Letter: Castlegar's medical health officer speaks to local Pertussis outbreak and immunizations

Letter: Castlegar's medical health officer speaks to local Pertussis outbreak and immunizations

To the Editor:

Regarding: Whooping Cough Outbreak and Pertussis Vaccine for Children

As a public health specialist physician who is the Medical Health Officer for the Kootenay-Boundary area (including Castlegar), it is my responsibility to ensure all residents of the region get the best health information possible on which to base their decisions for themselves and their families, and do everything possible to improve the overall health of the population I serve.

One of our legal and ethical responsibilities as MHOs under the Public Health Act of BC is to let area residents know when an outbreak of a communicable disease begins occurring, like happened this past week with whooping cough (pertussis) in the West Kootenay. While the majority of area parents have their children fully immunized and protected against whooping cough, the remainder 30 per cent of young children under two years are either behind on their immunizations, or unimmunized and not protected at all. This is a serious concern, because whooping cough is a very severe illness for infants and toddlers to catch. In the pre-vaccine era, it was one of the largest killers of our youngest children. For unimmunized infants, that risk still exists.

I think all parents, both those who have their children immunized and those who have chosen not to have their children immunized so far, want to do their best to protect their families. I also think that there is a lot of misinformation, myths and untruths out there about vaccines and their safety, with a lot of it popping up on web-based Google searches. There is also fortunately a lot of credible information on-line, from the Canadian Pediatric Society, Canadian Public Health Association, and the B.C. Center for Disease Control websites, but it can be hard to sort the credible information from that which isn’t.

My job is to try to ensure all parents get the most accurate information possible, and this is what I know – the pertussis vaccine in use in BC is very safe and very effective, and the only real way to protect our infants and toddlers against the severe effects of whooping cough. The albeit rare but severe “side effects” (brain/neurologic disorders) supposedly related to pertussis vaccine that are cited on the web by anti-vaccinationists, actually relate to the old whole-cell pertussis vaccine, and initially came from large UK studies done in the 1970s and 1980s. Further followup of the small numbers individual cases of neurologic disorders that had occurred in both the immunized group and the unimmunized group under study, showed other disease causes for the neurologic disorders, unrelated to the vaccine. The newer acellular pertussis has been in used in BC and elsewhere worldwide for 10 years now and has an excellent safety record with many millions of doses given, and no evidence or indication of any risk with regard to neurologic conditions. The most common post-vaccine reaction I review as an MHO is the expected one of a mildly sore red shoulder or leg at the immunization site, which is an expected reaction happening in about one- to five-per-cent of kids depending on age, and which lasts usually only a day or two.


I went into medicine to help people, and then into public health to try to help larger groups of people on a population level. I spent eight years of university study to get my undergraduate and then medical degree, and then after several years family practice, a further 5 years getting specialized training in community medicine and public health, with a focus on communicable disease control and prevention. I’ve spent 20 years practicing public health medicine in B.C., reviewing which vaccines to use when, and watching for any side effects which may be occurring, to ensure all vaccines are safe to use. I am not a fan of big multinational corporations or the pharmaceutical industry. I get no money from vaccine manufacturers to promote their products. My only wage is from you the citizens of BC, and my only job as a physician/public servant is to make sure you get the most accurate information possible.

You will see other Letters to the Editors in Kootenay newspapers in response to the outbreak or even my letter here, and things on the Web, with unsubstantiated conjecture, misinformation and statements taken out of context, trying to convince you that vaccines, either individually or as a whole, are unsafe. Be critical of these statements; be a skeptic. What are the individuals’ credentials and their specific training? Who are they citing - supposed experts who exist on websites from the United States, who want to sell you their books and/or natural products instead? Anti-vaccinationists oft cited Dr. Andrew Wakefield from the UK as having shown the supposed link between MMR vaccine and autism, but he is now fully refuted and discredited, both for bad science and for accepting bribes from companies in competition with the MMR manufacturers. Be a skeptic. What ties exist between the litigation lawyer lobby in the US and anti-vaccine pseudo-experts there? Locally, what are the credentials and training of self-proclaimed experts, and what book of their own are they trying to sell?

