Is this a rational rebuttal to the "herd immunity" theory?

[quelindo]

I cannot for the life of me remember where I read this, but I recently read an essay by someone who said that the herd immunity theory was flawed because it's based on the majority of people being immunized against disease. He said that until not that recently, doctors thought that one innoculation gave lifelong immunity, but now they're saying that we need boosters even into adulthood. So his thought was that people have been running around unprotected for the majority of the time vaccinations were in use...so where were all the deadly outbreaks if the herd was not immunized?

This makes sense to me, but I'm wondering if I'm missing something. Also, if anyone knows where I got this info, please let me know!

[Marnica]

I have not read all the links from this site, but it does give a nice overview of where the term herd immunity came from and how it is MEANT to be applied to disease and immunity (that would be naturally aquired disease and immunity, not vaccine induced immunity

http://www.lowellsfacts.com/herdimmunity.html

I found this too
http://epirev.oxfordjournals.org/cgi...tract/15/2/265

I wish I could get the full article...sounds like there might be a nice discussion of the two sides of the arguement, but one needs to pay for access

[member234098]

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Edited by member234098 - 6/11/12 at 6:58am

[silybum]

I totally hear you Miriam; and I have selectively vaccinated my LO (only just finished DTaP at 16m, nothing else). AND, I also hear the herd immunity argument and i wonder what you think of our responsibility to those in the community who are at risk for serious disease and even death if they caught, say, pertussis. (Maybe not a great example; I know its only 80% effective, but that is still quite a bit higher than 0%.) I am not trying to be confrontational, I totally support (and have lots of friends) who dont vaccinate at all and I think it really sucks to use scare and shame tactics. But I also feel a larger pull to care for our community. I am trying to reconcile this within myself and hoping for thoughts and guidance from others who have grappled with it too.

Shoot, is this a hiijack? Should I start a thread?

[emma1325]

Originally Posted by silybum

I totally hear you Miriam; and I have selectively vaccinated my LO (only just finished DTaP at 16m, nothing else). AND, I also hear the herd immunity argument and i wonder what you think of our responsibility to those in the community who are at risk for serious disease and even death if they caught, say, pertussis. (Maybe not a great example; I know its only 80% effective, but that is still quite a bit higher than 0%.) I am not trying to be confrontational, I totally support (and have lots of friends) who dont vaccinate at all and I think it really sucks to use scare and shame tactics. But I also feel a larger pull to care for our community. I am trying to reconcile this within myself and hoping for thoughts and guidance from others who have grappled with it too.

Shoot, is this a hiijack? Should I start a thread?

Totally relevant; not a hijack IMO.

Just FYI, pertussis vaccine is not known to prevent transmission; it is only known to potentially prevent a serious case in the vaccinated individual.

[claddaghmom]

Originally Posted by emma1325

Totally relevant; not a hijack IMO.

Just FYI, pertussis vaccine is not known to prevent transmission; it is only known to potentially prevent a serious case in the vaccinated individual.

Pertussis is a really bad example. It reduces symptoms (aka subclinical/atypical) for the individual and does not prevent transmission to others.

IMO this makes vaccinated people much more dangerous than vaccine-free people. Pertusiss comes with a very specific cough and pleghm. Those who are vaccinated can siletly pass the germs onto susceptible populations, such as newborns.

After learning how vaccines work, I find the myth to be either a tactic used to force parents into vaccinating or to discriminate/promote hostility against those who keep their children vaccine free.

Vaccines do not provide 100% immunity. They only provide temporal immunity (e.g. it wears off). They do not provide optimal immunity until the course is complete. Some vaccines do not prevent transmission of disease. Some vaccines are live and have the potential to shed and spread. Other vaccines are influencing serotype replacement. And of course, now we have two Pertussis strains that are resistant to vaccines.

