Dr. Barry Dworkin » Vaccines

Measles outbreak spreads in BC

Dr. Barry Dworkin — Fri, 09 Apr 2010 11:28:14 +0000

Madely Health Headlines Commentary for April 9, 2010

Source:

B.C. measles outbreak expands to 26 cases

H1N1 pandemic severity update and the effectiveness of antivirals in otherwise healthy adults

Dr. Barry Dworkin — Wed, 09 Dec 2009 15:03:47 +0000

Madely Health Headlines Commentary for December 9, 2009

Sources:

British researchers say little evidence Tamiflu works, but WHO says the drug is useful

Swine Flu Pandemic May Be Less Severe Than Expected

A headline’s tale of two flu stories: Reality vs deliberate misrepresentation of risk

Dr. Barry Dworkin — Sat, 17 Oct 2009 22:03:26 +0000

I am not a fan of how newspapers use headlines to misrepresent stories to provke unwarranted fear, and heightened risk perception. Today, the Ottawa Citizen published two stories about seasonal and H1N1 vaccine. The first story, For Guillain-Barre survivors, flu shot stirs up unwelcome memories, emblazoned on the front page has all the elements of what is regrettably become the norm in newspaper headlines. Headlines are not under control of the journalist. The article was written by Sharon Kirkey.

Ottawa Citizen journalist Dan Gardner’s book, Risk: The Science and Politics of Fear discusses this journalistic approach to sensationalizing news called the Example Rule.

This rule is used to present rare occurrences as if they are common or lurking among us, misrepresenting true risk. Therefore, it was no great surprise to read the front-page headline of today’s Ottawa Citizen continuing this tradition. It outlines the history of a woman who develops a rare neurodegenerative disease called Guillain Barre Syndrome (GBS) and implies a link to the flu vaccine.

The medical content of the story accurately presented the risks of developing GBS, about 1-2 per 100, 000 people. There is some evidence that indicates that the flu vaccine may add an extra 1 per 1 million people. However, the headline clearly did not reflect this. It cites one Ontario study that the seasonal flu vaccine increases the relative risk of contracting GBS by 45 percent.

The absolute risk change of the 1 in a million increase was mentioned immediately following the 45 per cent claim. This former should have been the only statistic cited.

Relative risk is presented to emphasize dramatic change. It is used by media, pharmaceutical companies, food manufacturers, and the Natural Health industry among others to bolster their health claims.

Relative risk does not provide context for the change in risk and should not be included in health reporting. However, it is the number that will be cited by the reader when they discuss this issue with others, hence the problem of skewed risk perception.

The story ends with the woman who had GBS stating, “I made a promise to myself, that if I ever walk again, I will do whatever it takes to keep whatever doesn’t belong in my body out of it.” Although it is understood that traumatic experiences can influence one’s sense of risk, the statement is used to conjure up the idea that unnatural substances are implicated in the disease process and are to be avoided.

If that were the case, one could argue that we should avoid touching any manufactured product, walking down the street and being exposed to car exhaust’s polyaromatic hydrocarbons, and using chemical cleanser’s and agents among others. Exposure to some of these potentially harmful compounds is likely in the parts per million or billion as well. We do not routinely think about this because our sense of risk from these everyday products and activities is low.

News reporting should present information with context. The public should be treated with respect, which includes removing the fear mongering for the sake of selling newspapers, TV and radio shows and magazines. Globe and Mail health reporter Andre Picard has commented on this issue as well as Dr. Noni MacDoanald in an article written for the Canadian Medical Association Journal.

The second story written by Pauline Tam, Our best shot against swine flu?, deserves kudos to the reporter for excellent evidenced-based content and science writing.

Ms. Tam accurately represented the uncertainty that is inherent in medical research yet clearly emphasized the strength of evidence against many misperceptions about the flu vaccine.

She covered the issue about adjuvants or immune system boosters and reviewed how the adjuvant improves efficacy of the vaccine. The adjuvant, squalene, is produced by our liver and is found in many foods as natural oil.

One wonders why, given the focus by some groups on how natural products are better than synthetic, there is such controversy. It would make sense that the logic should remain consistent.

Ms. Tam also reviews the preservative thimerosal found in some multidose vaccines and cites evidence from numerous reputable sources regarding its safety profile.

What Ms. Tam accomplished it to foster critical analysis of health information and present it in context allowing the reader to make an informed decision and risk assessment. She shows medical research is always evolving and is not perfect (nor should it ever be if we are to continue to learn) and how it is a jigsaw puzzle of information pieces that are brought together to create the best picture to date about flu vaccine efficacy and indication for use.

Background:

The evidence-based website Up to Date cites this data:

Vaccination — Guillain-Barré syndrome has followed vaccinations, but this danger may be overstated.

Influenza vaccination — In the United States, an increased risk of GBS was associated with the swine influenza vaccine in 1976, although the severity of the risk has been controversial. Subsequently, no increased risk was observed up to 1991.

Individuals who received either the 1992-1993 or 1993-1994 influenza vaccinations were not at significantly increased risk for GBS, but combining the two seasons suggested that influenza vaccination resulted in approximately one additional case of GBS per million patients inoculated. This risk appears to be substantially less than the overall health risk posed by naturally occurring influenza.

