Vaccines, Autism, and Guillain Barre Syndrome – PediaCast 014

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  • Mercury In Vaccines
  • MMR and Autism
  • Menactra and Guillain Barre Syndrome
  • Coming Soon To an Office Near You: New Vaccines



Announcer 1: This is PediaCast, episode 14 for the week of October 23rd 2006.


Announcer 2: Hello moms, dads, grandmoms, grandpas, aunts, uncles and anyone else who looks after kids. Welcome to this week's episode of PediaCast, a pediatric podcast for parents. And now, direct from BirdHouse Studios, here is your host, Dr. Mike Patrick Jr.

Dr. Mike Patrick: Hello, everyone and welcome to this week's edition of PediaCast, a pediatric podcast for parents. It's our 14th episode and I'd like to welcome everyone to the program this week. This week our main topic is going to be on immunizations, although instead of looking at each individual immunization and what they do this week we're actually going to tackle the most controversial of the topics and I'll give you my take on some of these.

The first one is going to be mercury in vaccines. What's that all about? MMR and autism will be coming up after that and then Menactra and Guillain Barre Syndrome. And then coming soon to an office near you, new vaccines that are on the horizon and will probably be routinely given within the next year or so; so we'll discuss those things.

Now I read on Drudge this morning that four elderly folks with chronic diseases died after getting the flu shot and so the country [01:35] actually suspended giving flu shots for the time being until they can look into this a little bit more. I will say that all four of these individuals did have chronic diseases that put their lives immediately at risk.

And we still don't know if it was something to do with the vaccine that caused their deaths or if it's just a coincidence that these folks happened to pass away within a few days of getting their flu shots because there was a big push to get folks with chronic illnesses immunized in Israel as in other countries, so it could be that it's just a coincidence that these four folks passed away from their illnesses and it wasn't related to the flu shot at all. Or it could be that there was some sort of contamination because, this is just speculation, but all four of the flu vaccines apparently did come from the same distributor.

So they're looking into it and as soon as there's more information we'll address that for you on the PediaScribe blog. And also probably next week will have some information about it as well.


OK. Don't forget if there's a topic that you would like us to address on PediaCast all you have to do is drop by the website and visit the Contact page that's at and just click on the Contact link once you're there. You can also email us at and then of course we also have our Skype line, which is 347-404-KIDS, that's 347-404-K-I-D-S.

Now before we get started with our first topic, let me remind you that PediaCast discussions do not address specific children or specific situations. A face-to-face interview and hands-on physical examination are crucial in determining a diagnosis and formulating a treatment plan. Therefore, if you have a concern regarding your child's health, be sure to consult your local doctor.

Every effort is to keep PediaCast accurate and up-to-date, but because medicine is a constantly changing field and because unique situations may call for variations in medical treatment our advice should not be taken as the standard of care for your community. And finally, the opinions expressed on PediaCast are my own and do not necessarily represent the opinions of any government agency or a professional organization.


OK. On to our first topic, we're going to discuss mercury in vaccines. I don't think there are any parents of infants out there that haven't heard about this. Thiomersal is the compound that's in question. It's a mercury-based preservative that has been used in vaccines really for the last 75 years. It was even used when Jonas Salk produced the first polio shot back in the 1950s. There has been speculation that Thiomersal, which is the mercury-based preservative, causes neurodevelopmental disorders, such as autism, ADHD and speech and language delay.

We are giving an ever increasing number of vaccines, meaning that babies are exposed or were exposed to more mercury in their immunizations. And basically, the pressure sort of reach the boiling point in the late 1990s and as it is now Thiomersal is no longer use as a preservative in vaccines with the exception of some multi-dose vials of flu preparation still have Thiomersal in them.

So if the mercury preservative is no longer in the vaccines, why are we discussing it? Well many parents listening have kids whose immunizations did contain Thiomersal and of course parents themselves were exposed to the mercury, too, when they had their vaccines when they were children.

Also there have been many vaccines supply issues which are in some degree related to the removal of the mercury preservative and I wanted to address those as well. So it is still something even though there's not a lot of immunizations out there that still have the mercury-based preservative in it. It's still a question that I get asked a lot in the office and you may have had questions about it yourself.


