Vaccine extortion.

Mark

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I see on the news tonight the Health Minister has clarified the Govt's position and has made it clear child immunisation can't be dodged on religious grounds. It seems like all the talk of belonging to an organisation opposed to immunisation as a way to keep family benefits was misleading - I stand corrected!
 

Ash

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Here you said:
(p.s. I don't mean to suggest that the vaccine is causing people to become infectious. )

Of course animal studies must be done but they are always safety and 'dry run' prototypes for human studies and their results cannot be used to base public policy. Imagine the furore of people if they were given a medication that was never tested on humans in a rigorous trial and that we could only tell them that 'it was safe in monkeys so that should be okay for you'?

As for studies on comparing infection rates between the immunised and the unimmunised, it is IMO a moot point since it is the unimmunised that get sick from the illness if they hadn't contracted it in the past 10 or so years. Whether the immune strength is better or not by contracting the actual disease as opposed to being vaccinated, it is also irrelevant here (even if true) because it is such a devastating disease to the unimmunised infant or elderly person. It is associated with a high mortality rate the more we look at the extremes of age, and of course it is the helpless little newborn infant that is most concerning.
 
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Ash

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I see on the news tonight the Health Minister has clarified the Govt's position and has made it clear child immunisation can't be dodged on religious grounds. It seems like all the talk of belonging to an organisation opposed to immunisation as a way to keep family benefits was misleading - I stand corrected!
I saw it too and I'm personally thankful for it. Then there is no call for discrimination on the way the government does its business on this matter (maybe in a lot of other matters, but just not this one!).
 

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Of course animal studies must be done but they are always safety and 'dry run' prototypes for human studies and their results cannot be used to base public policy. Imagine the furore of people if they were given a medication that was never tested on humans in a rigorous trial and that we could only tell them that 'it was safe in monkeys so that should be okay for you'?

Sure. But we're not talking about testing a NEW drug before it goes to market, we are discussing the efficacy of one that's already on the market. Remember the point of the study I quoted was "to provide a better understanding of vaccines for whooping cough." And what that study suggested was a perfectly logical and sensible explanation for the rise in pertussis despite a heavily vaccinated population. I.E. that is that it is vaccinated people who are just contagious than unvaccinated people, maybe more so as they may not present with symptoms while harbouring the bacteria..


As for studies on comparing infection rates between the immunised and the unimmunised, it is IMO a moot point since it is the unimmunised that get sick from the illness if they hadn't contracted it in the past 10 or so years.

That's not a moot point, it's the WHOLE POINT! :)
Personally I'd love to see a proper scientific study done on unvaccinated people that way we could operate and form opinions based on some actual evidence instead of hysteria and propaganda.

Whether the immune strength is better or not by contracting the actual disease as opposed to being vaccinated, it is also irrelevant here (even if true) because it is such a devastating disease to the unimmunised infant or elderly person.

Yes, we agreed on that point, it is an interesting point but not relevant to those who become infected with pertussis. But as the evidence strongly suggests that vaccinated people are just as contagious (maybe ore so?) as unvaccinated ones then forcing people to get vaccinated is a VERY dangerous move (from a societal point of view) that most likely will not achieve the purported aims.

But anyway, this conversation seems to have reached the 'going around in circles' stage so I'm happy to leave it there if you are. My main point was the outrage of government discrimination against people based on what amounts to idealogical grounds (no one has presented any science to back the claim that unvaccinated people spread these diseases any more than vaccinated people do). In effect they are blackmailing people to be assaulted against their will, at least that's how I see it. How long before force is used? How long before unvaccinated people aren't allowed to have jobs or go to school?

"The crops are failing, we better find a witch to burn!" :)
 
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Ash

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Sure. But we're not talking about testing a NEW drug before it goes to market, we are discussing the efficacy of one that's already on the market. Remember the point of the study I quoted was "to provide a better understanding of vaccines for whooping cough." And what that study suggested was a perfectly logical and sensible explanation for the rise in pertussis despite a heavily vaccinated population. I.E. that is that it is vaccinated people who are just contagious than unvaccinated people, maybe more so as they may not present with symptoms while harbouring the bacteria..

Scientifically, the aP-vaccinated people are not more contagious, they are only as contagious as an unimmunised person who has been infected with the active pathogen. We cannot infer increased infectivity from a baboon study. This is confirmation bias.

That's not a moot point, it's the WHOLE POINT! :)
Personally I'd love to see a proper scientific study done on unvaccinated people that way we could operate and form opinions based on some actual evidence instead of hysteria and propaganda.
There is no point in arguing this. There is plenty of robust scientific evidence in the efficacy of the aP-vaccine and people can choose to either accept it or reject it according to their own opinions.

