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Tuesday, October 21, 2014

For Some Diseases, It Was Vaccination, Not Sanitation

Posted by jlwile on February 3, 2014

This is the logo of Project Tycho.  It depicts Tycho Brahe with his unique view of the universe. (click for credit)

This is the logo of Project Tycho. It depicts Tycho Brahe with his unique view of the universe.
(click for credit)

Dr. Wilbert van Panhuis and his colleagues have started an exciting initiative called Project TychoTM. In it, they are taking public health data that have been collected over the years and putting them into an easy-to-access digital system that is open to everyone. They describe the goal of their project in this way:

We aim to advance the use of public health data for the improvement of public health. Oftentimes, restricted access to public health data limits opportunities for scientific discovery and technological innovation in disease control programs. A free flow of data and information maximizes opportunities for more efficient and effective public health programs leading to higher impact and better health. Our activities are focused on accelerating the availability and use of public health data…

They named the project after Tycho Brahe, one of the more colorful 16th-century astronomers. Not only did he live an interesting life, he had a very interesting view of the universe. He made an enormous number of astronomical observations that he meticulously documented, and those observations convinced him that the planets must orbit the sun, not the earth. However, he couldn’t give up the idea of the earth being at the center of everything, so he produced what is probably the most interesting view of the universe ever. As shown in the logo above, he put the earth at the center of the universe, and he had the sun and moon orbiting the earth. The rest of the planets were then assumed to orbit the sun, as it moved in its orbit around the earth. While this view of the universe is clearly unworkable, it was incredibly original!

Why would a project involving public health data be named after this colorful character? Because his main contribution to science was the data he collected. While he couldn’t make heads or tails of his data, another astronomer, Johannes Kepler (who was once employed by Brahe) did. Kepler was able to use Brahe’s data to develop three laws of planetary motion that demonstrated all the planets, including the earth, orbit the sun. Sir Isaac Newton was then able to use Kepler’s Laws to develop his Law of Universal Gravitation, which describes how gravity works both here on earth and throughout the universe. Brahe’s data, then, were the foundation of some of the greatest advancements in the field of astronomy in the 16th and 17th centuries.

In Dr. van Panhuis’s view, the data he is collecting could end up being like Brahe’s data. It might be used by other scientists to better understand diseases and how to deal with them as they spread through populations. While I can’t say whether or not that will ever happen, I can say that these data make it easy for me to address a popular myth about vaccination.

Anti-vaccination groups often suggest that vaccines had little to do with the reduction of diseases like smallpox, polio, and measles. Instead, they insist that better sanitation was the reason these diseases mostly disappeared from the U.S. population. However, a quick use of Project Tycho’s data shows how this is simply not true. I used the system to access data on smallpox, polio, and measles in the U.S. and then graphed the results:

smallpox_cases

polio_cases

measles_cases

The big thing to notice about these three graphs is that they all include the same years, 1928-2003. By looking at all three of them, you can see that each disease decreased at a different time. Smallpox cases were pretty much nonexistent by 1948. However, that’s when polio cases started to rise! They didn’t start decreasing until 1954, and they didn’t become virtually nonexistent until the early 1960s. Measles cases, on the other hand, stayed fairly steady until the late 1960s and didn’t become pretty much nonexistent until the 1990s. Unfortunately, because people are choosing not to vaccinate, measles is making a comeback in the United States.

The main point here is that if sanitation were responsible for getting rid of these diseases, you would expect them to all decline at roughly the same time. However, they clearly did not. This tells us that while good sanitation is responsible for the reduction of many diseases (such as cholera, dysentery, and typhoid), it is clearly not the reason for the reduction of diseases like smallpox, polio, and measles.

So what caused their reduction? Vaccination. Look at the polio graph. History’s largest clinical trial, which involved over a million children, was conducted on the polio vaccine in the U.S. in 1954.1 Notice how quickly the number of polio cases declined after that. This doesn’t conclusively demonstrate that the vaccine stopped the disease, because correlation doesn’t always mean causation. In other words, the vaccine might not have caused the reduction. Some other event might have happened at roughly the same time as the vaccine trial, and that might be the real cause. However, the results of the vaccine trial showed that the children given the vaccine were significantly less likely to get polio than those who were given an inert injection (called a placebo). This fact, combined with the graph, demonstrates fairly conclusively that the vaccine is what reduced polio in the United States.