Now a little bit of a history with this, if you do a medical literature search of all scientific articles containing the word Thiomersal, you'll find about a thousand scientific articles since the 1970s. Half of these articles were written between 1970 and the mid 1990s and these mostly dealt with allergic reactions to mercury containing preservatives at particularly in eye drops, which also have the Thiomersal in them.

During this timeframe there really were no outcries of concern over a possible link with neurodevelopmental disorders. Now the other half of the studies were written since the late 1990s and these mostly deal with a possible link of mercury to neurological problems.

So why the shift in the literature? From the 70s to the late 90s it was about allergic reactions and then from the late 90s to the present day we're dealing mostly with neurological problems that are associated with mercury. So why the shift? Well in 1997, congress passed the FDA Modernization Act and part of this act charged the FDA with reviewing the risks associated with all mercury-containing food and drugs and that included vaccines because of the Thiomersal which was being used widespreadly as a preservative.

Mercury is known to be toxic to humans. There's no question about that. The central nervous system is the body system that seems to be most affected by mercury, but other body systems can be affected as well including the kidneys, the lungs, the gut or GI tract and the skin.

Now the toxic effects of mercury at the cellular level, we won't get too deep into the specifics, but basically it interferes with the calcium balance, it disrupts membrane function and messes up protein production and basically causes some major problems.


The degree of the toxicity does appear to depend on at how much mercury you're exposed to, the patient's age, their overall health and also their nutritional status. And then it also is going to depend on exactly what type of mercury that you're exposed to. And basically there are three types of mercury, there's elemental mercury, inorganic mercury and organic mercury.

Elemental mercury is the one that's used or used to used, I should say, in thermometers and exposure to this form of mercury really cause the worst effects when it was inhaled. So if you inhale elemental mercury, it's going to cause lung disruption, you get some bloody secretions, it's pretty yucky. And of course, this elemental mercury is the ones that many parents and grandparents out there that may have played with when you were a kid.

I remember I had a college roommate who had a little container with mercury in it and we'd open it up and this mercury would stay in a ball and you could kind of roll it around. It stayed together, yet it was a thick liquid as well. We'd mess with it and move it around the room and some of you may have had that experience as well. Of course, if you do that now, the Health Department is going to come in and they're going to take all your furniture out of the house and it'll be like Monsters, Inc. when the baby patrol came, it'd be something like that, I think. I'm kind of making light of it, but it can cause some serious problems but we just have found that out sort of recently.


Now the inorganic mercury, it's actually still used in paints and dyes and it can cause the same sort of problems as the elemental form. But what we're really talking about with the preservatives is organic mercury, organic just meaning that there's carbon molecules that are attached to the mercury. And organic mercury exposure is actually mainly associated with neurological dysfunction like we've been talking about in the brain and then it can also have some skin reactions as well.

The organic mercury can be further divided into methyl mercury and ethyl mercury. So methyl with an "M" and then ethyl with an "E". Now ethyl mercury is the form we're talking about with Thiomersal while methyl mercury is the kind we're exposed to in tuna and swordfish and in some other types of sea life.

Now why is this important? Why am I even going into the chemistry of this? Well, there can be a big difference between chemical effects on the body when you're looking at a methyl compound versus an ethyl compound. OK? So this is kind of important to distinguish. For instance, ethanol, which is an ethyl compound, that's the alcohol that makes you drunk, that's what Budweiser has in it, has ethanol. Now methanol with an "m" is a methyl compound and this is the type of alcohol that can actually cause severe brain damage even in small amounts and can also result in blindness.

So when you're looking at ethanol, there is a big difference between ethyl versus a methyl compound. Now if we take this a step further, most of what we know about mercury poisonings actually comes from methyl mercury. Why would that be? Let's face it, no one's volunteering to have themselves intentionally exposed to a whole bunch of mercury, so we can't really study the effects, right?

So what we can do is look at some populations where methyl mercury, particularly in fish and also in contaminated rice in China has affected large populations and then looked to see what kind of problems that they had. Well in the 1950s, a large Japanese population was exposed to fish that was contaminated with large amounts of methyl mercury. And a Chinese population, as I said before, a little later than that in the 60s was exposed through a contaminated rice. And the effects on these patients after their exposure to massive amounts of methyl mercury did include mental retardation and blindness, as well as other neurological problems.


