Tdap vaccine is not linked to autism, just like any other vaccine (including the flu vaccine)

I remember when my dad told me that there was no such thing as Santa Claus. He sat me down and told me that it had been him all these years who had been buying me gifts and placing them under the tree. It was quite a shock to have this revealed to me; it shook my world. I did everything in my power to reason it through. In my head, dad was a liar. Dad wanted to take the credit for the big jolly guy who’d given me all the gifts I’d ask for in the letters I sent him through my dad.

I was 27 years old.

Soon enough, I came to accept the truth. All the evidence was there in the form of my dad’s receipts for the gifts he had gotten me. People had seen him buy me those gifts. Mom swore to having helped him wrap them. The evidence was compelling, substantial, tangible, credible… Santa Claus was no more.

I’m sad to say that this is not the case with the anti-vaccine crowd. You can tell them all you want that vaccines do not cause autism, and that vaccines actually protect from diseases that are deadly and/or disabling. But they will refuse to believe it because their entire ecosystem depends on the belief that vaccines cause autism. Anything short of that sucks away their life, their reason for living.

One such anti-vaccine zealot is everyone’s favorite “kid.” Even with a master of public health degree in epidemiology, he seems to remain convinced that vaccines cause autism. He’s stated on his blog that evidence he saw in school to the contrary is all a conspiracy from the pharmaceutical industry. It seems that, to him, the lies he has been exposed to over and over from a very young age have made up his mind. To him, Santa Claus (i.e. vaccines cause autism) still exists, and it will continue to exist because anything short of that eliminates his reason for living.

Seriously, he doesn’t seem to live for anything other than that. The primary example is a recent blog post of his where he takes a study that clearly shows that the Tdap (Tetanus, Diphtheria, and acellular Pertussis) vaccine doesn’t cause autism, and then he states that the study confirms that the influenza vaccine does cause autism.

Yeah, I was confused too.

His whole argument hinges on one table in the Prenatal Tetanus, Diphtheria, Acellular Pertussis Vaccination and Autism Spectrum Disorder by Becerra-Culqui et al.

This is table 3:

Screenshot 2018-08-14 10.18.59

Table 3 states that women who were vaccinated with Tdap during pregnancy had a similar incidence rate per 100,000 person-years of having an autistic child. Vaccinated women had an incidence rate of 3.78 autistic children per 100,000 person-years while un-vaccinated women had an incidence rate of 4.05. The ratio between the two was 0.98, meaning that vaccinated women had a lower incidence rate than vaccinated. Anything over 1.0 would indicate that vaccination leads to more autistic children being born.

Because this is one study with a limited number of people, and not a study looking at the entire universe of children born, scientists also report the 95% confidence interval (0.98 – 1.09). The 95% confidence interval is a way of us saying, “We are 95% confident that the true hazard ratio in the entire population (the whole of the population) is between 0.88 and 1.09.” Because it includes 1.0, we cannot say that this observation is not by random chance.

But look at how the kid displays the table on his blog:

Screenshot 2018-08-14 10.18.22

Only point out the things that seem to support your argument.

He points out that the adjusted hazard ratio of 0.85 (with a 95% confidence interval of 0.77 to 0.95) is adjusted for, among other things, influenza vaccination during pregnancy. In epidemiology and biostatistics, “adjusted for” means taking it into consideration. Let me give you an example:

Suppose that there are a group of people from Texas and a group of people from Alabama, and that we look at their test scores in biology. The group from Texas had an average test score of 77% while the people from Alabama had an average test score of 89%. You would conclude that being from Alabama leads you to having a better test score, right?

But what if we told you that they don’t teach biology in all schools in Texas? What if we told you that they only teach it in private schools in Texas, and that only 30% of schools in Texas are private schools? And then we told you that they teach biology in both types of schools in Alabama, and that there is a 50-50 split in the proportion of private to public schools in Alabama? How does this change your conclusion?

To reach the proper conclusion, you have to compare apples to apples, and oranges to oranges. You would compare the private school scores in each state to each other, and likewise with the public school scores. This is an adjustment. This is taking into account the differences in the distributions of a characteristic between the two groups being studied.

