Vaccinations appear to be the topic of the year with the recent outbreak of measles in California. Naturopathic Physicians are often unfairly assumed by the public to stand on the “anti-vax” side of the debate. What many people don’t realize, however, is that the College of Naturopathic Physicians of British Columbia (CNPBC), the governing body of our profession in BC, is far from being against immunizations. In fact, in British Columbia, some naturopathic doctors such as myself, even offer immunization services within their clinic.
The job of naturopathic doctors as primary healthcare providers is to provide informed consent to our patients about all aspects of treatment, including immunizations. This includes providing accurate information on the established pros and cons of vaccinations. Further, if an individual chooses to not vaccinate, it should be made known that naturopathic treatment is not a substitute for the security and effectiveness of vaccines.
No parents intentially want to harm their child. Whether a parent chooses to vaccinate or not vaccinate rests in their knowledge of the benefits and risks of vaccinations. However, conflicting information is rampant on the internet and leaves many parents confused about the safety of vaccinations. I am writing this post today with the hopes to clarify any confusion surrounding vaccines so that everyone can make an informed decision whether or not to vaccinate themselves or their children.
What are Vaccines?
There are three different types of vaccinations available: live attenuated vaccines, inactivated vaccines and subunit/conjugate vaccines.
Live Attenuated Vaccines
Live attenuated vaccines can be made for either bacterial or viral diseases but are more commonly used for viruses. This type of vaccine is composed of a weakened form of the virus/bacteria so that the body is able to naturally create an immune response without producing symptoms of the disease. A drawback to live vaccines is that they are more likely to produce side effects than other vaccine types. However, these side effects are usually short-lived and mild in nature. Once the immune system has created antibodies to the virus/bacteria, the body will be ready to fight off the disease immediately if it ever comes into contact with it in the future. As this type of vaccine is made of a live virus/bacterium, it is not recommended for people with weakened immune systems (e.g. those who are HIV positive or who are taking immunosuppressant medications). Measles, mumps, rubella, and varicella are examples of vaccines made from live, attenuated viruses.
Inactivated vaccines are made of dead bacteria or viruses. They generally have fewer side effects than live vaccines but they also tend to evoke a weaker immune response as well. Similarly to live vaccines, the immune response created with the administration of the vaccine will confer protection to any contraction of the virus or bacteria in the future. Polio, hepatitis A, rabies and typhoid are all preventable by vaccines made from inactivated viruses or bacteria.
Subunit/Conjugate vaccines are made of a specific protein or carbohydrate from viruses or bacteria that induces a protective immune response in the individual. Examples of subunit vaccines include influenza, pertussis and hepatitis B.
Understanding the Risks
Every action we take has risks. Here we compare the risks of the MMR vaccination with other kinds of risks per 1,000,000 people.
What Is in Vaccines?
There are a number of components of vaccines in addition to the immunogen (the live or inactive vaccine component). In recent years, there has been some concern raised about some additives such a thimerosal. Below you will find a list of the additives as well as any risks associated with them.
- Live attenuated virus
- Inactivated virus
2. Adjuvant aluminum salts are used to enhance the immune response by degree and/or duration. If the vaccine is delivered under the skin rather than into the muscle, a nodule can develop at the injection site from this adjuvant. However, this nodule will disappear over time. It is important to note that children are exposed to aluminum in the environment on a daily basis as it is found in air, water, food, breast milk and infant formulas. The amount of aluminum in a vaccine is similar to that in the infant formula a baby may drink in one day.
- Aluminum hydroxide
- Aluminum phosphate
- Potassium aluminum sulfate
3. Adjuvant MF59 is also used to enhance the immune response by degree and/or duration. MF59 is an oil (squalene) in water emulsion.
4. Preservatives are used to prevent bacterial or fungal contamination. In recent years there has been a great deal of opposition to the use of thimerosal, an ethyl mercury derivative, because of a theoretical risk of brain damage. Scientific evidence has refuted this risk. However, despite this, in Canada all routine childhood vaccinations (with the exception of influenza) are thimerosal free.
- 2 phenoxyethanol
5. All additives to the vaccinations are noted below. Most of these additives are removed in the manufacturing. Trace or residual amounts may remain in the final product and therefore there is some concern for those who are anaphylactic to these additives.