But what about ethyl mercury? Well we assume exposure to massive amounts of it would cause neurological problems as well, but there've been any reports of this happening to humans. We do know that ethyl compounds are generally less harmful than methyl compounds and we also know that infants were exposed to just miniscule amounts of the ethyl mercury in the vaccines.

Now still, with as many vaccines as were given in the late 1990s there was accumulative exposure over the first two years of life to ethyl mercury that slightly did exceed the safety limit established by the environmental protection agency from methyl mercury. So they looked at how much methyl mercury a person is allowed to be exposed to and still be safe based on their body weight and basically said, well, since we don't know for sure if ethyl mercury has the same effect or not, we're going to make that level be the same for ethyl mercury as well just in case.

Now how much is it are we talking about? It amounted to the same amount of methyl mercury you would expect to find in one can of tuna fish. But given the body size of an infant it was slightly too much. So if an infant ate a whole can of tuna fish, it'd be too much mercury and that's basically the amount of mercury that kids were exposed to during the first year of life.

But again, keep in mind, in the tuna it's the methyl with an "M" mercury and in the Thiomersal was the ethyl mercury. And again, ethyl things seem to be less of a problem for humans than methyl things are. But again, we don't know for sure because we've never done any studies to see because no one's going to volunteer. But we are comparing apples to oranges when we're comparing methyl and ethyl mercuries and what they do.


Now enter the mainstream media and the "French terror groups" and I do call these French groups "parental terrorists" because they basically inject fear into the hearts of moms and dads without really telling them the whole story. It's like the sky is falling, there's mercury in the vaccines and it's going to kill all you children! You know, the cry goes out; we're poisoning our infants with mercury and of course given the legal climate in our country and given the fact that every parent with a developmentally-challenged child really wants to find an explanation as to why that happened. The vaccine companies want the target remove from their backs, so they take the mercury out.

You may be asking yourself, what's the big deal here? Even if there's a slight chance that Thiomersal could be a problem, why not just take it out of the vaccines, right? It makes sense. Well the problem really is vaccines supply. When vaccines were packaged in multi-dosed vials with the Thiomersal in them, they had a pretty long shelf life. So the multi-dosed vials are basically a vial that you can maybe have five doses of the immunization in it and once it's opened it's only going to be good for so long just like a product you get at a grocery store, you it up and then you got to put it in the refrigerator. You could get five doses out of this bottle, but it can only stay open for so long.

But the advantage to it is you didn't have to do individual packaging, you could just have all five doses in one bottle. So it helps the product to be cheaper and then you can stockpile it a little bit better, too, because of the Thiomersal that's in there, it has a much longer shelf life.

When you take the Thiomersal out, then the shelf life is greatly diminished and diminished shelf life does make it harder for vaccine companies to stockpile vaccines so they slow down production because if they make more of the vaccine than they can sell and it has a short shelf life and then the vaccine goes bad and then the company loses money. And then the company stockholders, they're not really amused by that.


It also affects supply at the doctor's office level because if I'm ordering vaccines with the shorter shelf life, I'm going to order less of it because I don't want to take any chance that they'll expire because then I have to eat cost. You can't return expired vaccine to the manufacturer. If it goes bad because it's gone past its expiration date then we have to eat the costs. So the drug companies are making less and the doctors are ordering less because of fear that the vaccine is going to expire and will to be trashed. So this basically results in a diminished supply.

When I was training in the early and mid 90s, we never ran out of vaccines. Never. I don't ever remember a time that there was a shortage of any vaccine. And now we run out of vaccine all the time. There are babies who get their shots late and they're at risk for getting pertussis or polio or measles because of the shortages that we're seeing in vaccines.

And my personal opinion is that these shortages that we're now seeing really are related to the fact that we have shorter shelf lives of the vaccine material and again, that's because of the Thiomersal being taken out of it. It's easy for us to forget what life was like before routine immunization. I mean, nearly every family dealt with childhood death. It was not uncommon at all for a family to have six kids and two of them died before they were age 12. And in many parts of the world this is still the situation today.

Now flu vaccine, by the way, is the exception with all this. Some multi-dose vials for kids three and over do still contain Thiomersal. And you know what? We have plenty of that one in our office. The infant doses on the other hand, are single dose prepackaged syringes and guess what, without Thiomersal and guess what, we don't have any of it.

