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New guidelines by the American Academy of Allergy Asthma & Immunology say that individuals with egg allergies can safely receive the flu vaccine, without a skin test being performed first. Flu vaccines are grown in chicken eggs, which raised concerns about possible allergic reactions to residual egg protein. Up to now, precautionary steps were taken, which included vaccine skin testing, administration via a 2-step graded dose challenging (10%, followed by 90% of the age appropriate dose after a brief observation period), or stepwise desensitization.
This latest AAAAI paper “offers guidance in how to evaluate and treat the patient with egg allergy who desires influenza vaccination, and outlines the latest evidence based approaches to successfully administer the vaccine.” According to the position paper:
Conclusion There has been tremendous growth over the past year in demonstrating that TIV (and H1N1) are safe for egg allergic individuals to receive. While a few concepts bear further study, such as the safety of these vaccines in individuals with severe allergy to egg, it appears that most egg allergic patients can safely receive influenza vaccination if desired. While no particular approach to administering the vaccine has been shown to be the safest and most effective, several methods for providing this service exist. Providers should no longer withhold the vaccine on account of a patient’s egg allergy, and should feel comfortable selecting one of two strategies we outline for administering the influenza
Anti-vaccination scares are as old as vaccination itself – but now they are putting lives at risk in the developing world
Vaccine scares are nothing new. When Edward Jenner first pioneered the use of the mild disease cow pox to innoculate against the deadly small pox in the 18th century, satirists drew cartoons of vaccinated patients sprouting cow’s heads. Now, it seems, every country in the developed world has their own type of scare. In France, protesters claim that the hepatitis B vaccines cause multiple sclerosis, in the US, that the vaccine’s mercury additives are responsible for the rise in autism. In the UK, there was a furore over whooping cough and then, famously, MMR. All have been exposed as groundless fears, yet anti-vaccine feeling continues to reverberate on the the internet. Now doctors warn that such rumours from the UK, Europe and the US are spilling over into the developing world, where they are threatening to derail global vaccination programmes. Terrifyingly, this means putting the lives of thousands of children at risk.
In South Africa, concerns about MMR, generated by coverage in the rest of the English-speaking world – including the UK – have led to an unwillingness to receive the vaccine, and there has been an outbreak of nearly 7,000 cases of measles. For children with poor health and limited access to medical services, this decision has been disastrous. There have already been hundreds of deaths.
Meanwhile, in India the government has recently overturned recommendations from its own scientific advisers to include the Hib (shorthand for a bug called Haemophilus influenzae) vaccine in its basic childhood programme, despite the fact that the World Health Organisation says that 20% of the 400,000 childhood deaths from pneumonias caused by Hib worldwide occur in India. In the UK, childhood Hib vaccination has seen Hib-caused meningitis (the more common Hib illness in the developed world) fall away to almost nothing. Yet Indian lobbying groups, led by opposition politicians, still claim that Hib vaccines are not only unnecessary, but have caused a number of deaths. The tactics of the Indian anti-Hib groups draw directly on the work of UK and US anti-vaccine websites.
Our anti-vaccine fears, and the groups set up to highlight them in the developed world, may not directly cause these problems, but are “fuelling and amplifying them”, according to Dr Heidi Larson of the vaccine programme and policy group at Imperial College London. Shockingly, just five minutes spent looking at websites critical of vaccines increases your perceptions of the risks, and reduces the perceptions of the risks of not being innoculated, according to a recent paper from a German group published in the Journal of Health Psychology. Rumours about vaccines quickly gain credence in the internet hothouse, with sites feeding off each other. Many sites will tell you that four girls in India died within 24 hours of receiving HPV vaccines. What they don’t say is that two died in road crashes, one from a snake bite, and one fell down a well. Add this rumour to the feeling that vaccination is something that is done to you by government, by global agencies or by big pharmaceutical companies, and conspiracy theories are virtually guaranteed.
So what can be done? So far, campaigners have insisted on more information, awareness and education. But this approach has failed. Instead, the idea of each country taking ownership is being explored, along with advocacy and immediate action to quell rumours.
I want to take a second to publicly thank the good folks over at the Facts, Not Fantasy blog for being good supporters of Vaccine Central. Thank you for re-posting entries from Vaccine Central and helping spread the message. The main site Factsnotfantasy.com has some very useful information, especially about vaccines and evolution. For example, did you know that in 1950 Diphtheria, Tetanus, Pertussis, Polio and Measles killed 4,236 people in the US alone, whereas in 2005 those same 5 diseases killed only 33 people (31 of which were due to pertussis) a more than 100 fold decrease in mortality rates in 50 years? No? Neither did I, but thanks to Factsnotfantasy.com, it was easy to find out.
This has been making the news lately. The U. S. Supreme Court is hearing a case about vaccines. Well, it isn’t really, but that’s what some headlines would have you believe. The most misleading of the bunch is this one at Yahoo News: Court hears case about vaccine side effects. F! Not even close; what the Supreme Court is hearing is not a case about vaccine side effects, but a case about the right of individuals to sue a vaccine manufacturer outside of vaccine court. In a few words, the Supreme Court is trying to interpret the 1986 National Childhood Vaccine Injury Act, to give a better understanding of which cases of vaccine injury belong specifically to the Vaccine Court, and which cases can be brought before the regular courts (emphasis added).
