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Why are we so worried about vax vs non-vax? - Page 4

post #61 of 401
Quote:
Originally Posted by chickabiddy View Post
 

 

You've been informed that it offends people.  It feels very antagonistic when you continue to use it.

and the anti-science has been brought up tons of times……. with the long list Kathy supplied and that doesn't seem to change a thing - just saw it made mentioned recently as well - and I find it antagonistic! apparently others to as well……………I'm a happy Druid :rotflmao 

post #62 of 401

To be perfectly correct, teacozy and serenbat, those are all tertiary sources. I'd like to know where the information originates from about no transmissions ever being documented without a rash. The recommendation on the med center site, aimed at chemo patients, reiterates the common cautions given about live vaccines in general. If there is something specific about this one and it has been documented to be less contagious, that would be good information to have. If I get a minute I'll see if I can dig up full prescribing info.

 

serenbat, I'd really appreciate if you could work on the way you format your posts. You use bold and red a lot and it's not always clear which are your words and which are somebody else's, so it's really hard to follow the conversational threads. You even change back and forth in one post as to what you mean by each. 

post #63 of 401
Quote:
Originally Posted by serenbat View Post
 

 

Didn't you read this the last time I posted it? - http://www.merck.com/product/usa/pi_circulars/z/zostavax/zostavax_ppi.pdf

  1. Tell your health care provider if you expect to be in close contact (including household contact) with newborn infants, someone who may be pregnant and has not had chickenpox or been vaccinated against chickenpox, or someone who has problems with their immune system. Your health care provider can tell you what situations you may need to avoid. 

 

 

 

 

OrmEmbar You had every right to be concerned, even the manufacture, Merck mentions this.

 

 

 Have any links that support this? From a reputable public health site?  Why yes, and I have posted this several times also - UPMC reputable enough or do you need more?

 

http://www.upmccancercenter.com/cainformation/chemotherapy.cfm

 

You should avoid babies, children, or adults who have received live vaccinations within six to eight weeks. Live vaccinations include BCG (used to test for tuberculosis), chicken pox, measles, mumps, rubella, oral polio and yellow fever. A person who has received a live vaccination continues to shed small amounts of the live virus in their tears, saliva, nasal secretions, perspiration, urine and feces for one month.

 

I just addressed the vaccine by Merck, via the CDC which states that it is only possible if there is a rash.  Merck is a pharmaceutical company, in any case. 

 

Your second link is about people with cancer.  Her baby didn't have cancer as far as I am aware.  In her post it didn't say to only isolate kids vaccines with a live virus from cancer patients. The impression I got was that all kids should be isolated after receiving the live virus, which is going completely overboard in my opinion.  

 

Am I the only one who thinks this constant concern over vaccine shedding that some NVers have is ironic?  I mean, on one hand they argue that they are mild childhood illnesses that shouldn't be feared and are harmless in healthy children yet on the other hand think that children vaccinated with live viruses that have a *minuscule* chance of shedding should be isolated to protect unvaccinated children.  I mean you guys do realize that if it weren't for vaccines that chickenpox, measles etc would be rampant right? virtually EVERY child would be getting these full blown contagious diseases everyday in every city.  I really just do not get it. 

post #64 of 401
Quote:
Originally Posted by erigeron View Post
 

To be perfectly correct, teacozy and serenbat, those are all tertiary sources. I'd like to know where the information originates from about no transmissions ever being documented without a rash. The recommendation on the med center site, aimed at chemo patients, reiterates the common cautions given about live vaccines in general. If there is something specific about this one and it has been documented to be less contagious, that would be good information to have. If I get a minute I'll see if I can dig up full prescribing info.

 

serenbat, I'd really appreciate if you could work on the way you format your posts. You use bold and red a lot and it's not always clear which are your words and which are somebody else's, so it's really hard to follow the conversational threads. You even change back and forth in one post as to what you mean by each. 

actually Merck's info doesn't say it - it generalizes it

 

http://www.merck.com/product/usa/pi_circulars/z/zostavax/zostavax_pi2.pdf

5.2 Transmission of Vaccine Virus

Transmission of vaccine virus may occur between vaccinees and susceptible contacts.

 

 AND the contacts are what I listed, if a person had a vaccine two days ago, who is to say they are unable to transmit, when given the vaccine you are to be told to avoid contacts and you frankly don't know if you will or will not break out - bottom line is people are not being given this information! 

post #65 of 401
Quote:
Originally Posted by teacozy View Post
 

 

  Merck is a pharmaceutical company, in any case. 

