Vaccine advocacy 101

I recently finished a 2-year stint as an American Society for Microbiology Distinguished Lecturer. It’s an excellent program–ASM pays all travel expenses for lecturers, who speak at ASM Branch meetings throughout the country. I was able to attend Branch meetings from California and Washington in the West, to Massachusetts in the east, and south as far as El Paso, Texas, with many in-between. Each Lecturer selects several topics to speak on, and the Branch chooses from those which they want to hear. Mine included basic research (zoonotic disease, antibiotic resistance) as well as science outreach and advocacy topics (zombies, vaccines).

My talk on vaccines covered vaccine hesitancy and denial, the concerns some parents have regarding vaccination, and the way social media and celebrities contributed to the spread of vaccine misinformation. Inevitably, someone would ask in the Q&A or speak to me afterward inquiring, “But what can I do? I don’t feel I know enough about why people reject vaccines, and feel helpless to combat the fears and misinformation that is out there.” These were audiences of microbiologists and other types of infectious disease specialists–people who are very likely to be educated about vaccines and vaccine-preventable diseases, but who may not have followed the saga of disgraced former physician Andrew Wakefield, or aren’t familiar with the claims of the current anti-vaccine documentary, Vaxxed, or other common anti-vaccine talking points.

To help fill this gap, I recently published a paper in Open Forum Infectious Diseases,” Vaccine Rejection and Hesitancy: a Review and Call to Action.” As the title suggests, in it I give a brief overview of some of the figures in the anti-vax movement and the arguments they commonly use. I don’t go into rebuttals directly within the paper, but the supplemental information includes a subset of both anti-vax literature as well as several published rebuttals to them that interested individuals can look up.

I also briefly review the literature on vaccine hesitancy. Who fears or rejects vaccines, why do they do so, and how might we reach them to change their minds? This is really an area where many individuals, even if they’re educated about vaccines and infectious disease, lack a lot of background. As I note in the paper, many science-minded people still think that it’s enough to just educate people about vaccines properly, and that will be enough. While accurate information is indeed important, for many individuals on the vaccine-hesitant spectrum, it’s not only about misinformation, but also about group identity, previous experience with the health care field, and much more.

Still, vaccine advocates can get involved in a number of way. One of the easiest is simply to discuss your own vaccine history in order to normalize it. I regularly post pictures of my own vaccinations on social media (including my public Facebook and Twitter accounts), and those of my kids*. In over 17 years of parenthood, their vaccinations have all been…boring. These “uneventful vaccination” stories are the ones which rarely get told, as the media focuses on “vaccine injury” stories, in which the injuries may or may not actually be caused by vaccines. Those interested in promoting vaccines can write letters to the editor, get involved with local physicians to speak with hesitant families, break out and be political about vaccine exemptions; there are a number of ways that we can work to encourage vaccination and keep our children and our communities healthy (again, explored in more detail in the manuscript).

Figure 1: Examples of photos posted to the author’s social media accounts. Panel A: The author (middle) and her older children after receipt of seasonal influenza vaccines. Panel B: The author’s youngest child at Walt Disney World, wearing a shirt saying “Fully Vaccinated. You’re Welcome.” Both techniques can serve as conversation-starters around vaccination.

 

I hope this paper will serve as a starting point for those who want to be a vaccine advocate, but just aren’t sure they know enough background, or know where or how to jump in. Whether you’re an expert in the area or not, everyone can do small things to encourage vaccines and demonstrate your trust in them. Those of us working in the area thank you in advance for your help.

Reference:

Smith TCVaccine Rejection and Hesitancy: a Review and Call to Action. Open Forum Infectious Diseases, 2017, in press.

 

*AKA, how to get your kids’ pictures into a scientific paper.

Another “Frontiers In” journal steps in it

Almost a year ago, I wrote about a terrible article that was published in the journal Frontiers in Public Health. FiPH is a legitimate, peer-reviewed journal, and they had just published a manuscript that was straight-up HIV denial, titled “Questioning the HIV-AIDS hypothesis: 30 years of dissent.” At the time, it was listed as a regular review article; after much outrage, it was re-titled into an “opinion” statement, but not retracted.

Now another “Frontiers In” journal has stepped in it, publishing a paper that has the anti-vaccine groupies frothing at the mouth. Published in Frontiers in Neurology this time, the paper, “Biopersistence and brain translocation of aluminum
adjuvants of vaccines,” is another review article using cherry-picked data to suggest that aluminum in vaccines accumulates in the brain and nervous system, causing “toxic effects.”