So the kids most at risk for flu complications can't get flu protection, again, because there's no Thiomersal in the vaccine and we just have much trouble, a lot of trouble getting a hold of it. You may shrug your shoulders at this, but if your baby is the one who ends up in the ICU with severe pneumonia that started with a flu, which does happen to hundreds of previously well babies every year, you might change your mind about it.

And if the supply of other vaccines continues to be a problem and if we begin to see more cases of once extinguished diseases, such as infant pertussis and polio and measles, then the benefit of the Thiomersal may begin to outweigh its risk. See, it's all very complicated. I mean, it seems like a no-brainer, get the mercury out of the baby shots, right? It seems like it's the politically correct thing to do, but everything we do has consequences and you have to take a look at both sides of an issue.

You have to educate yourself and really that's what PediaCast is all about. You have to decide what's best for you and your family after you've given due consideration to both sides of an issue. It's different than it used to be because these are the same kind of things that doctors have always had to do deal with in terms of looking at benefit versus risk. But now that all the information is out there in the hands of parents, in the media and on the Internet, parents are put in a position where they have to look at these things themselves and try to decide which side of the coin that they agree with. And so this put the burden on the parent to look in to things and I'm hoping that's what PediaCast is able to do for a lot of you.


Now to be fair, let's take a look at what "the sky is falling" people are saying. If you go to and we'll have a link to that in the Show Notes and click on the link "The Science" and it reveals information from nine different research studies that looked at the effects of ethyl mercury. And one of the prominent ones on there, in fact, it's the first one listed, directly from the research itself, it says, "There was little difference in the neurotoxicities of methyl and ethyl mercury when effects on the dorsal root ganglion or coordination disorders were compared." And it goes on to further say, "The neurological science and symptoms of methyl and ethyl mercury intoxication are identical." OK. So this is the quote that they put up on their page. And then they nicely provide the link to the study itself, which is in a PDF form.

So what does the study actually say or what did it look at? What this particular study, which this organization is using to say "the neurological science and symptoms of methyl and ethyl mercury are identical", let's take a look at exactly what the study did. What they did is neurotoxicity, so brain problems and kidney problems were compared in rats that were given five daily doses of eight milligrams per kilogram of either methyl or ethyl mercury. So they gave eight milligrams per kilogram of mercury, either ethyl or methyl, for five days. Now that's the equivalent of a 20-pound baby getting 400 milligrams of mercury.


In reality, baby vaccines, when they had the Thiomersal in them, it was a tiny amount. In fact, the cumulative dose of mercury over the first six months of life was less than 200 micrograms. So the study is using a dose which is 2,000 times stronger and given over five days rather that over a six-month period.

Now just for fun, let's take a look at iron, right? Iron is a heavy metal and it's an important part of a baby's diet. The recommended amount of iron intake is six milligrams per day. That equals 1,000 milligrams or a gram over the course of six months. If we gave 2,000 times the recommended six-month dose over a five-day period, that would end up being 2,000 grams of iron over five days, OK, 2,000 grams.

A lethal dose of iron for a baby is around 600 milligrams and that means that 2,000 grams, which is two kilograms, isn't it? OMG! So two kilograms of iron would kill over 3,000 babies. My point here is that iron is not dangerous in tiny amounts, in fact, it's helpful. In large amounts, it's going to kill you. And this study showed that huge amounts of ethyl mercury is bad. No kidding!

I'm sorry, but these anti-immunization groups are parental terrorists. I mean, they strike fear into the heart of parents with grossly exaggerated studies. It's just craziness. Show Notes will have the link so you can take a look for yourself.

I also encourage you to visit the FDA's information page on Thiomersal and we'll have a link to that one in the Show Notes as well.



OK. Today we are not afraid to strike out against the main controversial topics. Oh, trust me; I'm planning on getting a lot of email over this episode.

MMR and autism. MMR, measles, mumps and rubella vaccine, has been licensed in the United States for three decades, so for about 30 years now. And it contains live attenuated measles, mumps and rubella virus, which basically that means that it's a live virus but it's been a bred, so to speak, to not be nearly as infectious as the real measles, mumps and rubella virus that's found out there in nature.

What a live virus vaccine does is that it stimulates the immune system to make antibodies against these viruses. So if the virus, itself, the real one, out in the wild enters the body, you can fight them off with antibodies that you made against the vaccine version of the measles, mumps and rubella.

