Ok folks

[PBEA]

I dont like this (if its true). Any comments on why this might either be a total crock or if it represents a major flaw in trying to "vaccinate" against the chicken pox. I know Im missing something when it seems we are, in some cases, willfully increasing the morbidity associated with a later manifestation of "chicken pox". Is this poor short term data or something else?

http://www.nytimes.com/2007/03/15/health/15pox.html?_r=1&oref=slogin

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[Miami_med]

Very interesting. This is exactly the sort of thing that makes me wary about mandatory vaccinations based on short term data. Unintended consequences.

 

[sdn1977]

I think there are a couple of issues here,

First, we do know that vaccines do not confer lifetime immunity as we once thought - many children who were vaccinated in the 60's & 70's require another booster of MMR, particularly if traveling to an endemic country. We also have a mini outbreak of pertussis in my area among the 40-somethings - who should have been fully immunized.

The lesson here - there is far, far more we don't know about immunity against disease than what we do know.

Second, the chicken pox vaccine is not just an issue for parents who can't take time off to keep their children home - it can be a very miserable disease & you can't tell who might get that particularly bad dose. It can also be disfiguring, which may not be so difficult for you as an adult, but can be very difficult for adolescents.

Third, we have many, many more people in society who are immunosuppressed for a variety of diseases - rheumatoid arthritis, psoriatic arthritis, HIV/AIDS, cancer treatments - so decreasing the "infectious" possibilities tremendously decreases the incidence of disease in these pts - who may or may not have had the disease as a child, so they are vulnurable. We cannot immunize these susceptible individuals because it is a live virus vaccine. Likewise, we "suspect", despite the article, that the disease does not confer lifetime immunity, but this may be due to poor patient history.

Since the "infectious" stage precedes the outbreak, it difficult to tell who is sneezing the chicken pox virus while you're in line at the grocery store....

Immunizations are always are to decide - thus, the parent's perogative.

 

[McDoctor]

Very interesting. This is exactly the sort of thing that makes me wary about mandatory vaccinations based on short term data. Unintended consequences.

I tend to think your wariness of mandatory vaccines also is influenced by your overall libertarian philosophy. The alternative in this case would be to purposefully expose young children to full blown varicella at a young age when risk of morbidity is theoretically lower. That doesn't strike me as ethical. This study merely reinforces the need for booster vaccinations. I think we could see further recommendation changes from ACIP down the road for adults.

I also think the Times article could have pointed out that the authors themselves in this NEJM article acknowledged significant limitations in their definition of disease severity based on their data. The authors clearly identify this as a limitation in their study "owing to constraints with respect to the number of subjects in our study, our definition of disease severity was limited to fewer than 50 lesions or 50 or more lesions and did not include complications or hospitalization." Clearly, this study was not properly designed to make any claims about disease severity of varicella later in life (though it didn't stop the authors from trying). The NY Times didn't mention any of this. Go figure.

I could also point out that two of the lead authors report significant financial ties to Merck (one is actually a Merck employee), which stands to profit a ton from this study with its Zostavax vaccine , but that would just be conspiracy mongering.

 

[McDoctor]

A closer look at this study makes me think this data is hardly definitive of any conclusions about varicella immunity. The authors defined a case of varicella as "an acute onset of a diffuse maculo-papular rash without another apparent cause." Personally, I'd want the data gathering process to be a little more precise than this before I came to any conclusions, especially since the data was gathered from a number of sources, not all of whom involved trained physicians. The reporting sites included child care clinics and public and private schools. (Anybody who's dealt with school nurses who seemingly insists that every case of red eye requires topical antibiotic treatment can attest that their diagnostic skills aren't always the gold standard).

A cynic would say these authors scoured enormous amounts of data from inconsistent sources for documented cases of rashes in children, which they then somewhat arbitrarily chalked up to varicella infection, in order to make a case for more frequent booster immunizations. And, perhaps not coincidentially, the lead authors are on the payroll of the pharmaceutical company that happens to be marketing a varicella booster for adults.

 

[sdn1977]

Very, very good call!

