The Science Behind Vaccine Schedule Discrepencies - Mothering Forums
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#1 of 28 Old 06-14-2014, 12:23 PM - Thread Starter
 
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The Science Behind Vaccine Schedule Discrepencies

I keep hearing the claim that discrepencies in vaccine schedules in different countries are based on science and a population's unique needs.

Focusing only on industrialized, first-world countries, can anybody provide specific instances of discrepencies and a well cited, scientific rationale behind them? As a couple of examples, what unique characteristics of the U.S. population would warrant routine childhood chicken pox vaccination that British children don't have? Why might children on one side of the St. Lawrence River, in Vermont, have a medical and physiologic need for the Hep B vaccine at birth, while Quebecan children on the other side may wait until adolescence?

Why might one U.S. physician, cited in another thread, say that there is no medically acceptable alternative vaccine schedules? Are there science-based reasons for discrepencies in other countries schedules, or are these other countries, to use a popular finger-pointing accusation, "anti-science?"

If there is real science going behind such decisions, may I have a look at it, pretty please?

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#2 of 28 Old 06-14-2014, 01:13 PM
 
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I wish Samantha Bee (The Daily Show) had picked some Quebec-Vermont border crossing - cross it or stand with one foot on each side and talk about the so-called consensus in vaxes. That would've been funny because that's the kind of insight
I expect and love from TDS.

Instead they took the most prosaic and mainstream views there could be.

No insight, no satire, no fun.
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#3 of 28 Old 06-14-2014, 01:25 PM
 
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Anyway, apropos the original question.

On chickenpox - from WHO, from 2003. If there's anything more recent, pls do share.
http://archives.who.int/vaccines/en/...#justification

From the 'Summary and conclusions' section:
...
Routine childhood immunization against varicella may be considered in countries where this disease is a relatively important public health and socioeconomic problem, where the vaccine is affordable, and where high (85%–90%) and sustained vaccine coverage can be achieved. (Childhood immunization with lower coverage could theoretically shift the epidemiology of the disease and increase the number of severe cases in older children and adults.)
...

Note the mention on epidemiological shift.
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#4 of 28 Old 06-14-2014, 01:31 PM
 
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And, this is on chickenpox from NHS (UK)
http://www.nhs.uk/Conditions/vaccina...outineschedule

[quote] ...
Why isn't the chickenpox vaccination part of the routine childhood immunisation schedule?

There's a worry that introducing chickenpox vaccination for all children could increase the risk of chickenpox and shingles in older people.

Whilst chickenpox during childhood is unpleasant, the vast majority of children recover quickly and easily. In adults, chickenpox is more severe and the risk of complications increases with age.

If a childhood chickenpox vaccination programme was introduced people would not catch chickenpox as children (as the infection would no longer circulate in areas where the majority of children had been vaccinated). This would leave unvaccinated children (there will always be a few who are unable or choose not to have the vaccine) susceptible to contracting chickenpox as adults when they are more likely to develop a more severe infection or a secondary complication, or in pregnancy when there is a risk of the infection harming the baby.


We could also see a significant increase in cases of shingles in adults. Adults who are naturally exposed to chickenpox (such as through contact with infected children) receive a natural boosting of their chickenpox antibodies which prevents the chickenpox virus (which remains dormant in the body after chickenpox infection) from reactivating in their bodies and causing shingles.


If you vaccinate children against chickenpox, you lose this natural boosting so current levels of immunity in adults will drop and more shingles will occur.
[endquote] ...
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#5 of 28 Old 06-14-2014, 11:51 PM
 
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The NHS in the UK is introducing a shingles vaccine for older people, which may be the first step in introducing cp vaccine for children.

There's even some parental advocacy calling for it. Some of is are cross that our kids are being made to get sick and miss school (or worse) in order to act as booster immunisations for the older population.

It also leaves the children susceptible to shingles in the future.