What is not at issue is that 18-year-old Hannah Bruesewitz is disabled, requiring special care for life.
Nor is the question of whether the diphtheria-tetanus-pertussis, or DTP vaccine, she was injected with as an infant caused her seizures and consequent brain damage, or whether vaccine maker Wyeth, now part of Pfizer, is to blame.
The question is whether Hannah’s parents, Russell and Robalee Bruesewitz, can sue.
Let me give you some background. On October 1, 1988, the National Childhood Vaccine Injury Act of 1986 (Public Law 99-660) created the National Vaccine Injury Compensation Program (VICP). The VICP was set up to: “ensure an adequate supply of vaccines, stabilize vaccine costs, and establish and maintain an accessible and efficient forum for individuals found to be injured by certain vaccines.” In other words, it is a special court that handles lawsuits for individuals that suffer certain rare, but known, side effects from vaccines.
The purpose of the VICP is to ensure an adequate supply of vaccines, by shielding vaccine manufacturers from certain lawsuits, which could be devastating to a company and can bankrupt them. Allowing that to happen would seriously threaten the supply of vaccines, and if our supply of vaccines is seriously affected many diseases could come back and wreak havoc with humanity.
However, this law shouldn’t be interpreted to shield vaccine manufacturers from negligent misconduct, and it appears the original 1986 law is a bit vague on what exactly should be covered by the vaccine court, so much so that even the experienced Supreme Court Justices are a bit confused over it, at least according to another headline.
The justices’ questions focused not on the facts of the case, but on the convoluted wording of the National Childhood Vaccine Injury Act of 1986
The Supreme Court is not expected to rule until next year and their questions show the justices struggled to understand the meaning of the law and of the intended lawsuit.
“What they — the language that they used is certainly, to say the least, confusing,” said Justice Ruth Bader Ginsburg.
My naive take on this issue is as such: the manufacturers should be held liable for negligent misconduct one way or another. A law cannot shield manufacturers for willful, or negligent misconduct. However, the original purpose of the VICP should be upheld. Parent’s shouldn’t be allowed to sue directly for injuries that are soundly refuted by the scientific evidence, such as autism for example.
This limitation is not meant to protect Big Pharma, evident by the fact that this protection does not extend to other drugs Big Pharma produces, but is meant to protect the supply of vaccines, which are probably the most important line of defence against many childhood vaccines, and which have collectively saved hundreds of thousands of lives since they were first used. As reported in the NYTimes:
Ms. Bruesewitz’s case turns on the text of the federal law, which bars ordinary lawsuits “if the injury or death resulted from side effects that were unavoidable even though the vaccine was properly prepared and was accompanied by proper directions and warnings.”
Much of the argument concerned the meaning of the word “unavoidable.”
“The language that they used is certainly, to say the least, confusing,” Justice Ruth Bader Ginsburg said.
Ms. Sullivan, the Wyeth lawyer, said Congress had meant to allow only lawsuits arising from manufacturing flaws and inadequate warnings. Suits over asserted design defects — those arising from the nature of the vaccine itself as compared with other, potentially safer ones — were meant to be barred, she said.
A little while ago I reported on a massive measles vaccination campaign in China, with the goal of reaching 100 million children from September 11 through September 20, 2010. The campaign was met with distrust by a portion of the chinese population, a product of previous chinese government health scandals. Clearly, this opposition to a government-backed initiative had to do with the lack of trust the chinese people have in their government, and is not indicative of the merits of the campaign. However, quite predictably, anti-vaccination sites jumped at the news as if the distrust the people of China harbor towards their government has anything to say about the vaccines themselves.
Good news is coming out of China, which will hopefully lay the question at rest in the public’s mind. According to Zhao Kai, a medical virology expert from the Chinese Academy of Engineering, in an interview with People’s Daily Online, as of September 14th, 50 million people had been vaccinated and only 400 adverse effects events had been recorded “the majority of which were allergic rash”.
Nevertheless, we must take these reported results with a grain of salt. Firstly, it is very early after the close of the campaign, and the full data is not available yet. Secondly, the vaccine used was produced domestically, and so far is showing lower rates of adverse effects than is expected from data from the WHO, which is a little interesting, since there is a tendency in totalitarian countries to make domestic products look/sound better than foreign counterparts. However, although we must keep that possibility in mind, wrong-doing cannot be presumed, but proven, so until, and if, evidence of wrong-doing comes out, we have to accept the results of this report.
Do you own a Kindle? $2? Then you can get Vaccine Central delivered wirelessly to your Kindle so you can read it offline. All proceeds, besides whatever chunk Amazon will keep, go to support the Super Sekrit project that will be unveiled this upcoming week. Go ahead, don’t be shy; and more importantly don’t be cheap.