The editor of this paper is Lucija Tomljenovic of the University of British Columbia. Tomljenovic is a biochemist who has made a career, with her advisor Chris Shaw, of publishing commentary suggesting that vaccines, and particularly the HPV vaccine and vaccine adjuvants, are unsafe. It probably will not shock readers that Shaw and Tomljenovic are funded in part by the The Dwoskin Family Foundation and the Katlyn Fox Foundation, both of which are big players in the anti-vaccine community (see this post at Harpocrates Speaks for more background info on those foundations). Both appeared at the 2011 Vaccine Safety Conference, with other notable vaccine foes including the NVIC’s Barbara Loe Fisher and Lawrence Palevsky, a doctor who appeared in the anti-vaccine movie “The Greater Good” and apparently spoke on the topic, “Rethinking the Germ Theory.” That should speak volumes about the scientific validity of the movement. Meanwhile, Shaw specifically notes in his bio, “He has two children. The youngest has not been vaccinated.”

Who else appeared at that meeting? The first author of the current paper, Romain K. Gherardi.

Others have already posted stinging critiques of Shaw and Tomljenovic’s previous papers (even the World Health Organization has criticized them), so I won’t go further into the science–suffice it to say, Shaw & Tomljenovic are cited widely within the review, and several other important citations are self-citations of the first author, Gherardi. It should be noted that Gherardi also receives funding from the Dwoskin Foundation. Further, Tomljenovic served not only as the paper’s editor, but also as a reviewer–and the Frontiers In journals as a whole have a crazy-high acceptance rate of 80-90% in the first place. Another reviewer, Mark Burns, is on FN’s editorial board.

So while the anti-vaccine brigade will count this publication as a victory, it’s really just another case of a poor paper being published in a shoddy journal, shepherded to publication by a like-minded editor–and you could certainly at least argue there was a conflict of interest here, with both Gherardi and Tomljenovic funded by the Dwoskins and running in the same small anti-vaccine circles. Not that it matters to those who will gleefully cite this publication, of course. The only time they really want to “follow the money” or pay attention to such matters is when the money is coming from “Big Pharma” or the government or other such boogeymen in order to allege some kind of conspiracy. Too bad they don’t hold all publications up to such lofty standards, or recognize conspiracy when it’s actually in their own backyard.

 

Has Mayim Bialik changed her stance on vaccines?

I’ve written previously about Mayim Bialik, an actress previously on the TV show “Blossom” and currently on the “The Big Bang Theory.” She has a PhD in neuroscience and is a brand ambassador for Texas Instruments. Sounds great, right?

She’s also gone on the record stating that her family is “a non-vaccinating” one, and has promoted anti-vaccine literature on her blog. She apparently remains affiliated with the Holistic Moms Network, which includes anti-vaccine advocates Barbara Loe Fisher and Sherri Tenpenny as members on its advisory board, among others.

Because of the anti-science views she has expressed, and their chance to do real harm, I’ve noted previously that I’m very uncomfortable with Bialik being used as any kind of an ambassador for science and STEM education. And of course, anti-vaccine advocates have seized on her education and anti-vaccine stance as proof of their own correctness:

Now, she’s wondering why people think she’s anti-vaccine:

i would like to dispel the rumors about my stance on vaccines. i am not anti-vaccine. my children are vaccinated. there has been so much hysteria and anger about this issue and i hope this clears things up as far as my part.

…which is great, from my point of view. I’d really like to see Bialik advocate for vaccines, as she is firmly in the “crunchy” camp that all too often have a reputation as eschewing vaccines.

So did she really change her mind and her stance? If so, why? Or is she just jumping on the “I’m not anti-vaccine” bandwagon like Jenny McCarthy and others who claim not to be anti-vaccine, but at the same time spew vaccine fear and misinformation? Are her kids fully vaccinated, or did they only have the ones she mentioned previously (such as polio for international travel)? Is she walking back statements that are basically anti-vaccine talking points, and removing her support of anti-vaccine doctors like Bob Sears and Lauren Feder (or her own pediatrician, Jay Gordon)?

I really hope so. But I won’t hold my breath, and take her statements that she’s “not anti-vaccine” with a big grain of salt. After all, that statement, itself, is often an anti-vaccine talking point.