I think in this case the NHS is wrong on the science.
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#6 of 28 Old 06-14-2014, 11:53 PM
 
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I think between the us and UK (where I have experience with both systems) a lot of the differences are sociological (with some science basis).

In the us health care is a business and patients are customers. In the UK health care is a public service and patients are the recipients of that service. That difference shifts the focus a bit for some choices.
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#7 of 28 Old 06-15-2014, 06:16 AM
 
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Originally Posted by prosciencemum View Post
The NHS in the UK is introducing a shingles vaccine for older people, which may be the first step in introducing cp vaccine for children.

There's even some parental advocacy calling for it. Some of is are cross that our kids are being made to get sick and miss school (or worse) in order to act as booster immunisations for the older population.

It also leaves the children susceptible to shingles in the future.

I think in this case the NHS is wrong on the science.
But vaccinated children are just as susceptible to shingles in the future. In fact, there is evidence that they may be MORE likely to develop shingles at an earlier age. http://www.news-medical.net/news/2005/09/01/12896.aspx

If you look beyond the industry-funded studies, there are some that come to different conclusions about varicella vaccine: http://www.ncbi.nlm.nih.gov/pubmed/22659447

"In a cooperative agreement starting January 1995, prior to the FDA's licensure of the varicella vaccine on March 17, the Centers for Disease Control and Prevention (CDC) funded the Los Angeles Department of Health Services' Antelope Valley Varicella Active Surveillance Project (AV-VASP). Since only varicella case reports were gathered, baseline incidence data for herpes zoster (HZ) or shingles was lacking. Varicella case reports decreased 72%, from 2834 in 1995 to 836 in 2000 at which time approximately 50% of children under 10 years of age had been vaccinated. Starting in 2000, HZ surveillance was added to the project. By 2002, notable increases in HZ incidence rates were reported among both children and adults with a prior history of natural varicella. However, CDC authorities still claimed that no increase in HZ had occurred in any US surveillance site. The basic assumptions inherent to the varicella cost-benefit analysis ignored the significance of exogenous boosting caused by those shedding wild-type VZV. Also ignored was the morbidity associated with even rare serious events following varicella vaccination as well as the morbidity from increasing cases of HZ among adults. Vaccine efficacy declined below 80% in 2001. By 2006, because 20% of vaccinees were experiencing breakthrough varicella and vaccine-induced protection was waning, the CDC recommended a booster dose for children and, in 2007, a shingles vaccination was approved for adults aged 60 years and older. In the prelicensure era, 95% of adults experienced natural chickenpox (usually as children)-these cases were usually benign and resulted in long-term immunity. Varicella vaccination is less effective than the natural immunity that existed in prevaccine communities. Universal varicella vaccination has not proven to be cost-effective as increased HZ morbidity has disproportionately offset cost savings associated with reductions in varicella disease. Universal varicella vaccination has failed to provide long-term protection from VZV disease."
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#8 of 28 Old 06-15-2014, 06:30 AM
 
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Some of is are cross that our kids are being made to get sick and miss school (or worse) in order to act as booster immunisations for the older population.

And some of us are cross that we and our children are being made to get sick via adverse reaction to vaccines that we don't want, but are forced to get in order to cater to those who fuss about their children having to miss school. Children who suffer adverse effects from vaccines also have to miss school (or worse).
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#9 of 28 Old 06-15-2014, 07:23 AM - Thread Starter
 
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I wish Samantha Bee (The Daily Show) had picked some Quebec-Vermont border crossing - cross it or stand with one foot on each side and talk about the so-called consensus in vaxes. That would've been funny because that's the kind of insight
I expect and love from TDS.

Instead they took the most prosaic and mainstream views there could be.

No insight, no satire, no fun.
I envision a remote, almost deserted border crossing, maybe between Montana and Alberta. Sam Bee puts on a biohazard suit before even dipping her toe into Canada because with some delayed vaccination and no mandates, Canada is just teeming with infectious infectious disease. Then her biohazard suit rips, (like in the movie, Outbreak), and panic ensues. She's been exposed! She checks into the ER and is met with strange looks. "What is wrong with you people??? I've been exposed! Test me!!" There are hundreds of places we could take this.