The same can be said for measles. The first measles vaccine was licensed for use in 1963.2 Note how quickly the number of measles cases dropped after that year. Once again, this doesn’t conclusively demonstrate that the vaccine caused the decline, but other studies add strong evidence to support that conclusion. For example, when measles outbreaks occur in a school, vaccinated children are more than 20 times (that’s more than 2,000%) less likely to get the disease than the unvaccinated children.3

In the end, then, data such as those collected at Project Tycho demonstrate that vaccines are very effective at preventing certain diseases. This, of course, does not indicate whether or not vaccines are safe. However, I do think there is plenty of evidence to support that fact as well.

REFERENCES

1. Francis Jr T, et al. “An evaluation of the 1954 poliomyelitis vaccine trials: summary report,” American Journal of Public Health 45(suppl):1-50, 1955
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2. Jeffrey P. Baker, “The First Measles Vaccine,” Pediatrics 128(3):435-437, 2011
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3. Feikin DR, et al. “Individual and Community Risks of Measles and Pertussis Associated with Person Exemptions to Immunization.” Journal of the American Medical Association 284:3145-3150, 2000
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Comments

60 Responses to “For Some Diseases, It Was Vaccination, Not Sanitation”
  1. Michelle says:

    Thank you for being willing to answer more questions! Some of this is just rambling and me sharing my concerns. If you don’t wish to read, I understand.

    1.) In reference to question number 1 – When I go to color my hair, the package advises me to do an allergy test first. Why are allergy tests not done on the children for vaccinations? Is there any way do this?

    2.) Not a true question here but thought I’d share what my concern is. I agree with what you are saying – the it’s possible that it’s just a coincidence. However, my concern is that you just don’t know.

    3.) You bring up an interesting point here. My family’s board-certified pediatrician is very careful with vaccinations and even shares some of my same concerns. She offers blood titers for vaccinations to see if the child needs any more doses. Do you feel this is a reliable way to protect a child? I have one child who reacts to the extreme with vaccinations. The last time I had her vaccinated, she ran a temp of over 105 and was vomiting. The health department said, “Must be a stomach virus”. I have 7 kids. I’ve NEVER had a stomach virus hit only one child and no one else in the house. I’m operating under the assumption that the vaccination caused this. The HD assumed it’s a stomach virus. Which leads me to new concerns: How can I know that the next vaccination won’t cause her temp to go even higher? My other worry, is I feel like health care professionals won’t even do anything until it’s too late. If I call and say, “Her temp is 105 and rising! No medicines are bringing it down!” will they do *anything* or will they wait until she has a seizure and possibly stops breathing? That’s not a chance I’m willing to take when I know her chances of getting the disease is very slim…and if she does, it’s probably treatable. Again, not trying to be argumentative – just sharing some good ole mama concerns.

    To be a little more long winded (because I know this must be interesting to you, hahaha ;) )- Peanuts are obviously NOT safe for everyone but are absolutely safe for some people. Our school system has banned ALL peanuts from the school. Your kid is not even allowed to bring a PB&J to school, just in case the kid next to him is allergic. Interesting, how we react to some allergies (like peanuts) compared to other allergies (like perhaps a vaccine allergy).

    4.) No questions really. Vaccine naysayers have used the same argument here. We are already exposed to so many toxins, the ones in vaccines contribute to the problem.

    5.) I was thrilled to know that tests have been done on children/infants concerning vaccinations. (And it’s entirely possible that I read that concerning 1 specific vaccination rather than all of them. I can be dipsy like that sometimes.) Thank you for that information.

    6.) Today is the death date of my little boy, born in 1998. My 4lb 10 oz son stopped breathing within 24 hours of receiving his Hep. B vaccination, right in front of me, while I was holding him. We were at home at the time, and we rushed him to the hospital. They were able to get his heart beating again (after 45 minutes of working on him). He died when he was 4 days old, after we removed life support from him. After his birth, he seemed fine until he got that vaccination. *I am not stating the vaccination caused his subsequent death.* He had other things that could have been a factor (like a true knot in his cord prior to birth that we think contributed to the low birth weight…all of my other birth children were 8 and 9 pounders!). But at the hospital, while the doctor’s were still trying to find a cause, I told them about his vaccination. They immediately said, “That didn’t cause it”. The doctor’s tossed around a bunch of different ideas on what could have caused this but they never could figure it out. His autopsy report basically says, “Cause of death: His heart stopped”. Our neonatologist was baffled at this and felt their report helped none. This leaves me a whole bunch of questions now: Why does a newborn need a HEP B vaccination when the primary way of contracting it is sexually (wasn’t aware of this at the time)? Could the dosage have been for a bigger baby (he was 5.8lbs when he was born). Could this have caused my son’s death?

