VAERS a Few Things We Need to Discuss

I've been remiss. There's a topic that I've written about in passing, but I have yet to devote an entire post to it. In all this time writing about different vaccines, studies about vaccines and anti-vaccine claims, there's a subject about which I have neglected to write more about than a paragraph here or there. I'm speaking, of course, about the Vaccine Adverse Event Reporting System, or VAERS. The handful of times I have written anything about VAERS (here, here, here and here), it's mainly been a very brief overview of what it is and how anti-vaccine activists like to abuse it (except that last link, which included a study using VAERS data).

So I thought I should rectify that situation. What prompted this was an exchange on Twitter with a doctor by the name of Jim Meehan, who tried to argue that the HPV vaccine is confirmed to have caused deaths...144 of them, to be precise. His reasoning is that there are 144 reports of death associated with HPV vaccine in the VAERS database. Therefore, he thinks HPV causes death:

He also tried to dismiss me and others by claiming we had financial conflicts of interest on the topic. Actually, he's rather fond of attacking the people he's arguing against, like suggesting that because they don't agree with him, they would probably also deny the Holocaust. (On further perusing his Twitter feed, he appears to be a full-on anti-vaccinationist himself, citing Robert Kennedy Jr.'s nonsense, "too many, too soon", "unvaccinated are healthier" and so on. And on even more perusing, I find that Dr. Meehan admits to being anti-vaccine:

If only I'd known that when I first saw this guy. Would've saved me a lot of time and explains a lot of his behavior. Perhaps at some point in the future I'll need to revisit this fellow.)

In the meantime, though, I thought it might be helpful to talk a little bit about VAERS: what it is, how it's supposed to be used and how it's abused.

An Honest Flu Ad

Click to enlarge.

Last week, the National Vaccine (mis-)Information Center ran an ad in a New Hampshire newspaper designed to make people fear the flu vaccine. I wrote about why the NVIC ad is misleading, as did Moms Who Vax and Epidemiological. In short, the NVIC ad played to the myth that the flu vaccine makes you sick (it doesn't) and promoted the idea that the vaccine doesn't work (it does). It also played on fears of adverse reactions to the vaccine ("know the risks"), but did not so much as hint at the benefits.

At any rate, I though I'd put together a somewhat more honest ad. Here's my take on the NVIC ad. Please feel free to share this, unaltered, far and wide. I also have a higher resolution version of it that should be good to print. E-mail me (contact info's in the sidebar) if you would like a copy.

NVIC? Know the Omissions (Part 2)

Those of you who read this blog regularly know some of the common tactics that anti-vaccine activists use. They're fond of the Pharma Shill Gambit, in which they accuse those with whom they disagree as being paid by pharmaceutical companies. This allows them to blissfully dismiss anything their detractors have to say. If you're paid by pharma, after all, you're hopelessly biased and nothing you say can be taken as true or honest. Of course, it doesn't matter whether you actually get paid by pharma or not. Facts don't tend to matter much to those using the pharma shill gambit.

That brings us to another tactic: dishonest or misleading rhetoric. The less, shall we say, sophisticated anti-vaccine activists aren't all that subtle about it. They will brazenly state as truth claims that are easily shown to be wrong (e.g., the false claim that MMR has the preservative thimerosal in it, or that vaccines contain antifreeze; they don't). The more skilled among the anti-vaccine movement, however, use insinuation. They imply certain claims using language that, on the surface, is technically true or could be classified as opinion, but the unstated claim is at best misleading and at worst dangerously wrong.

The National Vaccine Information Center (a more Orwellian-named organization would be hard to find) falls into that latter category, for the most part. Take, for instance, their latest ad, placed in a local New Hampshire newspaper:

The New California Personal Belief Exemption Form Unveiled

The anti-vaccine movement is a study in contradictions. They want fewer vaccines, but advocate for actions that ensure vaccines that could be taken off the schedule aren't. They want studies done, and even get involved in their design, but then reject them when the studies produce results they don't like. And they clamor for informed consent, but then raise a stink when efforts are made at improving education and helping parents make informed choices.

That was the case last year when, in March 2012, a bill was introduced in California (AB2109) that would require parents who want to opt out of required school immunizations for their children to get information about the "benefits and risks of the immunization and the health risks of the communicable diseases listed in Section 120335 to the person and to the community" from an authorized health care provider (which was rather broadly defined). These efforts at ensuring parents make informed choices were so objectionable, that anti-vaccine pro-informed choice activists vehemently opposed the bill. Yes, in the twisted world of people like NVIC's Barbara Loe Fisher, a doctor largely responsible for a measles outbreak or certain reality-challenged celebrities, a bill that requires parents be informed tramples on parents' rights to be informed. Yeah, I don't get it either, but supposedly it makes sense to them.

At any rate, AB2109 was signed into law by Gov. Jerry Brown on September 30, 2012, but with a catch. As I wrote at the time, Gov. Brown issued a signing statement with it, stating that he would direct the Department of Public Health to allow for religious exemptions to the whole getting informed piece of the legislation, despite the fact that California does not have any religious exemptions to vaccinations. As I noted at the time, there were significant problems with this, both legal and practical.

