potemkin
Inactive
http://www.medscape.com/prometheus/SRAM/2001/v05.n01/sram0501.03.fried/pnt-sram0501.03.fried.html
(Free registration required.)
Opposition To Immunization: A Pattern Of Deception
Edward R. Friedlander
[Scientific Review of Alt Med 5(1):18-23, 2001© 2001 Prometheus Books, Inc.]
Abstract
Several Internet Web sites opposing childhood immunizations are examined. Those sites that contain citations to scientific papers misrepresent their contents.
Introduction
Thanks mostly to immunization, diseases such as measles, polio, diphtheria, tetanus, and rubella are rare in the developed world. Today's immunizations work by enhancing the body's own immunity. Because they are effective, simple, natural, and prevention-based interventions, we might expect "complementary medicine" theoreticians to embrace them. However, opposition to immunization is common within the "alternative medicine" community, with many practitioners of the various schools denying its safety or usefulness.[1] Such opposition has been a factor in leading many people to become more concerned about risks of immunization than the risk of developing diseases that are no longer part of everyday experience in developed nations.
Although many chiropractors oppose immunization, many others strongly encourage their patients to accept immunization.[2] The Faculty of Homeopathy in Great Britain has a formal statement acknowledging that homeopathic remedies do not affect antibodies, and hence it does not recommend that homeopathy be substituted for standard immunization. Unfortunately many homeopaths ignore this statement. Recent US surveys of naturopaths and homeopaths,[3] and of chiropractors[4] revealed that some of each recommend immunization, and others openly oppose immunization. But in each category, the majority either declined to answer or said they left the decision to the family. This may surprise readers who pay their own physicians to give them well-informed guidance. Perhaps federal policies that call for complete immunization have affected the approach of these practitioners, many of whom would like to be reimbursed as legitimate primary care providers.
Outbreaks Among the Unimmunized
Many children in the United States are home-schooled for religious or philosophical reasons, and physicians tend not to monitor these children's immunization status.[5] In the United States, 15 states now allow children to forgo immunizations because of their parents' "philosophical" objections. In California, a parent need only submit an affidavit to obtain an exemption.
Outbreaks of infectious disease among communities receiving religious exemption from immunization showcase the effectiveness of the vaccines and the consequences of refusal. In 1985, measles raged through a Christian Scientist school, with 125 cases and 3 deaths.[6] In 1991, there were at least 890 cases of rubella among the Amish in 5 states, and over a dozen babies with congenital rubella syndrome in Pennsylvania alone.[7] These cases would have been entirely preventable with immunization. In a measles outbreak among the US Amish in 1987, there were 130 cases. The attack rate was 1.7% among immunized individuals, and 73.8% among unimmunized individuals. Two Amish died of measles in the following year.[8] In 1979, a polio outbreak paralyzed 14 Amish people in the United States; the outbreak spread to unimmunized non-Amish neighbors.[9] In 1992, a Netherlands epidemic of polio began in a religious community affecting 68 people, paralyzing 59, and killing 2. None of the affected were immunized.[10]
For some reason, Italian diptheria-pertussis-tetanus (DPT) immunization rates have been low for decades, with only about 50% coverage. So it is no surprise that people bring the disease home to newborn babies who cannot yet be immunized and who are most vulnerable to severe disease. One out of every 14 babies under 1 year of age is admitted to hospital for pertussis; of these, 1 in 850 dies.[11]
Measles is the most contagious of diseases. Since about 10% of people who receive the measles immunization do not become immune, only a high level of immunization ensures neighborhood safety. In the United States, 130 people died in the 1989-1991 outbreak alone. Among the urban poor, the cause is lack of immunization due to social and economic problems. Elsewhere, the epidemics have begun among "exemptors" and spread to people who had not responded to the vaccine.[12]
The Uncertainty of Vaccine Risks
Despite dark talk of conspiracies, the known risks of immunization, though small, are real and have been publicized by the Centers for Disease Control (CDC).[13] In addition, there is the theoretical possibility of autoimmune disease as a result of immunization. But so far, such a risk has not been demonstrated quantitatively, despite efforts to do so.[14,15]
A currently popular claim is that immunization can cause autism or other striking personality changes. The findings of relevant studies have been inconsistent, which is understandable given the way in which conscious or unconscious recall bias would influence reporting. If any cases of autism or striking personality changes occur in response to immunization, they must be very rare.[16,17] A scare about hepatitis B immunization causing multiple sclerosis failed to hold up under statistical study.[18]
Being a Good Neighbor
Despite the known and possible risks, there is a level of consensus otherwise rare either in science or politics that the health of the public is best served by requiring the usual immunizations. When you are asked to accept immunization, you are being asked to assume a small risk for the sake of not only your own health, but the health of your community. For example, as long as we maintain herd immunity in the United States, an individual who does not travel abroad will almost certainly not meet the polio virus. Citing the anti-immunization slogan, "The vaccine is more dangerous than the disease," a person may now increase individual safety at public expense by claiming a philosophical exemption. If such exemptions become widespread, herd immunity will drop, and epidemic disease will resurface. Much of the current anti-immunization rhetoric boils down to: "I don't care if my kid makes the others sick."
The DPT Fiasco
Pertussis (whooping cough) is a grisly disease that kills hundreds of thousands of children in the developing world each year. Antibiotics are largely ineffective against it. The disease can last for months, and permanent brain damage occurs in up to 4% of survivors from bleeding into the brain.[19]
Beginning in the late 1970s, activists in the "alternative medicine" community began urging people not to accept the DPT vaccine. Objections focused on the whole-cell pertussis vaccine. Prolonged crying, pallor, limpness, and/or seizures do sometimes follow this immunization, but the disease of pertussis is a far greater threat to community health than is the immunization. By the 1970s, because of the vaccine, pertussis was rare in the developed nations.
