Risk-Benefit Analysis: Chicken Pox, Hib, Flu

Welcome!  This is the tenth post in my vaccine series.  Today we are talking about Chicken Pox, Hib, Flu and their cooresponding vaccines. If you have missed any part of this series, you can catch up with these posts:Y 10 Bad Reasons Not to Vaccinate, Why “Science” Should Be Carefully Evaluated, What is Herd Immunity All About, How the Immune System Works, Ingredients in Vaccines Part 1, Ingredients in Vaccines, Part 2, Risk-Benefit Analysis: MMR, or Risk-Benefit Analysis: DTaP

Hib

Hib is a relatively new addition to the vaccine schedule, and one that parents are warned to take seriously. Why? What is it like and how serious is it?

What is Hib?

Haemophilus influenza type B, also known as “Hib” is a potentially severe respiratory infection. It is a bacterial infection that often causes a secondary infection following the flu, and it is the leading cause of meningitis. There are really six strains of this bacteria, but 95% of infections are caused by type b.

There are approximately 3 million cases each year, worldwide, and the majority of these occur in developing countries.

Up to 3% of infants and small children are asymptomatic carriers and could pass the infection along unknowingly. Most children, in the pre-vaccine era, acquired immunity through asymptomatic infection by the age of 5, and when grown, passed this to their children via pregnancy/breastfeeding, making babies under 6 months effectively immune.

Only a tiny fraction of those who carry this bacteria asymptomatically in their nasal passage will ever go on to develop symptomatic disease.  The chances of developing it if directly exposed are between 0% and 2.7%, depending on the circumstances.

Risk factors include low socioeconomic status, being a racial minority, living in a crowded home or large family, low parental education level, attending group childcare, and having a chronic disease.

Breastfeeding provides protection against Hib.

Normal Course of Hib

Most often, Hib infects the nasal passages. In some people, the infection gets into the bloodstream and affects distant body sites, especially the meninges in the brain. The way the infection gets into the bloodstream is unknown. 50 – 65% of cases will result in meningitis. Symptoms include stiff neck, sore throat, and changes in mental status.  It usually affects children in the 6 – 12 month range, and rarely affects children over 5 years.

Typically, Hib requires hospitalization and a 10-day course of antibiotics, and possibly a combination of a couple different types.  Most people recover without incident, although Hib is serious.

Hib infection in children under age 2 is not considered to provide immunity, and vaccination is recommended following illness.

Complications

Pneumonia is also possible. So is epiglottitis, an infection of part of the throat. Septic arthritis and cellulitis can also result.

Worldwide, 3 – 20% of those who actually contract the illness (which is a very tiny percentage of those who have the bacteria present in their bodies) will die. In the US, this is about 2 – 5%.

In the UK, there was actually an increase in Hib cases from 1999 – 2002, despite vaccination occurring routinely since 1992.  One theory is that by reducing the harmless colonization in the nasal passages, children were unable to get needed “boosters” and thus were more likely to become ill.

Vaccine Use

The initial Hib vaccination came out in 1985 and was used only until 1988.  It was not effective in children under 18 months, and efficacy in older children varied from 85% to -69% (“negative” because vaccinated children were 69% more likely to get Hib than non-vaccinated children).  This version is no longer available.

Two more versions were created and used in infants as young as six weeks, but are also no longer available.  Currently, there is a third vaccine available, a “conjugate” form, which is recommended at 2, 4, and 6 months, with a booster at 12 – 15 months and has an efficacy of 95 – 100%.  Children who delay vaccination until past age 2 are typically offered only one dose, if any, since the risk of disease drops dramatically.

Vaccine Side Effects

There were 810 side effects reported to the VAERS database in 2011.  121 of these were considered “serious” by VAERS, which is about 15% (this is an extremely high percentage; 3 – 4 times as many as other vaccines).  Side effects include fever, rash, lethargy, vomiting, diarrhea, seizure, difficulty breathing, swelling limbs, cellulitis, inconsolable crying.  Most common side effects are fever and pain at the injection site (which CDC says occur in up to 30% of those vaccinated).  A fair number experienced vomiting and diarrhea.