 

[mshheaddoc]

Well an additional point to make, there has been very limited clinical data that this vaccine will prevent latent infections of shingles either ...

This is a new vaccine and with every new vaccine, efficacies are found later down the road ... 12 years is a baby in terms of vaccines

 

[McDoctor]

Very, very good call!

What can I say, I attended the Oliver Stone School of Osteopathic Medicine. Michael Moore was my faculty advisor.

Seriously, though, I do think this article is a legitimate example of pharmaceutical bias having a harmful impact on scientific research.

 

[Miami_med]

I tend to think your wariness of mandatory vaccines also is influenced by your overall libertarian philosophy. The alternative in this case would be to purposefully expose young children to full blown varicella at a young age when risk of morbidity is theoretically lower. That doesn't strike me as ethical. This study merely reinforces the need for booster vaccinations. I think we could see further recommendation changes from ACIP down the road for adults.

I also think the Times article could have pointed out that the authors themselves in this NEJM article acknowledged significant limitations in their definition of disease severity based on their data. The authors clearly identify this as a limitation in their study "owing to constraints with respect to the number of subjects in our study, our definition of disease severity was limited to fewer than 50 lesions or 50 or more lesions and did not include complications or hospitalization." Clearly, this study was not properly designed to make any claims about disease severity of varicella later in life (though it didn't stop the authors from trying). The NY Times didn't mention any of this. Go figure.

I could also point out that two of the lead authors report significant financial ties to Merck (one is actually a Merck employee), which stands to profit a ton from this study with its Zostavax vaccine , but that would just be conspiracy mongering.

Now now, as a survivor of full blown varicella, I can tell you that this is a bit dramatic .

The real benefit of a chicken pox vaccine for kids would be the prevention of shingles. This is because the intial chicken pox infection is rarely more than a nuisance in children. As the research isn't there to prove that this vaccine accomplishes this, I question its compulsion. If the vaccine increases risk of chicken pox at a later age, we should question it, because chicken pox rarely causes serious long term harm in children, but this isn't the case in adults.

As for the conspiracy, I could point out that the makers of these vaccines have just as much to gain from making them mandatory as Merck does for Zostavax. Merck didn't seem to have a problem in attempting to push for all of the financial benefit it would receive from mandatory Gardasil vaccines. Let the conspiracy war begin .

Believe it or not, I actually don't have a problem with mandatory vaccinations for fatal disease for which we have a vaccine with a proven track record, as I believe that controlling infectious disease falls under defense and is a proper government function. Now, I believe that this should only apply to airborn diseases, but this is a topic for another thread.

 

[sdn1977]

Well an additional point to make, there has been very limited clinical data that this vaccine will prevent latent infections of shingles either ...

This is a new vaccine and with every new vaccine, efficacies are found later down the road ... 12 years is a baby in terms of vaccines

Are you referring to Varivax or Zostavax? Varivax has been around for about 15 years & was being used in immunosuppressed children & their siblings long before that - in fact the precursor to Lucile Salter Packard Children's Hospital at Stanford was a study site for it years ago.

Zostavax has an indication for those >60 so we don't feel duration of immunity is an issue at this point.

We know Varivax is safe & effective. We just don't know how long the immunity lasts (as we are finding out with adults who have been immunized for measles & pertussis who are now getting the disease).

 

[PBEA]

Now now, as a survivor of full blown varicella, I can tell you that this is a bit dramatic .

The real benefit of a chicken pox vaccine for kids would be the prevention of shingles. This is because the intial chicken pox infection is rarely more than a nuisance in children. As the research isn't there to prove that this vaccine accomplishes this, I question its compulsion. If the vaccine increases risk of chicken pox at a later age, we should question it, because chicken pox rarely causes serious long term harm in children, but this isn't the case in adults.

As for the conspiracy, I could point out that the makers of these vaccines have just as much to gain from making them mandatory as Merck does for Zostavax. Merck didn't seem to have a problem in attempting to push for all of the financial benefit it would receive from mandatory Gardasil vaccines. Let the conspiracy war begin .

