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For the anti-vaccinationists out there: The results of a real “vaxed versus unvaxed” study

ResearchBlogging.orgIn many ways, the anti-vaccine movement is highly mutable. However, this mutability is firmly based around keeping one thing utterly constant, and that one thing is vaccines. No matter what the evidence, no matter what the science, no matter how much observational, scientific, and epidemiological evidence is arrayed against them, to the relentlessly self-confident members of the anti-vaccine movement, it’s always about the vaccines. Always. Vaccines are always the root many human health problems, be they asthma, autoimmune diseases, autism, and chronic diseases of all types. Everything else is negotiable. For instance, back when Andrew Wakefield ignited a scare about the MMR vaccine by publishing a fraudulent case series linking the MMR to a new syndrome consisting of regressive autism and enterocolitis, it was the measles vaccine that caused this syndrome. Here in the U.S., it was the mercury in the thimerosal preservative that used to be used in many childhood vaccines until 2001 that was the cause of all evil. However, as scientists did more and more studies, testing vaccines to see if they were associated with an increased risk of autism and found zero, nada, zip association with either vaccines or the thimerosal preservative in vaccines, the anti-vaccine movement was nothing if not mutable. Before long, Jenny McCarthy was declaring that it was the “toxins” in vaccines that were causing autism, and Generation Rescue was asserting that children were getting “too many too soon.” Of course, as far as the anti-vaccine movement was concerned, the beauty of these ideas was (and is) that they are much harder to falsify scientifically because they are so much more vague.

Of late, the anti-vaccine movement has hit upon a new strategy. Specifically, they are demanding what they like to call a “vaxed versus unvaxed” study. Basically, their claim is that unvaccinated children are so much healthier than vaccinated children, and they think that such a study would prove it. Of course, they only hit on this message after making some rather embarrassing missteps. In particular, they didn’t seem to realize that a randomized, double blind study of vaccination according to the currently recommended schedule versus unvaccinated children was totally unethical. So, they figured out another angle. They acknowledge that a randomized trial of unvaccinated versus vaccinated children would not be feasible (although they appear not to be able to admit just how unethical it would be), and blithely suggest instead an epidemiological study of the vaccinated versus the unvaccinated without realizing just how horrendously difficult it would be to overcome the confounders that would plague such a study or that ethical considerations still require sound scientific justification for such a study. That’s why it’s so cute to see anti-vaccine loons trying to justify such a study.

All of which is why it’s pretty amusing that just such a study was recently reported in Germany. Can you guess what it found? Let’s just say that, to those of us who accept the science showing that vaccines do not cause autism, autoimmune diseases, asthma, and the like, the results were utterly unsurprising:

In their study, the authors compare the occurrence of infections and allergies in vaccinated and unvaccinated children and adolescents. These include bronchitis, eczema, colds, and gastrointestinal infections.

The evaluation showed that unvaccinated children and adolescents differ from their vaccinated peers merely in terms of the frequency of vaccine preventable diseases. These include pertussis, mumps, or measles. As expected, the risk of contracting these diseases is substantially lower in vaccinated children and adolescents.

Surprise, surprise! Unvaccinated kids differ from vaccinated kids only in having a much higher risk of vaccine-preventable disease! Who’da thunk it? But, as is my wont, I need to see the actual study, rather than a news report. So, as they say, let’s go to the tape. Unfortunately, the authors feel obligated to lay out exactly why they did their study:

The benefits, efficacy, and safety of protective vaccinations are widely scientifically proven. Furthermore, modern vaccines are well tolerated (4, 5). In spite of all this, some parents and doctors have reservations against vaccinations. The fear is that vaccinations overburden, stress, or weaken a child’s immune system and may therefore cause harm. As a result they think that vaccinated children are more prone to falling ill than non-vaccinated children. In addition, vaccinations are deemed to be responsible for the occurrence or increased incidence of other diseases, including chronic diseases (6, 7).

In other words, Generation Rescue, Dr. Jay Gordon, Jenny McCarthy, and others. They spread this misinformation.

Basically, what the German investigators did was to examine data collected aas part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which was conducted from May 2003 to May 2006 by the Robert Koch Institute. The data collected were primarily from a standardized, computer-assisted personal interview of the parents, but diagnoses reported and vaccination status were verified through medical records. Results were compared between vaccinated and unvaccinated children, defined thusly:

Children and adolescents were defined as unvaccinated if at the time of the KiGGS survey no documentation existed for any vaccination against diphtheria, pertussis, tetanus, Haemophilus influenzae type b, hepatitis B, poliomyelitis, measles, mumps, or rubella. By contrast, children who had by then received at least one vaccination according to their vaccination card were categorized as vaccinated. Immigrant families were excluded from the analyses in order to avoid misclassification because of the often missing or incomplete vaccination documents.

On the basis of the KIGGS data, investigators concluded that approximately 0.7% of nonimmigrant children and adolescents in Germany are completely unvaccinated. This is in line with estimates I have seen for the percentage of children in the U.S. who are completely unvaccinated, although this population is more difficult to ascertain in the U.S., at least on a national level. In any case, there was a vaccination card available for 13,453 children aged 1 through 17. Out of this group, for 94 children no evidence of vaccination could be found. Consistent with results in the U.S., the unvaccinated children tended to be from families of higher socioeconomic status. Less relevant, unvaccinated children tended to live in older German states than in the new German states.