- Antibiotics prevent bacterial contamination during the manufacturing process
- Egg/yeast proteins, glycerol, amino acids, & enzymes are used to assist with the growth of viral vaccines
- Formaldehyde is used to inactivate virus and protein toxins; it is removed in the vaccine development process and only trace amounts are left in the vaccine. The body naturally creates formaldehyde as part of our normal metabolism and therefore, this ingredient is relatively safe aside from any allergies to it.
- Potassium/sodium salts, lactose, polysorbate 20/80, CTAB, gelatin, human and bovine serum albumin are used to confirm product quality or stability. There have been no documented cases of transmission of infectious agents by human serum albumin. In Canada, the bovine-derived reagents are manufactured from animals considered to be free of bovine spongiform encephalopathy (BSE).
- Sodium citrate and citric acid are used to buffer the pH
Relative Risks of Diseases & Immunizations
Now that you are aware of what vaccines are and what they are created from, we should discuss what risks vaccines carry. In order for you to make an appropriate informed decision on whether or not to vaccinate, you should be aware of what the documented side effects are, not only for the vaccine but for the disease as well. It is up to you to decide whether the risks of the vaccine outweigh the risks of the disease. In order to clearly outline this information, I have created a handy PDF document that you can access here: Relative Risks of Diseases & Immunizations
Addressing Immunization Concerns
Babies are born with thousands of antibodies which are ready to fight against many different diseases. The immune system can create an antibody response to several vaccines at one time.
Within the first two years of life, babies are most susceptible to severe consequences including death from vaccine-preventable diseases (especially encapsulated organisms such as HIB and meningococcal meningitis).
A number of studies have shown that the recommended vaccines are as effective in combination as they are individually and carry no greater risk for adverse reactions.
Vaccines do not weaken the immune system. Rather, they harness and train it to defend, rapidly, against vaccine-preventable pathogens before illness can occur.
There is no increased risk of autism with MMR vaccine. Twenty-three (23) studies have refuted a relationship between vaccines and autism.
Studies have shown that there is no link between thimerosal and autism. In the mid-90’s much of the increase in autism was due to a broader definition of autism. Except for the influenza vaccine, no childhood vaccine contains thimerosal in Canada.
Studies comparing vaccinated and unvaccinated individuals did now show any increase in chronic fatigue syndrome, MS or children with Type 1 diabetes.
- Due to public concern (not safety), thimerosal is no longer present in childhood vaccines, with the exception of influenza.
- Formaldehyde naturally occurs in the human body and helps with metabolism.
- Aluminum is the most abundant element in the earth and is found in air, food, and water.
- Vaccines do not contain human cells or tissues.
Natural infections from certain diseases can kill or seriously harm a child before their body is able to mount an effective immune response. The vaccine triggers your own body’s natural immune response into action to protect you against the morbidity and mortality associated with the disease.
Vaccine preventable diseases can kill you. Severe adverse events from vaccines are extremely rare and are closely monitored and tracked nationwide.
Weren’t these diseases declining before vaccination because of things like better sanitation and clean water?
With some diseases, the number of cases prior to immunization did not go down, just the number of deaths. Whereas with some diseases like polio, vaccinations decreased both cases and death. With other diseases, such as chicken pox, the number of cases and deaths did not decrease due to sanitation and clean water.
It is true that many diseases such as polio and diphtheria are becoming less common due to vaccinations. If we stop vaccinating, the diseases will come back. In developing countries, vaccine-preventable diseases continue to cause outbreaks. Given the high rate of international travel, some diseases are just a plane ride away.
A healthy lifestyle is important to help maintain your overall health. But this alone will not stop you from getting a vaccine-preventable disease. Previously healthy people die of vaccine-preventable diseases. For example, in the 1918 influenza pandemic, healthy, young adults died from influenza.