Believe it or not, I actually don't have a problem with mandatory vaccinations for fatal disease for which we have a vaccine with a proven track record, as I believe that controlling infectious disease falls under defense and is a proper government function. Now, I believe that this should only apply to airborn diseases, but this is a topic for another thread.

Thank you Miami, you have helped confirm my feeling on the issue. From my limited perspective, it would seem that this vaccine accomplishes one main thing. That is to delay the onset of "chicken pox". In weighing risk vs benefit (for your average human) me thinks there is little reason to vaccinate an otherwise healthy child. What is the point if I then have to booster them every 4-5 yrs? All the while creating an ever more likely scenario whereby as an adult these children might contract a severe shingles! Seems like nonsense to me, is anyone suggesting that we can eradicate varicella? As far as the obvious conflict of interest that the authors represent, I chalk this up as creative "spin", on an otherwise glaring concern.

 

[McDoctor]

Now now, as a survivor of full blown varicella, I can tell you that this is a bit dramatic .

The real benefit of a chicken pox vaccine for kids would be the prevention of shingles. This is because the intial chicken pox infection is rarely more than a nuisance in children. As the research isn't there to prove that this vaccine accomplishes this, I question its compulsion. If the vaccine increases risk of chicken pox at a later age, we should question it, because chicken pox rarely causes serious long term harm in children, but this isn't the case in adults.

As for the conspiracy, I could point out that the makers of these vaccines have just as much to gain from making them mandatory as Merck does for Zostavax. Merck didn't seem to have a problem in attempting to push for all of the financial benefit it would receive from mandatory Gardasil vaccines. Let the conspiracy war begin .

Believe it or not, I actually don't have a problem with mandatory vaccinations for fatal disease for which we have a vaccine with a proven track record, as I believe that controlling infectious disease falls under defense and is a proper government function. Now, I believe that this should only apply to airborn diseases, but this is a topic for another thread.

I'm also a Varicella Survivor. I run a weekly support group in the basement of a local baptist church for others of my kind.

I think Merck obviously will be trying to broaden the indications for Zostavax. The vaccine is essentially a more potent varicella vaccine. I think this is where the bias is coming from.

I think its worthwhile to attempt to eradicate varicella through immunization, given the amount of morbidity that is created in adulthood. I just think that carrying out sloppy research is poor way to go about this. This study is crap. We need better data than this.

 

[sdn1977]

Now now, as a survivor of full blown varicella, I can tell you that this is a bit dramatic .

The real benefit of a chicken pox vaccine for kids would be the prevention of shingles. This is because the intial chicken pox infection is rarely more than a nuisance in children. As the research isn't there to prove that this vaccine accomplishes this, I question its compulsion. If the vaccine increases risk of chicken pox at a later age, we should question it, because chicken pox rarely causes serious long term harm in children, but this isn't the case in adults.

As for the conspiracy, I could point out that the makers of these vaccines have just as much to gain from making them mandatory as Merck does for Zostavax. Merck didn't seem to have a problem in attempting to push for all of the financial benefit it would receive from mandatory Gardasil vaccines. Let the conspiracy war begin .

Believe it or not, I actually don't have a problem with mandatory vaccinations for fatal disease for which we have a vaccine with a proven track record, as I believe that controlling infectious disease falls under defense and is a proper government function. Now, I believe that this should only apply to airborn diseases, but this is a topic for another thread.

I'd have to disagree on a number of points.

The real benefit of Varivax - which is the vaccination intedended for children is to prevent this disease, which is highly communicable, to be spread. Why??? Because we have so many children mainstreamed in our school systems who are immunocompromised.

In fact, far more than when you acquired chicken pox - in what .... the 70's???? At that time we didn't know about HIV & certainly we didn't treat children for it. We also didn't have so many children who have received chemotherapy, bone marrow transplants, etc... who acquire a fatal infection or perhaps just get encephalitis due to exposure from an unvaccinated child - or who themselves were unvaccinated by a well-intending parent. It is a public health issue.

Also....Merck makes both Varivax & Zostavax - ok - they're good at varicella. They also make many, many drugs - not all vaccines. Your point?