A conversation on smallpox and vaccination with Dr. William Foege

I can hardly do Dr. William Foege justice with a short introduction. He is one of the scientists who led the global smallpox eradication efforts. He developed the concept of ring vaccination, which targeted vaccination to those individuals around a known case of smallpox. This concept really made eradication possible, as it eliminated the need for universal vaccination.  Following the success of the smallpox campaign, he has worked tirelessly to increase global vaccination rates.  He led the effort to provide low-cost treatments for river blindness, resulting in an immense reduction in that disease in Africa. To read some of his amazing stories of his time in the field, check out his autobiography and chronicle of smallpox’s demise, “House on Fire: The Fight to Eradicate Smallpox.” He’s currently a fellow at the Gates Foundation after serving with the Carter Foundation and spending time as the director of the CDC. I could go on and on about his positions and awards, but suffice it to say, he’s a man who knows his stuff.

Dr. Foege was generous enough to answer my questions on vaccination and on smallpox in particular, after I ran across a particularly egregious anti-vaccine article which suggested that use of the vaccine actually increased smallpox cases, and did nothing to eradicate the virus. He also discusses what vaccine supporters can do to promote vaccination.

TS: You have certainly encountered resistance to vaccination in your day, and much misinformation about and fear of vaccinations. How did you overcome this misinformation and fear when working to eradicate smallpox, and later in your career to increase rates of vaccination overall in the developing world?

WF: The first anti-vaccination movements appeared immediately after Edward Jenner introduced smallpox vaccine in 1796.  I start from the premise that parents want to do the right thing for their children, and when they don’t it is because of misinformation rather than evil intent.  While resistance was found in many countries, the fear of smallpox overcame many of the problems.  When people observed a decreased risk of the disease in those vaccinated it was a powerful message.  Now parents don’t always see the disease impact and therefore have a harder time weighing risks.

An overwhelming concern in recent years has been the concern about autism.  We know the studies are good showing no increased risk in children who have been vaccinated, but parents are often left with the first impression when that concern was voiced some years ago and have no way of following the literature.  They have been poorly served by Andrew Wakefield.  We now know that his article in the Lancet was more than poor science.  He fabricated and received money from a lawyer.  He lost his license and yet he continues to give talks to parents looking for an answer to autism.  So he not only lost his license but he lost his way.

The research, by the way, is pointing to something that happens in the second trimester of pregnancy as a cause of autism, not something that happens after birth.

TS: Unfortunately, there is rampant misinformation today even in developed countries. A common anti-vaccine message is that “vaccines didn’t reduce” measles, polio, etc. A recent post even claims that “Small pox had greatly declined before the vaccine, increased after the vaccine in westernized countries, and was effectively eradicated in third-world countries due to the surveillance and containment quarantine program. The small pox vaccine was actually flawed, deadly, and ineffective, killing many and inflicting even more with serious adverse reactions. Small pox eventually exterminated itself when people had access to clean water, good food, clean living conditions, and proper hygiene.” (Source) As one who led smallpox eradication efforts in Africa and India, can you address the claim that what led to the elimination of smallpox was hygiene and quarantine rather than vaccination?

WF: I would never speak against clean water, good food, clean living conditions and proper hygiene, but that is not what eradicated smallpox.  Smallpox was almost a universal disease in Europe at the time the vaccine was developed in 1796.  Even in the 20th century there were an estimated 300 million deaths from smallpox worldwide.  The surveillance/containment strategy was based on using vaccine and getting it to the people at immediate risk because they were in the vicinity of people with smallpox.  Quarantine of smallpox patients in their homes was part of the strategy in order to reduce the number of people they could expose.  Visitors were allowed into their homes but only after being vaccinated.  The science of vaccine preventing smallpox is so abundantly clear that it is difficult to imagine one looking at the evidence and reaching the conclusions cited above.  The same is true of measles and polio.  Measles killed large numbers of children in Africa and Asia before vaccine was introduced.  The number of measles deaths was over 3 million a year in the early 1960’s and has been reduced by over 90% with the introduction of vaccine.  The people who ascribe the reductions of cases in measles, polio and smallpox to hygiene provide proof to Mark Twain’s comment that people who don’t read have no advantage over people who can’t read.

TS: Another common anti-vaccine claim is that “herd immunity is a myth.”  Would smallpox eradication have succeeded if this was the case? 

