K.-L. and Jacobsen, S. J. (2012), Surveillance of autoimmune conditions following routine use of quadrivalent human papillomavirus vaccine. Journal of Internal Medicine, 271: 193–203. doi: 10.1111/j.1365-2796.2011.02467.x

Arnheim-Dahlström, L., Pasternak, B.Svanström, H., Sparén, P., Hviid, AAutoimmune, neurological, and venous thromboembolic adverse events after immunisation of adolescent girls with quadrivalent human papillomavirus vaccine in Denmark and Sweden: cohort study

CDC Morbidity and Mortality Weekly Report (MMWR). Human Papillomavirus Vaccination Coverage Among Adolescent Girls, 2007–2012, and Postlicensure Vaccine Safety Monitoring, 2006–2013 — United States July 26, 2013 / 62(29);591-595

CDC Vaccine Adverse Event Reporting System (VAERS). Last updated July 24, 2013. Retrieved February 8, 2015.

U.S. Department of Health and Human Services Centers for Disease Control and Prevention Food and Drug Administration. Do Your Part for Vaccine Safety: Report to VAERS. Retrieved February 8, 2015.

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Categories: Ages + Stages, Infectious Disease + Vaccines, School-Aged Children, Science 101 + Mythbusting, Tweens + Teens