 

 

That means what? You don't trust the info from Merck? 

post #66 of 401
 A number of people have asked that NVers be called NVers as opposed to Anti-vax.  It is hit and miss whether it happens.    
post #67 of 401
Quote:
Originally Posted by teacozy View Post
 

 

 

Your second link is about people with cancer.  Her baby didn't have cancer as far as I am aware.  In her post it didn't say to only isolate kids vaccines with a live virus from cancer patients. The impression I got was that all kids should be isolated after receiving the live virus, which is going completely overboard in my opinion.  

 

 

again, we are not to trust what Merck says about avoiding those contacts?

post #68 of 401
Quote:
Originally Posted by teacozy View Post
 

 

 

Am I the only one who thinks this constant concern over vaccine shedding that some NVers have is ironic?  I mean, on one hand they argue that they are mild childhood illnesses that shouldn't be feared and are harmless in healthy children yet on the other hand think that children vaccinated with live viruses that have a *minuscule* chance of shedding should be isolated to protect unvaccinated children.  I mean you guys do realize that if it weren't for vaccines that chickenpox, measles etc would be rampant right? virtually EVERY child would be getting these full blown contagious diseases everyday in every city.  I really just do not get it. 

Ironic? NOPE! and you certainly don't speak for me! and NO, IMO you simply don't get it

post #69 of 401
Quote:
Originally Posted by serenbat View Post
 

again, we are not to trust what Merck says about avoiding those contacts?

 

I will post it again.  The link from the CDC was directly talking about the shingles vaccine from Merck.  They said it has been documented but *only* from people with the rare rash. 

 

"Although transmission of Oka/Merck strain VZV has been documented following varicella vaccination, such transmission is rare and has only been documented when the vaccine recipient first developed a varicella-like rash. Rates of varicella-like rash appear to be less common following zoster vaccination than following varicella vaccination, and transmission of the Oka/Merck strain VZV from recipients of zoster vaccine has not been detected." 

post #70 of 401

If you child has a live vaccine, you should be given the information to KNOW that close contact with certain people should be avoided. Why not tell people this?

 

Frankly (as I others have posted before) most have no clue unless their Dr tells them who they should avoid, not the other way around. This is not just for cancer patients but for those with compromised immune systems as well.

post #71 of 401
Quote:
Originally Posted by teacozy View Post
 

 

I will post it again.  The link from the CDC was directly talking about the shingles vaccine information from Merck.  They said it has been documented but *only* from people with the rare rash. 

 

"Although transmission of Oka/Merck strain VZV has been documented following varicella vaccination, such transmission is rare and has only been documented when the vaccine recipient first developed a varicella-like rash. Rates of varicella-like rash appear to be less common following zoster vaccination than following varicella vaccination, and transmission of the Oka/Merck strain VZV from recipients of zoster vaccine has not been detected." 

I'll ask it again, are we not to trust what Merck says about their own vaccine and ONLY trust the CDC?

post #72 of 401
Quote:
Originally Posted by teacozy View Post

 

Am I the only one who thinks this constant concern over vaccine shedding that some NVers have is ironic?  I mean, on one hand they argue that they are mild childhood illnesses that shouldn't be feared and are harmless in healthy children yet on the other hand think that children vaccinated with live viruses that have a *minuscule* chance of shedding should be isolated to protect unvaccinated children.  I mean you guys do realize that if it weren't for vaccines that chickenpox, measles etc would be rampant right? virtually EVERY child would be getting these full blown contagious diseases everyday in every city.  I really just do not get it. 

Kinda. Although in this situation, with a really young baby, I understand it. I wouldn't be concerned about either a vaxed child shedding, or an unvaxed child who might potentially be sick with a VPD, around my healthy child who is up to date on her vaxes. 

 

Quote:
Originally Posted by serenbat View Post
 

actually Merck's info doesn't say it - it generalizes it

 

http://www.merck.com/product/usa/pi_circulars/z/zostavax/zostavax_pi2.pdf

5.2 Transmission of Vaccine Virus

Transmission of vaccine virus may occur between vaccinees and susceptible contacts.

 

 AND the contacts are what I listed, if a person had a vaccine two days ago, who is to say they are unable to transmit, when given the vaccine you are to be told to avoid contacts and you frankly don't know if you will or will not break out - bottom line is people are not being given this information! 