WF: Herd immunity is a complex subject.  There is no percentage of protection that will automatically protect others.  For example, 90% smallpox vaccination in a state such as Bihar, India, would still allow more susceptible people per square mile than 10% smallpox vaccination in most of the United States.  Measles virus is so contagious that it seeks out susceptible children with tenacity.  Introduce a person with smallpox to a room of susceptible children and only about a third will have smallpox one incubation period later.  Do the same with a case of measles and 80% will have the disease one incubation period later.

However, the concept is correct that increasing the number of persons protected in the population will decrease the chances that an organism will be passed on.  Not only is the vaccinated person protected but they can’t pass on the disease to others.  At high levels of coverage the remaining population receives great protection.  With surveillance/containment in smallpox eradication, our objective was to vaccinate all contacts of a person with smallpox and in that sense attempt to get 100% of close contacts protected, a form of herd immunity in a small defined group.

TS: You were instrumental in increasing vaccination rates in developing countries in years past. What are your thoughts on those who sit in a position of privilege in the U.S., eschewing vaccines and declaring vaccine-preventable diseases “harmless” while many of them have never seen a case of polio or measles?

WF: It would be nice to be protected from both the diseases and the small risks of vaccine.  But it doesn’t work.  The social contract requires that we all participate or the diseases will come back.  Every pregnant woman in this country should be aware that their child will not have Congenital Rubella Syndrome.  Why?  Because other children have been vaccinated against rubella and while they get no direct benefit, they have stopped the transmission of the virus to a fetus.  It is a social contribution they can be proud of providing.  Parents who withhold vaccines from their children are doing their children a disservice. They put others at risk if their children get a vaccine-preventable disease and they have also put their children at increased risk if they want to travel abroad as students or later as adults.  It has turned out to be a heavy burden for parents who have lost their children in recent measles outbreaks.  Indigenous measles has disappeared in this country so every case can be traced to importations.  But we have continuous importations and at times we have had large outbreaks because of the many children are unvaccinated.

TS: In your campaigns against smallpox, for global vaccinations, and for the distribution of ivermectin to treat river blindness, it seems like you have frequently played the role of diplomat in addition to scientist/physician: bringing together people from opposing “turfs” to come to a mutually beneficial understanding and outcome. Do you have any advice for those of us working on raising vaccine awareness in the current U.S. climate, and how we can work to better play the role of diplomat as well?

WF: First, know what we all want.  Our children to be healthy.  Both sides can’t be right (although as Lincoln pointed out they could both be wrong!) so what information is needed to reach a decision?  Immunization rates have improved on Vashon Island because parents got together to try and understand why the difference of opinion.  My belief is that Andrew Wakefield so poisoned the well that the facts have to be explained before there can be common ground.

I often tell students that health leadership today is found not in a title but in a person that can make a coalition work effectively.  We need many coalitions to discuss this at local levels to discover what do the anti-vaccination people need in the way of information.  There has been a movement by some pediatricians to say they can’t care for children who are not immunized.  I understand the feeling but feel those are exactly the children who need care because they already have a strike against them because of parents not understanding the science.

You can make a great contribution by making the science clear, encouraging feedback and providing reassurance to the parents who need support.  Autism is such a difficult burden for parents that they want answers.  They need help in getting what is known about the science.  They are not helped by erroneous information.

 

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Guest post: Finn’s story and why vaccination is so critical

Guest post by Jessica Parsons.

In November 2013 my son, Finn, was diagnosed at 3 months old with Ewing Sarcoma. The news that your child has a potentially life threatening disease at the beginning of their life is something that no parent is prepared for. Despite the scary news, he has completed 9 of the 14 rounds of chemotherapy without many problems. After 6 months of relatively easy treatment and ruled “cancer free,” he has overcome more than most grown adults. He has had two surgeries, ten blood transfusions and countless shots but still maintains a happy demeanor.

Every part of his treatment came to a screeching halt at the beginning of April, when fever and cough landed him in the hospital. Finn was diagnosed with pertussis (“whooping cough”) and the steady downhill slope of his health happened quickly: he went from a happy, smiling baby to one the doctors were not sure would ever come home. He was intubated, 100% sedated and medically paralyzed so that he could have a machine breathe for him. He was kept alive by intubation for 12 heart-wrenching days before he was able to slowly be weaned from the machines.