You're right. That original episode was decidedly un-Daily Show.

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#10 of 28 Old 06-15-2014, 07:28 AM
 
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There's even some parental advocacy calling for it. Some of is are cross that our kids are being made to get sick and miss school (or worse) in order to act as booster immunisations for the older population.
This is exactly what non-vax parents say - that we resent being pressured into our children having to take a risk for the benefit of others.

Can you pay for the CP vaccine in the UK?

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#11 of 28 Old 06-15-2014, 07:32 AM - Thread Starter
 
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I think between the us and UK (where I have experience with both systems) a lot of the differences are sociological (with some science basis).

In the us health care is a business and patients are customers. In the UK health care is a public service and patients are the recipients of that service. That difference shifts the focus a bit for some choices.
I agree wholeheartedly. I think in first world countries, at least, schedule variances are based on the philosophical views of government officials and not science.

That is why I take issue with the U.S. system of mandates. I need to have a say in these philosophical, non-scientific decisions as a parent. My child doesn't owe anybody the gift of herd immunity from chicken pox just so that they can avoid taking time off because of our nation's lousy family leave policies.

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I envision a remote, almost deserted border crossing, maybe between Montana and Alberta. Sam Bee puts on a biohazard suit before even dipping her toe into Canada because with some delayed vaccination and no mandates, Canada is just teeming with infectious infectious disease. Then her biohazard suit rips, (like in the movie, Outbreak), and panic ensues. She's been exposed! She checks into the ER and is met with strange looks. "What is wrong with you people??? I've been exposed! Test me!!" There are hundreds of places we could take this.

You're right. That original episode was decidedly un-Daily Show.
lol.

Back to the Vermont/Quebec scenario:

There is a town called Stanstead/Derby Line in Quebec/Vermont (respectively). The border runs right through the town. There are houses that are divided - goodness know how that works for tax purposes and voting rights…... The library is divided as is the Opera house. Lots of the residents have dual citizenship. You could be in and out of compliance on any given day. Mother and newborn leave the house in Canada - hep b compliant. Cross into the USA to enter the library. Naughty non-compliant parents (anti-vaxxers, perhaps?) and then phew, walk into the stacks at the library, which is back in Canada. Compliant, once again!

For a bit more info on Stanstead/ Derby, look here:
http://www.canadiangeographic.ca/mag...order-town.asp

It sort of makes the words of a recent opinion piece from Time magazine where the author lamented that his being late on MMR makes him an "accidental anti-vaxxer" even more laughable.

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#13 of 28 Old 06-15-2014, 08:32 AM
 
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In some seriousness….I sort of get why there are differences in schedule. The powers that be look at areas as a whole and make decisions. In theory anyways.

The USA offers the same vaccines on the same schedule across the board - is that correct?? A lot of public health is meant to catch those that fall through the cracks or are prone to xyz due to demographics, which means a lot of people who are at very little risk are being asked to assume vaccine risks for others. We could mitigate this by using smaller catchment areas than an entire large country. Do we really think the health profiles and risk factors are the same in Vermont, Mississippi and Alaska?

I think breaking down countries into smaller areas and making public policy decisions accordingly makes a lot of sense from a science POV.

Even more sense, of course, would be to somewhat do away with the rigidness in the schedule and one-size fits most and make room for genuine individual differences. A girl can dream…


Even looking at the schedule within countries can be enlightenning.

Here is Canada's:

http://www.phac-aspc.gc.ca/im/ptimpr...able-1-eng.php

There are rather large differences in when Hep. B and MMR/ MMRV are offered. There are differences in if Men-C and rotavirus are offered (in some places those are not on the schedule). I am Canadian. While I get a few of the differences (Hep B is more common in the north than elsewhere - so it makes sense it is offered early there) a lot of it seems non-sensical from a risk factor POV. It really does make one question the arbitrariness of some aspects of the schedule. Hep B at birth in New Brunswick - but not til grade 7 in bordering Nova Scotia? They are very similar demographics. Rotavirus in Saskatchewan at 2 and 4 months, but not in bordering Manitoba or Alberta at all?