Otherwise, the children in both groups were very similar, except in one way. This graph in Figure 1 tells the tale.

i-c7ed88b7f634f2efb173053889959fd9-Figure1.jpg

Basically, unvaccinated children had a much higher prevalence of vaccine-preventable infectious disease. The results were significant for pertussis, measles, and mumps, as described in the text:

The proportion of children and adolescents who had had pertussis, measles, mumps, and/or rubella was much higher in unvaccinated children than in those who had been vaccinated against the respective disease to a sufficient extent. For pertussis, the lifetime prevalence in unvaccinated subjects was 15.8% (95% CI 8.5 to 27.6, n = 11), in those with sufficient vaccination cover only 2.3% (95% CI 2.0 to 2.8), n = 184). For measles, the lifetime prevalence was 15.0 (95% CI 7.7 to 27.4, n = 10) in unvaccinated subjects and 5.2% (95% CI 4.7 to 5.8, n = 431) in sufficiently vaccinated ones. For mumps, the lifetime prevalence in unvaccinated subjects was 9.6% (95% CI 4.2 to 20.2, n = 7) and in vaccinated ones, 3.1% (95% CI 2.6 to 3.7, n = 305). For rubella, the lifetime prevalence was 17.0% (95% CI 9.4 to 29.0, n = 11) for unvaccinated subjects and 6.8% (95% CI 6.0 to 7.6, n = 642) for vaccinated ones. Differentiated stratified analyses confirmed the described higher proportions of subjects with the respective disease among unvaccinated subjects for boys and girls and for different age groups (data not shown).

It was at this point that the authors included an interesting control. One might imagine that if, for some reason, there were differences in infectious disease prevalence in general between the two groups, there might be differences in diseases against which we do not or cannot vaccinate, such as colds. What the investigators found was that there was no difference in the number of infections between vaccinated and unvaccinated children in any of the age groups studied:

i-26f07b9c33d4bf3040a674d38050dcfe-Figure2.jpg

In other words, as expected, the only difference in prevalence observed was in diseases for which vaccines make a difference, and those diseases were much less prevalent among vaccinated children than among unvaccinated children.

Finally, the investigators examined the hypothesis that vaccines increase the risk of allergies and immune system dysfunction by looking at atopic disorders. The authors examined the prevalence of three conditions, bronchial asthma, atopic eczema, and allergic rhinoconjunctivitis. Just like the case for diseases not currently vaccinated against, there was no difference in prevalence found between vaccinated and unvaccinated children, strongly suggesting that vaccines do not cause atopic disorders. This evidence is, of course, consistent with previous studies that have similarly failed to find evidence that vaccines increase the risk of asthma and other atopic disorders. Overall, this study is a near slam dunk against the idea that vaccines are in any way associated with atopic diseases, including this part:

In addition to atopic disorders, we further compared diseases–such as obstructive bronchitis, pneumonia and otitis media, heart disease, anemia, epilepsy, and attention deficit hyperactivity disorder (ADHD)–in unvaccinated and vaccinated subjects. No relevant differences in the lifetime prevalences were found, neither for different age groups nor between girls and boys. Schneeweiß et al. conducted a comprehensive literature review of vaccine safety, the central part of which was the evaluation of vaccine critical arguments on the basis of the current state of scientific knowledge. None of the hypotheses were found to be valid (5).

Let me repeat this again. None of the hypotheses were found to be valid.

It is true that, as large as it is, this study is relatively small given the low percentage of completely unvaccinated children. This made subgroup analysis impossible for some measures and limited the power of the analysis due to low numbers of unvaccinated children in several of the categories. After all, there were only 94 unvaccinated children, which makes it impossible to compare autism and ASD prevalence with the vaccinated cohort, because the expected prevalence of autism is only approximately 1 in 100 anyway. That means that on average roughly one autistic child would be expected in such a cohort. To look at differences in autism prevalence between the groups, many times more than 13,000 subjects would be needed, which would be a hugely expensive study, particularly if medical records and vaccination cards were reviewed for every child. This study also bolsters what I said before by showing how difficult it would be to do such a “vaxed versus unvaxed” study with sufficient subjects to provide adequate statistical power to detect even fairly large differences in prevalence. For diseases and conditions sufficiently prevalent to allow the detection of differences in the sample size the investigators had, though, there was no evidence of differences in conditions commonly blamed on vaccines between vaccinated and unvaccinated children. Certainly, this study provides no support for doing a larger study. For it to do that, there would have to be a hint of a whiff of an association between vaccinated status and the atopic diseases examined or the risk of infectious diseases not prevented by vaccines. There wasn’t. If I were on an IRB, and someone proposed doing a larger study, this German study would be an argument that there is inadequate scientific justification to do a larger study, particularly in light of other studies like this, this, and this, which suggest that early vaccination might actually be protective against atopic diseases.

The wandering band of anti-vaccine propagandists over at, for example, Age of Autism say again and again that they want a “vaxed versus unvaxed” study. Indeed, after the recent Supreme Court decision in Bruesewitz v. Wyeth upholding the primacy of the Vaccine Court in disbursing compensation to children injured by vaccines, AoA seems to have lost what’s left of its mind, posting multiple times about it as though it were some grave injustice and their rights had been completely stripped away. Add to that the picture of Barbara Loe Fisher comparing the anti-vaccine movement to Winston Churchill facing down Hitler, and the picture remains truly nauseating.

Be that as it may, I’d like to finish by offering our “friends” in the anti-vaccine movement a bit of advice. You keep saying you want the government to fund a “vaxed versus unvaxed” study. You keep repeating it until you’re blue in the face. Based on this German study, you might want to be a bit more careful. In other words, be careful what you wish for. You just might get it. And, based on this study and the vast preponderance of evidence, if that study you so fervently wish for is well-designed and conducted properly, you probably won’t like the results.

But why worry? If a “vaxed versus unvaxed” study is negative, the anti-vaccine movements will just ignore it. It’s what they do.

REFERENCE:

Schmitz, R; Poethko-Müller, C; Reiter, S; Schlaud, M (2011). Vaccination Status and Health in Children and Adolescents: Findings of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) Dtsch Arztebl Int, 108 (7), 99-104

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

225 replies on “For the anti-vaccinationists out there: The results of a real “vaxed versus unvaxed” study”

I expect some loon with no understanding of error bars to come and try to point out triumphantly that there is a difference in the rates of infections, see? The bars on the graph aren’t the exact same height! *eyeroll*

Nice article. It undermines the idea that heard immunity is protecting the children whose parents chose not to vaccinate – even at <1% of the population, they’ll still contracting vaccine preventable diseases fairly regularly. Those prevalence rates are distinctly unfavourable in comparison to the rare incidence of adverse vaccination events.

