By Grant Jacobs 08/04/2017 10


Below are a few links to resources that people might find useful to share – or read if you want a quick introduction to vaccines for kids.

Short takes

For really short takes, these brochures—all in PDF format—might be useful. They make key points in few words:

A bit longer on a few key topics

Some what longer reading are these. They give more background and are well-written. Try them out!

Clear Answers and Smart Advice About Your Baby’s Shots (PDF). Written by a doctor from the USA (Ari Brown, MD, FAAP) this is a lively read. It covers a lot of stuff in a friendly, readable way.

Do Vaccines Cause Autism? A topic that never seems to go away. There is a lot research testing the idea that there is some relationship between vaccines and autism: the results find there is none. Here the excellent History of Vaccines website explores this. Do check out the rest of their website. They also have a 52-page eBook on the history of vaccines. (It’s at the bottom of the their educators resources.)

Diplomatic Immunity

Fellow sciblogger Helen Petousis-Harris is the vaccine person around here! Follow her blog, Diplomatic Immunity. Like all blogs here, you’re welcome to ask questions in the comments.

Auckland University’s Immunisation Advisory Centre

They have an excellent website. There’s a contact page, and an 0800 number people can ring. Head to immune.org.nz or 0800 immune (0800 466863). They also have a Facebook page, and you can find them on twitter, @immunenz. Their website has more resources, too.

Other sources

There are many more resources I could point at, but I hope this short selection has some use. Feel free to add others in the comments below (or just generally chatter!)

I’ve listed a few of my previous posts on this topic in a section below. Do read about the featured image – Charlotte’s story is worth being reminded of.

Featured image

Free, from wikipedia: ”Charlotte Cleverley-Bisman, child who survived amputations of all 4 limbs, and became “the face of” New Zealand’s meningococcal meningitis vaccination campaign. Between 1-2 years old.”

Wikipedia’s ‘Vaccine controversies’ page has this to say in the legend of the image there,

More complete vaccination could have protected her through herd immunity, preventing children too young to vaccinate from catching the disease.

The wikipedia entry is well worth reading. I wonder how many people remember even this, from relatively recent times?

Most Western countries have fewer than three cases for every 100,000 people each year, with New Zealand averaging 1.5 before the epidemic started in 1991; in 2001, the worst year of the epidemic in New Zealand, the rate hit 17. 5400 New Zealanders had caught the disease, 220 had died, and 1080 had suffered serious disabilities, such as limb amputations or brain damage. Eight out of 10 victims were under 20 and half were under 5 years of age.

The morning of 17 June 2004, Cleverley-Bisman vomited and was unhappy, but the parents took it as anticipated teething pains. By mid-morning she developed a small blemish on her neck, and her mother rushed her to Waiheke Ostend Medical Centre, where staff diagnosed meningococcemia. In ten minutes she was covered with small spots. She was injected with penicillin, and rushed to Starship Children’s Health by helicopter. Half an hour after the first spots were noticed, she was blistered, swollen, and purple over her entire body, with her extremities blackening. She was not expected to survive, and needed to be resuscitated twice during her first half-hour at Starship. She was connected to life support systems which fed her, transfused blood and drugs, and assisted her breathing.[4][5]

The second day, Starship doctors said that if she lived at all, Cleverley-Bisman would need to have at least both legs and most of her left hand amputated, to save her life from gangrene. During the three weeks while doctors waited for demarcation between dead and living flesh to become clearer, her catheters became clogged several times and needed to be replaced with additional surgery. By the end of June, it was clear that all four limbs would need to be amputated.[5] This was done on 2 July, amputating both legs and left arm “optimistically”, through the knee joints, rather than above them, hoping to preserve the growth plates at the end of the long bones, which would allow for better use of prosthetics later in life.

Previous posts

I’ve also written a few posts on vaccines, mostly from before when Helen was writing at Sciblogs (see also Footnotes) –

Footnotes

Aside from the topic itself, I’ve written a few posts about the NZ lobby group that is organising the screenings of Vaxxed in New Zealand – e.g. that I think it’s worth thinking about if their approach to discussion is worth trusting, particularly that their discussion rules repress open discussion and ensure they have the ‘last word’ – including simply banning people who point out information that runs counter to their ‘mantra’.*

These ‘page rules’ look to be unchanged since I wrote about them.

Bizarrely (to me), and on a more personal note, I’ve been blocked from their Facebook page! I’m surprised as they’ve long known about me and I’ve had access even when they tried to sideline me because they knew they were to face some media attention. I doubt anything I’ve written deserves being blocked, but then they’ve blocked others for less. It’s doubly surprising as I haven’t written on their page for (literally) years, and have hardly written on the topic for a long time either.