Yes, we agreed on that point, it is an interesting point but not relevant to those who become infected with pertussis. But as the evidence strongly suggests that vaccinated people are just as contagious (maybe ore so?) as unvaccinated ones then forcing people to get vaccinated is a VERY dangerous move (from a societal point of view) that most likely will not achieve the purported aims.
Not dangerous. That is just hysteria and propaganda.
Scientific evidence:
Paediatric formulation (DTPa)
A 3-dose primary series of immunisation with DTPa vaccine at 2, 4 and 6 months of age results in 84% protective efficacy against severe disease.(10) However, immunity following DTPa vaccine appears to wane over time. This has been demonstrated in younger children in Australia who had not received an 18 month booster dose, where the effectiveness of 3 doses of vaccine declined progressively from 2 years of age, to less than 50% by 4 years of age.5 Studies in older children have shown a similar decline in vaccine effectiveness prior to receiving the adolescent booster dose.(6,11)
Adolescent or adult formulation (dTpa)
A large clinical trial in adolescents and adults demonstrated overall vaccine efficacy against confirmed pertussis of 92% within 2.5 years of vaccination.(12) Long-term follow-up of adults vaccinated with dTpa has shown a rapid decline in levels of pertussis antibodies within the first 2 years after vaccination. Antibody levels then continued to decline steadily, although mean antibody levels remained above baseline 10 years after vaccination.(13)
Vaccination of pregnant women with dTpa has been shown to be effective in preventing pertussis disease in newborn infants via the transfer of maternal antibodies. Vaccination of mothers in the United Kingdom at least 7 days before delivery reduced pertussis disease by 91% in infants <3 months of age.(14)
The exact level of pertussis antibody required in the pregnant woman to achieve this protection is uncertain. However, antibody levels in maternal and umbilical cord blood of mother-and-newborn pairs have shown significant antibody waning over a 2-year interval between pregnancies;(15) hence vaccination is recommended during every pregnancy.
 

Ash

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Vaccine safety
DTPa-containing vaccines in children
The current acellular pertussis vaccines are safer than whole-cell pertussis vaccines (DTPw) previously used in Australia. Acellular pertussis vaccines are associated with a much lower incidence of fever (20% vs 45%) and local reactions (10% vs 40%) than DTPw vaccine.(16) Serious side effects are rare.
Extensive limb swelling reactions are a recognised adverse event that occurs rarely following booster doses of DTPa vaccine. Such reactions commence within 48 hours of vaccination, last for 1–7 days and resolve completely.(17) A history of extensive limb swelling after a booster dose of DTPa vaccine is not a contraindication to another booster dose of acellular pertussis-containing vaccine.(18,19) Parents of children about to receive a booster dose of a DTPa-containing vaccine (at 18 months or 4 years of age) should be informed of the small but well-defined risk of this adverse event which, even when extensive, is usually not associated with significant pain or limitation of movement.
Hypotonic–hyporesponsive episodes (HHE), defined as an episode of pallor, limpness and unresponsiveness, occur rarely following DTPa vaccine, 1 to 48 hours after vaccination. In 2012, 2.2 cases of HHE were reported per 100,000 doses of DTPa-containing vaccine given to children <1 year of age in Australia.(20) Follow-up of children with HHE shows no long-term neurological disorders and these children can receive further doses of DTPa-containing vaccines.(21)
Pertussis vaccines do not cause encephalopathy (22) or sudden infant death syndrome.(23)
dTpa-containing vaccines in adolescents and adults
dTpa vaccines are safe and well tolerated in adults. The incidence of fever is low.(24,25) Booster doses of dTpa vaccine within 10 years are also safe and well tolerated, with no increase in moderate or severe adverse events or fever, and limb swelling reactions are rare.(13,26,27) In adults who report a history of adverse event(s) following DTPw vaccine given in childhood, dTpa vaccine can almost always be given.
dTpa vaccines in pregnant women
Studies show that there is no increased risk of adverse pregnancy outcomes (such as stillbirth, fetal distress or low birth weight) related to pertussis vaccination during pregnancy.(28-30)
There is a small risk that injection site reactions might occur in some women who receive dTpa vaccines during successive closely spaced pregnancies. This low risk is considered to be balanced by the benefit to each infant of protection against pertussis.
Interval between dTpa and other tetanus/diphtheria-containing vaccines
A single dose of dTpa vaccine can be administered 4 weeks after a dose of a vaccine containing tetanus and diphtheria toxoids. The benefits of protection against pertussis gained from using dTpa vaccine, where recommended, are likely to outweigh the risk of an adverse event.(31)
Contraindications/precautions
The only contraindications to DTPa and dTpa vaccines are anaphylaxis following a previous dose of an acellular pertussis vaccine-containing, or anaphylaxis following any vaccine component.
References
1. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). Pertussis. In: Atkinson W, Wolfe C, Hamborsky J (editors). Epidemiology and prevention of vaccine-preventable diseases. 12th. Washington DC: Public Health Foundation; 2011. p. 215-31.
2. Quinn HE, McIntyre PB. Pertussis epidemiology in Australia over the decade 1995–2005 – trends by region and age group. Communicable Diseases Intelligence 2007;31:205-15.
3. Pillsbury A, Quinn HE, McIntyre PB. Australian vaccine preventable disease epidemiological review series: Pertussis, 2006–2012. Communicable Diseases Intelligence 2014;38:E179-94.
4. Kaczmarek MC, Valenti L, Kelly HA, et al. Sevenfold rise in likelihood of pertussis test requests in a stable set of Australian general practice encounters, 2000–2011. Medical Journal of Australia 2013;198:624-8.
5. Quinn HE, Snelling TL, Macartney KK, McIntyre PB. Duration of protection after first dose of acellular pertussis vaccine in infants. Pediatrics 2014;133:e513-9.
6. Misegades LK, Winter K, Harriman K, et al. Association of childhood pertussis with receipt of 5 doses of pertussis vaccine by time since last vaccine dose, California, 2010. JAMA 2012;308:2126-32.
7. Australian Government Department of Health and Ageing. National Notifiable Diseases Surveillance System. Available from: http://www9.health.gov.au/cda/source/rpt_5_sel.cfm (Accessed 25 March 2015).
8. Wiley KE, Zuo Y, Macartney KK, McIntyre PB. Sources of pertussis infection in young infants: a review of key evidence informing targeting of the cocoon strategy. Vaccine 2013;31:618-25.
9. Australian Technical Advisory Group on Immunisation (ATAGI). The Australian immunisation handbook. 10th ed (2015 update). Canberra: Australian Government Department of Health; 2015.
10. Zhang L, Prietsch SO, Axelsson I, Halperin SA. Acellular vaccines for preventing whooping cough in children. Cochrane Database of Systematic Reviews 2012;(3):CD001478. doi:10.1002/14651858.CD001478.pub5.
 