    7.) No question here; Just my general thoughts on your response and my concerns. True enough that lawyers and emotions do not make science. But the fact that lawyers argued this case doesn’t automatically means it wrong either, right? The case I linked to was about a doctor’s son who has autism as a result of his vaccinations, according to the courts and his father. Surely a doctor who closely monitored his son’s condition very closely before and after the vaccine would be able to give reliable medical evidence, one way or another. I understand what you are saying here, but I can’t help but feel like you are ignoring the evidence for what you feel is lack of science! Is it possible that science just hasn’t “asked the right questions” or done the right studies yet to see the link (if there is one – I truly don’t know).

    8.)I’d really, really, really like to know your opinion on this: Do you feel all of the routine vaccinations (on the vaccine schedule for children) are necessary? Some of them, I just don’t see the point. Hep B for a newborn (unless the mother has Hep B) seems ridiculous. It’s spread mostly through sex. By the time they are having sex, the vaccine no longer works anyhow. Chicken pox shot? Another one that seems ridiculous. I’d rather my young children get the disease (yes, it *can* be horrible, fatal, blah, blah, blah – but so can a cold). (I let my older children choose whether they wanted the chicken pox vaccine and they all chose it. None of them wanted to risk it as an older person, knowing it’s usually harder on an adult than a young child).

    9.) Do you think it’s safe to give as many vaccinations as is recommended in one setting? Our pediatrician advises one vaccination at a time. Is she just being overly cautious?

    *All of my children have had some vaccinations. 4 of them have had all the recommended vaccinations. I’m not anti-vax. My youngest 3, who are adopted seem to react very differently….frighteningly different.

  2. Michelle says:

    I wish you lived nearby and we could sit down for a cup of coffee and I could pick your brain. :)

    Thank you for being willing to open this topic up to me.

  3. jlwile says:

    Thanks for your reply, Michelle. In answer to your questions:

    1) This is why it is important to work with a board-certified physician who knows your family medical history before getting any medicine, including vaccinations. If a physician knows the medical history, he or she is likely to be able to predict if the child will have an allergy to a vaccine, and as a result will advise against getting the vaccine. You certainly could test for allergies prior to getting a vaccine. For example, people who are allergic to eggs should not get certain vaccines. Thus, you could test a child for an egg allergy to exclude certain vaccines. Of course, this is true for most medicines. There are people who are allergic to Penicillin, for example. That allergy could be tested for, but it is generally not, because family history generally tells you, and the allergy test has its own risks. That’s the real problem here. No medical procedure is without risk. If you decide to do allergy testing, then, you are putting your child at additional risk.

    2) The fact is that you do know. When one child dies of SIDS after a vaccine, for example, that could be a coincidence, or it could have been caused by the vaccine. The way you find out is to do a study on a few thousand children, and see if the children who got the vaccine die of SIDS at a higher rate than those who didn’t get the vaccine. If they do, then the vaccine is related to SIDS. If they don’t, the vaccine is not related to SIDS. By doing a study, then, you can determine whether it is a coincidence or not. That’s how we know both SIDS and autism are not related to vaccines. Unvaccinated children die of SIDS more often than vaccinated children (the pertussis vaccine actually has a small protective effect against SIDS), and unvaccinated children have the same rate of autism as vaccinated children.

    3) I really can’t judge what your physician is doing. I am not trained in that area, and even if I were, I would have to know your family medical history and examine your children. However, I can tell you that for the vast majority of children, not being fully vaccinated is a much higher risk than being fully vaccinated. Your specific children might be exceptions to that, which is why you should work with your doctor. Why don’t you ask her what she would do if your child’s fever gets high? I don’t know of any physician who would not treat a high fever.

    We are actually more careful about vaccine allergies than peanut allergies. All vaccines are heavily monitored specifically for reactions, which are then written up in medical journals and discussed with doctors so that allergic reactions are minimized. However, I had peanuts on the airplane the last time I flew, and no one even asked about allergies when they handed out the peanuts. Also, what about baths? More than 300 people die every year in baths. Are baths completely safe? Once again, the definition of “completely safe” from a medical perspective is that the risk of not doing it is higher than the risk of doing it. That’s why we say vaccines are completely safe. The risk of not being vaccinated is higher than the risk of being vaccinated.

    4) No, the “toxins” in vaccines do not contribute to any problem. They are far too low in concentration, and they happen only at specific times. The child is constantly exposed to significantly higher levels of all these “toxins” through eating and daily living.

    5) I don’t know of any vaccine that is administered to infant that hasn’t had many, many studies done specifically on infants. Once again, if you read a lot of anti-vaccine material, you are exposed to a lot of false information.