A key thought, then, is should anyone trust them if that’s how they treat others? Certainly is shows their approach to discussion isn’t consistent with free speech – a point relevant to my previous post, Vaxxed at University of Otago: venues should be able to decline.


10 Responses to “A few vaccine resources”

  • Interested to hear thoughts on the January update to health professionals on Gardasil 9, from IMAC website. Doctors told ‘not’ to do pregnancy test on women who are going to have a Gardasil 9 vaccine, but if they find they are pregnant later on, during the course of the vaccines, to cease giving them and wait until the baby has been born? (S.Yang, Clinical Reviewer, notes the increased number of spontaneous abortions in those who received Gardasil 9, when compared with Gardasil… cannot explain this and does not indicate if this will be further evaluated, but goes on later to say in the recommendations, that this post hoc reporting, to be ‘deleted.’) Thoughts?

    • Better to ask others for the full story. Helen at Diplomatic Immunity might be one person to try (but bear in mind that she may be too busy!) As I believe you know she is a vaccine specialist and has been writing on the HPV vaccine here for a while now.

      But let me at least offer something to get you started –

      Interested to hear thoughts on the January update to health professionals on Gardasil 9, from IMAC website. Doctors told ‘not’ to do pregnancy test on women who are going to have a Gardasil 9 vaccine,

      If you read the rest of the paragraph you were reading it explains why –

      “as inactive vaccines can be safely administered to pregnant women no intervention is needed if a HPV vaccine dose is inadvertently administered during pregnancy.”

      (My emphasis added.)

      Best ask others for details, but I imagine the reason for not doing the pregnancy test is simply that a pregnancy wouldn’t make any difference to the either the mother’s or child’s safety; it’d just be making the women do another test. One they may not want to do either!

      but if they find they are pregnant later on, during the course of the vaccines, to cease giving them and wait until the baby has been born?

      The sources I’ve seen say there is no evidence of harm to the fetus.

      Again, you’ll have to ask elsewhere for why. It may simply be a case of giving the benefit of the doubt. People do that 🙂

      (These things can be subtle. It’s worth finding out if the vaccine offers protection to the fetus after early stages of pregnancy; if not, there’d be no real reason to give the vaccine to later-stage pregnant mothers, especially if there’s little lost in waiting until afterwards for the mother to complete her vaccine series. My reading indicates research considers there is no harm to the fetus, though.)

      re:

      S.Yang, Clinical Reviewer, notes the increased number of spontaneous abortions in those who received Gardasil 9, when compared with Gardasil

      In the same document the statistician says clearly that she defers to the medical officers and epidemiologists on the review committee, meaning you’d have to look at their reports for the full story.

      A point here: if someone has presented what you wrote to me as the full story, that’d be misleading as it’s leaving out the rest of the work.

      I’m not going to chase that up, sorry – I have other things to do. Some general thoughts though:

      There’s a bigger picture to look at to work out if statistics show something biologically meaningful. That involves more than taking initial statistics “as is”. I can spot a few reasons why follow-on examination of this data might find it’s OK:

      One is that you really need to consider the ‘natural’ rate of miscarriage / spontaneous abortion; if the rates observed with vaccination falls within the range of miscarriage / spontaneous abortion without that vaccine, then that vaccine isn’t adding to the miscarriage / spontaneous abortion rate.

      It’s not my area of research, but the rates reported with the vaccine seem to be lower than the general miscarriage / spontaneous abortion rates. If so, then the vaccine isn’t adding to the miscarriage / spontaneous abortion rates.

      This is made more confusing for those that don’t do statistics because data always shows variation. The question isn’t if there is variation, but if the variation seen is meaningful, is something needing to be taken note of. Sorting that out goes beyond “raw” statistics.

      (As an aside: I’m a bit fussy about data; I’d have had the statistician include these background rates in the tables in the document, but then that may just not be how their teams do this work; it might routine that those aspects are covered later.)

      Another point is that you’d want to look take into account the case history of these women. Abortions depend on age, past medical history, etc. The statistician may not have had access to that data (and may not have permission to, either; there’s quite a lot of control of private of medical data), and may not be appropriately qualified to look at it (it’s medical case work, not statistics).

      These and other reasons may be why the statistician referred this on — you’d have to look at what was done by the medical officers and epidemiologists.

      Just a thought for the future: when asking questions, it’d really helps to provide direct links to the things you are talking about. Aside from saving the person replying time, it’d ensure that they are looking at the same thing that you are referring to!

      (On sciblogs you should be able to include two links without your comment getting held up; any more and it’ll look to much like spam!)