Ash

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11. Sheridan SL, McCall BJ, Davis CA, et al. Acellular pertussis vaccine effectiveness for children during the 2009–2010 pertussis epidemic in Queensland. Medical Journal of Australia 2014;200:334-8.
12. Ward JI, Cherry JD, Chang SJ, et al. Efficacy of an acellular pertussis vaccine among adolescents and adults. New England Journal of Medicine 2005;353:1555-63.
13. Booy R, Van der Meeren O, Ng SP, et al. A decennial booster dose of reduced antigen content diphtheria, tetanus, acellular pertussis vaccine (BoostrixTM) is immunogenic and well tolerated in adults. Vaccine 2010;29:45-50.
14. Amirthalingam G, Andrews N, Campbell H, et al. Effectiveness of maternal pertussis vaccination in England: an observational study. The Lancet 2014;384:1521-8.
15. Healy CM, Rench MA, Baker CJ. Importance of timing of maternal combined tetanus, diphtheria, and acellular pertussis (Tdap) immunization and protection of young infants. Clinical Infectious Diseases 2013;56:539-44.
16. Decker MD, Edwards KM, Steinhoff MC, et al. Comparison of 13 acellular pertussis vaccines: adverse reactions. Pediatrics 1995;96:557-66.
17. Rennels MB. Extensive swelling reactions occurring after booster doses of diphtheria-tetanus-acellular pertussis vaccines. Seminars in Pediatric Infectious Diseases 2003;14:196-8.
18. Centers for Disease Control and Prevention (CDC). Use of diphtheria toxoid-tetanus toxoid-acellular pertussis vaccine as a five-dose series. Supplemental recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommendations and Reports 2000;49(RR-13):1-8.
19. Centers for Disease Control and Prevention (CDC), Broder KR, Cortese MM, et al. Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommendations and Reports 2006;55(RR-3):1-34.
20. Mahajan D, Dey A, Cook J, et al. Surveillance of adverse events following immunisation in Australia, 2012. Communicable Diseases Intelligence 2014;38:E232-46.
21. Goodwin H, Nash M, Gold M, Heath TC, Burgess MA. Vaccination of children following a previous hypotonic–hyporesponsive episode. Journal of Paediatrics and Child Health 1999;35:549-52.
22. Moore DL, Le Saux N, Scheifele D, Halperin SA, Members of the Canadian Paediatric Society/Health Canada Immunization Monitoring Program Active (IMPACT). Lack of evidence of encephalopathy related to pertussis vaccine: active surveillance by IMPACT, Canada, 1993–2002. Pediatric Infectious Disease Journal 2004;23:568-71.
23. Brotherton JM, Hull BP, Hayen A, Gidding HF, Burgess MA. Probability of coincident vaccination in the 24 or 48 hours preceding sudden infant death syndrome death in Australia. Pediatrics 2005;115:e643-6.
24. Pichichero ME, Rennels MB, Edwards KM, et al. Combined tetanus, diphtheria, and 5-component pertussis vaccine for use in adolescents and adults. [erratum appears in JAMA. 2005 Dec 28;294(24):3092]. JAMA 2005;293:3003-11.
25. Blatter M, Friedland LR, Weston WM, Li P, Howe B. Immunogenicity and safety of a tetanus toxoid, reduced diphtheria toxoid and three-component acellular pertussis vaccine in adults 19–64 years of age. Vaccine 2009;27:765-72.
26. Halperin SA, McNeil S, Langley J, et al. Tolerability and antibody response in adolescents and adults revaccinated with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine adsorbed (Tdap) 4–5 years after a previous dose. Vaccine 2011;29:8459-65.
27. Mertsola J, Van Der Meeren O, He Q, et al. Decennial administration of a reduced antigen content diphtheria and tetanus toxoids and acellular pertussis vaccine in young adults. Clinical Infectious Diseases 2010;51:656-62.
28. Munoz FM, Bond NH, Maccato M, et al. Safety and immunogenicity of tetanus diphtheria and acellular pertussis (Tdap) immunization during pregnancy in mothers and infants: a randomized clinical trial. JAMA 2014;311:1760-9.
29. Donegan K, King B, Bryan P. Safety of pertussis vaccination in pregnant women in UK: observational study. BMJ 2014;349:g4219.
30. Kharbanda EO, Vazquez-Benitez G, Lipkind HS, et al. Evaluation of the association of maternal pertussis vaccination with obstetric events and birth outcomes. JAMA 2014;312:1897-904.
31. Centers for Disease Control and Prevention (CDC). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine from the Advisory Committee on Immunization Practices, 2010. MMWR Morbidity and Mortality Weekly Report 2011;60:13-5.