Because the immunity that the vaccine confers is incomplete, herd immunity is particularly important. In several countries, governments accepted the activist agenda. What followed is now history.[20]
In 1974, a year in which there had been no pertussis deaths in Japan, the Japanese government stopped immunizing against pertussis due to the anti-immunization "debate." In 1979 a pertussis epidemic resulted in over 13000 cases and claimed 41 lives.
Also in 1974, a prominent physician told the citizens of the UK that the dangers of brain damage outweighed the benefits. Immunization rates fell, and the annual incidence of pertussis increased from almost none to more than 100 per 100000 per year. Public confidence in the vaccine was reestablished in the mid-1980s and the disease has again become rare.
Pertussis was extremely rare in Australia until an early 1990s antivaccine campaign. Immunization rates dropped, and over 5000 people got sick in 1994 alone.
Sweden stopped immunizing in the late 1970s. During 1980-1983, the incidence of pertussis among children from birth to age 4 had increased to 3370 per 100000 per year, with rates of death and brain damage equal to those in the developing world.[21]
In the early 1980s the TV feature Vaccine Roulette and a book, A Shot in the Dark, told US audiences that the vaccine caused permanent brain damage or death. This was followed by lawsuits, manufacturers ceasing production, skyrocketing vaccine costs to cover liability, and the National Childhood Vaccine Injury Act of 1986. This compensation program has undoubtedly paid money to families whose children were not injured by vaccines, but it seems to be wiser social policy than leaving juries to evaluate scientific questions.[22] In 1994 the news media reportedly falsely that Miss America had become deaf as a result of DPT; her pediatrician confirmed that the actual cause was hemophilus meningitis, which now has been mostly eliminated due to a vaccine.[23]
Despite the scare, nobody has been able to demonstrate a statistical link or exhibit a distinctive pathologic lesion to support the claim of brain damage from DPT.[24] As of this writing, the Web site of the National Vaccine Information Center has no scientific citation less than 14 years old. DPT is still required for school entrance, and the 90 to 95% coverage seems to be enough to maintain herd immunity, with only a slight upward trend since the early 1980s. Outbreaks in North America occur primarily among the unimmunized and underimmunized, with most of the victims being either babies who have not completed their series or teens whose immunity has weakened. Outbreaks among well-immunized populations are rare, but do occur because the vaccine is only partially effective.[25]
Fabrications and Distortions
To discover why people would want "philosophic exemptions" from one or more immunizations, I examined the Internet sites of the anti-immunization activists. Here I found what I expected. There is rhetoric about "making informed choices," plus a mass of half-truths and (at most sites) outright, obvious lies. The links are mostly to other "alternative" medicine sites.
In particular, these people make a practice of citing scientific papers and lying about their contents. Several cite references to 1990s-era publications in refereed medical journals. None of the authors use their sources truthfully.
A Web site called "Dispelling Vaccine Myths" (www.unc.edu/~aphillip/www/vaccine/dvm1.htm) is typical. The author's most obviously untrue claims -- that immunizations have not made the diseases less common and that 29972 Japanese died of smallpox despite having been immunized -- are referenced only to the works of other anti-immunization activists.
The author also cites the Lancet[26] to claim that "Oman experienced a widespread polio outbreak six months after achieving complete vaccination." A check of the source shows this to be a cynical lie. Coverage was far from complete. Exposure was so massive where herd immunity was low that a few immunized children were not protected.
The author cites MMWR's account[27] of an outbreak of measles spreading from unimmunized people to vaccine nonresponders in order to support the claim that the vaccine is ineffective. The statistics presented actually showed that the vaccine gave a high level of protection.
He cites the New England Journal of Medicine (NEJM)[28] to claim that Romanian children have contracted polio from the vaccine. The article actually shows that polio was already common in the country, and that those children who already had polio when they were injected were more likely to develop paralysis -- a well-known phenomenon.
The site contains a fabricated quotation from a Swedish epidemiologist, and the statement that "England, Wales, and West Germany had more pertussis fatalities in 1970, when the immunization rate was high, than during the last half of 1980, when rates had fallen." This statement does not appear in the article to which it is referenced.[29]
The author claims that "oth national and international studies have shown vaccination to be a cause of [Sudden Infant Death Syndrome] SIDS." He cites no international study. He cites one unrefereed paper by one presenter at a scientific meeting, a review of 70 cases; the claim of having a statistically significant clustering of SIDS deaths is made without presenting any statistics.[30 ]
The author misrepresents an article in the American Journal of Epidemiology[31] as arguing that confounding could have masked vaccine as a cause of SIDS. The truth is that both participants in the discussion agreed that it could not.
The author claims that the Japanese found that the whole-cell pertussis vaccine was statistically linked to SIDS. He gives no references (and can't, because it is not true), but the source of the misunderstanding is probably a JAMA article.[32] SIDS, by definition, affects children during the first year of life. When the Japanese stopped immunizing babies under age 1, there were no cases of SIDS following immunization.
"Parents Advocating Vaccine Education" (www.unidial.com/~metroprint/pave2.html) misrepresents the Italian experience with pertussis. Citing a JAMA article[33] in which the vaccine was only 36% effective at the height of an epidemic (when people are inhaling huge numbers of bacteria), the author claims that this means the vaccine only works when the patient is not exposed. The author must actually know that pertussis bacteria are widespread throughout Italy, and there are always opportunities for exposure.
The remaining claims are not referenced. The ridiculous claim that rubella immunization places future unborn children at increased risk for congenital rubella syndrome is referenced only to works by other anti-immunization activists.
The author reports the views of an independent thinker on "stealth viruses" as fact, and claims these may be in vaccines. No mainstream virologist even writes about these hypothetical creatures.
The author cites reports of retrovirus fragments in vaccines, but fails to add that despite much effort, nobody at the CDC could grow them, indicating no infectious particles were present.