@Sarah: the errorbars are NOT directly related to statistical significance, eg. representing 95% confidence intervals. That is, unless the authors did some highly unusual math.

Sadly I can see our ever ignorant anti-vax crowd suggesting that due to the ginormous error bars on the unvaccinated group compared to the vaccinated group (sample size, no doubt) that they need to get another 10,000 unvaccinated kids before they’ll consider the results.

Then they’ll say it’s fake / big pharma lies / global conspiracy to poison their children.

Marius – I think Sarah knows that. That’s why she said some “loon” ill come around and make that claim.

What do you mean by “older German states” as opposed to “the new German states”? Is that the former West Germany versus the former East Germany? Not a great description if so as both parts have been German since the 1870s.

No idea. It’s the authors’ term, not mine. They refer to “old German states and the “new ones.” It’s quite a minor point, anyway.

Antivaxxers would simply shift the goalposts or pretend the study doesn’t matter.

You see it time and again with supporters of outlandish beliefs (e.g. 9/11 truth movement) – they’ll impose some arbitrary standard of evidence that they’ll accept and if that evidence happens to be provided they’ll shift the goalposts and demand something else.

Locka – of course they’ll move the goalposts. It is expected. Or, at least half of them will. The other half will just ignore it.

I’m curious, Orac, what references are cited in 6 and 7?

Well, the antivaxxers will just ignore this study because it’s not from the USA anyway.

@Ciaran: don’t know how accurate this is, but per Wikepedia:

Upon founding in 1949, West Germany had eleven states. These were reduced to nine in 1952 when three south-western states (South Baden, Württemberg-Hohenzollern and Württemberg-Baden) merged to form Baden-Württemberg. From 1957, when the French-occupied Saarland was returned (“little reunification”), the Federal Republic consisted of ten states, which are called the Old States today. West Berlin was under the sovereignty of the Western Allies and neither a Western German state nor part of one. However, it was in many ways integrated with West Germany under a special status.

East Germany (GDR) originally consisted of five states (i.e., Brandenburg, Mecklenburg-Vorpommern, Saxony, Saxony-Anhalt, and Thuringia). In 1952, the Länder were abolished and the GDR was divided into 14 administrative districts instead. Soviet-controlled East Berlin, despite officially having the same status as West Berlin, was declared the GDR’s capital and its 15th district.

Just prior to the German reunification on 3 October 1990, East German Länder were simply reconstituted in roughly their earlier configuration as five new states. The former district of East Berlin joined West Berlin to form the new state of Berlin. Henceforth, the 10 “old states” plus 5 “new states” plus the new state Berlin add up to 16 states of Germany.

Ciaran, you are right.
“Older German states” and “the new German states” is directly translated from German – “alte und neue Bundesländer”, which in fact means former West and East Germany states, respectively. The authors mention this because of the different vaccination policies in East and West Germany before the German reunification.

Hear that? It’s the sound of antivaxers covering their ears, closing their eyes, and repeatedly saying Wakefield’s name hoping he’ll come to their rescue.

The study’s finding “Unvaccinated children and adolescents also tended to live in the old German states (former West Germany) to a slightly higher extent than in the new ones (former East Germany)” is consistent with the fact that former West Germany adopted a non-compulsory
vaccination policy whereas the vaccinations in former East Germany were mandatory. Nowadays, the immunization is not compulsory in Germany, but probably new parents from the former East Germany tend to fully vaccinate their children more than their counterparts in former West Germany states.

@ marius:

Actually, read the caption for figure 1. The error bars ARE actually the 95% CI.

Second, this is fairly common in biology (Ref: I’m a grad student and read a lot of papers?). Either the 95% CI or the SEM is the norm for error bars in my field. Both of which are directly related to the significance (the 95% CI being 1.96 times the SEM for a normal distribution).

@Rene,

Hear that? It’s the sound of antivaxers covering their ears, closing their eyes, and repeatedly saying Wakefield’s name hoping he’ll come to their rescue.

You know, if you say Wakefield’s name three times in front of a mirror, he’ll appear in your house and ask you to pay him for a lecture on how he was wronged by the Big Pharma conspiracy by being such a brave maverick.

I love the smell of science in the morning.

The gnashing of teeth over at GR & AoA ought to be heard for miles. I envision a minor resurrection of ‘mommy science’, which as we all know beats everything.

The anti-vaxers will not be satisfied with this study. I bet they will complain that the study didn’t look at the vaccine status of the mother (and father).

They will then want the vaxed child vs unvax child + unvaxed mother + unvaxed father (+ unvaxed grandmother + ……) study.

After all, the toxins could be passed from mother to child….

Not a great description if so as both parts have been German since the 1870s.

While Orac is certainly right, this point isn’t of any particular significance, I couldn’t help but chuckle at that remark. You know, from “our” perspective here in the old world anything younger than a millennium (deliberately exaggerated) is quite new. Like that curious democracy thingy for instance or that whole freedom and free will business of yours. And since there have never been german federal states forming a state called Germany in any form before 1949, the first 11 were already really new states. But when even newer states came along around 1990, the former new states became older new states and the new new ones were the newest states. You might agree that such terminology tends to sound rather messed up, which is why it was decided to officially call the older states “older states” and the newer states “newer states”. Well, that has worked quite nicely up until now and while one might say with some reason that “eastern states” and “western states” would have been a more obvious and comprehendible choice, that wasn’t really considered at the time. Even now nobody would suggest such nomenclature (although for some purposes it makes sense, mostly if both older and newer states but not all 16 are referred to). Mostly for the reason that after some 40 years of iron curtain right through our very own countyry “east” and “west” aren’t just two points of the compass but carry a whole lot of for the most part unintended meaning.

Please excuse my poor English (not fishing for compliments, if it’s not that poor, ignore it) and the lengthiness of this comment, but being german and no physician I just had to take this opportunity to finally post something into this truly outstanding blog. And of course thank Orac for all of his insolence (respectful or otherwise) over the past couple of years, I’ve enjoyed every last bit of it. Keep it up. 🙂

The anti-vax crowd won’t believe anything that doesn’t support their position, evidence be damned.

Excellent article with some interesting data collected and tabulated by the German study. It probably will not receive any attention in anti-vax websites…for obvious reasons.

And, we will probably be disappointed by the absence of any of the trolls and “experts” (Dr. Jay), on this particular issue. After all Dr. Jay has not changed his stance on Prevnar (after eleven years of licensing) because “it is too new for me to recommend.”

Hello friends –

Overall, this study is a near slam dunk against the idea that vaccines are in any way associated with atopic diseases, including this part:

What a joke. This is a forum where the methodology of a study and the quality of the data is supposed to be important, regardless of what narrative is being supported or unsupported.

It is true that, as large as it is, this study is relatively small given the low percentage of completely unvaccinated children. This made subgroup analysis imposible for some measures and limited the power of the analysis.

Indeed.

Take Asthma, for example. In the entire study there were two unvaccinated children with asthma; all in the 10 – 17 age group (a vanishingly small 2% of the unvaccinated population). The rest of the asthma figures don’t make any sense either, and the authors acknowledge that their rates of asthma are strikingly lower than other values found in Germany.

No doctors’ diagnoses of bronchial asthma were reported for unvaccinated children aged 1-10 years. Because of the low incidence of asthma and given the fact that diagnosing asthma in this age group is difficult, no cases of asthma were to be expected within the small group of unvaccinated children. Furthermore, differences in the awareness of symptoms or parents’ advice seeking behaviors may explain different prevalences in doctors’ diagnoses. Studies that enumerated cases at the symptom level have continuously observed higher prevalences of asthma than KiGGS (17, 18).

Orac didn’t post the abstract, but it should be noted that in almost every category, the autism group did trend towards reduced incidence; the fact that the values didn’t reach significance is really more of a function of insufficient numbers.

Unvaccinated children aged 1-5 years had a median number of 3.3 (2.1 – 4.6) infectious diseases in the past year, compared to 4.2 (4.1 – 4.4) in vaccinated children. Among 11- to 17-year-olds, the corresponding figures were 1.9 (1.0 – 2.8) (unvaccinated) versus 2.2 (2.1-2.3) (vaccinated). The lifetime prevalence of at least one atopic disease among 1- to 5-year-olds was 12.6% (5.0%-28.3%) in unvaccinated children and 15.0% (13.6% – 16.4%) in vaccinated children. In older children, atopy was more common, but its prevalence was not found to depend on vaccination status: among 6- to 10-yearolds, the prevalence figures were 30.1% (12.9% – 55.8%) for unvaccinated children versus 24.4% (22.8% – 26.0%) for vaccinated children, and the corresponding figures for 11- to 17-year-olds were 20.3% (10.1% – 36.6%) versus 29.9% (28.4% – 31.5%).

Unvaccinated children in the 1-5 age group had a nearly 25% reduction in median infections diseases in the past year. Not posted in the abstract, for some reason, is the finding that asthma was twice as common in the vaccinated group than the unvaccinated group. Does anyone believe that these are meaningful findings? Or is it the case that we only ascribe findings to underpowered numbers when they support or meme, and conveniently forget to mention the instances when the same pitifully powered numbers seem to make our preferred conclusion?

These findings are amazingly dependent on microscopically small changes in absolute values in the unvaccinated side. In no breakdowns outside of vaccine preventable diseases did any classification of study contain more than four children without vaccines. For example, in children 1 – 5 with allergic rhinoconjuctivitis, there was one child in the unvaccinated group. Who is suprised that they were unable to find any statistically significant associations here? How could they?

One wonders if they age classifications were grouped into the 1-5 / 6-10 / 11-17 ranges for preventable diseases if the findings would have been significant or not; probably, and functionally it makes lots of sense, but generally I’ve seen a lot of skepticism on sites like this when studies slice and dice their populations depending on the measurement being made.

This study does do a good job of illustrating the very real problems with the type of epidemiological study that lots of people clamor for, but it’s only a slam dunk if the agenda takes a back seat to quality of analysis.

Flame away.

– pD

You know, if you say Wakefield’s name three times in front of a mirror, he’ll appear in your house and ask you to pay him for a lecture on how he was wronged by the Big Pharma conspiracy by being such a brave maverick.

Yes. I learned it the hard way when someone tricked me into saying his name by writing it backwards on a piece of paper, so I had to hold it up against the mirror to read it. I’ll never make that mistake again.

Uh, there was no “autism group.” In fact, the word “autism” doesn’t even appear in the entire article because the authors didn’t examine autism, as I pointed out in my post. Search the original German study if you don’t believe me when I tell you that the word “autism” never appears. Also, you do realize that there are these little things called “hyperlinks,” which, if you click on them, lead you to the original source paper (which appears to be freely available because I was able to access the paper at home without firing up my university’s VPN or going through its library website), don’t you? That’s why I didn’t post the abstract. I figured that anyone interested in the abstract or–oh, you know–the entire text of the study could just click on that little hyperlinky thing.

Whatever the shortcomings of this study, one can’t help but note that it is far superior to any any “vaxed versus unvaxed” study that the anti-vaccine movement can muster, the roster of which consists mainly of one incompetently performed telephone survey.

Finally, what “trending”? There sure didn’t look to be much in the way of “trending” to me.

@Orac

Other than sample size, what were some of the limitations of the study, esp. those that anti-vaxers might bring up?

@Greg Fish and Rene

If you say his name three times in front of a mirror at a birthday party, not only will he appear, but he’ll take your blood.

The war on vaccines continues – *mutatis mutandis*- because they neatly demonstrate the efficacy of SBM : diseases have been eradicated no thanks to herbal treatment, vitamin/mineral supplementation, homeopathy, veganism, or chakra wheel-allignment. Alt med must similarly attack HAART for HIV/AIDS: they changed the landscape. Vaccines and ARV’s show just how *wrong* alt med actually is.

Suppose one of our prolifically vile web woo-meisters were to *support* vaccination *while* still promoting his own line of products – the concept just wouldn’t fit in: it would be an admission that SBM is actually useful and safe.( We couldn’t have that!) It would concur that there are conditions which just are *not* amenable to lifestyle change. It would perhaps allow the idea of “germs” to enter the picture.

If you hate the message, you usually aren’t perticularly fond of the messenger**. I *do* find it funny that alt med proponents invoke the word “fraud” by SBM while simultaneously peddling unproven nostrums and promising moon-shot cancer cures based on spit and sealing wax.

** Wear it as a bdge of honor. My mother always said that if an idiot insults you, it’s really a compliment: they have poor taste and worse judgment.

If you say his name three times in front of a mirror at a birthday party, not only will he appear, but he’ll take your blood.

It’s true because you MUST invite him in before he can take your blood at home during a birthday party… I’ve heard.

@ Todd W. HAHAHAHAHA! wait a minute, aren’t *we* supposed to be the “dark side”?

Haha, cool. I can’t wait for Augustine et al to start their nonsense, I love the delicious tears of the stupid.

@passionlessDrone, I’ll use your asthma critique as an excuse for a basic statistics lesson.
This study has 44 unvaccinated children aged 1-5 and 20 aged 6-10. Since there were thousands of children in the vaccinated samples we can assume their incidence rates are closer to the true incidences. 1.8% of vaccinated 1-5 year olds has asthma. If a 44 child sample has the same incidence rate then (0.982)^44=44% of the time you wouldn’t see a single case of asthma in this small sample. For ages 6-10, with a sample size of 20 and an incidence rate of 4.6%, no asthma cases would appear 39% of the time.

This is a standard issue of studies of low incidence diseases with small sample sizes. The biggest real problem with this study is that the small unvaccinated sample sizes results in large error bars. That said, I’m glad the unvaccinated sample wasn’t any larger.

The anti-vax crowd will complain that this study had “flaws”, if they even admit that it exists. Sigh.

Thanks for the statistics refresher, bsci. I wish that you had time to expand on that to explain some of the other issues related to a “vaccinated vs. unvaccinated” autism study.

BTW, I think that pD meant “unvaccinated group” rather than “autism group.”

I suspect it’ll be claimed that they deliberately didn’t look at autism because they knew they’d find a link. Either that, or the fact that a link was not found will be presented as prima facie evidence that the study was fatally flawed and meaningless.

Remember, this are the same people who can say with a straight face “We gave this study our highest score because it appears to actually show that MMR contributes to higher autism rates”. The quality of a study is determined by whether it gets the results they want…

Either that, or the fact that a link was not found will be presented as prima facie evidence that the study was fatally flawed and meaningless.

This bears repeating.

Remember, Jay Gordon knows what the science says. He just denies it, because he disagrees with it. Since he is right, it just shows that the science must be wrong.

@Rene

Don’t worry, though. He’ll give you £5. Downside, though, is that if you suffer any ill effects (fainting, nausea, vomiting), he’ll laugh and joke about it in a room full of other people.

As expected, vaccine preventable diseases affected those who had been vaccinated against a particular disease to a lower degree than unvaccinated persons. The KiGGS data do not show at what age the disease first occurred. This means that vaccinated subjects may have contracted the disease before vaccine induced immunity had developed.

Vaccines have never prevented the vaccinated from getting the disease. On the contrary, they have already acquired the infection from the inoculation itself in order to effect a primary immune response. As always, they can let themselves get infected for as long as they want anytime, i.e. repeated vaccination.

Oh, goody. The clueless Th1Th2 spouting, yet again, its same, sad old misunderstanding of what constitutes infection. Folks, please do not reply to Th1Th2 or engage it in any way. That would just make it bolder and repeat the same garbage ad naseam.

I’ll give passionlessDrone one thing: jen would have just popped on, complained about ‘flaws’ without actually enumerating any, and been on her merry way.

I wonder how long it is ’till someone appears here and claims that this study is invalid for no other reason than because the words ‘[German] Federal Ministry of Health’, ‘Sanofi-Pasteur’ and ‘Glaxo Smith Kline’ appear in the list of joint funders?

As expected, vaccine preventable diseases affected those who had been vaccinated against a particular disease to a lower degree than unvaccinated persons. The KiGGS data do not show at what age the disease first occurred. This means that vaccinated subjects may have contracted the disease before vaccine induced immunity had developed.

Vaccines have never prevented the vaccinated from getting the disease. On the contrary, they have already acquired the infection from the inoculation itself in order to effect primary immune response. It is a must. Therefore, they can let themselves get infected for as long as they want and anytime they like, i.e. repeated vaccination. The vaccinated as always, lead the pack when it comes to infection-promoting agenda.

This study is not about the unvaccinated. It’s all about the vaccinated and the prevalence of them contracting different infections.

May I also say that, given the hilarious exchange on making an Andrew Wakefield equivalent of Bloody Mary, that we should all do our damnedest to make it an actual urban legend. 🙂

No doctors’ diagnoses of bronchial asthma were reported for unvaccinated children aged 1–10 years.

For the same reason they have, this study is all about the vaccinated.

When I saw that study, I immediately thought of that wacky person Dawn Winkler, and her idea that all vaccinated kids have continuous dripping snot (see the link on my ‘nym). It’s one of those images that stays with you.

Vaccinated children are sick, period. Their Th1/Th2 balance is messed up because they have overstimulated one response rather than naturally allowing both to take place. They have Th2 mediated diseases, asthma, etc. They have snot dripping all the time, they are on antibiotics more than anyone should be, they have ear infections, they have have dark circles around their eyes, they have allergies, and on and on and on. And our medical community labels them healthly, as I’m sure you do as well.

When I found that quote, I had another epiphany. Is it possible that Dawn, with her focus on Th1/Th2 balance, is really our friend Th1Th2?

Point, set and match. Not that that hasn’t already been the case a hundred times before.

If you put your ear to the ground you can hear it. No, it’s not horses in some Spaghetti Western. That’s the feet of oodles of loonies busy shifting the goalposts South across the Mexican border in the dead of night.

Although this article is painted as an “either or,” the fact is that not all vaccines are created equally. There are certainly “good” vaccines, and reasons for children to get vaccinated against an array of preventable illnesses. But, that is not to say that ALL vaccines are appropriate or desirable.

A better approach would be to strive for the least amount of needed vaccines, coupled with good public heath policy.

There is, of course, plenty of reason to be leery of over-vaccinating, over-medicating, and under-educating. In particular, there is reason to question the blanket flu vaccinations for all people over the age of 6 months (as espoused by the CDC), in the United States. http://flucrazy.blogspot.com/2011/02/should-you-get-flu-shot-probably-not.html

Th1Th2:

Vaccines have never prevented the vaccinated from getting the disease. On the contrary, they have already acquired the infection from the inoculation itself in order to effect primary immune response. It is a must. Therefore, they can let themselves get infected for as long as they want and anytime they like, i.e. repeated vaccination. The vaccinated as always, lead the pack when it comes to infection-promoting agenda.

So, are you arguing that once someone comes down with something, they never recover? They are always and permanently diseased? That’s the best as to what I can figure out what you’re saying.

This is why nobody takes you seriously. You’re operating out of an entirely different reality than the rest of humanity.

While I expected to see small, fringe blogs such as LBRB rejoice over this study I’m surprised to see you, a great supporter of good science, embrace this “study”.

My suspicion was first raised when it appeared in the Artzeblatt International, a bottom tier journal with an impact factor of 1 (compared with the Lancet and JAMA at 28 and 30) perhaps they’re trying to use a few manufactured conclusions to crawl up the rankings ladder

They ascertained the number of colds by questionnaire? Who can say how many colds a child had over a year? Does a sniffle count as a cold? Or is it two sniffles?

No doctors’ diagnoses of bronchial asthma were reported for unvaccinated children aged 1–10 years. Because of the low incidence of asthma and given the fact that diagnosing asthma in this age group is difficult, no cases of asthma were to be expected within the small group of unvaccinated children. Furthermore, differences in the awareness of symptoms or parents’ advice seeking behaviors may explain different prevalences in doctors’ diagnoses

So the study is, in the authors own view, too small when it doesn’t support their conclusion yet when it is supportive it’s not an issue

So unvaxxed get more measles. Scary. So now we don’t have to hear anymore drivel about taking advantage of the herd and freeriding since were not getting the protection they vaxxers are?

Also a single vaccination counted as much as the entire schedual

Finally I think pD is referring to the unvaccinated group when he says autism group. You Megaminds should have been able to figure that out on your own

@brian #35,
I think there are two very challenging additional issues with this type of analysis for an autism study. First, the autism incidence is under 1%. http://www.nimh.nih.gov/statistics/1AUT_CHILD.shtml
This means it would be even more challenging to find good numbers in a small population sample.

Second, unlike most of the other aspects of this study, it’s hard to make a proper diagnosis of autism. To do it right, you need more than to just have parents fill out a general survey and glance at medical records. You can’t just ask parents whether their child is autistic in the same way you can ask if they have asthma. A health professional would need to look at each child or at least interview each parent specifically about autism symptoms.

Lets say you could find 1000 unvaccinated children and somehow matched them to 1000 vaccinated children with similar age/socioeconomic profiles. Even then, you’d expect less than 20 cases of autism total. Given the existing science showing the link between autism & vaccines to be incredibly unlikely, to do such a study well would cost immense sums of money and time.

I wonder how long it is ’till someone appears here and claims that this study is invalid for no other reason than because the words ‘[German] Federal Ministry of Health’, ‘Sanofi-Pasteur’ and ‘Glaxo Smith Kline’ appear in the list of joint funders?

I was wondering why the text read like the script for a vaccine infomercial

Protective vaccinations are among the most important and effective preventive measures in modern medicine (1). They make a substantial contribution to reducing the probability of contracting many infectious diseases as well as their severity. The immediate goal of a vaccination is to protect the vaccinated person from a disease. Achieving high rates of vaccinated persons additionally results in the so called herd immunity.

Vaccines have never prevented the vaccinated from getting the disease. On the contrary, they have already acquired the infection from the inoculation itself in order to effect primary immune response. It is a must.

No, much as you might wish to redefine the words to conform to your personal obsessions, I’m afraid that they already have scientific meanings. In particular, there is a big distinction between developing an immune response to a disease organism and getting the disease. “Getting the disease” means that the causative organism is actually growing and reproducing inside the body, but many vaccines contain either killed organisms or fragments of organisms that are incapable of growing or multiplying.

The illnesses that we vaccinate against are those that produce damaging effects that go far behind the normally mild symptoms that are associated with the body mounting an immune response. Many of them secrete biological toxins that have been well-characterized in the laboratory and shown to produce damaging effects on cells that have nothing at all to do with the immune system.

Gray Falcon,

So, are you arguing that once someone comes down with something, they never recover? They are always and permanently diseased? That’s the best as to what I can figure out what you’re saying.

Both the vaccinated and the unvaccinated can contract something that can lead to disability. Every one is susceptible only that the vaccinated always get a head start in acquiring infections they are not supposed to have. Then they would be compared to the unvaccinated like in this study. For example, a recently vaccinated child who had been inoculated with measles virus would be compared to an unvaccinated child for the prevalence of measles, as if the vaccinated was characterized as someone who was also naive to measles virus, which is wrong. Thus, the usual claim by pro-vaccines that vaccines have prevented infections and diseases is very unscientific. Therefore, if the unvaccinated catches measles, that is equivalent to the primary immune response to that of the vaccinated since the vaccinated got the measles virus first.

This is why nobody takes you seriously. You’re operating out of an entirely different reality than the rest of humanity.

I believe most vaccinators know what what I’m talking about since they also know when to shut up when science prove them otherwise.

Th1Th2

Both the vaccinated and the unvaccinated can contract something that can lead to disability.

The odds are very different for both. If you can’t understand basic probability, you cannot join this discussion.

For example, a recently vaccinated child who had been inoculated with measles virus would be compared to an unvaccinated child for the prevalence of measles, as if the vaccinated was characterized as someone who was also naive to measles virus, which is wrong.

You’re still making the same claim, and if vaccination did have long-term effects like you claim, then the study would have picked them up, preconceived notions or not.

I believe most vaccinators know what what I’m talking about since they also know when to shut up when science prove them otherwise.

Or, they notice someone who makes statements their pets know are wrong and decide he’s too much of a fool to bother engaging.

My cats don’t just know more about immunology than the fool. My lava lamp does. Heck, a single electron knows more.

This is why nobody takes you seriously. You’re operating out of an entirely different reality than the rest of humanity.

I believe most vaccinators know what what I’m talking about since they also know when to shut up when science prove them otherwise.

trrll,

“Getting the disease” means that the causative organism is actually growing and reproducing inside the body, but many vaccines contain either killed organisms or fragments of organisms that are incapable of growing or multiplying.

Hence, they use vaccines to infect the host with killed and inactivated pathogens in order to bring about an immune response against that infection. There won’t be any resultant immune response if these dead microorganism are left unaided, i.e. incapable of invasion, penetration and colonization.

The illnesses that we vaccinate against are those that produce damaging effects that go far behind the normally mild symptoms that are associated with the body mounting an immune response. Many of them secrete biological toxins that have been well-characterized in the laboratory and shown to produce damaging effects on cells that have nothing at all to do with the immune system.

To vaccinate against is a misnomer let alone an outright lie. It really means to inoculate with, and you know what I’m talking about about.

Sid: I guessed at what pD meant, but you and he are assuming what you want to prove. There is no “autism group” here. There are vaccinated and unvaccinated groups, and no evidence that autism rates differ between them.

Calling one of them the “autism group” is no more accurate than calling one of them the “hockey group.”

FluGuy: The appropriate goal is the optimum number of vaccines for health. That number may not be the lowest number: chicken pox is rarely fatal in the United States today, but it’s still well worth avoiding.

Yes, it’s possible to over-vaccinate. Doctors understand this, which is why smallpox vaccination is no longer routine, and I won’t get a yellow fever vaccine unless I travel to someplace where that disease is endemic.

It is also possible to under-vaccinate, either by giving too few doses of some vaccines, or by not giving a vaccine to people who would benefit from it.

For example, has your doctor asked if you want a hepatitis vaccine? Mine hasn’t. Neither specifically or as a more general question about whether there are any vaccines I want/think I might need. The CDC guidelines suggest that a significant fraction of the adult population should be getting that one. It’s possible that your (generic you) doctor could know that you’re in the demographic for that, but virtually impossible that they could know you aren’t: it’s recommended for anyone who is sexually active with more than one person. That’s not something a doctor can know isn’t true of someone without asking (and maybe not then).

My cats don’t just know more about immunology than the fool. My lava lamp does. Heck, a single electron knows more.

Yeah, but they are always SO negative …

It’s good to see anti-vaxers getting their talking points shot down regularly these days, at least more people seem to be taking their threat more seriously. Local anti-vaxers posted some random crap about Brian Deere this morning, trying to prop up her hero Wakefield (she once said she thinks he is soo charming after she met him). Even in that overly “natural” area of the forums, where rarely there is any dissent allowed, someone spoke up and asked why she was defending him still.

The bad news for anti-vaxers is that their raising awareness on vaccines has had the exact opposite effect they wanted. It is making them have to answer questions.

@Sid

So unvaxxed get more measles.

No, the unvaxxed had a greater prevalence. You may want to read EpiRen’s post on incidence and prevalence.

Also a single vaccination counted as much as the entire schedual

Now there’s a new one. Antivaxers ask for a study looking at completely unvaccinated vs. vaccinated. Such a study is done. Now the argument is that the study should be unvax vs. completely vax vs. every combination in between? Seriously?

Th1th2:

Hence, they use vaccines to infect the host with killed and inactivated pathogens in order to bring about an immune response against that infection. There won’t be any resultant immune response if these dead microorganism are left unaided, i.e. incapable of invasion, penetration and colonization.

Which is why nobody has ever suffered an immune reaction to a perfectly innocuous substance. Oh wait, they have! They’re called allergies! So the body can react to things that to things “incapable of invasion, penetration and colonization”. In other words, you’re wrong. Deal with it.

To vaccinate against is a misnomer let alone an outright lie. It really means to inoculate with, and you know what I’m talking about about.

No we don’t. Please explain. Of course, if you’re right, then that means nobody in the history of humanity has ever recovered from a disease. Ever.

They ascertained the number of colds by questionnaire? Who can say how many colds a child had over a year? Does a sniffle count as a cold? Or is it two sniffles?

So what are you proposing? Parents who get their kids vaccinated are less likely to recognize a cold. Sounds like a bit of a stretch.

So unvaxxed get more measles. Scary. So now we don’t have to hear anymore drivel about taking advantage of the herd and freeriding since were not getting the protection they vaxxers are?

Come on Sid. I know that your understanding of probability is nearly zero, but surely even you can see the fallacy in your argument: the only way to measure the magnitude of the herd immunity protection would be to compare the frequency of the disease in unvaccinated individuals in vaccinated population to the frequency in a completely unvaccinated population. Nobody imagines that herd immunity provides absolute protection, which is implausible on a purely theoretical basis. Herd immunity just means that each infected person infects less than 1 other person, so the disease eventually peters out and never goes epidemic. But if the average number is just below that threshold, a disease could still spread through a fair number of people before running out of steam. Or to put it even more simply: the question is not whether unvaccinated people are at greater risk than vaccinated ones in a mostly-vaccinated community–obviously they must be. The question is whether they are at less risk than they would be if most of the people around them were not vaccinated.

