Japonica

Least controlled? Australia's at 95% compliance. You should be a shining model to other countries of the world of how well the vaccination program works. So far in 2009, you're at 26.0/100,000, more than the whole year of 2007. I'm only discussing pertussis right now because that's the conversation I'm having with PL (and other posters) who assert that the pertussis vaccination program as it is works, is effective, and saves lives.

You want to talk about failure rates with the other vaccines, sure, why not, I'm sure some of the other posters will humor you and give you the stats and info...or if you're really keen, why not find some yourself. To quote you, I don't have the time or effort either, with 2 small kids to chase after. But just from memory, the latest HiB outbreak, about 40% were fully or partially vaccinated, the last mumps outbreak in Canada, about 60% fully or partially vaccinated...It's not up to me to argue failure rates with you. If you vaccinate, why does it matter to you anyway?

But then there's more to this issue than just efficacy, at least to me. There's safety, composition, adventitious agents, clinical trials, epidemiology shifts, serotype replacement, epigenetics...efficacy is just one small drop in the bucket...

Princess Leia

Japonica,

I'll have to answer your post in parts as it is pretty long! I have a 3 year old at home and work part time. I will try and get around to the other segment when I can. But here goes for now....


This study was a review of a total of 52 studies. So given it’s a review of the literature, I think that the 84% efficacy found is a reasonably solid result.

There is another study that indicates that receiving a 3 component acellular provides protection through to age 6, two years after the last dose. Many countries now have 4 doses. http://www.ncbi.nlm.nih.gov/pubmed/1...gdbfrom=pubmed So possibly, it’s not as bad as you might think. The problem of waning immunity appears to be fairly limited because even now, the total number of pertussis cases and deaths is fewer than before vaccination.
Given that pertussis is highly contagious and prior to vaccination, just about every child colonised and carried it then what is the alternative? Every vaccinated person that gets pertussis and spreads it around would get it anyway naturally in the absence of herd immunity and with worse outcomes such as longer coughing spells and a greater dependence on antibiotics to treat it. Yes, immunity waning is more problematic in pertussis compared to other vaccinable diseases, but in my opinion it does the best of a difficult job. Again, you can see that by looking at the big picture of total number of actual cases prior to vaccination and afterwards.

Where does the 95% figure for Australia come from? According to Medicare http://www.medicareaustralia.gov.au/...ics.jsp#N108FC it’s 91% for 1 year olds, 93% for 2 year olds and 88% for 5 year olds. The Australian vaccination rates hasn’t always been that high. The current figures are as at 2008. Back in the late 1990s, it was only 87% for one year olds and 75% for 2 year olds. Back as the mid 1990s I’ve heard only 50% were vaccinated for some diseases. I don’t know the history of Canadian experience with pertussis and defer to your knowledge in the area, but I imagine there is a lot more to the difference in pertussis rates in the two countries than the way it might look at first glance due to differences in local conditions. A properly conducted study of the two countries would have to control for a fair number of factors. A more relevant comparison would be the number of pertussis cases total in Australia that would occur if Australian vaccination rates hadn’t increased since the mid 1990s.

Also the vaccination rate is patchy in different parts of the country in Australia and it’s noteworthy that many of the more serious outbreaks are taking place in areas known for low vaccination take up. The area where the little baby girl died of pertussis was Northern NSW, an alternative healthy living area where a third of children are reportedly not vaccinated. The Sunshine Coast where there has been a measles outbreak in Beerwah is another known area for low vaccination uptake – I believe that of the 21 cases diagnosed that all but one were unvaccinated and they aren't sure about the status of the other one? Interestingly, they have sourced the original carrier to a visitor from Nepal. So it goes to show that we don’t live in bubble in Australia.

More later if I can

Rob12paws

Please don't forget the mumps outbreak on Anglesey that I posted about the other day. With similar numbers to Beerwah, it's not exactly of epidemic proportions, but still noteworthy that out of the 23 confirmed cases only one was wholly unvaccinated.

In the quote from you above, can you please clarify for me whether you define "serious outbreaks" as "large in number", or "of serious pathology"?

homewardbound

Throwing spanner in works here... just wondering if those in the anti vax camp allowed their babies the vit K injection at birth?

comet555

Another slightly off topic question too.....

Who in the anti vax group would travel, or allow their children to travel into areas with known outbreaks or countries in general who still have high disease rates?

Rob12paws

No.

Rob12paws

Outbreaks of what?

Define "high disease rates". Which diseases?

Rob12paws

I'd like to know who in the *pro-vax* camp has had a booster jab for any "vaccine-preventable disease" in the last ten years?

Japonica

It's late here, so just a few comments...

About the studies and the 84%, we can toss studies back and forth all day. You can provide studies asserting that the vaccine is effective. I'll find some that question this. The fact that researchers are 1) looking at mucosal immunity and admitting that the current vaccines do a terrible job at this and 2) looking at carriage, colonization, and vaccine failure suggest to me that everything is not peachy keen with the vaxes...why would they bother? Research costs money, takes up time from scientists who could be doing other things. If the efficacy is working so well, why are they bothering to look into the issue any further?

