LDS Religious Exemptions from Vaccination

[bluebell]

1 hour ago, pogi said:

That must be a myth going around.  The church might require regular childhood immunizations for service to those areas and perhaps a meningococcal vaccine, but no travel related vaccines are required.  There is no risk or requirement for yellow fever, Japenese encephalitis, or typhoid vaccines. 

Not a myth.  I saw the papers myself, outlining what vaccines were required.  It was a couple decades ago though so things could have changed.

[Calm]

Pogo, I am not an automatic proponent of vaccines these days.  I have a good friend who was among four left living of his first grade class three years after they were used as test subjects for a polio vaccine.  And he was the only one not in a wheelchair.  Major problems all his life.  Much, much, much more careful now, so I never go first to don't get it, but I have had a 40 year history of doctors just assuming the status quo was fine and because they didn't look just a wee bit deeper when I asked them to or refuse to go to the second acceptable drug family when I informed them I was not tolerant of most acceptable drugs (vomiting, migraines, severe pain with the first three of the four drugs....but no, insisted I suffer through another three months trying to get sued to the last version and only projectile vomiting convinced her and still she put me on a halfassed version) so I do my own homework and will drop a doctor if they refuse to deal with the negatives and instead act like there is something wrong with me that will somehow magically change if required to.

I probably wouldn't get most flu shots as I don't get flus that bad and much more important, it is easy for me to socially withdraw making me low risk for others, but now I am caregiver to both my diabetic daughter who got hospitalized last year for the first time with low blood sugar due to vomiting and my 86 year old mom whose hip surgery requires antibiotics if she gets sick and she and antibiotics don't get along.  Plus Dad dying of a rotavirus that then swept through our family and a friend has made me aware that the risk is still there.  So now I am religious about that.

Edited November 14, 2016 by Calm

[pogi]

2 hours ago, ERMD said:

That's what I thought.  If you're going to try to use statistics to prove a point, you need an understanding of statistics.  You are claiming that data state something that is contrary to what it is actually stating.

Medical literature does not always use a p value.  They sometimes use a p value, they sometimes use a confidence interval, and they sometimes use both.  You don't need a p value when you are given a confidence interval to determine statistical significance.

To be clear, the risk for death is not statistically significant at a 95% confidence interval but it would be at about a 90% confidence interval.  In other words we are 90% confident that rotavirus causes death from pneumonia at 1.74 times the rate of placebo (RR: 1.74)

Edited November 14, 2016 by pogi

[pogi]

2 hours ago, ERMD said:

If you're going to cut and paste, use the entire quote.  Again, reality is different from the point you are trying to make.  I don't know what your background or area of expertise is, but it is certainly not medicine, and you are promulgating some very bad information.

You are out of your league here.

Please be specific, where is the "bad" information I am promulgating?  You asked for a CFR and I gave you one.  I have not lied or given false information.  The rest of the information you posted from that link does not contradict the simple fact that I made.

Vaccination is my area of expertise.

Edited November 14, 2016 by pogi

[pogi]

2 hours ago, bluebell said:

Not a myth.  I saw the papers myself, outlining what vaccines were required.  It was a couple decades ago though so things could have changed.

That is bizarre!  Maybe they had a rare typhoid outbreak at the time.  There are other travel related vaccines recommended for Africa and South America, but no other ones could possibly be recommended for Montana/Washington.  The vector for yellow fever is the Aedes mosquito (the same one spreading Zika), it does not live that far North in the US.  We have not had yellow fever in the US since 1905.  Japenese encephalitis is also a mosquito bourn illness that is only transmitted in parts of Asia. 

[bluebell]

41 minutes ago, pogi said:

That is bizarre!  Maybe they had a rare typhoid outbreak at the time.  There are other travel related vaccines recommended for Africa and South America, but no other ones could possibly be recommended for Montana/Washington.  The vector for yellow fever is the Aedes mosquito (the same one spreading Zika), it does not live that far North in the US.  We have not had yellow fever in the US since 1905.  Japenese encephalitis is also a mosquito bourn illness that is only transmitted in parts of Asia. 

We were making fun of the sisters (kindly of course) in the MTC who were going there because they had to get so many more shots than we did going to California.  

