Grand Rounds: Panel on Pediatric Vaccinations
**my take-home from lecture: give 100,000 IU's vit A with vaccine if pt not preg
**sign up for CDC notices (check)
interesting news from BBC: meningitis C vaccine wears off in teens
http://news.bbc.co.uk/2/hi/health/8668182.stm
Heather Zwickey does intro
Shari House speaking first
dark haired lady, 50's red shirt black skirt
she gives lots of vaccines
she does travel medicine
her clinic: An Integrated Clinic
I don't think this is her, this is in Egypt and interesting: http://www.integrated-clinic.com/
also not her: http://www.integratedhealthclinic.com/
works with Vanessa Esteves, two other docs, two chiros, one massage therapist
SOME HISTORY OF VACCINATION
first vaccines used in China
noticed that individuals only get certain dzs once
experimented with smallpox: variolation, some pts died in experiments
cow pox observations
experiments in Britain in 1700's
1994 MANDATE in US for MMR vaccine to go to public school
1998 Wakefield study looked at kids, published in Lancet
MMR risks with children: GI infx, brain dz
n = 12 pts, study was discredited
http://en.wikipedia.org/wiki/Andrew_Wakefield
DEMONSTRABLE PUBLIC HEALTH UTILITY OF VACCINATION
many diseases nearly eradicated by vaccination campaigns:
measles, diptheria*, mumps, pertussis, smallpox*, rubella, polio*, tetanus
all decreased by 95% or more since early 20th century
*denotes zero cases in 2006 in US
SECOND SPEAKER
Hillary Andrews
family practice
used to teach microbiology
she heard that ND students go in to school pro-vaccine and leave anti-
SAFETY
--Pre-licensing studies are small and will not find most rare events, so safety is not fully known before, adverse event reporting after vaccines are used in the public is how safety is further studied.
--1998 rotavirus vaccine was causing an increase in bowel obstruction, was removed from market. Haemophilus influenzae type B vaccine is now only recommended for adults because it causes immune tolerance, reduces ability to fight actual dz, also happened in killed measles vaccine, was taken off market.
--Salk-Polio vaccine was much in demand and new labs started making it-->Cutter Incident in 1955 wasn't sufficiently killing the vaccine-->increase in paralytic polio-->had to address sterilization techniques.
--Sabin polio vaccine, oral live vaccine, no longer used in US (since 2000) because live polio can convert back to paralytic kind, still much used in poorer countries.
--Only healthy kids are enrolled in the clinical trials.
--Premies are getting vaccinated without age adjustment.
--1994 Inst of Med of Nat Acad of Sci published review of Hep B vaccine, couldn't come to any conclusions because there was not any research
--1970's, 23 doses of 7 vaccines by age 6, first at age 2: DPT, TOPV, Measles, TB test, Rubella, Mumps, DTP, TOPV
--Now 48 doses of 14 vaccines by age 6 with first given at 12 hours
--immunization campaign based on herd immunity, no consideration for individual risks
--timing of vaccines linked to pediatric wellness visits, not on science of immune system development, not on individual risk factors, not on neurological maturity
--there is no research supporting the current pediatric schedule: money goes into marketing, not research
ADDITIVES
FDA now requires disclosure of what's in there
PRESERVATIVES
THIMEROSAL
causes genetic mutations
kills everything so it's not in live vaccines incl MMR, chick pox, some flu vaccines
thimerosal as preservative now replaced by 2-phenoxyethanol in pediatric vaccines
*look up 2-PHENOXYETHANOL
PHENOL also used as preservative
preservative free vaccines now available
thimerosal put in to kill then removed (not sure how)
usu single dose vial
2-PHENOXYETHANOL (2-PE)
Molecular formula: C8H10O2