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I envision a remote, almost deserted border crossing, maybe between Montana and Alberta. Sam Bee puts on a biohazard suit before even dipping her toe into Canada because with some delayed vaccination and no mandates, Canada is just teeming with infectious infectious disease. Then her biohazard suit rips, (like in the movie, Outbreak), and panic ensues. She's been exposed! She checks into the ER and is met with strange looks. "What is wrong with you people??? I've been exposed! Test me!!" There are hundreds of places we could take this.

You're right. That original episode was decidedly un-Daily Show.
And then she walks into a clinic and gets examined for FREE!!!! Dun dun duuuuuuuuun!

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#15 of 28 Old 06-15-2014, 06:42 PM
 
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kathymuggle wrote:
Quote:
The USA offers the same vaccines on the same schedule across the board - is that correct?? A lot of public health is meant to catch those that fall through the cracks or are prone to xyz due to demographics, which means a lot of people who are at very little risk are being asked to assume vaccine risks for others. We could mitigate this by using smaller catchment areas than an entire large country. Do we really think the health profiles and risk factors are the same in Vermont, Mississippi and Alaska?
No, even in the US the laws are not identical, plus over the last few years there are an increasing number of vaccines which are recommended but not mandated for school attendance. And the rules for daycare are less consistent that the school mandates.

The PANIC OVER THE UNVAXED brigade have used these discrepancies in some of their campaigns to get exemption laws changed. The CDC does a phone survey of about 30,000 families every year to collect data on vaccination rates by state in 19-35 month old kids. Unless they are in daycare, these children are not subject to mandates, and, as I said, the rules for daycare are inconsistent depending on your state and sometimes even your city. Anyway, the very best vax rates in the US for children in that age group are a tiny bit over 80% compliant with the CDC recommendations and the worst are in the 60s. This allows a lot of room for scaremongering.

The CDC recommendations are not just on whether children are getting all the vaccines, they are looking at whether they get them on time. Birth dose of Hep B? Rotavirus? Neither can be required for school attendance, for obvious reasons.

The Vermont Coalition for Vaccine Choice spent a lot of time sorting through the different ways the VT Department of Health messed with the various statistics. Hate to say it, but sometimes they even lied. The end result was that a lot of parents who basically believed in vaxing but wanted to select and delay and have some options moved to major distrust of the medical establishment. "They said what?!?"
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kathymuggle wrote:

No, even in the US the laws are not identical, plus over the last few years there are an increasing number of vaccines which are recommended but not mandated for school attendance. And the rules for daycare are less consistent that the school mandates.
they are per state - yet even vaccinated means different things and different times and people still travel all over the world!
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kathymuggle wrote:

No, even in the US the laws are not identical, plus over the last few years there are an increasing number of vaccines which are recommended but not mandated for school attendance. And the rules for daycare are less consistent that the school mandates.
:
But the schedule is the same - correct? I reread my post, I did clearly state "schedule."


I agree the laws are different.
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#18 of 28 Old 06-16-2014, 05:59 AM
 
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But the schedule is the same - correct? I reread my post, I did clearly state "schedule."


I agree the laws are different.
Yes, the CDC schedule is national. Thanks for clarifying.
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#19 of 28 Old 06-16-2014, 01:38 PM - Thread Starter
 
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The NHS in the UK is introducing a shingles vaccine for older people, which may be the first step in introducing cp vaccine for children.

There's even some parental advocacy calling for it. Some of is are cross that our kids are being made to get sick and miss school (or worse) in order to act as booster immunisations for the older population.

It also leaves the children susceptible to shingles in the future.