[ERMD]

16 hours ago, pogi said:

Please be specific, where is the "bad" information I am promulgating?  You asked for a CFR and I gave you one.  I have not lied or given false information.  The rest of the information you posted from that link does not contradict the simple fact that I made.

Vaccination is my area of expertise.

If I may ask, what is your training?

 

[pogi]

26 minutes ago, ERMD said:

If I may ask, what is your training?

RN BSN certified with the International society of Travel Medicine (ISTM).

[SeekingUnderstanding]

On 11/8/2016 at 0:21 PM, pogi said:

You didn't read both links:

"During the entire course of 8 clinical studies, there were 68 (0.19%) deaths following administration of ROTARIX (N = 36,755) and 50 (0.15%) deaths following placebo administration (N = 34,454). The most commonly reported cause of death following vaccination was pneumonia, which was observed in 19 (0.05%) recipients of ROTARIX and 10 (0.03%) placebo recipients (Relative Risk: 1.74, 95% CI: 0.76, 4.23)."

 

 

 

 

18 hours ago, pogi said:

Medical literature does not always use a p value.  They sometimes use a p value, they sometimes use a confidence interval, and they sometimes use both.  You don't need a p value when you are given a confidence interval to determine statistical significance.

To be clear, the risk for death is not statistically significant at a 95% confidence interval but it would be at about a 90% confidence interval.  In other words we are 90% confident that rotavirus causes death from pneumonia at 1.74 times the rate of placebo (RR: 1.74)

Now you are just making stuff up. The article you linked to says that we are 95% sure the relative risk of death is between 0.76 and 4.23 for the vaccine. It doesn't list a 90% confidence interval. There is not enough evidence based on this study to conclude the risk of death is statistically different between the two groups. 

 

On the larger issue you are right to a point. As the number of vaccinated people goes up, the risk of disease goes down. As the rate of disease approaches zero the side effects of the vaccine will do more harm than the disease itself in the population. The problem is that this only stays true if people get vaccinated. An individual can make a choice not to vaccinate for serious diseases in America. In theory this individual choice lowers the risk for that individual. The problem is that as more and more people make this choice, the system breaks down and you start having disease outbreaks. It's not just yourself that you put at risk either, its the entire population. Polio vaccine after 3 does has a 98% efficacy. So in a polio epidemic, a vaccinated individual still has a chance (small but significant) of catching the disease. Additionally there are at risk populations that for one reason or another can't vaccinate (too young, immune system too fragile) that an unvaccinated person selfishly puts at higher risk.

If an individual want to check out of society, home school, avoid public places, etc then I have no issues with them not vaccinating. Otherwise the decision not to vaccinate is an extremely selfish one. 

[pogi]

2 hours ago, SeekingUnderstanding said:

Now you are just making stuff up. The article you linked to says that we are 95% sure the relative risk of death is between 0.76 and 4.23 for the vaccine. It doesn't list a 90% confidence interval. There is not enough evidence based on this study to conclude the risk of death is statistically different between the two groups. 

I am not making stuff up.  First of all, it doesn't say that the relative risk is between 0.76 and 4.23, that is the confidence interval.  The relative risk was 1.74 if I remember correctly.  A higher level of confidence, say 95% for example, will mean a wider interval 0.76 - 4.23.  A lower level of confidence will shorten the interval.   In this case, a slightly lower level of confidence will cause the lower number in the interval to be greater than 1.0 making it statistically significant.  The higher number will be slightly below 4.0. 

I have more to address, but it will have to be later.

Edited November 15, 2016 by pogi

[pogi]

4 hours ago, SeekingUnderstanding said:

On the larger issue you are right to a point. As the number of vaccinated people goes up, the risk of disease goes down. As the rate of disease approaches zero the side effects of the vaccine will do more harm than the disease itself in the population. The problem is that this only stays true if people get vaccinated. An individual can make a choice not to vaccinate for serious diseases in America. In theory this individual choice lowers the risk for that individual. The problem is that as more and more people make this choice, the system breaks down and you start having disease outbreaks. It's not just yourself that you put at risk either, its the entire population. Polio vaccine after 3 does has a 98% efficacy. So in a polio epidemic, a vaccinated individual still has a chance (small but significant) of catching the disease. Additionally there are at risk populations that for one reason or another can't vaccinate (too young, immune system too fragile) that an unvaccinated person selfishly puts at higher risk.

