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 and 4 months of age:  DTaP, IPV, Prevnar, HiB, Rotateq = 8 injections (2 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:  50 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:  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 (21 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.

Wednesday, November 22, 2017

Vaccine Aluminum: Yet Another Attempt at Math by an Antivaxxer

I just can't underscore enough the way antivaxxers make claims as though they are fact without actually working out the math nor understanding the science behind vaccines and pharmacokinetics.  I'm by no means an expert in pharmacokinetics but having just a few basic math skills and understanding of the literature goes a long way in accurately demonstrating how vaccine components are handled in the human body.

This time, 4health aka @VBalance03, who was already previously corrected on math errors and logic errors regarding formaldehyde, attempts to question the comparison of vaccine aluminum adjuvants with aluminum in TPN following a link I referred to about the difference between injection and ingestion.  A previous antivaxxer had suggested that vaccines were being injected directly "into the bloodstream".



Of course, this is blatantly untrue and why I pointed this out with a link explaining how injected and ingested components reach the bloodstream.

In response, 4health points to formaldehyde again completely ignoring again how much formaldehyde is made naturally in the human body.  She then points to a comparison of IV Aluminum vs vaccine aluminum adjuvant amounts.





As I've stated before, math simply isn't a strong suit for many antivaxxers as demonstrated most recently regarding aluminum (Harold's errors) when another antivaxxer tried to do math.  4health doesn't seem to understand how/why TPN is used and how to make a comparison between IV aluminum exposure (pretty much 100% bioavailability) vs vaccine aluminum adjuvant exposure (very very little is bioavailable).  This is discussed in the link I provided:


And here's the math:

To compare apples to apples, I'll use a typical 2 month old who weighs roughly 5.8 kg receiving TPN (for whatever reason) vs another 2 month old of the same weight receiving their routinely recommended vaccinations including Pediarix, HiB, and Prevnar (PCV 13) with aluminum adjuvant amounts listed on the Children's Hospital of Philadelphia page .

As 4health pointed to, the FDA limit for aluminum in TPN is 25 micrograms (mcg) per liter = 0.025 mcg/mL.  At a weight of 5.8 kg, typical maintenance IV fluids would be about 100 mL/kg/day (every pediatrician knows this)  = 24 mL/hr.  At a rate of 24 mL/hr, that would be 0.6 mcg of aluminum in TPN per hour given x 24 hours in a day = 14.4 mcg/day.   100% is bioavailable.

A 2 month old receiving 3 vaccines would receive 0.125 mg (PCV or Prevnar), 0.85 mg (Pediarix), and 0.225 mg (HiB) of aluminum salt for a total of 1.2 mg/day.  The rate of absorption (as previously discussed re Harold's errors) of aluminum from this adjuvant salt is 0.6% = 0.0072 mg/day = 7.2 mcg/day.  

In summary, 4health strikes again and continues to discredit herself as well as antivaxxers in general who make false claims like this that simply don't hold up to actual scrutiny with correct math.  I've pointed out many many of her errors and lies before.  It remains to be seen how she responds to this new one.


Edited to add (23 November 2017) - It's been over 12 hours now since this blog post was pointed out to 4health.  It took her about an hour to realize that this was a new post pointing out her errors - she kept ignoring it and asking for an explanation.  I pointed out the link to this blog at least 8 times.









When it finally dawned on her that this was a new post, she has continued (and still continues) to make excuses not to "read it".  I suspect she has read it by now but simply can't admit it.













Saturday, November 04, 2017

Switzer Family Christmas Newsletter 2017

I never get our Christmas newsletter done this early!  Even have our cards, annual calendar, and ornaments already ordered as well!  Enjoy and have a great holiday!




Sunday, October 01, 2017

Vaccine Aluminum: Another Antivaxxer Attempts Math

A screenshot of a scientific table caught my eye when it was shared via Twitter by an antivaxxer that I had previously described related to her difficulty with chemistry and math (Vaccine Formaldehyde:  An Antivaxxer Attempts Math).  Back then, she was "emcc2" with the same twitter profile picture but had changed her name and twitter handle not too long after that blog post (most antivaxxers are accustomed to ascribing coincidences to causality and, in this case, I admit it did make me wonder...) to "4health" aka "Vbalance03".  The discussion was regarding vaccine aluminum and a provaxxer, Dorit, had provided a study by Mitkus regarding aluminum.  4health responded:




This marked up version of the table was not from the Mitkus study in 2011.  It was a study by Yokel in 2008 and it's obvious to really anyone that it has been marked up in a way that wouldn't have been published in this form.  The date on the table (2008) also gives this away.    

