THE VACCINATION DEBATE: Sorting Through the Bias and Fear

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THE VACCINATION DEBATE Sorting Through the Bias
and Fear

• Edwin Hofmann-Smith, PhD, ND
• Natural Childbirth and Family Clinic
• 10360 NE Wasco, Portland, OR 97220
• 503 252 8125

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Public Health Point of View

• Vaccination protects the individual AND OTHERS,
  potentially eliminates epidemics
• Measles 1/1000 death rate (pneumonia,
  encephalitis, nerve damage, etc.)
• Cost of doctors, hospitals, etc. greater than
  cost of vaccines
• Risks of vaccination less than risk of disease
• One of the greatest achievements of
  medicine/public health. Smallpox, polio,
  diphtheria, measles, rubella, mumps, tetanus, all
  practically eliminated

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Public health perspective

• Pregnant mom picked up pertussis, her newborn got
  it, spent next five weeks in NICU, permanent lung
  damage
• Child picks up measles in Switzerland, exposes
  plane full of people, many quarantined, some
  cases, no epidemic

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Individual familys perspective

• Risk of disease may be minimal (since there are
  no epidemics)
• Risk of vaccination is underestimated by
  officialdom
• Dont trust the vaccine authorities
• Can control exposure (hep B, HPV)
• Our situation isnt typical, we eat healthy, use
  homeopathy,

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BIAS

• A preference or an inclination, especially one
  that inhibits impartial judgment
• Helps us understand why there is such a wide
  divergence of opinions
• For instance, did you believe the cigarette
  manufacturers when they say smoking doesnt cause
  cancer?

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BIAS vaccine manufacturers

• Obvious, everybody knows this
• There are safeguards regarding conflict of
  interest, but revolving door is reality
• Like military-industrial complex
• Donate much money to political campaigns,
  lobbyists, media
• Regulators get captured by regulatees. (Its an
  axiom.)

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BIAS media

• Advertising dollars are extremely persuasive
• When was the last time you heard of a media
  outlet go against both government and
  advertisers?

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BIAS CDC/Federal Government

• Vaccines for Children Program Federal government
  supplies vaccines for free if clinic agrees to
  vaccinate according to the standard schedule
• Tends to keep pediatricians in lock-step

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BIAS Vaccine Injury Compensation Program

• Vaccine injury table - compensation only for
  accepted injuries with specific timing after
  vaccination
• Large cost to program if additional injury added
  to table
• Adversarial program - litigant must prove
  causation
• Poling case - autism and seizures, mitochondrial
  defect

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BIAS scientific method

• Hard to prove causation for adverse effects
• Hard to prove causation if effect is delayed,
  infrequent, subtle, not obviously related to
  disease
• Publication bias
• Funding bias
• Adverse effects research is a tough road

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BIAS Public health officers

• Vaccination is one of the greatest achievements
  of medicine
• Federal grants to states public health
  departments based on vaccination rates
• Keeps public health departments motivated to push
  vaccination

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BIAS pediatric community

• Dont want to think that what they do every day
  could be harming (some) kids
• Vaccinations are an integral part of practice,
  keep numbers up
• Vaccine objectors are seen as uninformed
  conspiracy theorists
• Dont worry, theyre completely harmless

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VACCINE APPROVAL

• Try to balance cost of development with safety
• Very brief followup in safety trials
• Autoimmune and other adverse effects may take
  weeks to months to develop.
• Generally look for immediate adverse effects,
  then rely on post-marketing surveillance

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Vaccine adverse events reporting system

• Reporting is required for serious effects
• Anyone can report
• Rate of reporting is between 1 and 10

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Vaccine safety datalink

• Some managed care organizations report data on
  adverse effects, etc.
• First hard evidence of an adverse effect from
  mercury (thimerasol)
• Quickly advised removal of thimerosal

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SAFE

• The U.S. Food and Drug Administration defines a
  safe product as one that has acceptable risks,
  given the magnitude of the benefit expected in a
  specific population and within the context of
  alternatives available. Determining what degree
  of risk is 'acceptable' is a particular challenge
  for regulators and policy-makers (and parents)

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BIAS Fear

• Unknown contaminants
• Stories of adverse effects have legs, not even
  necessarily true
• Internet sites - no peer review, have ax to
  grind
• Consequences are huge lifetime of care for
  disabled child
• Personal knowledge of vaccine-injured child

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Mechanisms of adverse effects

• Autoimmunity
• Microglial activation
• Unintended contamination virus, DNA/RNA, enzymes
  (hypothesized)
• Chemical toxicity mercury/thimerosal, aluminum,
  formaldehyde

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ASD and Developmental Disabilities

