Influenza Vaccine Has Been Studied in Pregnant Women

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Summer is very nearly over in the Northern hemisphere. Fall and winter creep ever closer. As the temperatures drop, we begin to think about pulling out our warmer clothes. We shake out our jackets. Those with oil heat make sure their tanks are filled. Others stock up on firewood. The really forward thinking might ensure that their shovels are in decent shape for any snow that may be coming their way.

We're also heading into flu season. Influenza rears its ugly head from fall, through winter, and into early spring. It's one of those diseases that people tend to underestimate and have a lot of misconceptions about. A lot of illnesses people think are the flu are actually different illnesses caused by bacteria, parasites, or different viruses. A lot of people think that it is a fairly benign disease, even though it kills thousands of people in the U.S. every year, and hundreds of thousands worldwide. Then there are the myths about the flu vaccine. Probably the most common mistaken belief is that the vaccine can give you the flu, even though it can't. The available vaccines use either inactivated virus or a severely weakened form of the virus, neither of which will give you the flu.

Suffice it to say, there is a lot of misinformation out there about the flu and the flu vaccine. But there is one population that is more seriously affected, both by the disease itself and by the myths: pregnant women.

Colorado's Non-Medical Vaccine Exemption Form Ruffles Anti-Vaccine Feathers

Back to school time. Show your child you care about their health.
Image Source: South Florida Caribbean News

Note: see update at the end of the article.
 
School is nearing (or already upon us) in many states. Parents are out buying notebooks, pens and pencils, folders, and new clothes for their children to make sure they're ready for the first day. It's also the time when many parents need to make sure that their children are up to date on their vaccinations in order to attend school. Naturally, this is also a time that anti-vaccine activists absolutely hate, especially in states where public health officials have taken efforts to ensure parents are better informed about vaccines and the diseases they prevent, as well as making opting out of vaccinations closer to the same burden that exists for those who choose to protect their children from diseases.

One of the latest battlegrounds is Colorado. Anti-vaccine activists and organizations, like the National Vaccine Information Center, are really upset with Colorado. Nothing has changed with regard to the law in that state, though. Non-medical exemptions haven't been removed, like they have in California. Parents aren't required to sit through an educational session on the benefits and risks of vaccines and the diseases they prevent. All that changed is this year's vaccine exemption form and the rules around its use.

Measles Doesn't Kill, Except When It Does

There are quite a number of things that people take for granted today, regarding their health, at least in developed nations, like the United States. The majority of the population doesn't think much about the possibility of starving or being malnourished. If we suffer an injury, we can find treatment at a nearby pharmacy or convenience store. For something more serious, medical care is generally not too far away along roads that are kept in good repair. The same thing if we get sick.

There are diseases that we may never see in our lives, anymore, thanks in large part to vaccines. While these diseases may ravage poorer countries that lack the resources and infrastructure to provide a high level of immunization, such as the Philippines, those who live in affluent countries seldom see diseases that were once a common occurrence, let alone deaths from those diseases. This leads to a measure of complacency. Those of us who suffered through vaccine-preventable diseases all too easily think that it was nothing. After all, we made it. We forget, however, those who weren't so lucky, those who are no longer here to tell their story. So it is that we think of diseases like measles as no big deal. We think that it's only dangerous for people "over there".

Unfortunately, measles does not care what we think. It doesn't recognize borders. It doesn't care if you're from the United States, Germany, the Philippines, Pakistan, Nigeria, Brazil. It will infect wherever it can. And it will kill without a care about who you are or what you believe.

Wakefield's "Vaxxed" Demands Less Safety

"This is not an anti-vaccine movie. We're just going to use ominous imagery to make people scared of vaccines."
- Del Bigtree, Vaxxed Producer [My paraphrase.]