- Variant Creutzfeld-Jakob Disease (vCJD): gelatin used for vaccine production can be bovine-derived, but there are no reported cases of vCJD linked to immunizations. (Minor, 2001, p409; Offit, 2003, p1398)
- Chronic Fatigue Syndrome: there is no evidence of a cause-effect between hepatitis B vaccinations and CFS (CCDR, 1993, p314)
- Multiple Sclerosis: vaccination against hepatitis B, influenza, tetanus, measles, or rubella is not associated with an increased risk of multiple sclerosis or optic neuritis (DeStefano, 2003, p504)
- Multiple Sclerosis: commonly administered vaccinations (specifically against tetanus, hepatitis B and influenza) do not increase the risk of relapse in patients with multiple sclerosis. (Confavreux, 2001, p324)
- Chronic Fatigue Syndrome: In patients with CFS, influenza immunization is safe, not associated with any excess early reactions and stimulates an immunizing response comparable with that of healthy volunteers. (Sleigh, 2000, p267)
There is no evidence that influenza vaccines cause Alzheimers. In fact, vaccinations against diphtheria or tetanus, poliomyelitis, or influenza was associated with lower risk for Alzheimer’s disease than no vaccinations. (Verreault, 2001, p1497)
- 25% decrease in upper respiratory illness
- 43% decrease in absenteeism from work due to upper respiratory illnesses
- 36% decrease in absenteeism from work due to all illnesses
- 44% decrease in physician visits for upper respiratory illnesses
- Sometimes the vaccines we had as children/infants do not provide lifelong protection and booster doses are needed (e.g. diphtheria/tetanus vaccination every 10 years)
- Sometimes virus or bacteria strains that are circulating at one time may be different than previous strains (e.g. influenza vaccine strains change yearly; therefore, annual immunizations are needed)
- Sometimes the aging immune system becomes more susceptible to diseases that were less of a threat at an earlier age (e.g. shingles)
Yes. Advances in science have improved how vaccines are made. Vaccines now contain fewer substances to stimulate just the part of the immune system needed to provide protection. The best example of such a change is the pertussis (whooping cough) vaccine. The ‘whole cell’ vaccine used before 1997 contained about 3,000 proteins and polysaccharides from the whole pertussis bacterium. The vaccines used in Canada today contain only 3 to 5 proteins. These stimulate only the parts of the immune system needed for protection, and they cause fewer side effects.
No. Vaccines do not contain human or animal cells. The viruses needed to make some vaccines can only be grown in human or animal cells. After the virus has been grown, it is separated from the cells and used to make the vaccine. So while human or animal cells may be used in the earlier stages of making the vaccine, no cells are present in the final product or vaccine.
The MMR (measles, mumps and rubella) vaccine and the influenza (flu) vaccines contain egg protein. Egg protein is present in these vaccines because the viruses used to make them are grown in eggs (flu vaccine) or in cells taken from eggs (MMR vaccine). The amount of egg protein in the MMR vaccine is not harmful for children with egg allergies.
The influenza vaccines available in B.C. are either inactivated or live attenuated vaccines. All influenza vaccines currently available in Canada are produced using eggs. The inactivated influenza vaccines have been well studied in people with allergy to eggs including those with severe allergies. These inactivated vaccines can be safely given to people with egg allergies, and are given by injection. The safety of the live attenuated influenza vaccine (given by nasal spray) in people with egg allergies has not been well studied. If you have an allergy to eggs, you should not get the live attenuated influenza vaccine.
A life-threatening allergic reaction after getting a vaccine is rare – only one in a million chance. If this happens, it is most likely to occur within minutes after the vaccine is given. This is why you are asked to stay at the clinic or health care provider’s office for 15 minutes after your child has been immunized. Your healthcare provider is prepared to treat this reaction.
Resources for Further Information
- Canadian Coalition for Immunization Awareness & Promotion: immunize.ca
- Public Health Agency of Canada: phac-aspc.gc.ca
- Canadian pediatric society: caringforkids.cps.ca
- Center for disease control and prevention (US): cdc.gov
- National Network for Immunization Information (US): immunizationinfo.org
- Children’s vaccine programs (US and international partners): childrensvaccine.org
- Every child by two (US): ecbt.org
- World health organization: who.int/immunization
- Immunize BC: immunizebc.ca
- HealthLinkBC: healthlinkbc.ca
- Book: Gold, R. (2006): Your Child’s Best Shot. Canadian pediatric society, Ottawa.
I hope all of your concerns have been addressed in this article. If you have any further questions, please contact your healthcare provider to have your questions answered. As a community, we can work together to keep our children safe and healthy.
Yours in health,