Finally, chicken pox is indeed an airborne disease - spread by coughing & sneezing of infected patients as well as skin to skin contact.

Check out the CDC on varicella. Fortunately, Varivax is among the routine vaccinations administered to children.

Again - as a parent - you can always opt out.

And, yes, PEBA - we would like to eradicate varicella infections completely because although they don't always cause death - they certainly cause morbidity. Do you read MMWR??? The morbidity has gone down dramatically after this vaccination came on the market years ago. Ask any IM or FM how many pts they see post-shingles & the pain management issues they have. We are attempting with Zostavax to lessen the incidence of this. Lets be clear - Varivax is intended for children, Zostavax is intended for those >60 who have not had shingles.

We eradicated smallpox - we hope to do so with varicella as well.

 

[PBEA]

The real benefit of Varivax - which is the vaccination intedended for children is to prevent this disease, which is highly communicable, to be spread. Why??? Because we have so many children mainstreamed in our school systems who are immunocompromised.

Is there a line between putting putting more chemicals into children vs hopefully preventing spread to immunecomp. people?

In fact, far more than when you acquired chicken pox - in what .... the 70's???? At that time we didn't know about HIV & certainly we didn't treat children for it. We also didn't have so many children who have received chemotherapy, bone marrow transplants, etc... who acquire a fatal infection or perhaps just get encephalitis due to exposure from an unvaccinated child - or who themselves were unvaccinated by a well-intending parent. It is a public health issue.

Again, Is there a line between putting putting more chemicals into children vs hopefully preventing spread to immunecomp. people?

And, yes, PEBA - we would like to eradicate varicella infections completely because although they don't always cause death - they certainly cause morbidity. Do you read MMWR??? The morbidity has gone down dramatically after this vaccination came on the market years ago. Ask any IM or FM how many pts they see post-shingles & the pain management issues they have. We are attempting with Zostavax to lessen the incidence of this. Lets be clear - Varivax is intended for children, Zostavax is intended for those >60 who have not had shingles.

We eradicated smallpox - we hope to do so with varicella as well.

Eradication!! OK, If it can be done. However it sounds to me (I am undereducated) like this vaccine does not meet that condition. The op link might lead one to believe that it could prolong the inevitable and potentially increase the likelihood of morbidity through a later manifestation. Flawed article aside, how do you account for what seems to be a limited time period of effectivity for this vaccine?

 

[QuikClot]

Eradication may be a poor goal. Smallpox is the exception that proves the rule. At the same time the WHO was winning the war on smallpox, it was failing misereably in its war on malaria.

My sense is that we ought to regard a pathogen like any other dangerous form of life -- to be removed and surpressed where dangerous, not exterminated. Pathogens may have roles in human homeostasis, or in the ecosystem in general, that we know nothing about. Eliminating them, besides being in many cases impractical, may also have unintended consequences.

Reducing the disease's spread, and developing therapies that drastically reduce morbidity and mortality, may be a better use of our resources than waging a war against this or that microbe.

 

[McDoctor]

Eradication may be a poor goal. Smallpox is the exception that proves the rule. At the same time the WHO was winning the war on smallpox, it was failing misereably in its war on malaria.

My sense is that we ought to regard a pathogen like any other dangerous form of life -- to be removed and surpressed where dangerous, not exterminated. Pathogens may have roles in human homeostasis, or in the ecosystem in general, that we know nothing about. Eliminating them, besides being in many cases impractical, may also have unintended consequences.

Reducing the disease's spread, and developing therapies that drastically reduce morbidity and mortality, may be a better use of our resources than waging a war against this or that microbe.

So are you saying we shouldn't vaccinate at all? That we shouldn't try to eradicate viruses like HIV, HPV, or various Hepatitis viruses?

 

[Miami_med]

I'd have to disagree on a number of points.

The real benefit of Varivax - which is the vaccination intedended for children is to prevent this disease, which is highly communicable, to be spread. Why??? Because we have so many children mainstreamed in our school systems who are immunocompromised.