If an individual want to check out of society, home school, avoid public places, etc then I have no issues with them not vaccinating. Otherwise the decision not to vaccinate is an extremely selfish one. 

You make fair points here.  It is true that fewer vaccinated people will likely lead to increased rates of disease (predominantly among the unvaccinated).  Keep in mind however, that states that allow for personal or philosophical exemptions have vaccination rates that are fairly comparable with national averages.  In other words, the people who do not want to get vaccinated are not getting vaccinated in those states, so there is no evidence to suggest that removing the mandate will significantly effect national vaccine rates.  

A small outbreak in disease will always lead to a dramatic increase in vaccination rates.  Take the example of measles in Disneyland, that one outbreak caused a significant increase in MMR rates across America.  That's the way it works, the system will always self-correct to keep the risks in balance.   Americans are generally pro-vaccine and consider the risk level of vaccination low enough to not cause anxiety.  In my experience, most people are more afraid of disease than vaccination, even when shown the risks for both.

Polio is virtually non-existent anywhere in the world.  There were only a handful of cases in the entire world in 2015 (I think it was below 30), limited to Afghanistan and Pakistan.  Epidemic activity is non-existent.  You are actually more likely to get polio from the live oral polio vaccine than from the disease itself.

As far as selfishness goes, it really goes both ways.  Insisting that my child be put at greater risk of death in order to protect your child from diarrhea is equally, if not more selfish in my mind. 

The pertussis vaccine creates silent carriers who unknowingly spread the disease.  This vaccine is thought to be partly responsible for increased pertussis rates across America.  Using your same argument, perhaps it is selfish to get your kid vaccinated with the pertussis vaccine.  You see, it is not as black and white as most people make it out to be.   

Edited November 15, 2016 by pogi

[SeekingUnderstanding]

4 hours ago, pogi said:

I am not making stuff up.  First of all, it doesn't say that the relative risk is between 0.76 and 4.23, that is the confidence interval.  The relative risk was 1.74 if I remember correctly.  A higher level of confidence, say 95% for example, will mean a wider interval 0.76 - 4.23.  A lower level of confidence will shorten the interval.   In this case, a slightly lower level of confidence will cause the lower number in the interval to be greater than 1.0 making it statistically significant.  The higher number will be slightly below 4.0. 

I have more to address, but it will have to be later.

This just shows a fundamental misunderstanding of statistics. We can't study everyone, so we take samples. We know going in that the sample will have some relationship with what actually happens in the real world, but its not an exact science. There is uncertainty. That's what a confidence level represents. The RR from the study you sited was 1.74 (please also note that this looks at actual deaths within 30 days of the study so trying to compare it to a life time reduction in the possibility of getting the disease is not possible). Based on this study we cannot state with certainty that the risk of death in the vaccinated group is any higher than that of the control group. It might be higher. It might be lower. Based on the sample size and the study, we can be reasonably certain (95%) that the RR of death is between 0.76 - 4.23. That is all we can conclude from this. The two death rates are not statistically different. Period. If you want to show that you are going to need a much larger study. 

 

Edited to add: You'll note the actual scientists doing the work did not note a statistical difference between the death rates.

Edited November 15, 2016 by SeekingUnderstanding

[SeekingUnderstanding]

2 hours ago, pogi said:

You make fair points here.  It is true that fewer vaccinated people will likely lead to increased rates of disease (predominantly among the unvaccinated).  Keep in mind however, that states that allow for personal or philosophical exemptions have vaccination rates that are fairly comparable with national averages.  In other words, the people who do not want to get vaccinated are not getting vaccinated in those states, so there is no evidence to suggest that removing the mandate will significantly effect national vaccine rates.  

The anti-science and anti-vaccine movement in the united states is dangerous and is growing like a cancer. It needs to be nipped in the bud. It is distressing to me that despite not having the requisite background in statistics to understand the studies you are reading, you are misapplying data here in a public forum and perhaps in your professional practice. Please stop. Skipping required vaccines without a medical reason selfishly puts the population at risk and allowing such is bad public policy.

