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Dr. Paul Offit's Vaccine Info Webinar "Communicating Good Science Under a Cloud of Doubt"

Posted May 10 2010 12:00am

Animal farm3 -RED copy1 Dr. Paul Offit spends some of his time teaching others how to convince the public vaccines are safe, even as his own vaccine, Merck's RotaTeq, faces scutiny and recall (in Hong Kong, not the USA).

Click HERE  to listen to the April 28th Virtual Immunization Communication Network Webinar "featuring Paul A. Offit, MD, Chief of the Division of Infectious Diseases and the Director of the Vaccine Education Center at the Children's Hospital of Philadelphia.

Dr. Offit will speak on current issues around parent and public concerns about vaccine safety and discuss how health professionals can effectively communicate scientific information to help the public distinguish between bad science and good science."

Review the presentation in .pdf form HERE.

The Virtual Immunization Communication (VIC ) Network is a project of the
National Public Health Information Coalition (NPHIC) and the California Immunization Coalition, funded through a cooperative agreement with the Centers for Disease Control and Prevention.

Below the jump is the straight text pulled from the .pdf. It's not formatted, but you can get an at a glance look at the content. Dr. Offit spends some time discussing Dr. Bob Sears's alternative vaccine schedule, the safety of aluminum, the "too many too soon" debate, and how many antigens an infant can receive.



VIC Network

A nationwide ‘virtual’ immunization community of health educators, public health communicators and others who promote immunizations



Objectives

• Describe communication strategies for public health
professionals to use in counteracting anti-vaccine messages


• Identify fact based messages that engage parents and
community members to help them make informed decisions
• Determine the best approach for communicating science to
the public


• Identify resources and support for immunization providers
who communicate with patients and parents about vaccine
safety.



Communicating Good
Science Under a Cloud of
Doubt


Featuring Paul A. Offit, MD, Chief of the
Division of Infectious Diseases and the
Director of the Vaccine Education Center at
the Children's Hospital of Philadelphia.


Paul Offit, MD

Delaying, Spacing Out,
Separating, and Withholding
Vaccines

Paul A. Offit

Division of Infectious Diseases

Children’s Hospital of Philadelphia

University of Pennsylvania School of Medicine



Too Many Vaccines Too Early



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Fewer immunologic components
are in vaccines today than

100 years ago



Number of antigens in
vaccines


Year Vaccine # of antigens

1900 Smallpox 198

Total 198



Number of antigens in
vaccines


Year Vaccine # of antigens

1960 Smallpox 198

Diphtheria 1

Tetanus 1

Pertussis (wc) ~3000

Polio (OPV) 15

Total ~3215



Number of antigens in
vaccines


Year Vaccine # of antigens

1980 Diphtheria 1

Tetanus 1

Pertussis (wc) ~3000

Polio (OPV) 15

Measles 10

Mumps 9

Rubella 5

Total ~3041



Number of antigens in
vaccines


Year Vaccine # of antigens



Immunological challenges from
the environment vastly exceed
challenges from vaccines



Are infants too young to be
vaccinated?


u Humans first develop the capacity to
respond to foreign antigens at about 14
weeks gestation.
u However, few foreign antigens are present
in utero. As a result, cells of the immune
system are largely naïve at birth.



Are infants too young to be
vaccinated?


u From birth, infants are challenged by
bacteria in the environment (colonizing
bacteria on intestines, skin, and throat;
bacteria inhaled on dust).


u Vigorous sIgA responses within the
first week of life keeps colonizing
bacteria from invading.



Are infants too young to be
vaccinated?


u Excellent immune response to HBV
vaccine at birth.
u About 90% of infants will develop
protective immune responses to HBV, Hib,
DTaP, polio, and pneumococcal vaccines
by 6 months of age.


u Need to be fully immunized against
certain infections (Hib, pertussis,
pneumococcus) by 6 months of age.



Children have an enormous
immunological capacity



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How many is too many vaccines?


u Combinatorial and junctional diversity
of antibody genes account for about
109-1011 different antibodies.



How many vaccines can we respond to?


u Each vaccine contains about 10
immunological components (proteins or
polysaccharides) and each antigen
contains about 10 epitopes (102 epitopes
per vaccine).
u Approximately 107 B cells are present
per ml of blood.


Cohn M, Langman RE. The protecton: the unit of humoral immunity selected by
evolution. Immunol Rev 1990;115:9-147.