Now the first dose of the MMR is usually given at 12 to 15 months of age and then the second dose is given at four to six years of age. Compared to the pre-vaccine era, the reported number of measles, mumps and rubella cases has dropped by about 99% in the United States.

For more detailed, look at those diseases, themselves. I refer you to episode five for measles, episode six for mumps and episode seven for rubella. We had a little series going there, if you can figure that out. So the MMR has definitely been a success story in terms of getting rid of these potentially deadly illnesses.

Now, in step trouble. The MMR-autism flap began in 1998 when Dr. Andrew Wakefield, a British bowel specialist, conducted a chart review of 12 patients. Really, I’m not making this up. Twelve patients. And based on that chart review, Dr. Wakefield concluded that MMR causes intestinal inflammation, which leads to “leaky bowel,” which then allows harmful toxins to enter the body and then that these toxins then travel to the brain and cause autism. And now since every autistic child in the developed world had received an MMR vaccine and since autism is most commonly diagnosed between the first and second birthdays, around the time of the MMR, many parents of autistic children sort of clung to this report like a colony of mold on old bread, if you know what I mean.

Never mind that the United Kingdom Medical Research Council condemned Dr. Wakefield’s report. Never mind that other medical researchers from around the globe found fault with his research methods. Never mind that subsequent well-designed statistically significant studies failed to show any link between MMR and autism. But these stricken parents had found what they wanted – a reason.

So now many parents fear the MMR vaccine and some downright refuse it. They’ll put their children in a speeding automobile a median’s throw away from a twenty-ton eighteen-wheeler rocketing in the opposite direction. And they’ll let their children ride in an airplane traveling 500 miles-per-hour at an elevation of 35,000 feet. They’ll allow their children to swim unattended and ride bicycles without helmets and get on slapped-together carnival rides run by a guy sporting more tattoos than teeth, but they won’t get the MMR vaccine. It’s too risky. After all, Dr. Wakefield looked at twelve kids, and again, these parental terrorist organizations, the ones who don't want you vaccinating your children agree with him.


So what kind of studies have been done since Dr. Wakefield's revelation back in 1998? Well in 1999 and I'm going to go through ten of these studies very briefly, in 1999, a study from the United Kingdom looked at the trends in autism diagnosis over a period of 20 years and found no difference in the age of autism diagnosis between the vaccinated versus unvaccinated children.

And then in 2001, another study from the United Kingdom looked at the incidents of autism diagnosed among boys who are ages two to five years; between 1988 and 1993 there was a seven-fold increase in the number of boys diagnosed with autism; while the vaccination rate with MMR stayed steady at over 95% of all children receiving the vaccination.

This probably reflects a better understanding of what constitutes autism leading to more widespread recognition and diagnosis of the disorder. But you wouldn't expect such a high increase in the number if it was just solely based on immunization.

Another study in 2001 looked at the incidents of autism between 1980 and 1994 in California and here the number of kids diagnosed with autism in that time period rose by 373%, while vaccination rates increased only by about 14%. Again, to me, what this probably just shows that we're understanding autism more and a lot of these kids before were just said "they are mentally retarded" and put away in an institution or at home of some sort. Whereas, starting in the 80s and 90s we began to understand what was happening with these children a little bit better and we had more programs to deal with them at home and keep them in the house. And so now, we have more kids instead of just being called mentally retarded, they are properly diagnosed as having autism.


Now in 2002, a study looked at a large group of kids born in Denmark and this is where it starts to become a little bit, for me, more of an issue in terms of this being something to really look at to show that there probably is not a relationship between MMR and autism. So this study looked at a large group of kids who are born in Denmark between 1991 and 1998 and it looked at a group of children who had received the MMR and a group of children who had not ever received the MMR.

And the "MMR group" actually had a lower relative risk of being diagnosed with autism than the "no vaccine group". So the group of kids who had the MMR were not being diagnosed with autism more often than the group of kids who did not have the MMR. And I don't have the numbers on how many kids were in this study but I do know it was a large number.

Then in 2002, a population study in London looked at autism rates in kids with a history of bowel problems and compared that to their MMR vaccine status and again, no link was found between MMR and autism or even between MMR and bowel problems like Dr. Wakefield had suggested.