    6) I am terribly sorry for your loss. I can’t imagine what you must have gone through. However, I can say that if the Hep B vaccine had anything to do with your child’s death, it would be one of the rarest medical events on the planet. Studies indicate that even allergic reactions occur in only about 1 in 1,000,000 doses, and what you describe doesn’t sound like an allergic reaction. There is no way to say for certain what caused your child’s death, but I would think there are lots more likely explanations than the Hep B vaccine. Why do children get the vaccine? Because sex isn’t the only way to get Hep B. The fact is, mothers with Hepatitis B can give it to their children, and if your child comes into contact with the bodily fluids of that child, your child can get it. In countries where vaccination rates are low, this kind of transmission is the most common way Hep B is contracted.

    7) One of the most important things to remember is that there is virtually nothing that can be determined medically from a single case. The fact is that when vaccinated and unvaccinated children are studied, the rates of autism are the same between the two groups. Thus, there is simply no way vaccines can be even partially causing autism. Some of the studies done in this area are so large that even if a vaccine increased a child’s chance of autism by 0.001%, the study would have found it.

    8) There are lots of vaccines that aren’t on the standard schedule in the U.S. because the risk of the vaccine is greater than the risk of the disease. The ones that make it on the schedule are the vaccines for which not getting the vaccine produces a greater risk than getting the vaccine. Once again, Hep B is not just transmitted by sex. In countries where the vaccination rates are low, sex isn’t even the most common means by which it spreads. The only one I am skeptical of is the HPV vaccine, and that’s because the only way you can get that is through sex. Of course, because of that, it isn’t given to infants. However, if I had a preteen daughter (which is who gets the vaccine), I am not sure I would give that one. I guess it would depend on my thoughts about her possible sexual activity.

    9) I think it is safe to get several vaccines at once, and several studies give evidence to support that. No studies of which I am aware (that are not fatally flawed) suggest otherwise. However, if it makes you feel better, please do it that way.

  4. Michelle says:

    Okay – the bath scenario. Baths don’t cause allergic reactions. They are certainly not idiot proof or negligent-parent proof. :( So I guess my answer would be the bath is safe. Perhaps an argument could be made that it’s not safe for everyone, or they wouldn’t be dead. ;)

    I go the health department for their shots because we State insurance. Our doctor’s office does not accept it for check-ups.

    I keep reading what you are saying about about doing a study and I’m not disregarding the value of studies. But what if *my* child is the one who is one in a million. A study wouldn’t pick that up if it’s based on a thousand.

    My son had many other factors that left everyone confused. For instance, he was having these tremors before we brought him to the hospital, but they were very subtle. We didn’t know why he was doing that. After they had him stabilized at the hospital, I asked them why he was doing that – it was like a little shudder. They told me it was a seizure. I search for answers and for ways to protect my other children. (Which leads to conversations such as this one.) Apparently allergies can cause seizures and also toxic metal’s can.

    I recognize that an infant can also acquire Hep B by way of the mother – so by all means, if the mother has it than the child should get the vaccine. But why did my child need it? I don’t have Hep B! Makes better sense to me, to actually test the mother first and then determine if the child needs it.

    You have been very patient with me. Thank you again. Much of what said DOES make me feel better! Some of what you said contradicts stuff I’ve read (for example, like it’s commonly reported by anti-vaxers that studies show that unvaccinated children are less sick and more healthy).

    Would you be open to looking at some of the studies that some of the anti-vaxers report on that support their beliefs? If that is just too time consuming, or just too boring, I’d understand!

    I can honestly say, you’ve made me feel a bit safer! Maybe I’ll take my youngest 3 back for more vaccinations later. But not for Hep B. Or Chickenpox. ;)

  5. jlwile says:

    Michelle, let’s suppose your child is one in a million. His chance of dying from a vaccine-preventable disease is significantly higher than that. That’s the point. A one-in-a-million vaccine reaction is still less risky than what can happen if he is not vaccinated.

    The reason your child needs the Hep B shot is because other children have Hep B, and in child-to-child interactions, your child can be exposed to the bodily fluids of a child with Hep B, through biting, open sores, etc. That can transfer the Hep B from the child to your child. Once again, where the vaccination rate is low, this is a very common way Hep B is transmitted.

    I have read all sorts of studies that anti-vaxers claim support their case. Indeed, in this very thread, both SS and David tried to bring up several of those studies. I had already seen each of them, and I gave them links or my own explanations that show how poor the studies are. Most of those “studies” would have received a failing grade in my college chemistry lab courses. Once again, this is the problem with getting info from anti-vaccine sources. Usually, the science is incredibly poor.