Synonyms: phenoxetol, phenoxyethyl alcohol, phenoxyethanol, 1-hydroxy-2-phenoxyethane, rose ether, phenylmonoglycol ether, 2-phenoxyethanol, glycol monophenyl ether, beta-hydroxyethyl phenyl ether, various trade names
Uses: perfume fixative, bactericide (inactivates gram + & - & yeast), insect repellent, topical antiseptic, solvent for cellulose acetate, dyes, inks, resins, organic synthesis of plasticizers, germicides, pharmaceuticals, cosmetics, preservatives (alternative to formaldehyde)
contains phenol which inhibits phagocyte activity
also contains ethylene oxide, irritant-->dermatitis, burns, blisters, eczema
sx attributed to 2-PE: headache, shock, weakness, convulsions, kidney damage, cardiac failure, kidney failure, death
vaccines containing 2-PE:
1. Hep A Inactivated (Havrix® SmithKline Beecham Biologicals http://us.gsk.com/products/assets/us_havrix.pdf),
2. DAPTACEL (Aventis Pasteur, http://www.vaccineshoppe.com/US_PDF/DAPTACEL_
3973_6.02.pdf)
3. Poliovirus Vaccine Inactivated (IPOL¨ Manufactured by: Aventis Pasteur, http://www.us.aventispasteur.com/PRODUCT/PDFFILES/IP
OL.pdf)
4. INFANRIX ® HepB Combined Diphtheria-Tetanus-acellular Pertussis (DTPa) and Hepatitis B Vaccine (SmithKline Beecham Biologicals, http://www.gsk.com.au/PDFs/INFANRIXHB.pdf)
5. TETRAVAC® Suspension for i.m. (intramuscular?) Injection - Used only in Germany.
6. long list of diptheria vaccines: Pediarix™, Tripedia®, DiTe Anatoxal Berna, DI Anatoxal Berna, ADT ™, DECAVAC™, DIFTAVAX, Ditanrix, DiTe Anatoxal Berna, DT (generic), Dual Antigen SII (India), DT - (Polio and diptheria), Primavax, Revaxis®, Td, Tritanrix HB-HIB, Td Polio Adsorbed, Adacel™, Boostrix™, Certiva™, DAPTACEL, Hexavac, Infanrix®, Infanrix Hexa, Infanrix Penta, Pediacel, QUADRACEL®, Pentacel®, TriHIBit®, Di Te Anatoxal Berna, Zaantide, ADT, CDT ™, Di-Te Booster, Acel-Immune, Repavax
TOXICOLOGY OF 2-PE
Harmful by inhalation, in contact with skin and if swallowed. Skin, eye and respiratory irritant. May cause serious eye damage.
ORL-RAT LD50 1260 mg kg-1 Oral Rat 50% Lethal Dose
SKN-RBT LD50 5000 mg kg-1 Skin Rabbit 50% Lethal Dose
Irritation data
SKN-RBT 500 mg/24h mld Skin Rabbit 500 mg 24 hours mild
EYE-RBT 6 mg mod Eye Rabbit 6 mg moderate
EYE-RBT 0.25 mg/24h sev Eye Rabbit 24 hours severe risk phrases
R20 R21 R22 R36 R37 R38 R41.
R20 Harmful by inhalation
R21 Harmful by contact with skin
R22 Harmful if swallowed
R36 Irritating to eyes
R37 irritating to respiratory system
R38 irritating to skin
R41 Risk of serious damage to eyes
Reference: http://physchem.ox.ac.uk/MSDS/ET/ethylene_glycol_monophenyl_ether.html
SOURCES on 2-pe: http://www.vaccinetruth.org/2-phenoxyethanol.htm
http://en.wikipedia.org/wiki/Phenoxyethanol
http://www.novaccine.com/vaccine-ingredients/results.asp?sc=17
back to notes from lecture:
ADJUVANTS
to stim immune response
live vaccines get robust immune response and don't need adjuvants
don't have preservatives because don't want to kill the bugs
in killed, acellular, whole cell vaccines there is an adjuvant
ALUMINUM is #1 used
vaccine microbial invasion not localized so no local site and no local immune response
aluminum in oil is reservoir of antigen at site of injection to provide a base where
B cells find the antigen, go to LN's the mount immune response and then
send immune cells to return to the site
macrophages/dendritic cells eat aluminum/oil at injx site
until they get constipated and die and stay there
MF59 squalene (adjuvant) has been exonerated from causing gulf war syndrome
MEDICAL EXEMPTIONS
ND's can sign in OR
exemptions: philosophical, religious, medical
don't use medical if you can use philosophical/religious
law varies by state
OR has lowest vaccination rate in US-->highest exposure risk
Ashland has 30% unvaccinated and lithium in the water
PANEL TIME NOW
VITAMIN A
give with vaccine!