I think that there is a percentage of parents, perhaps 10-20 per cent, who are understandable confused with all the variety of material out there about vaccines, and hesitate against getting their children immunized, wanting to protect their kids but uncertain which way protects them best.

I would urge these parents to review and arm themselves with the most credible information possible. Go to a credible source, such as www.ImmunizeBC.ca which was developed by specialist public health physicians in BC, who are independent and not beholden to any vaccine manufacturer. Talk to your local Public Health Nurse at the IH-Public Health office in your town.


In addition, if any Kootenay parent who has residual questions or concerns, who remains unsure about whether to go ahead and get immunization for their infant or pre-schooler, wants to go over their questions and concerns with me, then I would be more than happy to talk to you directly, and give you the best scientific and medical information I am aware of, on which to make your choice – just leave your name and phone number with the public health nurse and that you would like me to call.

We owe it to our children to protect them as much as possible, and I trust Kootenay parents in the decisions that they make, based on the best information available.

Dr. Rob Parker
Medical Health Officer
Director of Communicable Disease Control
Interior Health Authority
 

Comments

Sheep

I heard that theres a new bug comming, people are afraid running everywhere. But lets not worry lets not fear for the medical system will save us all. Sheep!

Ignore hysteria and vaccinate your children

There is no doubt that Dr Parker is correct here. And believe me I do not always agree with him. The chances of a bad outcome from vaccination are less than the risks of driving to the local market. Although there was a decrease in some infectious diseases like polio prior to widespread vaccination, likely from other public health efforts like water disinfection, there is no doubt that the rarity of many childhood diseases today are a direct result of widespread vaccination. Absolutely no doubt about it. To not vaccinate your children based on some vague internet "specialists" is irresponsible. You can also learn how we are all at risk of alien abduction from similar self proclaimed "experts" on the net.

totally confused

I think it was greatness of Dr. Rob Parker to make the Medical Alert regarding any kind of communicable disease and others in the community and to immunize the children and people to get rid of it. But i found vaccinating was not successful enough to get out of the disease just as pertussis and I have gone through other comments which made me confused about the pre-vaccines and immunizing system also the reactions from immunization. How far true is it? I am totally confused with the views of the friends who have commented back.

reply

Baxter Corporation makes the only cure for the Swine Virus and is facing massive layoffs and a sea of red ink. Like all evil corporations in movies they are behind the whole evil plot to make money in a massive conspiracy that goes all the way to the top. This is a scenario people love.

From the editor: Vaccine logic not a 'shot in the dark'

I'm not without sympathy for your position -  my son, too had an adverse reaction to immunization ...but what's your alternative?

The statistics are clear ... far, FAR more children died in the pre-vaccine era, of  Pertussis alone, never mind Polio, Rubella, etc., than do today as a result of immunization. The only reason unimmunized kids do okay today is the protection accorded them by the children around them who ARE immunized.

Instead of condemning vaccines wholesale, why not advocate for research that will better predict who will experience adverse reaction and why ... instead of, literally, throwing the baby out with the bathwater and attempting to force us back to a time that saw child mortality rates as high as one in five?

Spin it however you like - The adverse reaction to Pertussis is both more common and more severe than the reaction to Pertussis vaccine.

Respectfully,

Kyra Hoggan

Editor

 

