Newsgroup: it.scienza.medicina
Titolo: e di questa che dite??

Public Health Risks of Not Vaccinating Children
To the Editor: The article on vaccine "exemptors" by Dr Feikin and
colleagues1 concludes that 11% of the vaccinated children who contracted
measles (11% of 137 during a 12-year period, or about 1.25 per year) were
infected by an exemptor. The annual risk that a vaccinated child would
contract measles from an exemptor would thus be about 1 in 1 million if the
incidence were equal in all years. It isn't. There were 55 622 cases of
measles reported nationwide from 1989-1991, and 326 from 1997-1999. Is the
reason the authors chose to use the years 1987-1998 for measles, when the
period 1996-1998 was used for pertussis, to include the 1989-1991 measles
epidemic?
In 67% of the cases of measles in vaccinated children, the exposure source
was unknown. It seems likely that many of these cases were related to
importation, since most cases of measles are now traced to importation,
according to the Centers for Disease Control and Prevention's Pink Book.2
The article implies that exemptors are causing injury to vaccinated
individuals. In fact, the risk of serious permanent harm from contact with
exemptors is minuscule (less than 1 in 1 billion, if the incidence of
serious complications of measles is about 1 in 1000) and is not even
estimated by the authors. Moreover, any risk imposed by exemptors on others
is at least 2 orders of magnitude less than the risk they willingly assume
themselves. Everyone imposes much greater risk on others in many other ways,
such as by driving a car rather than using public transportation. Should
society therefore forbid automobiles?
The final decision concerning children's medical care should be made by
parents with the advice of their own physicians. This article provides no
justification for abridging the right of parents and patients to decline
giving informed consent to measles-mumps-rubella or pertussis vaccines.
Jane M. Orient, MD
Association of American Physicians and Surgeons
Tucson, Ariz
1. Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE.
Individual and community risks of measles and pertussis associated with
personal exemptions to immunization. JAMA. 2000;284:3145-3150. ABSTRACT  |
FULL TEXT  |  PDF  |  MEDLINE
2. Epidemiology and Prevention of Vaccine-Preventable Diseases. 6th ed.
Washington, DC: Public Health Foundation; 2000:124.
To the Editor: I was dismayed at the recommendation by Dr Feikin and
colleagues1 that legislators require evidence of the strength of parents'
religious convictions for obtaining exemptions from immunizations. Such a
policy, in my view, will intensify resentment and hostility to immunization
programs. It treats Christian Scientists and some other religious groups as
privileged elites, while parents who would like to claim a "philosophical"
exemption because of their fears of adverse reactions to vaccination are not
allowed the exemption.
A far better policy would be to repeal all religious and philosophical
exemptions from immunizations and also for state legislatures to "use the
criteria of severity, contagion, and effectiveness prior to mandating [a]
vaccine for all children," as Edwards2 recommends. Immunization programs
will be more appreciated by the public if they are based on science that is
explained to the public and not on religion.
The courts have never held that the First Amendment guarantee of freedom of
religion includes a right to deprive a child of preventive or therapeutic
health care. Indeed, in 1979 the Mississippi Supreme Court ruled the state's
religious exemption to immunizations unconstitutional because it
discriminated against both unvaccinated and vaccinated children.3 "Innocent
children, too young to decide for themselves," the Supreme Court wrote,
should not "be denied the protection against crippling and death that
immunization provides because of a religious belief adhered to by a parent
or parents." It further ruled that the exemption discriminated "against the
great majority of children whose parents have no such religious
convictions."
Salmon et al4 estimated that children with a religious or philosophical
exemption to immunizations are 35 times more likely to contract measles than
are vaccinated children. Feikin et al1 found that exemptors were 22.2 times
more likely to contract measles.
Why should society have laws that place one group of children at a 3500%
higher risk of contracting a dangerous disease? Children have Fourteenth
Amendment rights to equal protection of the laws and no child should be
deprived of the protection afforded by immunizations mandated by law, unless
they are medically contraindicated.
Rita Swan, PhD
Children's Healthcare Is a Legal Duty Inc
Sioux City, Iowa
1. Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE.
