Saturday, February 16, 2008

Vaccination policy lags behind vaccine science

December 09, 2007Vaccination policy lags behind vaccine science
by Teresa Binstock December 9, 2007
http://ravenintelle ctions.typepad. com/from_ the_desk_ of_teresa_ b/2007/12/ vaccination-pol.htmlination-pol. html

Although vaccinologists have long enjoyed the prominence of their field'sorthodoxy, skepticism is arising in respected venues. The British MedicalJournal allows the question, "Are US flu death figures more PR thanscience?" and the journal Vaccine presents an article titled, "Why isevidence-based medicine so harsh on vaccines?"

Debate about the safety ofvaccinations continues. Many parents believe their child's neurologic, behavioral, or certain otherphysiological problems were caused or exacerbated by vaccinations. The CDC,which receives gargantuan funding to promote vaccinations (1-2), assuresthe public of their safety. Despite these assurances, a reporting systemfor vaccine-related adverse effects exists (3-4). A growing body ofmedical research suggests that subgroups of individuals can be adverselyaffected by environmental exposures that, for most people, seem not togenerate untoward effects (eg, 5).

Consider some new words: pharmacogenomics, pharmacogenetics, andnutrigenomics. Each calls attention to the interplay between environmentalfactors and the human genome. Pharmacogenetics refers to how drugs interactwith various gene alleles. An example is that some people detoxify ananti-cancer drug before it can do its work. Conversely, some individualsdetoxify a given drug so poorly that a therapeutic dose normal for mostpeople is far too high. Nutrigenomics refers to relationships among properlevels of intra-body nutrients, a person's gene alleles, and his or herneed for nutritional boosting of one metabolic pathway or another (6). Theword toxicogenomics refers to the interplay between gene alleles andenvironmental chemicals (5). Each of these fancy words has an inherentprinciple. People are not identical. There is much inter-individualvariation in the human genome, and these differences often cause peoplerespond to differently to otherwise similar chemical exposures. A majorramification is that medical treatments based upon a "one size fits all"policy often create problems for some individuals. This may be what isoccurring as childhood vaccinations become more numerous.

In fact, the new insights about pharmacogenomics and nutrigenomics ought beapplied to the nation's vaccination policy. Might subtle genetic variationsaccount for why some children experience adverse reactions to vaccinations?If so, are one-size-fits- all mandates for vaccinations likely to injuresome children? Ought a sick child not be vaccinated? Certainly, somecontraindications against vaccinations are known and declared, but findingsin pharmacogenomics and nutrigenomics suggest that officially declaredvaccination contraindications circa 2007 may be insufficient for protectinginfants and toddlers whose gene alleles and nutritional status indicateenhanced likelihood of risk. These concerns are not theoretical.

Vaccine guidelines are virtually compulsory in most states. Most parentsare informed that they consent. School attendance is one of the primarylevers by which vaccinations are enforced. Recently, Maryland prompted aflurry of news articles describing school-related vaccination- enforcement(eg, 7). Similarly, New Jersey is likely to add four vaccinations asconditions for preschool and kindergarten registration (eg, 8). Theseevents proceed even as many physicians, researchers, and parents questionthe wisdom of infants, toddlers, and young children receiving so manyvaccinations so early in life.

Gregory A. Poland, M.D., is a Mayo researcher. He and his colleagues havepublished numerous findings about gene alleles and their effects upon anindividual's ability to produce titers to vaccinal antigens. Needless tosay, their research and similar studies by others help us understand thegenomic basis for inter-individual responses to vaccinations (eg, 9-19).Some individuals are low responders, they hardly generate a titer to avaccinal antigen. Other individuals are high responders, they generateantibody responses far higher than normal. These differences providepossible clues regarding why vaccinations are not safe for every child, whymany parents describe post-vaccinal adverse effects, and do so while theCDC and AMA continue to trumpet vaccine safety, even as some states seekincreased enforcement of compulsory vaccinations in accord with aone-size-fits- all policy.

For more than ten years, many parents of autistic children have purchasedtiter-based immune screens for vaccinal antigens and for herpes viruses.Many such parents report that their autistic child who had been vaccinatedhas one or several missing titers for a vaccinal antigen. Since somevaccines contain live-viruses (described as attenuated), if someindividuals have one or more alleles that impair immune responses to aspecific vaccine's antigen, might that vaccine's live-virus be effectivelyless attenuated for that subgroup of individuals? Since some viruses areknown to have the potential of affecting the central nervous system ofhumans (20-26), would vaccinal injections with attenuated versions of thoseviruses be more likely to generate adverse effects in individuals withmissing or weak titers against those viruses? As suggested by findings inpharmacogenetics and in the work of Dr. Poland and colleagues, the answermay well be Yes! Some individuals are likely to be affected by injectionsof live-viruses, even those claimed to be attenuated. Furthermore, thework of Merrill Chase and others has made clear that a missing titer mayrepresent additional immune weaknesses.