The true fallacy within the social responsibility myth is the assumption that we can control the spread and contraction of disease with a vaccine. The assumption that following the CDC's schedule will make my child protect another theoretical child is....well...amazing.

And I also find it hypocritical. In 2008, 37,000 people died in car accidents. Over 250,000 children were seriously/permanently injured, too. So how come those who push vaccines to "save other lives" aren't staying at home and selling their cars?

[member234098]

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Edited by member234098 - 6/11/12 at 6:59am

[silybum]

Originally Posted by emma1325

Just FYI, pertussis vaccine is not known to prevent transmission; it is only known to potentially prevent a serious case in the vaccinated individual.

Originally Posted by claddaghmom

Pertussis is a really bad example. It reduces symptoms (aka subclinical/atypical) for the individual and does not prevent transmission to others.

Thanks for the responses!

Hmmm, I have done a fair amount of vaccine study myself and have never heard that pertussis only reduces symptoms. Do either of you have a reliable source on this? I would be really interested to see one.

Its also not necessarily true that vaccines aren't effective until the course is complete. The % effective that is discussed is actually the % of kids who respond to each shot. So they give 3 shots to cast the net wider and get more kids to respond.

And, again, I completely agree that herd immunity concept should not be used to force anyone to make a choice they dont want to make. But I do not think its a myth. There are a lot of studies that show that when vaccinations go down, outbreaks go up. I'm coming from a place of being quite anti-vaccination at first, and now selective about them. I am in no way supporting the CDC schedule. But I'm grappling with the social responsibility aspect of it. Disclaimer: my Grandmother was a Commie.

There may be some shedding of virus, but I have a really hard time believing its as effective as someone who actually is sick. Someone with end-stage cancer has a very suppressed immune system and wouldn't be able to fight off germs that most people could. It does suggest that there is shedding after vaccination, but doesn't prove that its more or less than a sick person.

And while its true that vaccines dont provide 100% immunity, neither does the wild-type disease. I had Pertussis when I was 3 months and recently had my titers done, and 30 years later, I am no longer immune. (They used to think catching Pertussis gave life-long immunity, no longer.) I do believe that catching a disease will provide better, longer lasting immunity. But I also dont want to idealize it; because, well, its not perfect either.

I am really interested in this discussion; grappling with these ideas as I said in the previous post. I hope y'all can hear me in the spirit of respectful and interested debate. I'd like to hear what comes back...

[claddaghmom]

Originally Posted by miriam

The live vaccines as OPV, MMR and flumist do spread the disease, more effectively than someone with the disease.

No one has ever told me why the oncologists told my friend with end stage cancer to stay away from recently vaxed children. If unvaxed children are so dangerous, why should a dying cancer patient avoid recently vaxed children?

I wonder if it is simply b/c that is one vector of disease that you can be certain about...

[claddaghmom]

Originally Posted by silybum

Thanks for the responses!

Hmmm, I have done a fair amount of vaccine study myself and have never heard that pertussis only reduces symptoms. Do either of you have a reliable source on this? I would be really interested to see one.

Its also not necessarily true that vaccines aren't effective until the course is complete. The % effective that is discussed is actually the % of kids who respond to each shot. So they give 3 shots to cast the net wider and get more kids to respond.

And, again, I completely agree that herd immunity concept should not be used to force anyone to make a choice they dont want to make. But I do not think its a myth. There are a lot of studies that show that when vaccinations go down, outbreaks go up. I'm coming from a place of being quite anti-vaccination at first, and now selective about them. I am in no way supporting the CDC schedule. But I'm grappling with the social responsibility aspect of it. Disclaimer: my Grandmother was a Commie.

There may be some shedding of virus, but I have a really hard time believing its as effective as someone who actually is sick. Someone with end-stage cancer has a very suppressed immune system and wouldn't be able to fight off germs that most people could. It does suggest that there is shedding after vaccination, but doesn't prove that its more or less than a sick person.