This past weekend, Andrew Wakefield's factitious documentary Vaxxed: From Cover-Up to Catastrophe premiered in New York City at the Angelika Film Center, after being dropped from the TriBeCa Film Festival. A number of reporters and skeptics attended the film, live-tweeting the experience and writing up reviews of the movie afterward. You can read reviews at The Hollywood Reporter, STAT News, The Guardian, The Daily Beast, Indiewire, and others. The central story of the film, such as it is, is William Thompson and the CDC. For background on the saga, please read this reference guide. (As an aside, even though the impetus behind the film is William Thompson, the CDC researcher does not appear anywhere in the film. Instead, the audience is left with only recorded phone calls between Thompson and Brian Hooker. The transcripts were released last year in a book, which was discussed here, here, and here.) The movie alleges that the CDC covered up evidence that vaccines cause autism. However, according to William Thompson's own documents, which Matt Carey has kindly made publicly available at his blog Left Brain Right Brain, there was no cover up.

I have yet to see the film, so I will leave you to read those other reviews. Instead, I wanted to focus on a list of "demands" at the end of the film, helpfully posted by a Wakefield supporter on Twitter. The four demands would do little to help children or people with autism and would instead run counter to what the anti-vaccine community wants.

69 Doses and Matters of Trust

The other day, I wrote about the incorrect claim that there are 69 doses of vaccine on the U.S. recommended childhood immunization schedule. That claim has morphed into 71 (or 72 [Edited to Add (2/24/15): apparently, anti-vaccine groups are now dishonestly claiming 74!]) doses since the publication of the 2016 schedule, which added the Meningococcal B vaccine for at-risk individuals, as well as those for who would like to get the vaccine and their doctor agrees it is indicated. The MenB vaccine has not yet been added as recommended for all individuals. At any rate, I had hoped that my post might help those repeating the "69 doses" claim realize that they were mistaken and misled by whomever they heard the claim from (e.g., @VaxCalc has been quite busy on Twitter, spouting out that claim on an almost daily basis, despite being told that it is incorrect). I've share the post with a number of people on Twitter that have repeated the claim. As yet, I have not had a single person admit that the claim is wrong. Mostly, they try to come back with rationalizations, which really misses the point of my post.

So what's behind the misunderstanding? What point was I trying to make?

The Precautionary Principle to an Absurd Degree

Every now and then, we hear about some event in the news. Sometimes it can cause unjustified panic, like when people in the U.S. started panicking about Ebola virus, despite the risk to the average American being next to nothing. Other times, it can cause realistic concern, such as we see among the people of Flint, Michigan, or among members of communities where there are disease outbreaks. Reactions to these events run the gamut from the rational to the irrational and absurd. There is always an emotional component, but how much we let our emotions or our reason dictate our responses influences where we fall on the spectrum. Do we panic? Are we reasonable? Callous? Compassionate?

I was reminded of this today through an interaction with someone on Twitter (which lately seems to be a rather fertile spot for blog material). Self-described libertarian and stay-at-home dad, @CalypsoWaxed linked to a story in the Daily Mail, apparently in an attempt to scare people about vaccines.

Despite the Mail being known for rather sub-par reporting and being prone to sensationalism, I gave the story a look. The title says a fair bit, "Paramedics called to secondary school as pupils fall ill and collapse after being given their vaccinations".

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?

Locked in Ignorance

The other day, I got into a discussion with someone calling for Congressional hearings on the DeStefano 2004 study that is the latest to-do in anti-vaccine circles. I won't go into the background; you can read about it here. Instead, I'll just present the Storify curation of tweets. My interlocutor just didn't understand what she had read. There is nothing wrong with that. We all have areas in which we lack the requisite knowledge to fully grasp the subject. The real trick is figuring out where we are ignorant and put in the effort to learn and grow. I'm presenting the whole conversation here in the hopes that others might learn from it. It's a bit long, but it gives a good pictures of how our preconceptions can lock us into a state of ignorance.

Here are a few resources for your reference as you read through this.

