Sunday, June 03, 2018

HOW MANY VACCINES IS THAT?

Extreme hyperbole seems to be a common tactic for anti-vaxxers to use.  Comparing pediatricians to "nazis", vaccine mandates to "fascism", vaccine research to "Nuremberg", and the administration of vaccines to "murder", the misrepresentations are plentiful from the anti-vaccine side.

Even looking at the CDC recommended vaccination schedule, extreme hyperbole is employed by anti-vaxxers to frighten parents.  Either it's intentional misinformation or just really bad counting skills.  Or maybe it's a combination of both being used to promote "fear appeal".

A few examples demonstrating that, even amongst anti-vaxxers, the number of "vaccines" they claim varies greatly.

"74 injected vaccines by 4-6 years" 

"49 doses of 14 vaccines by age 6"
"74 vaccines"

"81 vaccines by 6 years of age"


So how many vaccines does a child actually receive?


To clarify, we need to define a few terms first.


and


and




and

A injectable vaccine dose is 0.5 mL for most vaccines with one exception:  the dose of influenza vaccine we give at 6 months of age and then at least a month later are 0.25 mL each.  A vaccine such as DTaP, Pediarix, Proquad, or MMR - although they are polyvalent, are still 0.5 mL in a single dose.


Using my own practice as an example, there are several different ways to "count".


Method one:  How many actual vaccines do we use in our office?


Engerix (not actually given in our office - birth dose given at hospital)
Pediarix
PedVaxHiB
Prevnar 13
Rotateq
Fluzone
MMR
Varivax
Havrix
Kinrix
Proquad
Menactra
Trumenba
Gardasil
Adacel

Total: 15 actual vaccines  

Method two:  If we count by the number of diseases we protect against with vaccines:


Hepatitis B (Hep B)
Diphtheria
Tetanus
Pertussis
Polio (IPV)
Streptococcus pneumoniae (S pneumo)
Hemophilus influenza type B (HiB)
Rotavirus (rota)
Influenza (flu)
Measles
Mumps
Rubella
Varicella (Chickenpox)
Hepatitis A (Hep A)
Neisseria meningitidis ACWY  (meningococcal ACWY)
Human Papilloma Virus (HPV)
Neisseria meningitidis B (meningococcal B)

Total:  17 diseases we protect against

Method three:  I'm not aware of any practice that doesn't use combination vaccines but for the sake of argument, the number of injections if no combination vaccines were used  for a child who receives every single possible recommended vaccine exactly on time without the availability of FluMist in my office:



Birth dose Hep B = 1 injection
2 months of age:  DTaP, IPV, Hep B, Prevnar, HiB, Rotateq = 5 injections (1 oral)
4 months of age:  DTaP, IPV, Hep B, Prevnar, HiB, Rotateq = 5 injections (1 oral)
6 months:  DTaP, Hep B, IPV, Prevnar, influenza, Rotateq = 5 injections (1 oral)
12 months:  MMR, Hepatitis A, Prevnar, influenza = 4 injections
15 months:  Varivax, HiB, DTaP = 3 injections
18 months:  Hepatitis A, influenza = 2 injections
3 years:  influenza = 1 injection
4 years:  DTaP, IPV, MMR, Varivax, influenza = 5 injections
5-10 years:  influenza = 6 injections
11 years:  HPV, Menactra, Tdap, influenza = 4 injections
12 years:  HPV, influenza = 2 injections
13-15 years:  influenza = 3 injections
16 years:  Trumenba, Menactra, influenza  = 3 injections
17 years:  Trumenba, influenza = 2 injections
18 years: influenza =1 injection


Total: 32 injections by age 6 if no combination vaccines are used (29 injections if we use FluMist)
52 injections by age 18 if no combination vaccines are used (33 injections if we use FluMist)

Method four: Number of actual injections given to a child who receives every single possible recommended vaccine exactly on time without the availability of FluMist in my office (including birth dose of hepatitis B that we don't actually give in our office)