As it turns out, in the study in question, women who get their Tdap were much more likely to get their influenza vaccine. It makes sense, right? Women who vaccinate in general are more likely to vaccinate in particular. So, in order to compare apples to apples, the researchers adjusted for influenza vaccination. That is, they compared flu-vaccinated women who got the Tdap and flu-vaccinated women who did not get the Tdap, AND non-flu-vaccinated women who got the Tdap and non-flu-vaccinated women who did not get the Tdap.

Taking flu vaccination into account, and the bias that would creep in because women who vaccinate against influenza seem to be more likely to vaccinated with the Tdap vaccine, vaccinating with Tdap is not associated with having a child diagnosed with autism.

So why does the kid think this proves that influenza vaccine causes autism?

It beats me. All they did was make the adjustment to make things equal between the two groups, something every epidemiologist worth their salt should do… Unless you want to misinform the public?

Hmmmm?

He then takes a table from a different, unrelated study and points out to just one result on it as evidence that influenza vaccine causes autism:

Screenshot 2018-08-14 10.35.03

The red circle seems to be his way of saying, “Only this matters! Pay no attention to the whole of the evidence!”

This is another misrepresentation of the findings, and I kind of blame the authors of the study for making the table so busy. Look at the “Variable” column on the left. All that the data circled in red are saying is this:

“Of the 13,477 children whose mothers were vaccinated in the first trimester, 258 (1.91%) of them were diagnosed with autism. Their hazard was 26% higher for an autism diagnosis when compared to children whose moms were vaccinated in other trimesters. However, when adjusting for maternal allergy, asthma, autoimmune conditions, gestational diabetes, hypertension, age, education, race/ethnicity, child conception year, conception season, sex, and gestational age, the hazard of autism diagnosis went down to 20% over children whose moms were vaccinated in other trimesters.”

The fact that the hazard ratio went down after adjusting tells us that there is something else explaining the elevated hazard (risk). Look at what happened in the adjustment in the other trimester groups… Nothing changed. Look at what happened in the adjustment in the “Anytime During Pregnancy” group… Nothing changed. So what could that “something else” be? I’m not an obstetrician, but it’s reasonable to conclude that outcomes measured in the first trimester are different than outcomes measured in the other trimesters.

Finally, look at the reasoning that the kid used. In the first table, because numbers were adjusted for influenza vaccination, then it must mean that influenza vaccination causes autism. In the second, he doesn’t say that all the factors adjusted for cause autism… Because that would tear down his narrative.

I’m not surprised at all by his misunderstanding of all this. After all, to my knowledge, he doesn’t work as an epidemiologist anywhere. Like any good muscle, lack of practice of your epidemiology skills leads you to lose them. Being unpublished, not working as an epidemiologist, and a staunch defender of the so-called autism-vaccine risk leads the reasoning muscle to atrophy.

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Fifteen Children in South Sudan Die During Vaccine Campaign

The Associated Press is reporting that 15 children have died as a result of a vaccination campaign in South Sudan. According to the report:

“Fifteen young children have died in a botched measles vaccination campaign that saw people as young as 12 years old administering the vaccines, South Sudan’s government announced Friday.

The United Nations said the children died of “severe sepsis/toxicity” from the contaminated vaccine, and the health ministry blamed the deaths on human error. One syringe was used for all the children during the four-day campaign, and the vaccine was stored without refrigeration the entire time.”

So let’s reemphasize the meaningful facts before the anti-vaccine liars get a hold of these news and start to use them to attack the vaccination campaigns here in the United States.

First, South Sudan has been embroiled in a civil war for quite a while now. They used to be part of Sudan, but broke off and became independent in 2011. The continuing state of war, along with periodic famines, have presented quite a challenge to deliver food, medicine, clean water, and other supplies. To top it off, measles has been on the increase, further putting a burden on the lives of the people there. (And, by extension, the lives of Sudanese refugees the world over as refugees go back to see family and take measles back to their host countries.)

Second, 12 year-old children should not be administering vaccines. Yes, there is a shortage of trained professionals to administer vaccines because of the situation on the ground. But it goes without saying that this was a huge mistake. There are many things that can go wrong — and apparently did — during the administration of a vaccine, and I’m sure 12 year-old children are not trained to handle it.