The annual reporting rate of GBS following influenza vaccination in adults declined significantly from 1996-1997 through 2002-2003 in the US. Nevertheless, the long onset interval for post vaccination GBS compared with other post vaccination adverse events (median 13 days versus one day, respectively) is consistent with a possible causal association between GBS and influenza vaccine.

Other data are conflicting, but suggest that influenza vaccination is associated with a low or negligible risk of GBS. In a self-matched case control series from Ontario, Canada that identified 269 hospital admissions for GBS diagnosed within 42 weeks of receiving influenza vaccination, the estimated relative incidence of GBS during the primary risk interval (weeks two through seven after vaccination) compared with the control interval (weeks 20 through 43) was 1.45 (95% CI 1.05-1.99). However, a separate time-series analysis of 2173 hospitalized cases of GBS showed no statistically significant increase in hospitalizations for GBS after institution of the universal influenza vaccination program in 2000.

References:

Guillain-Barre syndrome following influenza vaccination.
Haber P; DeStefano F; Angulo FJ; Iskander J; Shadomy SV; Weintraub E; Chen RT
JAMA 2004 Nov 24;292(20):2478-81.

The Guillain-Barre syndrome.
Ropper AH
N Engl J Med 1992 Apr 23;326(17):1130-6

Guillain-Barre syndrome after influenza vaccination in adults: a population-based study.
Juurlink DN; Stukel TA; Kwong J; Kopp A; McGeer A; Upshur RE; Manuel DG; Moineddin R; Wilson K
Arch Intern Med. 2006 Nov 13;166(20):2217-21.

The Guillain-Barre syndrome and the 1992-1993 and 1993-1994 influenza vaccines.
Lasky T; Terracciano GJ; Magder L; Koski CL; Ballesteros M; Nash D; Clark S; Haber P; Stolley PD; Schonberger LB; Chen RT
N Engl J Med 1998 Dec 17;339(25):1797-802.

Protecting immune system from attack

Dr. Barry Dworkin — Fri, 12 Nov 2004 22:14:36 +0000

Originally published in The Ottawa Citizen Friday, November 12, 2004
Original Title: Infection control for dummies

Infection control can be a complicated matter, especially for viruses that spread as easily as the flu. The flu can spread through direct hand-to-hand contact, via airborne droplets (fomites) after a sneeze, and with contact with recently touched surfaces such as doorknobs, telephones, countertops and desks.

Preventing infection does depend upon “boosting your immune system,” but not in the way some believe it to be.

Our immune system begins at birth as a bunch of raw army recruits. They are healthy and strong but lack experience at recognizing and fighting the enemy. With training and combat they gain experience and become more efficient in their role as a standing army. Some are selected for special-forces duty and reconnaissance missions. They are able to track down and identify their target so that the army can move in and destroy it.

Our immune system follows this analogy. It has the potential to respond to threats from viruses and bacteria. Indeed, it will respond well to minor threats such as colds and minor cuts and scratches. But other pathogens, like the measles virus, polio, diphtheria, meningitis, typhoid and hepatitis, among others, can overwhelm the immune system. It tries to fight back, sometimes succeeding but with great collateral damage to organs and other structures.

If the system is trained to recognize these pathogens before the war, it stands a greater chance of protecting the body. This is the underlying reason why vaccines work.

Vaccines stimulate the immune system to develop antibodies, the body’s special forces that will seek out, identify and target the invader for the main battle group. Without these specific antibodies, the immune system is not co-ordinated to quickly prevent the attack and damage; you either lose the battle, suffer collateral damage or play a game of attrition — a draining experience.

Some argue that exposure to the pathogen is the preferred route of developing immunity, as opposed to using a vaccine. Indeed, the infected person will create antibodies and immunity if they survive the real infection. But this may come at a cost of permanent damage.

The vaccines contain either killed or weakened strains of the organism that have orders of magnitude less potential to cause harm compared to the original virus or bacterium.

Indeed, some will disagree with me and cite Internet references or studies that indicate the opposite. The response is that the studies to support vaccine use far outnumber the ones that imply the opposite. There is no conspiracy.

The flu vaccine is a “best assumptions” vaccine. It is predicated on what flu virus strains we expect will come into Canada and the United States from other regions of the world. If the assumption proves incorrect or incomplete, the importance of proper hygiene practices becomes more apparent.

What other infection control measures can people take for the upcoming flu season?

If you have the flu, isolate yourself from others and do not go to school or work. Wearing a properly fitted surgical mask and goggles with side protectors will help prevent catching the virus from an infected person or transmitting it to a caregiver.

Ineffective hand washing after sneezing into a tissue or coughing into the hand will leave viral/bacterial organisms on the hands. The perfect cleanser does not exist. However, a combination of products will offer substantial protection.

Soaps are excellent detergents and remove grit, grime, dirt, soil, and other organic compounds. The non-antimicrobial soaps fail to remove resident disease-causing bacteria from the skin but do remove some transient bacteria. Sharing a plain soap bar has the potential to spread disease because it can become contaminated.

Numerous studies indicate that alcohol (ethanol) washes dramatically reduce hand bacteria and viral counts after washing for 30 seconds. The alcohol gels should be used for at least 20 to 30 seconds and cover the entire hand and under the nails. Apply about a nickel- to quarter-size blob in the palm. If the hands dry in less than 15 seconds, insufficient gel was used.