Then in 2004, another U.K. study looked at over 5,000 children and again, compared rates of autism between those who had been vaccinated with MMR and those who are unvaccinated. And again, the unvaccinated group actually had a higher relative risk for developing autism.

And then in 2005, a systematic review of 31 articles published before 2004 that looked in to unintended effects associated with the MMR and none of the studies reviewed showed an association between MMR or the development of bowel problems, such as Crohn's disease or ulcerative colitis and none of them showed any link between MMR and autism.


Then in 2005, another population-based study in Japan looked at the number of new autism cases between 1988 and 1996 in a population where MMR use has been withdrawn. And this study showed the rate of new cases of autism increased even after the MMR was withdrawn from use. So as kids started to not get MMR in the Japanese population, the number of kids diagnosed with autism continued to increase even though none of them were getting MMR vaccine.

And then in 2006, a study of over 27,000 children in Canada looked at the autism rates of vaccinated versus unvaccinated kids and there was not an increased occurrence of autism in the vaccinated group.

And finally, in 2006, a study of 904 children also showed no significant difference between vaccinated versus unvaccinated children in terms of the number of kids diagnosed with autism.

So there are 10 large, respected studies done since 1999 that show no link between MMR and autism, yet these parental terrorists strike fear into parents with Dr. Wakefield's theories of 12 patients and may have no studies at all to support their claim; only anecdotal reports of kids who had the MMR and a week later they were losing developmental milestones.

Now, thousands of kids get the MMR everyday in the United States and thousands are diagnose everyday with autism. Here and there you're going to have one who gets their shots one week and begins to show signs of autism the next week. That does not mean that the two events are related. But understandably, parents with autistic kids want something to blame and vaccines are an easy target. They give these parents a focus on which to seek revenge and it really has become that modern day medical equivalent to "Joseph McCarthy-ism", blame the vaccines for your woes.

But in the meantime, we do run the risk of seeing a rise in disease that routinely took the lives of our grandparents and great grandparents' children.



OK. I'm ranting today. I don't do this very often and I'll try not to have such controversial topics in our next episode. OK. Menactra and Guillain Barre Syndrome. What in the world is that?

Well, Menactra is a vaccine that protects you from a bacteria called the menin… See? Even I stumble on these words sometimes… Meningococcus is the name of the bacteria. It causes meningococcemia, which is a blood infection caused by the meningococcus bacteria.

It's a nasty little bacteria, let me tell you. It causes sepsis, meningitis and it can cause a blood-clotting disorder that leaves you with hundreds of tiny broken blood vessels and micro bruises in the skin. It's really a serious disease and it usually causes death in the great majority of cases if you get this bacterial meningococcus. So this is the kind of meningitis you occasionally hear about reported in colleges. And again, it has a high mortality rate over a short period of time.

Now the vaccine to protect against this particular type of meningitis was previously recommended for entering college freshmen. But last year the recommendation changed from age 18 down to age 12 to 15 years, because this age group is also at risk for becoming infected with the bacteria.

This means that over the course of the last year millions of doses have been given as we catch up all the 12 to 18-year-old. So it used to be given when kids got to be 18, now we give it at 12 to 15 years of age, but when we see a kid who is 16 or 17 we also give it to them to sort of catch everybody up.

Now, a problem is going to emerge with this, as we gave more of the vaccine, we began to see some cases of Guillain-Barre syndrome that were reported within a couple of weeks of teenagers getting the vaccine.


What is Guillain-Barre syndrome? Well Guillain-Barre syndrome, basically the body makes antibodies against the bacteria and we talked about this with the MMR vaccine as well. So you're basically giving a part of the bacteria, it's a protein on the bacteria meningococcus and when you get the vaccine you don't get the whole bacteria; you just get the protein that's on the bacteria. But it's enough to make your body's immune system respond and make an antibody against that protein. So then if the real bacteria comes along your immune system will have antibodies to attack it.

You're basically revving up the immune system to get it to make these antibodies. And in revving up the immune system, in some people you also get antibodies that then attack their own peripheral nerves, which leads to extreme weakness because these nerves in your body are inflamed. And some people at such a degree of weakness that you can't walk, sometimes they're so weak they have trouble breathing and even have to be placed on a ventilator. And the weakness progresses over at two to three-week period and then it slowly improves. It's rarely fatal, but it can be fatal if it's not diagnosed in a timely fashion and proper support of care instituted.