Third, even with the preservative thimerosal in it (which the MMR vaccine does not have, as it is a live-virus vaccine), vaccines can still become contaminated over the course of several days being open and not in proper storage conditions. Furthermore, needles can collect pathogens from all over the place, including people. They probably passed on those pathogens from person to person, causing all of this.

“The civil war has killed tens of thousands and sent more than 1.8 million people fleeing the country, creating the world’s fastest-growing refugee crisis.

In 2016, South Sudan had at least 2,294 measles cases and 28 people died, according to U.N. data. So far this year, at least one person has died and 665 people have been infected.”

So, when the anti-vaccine jerks tell you that it was the vaccine that killed these children, make sure to fire back with facts.

Laugh it up, jerks. Laugh it up.

I used to have a boss who was well into his 70s when he decided to retire. He had worked at the health department where I was just a young number-cruncher longer than I had been alive. He joked about starting to work as a public health inspector in the Johnson Administration. Slowly and steadily, he moved up the ranks to becoming the director of a very busy infectious diseases unit at a very busy health department.

He was there in 1976 when Legionnaires’ Disease appeared. He told me about being on a call with people in the White House and how they wanted something, anything done, and done immediately. That same year, the swine flu fiasco happened, throwing the flu vaccine program into disarray. And he was at his highest position when all the crazy was unleashed over “Vaccine Roulette” and the resulting anti-vaccine nonsense.

He survived all that, and more. From one administration at the federal and state levels to another. His bosses came and went. The things they stood for changed and changed, and tragedies happened. And he was still there in his old age, fighting the good fight.

As you might have guessed, anti-vaccine zealots from The Kid to the anti-Semitic jerks at Age of Autism are celebrating the Trump victory since Trump has questioned vaccines and has embraced certain anti-science people. Apparently, Andrew Jeremy Wakefield once posed for a picture a few feet away from Trump, so Trump is now likely to ban all vaccines everywhere for all time. Makes sense, right?

Much like their knowledge of vaccines, anti-vaccine activists show an ignorance of how public health works in America. The vaccine advisory committee is not made up of political appointees or partisans. It’s made up of experts on the subject matter. They recommend what vaccines to give to what age groups, and the recommendations are followed (or not) at the state and local level. In order to shut down all vaccines everywhere forever, anti-vaccine-obsessed people would need to convince all states and territories that the Earth is flat, or something just as ludicrous.

Could a Trump Administration pull the plug on funding? Yeah, maybe, but we’ve done a lot more with a lot less. (That’s what my old boss used to tell us stories about. One year, they had their budget cut by 70%, and they still managed to expand their services year after year, even if just a little bit.) See, unlike anti-vaccine activists, we in public health are not in it for the money. We don’t travel to far-away and very dangerous places for money. We are okay with being held at gunpoint when something gets lost in translation at a checkpoint in a banana republic because we know we’re there to serve, and, frankly, dying for what we do is a badge of honor. We’d become immortal if we ever die in the service of public health.

So, yeah, laugh it up, jerks. Write all your little blog posts about how beautiful it will be to live in a Trump-led world. (Spoiler Alert: He’s not leading anyone. He’s not a leader. It’s not some title you are given.) We will continue to vaccinate tomorrow, next year, and next century. We might stumble and fall here and there, yes. But, just when you celebrate at the thought of burying us, you will weep when you realize we’re seeds… When you realize what we’ve survived and, thus, what has made us stronger.

Just(in) asking questions

This is probably the last post I’ll write about Justin Kanew. The first post is here, and the second is here. In the first post, I explained to you how Mr. Kanew was slowly descending into anti-vaccine world. In the second, the conversion was nearly complete. So complete, in fact, that Andrew Wakefield was given a wide and full-of-praise interview by Mr. Kanew. To hide the fact that Wakefield was the main part of the show, Mr. Kanew made it seem like he was interviewing Brian Deer. But Brian Deer get the minority of air time.

It was an anti-vaccine show, is what I’m saying.

What does Brian Deer think of Mr. Kanew?

Wow.