Well, the California Department of Public Health has announced the new form and made it available here (PDF).

Measles, Cows and an "Oh crap!" Moment

In the history of the battle against diseases, there are only two that have been completely eliminated from the wild. Smallpox had been with us for millennia, but it wasn't until sometime around the 17th century that moderately successful attempts at preventing the disease were practiced in the form of variolation, or inoculation with pus from an infected individual. This practice, though effective, carried significant risks, such as actually causing the disease or infection with some additional disease, like syphilis. Then along came Edward Jenner, who discovered that those infected with cowpox appeared to be immune to the more dangerous smallpox. He developed the first rudimentary vaccine in the late 18th and early 19th centuries. As medical knowledge advanced, the vaccine was refined and improved, reducing (though not eliminating) the risk of adverse effects and improving its effectiveness through booster doses. In 1967, a worldwide campaign was begun to eliminate the disease from the wild, with the last known wild case of smallpox occurring in Somalia in 1977, making it the first disease eliminated through human efforts.

The second disease that we have managed to eradicate from the wild is rinderpest, a morbillivirus closely related to human measles virus. Rinderpest was once a scourge of cattle. As with smallpox, innoculation was an early attempt to control the disease. Unlike smallpox, inoculation never really caught on, partially due to lower efficacy. Jenner's successes with vaccination using cowpox led to unsuccessful attempts to use cowpox to prevent rinderpest. Vaccines using the rinderpest virus were developed in the early 1900s, yet despite the development of effective vaccines, control efforts often took the form of wholesale slaughter of livestock when outbreaks occurred. Regional efforts at eradication of the disease began in the 1920s, but coordinated global efforts wouldn't come about for several decades. Ultimately, widespread vaccination efforts led to the last confirmed case in 2001 in Kenya. Vaccination continued for several more years, as experts suspected the virus could still be circulating among wild animal populations. In 2011, with no other cases appearing, the World Organization for Animal Health declared the disease eradicated.

We know that in the right circumstances (like when a disease is limited to a single species), and with enough effort, we can eradicate diseases. But what if a disease jumps species?

Is It More Effective to Delay MMR Vaccination?

Recently, I asked the question is it safer to delay MMR vaccination?  Many of those who are opposed to the current schedule of vaccinations or have heard anti-vaccine claims and fear that vaccines somehow overwhelm an infant's immune system may put off getting their children immunized until well after the age recommended by the CDC and AAP. This decision not only leaves a child at risk of infection for a longer period, but, as I discussed in that post, new research on the MMR vaccine indicates that there is an increased risk of seizures and fever associated with delaying that vaccine. So delaying might not necessarily be safer, at least in terms of adverse reactions to the MMR vaccine. The authors of the recent paper speculated that one probable cause of this increased risk is due to a more robust immune reaction the older a child is when they receive their first dose of measles-containing vaccine.

Another recent study, Measles in Children Vaccinated With 2 Doses of MMR, by F. Defay, G. De Serres, D. M. Skowronski, N. Boulianne, M. Ouakki, M. Landry, N. Brousseau, and B. J. Ward and published online on October 21, 2013 in Pediatrics, asked a related question: does delaying the first dose of measles vaccine improve efficacy? Well, really, the question they asked was, "does age of first MMR vaccination affect vaccine efficacy in children who received 2 doses", but my paraphrase is close enough.

For Graduate Practicum, George Washington University Earns an F

Recently, news came out that Mark Geier, the man who tried to treat autistic children's autism by using a powerful drug that suppresses testosterone (essentially chemically castrating these children), the man who lost every one of his twelve state medical licenses and had a 13th denied due to his medical misconduct (to put it lightly), served as a site preceptor for a graduate student at George Washington University. Autism News Beat rightly criticized the university. That Geier was able to serve as a preceptor for a student is pretty damning, since it means that GWU did not do its due diligence to ensure that individuals who apply to be a preceptor meet certain minimum standards. Either that, or someone at GWU was actively promoting Geier's nonsense.

The problem is that a site preceptor has a number of responsibilities, according to the GW SHHS Practicum Site Preceptor Guide:

1. Visit the Practicum Website http://www.gwumc.edu/sphhs/studentres/practicum/index.cfm and Register. (See Register: for instructions)
2. Review and approve the Student’s Practicum Plan
3. Negotiate payment/stipend with Student, if applicable
4. Engage student in work and provide constructive feedback and guidance to the student
5. Provide guidance for professional conduct
6. Complete the following on the Practicum Website:
   a. Midpoint evaluation form in conjunction with the student
   b. Final site preceptor evaluation of student and practicum
7. Address student’s reports of problems, including site safety issues and/or harassment

Take note of numbers 2, 4, 5 and 6. Mark Geier is not fit to fill those responsibilities, having been stripped of his medical licenses and being found by several Special Masters of the vaccine court to lack expertise in many different areas relevant to epidemiology, biostatistics and immunology. Coupled with his lack of medical ethics, it is grossly irresponsible to allow him to serve as a site preceptor for any student. Orac and Reuben Gaines have both chimed in, as well, castigating George Washington University for allowing this to happen.