But anyway, this conversation seems to have reached the 'going around in circles' stage so I'm happy to leave it there if you are. My main point was the outrage of government discrimination against people based on what amounts to idealogical grounds (no one has presented any science to back the claim that unvaccinated people spread these diseases any more than vaccinated people do). In effect they are blackmailing people to be assaulted against their will, at least that's how I see it. How long before force is used? How long before unvaccinated people aren't allowed to have jobs or go to school?

This is no outrage IMO. This is government policy determining where government money should go. There is no discrimination against anyone. People can still choose whether or not they want to vaccinate their children. The argument of 'I choose not to vaccinate myself or my child, so don't disqualify me from Family Tax Benefits just because I choose to do so.' doesn't hold water on either scientific or social justice terms.

"The crops are failing, we better find a witch to burn!" :)
Tilting at windmills.
 
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Director

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HI Ash,

It seems you have completely misunderstood or misread the point I was trying to make.

There is no point in arguing this. There is plenty of robust scientific evidence in the efficacy of the aP-vaccine and people can choose to either accept it or reject it according to their own opinions.

Yes. And I have never argued otherwise. The remainder of your post contains links to back up the claim that the aP-vaccine is effective and I do not nor have I ever in this thread disagreed with that point.

Our discussion has been about how 1) Government prejudice against those who choose not to vaccinate and 2) how unvaccinated people (babies) can become infected and whether it is justified in blaming those who are unvaccinated from spreading these diseases when there seems to be NO evidence to suggest that that is the case (any more than vaccinated people spread these diseases that is).
 

Ash

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Okay, I must have misunderstood the inaccurate argument about how the vaccine increases infectivity. Though I fail to see the prejudice or discrimination. This is no different from incentivising any desired outcome and the government clearly sees the value in herd immunity for population health. This is a positive move.

The vaccine is not 100% effective and we will always have whooping cough, vaccine or no vaccine. But the rates of infection, morbidity and mortality are all far lower when there is effective herd immunity. There is plenty of evidence for this. As such, it is of both individual and public health concern when there is a loss of herd immunity due to unpredictable epidemics of whooping cough, which CAN be prevented with effective immunisation.

When an unimmunised family is affected by whooping cough, causing either significant morbidity or the unfortunate outcome of a death in a child, there is usually a very different opinion formed about vaccines. More often than not such cases are not publicised anywhere near as loudly as the cases against immunisation.
 
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