Finally, the author repeats the claim recently made by two indepoendent thinkers using their private methods,[34] that some diseases, such as childhood diabetes, are becoming more common, and perhaps immunization is the cause. If this were true, some honest scientist would have made a reputation by demonstrating a temporal relationship between immunization and the onset of diabetes. It hasn't happened. And if this were true, there would have been a tremendous upsurge in childhood diabetes when immunizations first became widespread. It didn't happen, and the mose recent work has shown no connection.[35] The author finishes by imputing the most vile motives to physicians, industry, and government.
When "Think Twice" (thinktwice.com/studies.htm) tells its visitors that "Science reported on a possible link between polio vaccines and the origin of AIDS," the author fails to mention that this was nothing more than a pair of letters about a Rolling Stone article whose author admitted it was idle speculation.[36]
The author cites "studies" (actually, only one study in JAMA) as support for the claim that asthma is more common in recipients of the pertussis vaccine.[37] A subsequent large study refuted the claim utterly,[38] and scientific misconduct was described in a previous study claiming a link.[38] In the original JAMA article, 16 of the 203 unimmunized children had already had pertussis, compared with 1 of 243 in the immunized group.
The author cites the Journal of Infectious Diseases,[39] alleging that DPT makes it more likely that a polio infection will turn paralytic. The article merely reported an illustration of the previously mentioned, well-known phenomenon resulting from injection during acute polio.
The author cites an increasing prevalence of hepatitis B among intravenous drug abusers despite the existence of a vaccine.[40] However, the author neglected to say that the vaccine never reached these people.
The author cites an old article in NEJM to claim that the original hepatitis B vaccine may have contained AIDS virus.[41] This was mere speculation at the time, and now we know it never happened.
The author cites another NEJM[42] article to claim that hepatitis B vaccine causes acute polyneuropathy. Actually, this was the report of a single case following immunization. Subsequent studies have shown no statistical relationship.
"Vaccinations -- Not Safe, Not Effective" (www.pnc.com.au/~cafmr/online/vaccine/vacc.html) cites a NEJM paper as support for the claim: "A report on a study of 11 healthy individuals to determine the effects of routine tetanus booster vaccinations showed that the vaccinations weaken the immune system of the recipients." What actually happened is that the circulating counts of T4 cells dropped, though not to dangerous levels, as these cells migrated to the site of immunization. And the author of the Web page fails to mention that all blood work returned to normal in a month.
The author quotes Pediatrics[43] as saying that the H. flu meningitis vaccine has been shown to cause serious reactions including convulsions, anaphylactoid allergic reactions, serum sickness-like reactions, and death. Actually, these were only reports of temporal associations, without further evidence of causality.
The author claims that atypical measles, which is wild-strain measles in people who received only the killed vaccine, as "a very severe form of the disease in which it appears that, because of the vaccination, there is an increased susceptibility to measles virus, resulting from a damaged immune system." The truth is that atypical measles is not "very severe," but variable; only one patient in the cited JAMA[44] article was seriously sick, and both patients recovered. Actually, atypical measles results from a vaccine-enhanced antibody production to wild virus in those whose T-cells did not respond to the immunization. To characterize this as a "damaged immune system" is a shameless lie.
The author cites MMWR's note[45] that mumps is now largely a disease of older people, and twists the language to claim (falsely) that it is now more common among these people than before immunization was available.
"Unknowing Women Victims of Hidden Birthcontrol [sic] Vaccine" (home.sprynet.com/~noshots/hcg.htm) tells a frightful story of women in developing countries being giving a tetanus vaccine that caused them to miscarry. The vaccine was supposedly the work of Orwellian UN officials bent on controlling population. Thankfully, it's just another cynical lie, as a check of the actual Lancet[46] reference will show. The women did not know why they were being immunized, and were suspicious. But there were no miscarriages reported.
An anticontraception conspiracy buff site (new-atlentean.com/birthcon.htm) is a "Think Twice" mirror. It claims that human chorionic gonadotropin (hCG) was introduced into tetanus toxoid to sterilize women. If this were true, it would be a terrible human rights violation. But the only evidence is an unpublished report that hCG was assayed in the vaccine. Using assays with extreme sensitivity but relative nonspecificity will generally give a small positive number even when none of the analyte is really present.
These are not isolated examples, but are typical of how these Web sites use scientific citations. Obviously, the activists making these claims are yelling "Fire!" when there is none. What disturbs me the most is that there seems to be no internal self-criticism in the anti-immunization community. The most obvious lies go unchallenged.
My Online Experience
On my Web site (www.pathguy.com/antiimmu.htm), where I refute false claims made by anti-immunization activists, I offer to do free reviews of autopsy reports in order to look for a credible link between a vaccine and a child's death. If I were to find a credible link, I would testify for free on behalf of the family.
Instead of being thanked by these people for being open-minded and decent, I have received 20 pieces of hate mail from anti-immunization activists. And not one "alternative" thinker has written to thank me for pointing out errors by colleagues.
Edward R Friedlander, MD, is Chairman, Department of Pathology, University of Health Sciences College of Osteopathic Medicine, Kansas City, MO 64106.
Notes
Ernst E. The attitude against immunization within some branches of complementary medicine. Eur J Pediatr. 1997;156:513-515.
Anderson R. Chiropractors for and against vaccines. Med Anthropol. 1990;12:169-186.
Lee ACC, Kemper KJ. Homeopathy and naturopathy: practice characteristics and pediatric care. Arch Pediatr Adolesc Med. 2000;154:75-80.
Lee ACC, Li DH, Kemper JH. Chiropractic care for children. Arch Pediatr Adolesc Med. 2000;154:401-407.
Klugewicz SL, Carraccio CL. Home schooled children: a pediatric perspective. Clin Pediatr. 1999;38:407-411.
Novotny T, Jennings CE, Doran M, et al. Measles outbreaks in religious groups exempt from immunization laws. Public Health Rep. 1988;103(1):49-54.