Finn hospitalized with pertussis
Finn hospitalized with pertussis

While watching Finn fight for his life, like every parent would ask, the persistent question of ” how could this happen to my baby?” kept playing over and over in my head. The doctors all agreed that because he could not be immunized, he had likely come into contact with someone who was not vaccinated and contracted the bacterium. Finn has beaten cancer by 9 months’ old but was almost taken down by a vaccine-preventable disease. Finn, like other immunosuppressed people, require herd immunity to survive and to help them finish their treatment without further struggle.

Finn recovered from pertussis
Finn,recovered from pertussis and beating cancer

Please think of Finn when you are considering whether or not to vaccinate your children, and remember that adults need booster vaccines as well to protect our most vulnerable. You can help support Finn at the Fighting for Finn site.

Jessica is an Executive Director of Financial Services and the wife of an Army Emergency Care Sergeant. She quit her job to take care of her son and has been a full-time bedside nurse for him since.

 

Mayim Bialik is a problematic ambassador for science

Mayim Bialik is an actress. She grew up playing TV’s “Blossom,” and recently has surfaced again on television as Dr. Amy Farrah Fowler, a neurobiologist on “The Big Bang Theory.” In between, she went to college and on to grad school, receiving a PhD in neuroscience. She is a “Brand Ambassador” for Texas Instruments and is this year’s featured speaker at the National Science Teachers’ Association conference.

She is also anti-vaccine, and a spokesperson for the “holistic mom’s network,” which eschews much that modern medicine has to offer and features several prominent anti-vaccine advocates on its advisory board.

Reactions have been mixed regarding her gig at the NSTA convention. Skeptical raptor thinks it’s OK as long as she’s just talking about her path to science (presumably, something like this article in Nature) (he clarifies here as well). Hemant Mehta (himself a math teacher) thinks not so OK, and I lean much more that way. As I noted on the Skeptical Raptor’s Facebook page, she may really like science, but the fact is that her position on vaccines undermines not only the science, but also the very *scientists* who do such work. She’s saying that some science is great, but other parts shouldn’t be believed and accepted. This is not cool or acceptable for such a big-name speaker.

That’s not to say that there are not controversial areas within science, or that everyone has to agree on every point. Certainly there are many areas which are fraught with controversy, and which we’re working to understand. But the basics of vaccines are not one of them. Certainly people would be outraged to see Michael Behe or another prominent evolution denier from the Discovery Institute or Answers in Genesis speaking at this conference, even though they may also have a PhD and, likely, a love of science. In Bialik’s case, she is *actively endangering the lives of others,* but because she’s a fellow science lover, it’s OK to give her a podium and additional notoriety? No.

Further, because she’s a PhD, many give her views on vaccines more weight than someone like Jenny McCarthy (who lacks any formal science training and is easier to write off), even though Bialik also lacks training in microbiology and immunology. In my opinion, that makes it even more important to avoid legitimizing her vaccine opinions.

Bottom line: if you love science, don’t actively undermine a part of it that actually affects the everyday lives of millions of people, and if you’re a company or organization who is promoting science, please don’t choose as a spokesperson or honored speaker someone who does this.

 

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NVIC and Mercola, sittin’ in a tree

Some who oppose vaccination do so, at least in part, because of concerns that pharmaceutical companies make profits off of vaccines. Many recommend alternative products, including supplements, in lieu of protective vaccinations.

As such, it’s a very…interesting…relationship that the anti-vaccine National Vaccine Information Center apparently has with supplement shill Mercola.com. Both sites are currently down with the following images, including Mercola’s logo on both sites.

NVICmercolaCertainly it’s no secret that the two organizations have worked together previously against vaccines, but this suggests more than just a casual friendship, not to mention the irony of NVIC shilling for Mercola, who’s been called a “snake oil salesman” and sells items of dubious medical value via his website. Does his “Health Liberty” coalition now run NVIC’s site?

 

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Why I vaccinate my kids

Being a new parent is exhausting. All of a sudden, you’re out of the hospital and on your own with this amazing, tiny human, and you alone are responsible for her care. You’re given reams of paperwork about feeding and sleeping, developmental milestones, red flags to look out for. You’re inundated with information you barely have time to look at. Mom is trying to heal from childbirth while barely sleeping, while her partner is trying to pick up the slack and pitch in as much as possible. You both fumble with the car seat, thinking that NASA must have equipment that’s easier to figure out. You obsessively check your sleeping baby to make sure she’s still breathing. You worry about every sneeze and try to decipher her cries. Is the diaper too tight? Is this acne normal? What do I do about her poor dandruffy head?