Birth dose Hep B = 1 injection
2 and 4 months of age:  Pediarix, Prevnar, HiB, Rotateq = 6 injections (2 oral)
6 months of age:  Pediarix, Prevnar, Rotateq, influenza in the winter = 3 injections (1 oral)
12 months:  MMR, Hepatitis A, Prevnar, influenza = 4 injections
15 months:  Varivax, HiB, DTaP = 3 injections
18 months:  Hepatitis A, influenza = 2 injections
3 years:  influenza = 1 injection
4 years:  Kinrix, MMRV, influenza = 3 injections
5-10 years:  influenza = 6 injections
11 years:  HPV, Menactra, Tdap, influenza = 4 injections
12 years:  HPV, influenza = 2 injections
13-15 years:  influenza = 3 injections
16 years:  Trumenba, Menactra, influenza  = 3 injections
17 years:  Trumenba, influenza = 2 injections
18 years: influenza =1 injection

Total:  25 injections by age 6 (with FluMist, there would be 22 injections total)
44 injections by age 18 years  (with FluMist, there would be 28 injections total)

Method five:  If we count by the number of doses of a vaccine with the same conditions as method four: 

Total:  47 doses (44 injections + 3 oral doses) by age 18 years

Method six  If we count by the number of "pathogens" with the same conditions as above:


birth dose hep B :  1 pathogen
2 and 4 months of age:  Pediarix (diphtheria, tetanus, pertussis, polio, hep B), Prevnar, HiB, rota = 16
6 months of age:  Pediarix (diphtheria, tetanus, pertussis, polio, hep B), Prevnar, Rotateq, influenza = 8
12 months:  MMR (measles, mumps, rubella), Hepatitis A, Prevnar, influenza = 6
15 months:  Varivax, HiB, DTaP (diphtheria, tetanus, pertussis) = 5
18 months:  Hepatitis A, influenza = 2
3 years:  influenza = 1
4 years:  Kinrix (diphtheria, tetanus, pertussis, polio), MMRV (measles, mumps, rubella, varicella), influenza = 9
5-10 years:  influenza = 6
11 years:  HPV, men ACWY, Tdap (tetanus, diphtheria, pertussis), influenza = 6
12 years:  HPV, influenza = 2
13-15 years:  influenza = 3
16 years:  men ACWY, men B, influenza  = 3
17 years:  men B, influenza = 2
18 years: influenza =1

Total:  72 "pathogens" by age 18 (many of which are the same pathogen)

Method seven:  include all the "pathogens" in method six and also throw in the maternal doses of influenza and Tdap (tetanus, diphtheria, pertussis):

Total number of "pathogens":  76 "pathogens" by age 18

Method eight:  include all of the "valences" or strains covered in method six:


birth dose hep B :  1 valence or strain
2 and 4 months of age:  Pediarix (diphtheria, tetanus, pertussis, polio, hep B), Prevnar (13 strains), HiB, rotateq (5 strains) = 48
6 months of age:  Pediarix (diphtheria, tetanus, pertussis, polio, hep B), Prevnar (13 strains), Rotateq (5 strains), influenza (4 strains) = 27
12 months:  MMR (measles, mumps, rubella), Hepatitis A, Prevnar (13 strains), influenza (4 strains) = 21
15 months:  Varivax, HiB, DTaP (diphtheria, tetanus, pertussis) = 5
18 months:  Hepatitis A, influenza (4 strains) = 5
3 years:  influenza (4 strains) = 4
4 years:  Kinrix (diphtheria, tetanus, pertussis, polio), MMRV (measles, mumps, rubella, varicella), influenza (4 strains) = 12
5-10 years:  influenza (4 strains) = 24
11 years:  HPV (9 strains), Neisseria meningitidis ACWY( 4 strains), Tdap (tetanus, diphtheria, pertussis), influenza (4 strains) = 20
12 years:  HPV (9 strains), influenza (4 strains) = 13
13-15 years:  influenza (4 strains) = 12
16 years:  men ACWY (4 strains), men B, influenza (4 strains)  = 8
17 years:  men B, influenza (4 strains) = 5
18 years: influenza (4 strains) =4


Total: 209 valences or strains  by age 18 (many of which are the same strains)