pertussis and vaccines

I think the debate on here and around immunizations is good, and I am happy to participate in it. I would agree with K.Hoggan that taking rigid, all-or-nothing stances is not the best place to be, and means one is not reviewing all the evidence or information available. There are significant differences between the different types of infectious disease agents – many different bacteria, and viruses – and the vaccines available have different degrees of effectiveness against them. This is at times due to the vaccine, and sometimes because of the type of infectious agent. Most viral infections that circulate through the blood and spleen tend to give lifelong immunity, as do the vaccines that deal with them. Measles, polio and smallpox are good examples of these. Other diseases that act on our body surfaces (norovirus on the gut surface, pertussis on our airway surfaces) don’t tend to produce permanent immunity, and we can be re-infected several times in our lifetime. The newer acellular pertussis vaccine in use in BC the last 10 years provides longer lasting immunity, through to the end of high school for most kids, whereas the older whole-cell vaccine’s protection tended to fade or wane after 4-5 years. The main point of the pertussis immunization program however is not to eradicate pertussis bacteria, but to minimize it’s circulation especially in children, to protect infants from exposure and serious disease. On susanfeltcher’s comment that many infectious diseases where declining due to public health sanitation activities beginning in the mid-1800’s, that is true. But that was mainly for water-borne diarrheal diseases. Really big declines in infant pertussis death rates began in the late 1940’s after widespread introduction of the pertussis vaccine. Even with modern sanitation and housing in the 1950s, polio outbreaks continued to ravage Canadian children until the widespread introduction of polio vaccine in the early 1960s. In more modern times, BC had about 40 cases a year of severe illness (meningitis or tracheitis, and death) in children under 5 due to Hib bacteria, until Hib vaccine became available in the mid-1990’s – now we almost never see a case. Likewise in BC, meningococcal C vaccine introduced in 2003 has eliminated 20 cases of severe meningitis in kids every year. Most recently in the last few years, the introduction of conjugate-pneumococcal vaccine in BC and elsewhere has significantly decreased illness, hospitalization and death in children across North America due to this bacteria. But just because something is a ‘vaccine’ doesn’t mean it is inherently good, effective or needed. I have sat on the BC provincial Communicable Disease policy committee for many years, where we have reviewed new vaccines and made recommendations on their approval or not. One example was rotavirus vaccine. Rotavirus, while causing severe illness in malnourished children in developing countries, is a cause of a relatively mild, self-limited diarrheal illness in most north American children, though still causes significant illness for some. It was considered but not brought into BC at the same time as in the US in 1997-98, because of uncertain demonstated need, and more surveillance data being needed. Subsequent study l surveillance data after introduction in the US in 1998 of showed side effects (increased risk of bowel strangulation in infants), and it was eventually pulled in the US market. Another example of a vaccine not yet approved in BC is an adult, seniors form of “shingles” vaccine (adult chickenpox reactivation). This has not been approved because the vaccine cost is set so high by the manufacturer, and the cost-effectiveness argument has not yet been fully proven. Finally, occurring a bit before my time, but a new live measles vaccine was testing in the late 1970s in Alberta, but was pulled after it was found to be too “active” for a live vaccine, actually causing a variant type of measles. I mention these to indicate every vaccine or medicine has to be assessed on it’s own merits. I have no “abiding faith” as susanfletcher states, in vaccines, but rather that each one has to be critically assessed on it's own merits and cons, before routine introduction into the immunization schedule. In public health, I consider myself a “health” advocate, not a “vaccine” advocate. We spend much of our time making sure child care centers are safe, that drinking water is safe and clean to drink, that waste burning and smoke is eliminated as much as possible to keep the air clean, that mom’s get support to have good breastfeeding established for as much of the first year of life for their babies as possible (and beyond for some, as desired), that kids are eating more fresh fruit and vegetables in schools, and that communities are designed in health-promoting ways to encourage activity, and are safe. And for those vaccines that are proven to be good, safe and effective, then those should also be recommended to prevent disease and ensure health. For adverse reactions to immunizations, BC and Interior Health has one of the best surveillance systems in the nation. With the same vaccines and the same type of population as other areas of BC and as other provinces, we consistently file more adverse reaction reports than anywhere else, simply because our public health nurses are consciencious about inquiring of parents post-immunization, and we as Medical Health Officers conscientiously review each one and make recommendations – some times to discontinue immunization, if a serious allergy has potentially developed to a particular vaccine. Fortunately this doesn’t happen too frequently, and for the individual they still have the ‘herd-immunity’ effect protecting them with the others around them immunized and preventing disease transmission. susan fletcher is wrong that getting seven or eight “antigen or disease stimulants would never occur in nature”. We are all constantly exposed daily to dozens of bacterial, viral and other protein antigen stimulants, from the day we are born until the day we die. It is part of the natural process of maturation of the infant and childhood immune system, to recognize what it should have tolerance for and what it should fight off (have antibodies for). Effective vaccinations give children early protection in a safe way, and let them develop protective antibodies before they are exposed to the real germ. An alternate way to go as a society is to let all the kids get “natural” infection from the real germ, and for the survivors that is fine, but such an approach leaves a lot severely damaged and maimed individuals in it’s wake. I have worked in Africa, and seen the crippled children and adults on street corners begging, because of wild polio outbreaks and ineffective inmmunization programs. I am happy to discuss and answer any questions on any of the above. I support parents looking at all information critically, then them doing what is best for thier child. Dr. Rob Parker Medical Health Officer