Do I vaccinate?

vaccineWilliam receiving the first of  his 2-month vaccinations

I know it can be scary. You might have heard from friends or relatives, or read on the internet, that vaccines can harm your baby. You may be concerned about autism, or think that “natural immunity” is better than that which develops from injections. You may think that the diseases she’s being vaccinated against “aren’t all that bad,” or that kids today receive too many vaccines. You might feel that your physician is “bought out” by “big Pharma” and that your health care providers are writing off your concerns.

I know you just want to do what’s best for your child. I feel you. I’m the parent of a teenager, a tween, and a 2-month old. Here is why I vaccinate my children.

William vax 2William receiving his vaccinations

I’ve spent almost 20 years of my life studying infectious diseases up-close and personal, not from random websites on Google. I’ve worked with viruses and bacteria in the lab. I respect what germs are capable of. I worry about vaccine-preventable diseases coming back because of low levels of herd immunity. I cry over stories of babies lost to pertussis and other vaccine-preventable diseases. As I’ve noted before, chicken pox has played a role in the deaths of two family members, so I don’t view that as just a “harmless childhood disease.” Vaccines have eradicated or severely reduced many of the deadliest diseases from the past: smallpox, polio, measles, diptheria.

But that’s not the only reason I vaccinate. I vaccinate because I’m all too aware of the nasty diseases out there that still don’t have an effective vaccine. My current work focuses on a germ called methicillin-resistant Staphylococcus aureus (“MRSA”), a “superbug” which kills about 11,000 people every year in the United States. We have no vaccine. I previously worked on two different types of Streptococcus: group A and group B. Group B is mainly a problem for babies, and kills about 2,000 of them every year. It leaves many others with permanent brain damage after infection. We have no vaccine. Group A kills about 1,500 people each year in the U.S. and can cause nasty (and deadly) infections like necrotizing fasciitis (the “flesh-eating disease”). We  have no vaccine. These are all despite the fact that we still have antibiotics to treat most of these infections (though untreatable infections are increasing). Infectious diseases still injure and kill, despite our nutritional status, despite appropriate vitamin D levels, despite sanitation improvements, despite breastfeeding, despite handwashing, despite everything we do to keep our kids healthy. This is why protection via vaccination is so important for the diseases where it’s available. If vaccines were available for the diseases I listed above, I’d have my kids get them in a heartbeat.

w after vax 1William with daddy, right after finishing his vaccinations

I’ve done my best to keep my kids healthy and safe. I nag about bicycle helmets and make sure they’re getting exercise. I make them eat vegetables. I don’t move the car until everyone is buckled up. My older kids were in booster seats for what felt like forever, as both were on the small size for their age. Vaccinations are just one more part of this arsenal. I’m well versed in the safety data and know that most vaccine side effects are minimal (fever, soreness at injection site). They don’t cause autism, or SIDS, or any of the other claims made by dubious sites such as Natural News or Mercola. They do save lives and prevent disease by training the body to recognize and fight germs.

My youngest recently went in for his 2-month shots. He cried a bit when he received them, but not any worse than he does when he needs to be burped, changed, or held. He slept a little extra that evening, but was back on his normal schedule the next day. At his visit, he received the oral rotavirus vaccine; his second Hepatitis B shot; his pneumococcal vaccination; and the combination shot including diptheria, pertussis, tetanus, polio, and Haemophilus influenzae (DTaP/polio/Hib). Each one I see as a small measure to support his health and safety, as well as my own peace of mind, knowing that I did what I could to protect him from infections that used to kill thousands of children every year. Some still do when vaccination isn’t available or accepted–measles killed over 120,000 people in 2012, most of them young children who hadn’t been vaccinated.

W after vax 3William at home after his vaccinations

We all try to do the best by our children. As a scientist who’s studied infectious diseases, vaccination is a no-brainer for me, and I worry for the children out there who are left undefended against these infections because of misinformation and wrongly-placed fears. I know these parents are trying to do right by their kids, but infectious diseases don’t recognize good intentions. As I sit here with my baby breathing softly beside me, I am thankful for those who came before me and dedicated their lives to protecting children like him, and grateful that he will never have to suffer from infections that were the scourge of earlier generations.