The findings mentioned in this brief essay indicate an important concern.Is enforcement of a one-size-fits- all vaccination policy certain to induceadverse effects in some children? Again, the answer appears to be Yes.Perhaps the policy of enforcing mandatory vaccinations needs be tempered bygenomic testing of children so that individuals with relevant alleles orweakened immunity can be identified before they are placed at risk byvaccination incidents. Such testing would not be inexpensive, butestablishing a pre-vaccination testing policy might reduce the number ofadverse events and thus inhibit the growing costs of long-term care forseverely affected individuals.
Teresa Binstock
1. http://www.iom.%20edu/Object.%20File/Master/%2019/029/0.%20pdf
4. http://www.nvic.%20org/
5. Toxicogenomics: a pivotal piece in the puzzle of toxicologicalresearch. Gatzidou ET et al. J Appl Toxicol. 2007 Jul-Aug;27(4) :302-9.
6. Nutrigenomics: The Genome–Food Interface
7. http://www.nytimes.%20com/2007/%2011/18/us/%2018vaccine.%20html?fta=
8. http://www.nytimes.%20com/2007/%2012/09/nyregion/%2009vaccine.%20html
9: Variation in vaccine response in normal populations. Pharmacogenomics.2004 Jun;5(4):417- 27.
10: The genetic basis for measles vaccine failure. Acta Paediatr Suppl.2004 May;93(445): 43-6; 11: Correlations among measles virus-specific antibody,lymphoproliferation and Th1/Th2 cytokine responses followingmeasles-mumps- rubella-II (MMR-II) vaccination. Clin Exp Immunol. 2005Dec;142(3):498- 504.
12: Human leukocyte antigen polymorphisms: variable humoral immuneresponses to viral vaccines. Expert Rev Vaccines. 2006 Feb;5(1):33- 43.
13: Human leukocyte antigen haplotypes in the genetic control of immuneresponse to measles-mumps- rubella vaccine. J Infect Dis. 2006 Mar1;193(5):655- 63. Epub 2006 Jan 27.
14: Immune activation at effector and gene expression levels after measlesvaccination in healthy individuals: a pilot study. Hum Immunol. 2005Nov;66(11):1125- 36. Epub 2006 Jan 4.
15: Importance of HLA-DQ and HLA-DP polymorphisms in cytokine responses tonaturally processed HLA-DR-derived measles virus peptides. Vaccine. 2006Jun 19;24(25):5381- 9. Epub 2006 May 3.
16: Associations between measles vaccine immunity and single-nucleotidepolymorphisms in cytokine and cytokine receptor genes. J Infect Dis. 2007Jan 1;195(1):21- 9. Epub 2006 Nov 20.
17: Human leukocyte antigen and interleukin 2, 10 and 12p40 cytokineresponses to measles: is there evidence of the HLA effect? Cytokine. 2006Nov;36(3-4): 173-9. Epub 2007 Jan 17.
18: Variations in measles vaccine-specific humoral immunity bypolymorphisms in SLAM and CD46 measles virus receptors.J Allergy ClinImmunol. 2007 Sep;120(3):666- 72. Epub 2007 Jun 8.
19: Heterogeneity in vaccine immune response: the role of immunogeneticsand the emerging field of vaccinomics. Clin Pharmacol Ther. 2007Dec;82(6):653- 64. Epub 2007 Oct 31.
20. Measles virus in the CNS: the role of viral and host factors for theestablishment and maintenance of a persistent infection. J Neurovirol. 1999Dec;5(6):613- 22.
21. Increase in adhesion molecules in cerebrospinal fluid of children withmumps and mumps meningitis. Scand J Immunol. 2006 Oct;64(4):420- 4.
22. An adult case of mumps brainstem meningoencephalitis with a pastmeasles-mumps- rubella (MMR) vaccination. Korean J Intern Med. 2006Jun;21(2):154- 7.
23. Neurological aspects of rubella virus infection. Intervirology.1997;40(2-3) :167-75.
24. Congenital rubella syndrome due to infection after maternal antibodyconversion with vaccine. Jpn J Infect Dis. 2003 Apr;56(2):68- 9.
25. Congenital rubella syndrome despite repeated vaccination of the mother:a coincidence of vaccine failure with failure to vaccinate. Acta Paediatr.1994 Jun;83(6):674- 7.
26. Complications of varicella in children: emphasis on skin and centralnervous system disorders. J Microbiol Immunol Infect. 2000 Dec;33(4):248- 52
27. Polymerase chain reaction analysis and oligoclonal antibody in thecerebrospinal fluid from 34 patients with varicella-zoster virus infectionof the nervous system. J Neurol Neurosurg Psychiatry. 2006 Aug;77(8):938- 42.

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