I think in this case the NHS is wrong on the science.
Wrong on the science? The NHS? Out of curiousity, is immunology your field of expertise? I think public health officials in the U.S. get the science wrong quite often. But if I speak up and provide citations, I get lectured for entering into the metaphorical country club of the Experts.

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I had no idea that Canadian recommendations changed from province to province. I had just assumed, apparently incorrectly, that Health Canada set the standard.

The federal government wields more power in the U.S. with carrot-and-stick funding enticements. So states are incentivized to mandate certain vaccines, and hospitals mandate flu shots in order to keep getting full Medicaid pay-outs.

But the Canadian setup sounds less centralized. I'm trying to picture a Health Minister in Saskatchewan telling a Health Minister in Nova Scotia, "There are no medically acceptable alternatives to our schedule. YOUR schedule is anti-science!"

Does anybody realize how foolish all of this black-and-white thinking looks? It's reached the point of absurdity!

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Even in the US, despite the push from the feds, there is less obedience to the CDC recommendations. I think the last recommendation that was fully implemented with school mandates was the chickenpox vaccine or maybe Prevnar.

Since then the CDC has added recommendations for Rotavirus vaccines which cannot be mandated for school because they can only be given to infants.

They also recommend the Hep B shot at birth, which also cannot be mandated for school for obvious reasons.

They recommended the HPV vaccines and the attempt to mandate the vaccines crashed, in large part because of dirty dealing by Merck trying to influence state legislatures.

Oh, and the Hep A vaccine has not been widely mandated even though it is on the recommended list.

I think that what used to be a smooth track to school mandates has been breaking down and this does not bode well for the vaccination system.
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#22 of 28 Old 06-17-2014, 10:12 AM - Thread Starter
 
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I hope you're right, Deborah!
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#23 of 28 Old 06-18-2014, 04:20 PM
 
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But vaccinated children are just as susceptible to shingles in the future. In fact, there is evidence that they may be MORE likely to develop shingles at an earlier age. http://www.news-medical.net/news/2005/09/01/12896.aspx
This link does not address how susceptible vaccinated children are to shingles. It is about how the circulation of wild chickenpox may act as a natural booster which helps prevent shingles in those of us who have had natural chickenpox, and so our risk of shingles may be increasing as we are no longer exposed to the wild virus.

Evidence so far indicates that children who were vaccinated have a much lower risk of shingles than kids who had wild chickenpox. Time will tell if that remains true over the long haul.


Quote:
If you look beyond the industry-funded studies, there are some that come to different conclusions about varicella vaccine: http://www.ncbi.nlm.nih.gov/pubmed/22659447

"In a cooperative agreement starting January 1995, prior to the FDA's licensure of the varicella vaccine on March 17, the Centers for Disease Control and Prevention (CDC) funded the Los Angeles Department of Health Services' Antelope Valley Varicella Active Surveillance Project (AV-VASP). Since only varicella case reports were gathered, baseline incidence data for herpes zoster (HZ) or shingles was lacking. Varicella case reports decreased 72%, from 2834 in 1995 to 836 in 2000 at which time approximately 50% of children under 10 years of age had been vaccinated. Starting in 2000, HZ surveillance was added to the project. By 2002, notable increases in HZ incidence rates were reported among both children and adults with a prior history of natural varicella. However, CDC authorities still claimed that no increase in HZ had occurred in any US surveillance site. ... Varicella vaccination is less effective than the natural immunity that existed in prevaccine communities. Universal varicella vaccination has not proven to be cost-effective as increased HZ morbidity has disproportionately offset cost savings associated with reductions in varicella disease. Universal varicella vaccination has failed to provide long-term protection from VZV disease."
There are some studies which do not show this increase, but I'm pretty sure I've seen the CDC believes that there was one?

In any case, shingles may have increased, but it was already increasing in the years before the chickenpox vaccine, and in those same years Alberta and the UK and other countries which did not yet have (and some still do not have) chickenpox vaccine and so the wild virus circulated freely.

Increase in shingles is a valid concern, and mathematical models predict it happening, it is just not clear if what was possibly being seen there was evidence that it was already happening or not.