[SeekingUnderstanding]

3 hours ago, pogi said:

You make fair points here.  It is true that fewer vaccinated people will likely lead to increased rates of disease (predominantly among the unvaccinated).  Keep in mind however, that states that allow for personal or philosophical exemptions have vaccination rates that are fairly comparable with national averages.  In other words, the people who do not want to get vaccinated are not getting vaccinated in those states, so there is no evidence to suggest that removing the mandate will significantly effect national vaccine rates.  

A small outbreak in disease will always lead to a dramatic increase in vaccination rates.  Take the example of measles in Disneyland, that one outbreak caused a significant increase in MMR rates across America.  The vaccination rates increased way higher than the disease rates, and those who were infected now have better immunity than anyone else.  That's the way it works, the system will always self-correct to keep the risks in balance.   Americans are generally pro-vaccine and consider the risk level of vaccination low enough to not cause anxiety.  In my experience, most people are more afraid of disease than vaccination, even when shown the risks for both.

Polio is virtually non-existent anywhere in the world.  There were only a handful of cases in the entire world in 2015 (I think it was below 30), limited to Afghanistan and Pakistan.  Epidemic activity is non-existent.  You are actually more likely to get polio from the live oral polio vaccine than from the disease itself.

As far as selfishness goes, it really goes both ways.  Insisting that my child be put at greater risk of death in order to protect your child from diarrhea is equally, if not more selfish in my mind. 

The pertussis vaccine creates silent carriers who unknowingly spread the disease.  This vaccine is thought to be partly responsible for increased pertussis rates across America.  Using your same argument, perhaps it is selfish to get your kid vaccinated with the pertussis vaccine.  You see, it is not as black and white as most people make it out to be.   

Of the 110 California measles cases at disneyland, 12 were children too young to be vaccinated. An additional 10 had received at least one dose of the vaccine. Collateral damage?

Edited November 15, 2016 by SeekingUnderstanding

[SeekingUnderstanding]

3 hours ago, pogi said:

As far as selfishness goes, it really goes both ways.  Insisting that my child be put at greater risk of death in order to protect your child from diarrhea is equally, if not more selfish in my mind. 

First there is not sufficient evidence (as pointed out above) to support a higher risk of death conclusion. A vaccinated population has a much lower risk of death from the rotovirus than an unvaccinated one. You want the benefits of both while putting the burden on your fellow citizens. A decision not to vaccinate made by everyone would be much more problematic.

 

From the CDC:

Quote

Rotavirus was the leading cause of severe diarrhea among infants and young children in the United States before rotavirus vaccine was introduced in 2006. Prior to the vaccine, almost all U.S. children were infected with rotavirus before their 5th birthday. Each year, among U.S. children younger than 5 years of age, rotavirus led to

• more than 400,000 doctor visits,
• more than 200,000 emergency room visits,
• 55,000 to 70,000 hospitalizations, and
• 20 to 60 deaths.

Globally, rotavirus is still the leading cause of severe diarrhea in infants and young children. In 2008, rotavirus caused an estimated 453,000 deaths worldwide in children younger than 5 years of age.

 

Edited November 15, 2016 by SeekingUnderstanding

[pogi]

20 hours ago, SeekingUnderstanding said:

This just shows a fundamental misunderstanding of statistics. We can't study everyone, so we take samples. We know going in that the sample will have some relationship with what actually happens in the real world, but its not an exact science. There is uncertainty. That's what a confidence level represents. The RR from the study you sited was 1.74 (please also note that this looks at actual deaths within 30 days of the study so trying to compare it to a life time reduction in the possibility of getting the disease is not possible). Based on this study we cannot state with certainty that the risk of death in the vaccinated group is any higher than that of the control group. It might be higher. It might be lower. Based on the sample size and the study, we can be reasonably certain (95%) that the RR of death is between 0.76 - 4.23. That is all we can conclude from this. The two death rates are not statistically different. Period. If you want to show that you are going to need a much larger study. 

 

Edited to add: You'll note the actual scientists doing the work did not note a statistical difference between the death rates.

Actually what I said is true and does not show a misunderstanding. These numbers can be analyzed using lower confidence levels to determine just how confident we are that these deaths are related to the vaccine and not due to random chance.  With a 95% CI: 0.76, 4.23, it is clear to anybody who knows how to interpret this data that the likelihood of deaths being related to vaccination is much greater.  Given a slightly lower confidence interval, it would show that the death rates are statistically different.  In other words, we can say with around 90% confidence that the deaths in the study are related to the vaccine and not random chance.  How will that play out in the "real world"? I think that is a valid question.

