Vaccinations: Myths vs. Facts

1. Vaccinations: Myths vs. Facts Cathy Harkins Logan Tinsley Harrison Research Society Discussant: Dr. Carolyn Ashworth

2. Then… • Years ago, thousands of children and adults contracted infectious diseases, including measles, poliomyelitis, and diphtheria. • At that time, most were much more fearful of the diseases than of the adverse effects (AEs) of the vaccinations.

3. Now… • Today the situation is reversed. • In the era of effective vaccines, many parents are becoming more concerned about the possible AEs. • Many parents of today have never experienced the consequences of these diseases and do not fully understand the dangers they impose.

4. The Problem… • Part of the shift in beliefs in vaccination is due to the lack of experience and therefore the lack of fear of these diseases. • Also, it is largely due to the vast amount of misinformation available regarding vaccinations. • It is much easier to find the false information than to locate information from reputable sources, including the CDC, NIH, etc.

5. Belief # 1:“Vaccines Are Unsafe”

6. “Vaccines Are Unsafe” • There is an emerging emphasis on the morbidity and mortality, or the “serious” AEs of vaccinations. • Often statistics and numbers are manipulated to suggest that vaccinations are the cause for disability and death, and that they are more harmful than the actual diseases they intend to prevent.

7. “Vaccines are unsafe” • “VAERS receives 11,000 reports of serious AEs annually, 1% are deaths…” • “Studies have shown vaccination to be a cause of SIDS.” • “Tip of the iceberg…deaths may be well over 1,000.”

8. Vaccine Adverse Events Reporting System • National AE reporting system operated by the CDC and the FDA • Established in 1990 to record and track adverse events that occur after a vaccine is given • Passive: voluntary reports from anyone • Used to detect early warnings about possible unrecognized AEs

9. VAERS • Strengths: • National surveillance • Has the ability to detect rare events • Ex. Intussusception due to Rotashield • Weaknesses: • It is not a complete database! • Susceptible to misclassification • Ex. Injection site=“serious” reaction and vice versa

10. Vaccine Safety Datalink • Created in 1990 by CDC in conjunction with 8 large HMOs to continually monitor vaccine safety • HMOs in Washington, California, Oregon, Colorado, Minnesota • Includes information such as vaccine, date, other vaccinations, manufacturer, lot number, injection site, etc • Data used to study SIDS deaths and found risk was the same in vaccinated and unvaccinated children

11. VSD • Strengths: • More complete: Almost all significant medical encounters are documented • Is not passive: It does not rely on a physician or patient to report the encounter • More accurate classification of the event • Weaknesses: • Population not completely representative of the US • Vaccine coverage rates high = few controls • Not large enough to examine very rare events

12. Back to the myth… • No vaccine is 100% effective and 100% safe! As with any drug, vaccines have risks and side effects. • Adverse Event= something that occurred close to the time a vaccine was given • All AEs that are reported are NOT caused by the vaccines administered!

13. Cause or Coincidence? • Correlation does NOT equal causation! • Many vaccines are given during times when other problems and developmental concerns are being recognized. • Each year, > 10 million vaccinations given to children less than 1 year of age. By coincidence alone, some will experience “events” shortly after a vaccine is given.

14. Cause or Coincidence? • VAERS reports include both coincidental events as well as true reactions. • VAERS reports are NOT verified cases of vaccine deaths • Events may be due to underlying diseases, concomitant medications, or simply by chance alone. • All reported AEs are NOT due to vaccines!

15. Target Audience • Many patients and families are unfamiliar with controlled studies, good studies versus bad, and even simple statistics. • Misinformation comes from friends and family, church members, and co-workers. • Everyone knows someone who knows someone who… • Beliefs can be deeply rooted in misinformation and mistrust.

16. Belief # 2:“Decline in disease is not a result of immunizations”

17. Disease decline… • A major belief is that the diseases which vaccines aim to prevent actually declined prior to the introduction of vaccinations. • “Not only did vaccines have no influence over the decrease of the diseases, the contrary is true, they slowed down the downward trend of all diseases.” -Anita Petek-Dimmer

18. Declined Prior to Vaccines? • “With diseases other than smallpox we have shown that 90% of the decline in mortality occured before vaccines were introduced.” www.vaclib.org • “If you view graphs of the mortality associated with infectious diseases for the United States and Western Europe for the period 1800 to 1950, it will become obvious that 90 to 95 percent of the mortality decrease occured before the introduction of vaccines. So it is non-controversial to state that during this period that the number of lives saved by vaccine was ZERO.” www.vaclib.org

19. Declined Prior to Vaccines? • “All diseases declined by as much as 95% before the introduction of vaccines or antibiotics. Improved personal and public hygiene can account for a considerable drop in deaths from disease. Diseases will decline without intervention.” www.know-vaccines.org • “According to the British Association for the Advancement of Science, childhood diseases decreased 90% between 1850 and 1940, paralleling improved sanitation and hygienic practices, well before mandatory vaccination programs.” www.mercola.com

20. Decline in Haemophilus Influenza

21. Decline in Polio

22. Decline in Measles

23. Decline in Mumps

24. Decline in Rubella

25. The truth… • Polio declined dramatically in the 1950’s. Measles did not decline until 10 years later. • If due to sanitation and nutrition, shouldn’t they decrease at roughly the same time? • Both had slight decreases during the trial phases of the vaccines and showed dramatic decreases after licensing of the vaccines.

26. Belief #3:“Vaccines are not effective.”

27. Vaccine Failure • “The medical literature has a surprising number of studies documenting vaccine failure. Measles, mumps, small pox, pertussis, polio and Hib outbreaks have all occurred in vaccinated populations…” • “A more recent study found that measles vaccination "produces immune suppression which contributes to an increased susceptibility to other infections." • "Evidence suggests that vaccination is an unreliable means of preventing disease.“ -www.mercola.com

28. Others Say… • “Six New England states reported increases in polio one year after the Salk vaccine was introduced, ranging from more than doubling in Vermont to Massachusetts' astounding increase of 642%; other states reported increases as well.” • “…Dr. Bernard Greenberg, head of the Dept. of Biostatistics for the University of North Carolina School of Public Health, testified that not only did the cases of polio increase substantially after mandatory vaccinations…but that the statistics were deliberately manipulated by the Public Health Service to give the opposite impression. • "The polio vaccine temporarily reversed disease declines that were underway before the vaccine was introduced; this fact was deliberately covered up by health authorities. -www.mercola.com

29. Who is REALLY at risk? • Exemptors were 22.2 times (95% confidence interval [CI], 15.9-31.1) more likely to acquire measles and 5.9 times (95% CI, 4.2-8.2) more likely to acquire pertussis than vaccinated children. Feikin. JAMA. 2000. 284(24):3145-50. • Measles Outbreak 1989-1991- number of cases in unvaccinated Hispanic and AA populations was 4-7 times higher than among non-hispanic whites.-www.cdc.gov • Since 1993, the largest outbreaks of measles have occurred in populations that refuse vaccination, including communities in Utah and Nevada, and in Christian Scientist schools in Missouri and Illinois. –www.cdc.gov

30. Belief #4:“Infectious diseases are benign and self-limiting.”

31. Benign Childhood Diseases • “Most childhood infectious diseases have few serious consequences in today's modern world.” • “The vast majority of the time, childhood infectious diseases are benign and self-limiting.” • “Not only are most infectious diseases rarely dangerous, they can actually play a vital role in the developing a strong, healthy immune system.” • "Dangers of childhood diseases are greatly exaggerated in order to scare parents into compliance with a questionable but highly profitable procedure." -www.mercola.com

32. The Truth: Polio • Polio virus causes acute paralysis that can lead to permanent physical disability and death. Before a vaccine was available, 13,000 to 20,000 cases of paralytic polio were reported each year in the United States. • One in 200 infections leads to irreversible paralysis (usually in the legs).

33. Polio

34. The Truth: Haemophilus Influenza • Before the Hib vaccine, H. flu was the most common cause of bacterial meningitis in U.S. infants and children. • Prior to the vaccine: 20,000 invasive Hib cases annually—2/3 meningitis, 1/3 other invasive Hib diseases (bacteremia, pneumonia, or epiglottitis) • Hib meningitis once killed 600 children each year and left many survivors with deafness, seizures, or mental retardation. -www.cdc.gov

35. The Truth: Measles • Before the vaccine was available, nearly everyone in the U.S. acquired measles. • Approximately 450 deaths associated with measles were reported each year between 1953 and 1963. • Complications: • ear infections • Pneumonia-approx 6% of deaths • encephalitis-while rare, can result in brain damage • diarrhea

36. Measles

37. The Truth: Pertussis • Pertussis can be a severe illness, resulting in prolonged coughing spells, and the illness can last for many weeks. • These spells can make it difficult for a child to eat, drink, and breathe. • Because vomiting often occurs after a coughing spell, infants may lose weight and become dehydrated. • In infants, it can also cause pneumonia and lead to brain damage, seizures, and mental retardation.

38. Pertussis

39. The Truth: Rubella • Usually mild in children and adults • Up to 90 percent of infants born to mothers infected with rubella during the first trimester of pregnancy will develop congenital rubella syndrome (CRS) • heart defects, cataracts, mental retardation, and deafness. • In 1964-1965, before rubella immunization was used routinely in the U.S., there was an epidemic of rubella that resulted in an estimated 20,000 infants born with CRS • 2,100 neonatal deaths and 11,250 miscarriages. • Of the 20,000 infants born with CRS, 11,600 were deaf, 3,580 were blind, and 1,800 were mentally retarded.

40. Rubella

41. The Truth: Tetanus • Tetanus is a severe, often fatal disease. Bacteria that cause tetanus are distributed in soil and street dust, are found in animal waste, and are very resistant to heat and germ-killing cleaners. • People who get tetanus suffer from stiffness and spasms of the muscles. • The larynx can close causing respiratory distress and eating difficulties, and muscles spasms can cause spine and long bone fractures. • Approximately 20 percent of reported cases end in death.

42. Tetanus

43. The Truth: Hepatitis B • More than 2 billion persons worldwide have been infected with the hepatitis B virus, 350 million are life-long carriers of the disease and can transmit the virus, and one million of these people die each year from liver disease and liver cancer. • Approximately 25 percent of children who become infected with life-long hepatitis B virus would be expected to die of related liver disease as adults.

44. Belief # 5:“MMR vaccine causes Autism.”

45. Increase in Autism? • “Today, one out of every 150 children are affected by autism, according to the National Vaccine Information Center. In the early 1940's, prior to the introduction of most vaccines in current use, it was considered a rare condition that few doctors would ever encounter in their practice.” • “California's autism rate has mushroomed 1000% over the past 20 years, with dramatic increases following the introduction of the MMR vaccine in the early 1980's.” -www.mercola.com

46. Increase in Autism? • Data from California (Department. of Developmental Services, 1999)-used to illustrate an increase in cases of autism since the introduction of the vaccine. • Do not account for population growth and changes in the composition of the population • Do not account for changes in diagnostic definitions-PDD in ‘80, Rett, Asperger, CDD in ‘94 • Children are diagnosed earlier, causing an increase in reported cases. –Fombonne. Pediatrics. 2001; Vol. 107

47. Autism Theory • The MMR-autism theory came to the forefront when, in 1998, Wakefield and colleagues reviewed reports of children with bowel disease and regressive developmental disorders. • The researchers suggested that MMR vaccination led to intestinal abnormalities, resulting in impaired intestinal function and developmental regression within 24 hours to a few weeks of vaccination. • This hypothesis was based on 12 children. In 9 of the cases, the child's parents or pediatrician speculated that the MMR vaccine had contributed to the behavioral problems of the children in the study. -www.cdc.gov

48. Autism Theory • Only 12 children were included in the study. • No healthy control children for comparison • The study did not identify the time period during which the cases were identified. • In at least 4 of the 12 cases, behavioral problems appeared before the onset of symptoms of bowel disease; that is, the effect preceded the proposed cause. • It is unlikely, therefore, that bowel disease or the MMR vaccine triggered the autism. -www.cdc.gov

49. Autism Theory • In 2004, 10 of the 13 authors of the study retracted the paper's interpretation, stating that the data were insufficient to establish a causal link between MMR vaccine and autism (Murch et al., 2004)

50. Autism Theory • A 2001 study (Dales et al.) used the autism case numbers provided by the California Department of Developmental Services and compared them with MMR immunization level estimates for California children. • Born 1980 through 1987: there was no major change in MMR immunization levels • Cases of autism increased markedly, from 44 cases per 100,000 live births in 1980 to 208 cases per 100,000 live births in 1994. • Even if there were a true increase in autism despite factors mentioned before, one would expect to see an increase in the MMR levels to make the conclusion that MMR causes autism. -www.cdc.gov