The reason I recognized this screenshot is because another antivaxxer, Harold Clarkson aka RGTWINGBLKMAN aka boglethemind, is the one I assume who marked up the original Yokel table with some pretty bad math during the course of a long Twitter discussion regarding vaccine aluminum.  Harold, like all antivaxxers, claims that vaccine aluminum is dangerous and a neurotoxin that results in neuroinflammation somehow related to autism.  Harold has an issue with an extremely detailed article by a BBB (blood brain barrier) scientist I linked to about vaccine aluminum and how the bioavailability of aluminum is very small even compared to oral aluminum ingestion.

During the course of this discussion, Harold made several factual errors that he has also neglected to acknowledge to date even before this latest math disaster.

(1)  He mistakenly believed that the FDA limits for vaccine aluminum is 5 mcg/kg/day. 





What Harold never admitted to (instead playing the very Dunning-Kruger-esque "I'm educating you..." card), is that this limit is not the one established for vaccine aluminum.  This limit is for parenteral (IV) administration of aluminum - typically in the form of parenteral nutrition (TPN).  The actual limits for vaccine aluminum set by the FDA is:

Harold was the one to be educated on this point.



(2)  It gets worse.  One would assume that anyone arguing about vaccine aluminum would at least know that vaccines are not, in fact, given IV.  This fact seemed to have escaped Harold's knowledge when I pointed out to him that, by definition, vaccines cannot have 100% bioavailability because they are not given IV.  This explains why he made his error above.



(3)  Harold tries to pass off numbers from a study on aluminum by Flarend claiming that the numbers in his homemade table was "real math" from the study but, as it turns out, these were not actual figures from the study.  He backpedaled later that the numbers he originally claimed were from the study, were actually what he (incorrectly) "calculated".  


(4)  Oddly, after pointing out his dishonesty regarding his fabricated numbers from the Flarend study, he starts demanding I "retract" what I said and threatening me for unclear reasons.  When asked what I would "regret", he avoided answering.



(5)  Harold's latest claim to which he still hasn't acknowledged his basic math and logic errors, is the dissemination of the marked up table referred to above.  He continued to tweet this table several times believing himself to be clever in "correcting" Yokel's table and its use in the BBB Scientist's article.  Here it is again.


Here's a bigger version to see the wrong calculations he made.


Now, where to start.

In the purple box at the top, he's trying to adjust the table according to the amount of oral feedings that an infant takes on a roughly daily basis at around 6 months of age and average weight of 5.8 kg.  These numbers look right to me and can be corroborated in the Children's Hospital of Philadelphia page about vaccine aluminum.   (scroll down to "Quantities of aluminum in other substances")

Error #1 - Harold didn't calculate the range of daily Al absorbed for oral intake correctly.  The authors used oral intake for adults and  took the smallest daily Al exposure divided by an average weight of an adult and then multiplied by the lowest amount of absorption for the low end of the range.  Harold should have used the highest daily Al exposure (the amount he inserted for a typical 6 month old) divided by an average weight of a 6 month old and then multiplied by the highest amount of absorption for the high end of the range:

650 mcg divided by 5.8 kg then multiplied by 0.003 = 0.336 mcg/kg/day rather than 0.11 mcg/kg/day - 3 orders of magnitude higher.  This is an important error to correct.

Error #2 - in the line for vaccine aluminum amounts, in the column entitled "absorption", it says "100 eventually" which is odd to list this as (1) there is no 100% bioavailability of an IM/SQ injected vaccine (and demonstrates why there's a difference between bioavailability and absorption) and (2) the daily rate is being determined here and we know that aluminum adjuvant (AA) is absorbed very very slowly following injection.  In other words, it isn't simply absorbed in one day.  The correct absorption should be based on the Flarend study of 0.6%.  (BBB scientist explains why he came to this figure in his article). Harold missed this (or ignored it) & at one point, even tried to claim "100% bioavailability".  

Errors #3 and #4 is his calculation of the daily AA absorbed in mcg/kg/day - this one I just can't figure out why Harold chose to do it this way - it makes zero sense.  The green box demonstrates his calculation of the amount of AA in mcg/kg/day.  The authors took the aluminum concentration and, when calculating the daily aluminum exposure, used 20 injections over 6 years to determine the daily AA exposure.  For example, using the higher end for dose:

850 mcg x 20 injections divided by 2160 days (6 years) = about 8 mcg/day.  To determine the daily Al exposure in mcg/kg/day, you just divide 8 by 20 kg (the weight of an average 6 year old) = 0.4 mcg/kg/day.  (the authors assumed 100% absorption).

Harold wants to substitute vaccines given over 6 months  (rather than 6 years) and use the average weight of a 6 month old (instead of a 6 year old).  The correct math should be (for the higher end of the range):

8 mcg/day divided by 20 kg (weight the authors used) x 0.006 (the actual daily absorption from Flarend) = 0.0024 mcg/kg/d.    This number is quite a bit smaller than the higher end of the range of AA absorbed orally (the one he calculated incorrectly). To find out how much AA that is for a 6 month old, you would multiply this rate (0.0024 mcg/kg/d) by 5.8 kg (average weight of a 6 month old) = 0.01392 mcg/day.

Why Harold multiplied the daily AA absorption by 20 kg and then divided by 5.8 kg is the mystery.  That makes no mathematical sense at all as this is a rate already expressed in mcg/kg/day.

But there's a further problem that Harold seemed to ignore entirely....

Error #5 - this error was actually in his favor.  I think in his fervor to generate what he thought was a "slam dunk win" in this "corrected" table, he didn't realize that the amount of vaccine given - the AA concentration and daily AA exposure are still for a 6 year old given 20 injections.  He should have adjusted these numbers to account for the amount of AA given in the first 6 months of life.  This amount increases the calculations significantly but, in the end, given the daily bioavailability of about 0.6%, it's still not as much as what a child can consume on the high range of oral intake.

The correct numbers would be (at least in my office):

Al "concentration" = hep b x 1, pediarix x 3, prev x 3, HiB x 2 = 500 mcg (I'm using the highest possible - it's actually usually 250 mcg) + (850 mcg x 3) + (225 mcg x 2) + (125 mcg x 3) = 3875 mcg

Daily Al exposure = 3875 mcg divided by 180 days = 21.5 mcg.

Using a daily bioavailability of 0.6%, the amount of daily AA absorbed = 21.5 divided by 5.8 kg x 0.006 = 0.022 mcg/kg/day.  

Comparing this number to what's absorbed via ingestion, AA exposure is either 3x more via vaccine OR 15 times less than ingestion depending on whether an infant is breastfed or formula (soy) fed.  A corrected table would look like this:


Admittedly, you can argue about the use of Flarend's 0.6% daily bioavailability given that some of the vaccine doses are given on the same day, but what I'm really just addressing is the math Harold presented and why both his math and his logic was deeply flawed and frankly in error.

I've waited 3 days for Harold to come forward and admit his math errors and finally just got tired of asking him to do it for himself.  I assume that he couldn't reconcile his own math which was clearly wrong.  This is just another example of antivaxxers who lack the basic knowledge of pharmacology, immunology, and, well, math but choose to argue against vaccines anyways.  Poorly done, at that, and certainly not to their credit.  

***edited to add (1 October 2017):  Now Harold believes that I am the author of the BBB Scientist article about vaccine aluminum.  I just had to throw this in as yet another error that he's made in the course of this long exchange.  And because it's just plain funny.




 ***edited to add (6 October 2017):  Now Harold believes I'm a "bot" and has made a "formal request" to have his "rebuttal" added to my blog.  He's even resorted to making threats as well.  This just keeps getting more entertaining....





Edited to add (4 December 2017):

Harold is going off the deep end again claiming that aluminum adjuvant is absorbed 100% and suggesting that this translates to 100% bioavailability.  Despite redirecting him back to the BBB scientist article that cites both Flarend and Mitkus regarding pharmacokinetics demonstrating that aluminum adjuvant is not 100% bioavailable, he continues to pretend that there are no citations that demonstrate this fact.  Antivaxxers also continue to dishonestly suggest 100% bioavailability of vaccine aluminum adjuvant.  Harold's latest humorous error (#6 now) is claiming that the BBB scientist said this:



What the BBB scientist actually said was this:



The BBB scientist is referring to the 2015 vaccinepapers.org article that was "recycled" by Jeffrey Roberts at Collective Evolution.  He links to the April 2017 Collective Evolution article that resurrected (aka recycled) 2015 article.  If I didn't say it before, I'll say it now.  Harold's Dunning-Kruger is absolutely stunning.