How many vaccines can we respond to?


u If we divide 107 circulating B cells per
ml by 102 epitopes per vaccine, then
each person can respond to about 105
different vaccines at the same time.
u Therefore, the 14 vaccines given to
infants in the first 2 years of life will
“use up” about 0.01% of the immune
system.



Limitations of analysis


u Naïve lymphocytes are generated
constantly. From studies of HIV-
infected patients, about 2 x 109 naïve
CD4+ T cells are generated each day.
u Therefore, vaccines never really “use
up” the immune system.


Ho DD, et al. Nature 1995;373:123-6



Aluminum Overload



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“The alternative schedule suggests only
one aluminum containing vaccine at a
time in infant years. By spreading out
the shots, you spread out the exposure
so infants can process the aluminum
without it reaching toxic levels.”

Robert Sears, The Vaccine Book, p. 239



Aluminum


u Aluminum is the third most abundant
element on the earth’s surface and the
most abundant metal.


u As a consequence, aluminum is in the
air we breathe, the food we eat, and the
water we drink.



Aluminum in food


u The greatest source of aluminum is in
food.


u Adults typically ingest 5-10 mg of
aluminum per day.
u Aluminum is found naturally in teas,
herbs, and spices.



Aluminum in food


u Aluminum is also added to foods such
as leavening agents, anti-caking agents,
emulsifiers, and coloring agents.


u Found commonly in pancake mixes,
self-raising flours, baking powder,
processed cheese, and cornbread.



Aluminum in food


u Aluminum is also found in breast milk
and infant formulas.


u By 6 months of age:


mg
Breast milk 10 mg

Infant formula 30 mg

Soy formula 120 mg



Disposition of aluminum


u 100% of aluminum is absorbed
following vaccination.


u Only 1% of aluminum is absorbed
after ingestion.



Disposition of aluminum


u Aluminum enters the circulation,
binds to transferrin, and is eliminated
by kidneys.


u 50% eliminated in 24 hour


85% eliminated in 13 days

96% eliminated in 3 years



Disposition of aluminum


u Aluminum is not completely
eliminated from the body.


u End of 1st year of life:


Breast milk 0.1 mg

Infant formula 0.1 mg

Vaccines 0.1 mg

Adult 50-100 mg



How do we know aluminum is safe?


u Aluminum can cause encephalopathy,
osteomalacia, and anemia in two
groups: severely premature infants and
patients on chronic dialysis.


u Must meet two criteria: decreased or
absent renal function AND large source
of exogenous aluminum (i.e., IV
solutions or antacids).



How do we know aluminum is safe?


u Circulating levels of aluminum in those
with symptoms between 100-1,000 ng/ml.


u Typically, children and adults have between
1-5 ng/ml of aluminum in blood.


u Injected vaccines do not raise that level.



Aluminum references


Baylor, NW et al. Aluminum salts in vaccines—US
perspective. Vaccine 2002;20:S18-S23

Bishop NJ et al. Aluminum neurotoxicity in preterm
infants receiving intravenous feeding solutions. N
Engl J Med 1997;336:1557-1561

Committee on Nutrition. Aluminum toxicity in infants
and children. Pediatrics 1996;97:413-416

Keith LS, et al. Aluminum toxicokinetics regarding
infant diet and vaccinations. Vaccine 2002;20:S13-
S17

Pennington JA. Aluminum content in food and diets.
Food Additives and Contaminants 1987;5:164-232



Too Many Shots at One Time



Are more shots more stressful?


u Study showing that two shots are not
more likely to induce cortisol (as a
marker for stress) than one shot.


Ramsay DS, Lewis M. Developmental changes in infant
cortisol and behavioral response to inoculation. Child
Development 1994;65;1491-1502.



The Harm



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Harm in alternative schedule


u Not science based
u More likely to induce needle phobia
u Increase time during which children
are susceptible to vaccine-preventable
diseases
u Responsibility to the waiting room
u No benefit



Q & A Session



Twitter
www.twitter.com/vicnetwork



Resources

www.chop.edu

Vaccine Education Center at Children’s Hospital of Philadelphia

www.pkids.org

Parents of Kids with Infectious Diseases

www.immunize.org

Immunization Action Coalition

www.whyichoose.org

Why I Choose



Resources

www.aap.org

American Academy of Pediatrics

www.ecbt.org

Every Child By Two

www.cdc.gov/vaccines

CDC Vaccine Pages



For more info e-mail

info@VICnetwork.org



National Public Health Information Coalition

www.nphic.org

California Immunization Coalition

www.immunizeca.org



Thank you



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