Mellinger AK, Cragan JD, Atkinson WL, et al. High incidence of congenital rubella syndrome after a rubella outbreak. Pediatr Infect Dis J. 1995;14(7):573-578.
Sutter RW, Markowitz LE, Bennetch JM, Morris W, Zell ER, Preblud SR. Measles among the Amish. J Infect Dis. 1991;163(1):12-16.
Follow-up on poliomyelitis. MMWR. 1979;28(29): 345-346.
Oostvogel PM, van Wijngaarden JK, van der Avoort HG, et al. Poliomyelitis outbreak in an unvaccinated community in the Netherlands, 1992-1993. Lancet. 334:665-670
Binkin NJ, Salmaso S, Tozzi AE, Scuderi G, Greco D, Greco D. Epidemiology of pertussis in a developed country with low vaccination coverage: Italian experience. Pediatr Infect Dis J. 1992;11:653-661.
Measles outbreak: Southwestern Utah. MMWR. 1997;46:766-769.
Vaccines: Update in side effects, adverse reactions, contraindications, and precautions. MMWR. 1996;45(RR-12):1-35.
Singh B. Stimulation of the developing immune system can prevent autoimmunity. J Autoimmun. 2000;14:15-22.
Shoenfeld Y, Aron-Maor A. Vaccination and autoimmunity. J Autoimmun. 2000;14:1-10.
Birmingham K, Cimons M. Reactions to MMR immunization scare. Nat Med. 1998;4(5S):478.
Fombonne, E. Are measles infections or measles immunizations linked to autism? J Autism Dev Disord. 1999;29:349.
Monteyne P, Andre FE. Is there a causal link between hepatitis B immunization and multiple sclerosis? Vaccine. 2000;18:1994-2001.
Galazka A. Control of pertussis in the world. World Health Stat Q. 1992;45:238-247.
Gangarosa EJ, Galazka AM, Wolfe CK, et al. Impact of anti-vaccine movements on pertussis control: the untold story. Lancet. 1998;351:356-361.
Romanus V, Jonsell R, Bergquist SO. Pertussis in Sweden after the cessation of general immunization in 1979. Pediatr Infect Dis J. 1987;6(6):364.
Evans G. Vaccine liability and safety: a progress report. Pediatr Infect Dis J. 1996;14(6):477-478.
Freed GL, Katz SL, Clark SL. Safety of vaccinations. JAMA. 1996;276(23):1869.
Golden GS. Pertussis vaccine and injury to the brain. J Pediatr. 1990;116:854-861.
Halperin SA, Bortolussi R, MacLean D, Chisholm N. Persistence of pertussis in an immunized population: results of the Nova Scotia Enhanced Pertussis Surveillance Program. J Pediatr. 1989;115:686-693.
Sutter RW, Patriarca PA, Brogan S. Outbreak of paralytic poliomyelitis in Oman: Evidence for transmission among fully vaccinated children. Lancet. 1991;338:715-720.
Measles outbreak among vaccinated high school students -- Illinois. MMWR. 1984;33(24).
Strebel PM, Ion-Nedelcu N, Baughman Al, et al. Intramuscular injections within 30 days of immunization with oral poliovirus vaccine -- a risk factor for vaccine-associated paralytic poliomyelitis. N Engl J Med. 1995;332:500-506.
Trollfors B, Rabo E. Whooping cough in adults. Br Med J. 1981;283:696-697.
Torch WC. Diphtheria-pertussis-tetanus (DPT) immunization: A potential cause of the sudden infant death syndrome (SIDS). Neurology. 1982;32(2):A169-170.
Ray WA, Griffin MR. Confounding in studies of adverse reactions to vaccines. Am J Epidemiol. 1994;139: 229-230.
Noble GR. Acellular and whole-cell pertussis vaccines in Japan: Report of a visit by US scientists. JAMA. 1987;257:1375-1376.
Marwick C. Acellular pertussis vaccine hailed for infants. JAMA. 1995;274:446-447.
Classen JB, Classen DC. Public should be told that vaccines may have long-term adverse effects. Br Med J. 1999;318:193.
Graves PM. Lack of assocation between early childhood immunization and beta-cell autoimmunity. Diabetes Care. 1999;22:1694.
Fox, CH. Possible origins of AIDS. Science. 1992;256:1259-1260.
Odent MR, Culpin EE, Kimmel T. Pertussis vaccination and asthma: Is there a link? JAMA. 1994;244:592.
Henderson J, North K, Griffiths M, Harvey I, Golding J. Pertussis vaccination and wheezing illnesses in young children: prospective cohort study. Br Med J. 1999;318:1173-1176.
Sutter RW. Attributable risk of DPT (diphtheria and tetanus toxoids and pertussis vaccine) injection in provoking paralytic poliomyelitis during a large outbreak in Oman. J Infect Dis. 1992;165:444-449.
Jacobsen IM. Lack of effect of hepatitis B vaccine on T-cell phenotypes. N Engl J Med. 1994;311:1030-1034.
Ribera ER, Dutka AJ. Polyneuropathy associated with administration of hepatitis B vaccine. N Engl J Med. 1983;309:614-615.
Eibl MM, Mannhalter JW, Zlabinger G. Abnormal T-lymphocyte subpopulations in healthy subjects after tetanus booster immunization. N Engl J Med. 1984;310:198-199.
Milstein JB, Gross TP, Kuritsky JN. Adverse reactions reported following receipt of Haemophilus influenzae Type b vaccine: An analysis after 1 year of marketing. Pediatrics. 1987;80:270-274.
Fulginiti VA, Helfer RE. Atypical measles in adolescent siblings 16 years after killed measles virus vaccine. JAMA. 1994;244:804-806.
Mumps US 1985-1988. MMWR. 1999;38:101.