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The Pap smear is no panacea, Katie Couric

Regular readers keeping up on infectious disease issues might have seen Seth Mnookin’s post yesterday, warning of an upcoming episode of the Katie Couric show  focusing on the HPV vaccine. Even though Mnookin previously spoke with a producer at length regarding this topic, the promo for the show certainly did not look promising:

“The HPV vaccine is considered a life-saving cancer preventer … but is it a potentially deadly dose for girls? Meet a mom who claims her daughter died after getting the HPV vaccine, and hear all sides of the HPV vaccine controversy.”

And indeed, reviews thus far show that unfortunately, Couric pretty much  mangled the issue and allowed heart-wrenching anecdotes to trump science (reminiscent of Jenny McCarthy’s appearance on Oprah). I won’t cover it all (you can view it here), but basically Couric allows stories about illness and death in the weeks following administration of the vaccine to go unchallenged, and brings on Dr. Diane Harper as her HPV expert (featured prominently in the anti-vaccine documentary “The Greater Good“). Dr. Harper believes the HPV vaccine is over-hyped, and that Pap screening is “100% accurate” so no HPV vaccine is really needed. This, frankly, is hogwash. Even with emphasis on screening, here in the U.S. we have 12,000 cases and 4,000 deaths from cervical cancer alone each year. (And in Mnookin’s post and in Matthew Herper’s Forbes post, both note that head and neck cancers can also be caused by HPV as well–but have no good screening process).

Even when HPV cervical infections are caught via screening, the treatment ain’t pretty. I’ve written before mentioning one such remedy–the LEEP procedure.  I had this done several years ago, after a Pap smear came back with abnormal cells and positive for HPV DNA:

“Next, a woman with abnormal cells can expect to undergo a LEEP procedure, where portions of your cervix are removed with a burning electric wire under local anesthetic, and the foul smoking remains of your cells are sucked up into the smoke shark, “a sleek, powerful, smoke-eating machine.” [And one gets to look forward to “coffee ground-like discharge” for up to several days following the procedure, due to the materials they use to stem the bleeding cervix]. After LEEP, side effects may include infection, hemorrhage and possibly cervical incompetence.  These are rare, but if we’re talking vaccine side effects versus possible outcomes from HPV infection, these types of outcomes need to be considered as well–not just death from cervical cancer.”

Being currently pregnant following such a procedure, cervical incompetence was something I was carefully monitored for. Nevertheless, it’s still been a huge source of stress throughout this pregnancy, as this is a significant cause of second-trimester miscarriage and there aren’t great, foolproof ways to detect it, or remedy it if it does occur. Harper acts as if finding HPV via Pap smears is like rainbows and unicorns, but it too has a risk-benefit equation, and I’d so much rather have received a vaccination than to have gone through that. And, some women’s treatments for HPV infections and cervical abnormalities are even more extreme than mine was.

This is why I had my now-almost-14-year-old daughter vaccinated for HPV, and why my pre-teen son will soon be getting his as well. There are multiple ways to prevent HPV-induced cancers, but the vaccine (in combination with routine Pap smears) is by far the least invasive and safest route, as multiple studies have confirmed.

Finally, the show was doubly disappointing because Couric has been such an outspoken advocate of colon cancer prevention, which was the cause of her husband’s death in 1998. While realizing this is a fluff talk show and not the kind of harder journalism she’s apparently now abandoned, she still failed to ask even the most basic of questions to the supposed HPV vaccine “victims” she featured on her show, nor to note during their segments that other possibilities may exist for the girls’ illnesses and death besides the HPV vaccine. In the second segment, Rosemary Mathis even admits blatantly doctor-shopping until one would “listen to her” about her daughter–in other words, give her a new diagnosis (vaccine injury). Why isn’t this even questioned? What did her previous doctors tell her about her daughter’s condition? Couric allowed ratings and anecdotes to trump actual science, potentially causing real harm to the public health. How disappointing that this is now part of her legacy.

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Student guest post: Seasonal Flu Vaccine: Why we need it

It’s time for this year’s second installment of student guest posts for my class on infectious causes of chronic disease. Fifth one this year is by Nai-Chung Chang. 

Of the many health problems that everyone is bound to have at some point, influenza, or just “the flu,” is one of the most prominent. In fact, we call the time during which it is most prevalent the “flu season”. It has now become a regular occurrence in the U.S. to just get a shot before the flu season hits, and be free of it for the rest of the year. In some cases, like me, people just decide not to get the vaccine at all. I say to myself all the time: “It is just the flu. If I do get it, I’ll just take a nap, and I’ll be fine.” However, there are serious complications with influenza if the individual is afflicted with certain diseases, making the vaccine a necessity. Even in the general population, influenza infections could lead to serious health problems, at a lower rate, that could complicate the daily lives of individuals.