Anyway, if there was any doubt that Justin’s conversion is complete, he decided to write yet another blog post on the notorious, anti-Semitic, vile anti-vaccine blog: Age of Autism. In it, he states that he can take the criticism he’s receiving:

“I should also say that in the 2 days since the first interview posted, I’ve found myself the target of ire from both sides. Anti-vaxxers are angry that my wife and I still plan to try to find a safe way to vaccinate our baby girl, while pro-vaxxers are angry that by doing these interviews I’m giving a platform to the makers of Vaxxed and like-minded anti-vaxxers.

It’s been heated, but it’s ok. I can take it. I’m a big boy. I knew this was a contentious comment, and I expected to hear a lot of what i’m hearing. It didn’t at all seem to be a reason not to talk about it, and if I’m being honest I sort of hoped to help facilitate a calmer conversation about it in however small a way, naive as that may have been.”

The “big boy” has been such a “big boy” about it that he has blocked multiple people who have attempted to reason with him. They have told him about the “vaccine court,” but he refuses to listen. They have told him that it’s not just the government and “big pharma” that does research on vaccine safety, but he refuses to listen. Plenty has been shared with him on why Ginger Taylor’s list of papers proving a link between vaccines and autism is just plain wrong. (Frankly, I doubt even The Ginge has read it.)

Justin Kanew is not a big boy. He’s a tool for the anti-vaccine forces now. He will regurgitate whatever they tell him, and he will pass it on to his friends in Hollywood. They will regurgitate it again. Wakefield et al will hit him up for cash, and he will oblige. And so it will go. Because he’s not “just asking questions”. He’s listening now only for the wrong and misguided answers.

Andrew Jeremy Wakefield wants rabies back

Known fraud and former physician, Andrew Jeremy Wakefield, recently had a picture taken of himself with a dog and a sign. Here it is:

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Tip of the hat to Ren, who found the picture on Facebook.

Andrew Wakefield seems to be the kind of person who has gone so far off the deep end in his anti-vaccine crusade that he is willing to do almost anything to continue the conspiracy. The man has used race baiting in the past. He’s spliced audio for his latest faux documentary. So why not pose with a “vaccine injured” dog to get a couple more bucks?

As if making children sick wasn’t bad enough, anti-vaccine zealots have been on a campaign of spreading their nonsense to pet owners. They claim all sorts of things about vaccines for pets like they do with vaccines for children. No, seriously, they claim dogs can be “brain damaged” and become aggressive if they are vaccinated. And now, Andrew Wakefield, the one quack to rule them all, is buying into the con.

Seriously, the man doesn’t know a con he doesn’t like, I bet.

But what if rabies came back? How bad could it be, really? After all, water sanitation and proper hygiene should hold it back, right?

Not quite. Rabies is transmitted through the bite of warm-blooded mammals. In North America, raccoons and bats make up most of the transmissions in animals. Because we do a bang-up job of vaccinating dogs and cats, and identifying exposures in the wild, human rabies is unheard of in the United States, Canada and Mexico. In places in the world where the resources are not there for veterinary public health, rabies still kills a lot of people.

When you hear these anti-vaccine loons clamor for no more vaccines for pets, please remind them what rabies looks like on a dog:

(Caution. Graphic content.)

And that’s just the first stages before the dog completely loses it and becomes violent. Here’s a violent cat with rabies:

(Again, graphic.)

But this next video is why I applaud vaccine manufacturers and veterinary public health workers. Because of their efforts, you can take your pet outdoors and not have to worry about them coming back and biting you, infecting you, with rabies. And, if they do catch rabies and they do bite you, there’s a vaccine that stops the infection in its tracks and keeps you from dying. Because death is certain without vaccines.

(Graphic, of course.)

Look, maybe some vaccine-preventable diseases are not as deadly as others. Maybe. They still cause disability and physical sequelae. But, for the sake of argument, let’s say that we as a society are okay with children being out of school and miserable with measles or chickenpox, and that we don’t care if children are born with deformities due to things like German measles.

But do you really want to gamble rabies? Do you really want your dog or cat to die from it like that? And do you want a person to die from it like that?

It looks like Andrew Wakefield does, and it doesn’t surprise me. He’ll do anything for glory and adulation from his followers.