• 1/110 current rate of autism spectrum (CDC)
• 13 with developmental disabilities
• ASD lifetime cost of care is 3.2 million
• Medical care cost about 5 times more than normal
  kids
• About 700,000 with ASD
• 50 - 60 of their parents believe illness was
  triggered by vaccination

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ASD causation

• Doctors treating ASD estimate 20-50 have
  clear-cut vaccine injury. Most parents blame
  vaccination.
• MMR is worst one
• Can be multiple illness/antibiotics
• Gut flora probably involved in some
• Some have bizarre immunological abnormality
• Family history autoimmune, neurological

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Neurodevelopmental Disorders Etiology

• Mercury? - rates not dropping
• Aluminum - not much research
• Autoimmune - auto-antibodies not found in
  convincing frequency, no delay in some cases
• Gut connection
• Microglial activation

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Hannah Poling case

• Multiple ear infections (food allergy,
  antibiotics, immune dysfunction?)
• Tympanostomy tubes
• At 19 months, We need to catch her up on her
  vaccinations. Got 9 vaccines.
• Prompt and profound decline
• Mitochondrial defect

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Mitochondrial dysfunction

• Mitochondria as cellular batteries
• They generate free radicals, also soak up free
  radicals by antioxidants
• Free radicals damage the mitochondria
• Genetic mitochondrial dysfunction? Unlikely.
• Nitric oxide generates free radicals

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Microglial/excitotoxin hypothesis for ASD

• Proposed in 2003 by Russell Blaylock, MD
• Microglia and astrocytes become activated when
  the systemic immune system becomes activated
• Secrete inflammatory chemicals (cytokines),
  excitotoxins (glutamate and quinolinic acid),
  free radicals and lipid peroxidation products
  (damage mitochondria)
• Similar to nitric oxide mechanism of CFS, etc.
  Can get stuck on

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Nitric oxide and chronic disease

• The proven mechanism of chronic fatigue syndrome,
  multiple chemical sensitivities, post-traumatic
  stress disorder, gulf war syndrome, etc. (Martin
  Pall)
• Over production of nitric oxide (eg. in
  inflammation) leads to damaging free radicals,
  etc. and can lead to positive feedback loop.
• Overproduction can be local. Autism has damage
  notably in cerebellum and frontal cortex.

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Vitamin D hypothesis

• Vitamin D has effects on about 10 of human genes
• Rise in autism parallels recommendation of sun
  avoidance
• More prevalent in dark-skinned, etc.
• Pregnant women should get 4000 IU per day, babies
  800IU/day

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Aluminum toxicity

• The calculated body burden of aluminum from
  vaccinations exceeds that from dietary sources,
  however, it is below the minimal risk level
  equivalent curve after the brief period following
  injection.
• In young children, vaccines with aluminium
  hydroxide caused significantly more erythema and
  induration than plain vaccines (odds ratio 187)
  and significantly fewer reactions of all types
  (021)

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Aluminum toxicity

• Impairs mercury excretion
• Impairs glutathione synthesis
• Maximum dose per vaccine (850 mcg) not based on
  safety studies
• Vaccines with aluminum DTaP, Hib, Prevnar, Hep
  B, Hep A, HPV

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US Recommended Vaccines

• Hep B (3 doses) Polio (4 doses)
• DTaP (5 doses) Rotavirus (3 doses)
• Hib (3 or 4 doses) Pneumococcus (4 doses)
• Varicella (2 doses) MMR (2 doses)
• Hepatitis A (2 doses)
• Total doses - 28
• Total vaccines 42

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Japanese schedule 2004

• Polio 3 shots starting around 3 months
• DTaP 3 shots starting around 3 months
• Measles, rubella age 1
• Japanese encephalitis 4 shots
• BCG 3 shots starting at 4 mo.
• Total doses - 14
• Total vaccines - 21

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Timing

• Immune system not mature till 1 year of age
• Maternal antibodies protect against disease in
  the infant and inhibit antibody response, last
  about 6 months
• Breast feeding protects against some diseases
  like Hib and PC

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Hepatitis B

• Childhood infection usually asymptomatic but
  25-90 risk of chronicity
• Chronic infection liver cancer, cirrhosis
• Common in Asia, Africa, Eastern Europe, Pacific
  Islanders, Central America, and the Carribean
• Transmitted by contact with blood, semen and
  vaginal secretions

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Vaccination added in 1991
Chronic
Acute
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Hepatitis B vaccine

• Risk of autoimmunity
• Extremely low risk of disease - very weak
  justification for vaccination
• Not recommended

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Pertussis (whooping cough)

• Increasing d/t lower vaccination rates
• Newborns not protected (lack of maternal
  antibody)
• Ordinary cough for a week then paroxysmal
• Serious in babies pneumonia, seizures, pulmonary
  hypertension

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Pertussis vaccine

• Start 3 - 6 months depending on exposure, etc.
• Follow general recommendations one shot at a
  time, not when sick or if gut is unhealthy,
  family history of neurological or autoimmune
  diseases, silicea 200C as preventive. Dont
  repeat if reaction to first shot.
• Recommended

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Diphtheria

• Bacteria cause sore throat and liberate a toxin
• Very rare except some foreign countries
• Recommended because cant get pertussis vaccine
  without it. Available as DTaP, Tdap, etc.