      • If you had read the Product Mongraph, you would see, that there were no well controlled studies in pregnant women. In fact the evidence of foetal safety just isn’t there either. Regarding inactivated vaccines being harmless, will beg to differ there. Try telling that to parents of babies that have died or are disabled post Dtap. There is a special Pregnancy Register for those who have received the HPV vaccine Gardasil and Gardasil 9. This seems to me like shutting the gate, after the horse has bolted. One thing is clear, you have not read the trial data. Please indicate where you believe I will find evidence of any true placebo being used in the clinical trials. The adverse outcomes, reveal a great deal, which is not surprising, when you consider the potential actions of the adjuvant and the excipients that were the ‘placebos.’ Did you read the Clinical review and the Statistical review? I have no wish to contact the person you recommend. I do not consider her to be an expert on this subject. You have made your position clear.

  • There are no adequate or well controlled studies for pregnant women and Gardasil 9. The vaccine has not been studied for safety for children under 9 years of age, so babies will be included in this.
    2006: According to the Gardasil 9 package insert, 1,028 women who were injected with Gardasil 9 became pregnant during the course of the clinical trials along with 991 women who had been injected with Gardasil. Overall, 14.1% of the Gardasil 9 women suffered adverse outcomes while 17.0% of the Gardasil women suffered the same fate. A total of 313 women either lost their babies to spontaneous abortion or late fetal death or gave birth to children with congenital anomalies.
    This population was further broken down into those who became pregnant within 30 days of an injection and those who became pregnant more than 30 days post-injection. The charts are below.
    OUTCOME WHEN INJECTED WITHIN 30 DAYS OF PREGNANCY ONSET
    Number of pregnancies
    Type of vaccine
    % abortion/stillborn
    Lost Babies
    62
    Gardasil 9
    27.4%
    17
    55
    Gardasil
    12.7%
    7
    OUTCOME WHEN INJECTED MORE THAN 30 DAYS BEFORE PREGNANCY ONSET
    Number of pregnancies
    Type of vaccine
    % abortion/stillborn
    Lost Babies
    960
    Gardasil 9
    10.9%
    105
    933
    Gardasil
    14.6%
    136
    Note: The numbers from these two charts do not add up to the total number Merck stated in the first paragraph. That is because in the ’more than 30 days’ group there were also 20 cases of congenital anomalies after Gardasil 9 and 21 cases after Gardasil.
    Merck stated in the package insert, ”The proportions of adverse outcomes observed were consistent with pregnancy outcomes observed in the general population.”
    Unless they are talking about some country other than the United States, this is not true.
    According to the CDC’s 2006 publication on fetal mortality, the rate of spontaneous abortions and fetal deaths in the United States was 6.05/1,000 pregnancies or 0.605% – hardly 10.9%, much less 27.4%, and certainly not ’consistent with outcomes observed in the general population’ of the United States. Thoughts?

      • You’re a bright woman, the clues are in the posting..CDC stats for 2006, The Clinical review by S. Yang and the wealth of information, from the Product Monograph itself. Maybe Grant could respond, given the reply was in response to him, not you, or has he asked you to help him out? By they way, no argument intended, just stating some home truths. As far as how I have set it out, don’t waste your petty attempts to discredit my postings. Fortunately intelligent parents are now reading trial data outcomes and will not be swayed by keyboard warriors, Skeptics and those who believe having a Ph.D or medical degree, gives them a monopoly, on understanding immunology, vaccines and clinical trial methodology. Perhaps it is time you all tried demonstrating some humanity and realise how far you have become disconnected from public awareness.

  • Fiona,

    “Thoughts?”

    With all respect, I’m now finding it hard to take this as sincere, as you appear to have ignored my earlier reply, and appear to simply be pushing a barrow.

    Nevertheless –

    I have no way of checking the line of numbers you offer as you don’t provide links to the source.

    That said, googling “Gardasil 9 package insert” gives: https://www.fda.gov/downloads/biologicsbloodvaccines/vaccines/approvedproducts/ucm426457.pdf

    which point out,

    “These rates of assessed outcomes in the prospective population were consistent with estimated background rates.”

    (i.e. that the rates of abortions observed with the vaccine look to be the same as the rates of abortions in the population-at-large)

    It also points to two studies and notes,

    “In both studies, rates of assessed outcomes did not suggest an increased risk with the administration of GARDASIL during pregnancy.”

    This also addresses your question about foetal safety, too.

    “One thing is clear, you have not read the trial data.”

    I said I looked at the rates reported. Just because someone didn’t quote numbers back at you doesn’t mean they didn’t consider them. I took the time to explain to you in words what I think you needed to understand to realise that the the data isn’t making the claims you have read somewhere, and I focused on that. You have to look further than the raw data: raw data must be set in context, confounders checked, etc. I went on to point out some likely reasons why the raw numbers might not be an issue when the larger picture is taken into account.

    “Please indicate where you believe I will find evidence of any true placebo being used in the clinical trials.”

    That would appear to be your interest, so why should I have to? (I’m not your servant, right!) I believe Helen wrote about this not long ago; you’ll want to read what she’s said.

    “Did you read the Clinical review and the Statistical review?”

    I took time to answer the question you asked. (Why would I do more than needed to answer it?)

    “I have no wish to contact the person you recommend.”

    Well, I gave you a suggestion of someone who knows this area better than me. While you’d don’t have to ask her, of course, it’s wise to learn from those that know an area well (a point I mention in this post: https://sciblogs.co.nz/code-for-life/2017/04/12/please-dont-share-vaccine-concern-posts/ ).

    “I do not consider her to be an expert on this subject.”

    She is knowledgeable about vaccines. A quick look in PubMed shows that she is an author on over 30 papers on vaccination, including several specifically on the HPV vaccine. She’s also recently been appointed to the WHO global advisory committee on vaccine safety.

    “You have made your position clear.”

    I have no idea what you intend by this.

    Also, re:

    “There is a special Pregnancy Register for those who have received the HPV vaccine Gardasil and Gardasil 9.”

    I have other writing to do, so I have to leave this, but a thought here: best to look first to ordinary answers first, they’re more likely to be right. You offer extreme (and unlikely) possibilities ahead of simpler and more modest ones. I think you’d help yourself if you wrote down all the possibilities and start with the simplest and less “exciting” first — the ones that don’t involve people “hiding” things, and so on. Vaccines get a *LOT* of scrutiny: there’s very little likelihood that you’ve uncovered something specialists have missed.

  • Anyone know of archives for rubella immunizations and rubella incidence?

    Rubella being more of a winter disease has the incidence been affected by warmer houses in NZ?

    The old coal fires didn’t heat the bedrooms. Electric heater use increased – electricity generation in NZ increased about 6 or 7 times from 1950 to 1970. Anyone compared the effects of house temperatures vs vaccinations on rubella incidence?

  • I’m a bit out of time to chase down sources (I’ve a plane to catch), but I think I mentioned records of incidence in this old post, Rubella: not a benign disease if experienced during pregnancy:

    https://sciblogs.co.nz/code-for-life/2010/02/10/rubella-not-a-benign-disease-if-experienced-during-early-pregnancy/

    I think you’d find that the dominant contribution to reduction of rubella is the introduction of the vaccine. For example after it was introduced, incidence of rubella-induced deafness dropped sharply to very low levels and has stayed that way. Prior to that there was an epidemics of deafness in NZ esp. around 1962 & 1964. If it were heating, it’d be a much slower and mixed decline, and really we’d still have it because we still have a lot cold houses.

    Anecdotal (but there will be numbers somewhere) there’s a lot old & cold housing in NZ. Ask anyone who lives south of the Bombay Hills! 😉

    (Or who lives in the southern part of NZ; my house is in Dunedin – wooden, no wall insulation, no double glazing, very typical down there, and mine is a better house than many. It’s warm on sunny winter days as it gets the sun well, but on cloudy days… no. Not warm at all.)

    As a generalisation, I would think ‘true’ warmer housing is mostly the preserve of those whose houses were built from the (late) 1970s onwards, or who have invested a fair whack into insulating the walls. (It’s not cheap to do that properly; you have to open up the walls, then redo them. The filler stuff that’s advertised is a flawed idea.)

  • Thanks Grant.
    You wrote: “New Zealand has experienced several epidemics of rubella, with particularly large ones in 1959/60 and 1963/4. Since 1970, rubella vaccination has been part of the vaccine schedule in New Zealand. Outbreaks have been observed in 1990, 1993 and 1995, ”
    and you say: “If it were heating, it’d be a much slower and mixed decline, and really we’d still have it because we still have a lot cold houses”
    However the amount of electricity generation from 1950 to 1970 showed a very rapid increase – a factor of 6 or 7 times. The change from heating an older house to a newer one does not override that factor.

    It may take a sufficient pool of cold families before an outbreak of rubella can occur.

    I am also thinking that young pregnant women when shifting into their new lodgings may not have been able to afford the heating they had with their parents.

    Will take a while to find data on family incomes and the proportion being spent on electricity over the years.

    Maybe the outbreaks in the 1990s have something to do with immigration, and lack of ability to heat but if vaccination is on the schedule why would immigration make any difference?

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