THE VACCINATION DEBATE: Sorting Through

the Bias and Fear

Edwin Hofmann-Smith, PhD, NDNatural Childbirth and Family Clinic

10360 NE Wasco, Portland, OR 97220

503 252 8125

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

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

Individual family’s perspective

Risk of disease may be minimal (since there are no epidemics)

Risk of vaccination is underestimated by officialdom

Don’t trust the vaccine authorities Can control exposure (hep B, HPV) Our situation isn’t typical, we eat

healthy, use homeopathy,

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 doesn’t cause cancer?

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.

(It’s an axiom.)

BIAS: media

Advertising dollars are extremely persuasive

When was the last time you heard of a media outlet go against both government and advertisers?

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

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”

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

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

BIAS: pediatric community

Don’t 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”

“Don’t worry, they’re completely harmless”

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

Vaccine adverse events reporting system

Reporting is required for serious effects

Anyone can report Rate of reporting is between 1 and

10%

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

“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)

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

Mechanisms of adverse effects

Autoimmunity Microglial activation Unintended contamination: virus,

DNA/RNA, enzymes (hypothesized) Chemical toxicity:

mercury/thimerosal, aluminum, formaldehyde

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

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

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

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

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

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”

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.

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

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 1·87) and significantly fewer reactions of all types (0·21)

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

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

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

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

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

Chronic

Acute

Vaccination added in 1991

Hepatitis B vaccine

Risk of autoimmunity Extremely low risk of disease -

very weak justification for vaccination

Not recommended

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

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. Don’t repeat if reaction to first shot.

Recommended

Diphtheria

Bacteria cause sore throat and liberate a toxin

Very rare except some foreign countries

Recommended because can’t get pertussis vaccine without it. Available as DTaP, Tdap, etc.

Tetanus

Anaerobic bacterium found in soil, manure

Infection due to dirty wound causes generalized muscle spasm

Recommended: DTaP, Tdap Can’t get pertussis vaccine without

it

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

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

Hib: not recommended

Have seen some neurological reactions, but none permanent

Risk of disease very low

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

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

Rotavirus

Almost all kids get this by the time they’re 5 years old

Vomiting 12 to 18 hours, then usually diarrhea

Self limited 37 deaths per year in US

Rotavirus vaccine

Live virus vaccine Rotarix (GlaxoSmithKline) contains parts

of a pig virus that doesn’t make pigs sick Rota Teq (Merck) contains parts of a pig

virus that kills baby pigs Increase in intussusception with Rota Teq Not recommended

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

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

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

Mumps

Relatively mild disease Self limited Vaccine: can’t get it without

measles and rubella Recommended after age 2

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

Rubella vaccine

15% of adolescent and adult women will get acute arthrisis, usually transient

Worse with wild virus infection Can’t get it without M and M Recommend: start after age 2 Don’t re-vaccinate if seronegative

as adult

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

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%

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