And while its true that vaccines dont provide 100% immunity, neither does the wild-type disease. I had Pertussis when I was 3 months and recently had my titers done, and 30 years later, I am no longer immune. (They used to think catching Pertussis gave life-long immunity, no longer.) I do believe that catching a disease will provide better, longer lasting immunity. But I also dont want to idealize it; because, well, its not perfect either.

I am really interested in this discussion; grappling with these ideas as I said in the previous post. I hope y'all can hear me in the spirit of respectful and interested debate. I'd like to hear what comes back...

Yes, but I personally do not care about 100% immunity. I simply find that most people assume vaccines impart 100% immunity. I know the people on MDC don't, but I'm talking about my average run-in.

Anyways, here's some stuff I have on the DTaP:

http://pediatrics.aappublications.or...act/104/6/1381

"The first is that a substantial number of B pertussis infections in unvaccinated children are mild and would not meet the case definition. The second is that all pertussis vaccines tend to modify duration and severity of disease rather than completely preventing illness"

http://www.cdc.gov/ncidod/eid/vol6no5/pdf/srugo.pdf

"The effects of whole-cell pertussis vaccine wane after 5 to 10 years, and infection in a vaccinated person causes nonspecific symptoms (3-7). Vaccinated adolescents and adults may serve as reservoirs for silent infection and become potential transmitters to unprotected infants (3-11). The whole-cell vaccine for pertussis is protective only against clinical disease, not against infection (15-17). Therefore, even young, recently vaccinated children may serve as reservoirs and potential transmitters of infection. "<<<<---

http://iai.highwire.org/cgi/content/full/68/12/7175

"In summary, booster immunization of adults with acellular pertussis vaccines was not found to increase bactericidal activity over preimmunization levels. Identifying ways to promote bactericidal immune responses might improve the efficacy of acellular pertussis vaccines. "

http://whqlibdoc.who.int/hq/1999/WHO_V&B_99.03.pdf

"In discussion, Dr Cherry pointed out that in Japan also the reported pertussis incidence in children under three months of age has not declined substantially with return to a high vaccination coverage."

http://iai.asm.org/cgi/reprint/58/10/3445

"This is consistent with animal experiments which suggest that adhesions not targeted by the vaccine may permit a bit of colonization and that neutralization of pertussis toxin would limit the severity of the disease but would not have an impact on the initial stages of infection."

http://www.journals.uchicago.edu/doi...10.1086/381204

"Of particular interest is the lack of a significant ACT antibody response in children for whom the DTP or DTaP vaccines failed. This induced tolerance is intriguing and may be due to the phenomenon called “original antigenic sin”

http://www.ima.org.il/imaj/ar06may-2.pdf

“Pertussis is considered an endemic disease, characterized by an epidemic every 2–5 years. This rate of exacerbations has not changed, even after the introduction of mass vaccination – a fact that indicates the efficacy of the vaccine in preventing the disease but not the transmission of the causative agent (B. pertussis) within the population [19].”

http://www.uga.edu/rohanilab/paperpdfs/lancet2000.pdf

“We now have access to a much more extensive dataset
(both temporally and spatially) than was available to Fine
and Clarkson.4 We found that the onset of pertussis
vaccination coincided with a significant increase in the
interepidemic interval, from 2·0–2·5 to nearly 4 years in the
ten largest cities of England and Wales (figure 1).”

http://www.adacel-locator.com/index....E&P=HowS_pread

“* It is unknown whether immunizing adolescents and adults against pertussis will reduce the risk of transmission to infants.3”

http://www.thefreelibrary.com/Pertus......-a066705900

“The study:
All the children in the day-care centers had been immunized in infancy with all four doses of Pasteur diphtheria-tetanus toxoid toxoid.......
All family members of the infant were also fully vaccinated with four doses of DTP. The infant had received only the first dose of vaccine at 2 months of age.”


Here are the ingredient lists (not copy/pasted mods) for two of the brands:

http://www.fda.gov/cber/label/dtapsan110806LB.pdf
Deptacel (diphtheria, tetanus, acellular pertussis)

10 micrograms detoxified pertussis toxin
5 micrograms filamentous haemagglutinin
5 micrograms fimbriae types 2 and 3 (FIM)
3 micrograms pertactin (PRN)
15 Lf (limit flocculation) diphtheria toxoid
5 Lf (limit flocculation) tetanus toxoid
1.5 mg aluminum phosphate (0.33 mg of aluminum)
5 micrograms or less of residual formaldehyde
50 nanograms or less of residual glutaraldehyde
3.3 mg (0.6% v/v) 2-phenoxyethanol

- Pertussis:
Bordetella pertussis cultures grown in Stainer-Scholte medium, with added casamino acids and dimethyl-beta-cyclodextrin.
Toxin detoxified with glutaraldehyde.
Filamentous hemagglutinin is treated with formaldehyde.
Residual aldehydes are removed by ultrafiltration.
Individual antigens adsorbed separately onto aluminum phosphate.

- Diphtheria:
Corynebacterium diphtheriae cultures grown in modified Mueller’s growth medium.
Toxin purified by ammonium sulfate fractionation and detoxified with formaldehyde and diafiltered.
Toxoid is individually adsorbed onto aluminum phosphate

- Tetanus:
Clostridium tetan: cultures grown in modified Mueller-Miller casamino acid medium without beef heart infusion.
Toxin is detoxified with formaldehyde and purified by ammonium sulfate fractionation and diafiltration.
Toxoid individually adsorbed onto aluminum phosphate.

http://www.fda.gov/cber/label/dtapsmi121302LB.pdf
Pediarix (diphtheria, tetanus, acellular pertussis)

25 Lf diphtheria toxoid
10 Lf of tetanus toxoid
25 micrograms inactivated pertussis toxin
25 micrograms filamentous hemagglutinin
8 micrograms pertactin
10 micrograms HBsAg (hepatitis B surface antigen)
40 D-antigen Units (DU) of Type 1 poliovirus
8 DU of Type 2 poliovirus
32 DU of Type 3 poliovirus
2.5 mg 2-phenoxyethanol (a preservative)
4.5 mg sodium chloride
Not more than 0.85 mg aluminum by assay
100 micrograms or less residual formaldehyde
100 micrograms or less polysorbate 80 (Tween 80)
Thimerosal is used at the early stages of manufacture and is removed by subsequent purification steps to below the analytical limit of detection (less than 25 nanograms mercury per 20 micrograms HBsAg) which upon calculation is less than 12.5 nanograms mercury per dose
0.05 nanograms or less of Neomycin
0.01 nanograms or less of polymyxin B
5% or less of yeast protein

- Diphtheria:
Corynebacterium diphtheriae cultures grown in Fenton medium containing a bovine extract.

- Tetanus:
Clostridium tetani cultures grown in a modified Latham medium derived from bovine casein.
Detoxified with formaldehyde.
Purified by precipitation, dialysis, and sterile filtration
- Pertussis:
Bordetella pertussis cultures grown in modified Stainer-Scholte liquid medium.
Toxin detoxified with glutaraldehyde and formaldehyde.
Filamentous hemagglutinin and pertactin, two pertussis antigens, are treated with formaldehyde.

[silybum]

Wow, thank you for all the links. This has really provoked some thought and some change in my thinking. I must say though, that I do wish this information was newer. 10-12 years is an eon in scientific literature. Do you know if/how DTaP has changed in that time? I might look into that. I'll comment on those I have time to look at right now, and look at the rest later.

Originally Posted by claddaghmom

http://pediatrics.aappublications.or...act/104/6/1381

"The first is that a substantial number of B pertussis infections in unvaccinated children are mild and would not meet the case definition. The second is that all pertussis vaccines tend to modify duration and severity of disease rather than completely preventing illness"

This looks like a really interesting article, but free full-text is not available so I wasnt able to find the quote you extracted. Do you have a pdf you might share?

Originally Posted by claddaghmom

http://www.cdc.gov/ncidod/eid/vol6no5/pdf/srugo.pdf
"The effects of whole-cell pertussis vaccine wane after 5 to 10 years, and infection in a vaccinated person causes nonspecific symptoms (3-7). Vaccinated adolescents and adults may serve as reservoirs for silent infection and become potential transmitters to unprotected infants (3-11). The whole-cell vaccine for pertussis is protective only against clinical disease, not against infection (15-17). Therefore, even young, recently vaccinated children may serve as reservoirs and potential transmitters of infection. "<<<<---

http://iai.highwire.org/cgi/content/full/68/12/7175
"In summary, booster immunization of adults with acellular pertussis vaccines was not found to increase bactericidal activity over preimmunization levels. Identifying ways to promote bactericidal immune responses might improve the efficacy of acellular pertussis vaccines. "

I'm just about convinced with the carrier/non-specific symptoms that DTaP may not measure up to my ideas of community-responsibilty. It sounds pretty similar to the unvaccinated situation, which can also have non-specific symptoms for the first couple week with potential for infectious-ness through that time, if I remember correctly. However, the second article in the above quote is only looking at 2 mechanisms for killing bacteria, and should be taken in context with the whole body of evidence (not saying I've done that--just sayin')

Originally Posted by claddaghmom

http://whqlibdoc.who.int/hq/1999/WHO_V&B_99.03.pdf

"In discussion, Dr Cherry pointed out that in Japan also the reported pertussis incidence in children under three months of age has not declined substantially with return to a high vaccination coverage."

This quote is in the middle of a discussion of vaccine reactions, and so its not clear to me whether its talking about pertussis disease or vaccine reactions not decreasing as vaccination coverage increases. But honestly, this article is too old to convince me it relates today.

Originally Posted by claddaghmom

http://www.ima.org.il/imaj/ar06may-2.pdf

“Pertussis is considered an endemic disease, characterized by an epidemic every 2–5 years. This rate of exacerbations has not changed, even after the introduction of mass vaccination – a fact that indicates the efficacy of the vaccine in preventing the disease but not the transmission of the causative agent (B. pertussis) within the population [19].”

This looks like a good article. Dont have time to read it now, but thanks for sharing. Do you know if Israel has the same DTap that we do?

Originally Posted by claddaghmom

http://www.uga.edu/rohanilab/paperpdfs/lancet2000.pdf

“We now have access to a much more extensive dataset (both temporally and spatially) than was available to Fine and Clarkson.4 We found that the onset of pertussis vaccination coincided with a significant increase in the interepidemic interval, from 2·0–2·5 to nearly 4 years in the ten largest cities of England and Wales (figure 1).”

This is a good thing no? Longer times between Pertussis outbreaks? And its due to the onset of vaccination.

Originally Posted by claddaghmom

http://www.adacel-locator.com/index....E&P=HowS_pread

“* It is unknown whether immunizing adolescents and adults against pertussis will reduce the risk of transmission to infants.3”

This doesnt convince me either way; it just says the research is equivocal or hasnt been done. It is too easily used by either side to say, "See, so you should do it my way just to be safe."

I didnt mean to turn this into a DTaP discussion. If anything, DTaP is one of the crappiest vaccines out there. Not in terms of risk, but efficacy, with only 80% of kids responding to it. Its kind of exhausting to think of it, but it seems to me that this much research and thought needs to go into each vaccine in order to make a truly informed, intelligent decision. Ouch.

ETA: @miriam: OPV is pretty much not used at all any more.

[member234098]

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Edited by member234098 - 6/11/12 at 6:59am

[silybum]

Sorry miriam, you are right. I was thinking about locally, the impact on my DD. Thanks for the clarification.

[claddaghmom]

Silybum, great breakdown! I'd love to get your new DTAP resources. Primarily American, but if you have any European ones I'd love those, too. I've got some friends across the pond. If it's a lot just PM for my email.


Thanks so much!

[FREEmom1120]

Read down in this article and it explains why herd immunity is not a valid argument.

Vaccine Myths Exposed

[ema-adama]

Which DTaP is in use in the USA? (I live in Israel)

[claddaghmom]

Originally Posted by ema-adama

Which DTaP is in use in the USA? (I live in Israel)

hmm, there are several for tDap, DTaP, etc:
http://www.vaccinesafety.edu/package_inserts.htm

Adacel
Boostrix
Daptacel
Decavac
Infanrix
Kinrix
Pediarix
Pentacel
Tripedia
Trihibit

[ema-adama]

Originally Posted by claddaghmom

hmm, there are several for tDap, DTaP, etc:
http://www.vaccinesafety.edu/package_inserts.htm

Adacel
Boostrix
Daptacel
Decavac
Infanrix
Kinrix
Pediarix
Pentacel
Tripedia
Trihibit

That's what I thought, that there is more than one in use in the USA. I know the most popular in use in Israel is Pentacel by sanofi.

The quote:
“Pertussis is considered an endemic disease, characterized by an epidemic every 2–5 years. This rate of exacerbations has not changed, even after the introduction of mass vaccination – a fact that indicates the efficacy of the vaccine in preventing the disease but not the transmission of the causative agent (B. pertussis) within the population [19].”
is from this study from the European Journal of Paediatrics, from 2001, and not relevant to Israel or the DTaP used in Israel.

[silybum]

claddaghmom--I wish I had a bunch of new DTap resources. I was just being picky. When I looked back at some of my info, a lot of it was older than I liked. I do have some stuff on PCV from a short paper I wrote a while back that might be helpful:

Centers for Disease Control and Prevention. Pneumonia Hospitalizations Among Young Children Before and After Introduction of Pneumococcal Conjugate Vaccine --- United States, 1997—2006. Morbidity and Mortality Weekly Report, 2009: 48(01);1-4. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5801a1.htm

Centers for Disease Control and Prevention. Progress in Introduction of Pneumococcal Conjugate Vaccine --- Worldwide, 2000—2008. Morbidity and Mortality Weekly Report. 2008: 47(42);1148-1141 Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5742a2.htm

Chowdhary, Sona and Jacob Puliyel1. Incidence of pneumonia is not reduced by pneumococcal conjugate vaccine. Bulletin of the World Health Organization. 2008: vol.86 no.10. Available at: http://www.scielosp.org/scielo.php?s...rm=iso&tlng=en

Marshall, Gary. The Vaccine Handbook: A Practical Guide for Clinicians. Philadelphia: Lippincott Williams & Wilkins, 2004.

Wyeth. Prevnar Pneuococcal 7-valent Conjugate Vaccine (Diptheria CRM197 Protein). Available at: http://www.prevnar.com/pi_pop.aspx

The Vaccine Handbook is where I found the info about MMR side effects including encephalitis.

I know this not what you asked for...I've been mia studying this week and am procrastinating now at the last minute. I'll see if I can find anything re DTap to share in the next week.

I love this message board. Thanks everyone for being awesome.

[amberskyfire]

You can actually find this information on the CDC's website which is where I read it. The CDC states that booster shots must be maintained into adulthood and they also state that only 1-2% of adults in the USA are vaccinated for anything other than flu.

This means that the vast majority if Americans are not vaccinated. I was really floored when I read this information. It makes me pretty upset when people get mad at me for not vaccinating my daughter and "putting their child in danger" when their child is free to be around as many adults as they like.

It makes me so irritable when people talk about herd immunity and it doesn't even exist. Sure it SOUNDS good, but it isn't the reality. There is no such thing as herd immunity.