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Originally Posted by Turquesa View Post
I had no idea that Canadian recommendations changed from province to province. I had just assumed, apparently incorrectly, that Health Canada set the standard.

The federal government wields more power in the U.S. with carrot-and-stick funding enticements. So states are incentivized to mandate certain vaccines, and hospitals mandate flu shots in order to keep getting full Medicaid pay-outs.

But the Canadian setup sounds less centralized. I'm trying to picture a Health Minister in Saskatchewan telling a Health Minister in Nova Scotia, "There are no medically acceptable alternatives to our schedule. YOUR schedule is anti-science!"

Does anybody realize how foolish all of this black-and-white thinking looks? It's reached the point of absurdity!
Health Canada does have a set of recommendations and a schedule for Canada. But... each province manages it's own health system and decides which vaccines and such it is actually going to pay for. Alberta is usually a little behind some of the other provinces and probably will add rotavirus eventually.
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#24 of 28 Old 06-18-2014, 07:14 PM
 
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I've been thinking about the shingles increase, which did begin before the vaccine was released. There are some clues as to why this might have occurred.

In the pre-vaccine days pediatricians came down with shingles at one-half to one-eighth of the usual rate. http://www.ncbi.nlm.nih.gov/pubmed/?term=7594784Kansenshogaku Zasshi. 1995 Aug;69(8):908-12.
[Incidence of herpes zoster in pediatricians and history of reexposure to varicella-zoster virus in patients with herpes zoster].

[Article in Japanese]
Terada K1, Hiraga Y, Kawano S, Kataoka N.

and http://www.ncbi.nlm.nih.gov/pubmed/?term=12057605

So, what has been happening in the US over the last 50 or 60 years besides the introduction of a number of vaccines, including, finally, a chickenpox vaccine?

One thing that has occurred is that very few grandparents live with their grandchildren. Many live several states away. The main opportunity for exposure to chickenpox for middle-aged people is being around their grandchildren when they have CP.

Many middle-aged or elderly people have no contact with children other than seeing them at a grocery store or other public setting. This trend began many years before the release of the vaccine and is, IMO, a quite adequate explanation for the increase in shingles.
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#25 of 28 Old 06-18-2014, 07:22 PM
 
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I've been thinking about the shingles increase, which did begin before the vaccine was released. There are some clues as to why this might have occurred.

.
I had always though the increase pre-vaccine was due to aging polualtions. I am sure that is part of it. I think the big question is if the rise is higher than expected (as a rise was expected).

Similar to your theory….I wonder if less kids in general has just meant less chances for immunity boosting? 75 years ago the average house may had 4 kids, since the 1970's the birth rate has dropped which means less boosting opportunities.
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#26 of 28 Old 06-18-2014, 07:35 PM
 
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I had always though the increase pre-vaccine was due to aging polualtions. I am sure that is part of it. I think the big question is if the rise is higher than expected (as a rise was expected).

Similar to your theory….I wonder if less kids in general has just meant less chances for immunity boosting? 75 years ago the average house may had 4 kids, since the 1970's the birth rate has dropped which means less boosting opportunities.
Good points. I think it is sloppy (probably deliberately sloppy) science to point to a downward trend prior to the vaccine and claim that it therefore follows that the vaccine has had no effect on the shingles rate. I mean the trend might have stabilized if they hadn't added in the vaccine. Who knows?
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#27 of 28 Old 06-22-2014, 06:00 PM - Thread Starter
 
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Here is an interesting piece that covers, among other issues, how chicken pox is benign where no vaccine is available...and evil and deadly where the vaccine is mandated. http://www.analyticalarmadillo.co.uk...sed-about.html

In God we trust; all others must show data. selectivevax.gifsurf.gifteapot2.GIFintactivist.gif
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#28 of 28 Old 06-22-2014, 06:40 PM
 
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Yes, luckily for the CDC only a few people will compare the schedule across countries.
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