After recognizing the increased rate of deaths due to pneumonia, Vicky Debold Ph.D, RN, who is a voting member on the FDA panel, voted against the vaccine and pointed out that the clinical trials did not include "premature, sick and otherwise biologically compromised infants" and asked, "What is going to happen when this vaccine is given to children in the real world?"

We are making a big fuss over this specific statistic related to pneumonia as if my entire argument hinges on this point.  It doesn't. Keep in mind, children are dying due to other adverse events related to this vaccine including intussusception, Kawasaki disease, anaphylactic reaction, etc.  Keep in mind also that death is not the only factor to consider, there are other serious adverse events related to the vaccine as well.

20 hours ago, SeekingUnderstanding said:

 If you want to show that you are going to need a much larger study

Thank you for corroborating a previous point I made.  The sample size is inadequate to really give a reliable safety profile.  Instead of ordering a "much larger study" after noting the increased rate of death due to pneumonia, the vaccine was voted upon (without unanimous agreement I remind you) and mandated to be given to all children across America.  How reckless is that!?

20 hours ago, SeekingUnderstanding said:

Edited to add: You'll note the actual scientists doing the work did not note a statistical difference between the death rates.

And you will note that the actual scientists doing the work did not not note a statistical difference between the death rates.  The numbers kind of speak for themselves.

Edited November 16, 2016 by pogi

[pogi]

18 hours ago, SeekingUnderstanding said:

The anti-science and anti-vaccine movement in the united states is dangerous and is growing like a cancer. It needs to be nipped in the bud. It is distressing to me that despite not having the requisite background in statistics to understand the studies you are reading, you are misapplying data here in a public forum and perhaps in your professional practice. Please stop. Skipping required vaccines without a medical reason selfishly puts the population at risk and allowing such is bad public policy.

It is distressing to me that you refuse to recognize that I am a licensed medical professional who is trained and qualified to read and interpret medical literature, including statistical analysis.

It is distressing to me that you would even think to link me to the anti-science and anti-vaccine movement.  I can assure you that mandating vaccination will only make the "cancer" grow stronger.

It is also distressing to me that you would accuse me in a public forum of "misapplying" data in my professional practice.  Please stop.

You are only viewing this from one side of the story.

[pogi]

20 hours ago, SeekingUnderstanding said:

Of the 110 California measles cases at disneyland, 12 were children too young to be vaccinated. An additional 10 had received at least one dose of the vaccine. Collateral damage?

Again, you are only viewing this issue from one side of the story.  Lets do a simple comparison:

In 2015, 189 people were infected with measles (mostly unvaccinated).  Up through October 8 of 2016, there have only been only 54 cases of measles in the US.

In comparison, serious adverse events (SAE) (life-threatening reaction, death, hospitalization, or permanent disability) possibly caused by the Measles vaccine occur at a rate between 3.2 and 5.3 vaccines or doses per 100,000.  There are around 10 million doses of measles vaccine distributed in the US annually.

Now lets do some simple math.  3.2 - 5.3 SAE's per 100,000, equals 320 - 530 SAE's per 10 million.  That means there is a possible 320 -530 SAE's caused by the measles vaccine annually in the US compared to 189 actual infections in 2015.  Keep in mind only a small fraction of that 189 where vaccinated for measles.  Also keep in mind that the disease is almost always much more mild in vaccinated individuals and is unlikely to lead to serious or long-term consequences.

One of the more common serious adverse reactions to MMR is brain inflammation (encephalitis and encephalopathy) which can lead to permanent brain damage.  Collateral damage?

Again, I am not advocating that people stop getting vaccinated.  I am simply saying that when the risks are stacked on either side, parental choice after informed consent is the only ethical option.  Compulsory means is not ethical.  It will only strengthen the anti-vax movement.

Edited November 16, 2016 by pogi

[pogi]

20 hours ago, SeekingUnderstanding said:

First there is not sufficient evidence (as pointed out above) to support a higher risk of death conclusion. A vaccinated population has a much lower risk of death from the rotovirus than an unvaccinated one. You want the benefits of both while putting the burden on your fellow citizens. A decision not to vaccinate made by everyone would be much more problematic.:

You are not factoring in death rates from other factors besides pneumonia, such as intussusception, Kawasaki's, anaphylactic reaction etc.  The death rate from disease pre-vaccine era was only between 20-60 cases annually.  I can't find current death rates, but with the current national vaccination coverage for rotavirus at 71.7%, we can theoretically reduce that previous death rate by around 71.7%. 