• MMR, the CDC and Brian Hooker: A Guide for Parents and the Media 
• Age at first measles-mumps-rubella vaccination in children with autism and school-matched control subjects: a population-based study in metropolitan atlanta (Original study from DeStefano et al.) 
• A look at the analysis plan for DeStefano’s MMR study: no evidence of fraud (includes a link to the 2001 Draft Analysis Plan) 
• Measles-mumps-rubella vaccination timing and autism among young african american boys: a reanalysis of CDC data (Brian Hooker's retracted study)

Ignorance is not bad, unless we make no effort to overcome it. Being wrong is not bad, unless we do not accept that we are wrong.

Donald Trump's "Massive" Vaccines

This will be a very brief post. As I was reading Orac's post about Donald Trump's anti-vaccine musings, one thing kept jumping out at me. Trump kept talking about "massive shots" that kids get, going so far as to say that "tiny children are not horses". I get the impression that Trump has either never seen an actual vaccine syringe or he is so terrified of needles that when he did see one, his interpretation of reality was so warped he imagined it to be some huge monstrosity.

At any rate, I put this image together to illustrate what I think is going on in Trump's mind. Enjoy.

Oh, and as a side note, do you know how hard it is to find images of doctors practicing good hand hygiene by wearing gloves while administering a vaccine?

Ethan Posard's The Shots Book

Be a community immunity superhero!

I meant to do this post at the beginning of the month. I really did. But life finds ways of interfering. In case you didn't know, August is National Immunization Awareness Month. I've posted stuff for NIAM before, like my lineup of vaccine preventable disease wanted posters. I've also written other posts for past Vaccine Awareness Weeks that could fit in well with NIAM, too, like the myth that if vaccines work, then it doesn't matter if you vaccinate your kid or not. Some years, though, I've let August slip past without writing anything specifically for NIAM, even though I have written posts with some vaccination issue as the main topic.

Not this year. I could write about outbreaks of diseases or the activities of the anti-vaccine movement, but I'd rather keep things nice and positive, at least for now. In July, I received a review copy of The Shots Book: A Little Brother's Superhero Tale, by Ethan Posard. Rather than publishing a post about the book right away, I wanted to hold off until Immunization Awareness Month. Then, as sometimes happens, life decided to muck up my good intentions and delay me for a while. Better late than never, right?

Ethan is the younger brother of Camille Posard, one of the talented young high schoolers who wrote and produced the film Invisible Threat, which I discussed last year. Although the film was met with exceptionally harsh criticism from the anti-vaccine movement (without their even having viewed the documentary), the teens who produced it proudly stood up to the bullies that tried to silence them and shut down screenings. One portion of the film follows Ethan as he goes in for one of his scheduled shots, and it's that experience with both the shot and the film that inspired him to write this book.

Jim Carrey's The Bad Tweet

Did you learn nothing from this movie, Jim?

[Update 7/2/15 at 6:30pm: Jim Carrey has removed the tweets mentioned below and replaced them with text-only tweets. He has not tweeted any apologies.]
 
Oh, Jim Carrey. Not content to be a fool on screen, you decide to (continue) to be a fool on Twitter. After the passage and signing of California's SB277, a new law that removes non-medical exemptions to school immunization requirements, Carrey went on a bit of a rant on Twitter, declaring the law fascist (it's not), playing the Pharma Shill Gambit, the toxin gambit, and, like so many other anti-vaccine activists, declaring he's not anti-vaccine. In short, he's just following the anti-vaccine handbook. But he wasn't content to keep it to just being mildly unhinged. But I'll get to that in a bit.

I first became aware of Carrey's anti-vaccine nonsense back in 2009, when Carrey was with anti-vaccine spokesperson Jenny McCarthy. For a while, Phil Plait, aka the Bad Astronomer, had occasionally written about the anti-vaccine movement. Like clockwork, anti-vaccine activists would show up in the comments spouting the same tired tropes over and over. It prompted me to write up a summary addressing the more common myths around vaccines. It's helped some learn the truth and facts about vaccines and exposed many of the lies told about them.