In fact, far more than when you acquired chicken pox - in what .... the 70's???? At that time we didn't know about HIV & certainly we didn't treat children for it. We also didn't have so many children who have received chemotherapy, bone marrow transplants, etc... who acquire a fatal infection or perhaps just get encephalitis due to exposure from an unvaccinated child - or who themselves were unvaccinated by a well-intending parent. It is a public health issue.

First of all, I had Varicella in 1988. Second of all, I am not arguing that the vaccine should be taken off of the market. I question its compulsion. If the vaccine doesn't cause permanent protection, I'm not sure that you don't end up hurting the people receiving it. I do not believe that we should put someone at higher risk for Varicella Pneumonia later in life by law in order to protect a hypothetical immunocompromised kid. For the most part, Varicella is a nuisance. Just like the flu, there are some exceptions to this, but most people don't have a panic attack when you tell them that their kid has the flu.

Also....Merck makes both Varivax & Zostavax - ok - they're good at varicella. They also make many, many drugs - not all vaccines. Your point?

The original idea in this post was that Merck might be trying to downplay Varivax efficacy in order to sell more Zostavax. I was only pointing out that the universal requirement for vaccination could also have been such a ploy. One is not more likely than the other.

Finally, chicken pox is indeed an airborne disease - spread by coughing & sneezing of infected patients as well as skin to skin contact.

Check out the CDC on varicella. Fortunately, Varivax is among the routine vaccinations administered to children.

As the parent of a child with the vaccine, I know.

Again - as a parent - you can always opt out.

Not if you want to send your kid to school.

And, yes, PEBA - we would like to eradicate varicella infections completely because although they don't always cause death - they certainly cause morbidity. Do you read MMWR??? The morbidity has gone down dramatically after this vaccination came on the market years ago. Ask any IM or FM how many pts they see post-shingles & the pain management issues they have. We are attempting with Zostavax to lessen the incidence of this. Lets be clear - Varivax is intended for children, Zostavax is intended for those >60 who have not had shingles.

I have seen no plan to totally irradicate all varicella. When I see this, we can approach this point again.

We eradicated smallpox - we hope to do so with varicella as well.[/QUOTE]

 

[sdn1977]

First of all, I had Varicella in 1988. Second of all, I am not arguing that the vaccine should be taken off of the market. I question its compulsion. If the vaccine doesn't cause permanent protection, I'm not sure that you don't end up hurting the people receiving it. I do not believe that we should put someone at higher risk for Varicella Pneumonia later in life by law in order to protect a hypothetical immunocompromised kid. For the most part, Varicella is a nuisance. Just like the flu, there are some exceptions to this, but most people don't have a panic attack when you tell them that their kid has the flu.


The original idea in this post was that Merck might be trying to downplay Varivax efficacy in order to sell more Zostavax. I was only pointing out that the universal requirement for vaccination could also have been such a ploy. One is not more likely than the other.


As the parent of a child with the vaccine, I know.


Not if you want to send your kid to school.



I have seen no plan to totally irradicate all varicella. When I see this, we can approach this point again.

We eradicated smallpox - we hope to do so with varicella as well.

[/QUOTE]

I can't comment on the Florida school system - my kids went to school in CA. We could just sign a form which indicated immunization went against our personal &/or religious beliefs. I never signed the form....but it is still a policy here.

As for the hypothetical immunocompromised kid.....we have lots and lots in our school system and for every one kid, immonocompromised or otherwise, who gets the chicken pox, in their prodrome phase, they can infect many others they come in sneezing distance with - the grocery store, the library, the mall - everywhere our population with HIV/AIDS/cancer can be found daily.

As for eradication of varicella....you might check out this reference in the American Family Physician:

http://www.aafp.org/afp/20050601/tips/14.html

Its also on the cdc & WHO websites, but they are too extensive for me to make that search tonight.

But...I don't think it would make any difference to you anyway, particularly when you see a "ploy" in preventative public health policies.

 

[sdn1977]

Eradication!! OK, If it can be done. However it sounds to me (I am undereducated) like this vaccine does not meet that condition. The op link might lead one to believe that it could prolong the inevitable and potentially increase the likelihood of morbidity through a later manifestation. Flawed article aside, how do you account for what seems to be a limited time period of effectivity for this vaccine?