Influenza is a generic description of a variety of strains of influenza viruses, including influenza A (H1N1, H3N2), and influenza B. It is a widespread virus, and can infect both human and animals, albeit with different strains. (1) The influenza virus is difficult to completely control since it constantly undergoes different changes through antigenic drifts and shifts, small and abrupt changes in the virus constructs, respectively. (2) It causes fever, coughs, sore throat, runny nose, and a host of other symptoms that target different parts of the body. In extreme, severe cases, it may cause the death of the infected individuals. It can spread from person to person up to 6 feet away through coughing and sneezing, spraying droplets containing infectious particles into the air. The droplets either lands in the other individual’s mouth, or is inhaled into the lung. Influenza is very contagious, due to the fact that it can infect others prior to the development of symptoms, as well as a period after. In addition, there exist asymptomatic carriers that can infect others without knowing. There are vaccines provided every year prior to the start of the “flu season:” a period of time in which the population is most likely to acquire the disease. Once the symptoms develop, it can be treated with antiviral medicine, such as Tamiflu (oseltamivir) and Relenza (zanamivir).

In addition to the problems that a regular influenza infection can cause, in individuals with certain diseases, complications could develop from the interaction between the influenza virus and the disease currently affecting the patient. In asthma patients, the attacks are often triggered by respiratory virus infection, whether by the virus particle itself or the inflammation resulting from the influenza symptoms. Also, the influenza viruses could augment natural responses to allergenic particles resulting in a more severe than normal attack; influenza patients with asthma are often hospitalized as the result. (3) In patients with cardiovascular disease, influenza infections represent a high level risk. The infection could destabilize existing plaques (blocks in the artery) in atherosclerotic patients. In addition to the acute responses from the destabilization, influenza infections could also induce chronic inflammation in the body, as well as reduced clotting ability. (4) For patients with diabetes, infection with influenza represents a high risk of hospitalization and death. In diabetics, the immune system is weakened, making it difficult to fight of the disease. In addition, the infection can cause fluctuation in the level of blood sugar in the patients, through natural immune responses, or lack of desire to eat due to the effects of the influenza symptoms. There is also an increased risk of acquiring pneumonia as a complication of the infection. (5) As in the case with diabetics, patients with cancer and HIV/AIDS are also likely to have complications due to weakened immune systems from both treatment and disease.

From the variety of complications that could result from influenza infections, one can now see that it is extremely important for an individual to receive the vaccines when available. In some places, vaccines are often offered free of charge, especially in workplaces that have high exposure risks, such as hospitals and research facilities. In addition to reducing the likelihood of being affected by influenza, flu vaccines have shown to have reduced the development and progression of other diseases such as chronic obstructive pulmonary disease (COPD). (6) For individuals with HIV/AIDS, vaccines are especially important since they are more vulnerable to infections. In addition, they must be aware of the type of vaccines they are using, since certain vaccines do not work sufficiently in people with immune-deficient issues. However, there exist other treatments for the prevention of the disease, such as chemoprophylaxis, that would allow these individuals to be properly protected against possibilities of infection. (7) With the prevalence of the influenza virus in both the U.S. and globally, it is important that an individual keep up with the most current vaccines, as they are designed to combat the most common forms that would appear that flu season, since the strains changes every year.

References:

  1. CDC. Seasonal Influenza (Flu). http://www.cdc.gov/flu/index.htm
  2. CDC. How the Flu Virus Can Change. http://www.cdc.gov/flu/about/viruses/change.htm
  3. Glezen, W. Paul. Asthma, influenza, and vaccination. Journal of Allergy and Clinical Immunology 188(6): 1199-1206.
  4. Madjid M, Nagahvi M, Litovsky S, Casscells SW, Influenza and Cardiovascular Disease. Circulation 108:2730-2736.
  5. CDC. Flu and People with Diabetes. http://www.cdc.gov/flu/diabetes/index.htm
  6. Poole PJ, Chacko E, Wood-Baker RWB, Cates CJ. Influenza vaccine for patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews.
  7. CDC. HIV/AIDS and the Flu. http://www.cdc.gov/flu/protect/hiv-flu.htm