Science, Vaccines, Public Health, And Having It All

So? Did you get your flu shot this year? Did your kids? If you got the flu, the nasty H1N1 (far descendent of the great 1918 pandemic) or H3N2 (relic of the 1968 pandemic)  Brisbane-like seasonal flu that is circulating in the US might have evaded the protection from your flu shot because this year the vaccine wasn't a close match to circulating virus.

Usually, the vaccines match pretty well the circulating strains. That in itself is amazing because the vaccine is decided by committee months before  flu season ever hits. But when the vaccine is a mismatch like this year, it's a real downer.

"It is often portrayed as a kind of 'on' or 'off' kind of thing. There's a match or there's a mismatch. And in that kind of situation, it's a very discomforting presentation for the public health community," says Dr. Keiji Fukuda, co-ordinator of the World Health Organization's Global Influenza Program.

"There is always concern we're really setting up a situation where people would say: 'Oh, why should I get something which is worthless?' "

A mismatch doesn't mean a flu shot was a waste of time, Fukuda and others insist.

The vaccine may confer less protection than it would have if it was made from viruses identical to those being coughed around your office or your child's school. But less and useless are not synonymous.

But there's more than flu shots shaking people's faith in vaccine science. Back in 2005, I wrote about the autism controversy and came down squarely on the side of the pediatricians on this one. Vaccines don't cause are not associated with autism, even though the consistently ill-informed John McCain thinks so.

McCain said, per ABC News' Bret Hovell, that "It’s indisputable that (autism) is on the rise amongst children, the question is what’s causing it. And we go back and forth and there’s strong evidence that indicates that it’s got to do with a preservative in vaccines."

McCain said there’s "divided scientific opinion" on the matter, with "many on the other side that are credible scientists that are saying that’s not the cause of it."

As this NY Times article about the Hannah Poling case indicates, however, there's no divided science. The first line says it all.

Study after study has failed to show any link between vaccines and autism, but many parents of autistic children remain unconvinced. For the skeptics, the case of 9-year-old Hannah Poling shows that they have been right along.

The government has conceded that vaccines may have hurt Hannah, and it has agreed to pay her family for her care. Advocates say the settlement -- reached last fall in a federal compensation court for people injured by vaccines, but disclosed only in recent days -- is a long-overdue government recognition that vaccinations can cause autism.

''This decision gives people significant reason to be cautious about vaccinating their children,'' John Gilmore, executive director of the group Autism United, said Friday.

Mr. Gilmore has filed his own claim that his son became autistic as a result of vaccinations.

Government officials say they have made no such concession.

''Let me be very clear that the government has made absolutely no statement indicating that vaccines are a cause of autism,'' Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention, said Thursday. ''That is a complete mischaracterization of the findings of the case and a complete mischaracterization of any of the science that we have at our disposal today."

and more:

Five major studies have found no link, and since thimerosal's removal from all routinely administered childhood vaccines in 2001, there has been no apparent effect on autism rates.

And more:

According to Joel Bregman, MD, chair of the committee on developmental disabilities of the American Psychiatric Association (APA), it is known that this child has a rare underlying mitochondrial condition and received a number of vaccines at once, which is also atypical, and subsequently developed autismlike symptoms.

"This is a unique set of circumstances that should not be extrapolated to the rest of the population," Dr. Bregman told Medscape Neurology & Neurosurgery. "Even though there is a great deal of research — not just in the United States, but in other countries as well — there is no evidence linking childhood vaccines to autism. We are very concerned the public may misinterpret this decision," he added.

Parents of autistic children have tremendous burdens to bear and my heart goes out to them regardless of vaccine discussions. Hhowever, that doesn't change the science.

But it isn't just the parents of autistic children that are rejecting vaccines. Vaccine rejection is becoming a major public health issue (hello, McCain? Haven't we had enough anti-science from Republicans?). This NY Times article discussed a CA trend that is quite disturbing:

In a highly unusual outbreak of measles here last month, 12 children fell ill; nine of them had not been inoculated against the virus because their parents objected, and the other three were too young to receive vaccines.