The incidents of Guillain-Barre are higher in some families which does suggest that there's probably a genetic component involved with this. You may have heard about this, especially if you have a teenager at home, the media was all over it because these kinds of headlines attract viewers and readers and viewers and readers attract advertising dollars, not that I'm bucking that trend if there are any potential sponsors for PediaCast out there, I'm just explaining motives. Actually, Guillain-Barre has been reported with other vaccines as well, not just this Menactra, most notably the flu vaccine, but the incidents are extremely low and it does tend to run in families.


For more information about Guillain-Barre, itself, check the Show Notes for a link to a fact sheet from the National Institute of Neurological Disorders and Stroke.

Now what kind of numbers are we talking about? Well since the age of recommendation was lowered from 18 to 12 to 15, there have been (drum roll please) 17 reported cases of Guillain-Barre syndrome. Seventeen! That's all! Seventeen! That means that there are 1.25 cases of Guillain-Barre syndrome per one million doses of vaccines given, which is about the same incidents that we see with the flu vaccine as well, that you usually see one or two cases of Guillain-Barre per one million doses given.

So the rate of occurrence is very, very low. And in the opinion of the medical community, myself included, the benefit of the vaccine outweighs the risk because meningococcal disease has a very high mortality rate.

Now here in lies a problem with the Internet, before the mass the distribution of information became available to regular folks, these same issues came up in medicine and other disciplines all the time. There are risks in everything we do. Build a bridge and there's a risk an earthquake will knock it down. Of course we try to minimize the risks by building the bridge in the right location and giving it special characteristics that make it more likely to hold up. But there may still be conditions under which that bridge could fall. Engineers understand that, but as long as the benefit outweighs the risk by a very large margin, it's OK.

Now if your loved one is on the bridge when it falls or my loved one is the one who gets Guillain-Barre after their Menactra vaccine, you and I are not happy campers. But as professionals, as engineers, as scientists and as doctors, we have to look at the big picture.

If we withhold advances because of every tiny risk, we get absolutely nowhere. These tiny risks are made public and spread easily via the Internet and that's fine. Knowledge is power as I've said before. But it also does come with responsibility. You cannot become a "sky is falling" person. You have to become a scientist. You have to look at both sides of an issue. You have to look in the right places and you have to find the source that gives you as clear a picture as possible.

And when it comes down to it, that is the goal of PediaCast, to empower parents with the knowledge you need to make good decisions.



OK. Our Coming Soon, if not already, to a Doctor's Office Near You segment, we are going to about four vaccines that are just about ready. The first one is the hepatitis A vaccine. Hepatitis A virus infects the liver and leads to jaundice and also possible liver failure. It is spread by the fecal-oral route and I'll leave that to your imagination on how that sort of thing spreads. If you still can't figure it out just think lettuce and spinach workers in California.

There has been a vaccine that prevents hepatitis A for some time and it's often given prior to foreign travel, but with the incidents of hepatitis A increasing in the U.S. and the degree of liver damage it can cause, the Advisory Committee on Immunization Practices of the CDC is recommending that all children receive a vaccine at one year of age. Now we're still waiting for the American Academy of Pediatrics to add the vaccine to its official schedule, but that should come soon, so check with your doctor to see if he/she has it in stock.

The next vaccine is MMRV and this vaccine contains measles, mumps, rubella and varicella, which is fancy word for chickenpox. It doesn't really add anything new; it just combines two vaccines that are given now between 12 and 15 months of age. And then it can also be given prior to kindergarten when most kids get the second MMR and this would help boost chickenpox immunity during the school-age years as well. So look for that one, coming soon.

Also the rotavirus vaccine; rotavirus is a viral disease that causes severe vomiting and diarrhea, also frequently causes dehydration as well. In the developed world, it's rarely fatal due to access to IV fluids. But in the developing world, it does cause significant problems with disease and even quite a bit of death as well from dehydration with kids who get it and then don't have access to medical care or IV fluids if they need them.

Now an oral rotavirus vaccine was introduced several years ago, but subsequently it was withdrawn due to an association with a potentially serious type of bowel obstruction known as intussusception, which can be deadly in some cases. And here's an example where a vaccine was shown to have a problem in statistically significant research studies and look what happened. The manufacturer withdrew it and all the organizations that recommend vaccine said, "Oop, let's not do this," because there really was a potential problem with that particular vaccine. So there's not a big conspiracy to hide the fact that there are problems with vaccines. It's not the case.