The fantasies of the anti-vaccine crowd

I really feel bad for people who are deep into the anti-vaccine cult. It has got to be a horrible existence to have to explain away reality day after day. Vaccines do not cause autism, but they have to go to enormous lengths to try and convince themselves (and others) that vaccines do cause autism. They make really weird movies with really bad reviews. Then they show up in the comments section of the reviews to ask the reviewer how much they got paid by Big Bad Pharma to write the review. Because a mockumentary directed by a disgraced former physician who uses spliced audio as evidence of ultimate evil could not possibly get bad reviews.

As if that wasn’t bad enough, they try to convince themselves that Robert De Niro is still a supporter of the mockumentary. For example, “Tanner’s Dad” (aka “Tim”) sent out a tweet stating that Robert De Niro and his wife went to the premiere of the mockumentary:

If you can’t tell it’s a photoshopped picture, here’s a picture from the original event:

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The original event was a gala for Autism Speaks. After it was explained to Tim that the photograph was photoshopped, he claimed it was a “cruel” April Fool’s joke… One sent on April 2. Again, you have someone trying to explain away reality.

This is par for the course for the anti-vax crowd. Reality: De Niro took back his support for the quackumentary. Anti-vax Fantasy: De Niro showed up at the quackumentary’s premiere. Reality: The picture is fake. Anti-vax Fantasy: It was a cruel joke. (The equivalent to “my account’s been hacked!”)

Reality: Andrew Wakefield lost his medical license and was struck off the register. Anti-vax Fantasy: Big Pharma did it. Reality: Wakefield was trying to patent his own vaccine and discredit the existing one. AV Fantasy: Nah-nah-nah, I can’t hear you!

Seriously, pay close attention to everything the anti-vaccine cult members write or do or say. They’re constantly trying to explain away reality any way they can. I can’t imagine it’s an easy thing to do. They must be exhausted, and it must be a very scary world. At every turn, reality pops up and slaps them across the face, and they find themselves having to explain it away all over again.

Silly Bobby Junior wants to get sued

Over the weekend, a group of anti-vaccine activists gathered outside CDC headquarters to protest the manufactured controversy of the “CDC Whistleblower.” They had all of the usual anti-vaccine tropes. “Vaccines cause autism.” “There are too many vaccines given too soon to too many babies in too many places.” “Andrew Wakefield was right.” And so on.

Some of the conspiracy nuts there went as far as to say that a maintenance man who was cleaning a nearby wall was “literally” spraying them with water. No, seriously:

wtf_tim

Lucky for us, a skeptic was nearby with his handy iPhone and recorded the whole thing. Get ready for a yawn:

Remember that anti-vaccine activists don’t let reality get in the way.

Speaking of delusional, one of the speakers at the rally of about 100 people (because most people were stuck on buses on the way there, apparently), was one Robert F. Kennedy, Jr. Mr. Kennedy has gone deep, deep down the well of conspiracy theories. He is so far gone that he believes that he was vaccine injured. He believes that several people in his family were vaccine injured. If you can stomach it, listen to his speech at the rally:

He sounds a little disjointed to me. What do you think?

Anyway, aside from all the misinformation he imparts, the anecdotes and the outright lies, part of his spiel is that he wants to be sued by CDC scientists. He wants to be sued so that “the truth” comes out at trial. His followers are spreading this “dare” on social media:

rfk_challenge_2

When he said that, people in the audience lost their collective minds.

hysterical_laugh

Sorta like this.

The rest of the speakers gave out all of the usual anti-vaccine lies, and some even engaged in race-baiting (as did RFK Jr.) by saying that CDC knowingly “killed” (yes, they said “kill”) African American children.

But, no, Bobby Junior, no one is going to sue you. You’re going to be allowed to say these lies over and over again because of one simple reason: SCIENCE IS NOT SETTLED IN THE COURTS. From evolution to climate change, no amount of jury opinions or judgments will change the science. You can speak lawyer-speak until you’re blue in the face, and you will will not change the science of vaccines. You can continue to lie as much as you want because lies don’t change reality.

Vaccines save lives, Bobby Junior. Stop being silly.