vit A depletion is big with certain dzs, esp measles
100,000IUs given along with vaccines in some 3rd world countries
she used to recommend 10 days before do 10,000 IUs/day BUT
learned that the big dose with the vaccine is more effective, she uses the drops
10,000IUs per drop
viral dz or vaccine-->sudden drop in vit A-->pneumonia more likely to develop
STREP
new study
new strains are emerging
incidence of pneumonia is increasing
vaccination is driving the evolution
TB
vaccination and treatment for TB-->increased RA incidence
organism modifies host so it can live there then host doesn't get rheumatoid arthritis
TB suppresses certain cytokines (IL1, TNFalpha)
let those cytokines come back-->RA
MALARIA
endemic pops have low cancer risk
maybe fevers (TNFalpha) kills precancerous cells
ALLERGIES/ASTHMA
new Canadian study 2009
delay vaccination to after 1 year
-->reduce allergy and asthma in children
CANCER
another new study
more exposure to bugs when young-->less cancer later in life
PERTUSSIS
vaccine only effective for 5 years
MY THOUGHTS
panel not fair, Shari outnumbered and people are laughing at her
Shari is snorting at other two panelists so respect is lacking both ways
she represents the majority opinion more so than Z&A
Zwickey and Andrews teach Vaccines together and are in agreement
we need more of the voices that are educated and will challenge them
where are they?
BESIDES VACCINATING WHAT CAN YOU DO?
give probiotics
(chickens given probx in 1st day of life produce natural ABs to tetanus)
vitamin D
traditional naturopathy: hydrotherapy, diet changes/fasting, sunlight
**sign up for CDC notices (check)
interesting news from BBC: meningitis C vaccine wears off in teens
http://news.bbc.co.uk/2/hi/health/8668182.stm
Heather Zwickey does intro
Shari House speaking first
dark haired lady, 50's red shirt black skirt
she gives lots of vaccines
she does travel medicine
her clinic: An Integrated Clinic
I don't think this is her, this is in Egypt and interesting: http://www.integrated-clinic.com/
also not her: http://www.integratedhealthclinic.com/
works with Vanessa Esteves, two other docs, two chiros, one massage therapist
SOME HISTORY OF VACCINATION
first vaccines used in China
noticed that individuals only get certain dzs once
experimented with smallpox: variolation, some pts died in experiments
cow pox observations
experiments in Britain in 1700's
1994 MANDATE in US for MMR vaccine to go to public school
1998 Wakefield study looked at kids, published in Lancet
MMR risks with children: GI infx, brain dz
n = 12 pts, study was discredited
http://en.wikipedia.org/wiki/Andrew_Wakefield
DEMONSTRABLE PUBLIC HEALTH UTILITY OF VACCINATION
many diseases nearly eradicated by vaccination campaigns:
measles, diptheria*, mumps, pertussis, smallpox*, rubella, polio*, tetanus
all decreased by 95% or more since early 20th century
*denotes zero cases in 2006 in US
SECOND SPEAKER
Hillary Andrews
family practice
used to teach microbiology
she heard that ND students go in to school pro-vaccine and leave anti-
SAFETY
--Pre-licensing studies are small and will not find most rare events, so safety is not fully known before, adverse event reporting after vaccines are used in the public is how safety is further studied.
--1998 rotavirus vaccine was causing an increase in bowel obstruction, was removed from market. Haemophilus influenzae type B vaccine is now only recommended for adults because it causes immune tolerance, reduces ability to fight actual dz, also happened in killed measles vaccine, was taken off market.