A well-meaning but controversial population policy. Lancet. 1988:1273.
edited to add topic header
(Free registration required.)
Opposition To Immunization: A Pattern Of Deception
Edward R. Friedlander
[Scientific Review of Alt Med 5(1):18-23, 2001© 2001 Prometheus Books, Inc.]
Abstract
Several Internet Web sites opposing childhood immunizations are examined. Those sites that contain citations to scientific papers misrepresent their contents.
Introduction
Thanks mostly to immunization, diseases such as measles, polio, diphtheria, tetanus, and rubella are rare in the developed world. Today's immunizations work by enhancing the body's own immunity. Because they are effective, simple, natural, and prevention-based interventions, we might expect "complementary medicine" theoreticians to embrace them. However, opposition to immunization is common within the "alternative medicine" community, with many practitioners of the various schools denying its safety or usefulness.[1] Such opposition has been a factor in leading many people to become more concerned about risks of immunization than the risk of developing diseases that are no longer part of everyday experience in developed nations.
Although many chiropractors oppose immunization, many others strongly encourage their patients to accept immunization.[2] The Faculty of Homeopathy in Great Britain has a formal statement acknowledging that homeopathic remedies do not affect antibodies, and hence it does not recommend that homeopathy be substituted for standard immunization. Unfortunately many homeopaths ignore this statement. Recent US surveys of naturopaths and homeopaths,[3] and of chiropractors[4] revealed that some of each recommend immunization, and others openly oppose immunization. But in each category, the majority either declined to answer or said they left the decision to the family. This may surprise readers who pay their own physicians to give them well-informed guidance. Perhaps federal policies that call for complete immunization have affected the approach of these practitioners, many of whom would like to be reimbursed as legitimate primary care providers.
Outbreaks Among the Unimmunized
Many children in the United States are home-schooled for religious or philosophical reasons, and physicians tend not to monitor these children's immunization status.[5] In the United States, 15 states now allow children to forgo immunizations because of their parents' "philosophical" objections. In California, a parent need only submit an affidavit to obtain an exemption.
Outbreaks of infectious disease among communities receiving religious exemption from immunization showcase the effectiveness of the vaccines and the consequences of refusal. In 1985, measles raged through a Christian Scientist school, with 125 cases and 3 deaths.[6] In 1991, there were at least 890 cases of rubella among the Amish in 5 states, and over a dozen babies with congenital rubella syndrome in Pennsylvania alone.[7] These cases would have been entirely preventable with immunization. In a measles outbreak among the US Amish in 1987, there were 130 cases. The attack rate was 1.7% among immunized individuals, and 73.8% among unimmunized individuals. Two Amish died of measles in the following year.[8] In 1979, a polio outbreak paralyzed 14 Amish people in the United States; the outbreak spread to unimmunized non-Amish neighbors.[9] In 1992, a Netherlands epidemic of polio began in a religious community affecting 68 people, paralyzing 59, and killing 2. None of the affected were immunized.[10]
For some reason, Italian diptheria-pertussis-tetanus (DPT) immunization rates have been low for decades, with only about 50% coverage. So it is no surprise that people bring the disease home to newborn babies who cannot yet be immunized and who are most vulnerable to severe disease. One out of every 14 babies under 1 year of age is admitted to hospital for pertussis; of these, 1 in 850 dies.[11]
Measles is the most contagious of diseases. Since about 10% of people who receive the measles immunization do not become immune, only a high level of immunization ensures neighborhood safety. In the United States, 130 people died in the 1989-1991 outbreak alone. Among the urban poor, the cause is lack of immunization due to social and economic problems. Elsewhere, the epidemics have begun among "exemptors" and spread to people who had not responded to the vaccine.[12]
The Uncertainty of Vaccine Risks
Despite dark talk of conspiracies, the known risks of immunization, though small, are real and have been publicized by the Centers for Disease Control (CDC).[13] In addition, there is the theoretical possibility of autoimmune disease as a result of immunization. But so far, such a risk has not been demonstrated quantitatively, despite efforts to do so.[14,15]
A currently popular claim is that immunization can cause autism or other striking personality changes. The findings of relevant studies have been inconsistent, which is understandable given the way in which conscious or unconscious recall bias would influence reporting. If any cases of autism or striking personality changes occur in response to immunization, they must be very rare.[16,17] A scare about hepatitis B immunization causing multiple sclerosis failed to hold up under statistical study.[18]
Being a Good Neighbor
Despite the known and possible risks, there is a level of consensus otherwise rare either in science or politics that the health of the public is best served by requiring the usual immunizations. When you are asked to accept immunization, you are being asked to assume a small risk for the sake of not only your own health, but the health of your community. For example, as long as we maintain herd immunity in the United States, an individual who does not travel abroad will almost certainly not meet the polio virus. Citing the anti-immunization slogan, "The vaccine is more dangerous than the disease," a person may now increase individual safety at public expense by claiming a philosophical exemption. If such exemptions become widespread, herd immunity will drop, and epidemic disease will resurface. Much of the current anti-immunization rhetoric boils down to: "I don't care if my kid makes the others sick."
The DPT Fiasco
Pertussis (whooping cough) is a grisly disease that kills hundreds of thousands of children in the developing world each year. Antibiotics are largely ineffective against it. The disease can last for months, and permanent brain damage occurs in up to 4% of survivors from bleeding into the brain.[19]
Beginning in the late 1970s, activists in the "alternative medicine" community began urging people not to accept the DPT vaccine. Objections focused on the whole-cell pertussis vaccine. Prolonged crying, pallor, limpness, and/or seizures do sometimes follow this immunization, but the disease of pertussis is a far greater threat to community health than is the immunization. By the 1970s, because of the vaccine, pertussis was rare in the developed nations.