Bottom Line

Hib was a little odd to research.  It has some similarities to polio (affects brain/spinal area; many cases are asymptomatic; uncertain how exactly the pathology occurs; unlikely for those in contact with ill individual to also get sick).  It also seems that the disease itself is very uncommon, and that in certain cases the vaccine has increased the likelihood of catching it.  Breastfeeding appears to be extremely important to protect young infants who are most vulnerable to the disease.  Up to 15% of the vaccine reactions are serious, meaning it comes with quite a risk.  It’s likely that there’s a lot of research here that has simply not been done yet, and that in many cases, the best protection is exclusive breastfeeding combined with a healthy lifestyle.

Varicella

What is varicella?

Varicella is the clinical name for chicken pox, a relatively minor viral infection that causes an itchy red rash and fever for about a week. Prior to vaccine use, almost all children got the chicken pox. In fact, the vast majority of the current generation of parents (including me) have had it and know exactly what it is like. The same virus is also responsible for shingles.

It is interesting to note that WHO has no position paper on varicella vaccination, and that varicella vaccination typically does not occur in other countries, only in the USA.

Normal Course of varicella

Incubation is 10 – 21 days, usually around two weeks. This is followed by 1 – 2 days of fever and tiredness, especially in teens/adults; it is not always seen in children. The eruption of the rash follows this. The rash begins usually on the head, following by the body, then arms and legs. Spots continue to erupt in crops over 2 – 4 days. The spots mature and then eventually crust over. Most children will have 200 to 500 spots.
Chicken pox is generally mild, with low to moderate fever (up to 102), fatigue, and itching. It usually lasts about a week, and complications are rare except in children who have a known immune system issue.

Shingles also results from the same virus and why it occurs is not well understood. It is more likely if a child has chicken pox prior to 18 months, is exposed while in utero, or is immune compromised. Older people are more likely to get it than younger people (this is changing as more and more people are vaccinated, though – cases have been discovered increasingly in children and even infants). This produces a painful, itchy rash.

Complications

A number of complications are possible, but they are rare. The skin lesions (spots) may become infected with strep or staph bacteria. Pneumonia also sometimes occurs. Rarely, encephalitis occurs (less than 2 in 10,000 cases).  Hospitalization occurs in about 2 or 3 out of every 1000 cases.

The chances of death from varicella is about 1 in 60,000. In healthy children aged 1 – 14 years, it is only 1 in 100,000. (Adults have 25 times the chance of death.)

Vaccine Use

This vaccine is cultured in aborted fetal tissue.  It is a live-virus vaccine, which may shed and could spread or cause chicken pox.

Two doses are recommended: one at 12 – 15 months, and one at 4 – 6 years.  Prior to the booster dose, up 17% of vaccinated children were still getting chicken pox (up to 40% in some areas) if the disease circulated in elementary schools.  The vaccine is supposed to be 70 – 90% effective against infection.

Receiving another live-virus vaccine at the same time as varicella (like MMR) increase the risk of catching a minor case of chicken pox from the shot by 2.5 times.

Seroconversion (showing appropriate antibodies on the titre test) does not always correlate with protection, according to the CDC.  (Which should make us question if we are really protected in general…the titre test is ‘the’ way they ‘prove’ immunity.)

Vaccine Side Effects

There were 2810 adverse reactions reported to VAERS in 2011.  121 were serious, or about 4%.  Reactions include rash, itching, fainting, fever, nausea, vomiting, headache, seizures, chicken pox, death, and more.  Fever, rash, and fainting are relatively common.

Bottom Line

In the vast, vast majority of cases, chicken pox is not a serious disease.  Gaining natural immunity through infection and re-exposure to other wild cases during one’s life protects against shingles.  Without this, young children and even babies are getting shingles.  The vaccine has been proven not to be very effective.  It also causes fainting frequently.  A child who is not immune-compromised is not really at risk of complications from chicken pox, and getting it could even be beneficial given the risk of shingles later in life.

Influenza

What is influenza?