There is an antiviral flu medication available called Tamiflu. It must be used close to the onset of the flu and will only reduce, not eradicate the symptoms and duration of the illness.

Carry a small squeeze bottle of alcohol gel with you and use it routinely to prevent the usual winter colds and flu this season.

Prepare now for the flu season

Dr. Barry Dworkin — Mon, 18 Oct 2004 22:18:43 +0000

Originally published in The Ottawa Citizen October 18, 2004
Original Title: The HN factor

New information and reports of bird flu have shifted attention to the possibility of a new flu pandemic. The most lethal pandemic in our history occurred from 1917 to 1919 killing an estimated 20 million to 50 million people.

The World Health Organization (WHO) released a statement this month encouraging governments and pharmaceutical companies to begin production of bird flu vaccines.

To date there has not been any documented human-to-human transmission of the bird flu virus, but it is the high mortality rate for those who have caught it that has garnered attention. Millions of chickens have been killed during the past few years to contain the latest incarnation of the bird flu.

Why does the flu pose such potential danger, what are its origins and why does the vaccine change every year?

Imagine a beach ball with a small stick trapped inside it. Covering much of the beach ball’s surface is gritty sand. This is what influenza looks like under an electron microscope. The stick is the genetic material that infects us. The beach ball is the shell that protects the genetic material until it can invade our cells. The grains of sand represent the pieces of protein called antigens protruding out on the shell surface.

The antigens are designated with the “H” (hemagglutinin) and “N” (neuraminidase) monikers. For example, the bird flu has a designation of H5N1.

If our immune system is sufficiently primed for this viral invasion it will attack the antigens on the shell. The shell will break open and the immune system’s cells move in to destroy the genetic material before it causes disease. Our bodies develop immunity with each exposure to the flu virus and with each vaccination.

Many viruses slowly mutate or change over time. Most healthy people can adapt to these minor changes.

Epidemics and pandemics occur when the virus (usually Influenza A) undergoes a radical genetic change over a short time. This occurs when a human and bird virus both infect an animal simultaneously. The viruses swap genetic material, forming a new strain.

Because the immune system has never seen this new strain, it has no counter-measures to fight it; the body is defenceless.

Scientist Yoshihiro Kawaoka, of the University of Wisconsin-Madison and the University of Tokyo, looked into why the Spanish flu was so lethal. He stated, “We found that just one gene called HA, hemagglutinin, is sufficient to make a benign virus pathogenic.” The results of the study were reported in the journal Nature.

“One of the hallmarks of the 1918 Spanish flu is hemorrhage in the lungs,” said Mr. Kawaoka.

The suspicion is that the Spanish flu originated from birds. The research team wanted to look for clues within the genetic code of the virus that could help predict future lethal strains before they had a chance to spread.

Those most vulnerable are people over age 65, pregnant women, young children and those with chronic illnesses like asthma diabetes. Hospitalization rates for children under the age of two who have the flu are equal to those over 65.

The historical record of flu pandemics, the last in 1968, indicates a cycle of roughly 20 to 30 years; we are overdue. The WHO’s concern is that the world is unprotected against the bird flu virus, hence its recommendation for vaccine development.

The vaccine’s ability to protect you is determined by how closely they can match the strains that will arrive in North America each year. With a close match, protection rates against clinical influenza approach 70 to 90 per cent.

The flu vaccine contains dead viruses; it does not cause the flu. The vaccines cause side effects less than five per cent of the time. These commonly include a low-grade fever and fatigue for eight to 24 hours after immunization; minimal discomfort compared to the actual flu.

The vaccine is recommended for:

Persons 65 years of age or older;
Residents of nursing homes and chronic care facilities that house people with chronic medical conditions;
Adults and children who have chronic heart and lung disorders, including children with asthma;
Adults and children who with chronic diseases including diabetes mellitus, kidney failure, anemia or poor immune system function;
Healthy pregnant women in their second or third trimester;
And you!

Ottawa Public Health does not recommend the vaccine for people with:

A previous allergic reaction to influenza vaccine;
An allergy to eggs or thimerisol;
A changing neurological condition;
A history of Guillain-Barre Syndrome;
A history of Oculo-Respiratory Syndrome.

Studies in the United States demonstrate marked cost savings to the health care system and increased work productivity. In one study, vaccinating working adults reduced absenteeism by 50 per cent.

There’s no good reason to avoid taking a flu shot

Dr. Barry Dworkin — Wed, 23 Oct 2002 02:30:45 +0000

Originally published in The Ottawa Citizen October 22, 2002
Original Title: Where for art thou virion?

At the end of October, the Flu vaccine will be available in our region. Many will opt to forego an inexpensive and safe approach to preventing a disease that causes significant misery and death. Some fear the vaccine causes the flu; others take the chance that it will pass them by and many others will roll up their sleeves. Why should we protect ourselves? The historical record provides an excellent answer.

Indeed, the history of the disease dates back to 400 BC when Hippocrates noted a disease outbreak in northern Greece with symptoms akin to the flu. Since then recurring epidemics (a disease simultaneously striking many people in one region) and pandemics (an epidemic spreading across many regions of the world) have decimated populations and societies.

There is concern that we are due for flu akin to the Spanish flu of 1917 to 1919, the most lethal pandemic in our history killing an estimated 20 million to 50 million people: more than all who died during World War I.

The nature of the Spanish flu concerns many immunologists, infectious disease experts and epidemiologists with respect to future epidemics. The flu usually kills the very young, the sick and the elderly. Adolescents and adults tend to weather the storm. The Spanish flu was different because the death rate was unusually high among young healthy adults.

Our last pandemic was the 1968 Hong Kong flu that killed 700,000 worldwide. The next pandemic is overdue.

Why does the flu pose such potential danger, what are its origins and why does the vaccine change every year?

The flu viruses that cause the most damage are Influenza A and B. Influenza likely comes from birds, especially waterfowl that shed large amounts of the virus. The virus is harmless to birds but not so for mammals. In 1997, Hong Kong destroyed millions of chickens for fear they harboured a potentially virulent strain of the flu. Some think this action averted a major pandemic.

Imagine a beachball with a small stick trapped inside it. Covering much of the beachball’s surface is gritty sand. This is what Influenza looks like under the electron microscope. The stick is the genetic material that infects us. The beachball is the shell that protects the genetic material until it can invade our cells. The grains of sand represent the pieces of protein called antigens protruding out on the shell surface.

Our body recognizes these antigens and attacks them. Once attacked, the shell breaks open. The cells of our immune system move in to destroy the genetic material before it can cause the flu.

Our bodies develop immunity with each exposure to the flu virus. The problem is the virus changes every year producing different antigens on the shell surface. With each mutation, our body’s immune system is less able to recognize the virus. The result is another flu infection.

Many viruses mutate, or change at a slow rate. The mutations are minor and most healthy people can adapt to these changes. They catch the flu but do recover.

Epidemics and pandemics occur when the virus (usually Influenza A) undergoes a radical change or mutation over a short time. This radical change occurs when a human and bird virus both infect an animal at the same time. The viruses swap genetic material to form a completely new strain.

The antigens bear little resemblance to what the body has already fought. The immune system has no countermeasures to fight this new strain leaving most of the world population defenseless. It is nature’s brand of germ warfare.

The Centers for Disease Control and Prevention (CDC), in collaboration with the World Health Organization and its reporting network monitors worldwide Influenza virus disease activity. The CDC predicts the appropriate antigens to include in the annual influenza vaccine (http://www.cdc.gov/ncidod/diseases/flu/weekly.htm).

The vaccine contains highly purified inactivated egg grown split viruses. A vaccine containing the viral antigens is also available for people who have egg allergies.

Contrary to popular belief, the vaccine does not cause the flu. Administration of the vaccine occurs during months when many people get colds and flu. If everyone in Ottawa received an apple instead of the vaccine those people who fell ill would have still fallen ill. I doubt anyone would believe the apple made him or her sick.

Because inactivated vaccines take approximately nine months to manufacture, they contain antigens from strains that circulated during the previous year. The vaccine’s ability to protect you is determined by how closely they can match the strains in the vaccine and viruses that circulate in the outbreak.

With a close match, rates of protection against clinical influenza approach 70 to 90 percent. The vaccines, usually well tolerated, cause reactions less than five percent of the time. Side effects consist primarily of low-grade fever and fatigue for eight to 24 hours after immunization.

The vaccine recommendations are for:

Persons 65 years of age or older
Residents of nursing homes and chronic care facilities that house people with chronic medical conditions
Adults and children who have chronic heart and lung disorders, including children with asthma
Adults and children who with chronic diseases including diabetes mellitus, kidney failure, anaemia or poor immune system function
Healthy pregnant women in their second or third trimester
And you!

Studies in the United States demonstrate marked cost savings to the health care system and increased work productivity from fewer sick days. In one study, vaccinating working adults reduced absenteeism by 50 percent. Ontario offers the vaccine for everyone. Your doctor or the public health department can respond to any concerns or questions about the vaccine.

© Dr. Barry Dworkin 2002

Childhood rashes hard to diagnose at first

Dr. Barry Dworkin — Tue, 15 Oct 2002 21:21:47 +0000

Originally published in The Ottawa Citizen October 15, 2002
Original Title: Daycare Part III: A little red in the face

Part I – Why children fight one cold after another
Part II – Children’s eye diseases spread quickly

What are the common childhood rashes seen in the school and daycare setting? Initially, many rashes can look the same, which can sometimes make identification difficult. Rashes eventually branch off in their own direction within a day or two prompting the doctor to say “Aha! I knew what it was happening all along!” This is something akin to what your investment broker says to you now.

Roseola is a viral rash usually seen in children between six and 24 months of age. These children do not appear ill but can have a low-grade fever for a few days. In rare cases, children can develop high fever and febrile seizures. Once the fever breaks, the rash appears as small red spots scattered on the face and body that last a day or two. It is not very infectious and there is no specific treatment.

Hand, Foot and Mouth disease most often affects young children but can appear at any age. It is an infectious viral illness spreading from person to person by air or touch. It occurs more commonly in the summer and fall. It will incubate for ten to 14 days before the start of symptoms. Although usually not severe, it does cause fever, headaches, loss of appetite, diminished activity and energy levels, sore throat and a particular rash.

Small red spots with a blister on top appear on the hands and feet and sometimes on other body parts. There can be painful mouth ulcers. The rash lasts seven to ten days. Children remain infectious one to two weeks after the onset of the illness. There is no specific treatment. Children can return to school or daycare once they feel up to participating in normal activities.

Fifth disease commonly referred to as Slapped Cheeks Syndrome occurs in school-aged children. One to four days before the onset of rash, the child may have had a cold-like illness. Some children will have a headache, sore throat, runny nose, itchiness, nausea, diarrhea and vomiting, joint pain and sore eyes. The range of occurrence of these symptoms runs on average between zero to 50 percent.

It starts as a dark red rash on the cheeks that looks like the face was slapped. By the time the rash develops, the child usually feels better. A rosy red lacy rash appears on the arms and body that can come and go over a period of one to three weeks. There is no specific treatment. They are no longer infectious once the rash appears. Children can return to school when they feel better.

Chicken pox, despite the popular misconception, is not a benign disease. Caused by the Varicella Zoster virus, its complications include skin and soft tissue infection, ear, eye, nose and throat infections, serious bacterial infections like necrotizing fasciitis (“flesh eating disease”), pneumonia, encephalitis and meningitis. In Canada, 2000 children were admitted to hospital last year and 12 died.

Chicken pox has an incubation period of eight to 13 days after viral exposure. It spreads through the air and by direct contact with the blisters.

It starts with a fever for the first two days. Thereafter the classic “fried egg” blisters appear (a red circular spot with a blister in the centre) on the skin. An average of 350 blisters will erupt on the child’s body.

If you think the child has chicken pox or if indeed they do, isolation from pregnant women who have never had chickenpox is important because the virus can damage the fetus. There is no danger to pregnant women who are immune to the virus.

Do not give aspirin (Acetylsalicylic Acid (ASA)) or any products that contain ASA to a child with chicken pox. They can develop Reye’s syndrome that can damage the liver and brain. Use Acetaminophen (Tylenol or Tempra) instead.

Good gentle skin hygiene will help prevent bacterial infections of the pox blisters. Scrubbing the skin can promote infection and scarring. Antihistamines (Claritin, Benadryl) and Aveeno bath powder can help relieve the itch. Calamine lotion is ineffective.

After a chicken pox infection, the virus can lie dormant in the body for years. Once reactivated, it will cause Shingles, a large painful blistered rash on a segment of your body or face with its own set of painful and damaging complications.

What can we do to prevent some of the illnesses reviewed over these past three weeks? Good hygiene and disinfecting toys reduces contagion. However, this is a Herculean task in a room full of toddlers and young children. Some diseases warrant isolating the child during their contagious period. There are vaccines available that can reduce the risk of some of these diseases.

Varivax will protect children from chicken pox. Over 20 million doses and 28 years of experience show long-lasting immunity. Ninety-five percent of children will become immune six weeks after vaccination.

Prevnar will reduce the rate of ear infections and pneumonia caused by the bacteria Streptococcus pneumoniae. It is the most common cause of ear infections, pneumonia and meningitis in infants and toddlers. Menjugate vaccine will protect children from another type of meningitis.

All children that follow the routine vaccination schedule receive the Pentacel vaccine. One component of it protects infants and children against the bacteria Hemophilus influenzae that causes ear infections and pneumonia.

Your doctor can provide more information on your next well-child visit. The only thing infectious in your child should be their smile. May they all be happy and healthy.

© Dr. Barry Dworkin 2002

Chickenpox Vaccine is Effective

Dr. Barry Dworkin — Wed, 14 Nov 2001 21:19:23 +0000

Originally published in The Ottawa Citizen November 14, 2001

Original Title: The new vaccines: How to crash a party

A recent article about parents holding chickenpox parties to intentionally infect their children perpetuates the popular misconception that chickenpox is a benign disease. One of the parents said: “It’s a natural way to deal with the problem, instead of introducing more chemicals into kids.” She was concerned about whether it provided lifelong immunity and erroneously believed that the vaccine had been available for only six years.

The mother expresses a valid concern that deserves to be answered. No parent wants to harm their child. Her actions reflect her desire to minimize the risk of chickenpox should it occur when her children are teens or adults. Indeed, in a broader context, three childhood vaccines have been added to the arsenal in recent years.

Chicken pox is caused by the Varicella Zoster Virus. By age 20, 95 per cent of us have had the disease. The complications of this disease include skin and soft tissue infection, ear, eye, nose and throat infections, serious bacterial infections like necrotizing fasciitis (the flesh eating disease), pneumonia, encephalitis and meningitis.

According to Dr. Steven Moss, assistant professor of pediatrics at the University of Toronto, chickenpox complication rates are one in 75. In Canada last year, 2,000 children were admitted to hospital. Twelve died. More than 90 percent of these children who contracted chickenpox were healthy.

The live attenuated vaccine (weakened live virus) has been used in Japan and in the United States for 27 and 13 years respectively. More than 20 million doses have been given. The vaccine’s side effects are a two to five per cent chance of a low-grade fever and three to six per cent chance of a local rash at the injection site. No other side effects have been reported.

The vaccine will provide complete protection in 90 to 95 per cent of those vaccinated. The remaining five to 10 percent will have partial immunity. The partial responders will experience about 30 pox marks instead of the average 350. It will continue to reduce their complication risk and disease severity. The data suggests that it will provide lifetime immunity. Once somebody has had chickenpox, their lifetime risk for developing shingles, a large bubbled painful rash, is 20 per cent. If vaccinated, the risk falls to .000015 per cent.

The Hepatitis B virus infects the liver. It is extremely contagious and easier to catch than the AIDs virus, HIV. It is found in every body secretion and can be transmitted through sexual activity, contaminated needles, tattooing, breastfeeding, toothbrushes and razors.

It is a hardy virus. You can take a syringe containing the virus, bury it, let it sit underground all winter, dig it up in the spring, add water and presto! You now have active Hepatitis B virus.

One of my 18 month-old patients picked up a syringe they found in a park and put it in her mouth. The syringe was indeed contaminated with Hepatitis B.

Approximately 300 to 350 million people are chronic carriers of this disease. In Canada about one person in 200 is a chronic carrier. There are 20,000 new infections each year. About ten per cent become chronic carriers. The exposure of newborns to this virus can result in liver cancer later in life nine times out often.

The vaccine contains pieces of the protective shell that surrounds the virus. The Hepatitis B virus is not present in the vaccine. There are few if any side effects and it provides at least ten years of immunity and probably much longer in 95 percent of all recipients.

Prevnar (Pneumococcal vaccine) was approved for use in Canada on June 25 and is recommended from birth to nine years of age. This is the first vaccine that is able to protect young children from the Streptococcal pneumonia bacteria. It contains pieces of the bacterial shell.

This organism causes blood infections, meningitis, pneumonia, middle ear and sinus infections. It is the most common cause of meningitis in children in the United States.

In children under two years of age, the incidence of pneumococcal meningitis is approximately .0007 per cent. Death occurs in eight per cent, brain damage in 25 per cent and hearing loss in 32 per cent of children with meningitis. It is responsible for 20 to 40 per cent of all middle ear infections. Antibiotic resistance to this organism is on the rise worldwide.

The most common side effects of the vaccine are pain, redness and swelling at the injection site. These vaccines offer more protection for our children. My two boys have been vaccinated against all three diseases. Chicken pox parties will continue but at least parents now have other options.

The Truth About Vaccinations

Dr. Barry Dworkin — Wed, 04 Jul 2001 21:35:06 +0000

Originally published in The Ottawa Citizen July 4, 2001

We know all too well the pain and suffering the victim, their families and friends endure from the scourge of AIDs. Imagine it’s the year 2051 and there is a vaccine for AIDs. AIDs has been virtually eliminated. Small outbreaks continue to occur but for the most part people have begun to forget what it was like to have a family member die from AIDs.

A movement begins stating that there is no further need to vaccinate your children. They fear that the vaccine will weaken their immune system, cause terrible side effects and physical harm. Despite reams of evidence demonstrating the efficacy and safety of the vaccine, some people stop vaccinating their children. Soon the level of HIV infection increases and people once again begin to die a horrible death. People who lived through the AIDs epidemic are aghast. “Why”, they say, “when overwhelming evidence clearly shows the effectiveness of the vaccine would some refuse it and promote its non-use to others? Why invite this deadly illness back to re-infect our children once again?”

Just as we have urgent appeals today to stop the scourge of AIDs, Hepatitis C and cancer to name a few, so too it was that parents would have done anything fifty years ago to save their children from the horrible diseases of that time. How many people would deny themselves or their children a vaccine for AIDs?

This scenario is being played out right now in most communities in the Western World. Some people are not vaccinating their children because of fear and misinformation provided by anti-vaccination advocacy groups. I for one am at a loss to understand why we would increase a child’s risk to deadly diseases that we were once praying to God for a cure. I am sure these groups believe that they are acting in the best interests of the children but in their zeal they misrepresent the facts and foster a belief system that becomes difficult to change. Some people that once feared the disease now worry about the safety of the vaccine. Let’s start to change these views with documented factual information.

There are two standard vaccines that are given to children from infancy to the toddler years. PENTA ((pertussis)whooping cough, diphtheria, tetanus, polio, and Hemophilus Influenza B) is given at 2, 4, 6 and 18 months of age and PRIORIX (measles, mumps and rubella) given at 12 months and 4 years of age. Other vaccines recommended by the Canadian and American Pediatric Societies are Hepatitis B (Engerix and Recombivax), Varivax II for Chicken Pox . Prevnar has just been approved for ear infections, meningitis and pneumonia caused by Streptococcus pneumonia (the infection that killed Jim Henson in four days).

Contrary to some opinions, vaccinations do not weaken your immune system. They stimulate your immune system to produce antibodies, which act to destroy invading disease organisms. Antibodies are like soldiers. It is easier to defend against an invader with a standing army at the ready than trying to recruit your soldiers during a surprise attack. You may not be able to mobilize enough soldiers to destroy the attacking force. In order for your immune system to be healthy and functioning at peak efficiency it needs to be continually stimulated and challenged; a biological arms build-up.

I think it is important for people to know what diseases are prevented with vaccination and the risks if the decision is made not to vaccinate.

Diptheria

Diptheria is a bacterial throat infection that kills 1 in 10 people despite treatment. It can produce a toxin that can causes the throat to swell and forms a thick filmy membrane that becomes large enough to suffocate its victim. The toxin can be absorbed into the body and cause damage to the heart, kidneys and nerves.

The vaccine, developed in the 1920’s reduced the rates of infection from 9000 cases in 1924 to less than five per year since 1983.

Pertussis (Whooping Cough)

Pertussis is a bacterial nose, throat and lung infection. It kills 1 in 400 infants and 1 in 400 suffer brain damage. Areas of the lung can fill up with mucous and collapse. 20 to 30% of infants are admitted to hospital because of how sick they become. The incessant coughing can cause the blood vessels in the brain to rupture, cause the infant to stop breathing and block the flow of blood to the brain. Complications include pneumonia and ear infections.

The vaccine has been reformulated to dramatically reduce the side effects of fever, crying, swelling, pain and redness at the injection site. It protects about 70% of children. In spite of this percentage, it reduces the severity of the illness in children compared to those who remain unvaccinated. Those most at risk for complications are children under the age of 6 months but it is used up to the age of seven. The complications from the disease are less severe in older children and adults. In Sweden, Japan and Italy, vaccine discontinuation resulted in a dramatic increase in the number of new cases.

Tetanus

Tetanus is caused by a toxin produced by the bacteria Clostridium tetani. It attacks the nervous system and causes severe painful muscle contractions that can stop you from breathing.

In the early 1900’s there were over 5000 cases per year mostly in newborns, older boys and young men. In the past 15 years there have been fewer than 2 cases per year in Canada. Since 1984 there has not been one case of tetanus in newborns.

The vaccine contains the deactivated tetanus toxin. It cannot give you tetanus.

Polio

Polio is a viral infection that permanently affects nerve cells in the spinal cord that control the muscles in your body. These nerve cells die leading to paralysis of the legs or arms and in some cases, death. About 1 in 100 who suffer from the disease develop paralysis.

The vaccine became available in 1955 when the total number of cases of paralytic polio in Canada, the U.S., the former Soviet Union, Western Europe, Australia and New Zealand was more than 76,000. This means over 7,600,000 people contracted the disease that year. By 1967 the total number of cases of paralytic polio for the year was 1,013 for those same countries; a reduction of over 99%. The last case of paralytic polio in Canada was in 1989.

The vaccine used in Canada is a killed virus (inactivated). It cannot cause polio.

Haemophilus influenza b (Hib)

This bacteria causes meningitis and blood, bone, lung, joint, skin and ear infections. It has nothing to do with the flu. Prior to 1985 in was the most common cause of meningitis in children in Canada with 1500 cases every year in children under 5 years of age. 1 in 300 Canadian children developed meningitis or other severe infections by age 5.

In 1985 there were 495 children admitted to hospital with Hib infection. The vaccine program began in 1986. By 1996 that number was reduced to eight, a decrease of 98%.

The vaccine is made of small purified pieces of the bacterial outer shell or protective coat. There is no possibility of contracting the disease from this vaccine.

Measles

Measles is a highly contagious severe viral infection that causes inflammation of the brain (encephalitis) in 1 out of every 1000 cases often leading to permanent brain damage. Everyone contracted measles before the age of 18 in Canada and epidemics occurred every 2 to 3 years prior to the arrival of the vaccine. There was an average of 350,000 cases every year with 90% of those affected under the age of ten. Each year it was responsible for 50 to 75 deaths, 5,000 hospital admissions and 400 cases of encephalitis.

Soon after the vaccine was released in 1963, the number of cases dramatically fell. There were 2,000 cases in 1995.

The vaccine is a live attenuated one. This means that it is weakened compared to the wild strain which causes natural measles. It is effective in 95% of all children when given after their first birthday. A booster dose is given at four years of age to increase the immunity rate to close to 100%. Immunity is lifelong.

There are claims that the measles vaccine is associated with autism. To date there is insufficient evidence to support this claim. Further the recent fear of a certain vaccine preservative which contains mercury could be a link to autism is not applicable for Canadian vaccines. This preservative is not used in this or any other Canadian vaccine. The risk of developing encephalitis from the vaccine has been difficult to determine because it is so rare. It is estimated to be less than one per one million doses.

Mumps

This viral infection causes meningitis in 1 out of 10 people. Mumps meningitis is usually mild and does not cause permanent brain damage. In some cases it causes encephalitis (brain swelling) that can lead to permanent brain damage. Other complications include deafness, painful swelling of the testicles in teenage boys and men and painful infection of the ovaries in women.

Before the vaccine the rate of infection was 1 out of every 6 susceptible children. Although mumps did not cause significant damage to the children it was determined that the cost of treating the disease was far more expensive compared with the safety, effectiveness and the cost of the vaccine. Today the number of cases of mumps has fallen by 90% with no reports of encephalitis.

As with the Measles vaccine, it is a live attenuated virus which does not cause the mumps infection in most people. The mumps vaccine risk of causing mumps meningitis is 1 in 800,000 compared to 1 in 10 due to the natural mumps virus.

Rubella

Also known as German Measles, this virus is fairly mild in children but worse for teens and adults. The big problem is contracting rubella when pregnant which causes birth defects and can kill the unborn child. This is Congenital Rubella Syndrome (CRS)

Prior to the vaccine, by the time of your twentieth birthday, 85% of people already had rubella. Those left unaffected could still catch the disease. Of course, childbearing women were most at risk.

Since the start of routine immunization in 1980, the number of babies born with CRS dropped from 2000 to 2 cases per year.

It too is a live attenuated virus but rarely produces any side effects.

Hepatitis B

This virus infects the liver. It is extremely contagious and easier to catch than the AIDs virus, HIV. It is found in every body secretion and can be transmitted through sexual activity, contaminated needles, tattooing, breastfeeding, toothbrushes and razors. It is an extremely hardy virus. You can take a syringe containing the virus, bury it, let it sit underground all winter, dig it up in the spring, add water and presto! You now have active Hepatitis B virus. I had one of my 18 month old patients pick up a syringe they found in a park and suck on it. The syringe was indeed contaminated with Hepatitis B.

Approximately 300 to 350 million people are chronic carriers of this disease. In Canada about 1 person in 200 is a chronic carrier. There are 20,000 new infections each year. About 10% of those will become chronic carriers. The danger is that newborn exposure to this virus can result in liver cancer later in life nine times out of ten.

The vaccine contains pieces of the protective shell that surrounds the virus. The Hepatitis B virus is not present in the vaccine. It does not come from blood products. There are few if any side effects and it provides at least 10 years of immunity and probably much longer in 95% of all recipients.

The New Vaccines

Varivax II (Chicken Pox)

This disease is caused by the Varicella Zoster Virus. Most people believe that Chicken Pox is a benign disease that causes little harm save some itching and discomfort. By the age of twenty, 95% have had the disease. The complications of this disease include skin and soft tissue infection, ear, eye, nose and throat infections, serious bacterial infections like necrotizing fasciitis (“flesh eating disease”), pneumonia, encephalitis and meningitis.

According to Dr. Steven Moss (Assistant Professor of Pediatrics at the University of Toronto, Consultant Pediatrician at the North York General Hospital and staff in Pediatric Emergency Medicine at the Hospital for Sick Children in Toronto) the complication rate for chicken pox is 1 in 75. In Canada 2000 children admitted to hospital due to complications last year. Of those there were 12 deaths. Over 90% of these children were healthy.

The vaccine has been in use in Japan for 27 years and in the United States for 13 years. Twenty-seven US States mandate Varivax inoculation prior to admission into daycare.

Over 20 million doses have been given. The only side effects of the live attenuated vaccine are a 2 to 5% chance of a low-grade fever and 3 to 6% chance of a local rash at the injection site. No other side effects have been reported. The vaccine will completely protect 90% of those vaccinated. The remaining 10% will have partially immunity. Instead of the usual average 350 pox marks they will experience about 30. It will still reduce their complication risk.

Once one has had the chicken pox their lifetime risk for developing Shingles, a large bubbled painful rash on your body or face is 1 in 5. If vaccinated this risk drops to 1.5 per 100,000. The vaccine is not used in those people who have already had chicken pox.

Prevnar (Pneumococcal vaccine)

Approved for use in Canada on June 25, 2001, Prevnar is recommended from birth to 9 years of age. This is the first vaccine that is able to protect young children from the Streptococcal pneumonia bacteria. This organism causes blood infections, meningitis, pneumonia, middle ear and sinus infections. It is the most common cause of meningitis in children in the United States. In children between 1 to 23 months of age, the incidence of pneumococcal meningitis is approximately 7 per 100,000. Death occurs in 8%, brain damage in 25% and hearing loss in 32% of children with meningitis. It is responsible for 20 to 40% of all middle ear infections. Antibiotic resistance to this organism is on the rise world-wide. The most common side effects of the vaccine are pain, redness and swelling at the injection site.

It is important to understand why we vaccinate. I think it is important to know about the diseases that threaten your child’s life. I believe it is paramount that patients be kept informed. I encourage you to ask questions of your physician about the vaccines recommended for your child. An excellent resource that I use is “Your Child’s Best Shot, A Parent’s Guide to Vaccination” published by the Canadian Pediatric Society.

I have only touched the surface of evidence that proves the safety and usefulness of our vaccination program. Our goal as parents is to protect our children from harm. Of course vaccines do not protect everyone one hundred percent of the time. Nothing in this world is perfect. But it is of paramount importance to look at the evidence. Sweden, Japan, Australia and the United Kingdom all at one point discontinued the Diptheria, Pertussis and Tetanus vaccination programs due to the anti-vaccination debate. The results were disastrous. The diseases returned and children suffered. These countries reversed their decision and now the diseases are controlled once again.

Claims that vaccines put our children at risk do not stand up well against the facts. It reminds me of the scene in Jerry McGuire. Tom Cruise is on the phone with Cuba Gooding Jr. He asks Tom to blurt out “Show me the money!” as proof of his intentions to help him secure a good contract. With due diligence he does. It is with due diligence that we have never been healthier or lived longer than now. Our good health is considered the norm. It is important to remember your history. Vaccines work. Period. And that’s my two cents worth!

Internet Sites of Interest:

http://www.uptodate.com/patients
http://www.mayohealth.org/home
http://familydoctor.org/
http://www.cdc.gov/

References:
Your Child’s Best Shot, Canadian Pediatric Society

Opposition to Immunization: A Pattern of Deception, The Scientific Review of Alternative Medicine Vol. 5, No. 1

Varicella Dangers by Dr. Barbara Law. Contemporary Pediatrics, December, 1998

Canada Communicable Disease Report, National Committee on Immunization (NACI): Statement on Recommended Use of Varicella Virus Vaccine. Vol. 25, May 1, 1999.

Prevnar Monograph, Wyeth Ayerst