Because the immunity that the vaccine confers is incomplete, herd immunity is particularly important. In several countries, governments accepted the activist agenda. What followed is now history.[20]
In 1974, a year in which there had been no pertussis deaths in Japan, the Japanese government stopped immunizing against pertussis due to the anti-immunization "debate." In 1979 a pertussis epidemic resulted in over 13000 cases and claimed 41 lives.
Also in 1974, a prominent physician told the citizens of the UK that the dangers of brain damage outweighed the benefits. Immunization rates fell, and the annual incidence of pertussis increased from almost none to more than 100 per 100000 per year. Public confidence in the vaccine was reestablished in the mid-1980s and the disease has again become rare.
Pertussis was extremely rare in Australia until an early 1990s antivaccine campaign. Immunization rates dropped, and over 5000 people got sick in 1994 alone.
Sweden stopped immunizing in the late 1970s. During 1980-1983, the incidence of pertussis among children from birth to age 4 had increased to 3370 per 100000 per year, with rates of death and brain damage equal to those in the developing world.[21]
In the early 1980s the TV feature Vaccine Roulette and a book, A Shot in the Dark, told US audiences that the vaccine caused permanent brain damage or death. This was followed by lawsuits, manufacturers ceasing production, skyrocketing vaccine costs to cover liability, and the National Childhood Vaccine Injury Act of 1986. This compensation program has undoubtedly paid money to families whose children were not injured by vaccines, but it seems to be wiser social policy than leaving juries to evaluate scientific questions.[22] In 1994 the news media reportedly falsely that Miss America had become deaf as a result of DPT; her pediatrician confirmed that the actual cause was hemophilus meningitis, which now has been mostly eliminated due to a vaccine.[23]
Despite the scare, nobody has been able to demonstrate a statistical link or exhibit a distinctive pathologic lesion to support the claim of brain damage from DPT.[24] As of this writing, the Web site of the National Vaccine Information Center has no scientific citation less than 14 years old. DPT is still required for school entrance, and the 90 to 95% coverage seems to be enough to maintain herd immunity, with only a slight upward trend since the early 1980s. Outbreaks in North America occur primarily among the unimmunized and underimmunized, with most of the victims being either babies who have not completed their series or teens whose immunity has weakened. Outbreaks among well-immunized populations are rare, but do occur because the vaccine is only partially effective.[25]
Fabrications and Distortions
To discover why people would want "philosophic exemptions" from one or more immunizations, I examined the Internet sites of the anti-immunization activists. Here I found what I expected. There is rhetoric about "making informed choices," plus a mass of half-truths and (at most sites) outright, obvious lies. The links are mostly to other "alternative" medicine sites.
In particular, these people make a practice of citing scientific papers and lying about their contents. Several cite references to 1990s-era publications in refereed medical journals. None of the authors use their sources truthfully.
A Web site called "Dispelling Vaccine Myths" (www.unc.edu/~aphillip/www/vaccine/dvm1.htm) is typical. The author's most obviously untrue claims -- that immunizations have not made the diseases less common and that 29972 Japanese died of smallpox despite having been immunized -- are referenced only to the works of other anti-immunization activists.
The author also cites the Lancet[26] to claim that "Oman experienced a widespread polio outbreak six months after achieving complete vaccination." A check of the source shows this to be a cynical lie. Coverage was far from complete. Exposure was so massive where herd immunity was low that a few immunized children were not protected.
The author cites MMWR's account[27] of an outbreak of measles spreading from unimmunized people to vaccine nonresponders in order to support the claim that the vaccine is ineffective. The statistics presented actually showed that the vaccine gave a high level of protection.
He cites the New England Journal of Medicine (NEJM)[28] to claim that Romanian children have contracted polio from the vaccine. The article actually shows that polio was already common in the country, and that those children who already had polio when they were injected were more likely to develop paralysis -- a well-known phenomenon.
The site contains a fabricated quotation from a Swedish epidemiologist, and the statement that "England, Wales, and West Germany had more pertussis fatalities in 1970, when the immunization rate was high, than during the last half of 1980, when rates had fallen." This statement does not appear in the article to which it is referenced.[29]
The author claims that "oth national and international studies have shown vaccination to be a cause of [Sudden Infant Death Syndrome] SIDS." He cites no international study. He cites one unrefereed paper by one presenter at a scientific meeting, a review of 70 cases; the claim of having a statistically significant clustering of SIDS deaths is made without presenting any statistics.[30 ]
The author misrepresents an article in the American Journal of Epidemiology[31] as arguing that confounding could have masked vaccine as a cause of SIDS. The truth is that both participants in the discussion agreed that it could not.
The author claims that the Japanese found that the whole-cell pertussis vaccine was statistically linked to SIDS. He gives no references (and can't, because it is not true), but the source of the misunderstanding is probably a JAMA article.[32] SIDS, by definition, affects children during the first year of life. When the Japanese stopped immunizing babies under age 1, there were no cases of SIDS following immunization.
"Parents Advocating Vaccine Education" (www.unidial.com/~metroprint/pave2.html) misrepresents the Italian experience with pertussis. Citing a JAMA article[33] in which the vaccine was only 36% effective at the height of an epidemic (when people are inhaling huge numbers of bacteria), the author claims that this means the vaccine only works when the patient is not exposed. The author must actually know that pertussis bacteria are widespread throughout Italy, and there are always opportunities for exposure.
The remaining claims are not referenced. The ridiculous claim that rubella immunization places future unborn children at increased risk for congenital rubella syndrome is referenced only to works by other anti-immunization activists.
The author reports the views of an independent thinker on "stealth viruses" as fact, and claims these may be in vaccines. No mainstream virologist even writes about these hypothetical creatures.
The author cites reports of retrovirus fragments in vaccines, but fails to add that despite much effort, nobody at the CDC could grow them, indicating no infectious particles were present.