Respectively, the editor is wrong

Dr Parker finds it difficult to counteract vaccine information on the internet; I find it difficult to counteract the info that comes from the medical establishment. Kyra Hoggan's arguments are a direct regurgitation of those of the medical establishment. She obviously has never learned that the ravages of most of the childhood infections including pertussis and polio were steadily decreasing well before their vaccines were introduced. The incidence of polio actually rose after the Salk vaccine was introduced. All this is documented on the VRAN website and in the easy-to-understand ‘Vaccine Safety Manual’ by Neil Z Miller. Sincere wishes for everyone's good health!

From the editor: This kind of polarization is sad

 
I find it sad that both the mainstream medical community and its opposition are taking such rigid, all-or-nothing stances ...while neither seems able to see the subsequent cost to our children.
 
The medical community plays ostrich, understating or altogether ignoring the rate of adverse reaction to immunization, rather than shining a spotlight on the issue in an effort to determine for whom immunization is contra-indicated and how to treat those who do react negatively. In so doing, they cost themselves public trust and diminish the immunization rates they so fervently wish to increase.
 
Conversely, opposition refuses to acknowledge any merit in vaccination whatsoever, in gross defiance of both statistics and logic, discrediting their own cause and allowing the medical community at large to dismiss them as fanatics rather than developing a credible lobby for better immunization research and testing.
 
Such as the above argument - of course infection rates went down ... sanitation and hygiene rates went up. That doesn't make the diseases any less deadly.
 
Both extremist perspectives hurt our kids.
 
What happened to finding mid-ground; to taking the best of each paradigm and discarding the rest?
 
Can we not, if only for the sake of our children, relinquish our enmities and biases, together looking for a solution that works?
 
Can we not be the grown-ups? And if not ... then who will?
 
Respectfully,
Kyra Hoggan
Editor

 

 
 

pertussis vaccines

Thank you for speaking out... myself and two of my siblings all had serious reactions to the pertussis vaccine and as a result I refused to vaccinate my daughter who hasn't suffered from the lack of in her 28 years.

MHO assumes too much

MHO assumes too much Dr Rob Parker claims to have zero competing interests concerning the advice he disseminates re vaccinations. He forgets that his 8 yrs of university training instilled in him the medical profession’s abiding faith in “immunizations”. His subsequent employment as an MHO requires that he promote them. I have a personal story to tell. The failure of pertussis vaccine is the reason I’ve become enlightened about “immunizations”. My infant grandchild was infected by siblings who’d been fully vaccinated. He nearly died but managed to pull through after a month in hospital. He was breast-fed but, due to decades-long use of pertussis vaccines, mothers are rarely exposed to the disease and so are no longer able to confer natural immunity to their offspring. Meanwhile, spasmodic outbreaks of pertussis continue to occur. Public Health’s answer to this hitch in their plan has been to continually increase the number of doses and boosters given to the point that, now, adults are asked to submit to pertussis vaccination. Furthernore, the pertussis vaccine given in the early years now contains not only pertussis disease antigens but also antigens of seven other diseases. Dr Parker makes the questionable remark that acellular pertussis vaccine is safe; he doesn’t even address safety issues re a vaccine which delivers immune stimulants of eight diseases, a provocation which would never occur in nature. Dr Parker asks us to “be a skeptic”. I have been for the last nine years and, after studying the vaccination issue that length of time, I conclude that the information provided by Vaccination Risk Awareness Inc, Canada’s information source with no ties to government or pharmaceutical corporations, is some of the most reliable available.