And if the multi-component aP is so effective, how do you explain the results of the recent Canadian study I linked earlier? Those aP vaxed kids had worse immunity than the old whole cell group.

If the problem of waning immunity is "very limited," why are boosters required?

Again with the herd immunity...I guess we're going to have to agree to disagree on that one. To me, if there is a problem with the vaccine providing mucosal immunity as Dr Cherry points out and it means that children who are fully vaccinated cannot clear ACT and cannot fight off a pertussis infection, then to me, they will never contribute to "herd immunity" no matter how often they are vaccinated. It just won't happen, even with 100% compliance. That's just a shortcoming of the vaccine and has nothing to do with anti-vaccinators. That's something to take up with researchers, the drug companies, and government.

The stats I was quoting come from the CDI, vol 32, no.2, June 2008:
http://www.health.gov.au/internet/ma...ontent/cdi3202

I was looking at the coverage for 2 year olds, who presumably would have received all their initial series and boosters.

OK, so let's look at those numbers of cases nationwide since 1991 (this is using data from the National Notifiable Diseases Surveillance System:
http://www9.health.gov.au/cda/Source/CDA-index.cfm

Reported pertussis cases for all ages, nationwide...rates per 100,000
1991 1.8*
1992 4.5* these seem very low, I bet the system was just getting started
1993 24.7
1994 30.0
1995 22.9
1996 24.5
1997 56.9
1998 30.0
1999 22.8
2000 30.8
2001 48.4
2002 28.0
2003 25.3
2004 42.9
2005 54.1
2006 52.3
2007 25.4
2008 69.0
2009 26.2

So, even if we take your account for it and say that current vaccination ranges at 88-93% and if we also say that back in the mid 90s, it was anywhere from 50% to 75% (from your estimates), would we see cases of pertussis decreasing with increased vaccine compliance? But that is not happening.

As for reported cases, also keep in mind that doctors tend not to report atypical pertussis cases as pertussis, so it is also underreported...I found a BMJ article on this the other day...missed cases of pertussis among children...doctors tend to look for the "whoop." If there's no whoop or just a slight cough, they'll say it's bronchitis or something similar and will not bother with a culture and not report it as pertussis. This happened to me. I had a "bronchitis" that lasted months, was on 4 types of antibiotics, all to no effect, and a heavy hitting prescription cough suppresant (he told me it was never given to kids, but made an exception for me since I was coughing for about 10 weeks) that worked to shut down the cough mechanism in the brain. My GP refused to take a culture, knowing that I was vaccinated for pertussis, therefore in his mind, it was out of the question that vaccines could fail. So, I went on my merry way, spreading pertussis through the school for weeks...and this is a usual occurrence here.

As for a Canadian-Australian comparison, that's true that you cannot do a straight comparison across the board without controlling for a lot of variables. However, it is a starting point for further research. We have roughly the same population, standard of living, medical system, vaccination schedule, yet with our coverage about 11% less than Australia's, logic suggests that we should have a higher rate of pertussis from all those thousands (or hundreds of thousands) of unvaccinated kids roaming around. But the numbers don't indicate that. Of course, we could have more cases that are unreported, but then so could Australia...

Yeah, it can be easy to point to deaths or outbreaks and say, "Oh, it's the anti-vaxers' fault.....this area is known for that kind of people." But just as often, we can also find cases of vaccine failure and until anyone knows for sure what the vaccine status (and health status!) was of all the people involved, then it's just speculation. Being unvaccinated (or undervaccinated) does not make anyone an instant magnet for vaccine associated diseases...I've had friends expose their children to chicken pox at least 5 times (so they could get it as children and not risk the side effects as adult cases) and the kids had either such a strong immune system or somehow gained previous immunity that they never caught it. A strong immune system and good health is more than what comes out of a needle.

comet555

I have, I had to have a booster for Rubella (possibly the whole MMR, not sure now).

I had no issues having the booster because vaccines are not 100% effective. I don't dispute that at all. By having the booster it protected me (and any future babies) against the effects of rubella.

Japonica

Again, what countries, what diseases?

My two unvaccinated children have been to Europe, Australia, meandering through some of the germiest airports imaginable, meeting people from all over the world. They never even catch a cold, lucky buggers.

comet555

I wasn't avoiding your question, I just only had about 30 seconds to respond before I left to pick up the oldest from school.

I wouldn't consider Europe to be a country with a high disease rate, I would typically think of more third world countries.

Here are some scenarios then for you to answer:

- would you send your child to school if there were cases of measles or mumps reported, or would you keep them at home? This is just general curiosity because if there was a serious disease going about then I'm sure most parents would do the same thing, vaccine or not.

- would you avoid travel to areas (Africa, Nigeria, etc) on the off chance that you might be exposed to things like Polio, measles, etc? Now it's one thing to say you'd never go there because you don't have an interest in it, but what if you really wanted to see parts of Africa.... would you go there if you were unvaccinated and there was a chance you might catch one of those diseases? I know there's plenty of other diseases to catch that don't have vaccines, so as I say I'm just curious.