    I am glad that you feel a bit better about vaccines. However, please remember that I am not trying to get you to vaccinate. That’s a decision only you and God can make. I am just trying to be sure that you make that decision based on accurate information.

  6. Michelle says:

    I’m trying to weed through the information and see what is accurate and what is not. Thank you again for taking the time to chat with me!

    If you are ever in the Atlanta area and would like a home cooked meal, we’re in the metro area. We’d love to meet in person!

  7. Jonathan Sarfati, Ph.D. says:

    Here is an interesting account, originally published in 1999, about a horrible polio epidemic in Ireland written by a surivor: Polio: The deadly summer of 1956. Polio is probably the clearest evidence that it was vaccination, not sanitation, which eradicated the disease, because sanitation actually made the disease more prevalent:

    The fear was all the greater because polio did not behave like other diseases. Unlike typhus or cholera, it mainly hit the middle classes rather than the poor. In Cork most of the victims were in the relatively prosperous southern suburbs and not the terrible slums in the north of the city.

    But at the end of the 19th century polio took on a new and more menacing form. For the first time there were polio epidemics and they happened in the richer countries like the US, Denmark, Sweden, Australia and New Zealand. This was because public health was improving with better water supply and sewage systems. Previously people lived in symbiosis with the polio virus. The majority of small children were self-immunised because they got the disease, often without symptoms, when they were still protected by their mother’s antibodies. Only in the last decades of the last century were there enough potential victims without immunity for polio to turn into an epidemic. These victims, as Dr McCarthy noted, were likely to be the children in better-off families living in the most hygienic conditions.

  8. jlwile says:

    Thanks so much for the link, Dr. Sarfati. That kind of account needs to be spread far and wide. One of the reasons anti-vaccination sentiment can take hold in this country and other developed countries is that because of the success of vaccinations, very few people know the real devastation that vaccine-preventable diseases can produce!

  9. David says:

    Dr. Jay,

    I’d be interested in your take on this nephrologist’s talk on a correlation between DDT and polio.
    https://www.youtube.com/watch?v=rZMn7oapJD4

  10. jlwile says:

    Thanks for the link, David. I have seen this before. There are several things wrong with her presentation. I will concentrate on just four:

    1) Even if what she said about the graph was correct (and it is not – see point 2), it would not show that DDT is responsible for polio. Remember, correlation does not mean causation. Organic food sales are more directly correlated with autism than the correlation shown in Dr. Humphries’s graph. I seriously doubt Dr. Humphries would suggest that organic foods cause autism.

    2) What she says about the graph is not even correct. You can see a clearer version of it here. Note that the graph itself says the dashed line is not just DDT. Instead, it is DDT, BHC, arsenic, lead (persistent pesticides). This is important. By grouping the right mix of insecticides, I can get basically any correlation I want. Also, there is no way to check to see if the dashed line is even correct. BHC was in use in the U.S. since the 1940s, and the EPA didn’t even review its use until 1977. It wasn’t eliminated until 2006. Given that its use wasn’t even reviewed until 1977, I seriously doubt it fell off by 1970.

    3) She says in the talk that if there’s one reference we read, it should be “DDT poisoning and the elusive ‘virus X:’ A new cause for gastro-enteritis.” When I first saw this argument, I read that article. It does discuss the possibility that DDT was making people sick, but the symptoms reported in the paper are hardly anything like the symptoms of polio. They include giddiness, irregular spasms of the smooth muscle in the GI tract, anxiety, apprehension, a feeling of contraction in the throat and chest, hypersensitivity of the skin, erratic twitching of voluntary muscles, vertigo, and syncope. About the only thing that makes this illness look like polio is that it includes joint pain and muscle weakness. However, the other symptoms rule out polio. Also, the muscle weakness discussed in the paper is not persistent. It is acute. That’s not like polio at all.

    4) She is ignoring the largest clinical study ever conducted in the history of medicine, which I discussed in the original post. In that study (which included over a million children) the children given the vaccine were significantly less likely to get polio than those who were given an inert injection. This gives us a direct link between the polio vaccine and the decline in polio.

    Dr. Humphries is a part of the International Medical Council on Vaccination, which is not very interested in communicating the facts. Indeed, they sponsored and heavily-publicized a debate between me and a chemist who thinks vaccines cause autism. Once the debate was over, however, the International Medical Council on Vaccination erased all record of the debate from their website. You can watch the debate from my website to see why they erased it from theirs.

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