Not just this vaccine - just about any vaccine. We only found the immunity to measles is not lifetime after the first doses when the cases started to reappear in the 1980s.

How do I account for this - our lack of knowledge of our immune system and the difficulty in vaccine development. None of us expect our knowledge to be perfect - but we do the best we can with what we know. Given that....we have new recommendations for booster doses & are refining the vaccine components to assure greater & longer lasting immunity with fewer side effects & complications - the pertussus vaccine is a prime example.

But...don't throw the baby out with the bathwater, so to speak. We have a tremendous track record with vaccines and our understanding of the immune system is improving with more research into AIDS/HIV.

But - I am old enough to remember what it was like to not go to a pool in the summer because of a polio outbreak. Thankfully, most all our kids can swim without any of us worrying they might get polio.

 

[sdn1977]

Eradication may be a poor goal. Smallpox is the exception that proves the rule. At the same time the WHO was winning the war on smallpox, it was failing misereably in its war on malaria.

My sense is that we ought to regard a pathogen like any other dangerous form of life -- to be removed and surpressed where dangerous, not exterminated. Pathogens may have roles in human homeostasis, or in the ecosystem in general, that we know nothing about. Eliminating them, besides being in many cases impractical, may also have unintended consequences.

Reducing the disease's spread, and developing therapies that drastically reduce morbidity and mortality, may be a better use of our resources than waging a war against this or that microbe.

Somehow the world does go on without smallpox without any apparent consequences....and we don't have people die or suffer morbidity from that terrible disease. To my knowledge, smallpox did nothing in the greater ecosystem other than cause disease, but I don't have any insight into its "better" side.

But...to equate the issue of malaria with that of public health communicable diseases here is comparing apples to oranges - at least to me.

Malaria is a disease of not just a geographic area of the world which suffered from being of not much influence until recently, it is also a disease of poor education, poverty, poor civic substructures (vector control, drainage, etc) - and would, even today, be a disease which would be much ignored but for the Bill & Melinda Gates Foundation.

Now - as philanthropic as they are (& they are indeed!), they also recognize that from a public health issue, we must think globally - not just nationally, when it comes to communicable diseases. So, when they send their employees to other nations or continents...or their employees come here - they bring diseases that are endemic to those areas here as well. It then becomes our public health issue. They are to be commended for their huge financial, personal & public contribution to the treatment, social change which will decrease its incidence & research into malaria prevention.

Don't get me wrong - malaria is a terrible & often difficult to treat disease (oh - we could lump TB in here as well). But...that does not diminsh our need or desire to seek immunization against diseases we can PREVENT right now. Perhaps - if we're lucky, we will also find a way to immunize against malaria, TB, & other pathogens we suspect cause disease in ways we may not even know.

Do you really want to just treat disease - not eradicate those we can? I think there are plenty to go around even with those few that are on track to hopefully be eradicated.

 

[Miami_med]

But...I don't think it would make any difference to you anyway, particularly when you see a "ploy" in preventative public health policies.[/QUOTE]

For the record, are you saying that drug companies never have a ploy to mandate compulsion of one of their products in order to sell more units? I was only stating that this was possible, without coming down on one side or the other. If you read my other post, you'd note that I actually have no problem with certain public health policies that control infectious disease. However, I don't believe that these policies should actually put the people receiving the injections at greater risk. I also know that EVERYTHING is politics, and trying to seperate politics from public health is like trying to take the ears off of the Easter Bunny.

 

[sdn1977]

But...I don't think it would make any difference to you anyway, particularly when you see a "ploy" in preventative public health policies.

For the record, are you saying that drug companies never have a ploy to mandate compulsion of one of their products in order to sell more units? I was only stating that this was possible, without coming down on one side or the other. If you read my other post, you'd note that I actually have no problem with certain public health policies that control infectious disease. However, I don't believe that these policies should actually put the people receiving the injections at greater risk. I also know that EVERYTHING is politics, and trying to seperate politics from public health is like trying to take the ears off of the Easter Bunny.[/QUOTE]

For the record - when it comes to immunizations only - I do not believe that drug companies have a ploy to sell more units. The reason is it costs more than they make when you factor in research & money spent on litigation. In fact, prior to 1986 when the National Vaccine Injury Compensation Program went into effect, all manufacturers of vaccines were going to pull out of the market completely. The only way public vaccination was saved at all was to develop this plan, which is paid for by an excise tax on each disease prevented (not vaccine dose...thus the excise tax on MMR is 3 times that for Varivax).