And now it looks like GWU has taken notice.

More VPD Cards Available

[UPDATE 3/8/16: I am out of VPD wanted poster card sets. Thank you to everyone who requested a set! You made it all worthwhile.]

In March of this year, I announced that I was making prints of an art project of mine available for free. These were sets of sixteen 4" x 5" cards with information about each of the diseases that is prevented by a vaccine on the current childhood immunization schedule. The cards are modeled after wanted posters, complete with mug shots and vital statistics of each virus or bacterium, as well as a description of what the disease does (its modus operandi, if you will). I received a lot of positive feedback on them, and I recently sent out the last of my initial 100 sets.

Because of continued requests, I've decided to do another printing. If you would like a set of VPD cards, click on that link or click the button below or in the sidebar to the right. Remember, it's absolutely free, though if you'd really like to open your wallet, please make a donation to a science-based autism charity or to support vaccine research. Here are some suggestions, which I have supported myself, or give to your favorite charity.

Much of the information is drawn from the CDC's Pink Book chapters on each disease, which I've tried to summarize in an easy-to-read format. These cards are a great way to learn about vaccine preventable diseases. Some people have even turned the cards into a game, shuffling and dealing them out, then playing hands of "who has the worst disease".

Is It Safer to Delay MMR Vaccination?

Most people follow the recommended schedule of childhood immunizations. They understand the importance of immunization, not only for their own children, but for their communities as well. Certainly, parents put varying degrees of thought into their decision. Some simply go along with whatever their pediatrician recommends, while others thoroughly research the vaccines their child will receive before accepting the science-based recommendations behind the current vaccination schedule. Whatever level of scrutiny they give to the issue, the majority immunize their children fully and on-schedule, barring valid medical reasons to the contrary.

Then there's the minority, the parents who either delay vaccines, spreading them out over a much greater timeframe than recommended by the Centers for Disease Control and Prevention and the American Academy of Pediatrics, the parents who only allow some vaccines, and those who eschew vaccines altogether. Some are strongly committed to the ideology that vaccines cause all manner of maladies, often becoming quite vocal about it. Their views stem from misunderstanding of the science, confusing correlation with causation, and distrust of large corporations and the government. Some parents have simply been misled by those anti-vaccine activists. The arguments resonate on an emotional level, despite being void of scientific validity. And finally there are those who delay or skip vaccines because they lack access or the resources to keep up. They cannot afford insurance to cover the vaccines. They may not be able to take the time off from work to take their children to the doctor's office. In short, through failures of the health care system, rather than any fear or distrust of vaccines, their children are under- or unimmunized.

Whatever the reasons, the decision to delay or avoid vaccinations carries certain risks. Most readily apparent is the increased risk of infection, contributing to outbreaks in regions of low vaccination. We need only look, for example, at recent measles outbreaks (Minnesota, New South Wales, Australia, Massachusetts, Indiana, North Carolina and New York, Pakistan and Wales, Texas) to see how lack of immunization increases the risks of infection and spread of disease. Not so obvious is that delaying some vaccines increases the risk of not being fully immunized.

And now there's another risk to add to the list, at least as regards measles vaccines.

B-lyme-y!

The last couple weekends in July and the first weekend of August, I helped out with a project down in Connecticut. It allowed me to tap into my woodworking interests and challenged me with techniques I hadn't done a great deal of before, like sculpting with a chisel and lashing several different ways. Because of time constraints, I made use of some power tools (saws, screwgun and sander), hand tools (axe, chisel, knives) and some more unusual tools (like a blowtorch). Most of the work used rough branches, rather than lumber, and some didn't involve wood at all.

The project was also a great excuse to get outside to enjoy nature, as it took me into the woods quite a bit. That was both good and bad, because, unlike the Disney (and quackery) version where nature is all happy and fluffy and nary a hair on your head will be harmed, I encountered the real nature. The more immediate problem was relatively minor: it was hot. Really, really hot. And humid. But I could live with that. I could even live with the little bit of contact dermatitis I got from either poison ivy or poison sumac that brushed my wrist against at some point without knowing it. Itchy and ugly, but luckily I'm not hypersensitive to it. What was more concerning was what I got, much like the dermatitis, without knowing it. I never noticed that I'd had a visitor that came for a bite to eat, then left without so much as a "how d'you do?". The only indication I had of the encounter came weeks later: a characteristic bulls-eye rash. I had lyme disease.

Didn't get a photo of my rash, but it looked like this.
Photo credit: James Gathany. Source: Public Health Image Library

Since there is a great deal of misconception about this disease among the public, and because more than a few people were gravely concerned when I told them, thinking that I would be in extremely poor health because of it, I figured it might be good to share my experience.