So, in summary:

  • "74 injected vaccines by age 4-6"?  
False.  By age 6, a child in my office receives, at the most, 25 injections (22 if we use FluMist)
  • "49 doses of 14 vaccines by age 6"?  
False.  By age 6, a child in my office receives, at the most, 28 doses of 11 vaccines. 
  • "81 vaccines by 6 years of age"?  
False.  By the age of 6, a child in my office receives, at the most, 25 injections or 28 doses of 11 vaccines
  • "69 doses of 16 vaccines by age 18"?
False.  By the age of 18, a child in my office receives, at the most, 47 doses of 15 vaccines. 


I suppose if you're going to accurately exaggerate what vaccines do, the claim would be 209 valences/strains by age 18 but that just doesn't sound nearly as scary.  The take home message here is that we have the ability to protect against 17 different diseases that cause significant harm and we can do so safely and effectively.

Sunday, January 28, 2018

Oklahoma legislative bills introduced for 2018 session

4 pro-vaccine bills
13 anti-vaccine bills

Senate


SB1433  - Dahm
Add section to current law that “child abuse” shall not include refusal to vaccinate a child or a decision to delay vaccination of a child.

SB1551 – Dahm
(same as HB 1386 in 2017 by Gann - defeated in committee and HB 3016 in 2016 by Grau, Ritz, Roberts, Murphey of the house and Dahm of the senate - vetoed by Gov Fallin)
"Parental Rights Immunization Act" - Healthcare providers must provide relevant information for informed consent prior to vaccination, including VIS (Vaccine Information Statement), info on NVICP (National Vaccine Injury Compensation Program), the CDC Vaccine Excipient List/Vaccine Injury Table/Contraindications and Precautions to Vaccination.

SB1432 – Dahm
Adds section to current law that “administration of any immunization” is excluded in the routine medical care and treatment provided for children taken into custody.

SB1220 - McCortney

Similar to HB 3288 - to provide information to assisted living center residents about risks of influenza disease, availability/effectiveness and contraindications of influenza vaccination, influenza symptoms, means of spread and current VIS (Vaccine Information Sheet) from the CDC no later than Sep 1 of each year.

SJR57 – Yen
Strike from current law ability for immunization exemption made solely due to written statement by parent, guardian or legal custodian.

SB1123 – Yen
Similar to above

House:
HCR1012 - West
A Concurrent Resolution urging Congress to repeal the National Childhood Vaccine Injury Act, which was signed into law to reduce the potential financial liability of vaccine manufactures.

HB3288 – Enns
New law to provide information to assisted living center residents about risks of influenza disease, availability/effectiveness and contraindications of influenza vaccination, influenza symptoms, means of spread and current VIS (Vaccine Information Sheet) from the CDC no later than Sep 1 of each year.

HB2627 – West
New law to prevent an employer from refusing to hire, discriminate in any manner related to employment on the basis that the person has not been vaccinated. It may require an employee that has not been vaccinated against influenza to comply with a reasonable alternative policy adopted by employer, shall not be expanded to other diseases.

HB3444 – Gann
Set up new section of law entitled “Oklahoma Choice in Vaccination Act of 2018”

HB2685 – Strohm
Education; creating the Vaccination Informed Consent Act of 2018; effective date. 

HB2684 - Strohm

A newborn infant shall not be immunized without the written consent of the parent. Consent shall be obtained at the time of immunization and may not be obtained prior to immunization of the child. 

HB2675 - Strohm

Health; creating the Immunizations Informed Consent Act of 2018; effective date.

HB3443 – Gann

New law “A parent or legal guardian of a child shall have the right to exempt a child from vaccination for any reason that is determined by the parent or legal guardian. The State Department of Health shall be prohibited from denying a vaccine exemption.
HB3442 – Gann
New law to allow exemption for immunization of a child in a kinship care home or foster care home.

HB2624 – West
Set up new section of law entitled “Immunization and Parental Rights Act of 2018”

HB2623 – West

Amend law that any proposed change to required immunizations for school enrollment by approved via State Legislature.