When you factor in the other serious adverse events besides death, I'd much rather take my chances with the disease.  Simple rehydration will always prevent death and serious harm from disease, I don't have that same guarantee with vaccination, so I don't want the government (who may be heavily influenced by pharmaceutical lobbyists and donations) to be making that decision for me or my child.

Edited November 16, 2016 by pogi

[Yirgacheffe]

9 hours ago, pogi said:

Simple rehydration will always prevent death and serious harm from disease

Always?  I do not believe this. 

[ERMD]

On 11/15/2016 at 1:55 PM, pogi said:

 

Polio is virtually non-existent anywhere in the world. 

 

And why do you think this is so?

[ERMD]

On 11/15/2016 at 1:55 PM, pogi said:

 

The pertussis vaccine creates silent carriers who unknowingly spread the disease.  

What is the evidence for this?  Are you a Mercola disciple?

Edited November 17, 2016 by ERMD

[ERMD]

On 11/14/2016 at 5:25 PM, pogi said:

Please be specific, where is the "bad" information I am promulgating?  You asked for a CFR and I gave you one.  I have not lied or given false information.  The rest of the information you posted from that link does not contradict the simple fact that I made.

Vaccination is my area of expertise.

You made the claim that having had a disease provides superior immunity to vaccinations and used a proof-text in an attempt to back up your point.  The rest of the article gave specific examples.  I post that part (from the article you cited) here again for your perusal:

Of interest, a few vaccines induce a better immune response than natural infection:

Human papillomavirus (HPV) vaccine — The high purity of the specific protein in the vaccine leads to a better immune response than natural infection.

Tetanus vaccine — The toxin made by tetanus is so potent that the amount that causes disease is actually lower than the amount that induces a long-lasting immune response. This is why people with tetanus disease are still recommended to get the vaccine.

Haemophilus influenzae type b (Hib) vaccine — children less than 2 years old do not typically make a good response to the complex sugar coating (polysaccharide) on the surface of Hib that causes disease; however, the vaccine links this polysaccharide to a helper protein that creates a better immune response than would occur naturally. Therefore, children less than 2 years old who get Hib are still recommended to get the vaccine.

Pneumococcal vaccine — This vaccine works the same way as the Hib vaccine to create a better immune response than natural infection.

Another example could be Hepatitis B.  Hep B infection does not provide future immunity but rather leads to a variety of conditions ranging from dormant, to chronic, to chronic active Hep B.  Vaccination provides immunity, with necessary monitoring to assure antibody titers remain adequate.

 

Again, you are spreading a significant amount of misinformation.

[pogi]

10 hours ago, Yirgacheffe said:

Always?  I do not believe this. 

Cause of death with rotavirus is severe dehydration due to diarrhea and vomiting.  You are right, it is not a good idea to say "always or never" in medicine, but I can say that early treatment with oral rehydration salts and IV hydration if it becomes severe, will put your chances of death from dehydration to near zero.  The already extremely rare deaths from rotavirus are almost always from malnourished children who did not receive proper treatment.  Again, I'll take my chances with the disease, but I respect the decision of anyone who chooses otherwise.

[pogi]

1 hour ago, ERMD said:

And why do you think this is so?

Why would you think I wouldn't know this after telling you what I do for work?  That is part of my job in international travel medicine.  I am updated daily with infectious disease reports from all over the world.

Quote

According to global polio surveillance data from March 9, 2016, 5 wild poliovirus cases were reported in Pakistan and 1 wild poliovirus case was reported in Afghanistan in 2016. In 2015, 74 cases of wild poliovirus were reported: 54 from Pakistan and 20 from Afghanistan.

http://www.cdc.gov/polio/updates/

74 total cases worldwide in 2015, which was limited to 2 countries, out of 7.4 billion people worldwide and 196 countries (counting Taiwan).  I think it is safe to say that polio is "virtually non-existent".

Edited November 17, 2016 by pogi