The parents who objected to their children being inoculated are among a small but growing number of vaccine skeptics in California and other states who take advantage of exemptions to laws requiring vaccinations for school-age children.

The exemptions have been growing since the early 1990s at a rate that many epidemiologists, public health officials and physicians find disturbing.

Children who are not vaccinated are unnecessarily susceptible to serious illnesses, they say, but also present a danger to children who have had their shots — the measles vaccine, for instance, is only 95 percent effective — and to those children too young to receive certain vaccines.

So what's happening is the success of vaccination allows parents to avoid giving vaccines to their kids thereby putting the entire community at risk (let's not hear any more about how self-centered boomers are; maybe they are, but they clearly don't have a monopoly on the subject).

While nationwide over 90 percent of children old enough to receive vaccines get them, the number of exemptions worries many health officials and experts. They say that vaccines have saved countless lives, and that personal-belief exemptions are potentially dangerous and bad public policy because they are not based on sound science.

"If you have clusters of exemptions, you increase the risk of exposing everyone in the community," said Dr. Omer, who has extensively studied disease outbreaks and vaccines.

It is the absence, or close to it, of some illnesses in the United States that keep some parents from opting for the shots. Worldwide, 242,000 children a year die from measles, but it used to be near one million. The deaths have dropped because of vaccination, a 68 percent decrease from 2000 to 2006.

"The very success of immunizations has turned out to be an Achilles’ heel," said Dr. Mark Sawyer, a pediatrician and infectious disease specialist at Rady Children’s Hospital in San Diego. "Most of these parents have never seen measles, and don’t realize it could be a bad disease so they turn their concerns to unfounded risks. They do not perceive risk of the disease but perceive risk of the vaccine."

Dr. Sawyer and the vast majority of pediatricians believe strongly that vaccinations are the cornerstone of sound public health. Many doctors view the so-called exempters as parasites, of a sort, benefiting from the otherwise inoculated majority.

This is a serious and important topic to think about. parents have the right to be making these decisions, but facts and science and not hearsay and rumor ought to be the foundation for these decisions. We pride ourselves on being a reality based community, but the tendency to prefer astrology over astronomy ought not to be ignored and overlooked, and it's a harmful trend not just to individuals but to the community. And if you need a reminder of the benefits of vaccination, it's easy enough to find.

A dangerous type of childhood meningitis has been virtually eliminated in Uganda in just five years after a vaccine was introduced, according to a study released this week.

That should save the lives of 5,000 children a year, the authors estimated.

''This is the first time we've seen this kind of impact, a 100 percent drop,'' said Dr. Julian Lob-Levyt, executive secretary of the GAVI Alliance, which paid for the vaccines. ''We hope this can be repeated in other countries.''

The study, released by the World Health Organization, monitored cases from 2001 to 2006.

The vaccine, known as Hib, protects against haemophilus influenzae type B, a bacterium that can inflame the lining of the brain or cause pneumonia. Each year, it kills 386,000 children globally. Three million more have severe side effects like deafness, paralysis or retardation.

Childhood Haemophilus influenzae type B (Hib) disease is just about gone in the US, eliminated by vaccines and one of the unsung public health triumphs of modern times. We'd hate to see a reoccurrence because folks skimp on their vaccines.  Cases of pertussis (whooping cough) are already rising. Skipping the vaccine will only make things worse (cases have doubled in the UK this year, showing it's hardly a conquered disease).

Safeguards, checks and balances are always appropriate. there are always individual cases that can and should be questioned. If vaccinations do harm in rare cases, injured parties are entitled to compensation, but rejecting the entire vaccination program outright is as anti-science and anti-public health as it gets.

So, getting back to flu, did you know that even seasonal flu could be deadly?

MINNEAPOLIS

The state Health Department is investigating the deaths of a father and son from a northern Minnesota family from an influenza-like illness.

Officials said Thursday they were investigating whether the victims had a secondary bacterial infection that contributed to their deaths. The department emphasized that there was no reason to conclude that the deaths were caused by an unusual strain of the influenza virus.

That's why the CDC now recommends flu shots for all children.

So are you getting your flu shot this year? I did. How about you?