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Tetanus

• Anaerobic bacterium found in soil, manure
• Infection due to dirty wound causes generalized
  muscle spasm
• Recommended DTaP, Tdap
• Cant get pertussis vaccine without it

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Polio

• Disease eradicated from the Western Hemisphere,
  Europe, etc. No risk of disease
• Vaccine is now relatively safe but not needed.
  Disease may be eradicated world-wide in future
• Can vaccinate later before foreign travel

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Haemophilus influenza type B

• Bacterium is normal flora for nose and throat.
  Can become invasive and cause meningitis,
  pneumonia, cellulitis, epiglottis, etc.
• Now rare due presumably to vaccination
• Largely prevented by maternal antibody and breast
  feeding

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Hib not recommended

• Have seen some neurological reactions, but none
  permanent
• Risk of disease very low

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Strep. pneumoniae (Prevnar)

• More than 90 separate strains exist
• Causes pneumonia, otitis media, sinusitis,
  sepsis, septic arthritis, meningitis, etc.
• Vaccine is directed against the 13 worst strains
• Now other strains are causing more disease
  (serotype replacement) and Staph carriage is
  increased

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Prevnar not recommended

• Risk of disease is very low in the absence of
  specific risk factors like immune dysfunction
• Breast feeding is protective
• Serotype replacement
• Vaccine is relatively reactogenic

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Rotavirus

• Almost all kids get this by the time theyre 5
  years old
• Vomiting 12 to 18 hours, then usually diarrhea
• Self limited
• 37 deaths per year in US

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Rotavirus vaccine

• Live virus vaccine
• Rotarix (GlaxoSmithKline) contains parts of a pig
  virus that doesnt make pigs sick
• Rota Teq (Merck) contains parts of a pig virus
  that kills baby pigs
• Increase in intussusception with Rota Teq
• Not recommended

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Hepatitis A

• Fecal-oral transmission
• Very common in third world, rare in US
• Usually asymptomatic in kids but more severe in
  adults
• No chronic state
• Vaccine relatively safe but not recommended
  unless a high risk group

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Measles

• Measles 1/1000 death rate, neurological damage
• Virtually eliminated in US d/t vaccine
• Drop in vaccination rate associated with
  many-fold increase in cases

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Measles vaccine

• MMR is the most common vaccine trigger of autism,
  but usually was given with other vaccines and kid
  was already sick
• Recommended to support public health effort
• Give after age 2 - 3
• Give 50 - 75,000 IU vitamin A, good vitamin D
  status, healthy, not with other vaccines

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Mumps

• Relatively mild disease
• Self limited
• Vaccine cant get it without measles and rubella
• Recommended after age 2

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Rubella

• If pregnant mom contracts it in first trimester,
  fetus gets it and might die or have severe birth
  defects
• Our public health approach - vaccinate all kids.
  Prevents epidemics. Successful.
• Essentially eradicated from US

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Rubella vaccine

• 15 of adolescent and adult women will get acute
  arthrisis, usually transient
• Worse with wild virus infection
• Cant get it without M and M
• Recommend start after age 2
• Dont re-vaccinate if seronegative as adult

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Varicella Zoster (Chickenpox)

• Epidemics among young children
• Occasional severe disease
• Susceptibles like immuno-suppressed, chemotherapy
  at risk for severe disease
• Carrier state with 30 getting shingles later
• Exposure to children with chickenpox boosts
  immunity

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CHICKENPOX (VARICELLA)

• Disease is usually mild but virus persists
• Asymptomatic re-activation of vaccine virus
• Risk of shingles later in life less with vaccine?
  Likely.
• Shingles vaccine necessary because less boosting
  of immunity from epidemics.
• Risk of serious reaction to vaccine is 0.03 to
  0.3

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Chickenpox vaccine program

• Best information says, shingles less frequent and
  milder after vaccination than wild disease
• Live virus, slight risk of mild disease after
  shot
• Risks less after shot than from disease
• Recommend after age two or three with usual
  preventive for live virus

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