Now a new oral rotavirus vaccine called RotaTeq has recently done well in three research trials which included an unprecedented study population of 70,000 infants. So look for the Advisory Committee on Immunization Practices and the American Academy of Pediatrics to come out with their recommendations regarding this one some time here soon.


Finally, we're going to look at the Gardasil, which is the HPV or human papillomavirus vaccine. This is another vaccine that's aimed to the virus and this one protects, again, it's called human papillomavirus. It's an organism often spread during sexual encounters and it has been implicated in the development of cervical cancer.

Gardasil was evaluated in four clinical trials involving over 20,000 recipients. And overall, 99% of girls and women immunized in the study developed good immunity against the virus. Gardasil is going to be given to girls and women between 9 and 26 years of age in a three-dose series over the course of six months.

We're still awaiting official recommendation of this one from the American Academy of Pediatrics, but again, that should be coming soon. That recommendation is important because this is a very expensive vaccine, so you'll definitely want to ask your doctor about it once it's recommended and the insurance companies are covering it.

Now, do we have too many vaccines? We already have so many and then we're coming out with all these new ones. Is it too many? There are those who criticize that the development of so many new vaccines is a problem, suggesting that we're simply giving too many of them and that our immune system can't handle them for some reason.

Sigh. Give me a break. The typical school-age child is exposed to hundreds, possibly thousands of viruses during a typical school year and his/her immune system revs up with every one of them. We are simply revving up the immune system artificially, so that when the real bug comes along we have protection and in this way we can avoid the diseases that are known to cause the biggest problems.


Do vaccines, themselves, cause problems? I think sometimes they do. Life threatening allergic reactions are possible as is Guillain-Barre and other significant complications which you can read about when your doctor gives you the vaccine information sheet.

However, the incidents of any of these conditions are extremely low. And when you look at the big picture, when you look at the protection, our society, our way of life and the health and well-being of our children have, over the overwhelming evidence suggest that the benefit far outweighs the risk.

I'm all for parents making choices for their children. Don't get me wrong. And when parents choose not to vaccinate, I respect their wishes. I also have them signed a waiver stating that they understand that I disagree with their decision, but that's a legal issue, not a medical issue.

All I ask is that parents tap in to good resources when they make a decision and my hope is that PediaScribe and PediaCast will become a source parents trust when it comes time to search for answers. So the information is out there, you just have to find it from a good place.

Now I'm not saying that in the end if you look over the information for vaccines and against vaccines and you decide that based on that information you really don't want to give your kids vaccines, I'm fine with that. I really am. I am all for parents making choices for their kids and you won't find a lot of pediatricians who admit that. But I do want to say though, you have to look at both sides and you cannot be scared by these parental terrorist organizations whose sole motive is to strike fear into parents in order to get you to do what they want. If they had good statistically significant studies to show that the problems that they talk about are valid problems that aren't just happening by chance or that they're not just a coincidence, then I would be all for them.



All right. Well that wraps up this week's episode of PediaCast. Thanks for bearing with me as I sort of ranted a little bit about these issues. Thanks to all the listeners. Also I'd like to thank Nicholas, my nine-year-old son who is my sound engineer today. He did a fantastic job with the interludes. So thank you to him.

Don't forget if you have a topic you would like us to address here on PediaCast, you can go to the Contact page at our website, which is and then click on the Contact link. You can also email us at And our voice line is waiting for you at 347-404-KIDS, 347-404-K-I-D-S. And feel free to leave a voice mail message and we might play it on our next program.

Also our PediaScribe blog is waiting for you. It's kind of a blog/collection of articles. So if you want to check that out, it's at That came before PediaCast. I've been writing articles for almost a year now. So you can look at those at

Also we have a listener survey for you at either PediaScribe or PediaCast on the Internet and that just helps us to get an idea of what our audiences like. Also make sure you spread the word and tell your friends and family about PediaCast. And if you have time to leave a review in the iTunes Store, that would be appreciated as well.

So until next time, this is Dr. Mike Patrick saying stay safe, stay healthy and stay involved with your kids. So long everybody!


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