--Salk-Polio vaccine was much in demand and new labs started making it-->Cutter Incident in 1955 wasn't sufficiently killing the vaccine-->increase in paralytic polio-->had to address sterilization techniques.
--Sabin polio vaccine, oral live vaccine, no longer used in US (since 2000) because live polio can convert back to paralytic kind, still much used in poorer countries.
--Only healthy kids are enrolled in the clinical trials.
--Premies are getting vaccinated without age adjustment.
--1994 Inst of Med of Nat Acad of Sci published review of Hep B vaccine, couldn't come to any conclusions because there was not any research
--1970's, 23 doses of 7 vaccines by age 6, first at age 2: DPT, TOPV, Measles, TB test, Rubella, Mumps, DTP, TOPV
--Now 48 doses of 14 vaccines by age 6 with first given at 12 hours
--immunization campaign based on herd immunity, no consideration for individual risks
--timing of vaccines linked to pediatric wellness visits, not on science of immune system development, not on individual risk factors, not on neurological maturity
--there is no research supporting the current pediatric schedule: money goes into marketing, not research
ADDITIVES
FDA now requires disclosure of what's in there
PRESERVATIVES
THIMEROSAL
causes genetic mutations
kills everything so it's not in live vaccines incl MMR, chick pox, some flu vaccines
thimerosal as preservative now replaced by 2-phenoxyethanol in pediatric vaccines
*look up 2-PHENOXYETHANOL
PHENOL also used as preservative
preservative free vaccines now available
thimerosal put in to kill then removed (not sure how)
usu single dose vial
2-PHENOXYETHANOL (2-PE)
Molecular formula: C8H10O2
Synonyms: phenoxetol, phenoxyethyl alcohol, phenoxyethanol, 1-hydroxy-2-phenoxyethane, rose ether, phenylmonoglycol ether, 2-phenoxyethanol, glycol monophenyl ether, beta-hydroxyethyl phenyl ether, various trade names
Uses: perfume fixative, bactericide (inactivates gram + & - & yeast), insect repellent, topical antiseptic, solvent for cellulose acetate, dyes, inks, resins, organic synthesis of plasticizers, germicides, pharmaceuticals, cosmetics, preservatives (alternative to formaldehyde)
contains phenol which inhibits phagocyte activity
also contains ethylene oxide, irritant-->dermatitis, burns, blisters, eczema
sx attributed to 2-PE: headache, shock, weakness, convulsions, kidney damage, cardiac failure, kidney failure, death
vaccines containing 2-PE:
1. Hep A Inactivated (Havrix® SmithKline Beecham Biologicals http://us.gsk.com/products/assets/us_havrix.pdf),
2. DAPTACEL (Aventis Pasteur, http://www.vaccineshoppe.com/US_PDF/DAPTACEL_
3973_6.02.pdf)
3. Poliovirus Vaccine Inactivated (IPOL¨ Manufactured by: Aventis Pasteur, http://www.us.aventispasteur.com/PRODUCT/PDFFILES/IP
OL.pdf)
4. INFANRIX ® HepB Combined Diphtheria-Tetanus-acellular Pertussis (DTPa) and Hepatitis B Vaccine (SmithKline Beecham Biologicals, http://www.gsk.com.au/PDFs/INFANRIXHB.pdf)
5. TETRAVAC® Suspension for i.m. (intramuscular?) Injection - Used only in Germany.
6. long list of diptheria vaccines: Pediarix™, Tripedia®, DiTe Anatoxal Berna, DI Anatoxal Berna, ADT ™, DECAVAC™, DIFTAVAX, Ditanrix, DiTe Anatoxal Berna, DT (generic), Dual Antigen SII (India), DT - (Polio and diptheria), Primavax, Revaxis®, Td, Tritanrix HB-HIB, Td Polio Adsorbed, Adacel™, Boostrix™, Certiva™, DAPTACEL, Hexavac, Infanrix®, Infanrix Hexa, Infanrix Penta, Pediacel, QUADRACEL®, Pentacel®, TriHIBit®, Di Te Anatoxal Berna, Zaantide, ADT, CDT ™, Di-Te Booster, Acel-Immune, Repavax
TOXICOLOGY OF 2-PE
Harmful by inhalation, in contact with skin and if swallowed. Skin, eye and respiratory irritant. May cause serious eye damage.