Individual and community risks of measles and pertussis associated with
personal exemptions to immunization. JAMA. 2000;284:3145-3150. ABSTRACT  |
FULL TEXT  |  PDF  |  MEDLINE
2. Edwards KM. State mandates and childhood immunization. JAMA.
2000;284:3171-3172. FULL TEXT  |  PDF  |  MEDLINE
3. Brown v Stone. 378 So2d 218 (Miss 1979).
4. Salmon DA, Haber M, Gangarosa EJ, Phillips L, Smith NJ, Chen RT. Health
consequences of religious and philosophical exemptions from immunization
laws: individual and societal risk of measles. JAMA. 1999;282:47-53.
ABSTRACT  |  FULL TEXT  |  PDF  |  MEDLINE
In Reply: Parents should be informed of the risks and benefits of
immunization, including both the risks of severe adverse events related to
vaccination (which have been shown in multiple studies to be rare) and the
risks of not vaccinating. Pertussis and even measles infections still occur
in the United States and pose risks both to the individual and to the
community, especially in the setting of reduced frequencies of vaccination
against these diseases. We chose to use the years 1987-1998 for the measles
analysis because we had data from those years. Moreover, the relative risk
of measles among vaccinated and unvaccinated children would not be affected
by the outbreak period. In mentioning the 55 622 cases of measles that
occurred during 1989-1991, Dr Orient highlights the threat of measles in the
absence of an effective vaccination program. She incorrectly suggests that
most of the 67% of vaccinated children in measles outbreaks who had an
unknown exposure source were not exposed to exemptors but rather to
internationally imported cases. In fact, few of these individuals were
likely exposed to imported cases since these only accounted for 5% of
measles cases among children in Colorado during 1987-1998 while exemptors
accounted for 22% of cases. Orient also points out that the risk of disease
among exemptors in our study was several times higher than that imposed by
exemptors on vaccinated children. Although she asserts that the risk of
measles in a vaccinated child exposed to an exemptor is small, this does not
mean that it is acceptable. This risk would most likely be greater for other
vaccine-preventable diseases that are more common than measles, such as
pertussis, varicella, and pneumococcal diseases.
We concur with Dr Swan that "immunization programs will be more appreciated
by the public if they are based on science that is explained to the public.
... . ." We hope our results will contribute to this. When we referred to
strength of conviction in claiming personal exemptions, we did not intend to
legitimize religious exemptions over philosophical exemptions. We meant that
parents should not be making decisions about vaccination based on
convenience but, rather, should be given adequate information and counseling
before deciding to withhold vaccination from their children.
Daniel R. Feikin, MD, MSPH
Robert T. Chen, MD, MA
Centers for Disease Control and Prevention
Atlanta, Ga
Daniel A. Salmon, MPH
Johns Hopkins University School of Hygiene and Public Health
Baltimore, Md
Richard E. Hoffman, MD, MPH
Colorado Department of Public Health and Environment
Denver
JAMA
Vol. 285 No. 12,
March 28, 2001

...
Salve Maurizio e bentornato  :-))
Un bell'argomento di discussione. Però sarebbe giusto che, per
l'universale comprensione e per il rispetto allo spirito del NG, tu
non ti limitassi a postare articoli ma esprimessi una tua opinione in
merito per impostare una discussione. Avrei molte cose da dire (come
ben sai) ma preferisco attendere da te un commento a quanto hai
postato  :-)))
A disposizione
Docpocket


ciao maurizio

tutti i giorni per mangiare....... [CUT]
Una bella metafora che userò anch'io in seguito (se non ti dispiace)
per esporre le mie idee.  :-)))
Io credo fermamente nell'utilità dei vaccini come enhancers
dell'immunità naturale e come (soprattutto) preventivi nei confronti
di malattie mortali o invalidanti.
Quello che non ritengo logico è il modo con cui vengono utilizzati.
Vengo al discorso riprendendo il tuo esempio della gente che beneficia
della macchina per migliorare le sue condizioni di vita (e per non
morire di fame). Ti renderai conto che, implicitamente, il mezzo per
procurarsi più facilmente da mangiare è utile solo per quelli che non
hanno (ad esempio) l'orto sotto casa  :-)))
Questi ultimi non hanno certo bisogno della macchina per procurarsi il
cibo e non morire di fame  :-))))
Perchè costringerli a comperarla? In questo caso comporterebbe loro
soltanto oneri  :-)))
Torno al pratico: i vaccini (mirati) dovrebbero (per tantissime
ragioni) essere usati con criterio. Esistono categorie a rischio
(specifico o generico) per contrarre determinate malattie? certamente!
Allora questi (che non hanno l'orto) andranno forniti dei mezzi idonei
alla prevenzione delle medesime.
Perchè faccio questo discorso? Semplicemente per il fatto che i virus,
i batteri, ecc., esattamente come noi "organismi superiori", si
adattano all'ambiente. Il loro humus è rappresentato dagli organismi
superiori, ovviamente (cioè anche noi umani). Una popolazione
altamente vaccinata tende a selezionare ceppi "resistenti", quindi a
dare origine a nuovi gruppi di germi capaci di indurre la malattia
anche in presenza di anticorpi  :-))
Attenzione: questo non lo dico io perchè mi sono alzato male
stamattina: questo lo dice la biologia  :-)))
Ora: quando vedo scrivere da qualcuno che gli exemptors hanno
contagiato i vaccinati i quali, nonostante la copertura, si sono
ammalati, mi viene un pò da ridere (a denti stretti, per la verità).
E' testimoniato infatti che (ad esempio) il ricircolo dell'OPV in
popolazioni altamente vaccinate, ha provocato una virulentazione
dell'OPV stesso il quale ha iniziato a comportarsi da virus selvaggio
MUTANDO le sue caratteristiche e quindi acquisendo la capacità di
infettare sia i non vaccinati che (udite, udite) i vaccinati!!!
E' testimoniato anche che la vaccinazione antiepatite ha selezionato
un virus (sempre dell'epatite) mutato....
Cosa voglio dire con questo?
Semplicemente che i vaccini sono un mezzo e non un fine e che
l'eradicazione degli agenti infettivi dalla faccia della terra è una
pia illusione. Gli agenti eziologici delle malattie infettive vogliono
VIVERE (esattamente come noi) quindi EVOLVONO in conseguenza di mutate
condizioni ambientali. Vaccinando a largo strato, i passaggi tra gli
individui possessori di anticorpi portano inevitabilmente a mutazioni
che rendono inattaccabili le generazioni future di virus e
batteri.....
Come? Ad esempio instaurando una condizione di "portatore sano"......
I virus iniettati con le vaccinazioni antimorbillose continuano ad
essere eliminati per molto tempo dopo l'avvenuta vaccinazione. Ciò
significa che rimangono in equilibrio con l'ospite....ti dice nulla
questo fatto?  :-)))
Questo vale anche per l'OPV.....e per tutte le vaccinazioni a base di
germi vivi attenuati.
Per ciò che attiene ai vaccini ricombinati, converrai con me che per
gli agenti eziologici è ancora più semplice mutare, visto che
l'immunità indotta da questi preparati è, per definizione, rivolta
verso alcuni degli antigeni determinanti e non tutti, come nel caso
della profilassi con microrganismi interi. Lo stato di portatori sani
è ancora più facile da instaurare  :-))))
Come concludo questo mio piccolo commento? Auspicando uno sviluppo
maggiore (ed una ricerca più accurata) nel campo dell'epidemiologia.
Chi è a rischio (per motivi personali, ambientali, socio-economici,
igienico-sanitari) va vaccinato....gli altri vanno sorvegliati. Per
tutti, inoltre, è opportuno creare condizioni favorevoli A MONTE
(stato di nutrizione, igiene, istruzione, prevenzione, ecc.) in modo
da rendere meno probabili epidemie e contagi   :-)))
Un caro saluto
Docpocket (che rimane conunque a disposizione per un'ulteriore
eventuale prosecuzione della discussione)