Finally, the author repeats the claim recently made by two indepoendent thinkers using their private methods,[34] that some diseases, such as childhood diabetes, are becoming more common, and perhaps immunization is the cause. If this were true, some honest scientist would have made a reputation by demonstrating a temporal relationship between immunization and the onset of diabetes. It hasn't happened. And if this were true, there would have been a tremendous upsurge in childhood diabetes when immunizations first became widespread. It didn't happen, and the mose recent work has shown no connection.[35] The author finishes by imputing the most vile motives to physicians, industry, and government.
When "Think Twice" (thinktwice.com/studies.htm) tells its visitors that "Science reported on a possible link between polio vaccines and the origin of AIDS," the author fails to mention that this was nothing more than a pair of letters about a Rolling Stone article whose author admitted it was idle speculation.[36]
The author cites "studies" (actually, only one study in JAMA) as support for the claim that asthma is more common in recipients of the pertussis vaccine.[37] A subsequent large study refuted the claim utterly,[38] and scientific misconduct was described in a previous study claiming a link.[38] In the original JAMA article, 16 of the 203 unimmunized children had already had pertussis, compared with 1 of 243 in the immunized group.
The author cites the Journal of Infectious Diseases,[39] alleging that DPT makes it more likely that a polio infection will turn paralytic. The article merely reported an illustration of the previously mentioned, well-known phenomenon resulting from injection during acute polio.
The author cites an increasing prevalence of hepatitis B among intravenous drug abusers despite the existence of a vaccine.[40] However, the author neglected to say that the vaccine never reached these people.
The author cites an old article in NEJM to claim that the original hepatitis B vaccine may have contained AIDS virus.[41] This was mere speculation at the time, and now we know it never happened.
The author cites another NEJM[42] article to claim that hepatitis B vaccine causes acute polyneuropathy. Actually, this was the report of a single case following immunization. Subsequent studies have shown no statistical relationship.
"Vaccinations -- Not Safe, Not Effective" (www.pnc.com.au/~cafmr/online/vaccine/vacc.html) cites a NEJM paper as support for the claim: "A report on a study of 11 healthy individuals to determine the effects of routine tetanus booster vaccinations showed that the vaccinations weaken the immune system of the recipients." What actually happened is that the circulating counts of T4 cells dropped, though not to dangerous levels, as these cells migrated to the site of immunization. And the author of the Web page fails to mention that all blood work returned to normal in a month.
The author quotes Pediatrics[43] as saying that the H. flu meningitis vaccine has been shown to cause serious reactions including convulsions, anaphylactoid allergic reactions, serum sickness-like reactions, and death. Actually, these were only reports of temporal associations, without further evidence of causality.
The author claims that atypical measles, which is wild-strain measles in people who received only the killed vaccine, as "a very severe form of the disease in which it appears that, because of the vaccination, there is an increased susceptibility to measles virus, resulting from a damaged immune system." The truth is that atypical measles is not "very severe," but variable; only one patient in the cited JAMA[44] article was seriously sick, and both patients recovered. Actually, atypical measles results from a vaccine-enhanced antibody production to wild virus in those whose T-cells did not respond to the immunization. To characterize this as a "damaged immune system" is a shameless lie.
The author cites MMWR's note[45] that mumps is now largely a disease of older people, and twists the language to claim (falsely) that it is now more common among these people than before immunization was available.
"Unknowing Women Victims of Hidden Birthcontrol [sic] Vaccine" (home.sprynet.com/~noshots/hcg.htm) tells a frightful story of women in developing countries being giving a tetanus vaccine that caused them to miscarry. The vaccine was supposedly the work of Orwellian UN officials bent on controlling population. Thankfully, it's just another cynical lie, as a check of the actual Lancet[46] reference will show. The women did not know why they were being immunized, and were suspicious. But there were no miscarriages reported.
An anticontraception conspiracy buff site (new-atlentean.com/birthcon.htm) is a "Think Twice" mirror. It claims that human chorionic gonadotropin (hCG) was introduced into tetanus toxoid to sterilize women. If this were true, it would be a terrible human rights violation. But the only evidence is an unpublished report that hCG was assayed in the vaccine. Using assays with extreme sensitivity but relative nonspecificity will generally give a small positive number even when none of the analyte is really present.
These are not isolated examples, but are typical of how these Web sites use scientific citations. Obviously, the activists making these claims are yelling "Fire!" when there is none. What disturbs me the most is that there seems to be no internal self-criticism in the anti-immunization community. The most obvious lies go unchallenged.
My Online Experience
On my Web site (www.pathguy.com/antiimmu.htm), where I refute false claims made by anti-immunization activists, I offer to do free reviews of autopsy reports in order to look for a credible link between a vaccine and a child's death. If I were to find a credible link, I would testify for free on behalf of the family.
Instead of being thanked by these people for being open-minded and decent, I have received 20 pieces of hate mail from anti-immunization activists. And not one "alternative" thinker has written to thank me for pointing out errors by colleagues.
Edward R Friedlander, MD, is Chairman, Department of Pathology, University of Health Sciences College of Osteopathic Medicine, Kansas City, MO 64106.
Notes
Ernst E. The attitude against immunization within some branches of complementary medicine. Eur J Pediatr. 1997;156:513-515.
Anderson R. Chiropractors for and against vaccines. Med Anthropol. 1990;12:169-186.
Lee ACC, Kemper KJ. Homeopathy and naturopathy: practice characteristics and pediatric care. Arch Pediatr Adolesc Med. 2000;154:75-80.
Lee ACC, Li DH, Kemper JH. Chiropractic care for children. Arch Pediatr Adolesc Med. 2000;154:401-407.
Klugewicz SL, Carraccio CL. Home schooled children: a pediatric perspective. Clin Pediatr. 1999;38:407-411.
Novotny T, Jennings CE, Doran M, et al. Measles outbreaks in religious groups exempt from immunization laws. Public Health Rep. 1988;103(1):49-54.