Prior to this program, drug companies were threatened with huge losses & in fact, for pertussis alone, the manufacturers went from 8 to 1 while the cost of insurance for that one vaccine went from $0.15 to $11 in a matter of a few years. Neither Cutter nor Wyeth are in the vaccine business & they both were one of the first manufacturers of the polio vaccine. (The new Adacel vaccine only costs about $30 & most insurers reimburse about $26 & research on the pertussis portion of Adacel has been going on for 20 years!). They didn't often get judgements against them, they just had to litigate which became prohibitively expensive.

So...no. I do not believe in a ploy for drug companies to sell more units when it comes to immunizations anymore than when they develop an orphan drug which has a very small affected population. Nor do I believe these vaccines put people at greater risk & in fact, vaccines in the 20th century increased the lifespan of people receiving them by 30 years.

You claim you don't have an issue with policies which control infectious diseases - well, this is one & you apparently do. If you believe these vaccines put you or your children at risk - again - opt out. I checked the Miami-Dade Office of Education & they allow 2 exemptions - medical & religious. As a physician, you could certainly opt your children out & most everyone can obtain a religious exemption to almost anything. If you look in the Peds forum, they also have patients who choose to not immunize so you're not the first nor only.

But....I do wonder when so many millions are immunized & so few opt out..it seems as though you see a conspiracy where none exists. Paul Offit, MD - chief of infectious disease at Children's Hospital in Philadelphia in fact proposes there be no opt out choice, but we're not at that point, nor do I feel we necessarily should be to prevent the parental choice for any medical intervention.

 

[Miami_med]

For the record - when it comes to immunizations only - I do not believe that drug companies have a ploy to sell more units. The reason is it costs more than they make when you factor in research & money spent on litigation. In fact, prior to 1986 when the National Vaccine Injury Compensation Program went into effect, all manufacturers of vaccines were going to pull out of the market completely. The only way public vaccination was saved at all was to develop this plan, which is paid for by an excise tax on each disease prevented (not vaccine dose...thus the excise tax on MMR is 3 times that for Varivax).

Prior to this program, drug companies were threatened with huge losses & in fact, for pertussis alone, the manufacturers went from 8 to 1 while the cost of insurance for that one vaccine went from $0.15 to $11 in a matter of a few years. Neither Cutter nor Wyeth are in the vaccine business & they both were one of the first manufacturers of the polio vaccine. (The new Adacel vaccine only costs about $30 & most insurers reimburse about $26 & research on the pertussis portion of Adacel has been going on for 20 years!). They didn't often get judgements against them, they just had to litigate which became prohibitively expensive.

So...no. I do not believe in a ploy for drug companies to sell more units when it comes to immunizations anymore than when they develop an orphan drug which has a very small affected population. Nor do I believe these vaccines put people at greater risk & in fact, vaccines in the 20th century increased the lifespan of people receiving them by 30 years.

You claim you don't have an issue with policies which control infectious diseases - well, this is one & you apparently do. If you believe these vaccines put you or your children at risk - again - opt out. I checked the Miami-Dade Office of Education & they allow 2 exemptions - medical & religious. As a physician, you could certainly opt your children out & most everyone can obtain a religious exemption to almost anything. If you look in the Peds forum, they also have patients who choose to not immunize so you're not the first nor only.

But....I do wonder when so many millions are immunized & so few opt out..it seems as though you see a conspiracy where none exists. Paul Offit, MD - chief of infectious disease at Children's Hospital in Philadelphia in fact proposes there be no opt out choice, but we're not at that point, nor do I feel we necessarily should be to prevent the parental choice for any medical intervention.