I fully admit that vaccines aren't 100% effective, I'm proof of that. I would like to see them keep researching and making things better. But I don't think things will improve if large numbers of the population stop vaccinating.

Rob12paws

Not an option. As an unvaccinated child, my daughter is officially excluded from school in the event of an outbreak of "vaccine-preventable" illness. AFAIK, it is the same in most countries with a more relaxed attitude to vaccination. They seem to think she is a risk to other vaccinated children...

But to be perfectly honest, if there was an option, I would send my daughter to school. She has had mumps, rubella and varicella, and I would like her to get measles before she is much older (now 11). Having said that, she has been around children with measles in the UK and hasn't contracted it yet, so she may simply not be susceptible.

If my family wished to go to Africa for some reason (and I honestly don't believe we would), we would not get vaccinated for the privilege. I think many African nations require a Yellow Fever certificate, and I would not be prepared to submit to that one. In a country that had no requirements - and that is the bulk of the world, I would certainly visit as an unvaccinated person. Most countries - including the UK - have routine recommendations but very few make being vaccinated a condition of entry.

We'll see, won't we? I moderate on one of the largest vaccinations fora and the numbers of new members over recent months is staggering. Granted mostly American, but it is amazing how many people are suddenly becoming very concerned about the issue and are not vaccinating their children. It's still unusual to see people joining who haven't incurred vaccine damage, either personally or more often in their children, but even so, numbers making the decision not to vaccinate ahead of giving birth seems to be growing. Many have described vaccination as a mass medical experiment - something with which I personally agree - but time will tell the outcome.

What is really interesting is the number of health professionals who openly admit to not vaccinating - I read an article a couple of months ago that said 70% of HPs in the US did not vaccinate their own kids. How true? Don't know...but makes you wonder.

comet555

Rob12Paws, thanks for your honest answers. I was just interested as a matter of point of view, nothing I wanted to debate about. Just pure curiosity.

It's refreshing to see an anti-vaxer (not meant negatively!) that can debate in an intelligent fashion. I've seen too many vaccination debates where people look like raving loonies which sadly does nothing for your cause.

I've done my reading, to the best of my ability, and I still choose to vaccinate. It's my choice though just as every other parent has the same option. I can respect those that choose not too after they've throughly researched it and weighed the pros and cons. However, I'm afraid often people don't know enough to do it properly or don't bother to go into great detail beyond what they may have seen on Oprah or read in a crappy paper. I wish every put as much thought and effort into the decision as some of the posters on this thread.

Princess Leia

Okay, finally have a chance to read that big chunk of text you threw at me. Some thoughts follow.

So what does Hilary propose in response? That everyone be exposed again to the natural infection that caused significant morbidity before vaccination for pertussis started?


Again, people are good at highlighting the problems but are not coming up with any solutions. I think the key in the quote here is that while the vaccine does not protect against infection as much as other vaccines that people are spared of the severest aspects of the disease such as brain damage and pneumonia. Again, not a perfect system but does the best of a bad job.

So again, let's say this is agreed in the mainstream what is the alternative? In the UK there was a time in the 1970s when vaccination coverage for Whooping cough dropped from 80% to 30% and there followed 3 major epidemics in which 100 people died. Same with Japan in 1979 when coverage dropped to 10% due to vaccine safety rumours and guess what, they had an epidemic that resulted in 41 deaths. Are these scenarios better than the current system because people get natural immunity to clear ACT? For all of the current problems, we are not seeing the same level of deaths. The little baby that died here in Australia was the first death since 2000 I believe from whooping cough.


Actually, I learned on another board that there is discussion going on in some legal circles as to whether institutions that accept unvaccinated children and parents who do not vaccinate their children can be held to be negligent and sued for damages if proven to be the source of an infection that causes harm to a vulnerable person. See http://www.michiganlawreview.org/fir...accination.pdf
They now have the technology to trace the source of the disease to the originator. So it looks like a case of going both ways.

It's not clear yet what this impact will have on the overall effectiveness of the Prevnar program in the long term. This is something that is on the wait and see list. However, prolonged antibiotic use in the treatment of streptococcus pneumonia has also led to strains evolving that are very difficult to get rid of. Without the vaccine then antibiotics is the usual course of action when carriage leads to colonisation and infection. So there is no easy answer.

Again we can talk about all the problems with specific vaccines until the cows come home. There is no denial here from me, as with the vast majority of medical procedures and pharmaceuticals there are risks and complications involved. Vaccination is not particularly special in that regard. However, it cannot be denied that total deaths and morbidity has been reduced since vaccination and programs should only be discarded if it can be shown that there is no benefit compared to before vaccination was introduced. Again this all has to be weighed up against what alternative would you propose which would lead to less death and morbidity than we have now? I'm still waiting to hear a bit more about that.

Anyway, that's enough from me.