Friday, June 20, 2014

Work with anthrax, why get vaccinated?

The phrase "safe and effective" is frequently used in regards to vaccination. An increasing number of vaccines is "recommended" (in a mandatory sort of way) for an ever larger number of people by the Center for Disease Control's (CDC) own Advisory Committe on Immunization Practices (ACIP).

Last week more than 80 people who work at the CDC in Atlanta were possibly exposed to Anthrax. It's unknown how many of this group may already have been vaccinated against anthrax, but 27 of them were vaccinated (in addition to taking antibiotics) in an attempt to reduce their risk of actually becoming ill. Fortunately, no one seems to have come down with
any form of the illness, and hopefully no one will.

In reviewing the CDC's own statement about this unintentional exposure of their lab personnel to anthrax, it is surprising that there is no affirmation indicating said personnel were already vaccinated against the pathogen with which they were working.

It seems that vaccination against anthrax is not mandatory for at least some of those who are involved in actually working with live cultures of this bacteria. Why? After all, vaccines are "safe and effective" and there is an anthrax vaccine available. Why? This is the very agency whose recommendations for all manner of vaccines is taken as gospel truth and implemented with the force of law. Many people are unable to keep their jobs or go to school unless they are vaccinated against a variety of pathogens - yet it seems that at least some of the people who are actually handling (and thus at higher risk of exposure ... as clearly demonstrated by recent events) are not vaccinated against the very germ to which they are at risk of exposure? Huh? Many in the military are not at such direct risk of exposure, yet are required to be vaccinated against anthrax - and the package insert states that yearly "booster" shots are necessary.

Perhaps those working in the lab involved with this incident were given the choice to decide for themselves which risk/benefit ratio they were willing to accept (either when they began working in the lab or when this risk of contamination was discovered) - if only this were the case for all.

Tuesday, June 17, 2014

Measles mortality - Pakistan

The following link scrolled across my Facebook feed, the writer lamenting the fact that parents in Pakistan are questioning the use of vaccines in the midst of a measles epidemic - no link to an original article, though.

The writer states there have been 100 deaths so far, out of 15,000 cases in 1 province (Khyber Pakhtunkhwa) - a death rate of 0.66% based on the information in this letter to the editor.

But it isn't measles that is killing Pakistan's children - their newborns and neonates die at alarming rates from prematurity, birth asphyxia and birth trauma, and sepsis ... problems that are symptoms of systemic problems - problems that are amenable to trained midwives, prenatal care and good nutrition during pregnancy, and a higher level of care, when necessary.

If they survive their first year of life, it isn't measles that kills them (not directly, anyway) - it is acute lower respiratory infections, diarrhea, other non-communicable diseases, and injuries.

But looking at UNICEF data it seems that Pakistan has made great strides in improving their
child mortality stats:

And perhaps the high coverage of Vit A dosing is why their measles deaths are (relatively) low!

The question that is left begging, is why do we spend huge sums of money, time, and talent on vaccination instead of raising the standard of living - education and economic development has a huge impact on health - as then people are able to afford a healthier lifestyle - like electricity or gas so they aren't using cow dung to cook their food inside their dwelling, like electricity so they can have a refridgerator to keep food from spoiling, like access to clean water, and indoor toilets so their waste is kept separate from the source of their drinking water, money to buy higher quality and more nutritious food.  

Perhaps the reason people are avoiding vaccination is because it has been used as a ruse (in Pakistan no less!) to obtain DNA in an effort to identify terrorists and their locations.

Regardless, vaccination should be accepted freely by parents or adults - not forced upon people for any reason. Doing the right thing, in the wrong way, makes the right thing wrong - it doesn't make the wrong means/method right!

Monday, June 16, 2014

Whooping Cough - let's hack at facts ...

The following link scrolled through my FB feed today:

Whooping cough is not fun - I had it as a child and remember a house call from our family physician and steam treatments in an effort to help me breath (I was likely 3-5 years old at
the time). I'm not sure if I had received the vaccine. I don't blame parents (or anyone else)
who wants to avoid getting ill - and there is reason to believe that vaccines reduce risk of
disease. But even the best intended interventions can have unintended consequences (many
of which are discovered after the fact) - and for this reason we should be free to determine
whether or not to receive, or decline, vaccination for anything.

In Cali, of those for whom they had a vaccination history (almost 3/4 of peds cases), only 9% had never had a pertussis containing vaccine, so at least 2/3 of cases had had at least 1 dose of pertussis vaccine.
This link was provided in the article above:

If most cases have been vaccinated (to one degree or another) it begs the question of effectiveness (see below about b. parapertussis) - but there is also research implying that any risk reduction (I won't call it "protection" - we try to consider these two, different concepts equivalent when they are not) wanes farely quickly (within a few years of receipt of the vaccine) so it may be necessary to re-vaccinate frequently in order to maintain whatever benefit of risk reduction you may obtain from vaccine use. 

There is research linking pertussis vaccine with the rise of b. parapertussis, a related organism producing nearly identical symptoms;  I suspect this is like anti-biotic resistance, a lessen we are only beginning to learn. 

Also, the recently vaccinated may well be reservoirs for infection (and so they may also play a role in the spread of the infection, not just the unvaccinated) - here's a link to a study that showed this in baboons: 

Lastly, there are reports (both anecdotal and in the medical/scientific literature) of the use of high doses of Vit C as a treatment modality for pertussis ... seems to have a direct action against the bacteria as well as against the toxin it produces. It's been given either orally or intravenously.

Vaccination isn't without risks ... the decision to vaccinate (or not) should be made freely, without coercion or manipulation. Each parent/adult should decide for themselves which risk/benefit ratio they wish to accept.