In an attempt to bring this thread back from a personal discussion between you and I, I will stop arguing. However, I still believe that you are not understanding what I've been saying.

If there is such an exemption in Miami-Dade, then I was unaware, and I rescind my statement. My child IS actually vaccinated by the way. I had no intention of not vaccinating him, so I didn't research this as closely as I might have. I was only commenting on the new research about later life complications and commenting that we shouldn't force vaccinations on people if it actually opens them up to risk. I am not arguing that vaccines are bad, only that they should be routinely evaluated, and we should pay attention to potential adverse reactions. I am quite happy to live in the post small pox world.

 

[PBEA]

Not just this vaccine - just about any vaccine. We only found the immunity to measles is not lifetime after the first doses when the cases started to reappear in the 1980s.

How do I account for this - our lack of knowledge of our immune system and the difficulty in vaccine development. None of us expect our knowledge to be perfect - but we do the best we can with what we know. Given that....we have new recommendations for booster doses & are refining the vaccine components to assure greater & longer lasting immunity with fewer side effects & complications - the pertussus vaccine is a prime example.

But...don't throw the baby out with the bathwater, so to speak. We have a tremendous track record with vaccines and our understanding of the immune system is improving with more research into AIDS/HIV.

But - I am old enough to remember what it was like to not go to a pool in the summer because of a polio outbreak. Thankfully, most all our kids can swim without any of us worrying they might get polio.

I too would like my children swim in the water and not contract polio, so yes I do agree with vaccination as a general concept. I'm just trying to clarify the issues for myself. For instance, are you advocating a booster schedule for the entire country? So every person will receive this booster every ~5yrs? Is that practical? If it isnt practical then should it be indicated at all? Also it seems that your justifying a potential later onset (which is worse right?) by saying we need to protect the hiv/immunity people from the healthy ones? I guess that the needs of the many outweigh the needs of the few, but Ill be damned if that should be the primary reason to go "tinkering" with a healthy humans immunity.

This is totally off topic, but I'm glad you brought up the National Vaccine Injury Compensation Program. The way I read it, companies are now sheltered from liability with regard to their product. So they no longer have this burden of litigation to make the manufacturer of vaccinations unprofitable. In other words they can now make money again. They are back on track and while you quote $30 as a relative pittance you might want to consider the enormous volume of that dollar amount repeated N times. Its interesting to me that such a wonderful law doesnt exist to protect doctors (who clearly are acting in their pts best interest) from "unecessary" litigation from their patients, yet pharma enjoys this luxury? I mean companies are always acting in their customers best interest, right?

 

[sdn1977]

I too would like my children swim in the water and not contract polio, so yes I do agree with vaccination as a general concept. I'm just trying to clarify the issues for myself. For instance, are you advocating a booster schedule for the entire country? So every person will receive this booster every ~5yrs? Is that practical? If it isnt practical then should it be indicated at all? Also it seems that your justifying a potential later onset (which is worse right?) by saying we need to protect the hiv/immunity people from the healthy ones? I guess that the needs of the many outweigh the needs of the few, but Ill be damned if that should be the primary reason to go "tinkering" with a healthy humans immunity.

This is totally off topic, but I'm glad you brought up the National Vaccine Injury Compensation Program. The way I read it, companies are now sheltered from liability with regard to their product. So they no longer have this burden of litigation to make the manufacturer of vaccinations unprofitable. In other words they can now make money again. They are back on track and while you quote $30 as a relative pittance you might want to consider the enormous volume of that dollar amount repeated N times. Its interesting to me that such a wonderful law doesnt exist to protect doctors (who clearly are acting in their pts best interest) from "unecessary" litigation from their patients, yet pharma enjoys this luxury? I mean companies are always acting in their customers best interest, right?

The standard vaccine immunization booster schedule for adults has been modified for each vaccine to reflect the changes we've realized in immunity.

And....the VIP program does protect not just manufacturers but also providers.

You may find it interesting to read the CDC guidelines for vaccination online for yourself....they are easily accesible at www.cdc.gov with links to all the research & pt/provider information.

Best wishes no matter what decison you choose to make.