Mellinger AK, Cragan JD, Atkinson WL, et al. High incidence of congenital rubella syndrome after a rubella outbreak. Pediatr Infect Dis J. 1995;14(7):573-578.
Sutter RW, Markowitz LE, Bennetch JM, Morris W, Zell ER, Preblud SR. Measles among the Amish. J Infect Dis. 1991;163(1):12-16.
Follow-up on poliomyelitis. MMWR. 1979;28(29): 345-346.
Oostvogel PM, van Wijngaarden JK, van der Avoort HG, et al. Poliomyelitis outbreak in an unvaccinated community in the Netherlands, 1992-1993. Lancet. 334:665-670
Binkin NJ, Salmaso S, Tozzi AE, Scuderi G, Greco D, Greco D. Epidemiology of pertussis in a developed country with low vaccination coverage: Italian experience. Pediatr Infect Dis J. 1992;11:653-661.
Measles outbreak: Southwestern Utah. MMWR. 1997;46:766-769.
Vaccines: Update in side effects, adverse reactions, contraindications, and precautions. MMWR. 1996;45(RR-12):1-35.
Singh B. Stimulation of the developing immune system can prevent autoimmunity. J Autoimmun. 2000;14:15-22.
Shoenfeld Y, Aron-Maor A. Vaccination and autoimmunity. J Autoimmun. 2000;14:1-10.
Birmingham K, Cimons M. Reactions to MMR immunization scare. Nat Med. 1998;4(5S):478.
Fombonne, E. Are measles infections or measles immunizations linked to autism? J Autism Dev Disord. 1999;29:349.
Monteyne P, Andre FE. Is there a causal link between hepatitis B immunization and multiple sclerosis? Vaccine. 2000;18:1994-2001.
Galazka A. Control of pertussis in the world. World Health Stat Q. 1992;45:238-247.
Gangarosa EJ, Galazka AM, Wolfe CK, et al. Impact of anti-vaccine movements on pertussis control: the untold story. Lancet. 1998;351:356-361.
Romanus V, Jonsell R, Bergquist SO. Pertussis in Sweden after the cessation of general immunization in 1979. Pediatr Infect Dis J. 1987;6(6):364.
Evans G. Vaccine liability and safety: a progress report. Pediatr Infect Dis J. 1996;14(6):477-478.
Freed GL, Katz SL, Clark SL. Safety of vaccinations. JAMA. 1996;276(23):1869.
Golden GS. Pertussis vaccine and injury to the brain. J Pediatr. 1990;116:854-861.
Halperin SA, Bortolussi R, MacLean D, Chisholm N. Persistence of pertussis in an immunized population: results of the Nova Scotia Enhanced Pertussis Surveillance Program. J Pediatr. 1989;115:686-693.
Sutter RW, Patriarca PA, Brogan S. Outbreak of paralytic poliomyelitis in Oman: Evidence for transmission among fully vaccinated children. Lancet. 1991;338:715-720.
Measles outbreak among vaccinated high school students -- Illinois. MMWR. 1984;33(24).
Strebel PM, Ion-Nedelcu N, Baughman Al, et al. Intramuscular injections within 30 days of immunization with oral poliovirus vaccine -- a risk factor for vaccine-associated paralytic poliomyelitis. N Engl J Med. 1995;332:500-506.
Trollfors B, Rabo E. Whooping cough in adults. Br Med J. 1981;283:696-697.
Torch WC. Diphtheria-pertussis-tetanus (DPT) immunization: A potential cause of the sudden infant death syndrome (SIDS). Neurology. 1982;32(2):A169-170.
Ray WA, Griffin MR. Confounding in studies of adverse reactions to vaccines. Am J Epidemiol. 1994;139: 229-230.
Noble GR. Acellular and whole-cell pertussis vaccines in Japan: Report of a visit by US scientists. JAMA. 1987;257:1375-1376.
Marwick C. Acellular pertussis vaccine hailed for infants. JAMA. 1995;274:446-447.
Classen JB, Classen DC. Public should be told that vaccines may have long-term adverse effects. Br Med J. 1999;318:193.
Graves PM. Lack of assocation between early childhood immunization and beta-cell autoimmunity. Diabetes Care. 1999;22:1694.
Fox, CH. Possible origins of AIDS. Science. 1992;256:1259-1260.
Odent MR, Culpin EE, Kimmel T. Pertussis vaccination and asthma: Is there a link? JAMA. 1994;244:592.
Henderson J, North K, Griffiths M, Harvey I, Golding J. Pertussis vaccination and wheezing illnesses in young children: prospective cohort study. Br Med J. 1999;318:1173-1176.
Sutter RW. Attributable risk of DPT (diphtheria and tetanus toxoids and pertussis vaccine) injection in provoking paralytic poliomyelitis during a large outbreak in Oman. J Infect Dis. 1992;165:444-449.
Jacobsen IM. Lack of effect of hepatitis B vaccine on T-cell phenotypes. N Engl J Med. 1994;311:1030-1034.
Ribera ER, Dutka AJ. Polyneuropathy associated with administration of hepatitis B vaccine. N Engl J Med. 1983;309:614-615.
Eibl MM, Mannhalter JW, Zlabinger G. Abnormal T-lymphocyte subpopulations in healthy subjects after tetanus booster immunization. N Engl J Med. 1984;310:198-199.
Milstein JB, Gross TP, Kuritsky JN. Adverse reactions reported following receipt of Haemophilus influenzae Type b vaccine: An analysis after 1 year of marketing. Pediatrics. 1987;80:270-274.
Fulginiti VA, Helfer RE. Atypical measles in adolescent siblings 16 years after killed measles virus vaccine. JAMA. 1994;244:804-806.
Mumps US 1985-1988. MMWR. 1999;38:101.
A well-meaning but controversial population policy. Lancet. 1988:1273.
edited to add topic header
Last edited by a moderator:
