Monday, January 18, 2016

69 Doses...or Is It 53? Or Even Fewer?

Please note additional edits to this article, particularly those added after 2/3/16, with the publication of the new 2016 recommended schedule.
My deepest apologies to my readers for this rather long spell without any new posts. Work and real life both got rather too busy for me, and I just did not have the time or energy to write. It certainly isn't for a lack of topics. I have a couple that I would really like to get to, including at least one request. But to get back into the swing of things, I thought I'd start with something pretty easy.

The other day, I got into a discussion on Twitter with a naturopath by the name of Stephen M. Gibson. He caught my eye because he appeared to be using my post about package inserts to suggest that they are evidence that vaccines cause harm. Now, vaccine package inserts do list adverse reactions (i.e., something known to be caused by the product) discovered during clinical trials. They also include adverse events (i.e., something that occurs after using the product, but may or may not actually be caused by it) reported to the manufacturer after it has been put on the market. I tried to get Mr. Gibson to let me know which specific injuries he was concerned about. The best I got was him referring to Section 6 of the inserts (which, again, includes reports of things that are not necessarily caused by the vaccine) and that he's opposed to "Any. And every" bit listed in Section 6.

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But it wasn't his misuse of my post that really grabbed my attention and prompted this post. Rather, it was his claim that he has "read and studied the 69 vaccines package inserts in the Feds recommended list":

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Sixty-nine package inserts? Really? Where did he get this number?

As of this writing, the FDA lists 81 vaccines approved for us in the U.S. Now, that list includes vaccines that are no longer used (e.g., smallpox), as well as vaccines that are not on the recommended schedule (e.g., BCG, rabies, yellow fever). There are also multiple brands of vaccine (e.g., Fluarix and Fluvirin) that cover the same disease but are made by different manufacturers. Eliminating the obsolete vaccines, the ones not on the schedule, and the multiple variations of the same vaccine, the number is way below Gibson's claim of 69, meaning his claim that he read 69 package inserts is wrong.

Well, maybe his grammar is just bad and he missed an apostrophe, as in, "the 69 vaccines' package inserts". Since he mentioned the recommended list, I went to the CDC's 2015 Combined Recommended Immunization Schedule for Persons Aged 0 through 18 Years (PDF). At most, there are 13 vaccines recommended for the average child, which protect against 16 different diseases:
  • Hepatitis B (HepB)
  • Rotavirus (RV)
  • Diphtheria, Tetanus, and acellular Pertussis (DTaP)
  • Tetanus, Diphtheria, and acellular Pertussis (Tdap)
  • Haemophilus influenzae type b (Hib)
  • Pneumococcal Conjugate (PCV)
  • Inactivated Poliovirus(IPV)
  • Influenza (Flu)
  • Measles, Mumps, Rubella (MMR)
  • Varicella (VAR)
  • Hepatitis A (HepA)
  • Human Papillomavirus (HPV)
  • Meningococcal (Men)
Maybe he meant the number of doses of those 13 vaccines? Let's see...nope, there are only 53 doses [Edited to Add (2/3/16): (or 52, depending on the rotavirus vaccine used)]:
  • 3 doses of Hepatitis B (HepB)
  • 3 doses of Rotavirus (RV) [Edited to Add (2/3/16): if RotaTeq used, 2 doses if Rotarix used]
  • 5 doses of Diphtheria, Tetanus, and acellular Pertussis (DTaP)
  • 1 dose of Tetanus, Diphtheria, and acellular Pertussis (Tdap)
  • 3 doses of Haemophilus influenzae type b (Hib)
  • 4 doses of Pneumococcal Conjugate (PCV)
  • 4 doses of Inactivated Poliovirus(IPV)
  • 19 doses of Influenza (Flu)
  • 2 doses of Measles, Mumps, Rubella (MMR)
  • 2 doses of Varicella (VAR)
  • 2 doses of Hepatitis A (HepA)
  • 3 doses of Human Papillomavirus (HPV)
  • 2 doses of Meningococcal (Men)
I even  tweeted at him how I came up with the total number of doses (though I incorrectly listed 3 doses of Men at the time). Note that this list includes all of the boosters, despite his erroneous admonishment that I should include boosters. (As an aside, it should be noted that not all of these are required for school enrollment, so the number that kids have to get for school is even lower.)

Since I had shown the math that I used to arrive at my total number of doses, I asked Mr. Gibson to do the same. All he did was send me links to the recommended schedule I already referenced and an easy-to-read version of the same thing, which also adds up to 53 doses.

So where was he getting this mysterious figure of 69 doses by age 18? Where else but the anti-vaccine organization known as the National Vaccine Information Center. Specifically, he referenced a poster titled 49 DOSES OF 14 VACCINES BEFORE AGE 6? 69 DOSES OF 16 VACCINES BY AGE 18? (PDF, all-caps in the original). Here's a screen shot for your reference so you don't have to click through to their site:

Click to enlarge and find the dishonesty.
Take a look at that list and see if you can spot the dishonest tactic that the NVIC is using. Yes, they break out the DTaP, Tdap, and MMR vaccines into separate, individual doses. NVIC is adding 16 doses to the list.

Why is this dishonest? Well, when looking at the antigens alone, yes, there are 69 doses of antigen that a child receives. [Edited to Add (1/21/16): It should be noted that the overall antigen load in the vaccination schedule has been decreasing, even though the number of vaccines has increased, over the past 50 years.

Click to enlarge.

But as you can see, even going by antigens, the NVIC list is still misleading.]

But their poster implies that it's 69 doses of the complete vaccine (i.e., antigens plus all of the other stuff like stabilizers, liquid vehicle, etc.), especially given their footnote about vaccine ingredients. That's not the case. Let's look at it this way. There is a stand alone measles vaccine (e.g., India's M-Vac), but it isn't used in the U.S. M-Vac is given in a 0.5mL dose. In the U.S., the MMR vaccine is also a single 0.5mL dose, not a 1.5mL dose. You can see, then, why listing measles, mumps, and rubella out separately misleads people, and why the claim of 69 doses by age 18 is false.

And even 53 doses is a bit high. There are newer combination vaccines that mean even fewer injections. For example, Pediarix (PDF), given in a 3-dose series, combines the DTaP, HepB and IPV vaccines into one, meaning 6 fewer doses (3 doses of HepB and 3 doses of IPV), bringing the total doses a child receives down to 47. Or there's Pentacel (PDF), which is given in a 4-dose series and combines DTaP, Hib, and IPV. Using that would eliminate 7 doses from the total (3 doses of Hib and 4 doses of IPV), bringing the maximum doses received down to 46.

The next time you see someone claim that kids get 69 doses of vaccines by the time they're 18 years old, you can rest assured that they have either not done the math, simply taking the word of others for granted; misunderstood what they were counting; or they are lying. I'd recommend being charitable and assuming that they either haven't done the legwork to count things up or they simply misunderstood. But then, I tend to assume the best of people.

[Edited to Add (1/22/16): Mr. Gibson wasn't the only one parroting the 69 doses claim on Twitter. @VaxCalc did as well, posting this image:

Click to enlarge.

When I asked if they thought each time a child got a DTaP they got a 1.5mL dose, they responded, "Stick to "dose" as used in CDC schedule. Stop trying to obfuscate simple fact of 69 doses of 16 vaccines #Astroturf". Notice that the CDC schedule in VaxCalc's own image notes "1st Dose", "2nd Dose", etc., which adds up to 53, not 69.

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I do enjoy the irony of VaxCalc misleading by muddying the definition of "dose" while accusing me of obfuscation. Oh, and their apparent belief that "astroturf" just means "someone I disagree with saying saomething I don't understand".]

[Edited to Add (2/3/16): With the publication of the 2016 updated vaccination schedule, anti-vaccine folks are now claiming 71 doses or even 72 doses of vaccine. This is because the CDC has added the recently approved Meningococcal B vaccine to the schedule. However, what they do not note is that currently, the MenB vaccine is included only for those not at high risk, subject to individual clinical decision making, as well as for certain high-risk groups. It is not part of the standard recommendations for all children.]

I've written a follow-up to this post that I hope clears up some things. You can read it here.


  1. Perhaps he learned to count from D. Marie.

  2. I'm currently being exposed to many thousands of antigens, some quite novel to my body, as I've moved to quite a different environment than I have lived in for the majority of my life. I mean, there's a whale of a difference between SW PA and NW LA and I'm sure spring will be even more, um, interesting.
    Antigens are ubiquitous in this world, be they allergens or various microorganisms. In the latter case, they could be harmless microbes or pathogens.
    Regardless, we're literally bombarded by microbes of all sorts, including those who could be pathogens, yet we amazingly - at least to the antivaxer crowd, survive quite well.
    But then, in their ignorance, they'll proclaim that "I have a strong immune system", which is poppycock, as cytokine storms kill those with strong immune systems.
    But then, they're just another fine example of the Dunning-Kruger effect.

    1. Wzrd1, thank you for bringing up antigen exposure. It reminded me of another point that I meant to include (and have added) that the overall antigen exposure from the vaccine schedule has been decreasing as technology improves, meaning that even though there are more vaccines on the schedule today, they expose children to fewer antigens than were in the vaccine schedule of the 1960s or 1980s.

  3. I don't know about USA but in Australia the influenza vaccine is not on any schedule and if it was why would it be given at 6 and 7 months? I think they perhaps mean HiB but even then it wrong. HiB is given at 2 months, 4 months, 6 months and 12 months. There is so much wrong with that list I don't know if they're deliberately making it up or just stupid.

    1. The flu vaccine is recommended by the CDC because of the risk of complications, especially for children under 2 years old, but it's generally not required for school attendance. The reason I think they put influenza at 6 months and 7 months is because 6 months is the earliest recommended time for a child to get it, and it's recommended that they have a second shot 4+ weeks later. One dose and they probably will not mount a strong immune response.

      The ages that they list for each vaccine are accurate. What is wrong is that they split out DTaP into three separate vaccines. Same with MMR. That is why it is dishonest and misleading, because children don't get separate vaccines for those.

  4. Thanks for the attention to the writer I stand by the essence of my twitter feed

    1. Thank you for admitting that you're dishonest and dumb, Gibson.

    2. The essence, but not the details? Do you maintain that children receive 69 doses? Do you maintain that you read 69 vaccine package inserts?

      Also, I noticed that you mentioned on Twitter that my post painted you in a less than flattering light. Well, you have no one but yourself to blame for that, since I have simply shared what you stated. If you feel that I have reported anything incorrectly, please feel free to point it out and provide evidence that I have done so, and I will correct my post.

  5. I conclude that you are a "troll" those who know me know my truth those who believe as you are gleefully invited to remain deluded. I am not responsible to you or to those who speck of science as it is infallible IMO few of you actually are invested enought to go beyond the talking points you have adopted. I wish you all the just rewards of your work ......

    1. Again, if you feel that anything in my post is in error, by all means, point it out and provide evidence to support your position. I will correct my post as the evidence warrants. If, however, you would rather call me names and choose not to offer anything substantive, then my post will stand, and your claims and behavior will remain for all to see.

  6. A final observation your blog certainly inspires huge commentary . Recruit a few more trolls

    1. Why do you think insults are a valid substitute for scientific evidence?

  7. Stephen, your use of punctuation is better than your use of facts.

  8. Apples to oranges. Your definition of "dose" is a cleaver way to minimize the actual vaccine count. You (and the CDC) confuse the meaning of *injection* with *dose*. You attempt to count three individual vaccines as "one dose" simply because they are combined into ONE INJECTION. The meaning of injection and dose are not interchangeable.

    To be clear, the schedule for DTaP, MMR and Tdap are in fact *injections* of a combination of one dose EACH of THREE different vaccines. This amounts to THREE DOSES in ONE INJECTION administered multiple times.

    But of course you're smart enough to understand this - you and the CDC simply take the rest of the world as ignorant fools.

    With this fuzzy logic why not combine all 69 doses into ONE whopping injection, replace the word injection, and call it a single "dose"? Problem solved. We can all count to one, right? (And One isn't REALLY the loneliest number, is it? ;-))

    This is just another pharma shill article. When all else fails, dilute the argument with personal attacks against grammar or punctuation -- a classic shill tactic. Next you'll attack personality, or revert to name calling. (Rats! there goes your counter attack!)

  9. Oops! Spellcheck changed clever to *cleaver*. I guess now I'm completely discredited. :'(


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