True on all counts. I really want to know where that claim on the CDC website comes from now, if it's not from the package insert. I mean, I don't think the CDC is making crap up, but I still want to know where they're getting it from. 

post #73 of 401
Quote:
Originally Posted by serenbat View Post
 

I'll ask it again, are we not to trust what Merck says about their own vaccine and ONLY trust the CDC?

I don't know. Maybe the CDC has new information that didn't come from Merck, or Merck did provide this information but hasn't updated their package insert. After all, the package insert doesn't say that they HAVE recorded transmission, either (although it did report that there was a rash in a vanishingly rare number of people). I'm not going to reach a conclusion either way without more information; I don't want to lean on either a vague statement from Merck or a vague statement from the CDC, if I can help it. 

post #74 of 401
Quote:
Originally Posted by erigeron View Post
 

I don't know. Maybe the CDC has new information that didn't come from Merck, or Merck did provide this information but hasn't updated their package insert. After all, the package insert doesn't say that they HAVE recorded transmission, either (although it did report that there was a rash in a vanishingly rare number of people). I'm not going to reach a conclusion either way without more information; I don't want to lean on either a vague statement from Merck or a vague statement from the CDC, if I can help it. 

I'm sure Merck has consulted their lawyers and there is a reason they included who should be avoided and the language they did about transmission. You (should) are to be told who to avoid. 

post #75 of 401
Quote:
Originally Posted by erigeron View Post
 

I don't know. Maybe the CDC has new information that didn't come from Merck, or Merck did provide this information but hasn't updated their package insert. After all, the package insert doesn't say that they HAVE recorded transmission, either (although it did report that there was a rash in a vanishingly rare number of people). I'm not going to reach a conclusion either way without more information; I don't want to lean on either a vague statement from Merck or a vague statement from the CDC, if I can help it. 

 

Good lord, this thread. 

 

From what I can tell, there is evidence the vaccine sheds; so theoretically transmission is possible.  But transmission has never been documented (as of 2011).  http://jid.oxfordjournals.org/content/203/11/1542.full#ref-6  Which references the ACIP document for shingles.

post #76 of 401
Quote:
Originally Posted by cwill View Post
 

 

Good lord, this thread. 

 

From what I can tell, there is evidence the vaccine sheds; so theoretically transmission is possible.  But transmission has never been documented (as of 2011).  http://jid.oxfordjournals.org/content/203/11/1542.full#ref-6  Which references the ACIP document for shingles.

and my understanding (I can't find the link off hand) is that you can not (as in Merck's case) state un-true information, the CDC will go after you if you do that, so as I stated, I'm sure there is a real good reason that wording is there by Merck, as with every word, their lawyers go over it well

post #77 of 401

Hmmmm. Interesting.  If you look at the CDC site, they also contradict a change that Merck made to their package back in 2009. 

 

"

Simultaneous administration with other vaccines

Zostavax is a live virus vaccine. It can be administered concurrently with all other live and inactivated vaccines, including those routinely recommended for persons in 60 years and older age group, such as influenza and pneumococcal vaccines.

Of note, in December 2009 Merck revised the package insert for herpes zoster vaccine (HZV) to advise that HZV and 23-valent pneumococcal polysaccharide vaccine (PPSV) should not be administered concurrently. This recommendation was based on a Merck study that showed the average titer against varicella zoster virus (VZV) was lower in persons who received zoster and PPSV at the same visit compared to persons who received these vaccines 4 weeks apart. However, the clinical relevance of this observation is unknown because there is no evidence to indicate that antibody titers against VZV are a measure of protection against HZ (results were additionally confounded by unexplained differences across comparison group in the baseline VZV antibody titers). In fact, a large study was subsequently conducted that showed that zoster vaccine was equally effective at preventing herpes zoster whether it was administered simultaneously with PPSV or 4 weeks earlier. Also, the safety profile of zoster vaccine is unaffected by simultaneous administration of PPSV. Consequently, to avoid introducing barriers to patients and providers who are interested in these two important vaccines, CDC has not changed its recommendation for either vaccine, and continues to recommend that HZV and PPSV be administered at the same visit if the person is eligible for both vaccines."

If you look at the Merck package insert, it *still* has that warning, though.

 

 ------------------------------- DRUG INTERACTIONS ------------------------------- 
In a randomized clinical study, a reduced immune response to 
ZOSTAVAX as measured by gpELISA was observed in individuals 
who received concurrent administration of PNEUMOVAX® 23 and 
ZOSTAVAX compared with individuals who received these vaccines 4 
weeks apart. Consider administration of the two vaccines separated by 
at least 4 weeks (7.1, 14.3). 

http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM132831.pdf

 

Looks like the CDC is better at staying up to date than Merck? 

 

post #78 of 401

The MMWR concerning shingles approval: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5705a1.htm

 

They use the same "no transmission reported" language, citing this piece: http://www.nejm.org/doi/full/10.1056/NEJMoa051016#t=articleResults

 

But neither of those pieces goes into detail about it. What does it really mean to say something wasn't documented? That it was looked for and not found, or that it was never looked for? I still can't tell which of these is the case. 

 

Meh. I'm not too worried about a recent zoster recipient sneezing on me and giving me CP (especially since I actually had CP as a child), but given the information cwill posted, it does sound like shedding is theoretically a risk. Until/unless someone tracks down the source of that "no transmission documented" I'll stick with that. 

post #79 of 401
Quote:
Originally Posted by teacozy View Post
 

Hmmmm. Interesting.  If you look at the CDC site, they also contradict a change that Merck made to their package back in 2009. 

 

"

Simultaneous administration with other vaccines

Zostavax is a live virus vaccine. It can be administered concurrently with all other live and inactivated vaccines, including those routinely recommended for persons in 60 years and older age group, such as influenza and pneumococcal vaccines.

Of note, in December 2009 Merck revised the package insert for herpes zoster vaccine (HZV) to advise that HZV and 23-valent pneumococcal polysaccharide vaccine (PPSV) should not be administered concurrently. This recommendation was based on a Merck study that showed the average titer against varicella zoster virus (VZV) was lower in persons who received zoster and PPSV at the same visit compared to persons who received these vaccines 4 weeks apart. However, the clinical relevance of this observation is unknown because there is no evidence to indicate that antibody titers against VZV are a measure of protection against HZ (results were additionally confounded by unexplained differences across comparison group in the baseline VZV antibody titers). In fact, a large study was subsequently conducted that showed that zoster vaccine was equally effective at preventing herpes zoster whether it was administered simultaneously with PPSV or 4 weeks earlier. Also, the safety profile of zoster vaccine is unaffected by simultaneous administration of PPSV. Consequently, to avoid introducing barriers to patients and providers who are interested in these two important vaccines, CDC has not changed its recommendation for either vaccine, and continues to recommend that HZV and PPSV be administered at the same visit if the person is eligible for both vaccines."

If you look at the Merck package insert, it *still* has that warning, though.

 

 ------------------------------- DRUG INTERACTIONS ------------------------------- 
In a randomized clinical study, a reduced immune response to 
ZOSTAVAX as measured by gpELISA was observed in individuals 
who received concurrent administration of PNEUMOVAX® 23 and 
ZOSTAVAX compared with individuals who received these vaccines 4 
weeks apart. Consider administration of the two vaccines separated by 
at least 4 weeks (7.1, 14.3). 

http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM132831.pdf

 

Looks like the CDC is better at staying up to date than Merck? 

 

none of this makes the language about transmission or avoidance of contact un-true (this information can also be found on non-Merck & CDC sites)

 

CDC also has had retractions, revisions and the like to their info

post #80 of 401
Quote:
Originally Posted by teacozy View Post
 

 In fact, a large study was subsequently conducted that showed that zoster vaccine was equally effective at preventing herpes zoster whether it was administered simultaneously with PPSV or 4 weeks earlier. Also, the safety profile of zoster vaccine is unaffected by simultaneous administration of PPSV. Consequently, to avoid introducing barriers to patients and providers who are interested in these two important vaccines, CDC has not changed its recommendation for either vaccine, and continues to recommend that HZV and PPSV be administered at the same visit if the person is eligible for both vaccines."

 

I would try to track down that study, but I'm tired now... It bugs me that these CDC pages don't have good citations. Even the health care provider pages are mostly patient handouts and other distillations of the material. 

 

Looks like the CDC is better at staying up to date than Merck? 

Or Merck has to jump through hoops to change the package insert that they don't feel like jumping through. Merck's agenda is to make sure people get their vaccine; whether they get another one is of secondary importance to them.

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