ORL-RAT LD50 1260 mg kg-1 Oral Rat 50% Lethal Dose
SKN-RBT LD50 5000 mg kg-1 Skin Rabbit 50% Lethal Dose
Irritation data
SKN-RBT 500 mg/24h mld Skin Rabbit 500 mg 24 hours mild
EYE-RBT 6 mg mod Eye Rabbit 6 mg moderate
EYE-RBT 0.25 mg/24h sev Eye Rabbit 24 hours severe risk phrases
R20 R21 R22 R36 R37 R38 R41.
R20 Harmful by inhalation
R21 Harmful by contact with skin
R22 Harmful if swallowed
R36 Irritating to eyes
R37 irritating to respiratory system
R38 irritating to skin
R41 Risk of serious damage to eyes
Reference: http://physchem.ox.ac.uk/MSDS/ET/ethylene_glycol_monophenyl_ether.html
SOURCES on 2-pe: http://www.vaccinetruth.org/2-phenoxyethanol.htm
http://en.wikipedia.org/wiki/Phenoxyethanol
http://www.novaccine.com/vaccine-ingredients/results.asp?sc=17
back to notes from lecture:
ADJUVANTS
to stim immune response
live vaccines get robust immune response and don't need adjuvants
don't have preservatives because don't want to kill the bugs
in killed, acellular, whole cell vaccines there is an adjuvant
ALUMINUM is #1 used
vaccine microbial invasion not localized so no local site and no local immune response
aluminum in oil is reservoir of antigen at site of injection to provide a base where
B cells find the antigen, go to LN's the mount immune response and then
send immune cells to return to the site
macrophages/dendritic cells eat aluminum/oil at injx site
until they get constipated and die and stay there
MF59 squalene (adjuvant) has been exonerated from causing gulf war syndrome
MEDICAL EXEMPTIONS
ND's can sign in OR
exemptions: philosophical, religious, medical
don't use medical if you can use philosophical/religious
law varies by state
OR has lowest vaccination rate in US-->highest exposure risk
Ashland has 30% unvaccinated and lithium in the water
PANEL TIME NOW
VITAMIN A
give with vaccine!
vit A depletion is big with certain dzs, esp measles
100,000IUs given along with vaccines in some 3rd world countries
she used to recommend 10 days before do 10,000 IUs/day BUT
learned that the big dose with the vaccine is more effective, she uses the drops
10,000IUs per drop
viral dz or vaccine-->sudden drop in vit A-->pneumonia more likely to develop
STREP
new study
new strains are emerging
incidence of pneumonia is increasing
vaccination is driving the evolution
TB
vaccination and treatment for TB-->increased RA incidence
organism modifies host so it can live there then host doesn't get rheumatoid arthritis
TB suppresses certain cytokines (IL1, TNFalpha)
let those cytokines come back-->RA
MALARIA
endemic pops have low cancer risk
maybe fevers (TNFalpha) kills precancerous cells
ALLERGIES/ASTHMA
new Canadian study 2009
delay vaccination to after 1 year
-->reduce allergy and asthma in children
CANCER
another new study
more exposure to bugs when young-->less cancer later in life
PERTUSSIS
vaccine only effective for 5 years
MY THOUGHTS
panel not fair, Shari outnumbered and people are laughing at her
Shari is snorting at other two panelists so respect is lacking both ways
she represents the majority opinion more so than Z&A
Zwickey and Andrews teach Vaccines together and are in agreement
we need more of the voices that are educated and will challenge them
where are they?
BESIDES VACCINATING WHAT CAN YOU DO?
give probiotics
(chickens given probx in 1st day of life produce natural ABs to tetanus)
vitamin D
traditional naturopathy: hydrotherapy, diet changes/fasting, sunlight