Influenza, or “flu,” is a seasonal illness that many have had at least once in their lifetime.  Flu shots are recommended each year to protect against that year’s circulating strains.  It is not typically dangerous except to very small children or elderly children.  Most flu deaths occur in people over 65 and are due to complications from the flu.

2009 H1N1 is noted as a “global pandemic” according to the CDC.  It estimates this flu sickened 60 million people and killed 12,500 (no source cited for data).  (I’m pretty sure, since I obviously lived through this “pandemic” that these numbers are sharply inflated.  Anyone who complained of any flu-like symptoms during this time was counted as having H1N1.  I even went to the hospital after fainting when I was 7 months pregnant — this would have been in May 2009 — and they mentioned I might have it.  I did not have any flu symptoms.  But I was probably counted.  A lot of this sort of thing went on to try to scare people and sell vaccines, unfortunately.  Plus, since the CDC calls it ‘an estimate’ and cites no source for its data, it’s not really believable.  Looking at their own graph further down the page, there was no significant increase in cases or deaths; there was, however, in 2006, which was not hyped like it was in 2009.)

Normal Course of influzenza

Incubation is 1 – 4 days.  Typically, a low to moderate fever occurs, with chills and body aches.  Lack of appetite and fatigue are also common.  This lasts 2 – 4 days on average before clearing up.

Complications

Pneumonia is the most common complication of the flu, and usually occurs in the elderly.  Reye syndrome also occurs in children given aspirin.  Worsening of chronic heart issues or chronic bronchitis occur occasionally as well.

Hospitalization rates for children 0 – 4 years is estimated to be 1 in 1000.  Healthy children 5 – 18 years are not at great risk of complications.  About 5 – 7 out of every 100 children see a doctor for a flu-related visit (or with “flu-like symptoms”) each year, and many of the children are given antibiotics (which are largely unnecessary).

Death occurs 1 in every 1000 to 2000 cases, and 90% of flu deaths in a given year are people over 65.

Vaccine Use

The flu shot contains H3N2 and H1N1 group A strains, and a group B strain each year, according to the CDC.  However, it also says on another page that the vaccine “may be updated” each year and that immunity wanes over time, which is why annual vaccination is recommended.  It appears that the strains are generally not changed each year as we have been told; they are “possibly” changed time to time.

The shot has not been studied in pregnancy women.  It has not been studied for efficacy (according to the package inserts).  There is no proof it works.  It is recommended for every person over the age of 6 months annually.  This is a new recommendation in the last few years; it used to be recommended only for older or susceptible people.

Flu vaccine has not been tested or approved for children under 4 (Fluvirin by Novartis).  Fluarix is only approved in people over 3 years and not in pregnant women.  Flulaval has also not been approved for children (at all) or pregnant women.  All of these state: “…there have been no controlled trials indicating a decrease in influenza disease after vaccination.”

Vaccine Side Effects

There were 7,342 incidents reported to VAERS in 2011 (the high number is likely due to the greater number of people receiving this vaccine compared to the childhood ones).  498 of these were serious, or about 6.7%.

This vaccine contains thimerosal (Flulaval).  Side effects include fainting, fever, soreness, headache, chills, fatigue, ear ache, nausea, vomiting, altered mental status, death, Guillaine-Barre, and more.

Bottom Line

The flu shot has no demonstrated clinical efficacy in reducing flu infections.  It is not approved in young children, who are more at risk of complications (than older children).  The flu is an extremely minor, if annoying illness that causes no serious complications in healthy individuals.  Keeping one’s vitamin D levels high reduces the risk in actuality and without side effects.  The risk of complications from the vaccine, especially since it is recommended annually for everyone, is greater than the risk from the disease in almost all cases.  There appears to be no point whatsoever in taking the flu vaccine.

Final Thoughts

This is another interesting crop of diseases.  Make sure to read the WHO and CDC sites for yourself, as well as checking package inserts.  There have been recent reports of doctors claiming ingredients like aluminum were “made illegal years ago” when in fact that is not the case.  Always ask to see the current package inserts and do not accept any vaccination from a doctor who is unable to provide them.

How do you feel about chicken pox, hib, flu and their vaccines?

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