Also a single vaccination counted as much as the entire schedual

This is actually rather generous to the anti-vaccine hypothesis. What if all it took was one vaccination to cause disease?

The bottom line of the study is clear–while the limited number of unvaccinated individuals limits the resolution of the study, the error limits are certainly tight enough to exclude the large deleterious effects that antivaccine zealots have been claiming. Note that the study certainly has adequate sensitivity to detect a significant protection for 3 out of 4 vaccine-preventable diseases, even in a population with herd immunity. So we can say with some confidence that any deleterious effect with respect to atopic diseases must be less than the protective effect vs. infectious diseases.

And in fact, the study is generous to the antivaccine hypothesis in another way, because they break out specific conditions and age groups. In Table 2, they are looking at 3 age groups times three conditions. With that many comparisons, it would be fairly likely to find a statistically significant increase in the vaccinated population just by chance, even if there were no real difference–and it would obviously be even more likely if there were some real adverse effect of vaccination.

Oh, Thingy is baaaack; with some more drivel.

I’ve been slumming again, at Age of Autism and still no reporting/editorial about the infant deaths in Japan. Posted this AM however, is a new video of a radio interview between Robert Kennedy, Jr. and Boyd Haley. IMO, RFK Jr. is embarking on a his “rehabilitation” campaign after being disgraced and debunked in the media for his extensive paper on the thimerisol-autism link.

(I couldn’t view the video and linked to Kennedy’s “Ring of Fire” website which featured the 2 part video. After viewing 40 minutes of the video on Ring of Fire my computer had an attack of spam indigestion. The 2-part video is available on You Tube at “Ring of Fire Boyd Haley interview.”)

It is the same old same old crap with the addition of some new garbage.

I’d much rather watch the Charlie Sheen videos…much more fun.

I rather hate to ask, but I must: given the mentioned issues that tend to prohbit vaxed-vs-unvaxed studies, how was the efficacy of the current vaccine schedule established in the first place?

I know they are effective, except I feel bad saying I “know” it because in almost every area of life, I believe strongly in the principle that our beliefs should be falsifiable and correspond to strict tests and observations, not just “what makes sense”, as is the case with woo-based thinking. It seems like everything in medicine but vaccines can point to specific studies demonstrating their effectiveness. (Hence the tremendous power of scientific medicine.) I know I’m probably wrong about that, and simply ignorant. Can someone please enlighten me?

Okay, come to think of it, an obvious answer to my question would be the massive drops in vaccine-preventable diseases after the vaccines’ introduction. But how, for each specific vaccine, did we get to the point where we know they would work in actual humans, if they weren’t subjected to double-blind trials? That’s what I’m wondering.

Darn, when did Th1Th2 find its way over here from SBM??? Boy, am I late to the party!

I said Andrew Wakefield’s name three times. He offered me a zagnut and changed into a giant striped sand-worm before my eyes.

Gray Falcon,

Which is why nobody has ever suffered an immune reaction to a perfectly innocuous substance. Oh wait, they have! They’re called allergies! So the body can react to things that to things “incapable of invasion, penetration and colonization”. In other words, you’re wrong. Deal with it.

Nah. It’s called vaccine failure.

No we don’t. Please explain. Of course, if you’re right, then that means nobody in the history of humanity has ever recovered from a disease. Ever.

You don’t need to be paralyzed just to get a diagnosis of poliomyelitis. The mere inoculation of the poliovirus itself is a living proof of an induced infection regardless of the symptoms.

So, there were about 285 vaccinated for every 2 unvaccinated and they are looking for the prevalence of infection among the two groups, is this correct?

Th1Th1:

Nah. It’s called vaccine failure.

Are you claiming allergies are vaccine failures? What?

You don’t need to be paralyzed just to get a diagnosis of poliomyelitis. The mere inoculation of the poliovirus itself is a living proof of an induced infection regardless of the symptoms.

Calling something an infection does not make it an infection, any more than calling you a duck makes you a duck. It’s up to you to prove otherwise.

Besides that, if what you’re claiming is true, and vaccines cause infections, then why aren’t they causing the mass waves of infant death that would be caused by full infections?

Gray Falcon,

The odds are very different for both. If you can’t understand basic probability, you cannot join this discussion.

Of course, the odds only apply to those groups with infection-promoting agenda, that is, pro-vax and pro-pox, for they ride in the same boat riddled with holes.

You’re still making the same claim, and if vaccination did have long-term effects like you claim, then the study would have picked them up, preconceived notions or not.

Hence, this study is all about the vaccinated.

Jen popping in here. The “study” does sound like a bit of a joke and yes, the pharmaceutical involvement probably explains that. I’ll be merrily on my way now 😉

Gray Falcon,

Calling something an infection does not make it an infection, any more than calling you a duck makes you a duck. It’s up to you to prove otherwise.

So, calling something like asymptomatic poliomyelitis, which represents more than 95% of poliomyelitis cases, not poliomyelitis, is this what you mean?

Was there a time when poliomyelitis not considered an infection?

I’m afraid, the burden of proof lies upon you.

By the way,if I stepped in here with a study with “n=7, 10, or 11” you’d probably be rightfully unsatisfied. Nonetheless, the topic is incredibly well presented, Orac.

Is that incorrect?

Jay

@trrll

You are aware of the dose-response relationship concept? If vaccines were responsible for atopic disease and a dose-response relationship were in effect, including a child who has received one vaccine into a group of children having received 15 would artificially decrease cases of atopy on the vaccinated side.

So what are you proposing? Parents who get their kids vaccinated are less likely to recognize a cold. Sounds like a bit of a stretch.

I’m proposing that relying on a questionnaire and recollections to ascertain the number of colds a child may or may not have had is no better than guesswork

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