Apparently Jim Carrey didn't bother reading it, or, if he did, he didn't learn a thing. So what has he done this time around that went beyond merely making a fool of himself and showed that he is an opportunistic and insensitive ass that doesn't really care about those affected by autism?

SB277 Signed! Congratulations, California!

June 30, 2015 - A happy day for California children!

This is just a very brief post to celebrate the triumph of science and public health over the fear and lies of the anti-vaccine movement. On June 30, 2015, Gov. Jerry Brown signed SB277 into law. As I mentioned briefly before, SB277 ensures that only medical exemptions will be allowed for school immunization requirements. California has joined Mississippi and West Virginia as the only three states in the country that put children's health above misguided personal and superstitious beliefs.

In his signing statement (PDF), Gov. Brown noted the importance of vaccines and the science that supports their use:

The science is clear that vaccines dramatically protect children against a number of infectious and dangerous diseases. While it's true that no medical intervention is without risk, the evidence shows that immunization powerfully benefits and protects the community...

...Thus, SB277, while requiring that school children be vaccinated, explicitly provides an exception when a physician believes that circumstances - in the judgement and sound discretion of the physician - so warrant.

My thanks go out to Senators Pan and Allen for shepherding this bill through the California legislature, to all of the senators and assembly members who voted for this bill, the parents and activists who supported their efforts, and Gov. Brown for signing it. You have all done an amazing thing to protect the health of California's most vulnerable population.

SB277 Opposition: The Smokescreen of Parental Choice

Humans love to have choices. From early on in our childhood, we like to be able to choose what we want to do. Play with this toy or that one. Eat this food or that. And we don't like having limitations placed on our choices, especially if it involves doing something we don't want to do. Our parents try to teach us that while we are able to choose, sometimes our choices have strings attached. "You need to finish your vegetables if you want dessert." We're given the power to choose what to do: eat the veggies so we can have dessert, or choose not to eat the veggies and miss out on dessert. We might not like the options, we might wish we could choose the dessert without any other limits on our choice, but we have to deal with the reality. Depending on our maturity, we may throw a tantrum when we don't get what we want, when there is even the most minor constraint on our choices.

By the time most people are adults, they're mature enough to realize that every choice we make has some sort of consequences. They may occur prior to getting what we want, or they might follow it; they may be good consequences, or they may be bad. Then there are those who never seem to reach that maturity. They're stuck in the childish dream of wanting their choices to be free from any limitations, unable to accept that their choices may have consequences or that there may be some manner of prerequisite before they can have their choice fulfilled.

We can see this in action in the anti-vaccine movement, in particular as they fight against a bill in California (SB277).

Beware the Humpty Dumptys

Language is a very powerful thing. We use it to convey our thoughts and desires. The words we use have meaning. It may be literal, where what we say is exactly what we mean. Or the subtext may carry a meaning beyond, or even at odds with, the specific words that we choose. No matter which language we speak, there are certain assumptions we all have regarding the words that we use. Primary among those assumptions, and what allows language to work as a means of communication, is that we all agree on the actual meanings of words. When we do not agree on the basic meanings of words, then we can no longer communicate.

A good example of how communication breaks down when we begin to change the agreed-upon meanings comes from Lewis Carroll's Through the Looking Glass, when Alice encounters Humpty Dumpty:

'And only one for birthday presents, you know. There's glory for you!

'I don't know what you mean by "glory",' Alice said.

Humpty Dumpty smiled contemptuously. 'Of course you don't — till I tell you. I meant "there's a nice knock-down argument for you!"'

'But "glory" doesn't mean "a nice knock-down argument",' Alice objected.

'When I use a word,' Humpty Dumpty said, in rather a scornful tone, 'it means just what I choose it to mean — neither more nor less.'

Humpty takes a common word and makes up an entirely different meaning for it. If I were to ask you to pass me that apple, you'd be rightly confused if I got upset that you handed me an apple instead of a wrench. Yet this is a behavior that seems to be fairly common among those who strongly oppose vaccinations.

Stand Up for Parents' Rights to Accurate Information on Vaccines

A few years ago, California's legislature took steps to ensure that parents who wished to opt out of getting their children immunized for school or day care understood what their decision meant. Assembly bill AB 2109 required that before a philosophical exemption could be granted, parents had to get a health care provider to sign the exemption form, indicating that the parent received information on the risks and benefits of vaccination. In order for parents to make an informed choice, they ought to have good, science-based information on which to base that choice. SB 2109 seemed like a bill that should have had unequivocal support from the anti-vaccine, sorry, "pro-vaccine-choice" movement. Instead, they vehemently opposed it, led by the National Vaccine Information Center (NVIC). Despite NVIC's lobbying, AB 2109 passed.

The latest unprecedented outbreak of measles, starting in California and up to 132 cases in that state as of March 6, has led several state legislatures to consider bills that would tighten up school vaccine exemptions and improving parent education regarding immunizations. Naturally, this led to claims that government was trying to remove choice and personal belief. Some of those complaints are against bills aimed at removing non-medical exemptions. And some oppose bills similar to AB 2109, like Minnesota's SF380/HF393.

Is the Government Taking Away People's Beliefs?

Measles has been in the news a lot, lately. And it's not surprising, with the unusual 644 cases in 2014 and 154 (as of Feb. 20)  and counting already in 2015. The outbreaks have not only grabbed the attention of the media, but politicians are starting to take notice, as well. Several state legislatures are either already considering or will be introducing bills aimed at improving tracking of vaccine uptake and improving immunization rates overall. Some of these bills require disclosure of immunization rates for each school. Others go much further and would remove philosophical exemptions from school immunization requirements. These latter bills would bring those states more in line with Mississippi and West Virginia, which only allow for medical exemptions for students' school shots (and also just happen to have some of the lowest rates of vaccine preventable diseases).

To say that those who, either in total or just the mandated school-entry immunizations, are opposed to vaccinations are unhappy would be an understatement. Moves to remove non-medical exemptions from school vaccination requirements are met with arguments about personal freedom, that this is no different than what the Nazis did to the Jews during the Holocaust, or that the government is taking away people's beliefs or rights.

So what's going on? Is the government taking away people's beliefs? Are they infringing on our rights as citizens? And what about the children who are affected by all of this?

Genotypes, Serotypes and the MMR: Cognitive Dissonance in Action

Many of those who have bought into the anti-vaccine message seem to hold very tightly to their chosen belief. The more emotionally invested they are, the more likely they will go to great lengths to justify or rationalize their position. True, this is not unique to anti-vaccine activists or those closely associated with them, but it quite commonly dictates their reaction to evidence that challenges their beliefs. Evidence that contradicts their worldview, causing cognitive dissonance, leads to different mechanisms to cope with the psychological discomfort that results. The less entrenched individuals may look at the evidence, accept it as valid, and change their prior beliefs to fit with the new evidence. Some may simply ignore the evidence and pretend it doesn't even exist (e.g., "vaccine have never been studied for safety" despite numerous studies doing exactly that). But more commonly, they will invent rationalizations to explain away the contradicting.

The most recent example of this is the current outbreak of measles that started at Disneyland in California, and to a lesser extent last year's historic case count (644 cases) that hasn't been seen in the past 20 years and surpassed the number of measles cases from the previous five years combined. The Disney outbreak has resulted in 125 cases (through February 8) in just over one month (141 cases in two outbreaks as of February 13) resulting in 17 known hospitalizations. The majority (88%) of cases were either unvaccinated (45% of the total) or had unknown or undocumented vaccination status (43% of the total). The unvaccinated have been a significant contributor to the size of this outbreak and the speed with which it has spread. And the media has taken notice, with the majority of outlets putting the blame right where it belongs: on the anti-vaccine movement.

So how have anti-vaccine types responded?

Demystifying Vaccine Ingredients - Aluminum

People, in general, tend to have a fairly poor grasp of chemistry. I don't blame them; there's an awful lot to learn and it can get pretty complex. To make matters worse, this lack of understanding is often coupled with what some would call "chemophobia" (not a very good name, as it's not a real phobia, nor does it generally rise to the level of debilitating pathology). In short, people tend to have an inherent, emotional distrust of "chemicals" and substances that have weird, hard to pronounce names or that tend to have negative associations. For example, who wants to ingest 7,8-Dimethyl-10-[(2S,3S,4R)-2,3,4,5-tetrahydroxypentyl]benzo[g]pteridine-2,4-dione? Maybe you'd prefer C₁₇H₂₀N₄O₆? But that chemical is in a lot of foods that we eat. Many processed foods, like cereals, pastas and cheeses contain it. Don't eat processed foods and eat nothing but an all-natural, organic, "healthy" diet? You still won't avoid that chemical, since it's also in a lot of leafy greens and legumes. Both of those are the same chemical, also known as riboflavin, or vitamin B2. What about potassium? It's a metal that, when exposed to water, reacts very violently, exploding almost immediately. If you are exposed to excessive amounts of potassium, you can develop muscle paralysis and heart palpitations. And yet, it is an essential part of our diet. Your body needs potassium in order to function properly.

When it comes to medical products, there is an even greater uncertainty around the ingredients. Not only do the problems above come into play, but add on distrust of faceless companies or unsavory associations, and the fear increases. I illustrated this in two of my previous posts, one on formaldehyde and one on monosodium glutamate. Some vaccines contain small amounts of these substances as a part of the manufacturing process. But there is a vaccine ingredient that gets even more bad press than either of those: aluminum (or aluminium, if you prefer). Let's take a look at this substance, how we're exposed, how our bodies deal with it, and its role in vaccines.

Grant Opportunity: Help Advance Vaccine Safety

Photo credit: James Gathany
Source: CDC/Judy Schmidt

I know I've had a bit of a dry spell lately, having written nothing since my posts in November on so-called "Right to Try" laws in the U.S. and the Medical Innovation Bill (aka the Saatchi Bill) in the U.K. Life outside of the blogosphere took up a bit of my time, getting me out of the habit of sitting down to write. So, my apologies to my readers.

To get back into the swing of things, I thought I'd start off with a brief post about a grant opportunity from the Department of Health and Human Services' National Vaccine Program Office (NVPO). NVPO plans to award two grants of up to $250,000 each to support research aimed at improving the safety of vaccines. Vaccine safety research is something I can get behind. In fact, some of you may recall that a few years ago, I put my life on the line to support vaccine research by racing through 5km of zombie-infested countryside. (The zombies got me, but I recovered!)

So what is this grant all about?

Brian Hooker's Paper on Increased risk of ASD in African American Boys Retracted

Just a very quick post to let my readers know a bit of recent news about that whole Hooker-MMR-CDC coverup nonsense. The journal that originally published Brian Hooker's paper originally issued a statement of concern about the conclusions and possible undeclared conflicts of interest. Yesterday, October 3, 2014, the journal fully retracted Hooker's paper. Here is their statement regarding the retraction:

The Editor and Publisher regretfully retract the article [1] as there were undeclared competing interests on the part of the author which compromised the peer review process. Furthermore, post-publication peer review raised concerns about the validity of the methods and statistical analysis, therefore the Editors no longer have confidence in the soundness of the findings. We apologise to all affected parties for the inconvenience caused.

I sent an email to the journal asking for more details. If I get a response, I will update this post accordingly.