You are here

Changing Disease Epidemiology Via Vaccines - Are We "Robbing Peter To Pay Paul"?

Daily News Navigator


If there ever has been a vaccine that, at least on the surface, looks like a hands-down success story, it would have to be the Hib vaccine, against haemophilus influenzae type b, a bacterial infection (in spite of its name), which can be serious and occurs primarily among children under 5 (although breastfeeding is an effective preventative).  The best known serious complication of this disease is meningitis, but other very major complications, including epiglottitis, pneumonia, and cellulitis also can result.

The vaccine, it would seem, has resulted in considerable reduction in disease incidence (">99% compared to the prevaccine era").

It is worth noting, however, that we really don't know all that much about the incidence of haemophilus influenzae b, particularly prior to vaccine licensure.  According to the CDC, "haemophilus influenzae infections became nationally reportable in 1991", although "several areas carried out active surveillance...which allowed estimates of disease nationwide".  And according to Ward and Zangwill in the 1999 Third Edition of "Vaccines", "invasive H. influenzae type b disease is not reliably reported nationally or internationally..." At best then, the actual incidence prior to introduction of the vaccine is only known for certain areas, and merely an estimate otherwise.  Remarkably, it is still not "reportable" in all states, even now. 

Also according to the CDC, Hib vaccines licensed for use in infants did not become available until 1990.  Since routine disease reporting and vaccination occurred almost simultaneously, it is hard to be certain about pre-vaccination incidence and, hence, how much post-vaccination declines are attributable to the Hib vaccine, particularly given that the first vaccine (HbPV - licensed in 1985) against this disease actually increased the likelihood of contracting the disease in some children older than 18 months.

As is often the case with vaccinations, once you look below the surface,  things are not always what they seem.  And what is beginning to emerge is disturbing.

Evidence is beginning to emerge that suppression of one serotype of bacteria via vaccination may merely result in one or more other serotypes gaining prominence.  Thus, for instance, while meningitis caused by the haemophilus influenzae type b bacteria may have declined, meningitis caused by other serotypes may be on the rise.  The same may hold true for pneumonia.

According to Hilary Butler, in her fascinating exposé of this issue, The Perilous HIB, just that very thing has been reported: "The June 1992 issue of Newsletter from the Journal of Paediatric Infectious Disease (JPID) stated: 'THE PERILOUS PNEUMOCOCCUS. We have great concern for the increasing prevalence of relatively or absolutely penicillin resistant pneumococci coupled with the increased relative frequency of pneumococcal diseases as a result of universal Haemophilus vaccination.'" (my emphasis)

We have seen the consequences of indiscriminate use of antibiotics in the appearance of drug-resistant strains of  bacteria.  Clearly bacteria are not passive recipients of our malevolent (at least to them) intent. 

Is one of the consequences of vaccination the manifestation of newly emerging or prominent diseases, including other forms of meningitis and pneumonia?  If so, then each time it happens, will the situation inevitably be viewed as requiring additional vaccine intervention?

How are we to determine if the use of one vaccine simply creates the need for another? Clearly, at a minimum, reporting of meningitis and pneumonia should be required, including of serotypes, in all states. Currently, only streptococcus pneumonia is a "notifiable disease", and all meningitis cases are lumped together.  (Note that according to the CDC, ""Serotype-specific reporting continues to be incomplete".)

This unending, growing apparent need for more and more vaccines clearly serves the interests of the vaccine manufacturers and those with financial ties to them.  But what about the rest of us?

If it is true that we are merely swapping out one serious disease for another, and in the process creating a growing need for more and more vaccines, how do we put a stop to this vicious cycle?  If  we don't find a way, will there be no end to the number and kinds of vaccines we are urged, even required, to get?

Sandy Gottstein

Date: 11-1-2002

"Eternal vigilance is the price of liberty." - John Philpot Curran (1808)