Are unvaccinated pupils a danger to immunosuppressed ones?
A premise is necessary because we are talking about health, the health of our children and we often let ourselves be exploited by politicized subjects or those who have ulterior motives, certainly not the health of our children.
We will try with this short text, taken from a more full-bodied document written by an immunodepressed girl and the team #NotInMyName, to turn on a light bulb. We do not care what your position is on the usefulness or not of vaccination, but we are interested in showing you how everything is not simple and how immunosuppressed and vaccinations in general are exploited by a political class that sees the ground crumbling underfoot.
Who is giorgia scataggia
Giorgia Scataggia is a 29 year old immunodepressed girl. His physical condition is therefore instrumentalized to justify compulsory health treatment on other bodies, defenseless, of healthy children. A coercion IN HER NAME, an obligation as a weapon of protection towards those who cannot get vaccinated like her. The acceptance of a deprivation in exchange for protection, violation of privacy, security, terrorism: this is how to "excuse" the limitation of the individual's freedom. This is why it is important not to give up this battle, for the way it was imposed, not just for what it imposes.
Giorgia months ago wrote a letter to politicians who then left to subscribe to other immunodepressed people as an objection to the media and instrumental manipulation in progress. His words are better than many explanations and therefore and we report a short excerpt, taken from a text delivered to the President of the XII Hygiene and Healthcare Commission Sileri in reference to the hearings of DDL 770 on vaccine prevention:
"... I will not go into the effectiveness and safety of vaccines as I do not think I have the skills, but from direct experience I tell you that the life of an immunodepressed person is difficult, not for the transmissible exanthematic diseases but for the infinite pathogenic microorganisms more worrying about the daily life of an immunodepressed person. Let's imagine that they shoot outside with machine guns and let's imagine we have a helmet available. Bullets are all the pathogens that can be contracted, the helmet is vaccinations. To believe that an immunosuppressed child is safe in a vaccinated class is like exposing himself to machine gun bursts with a helmet on his head: the head could be protected, but you can safely die even from a blow to the stomach, heart, lung and so on. I therefore ask you to put a point to the exploitation of the immunosuppressed for a social utility based on hypotheses, which has seen sacrifice the right to inclusion of children and the right to study. Every health treatment has possible side effects and I accept this, although I hope that things will improve. The point is constraint. If you are not free to choose, all those who unfortunately suffer damage from that mandatory health treatment will in fact be human sacrifices, immolated for the protection of the common good. If there is even a small risk, a person must be able to choose. It is useless and hypocritical to worry about the individual immunosuppressed, and then not to care about the damaged individual, as if it were a useless waste of society. Having my pathology gives me no right to decide on the children of others. Having my pathology gives me no right to decide on the children of others. The existence of a group of people with a characteristic does not legitimize anyone to mere exploitation. I trust in your reflection and reading of these reflections, so that the definition of the text of DDL 770 in the part of school suspension in the hope that whatever the decision is but NOT IN MY NAME. "
Real places and risks for immunosuppressed people
What are the first dangers?
Who has an immunosuppressed child or who suffers from an immunosuppressive pathology knows that the first recommendations for himself and for those around him are hand washing, even with the trick of running the water for a long time before oral use to reduce the risk of Legionella.
Anyone with an immunosuppressive disease must know that bacterial infections, viral infections, fungal infections, protozoan and helminthic infections are the main families of infections that can put their health at risk. Invasive pulmonary aspergillosis, Penumocystis Jirovecii, Candida albicans, CMV, Toxoplasma gondii, Crypococcus neoformans, Herpes simplex, S. aureus and S. pneumoniae bacteraemia, influenza A and B infections, influenza A and B viruses, cytomegalovirus, viruses, cytomegalovirus, Epstein Barr, adenovirus and respiratory syncytial virus are just some of the viruses for which there is no vaccination and they are all potentially dangerous for an immunocompromised person.
For now we have talked about potentially dangerous pathogens of which there is no vaccination, but those subject to the vaccination obligation?
The previous government has adopted Law Decree 31 of 2017 July 73 due to a decrease in vaccinations, but has applied this decree, whereby the compulsory nature of 10 vaccines, to a small portion of the population, the 0-16 age range years which makes up less than 16% of the total population.
This 16% must be assessed on the basis of all 10 diseases preventable by vaccination and for 6 of these, immunization for an immunodepressed subject is absolutely not recommended. In fact, those suffering from immunosuppression can (indeed are recommended) receive vaccines. The Primary Immunodeficiency Association through the A. Meyer University Pediatric Hospital (https://goo.gl/G7kcgj pages 4 and 5) we can read that:
“Primary immunodeficiencies are a heterogeneous group of rare, congenital and genetically determined conditions, caused by one or more defects of innate and / or specific immunity. The affected subjects show a particular susceptibility to infections and, since these determine the prognosis, prophylaxis procedures are fundamental. Among these, vaccines play a key role. However, they can have different effects depending on the type of deficit: in some cases they induce the same protection as in healthy subjects; in others, due to the immune defect, they do not evoke any response. In addition, in some conditions, serious vaccine effects may occur if live vaccines are administered, including vaccine strain disease. Sometimes, for fear of adverse events, there is a risk that these patients will not be vaccinated. [...] On the other hand, for the same reason it is not said that they are able to respond to the immunizing agent; even some vaccines - those consisting of the bacterium or live virus - may represent a risk, as they are capable of inducing the disease itself. Too often children with immunodeficiencies are not vaccinated at all due to their condition. This is due to the fear of adverse events, dictated by poor knowledge. "
Only in rare cases of immunodeficiency does vaccination with live virus vaccines, such as anti-measles, mumps, rubella and chickenpox, have contraindications but in this case a specific and personalized evaluation is obviously required, and yet the 'tout court' idea of not vaccinating patients with an immune defect because they consider themselves unable to respond to the vaccine stimulus is an idea that is absolutely outdated. There is clear scientific evidence that shows how, in numerous conditions of immunological pathology, an immune response can be induced through the vaccine.
So, to summarize the immunization-depressed vaccination issue, the problem does not arise absolutely for vaccines against: diphtheria, tetanus, pertussis, polio, hepatitis B and haemophilus influenzae type b, as well as for non-mandatory vaccines such as anti-meningococcus, anti-pneumococcal, anti-influenza. The risk for severe immunosuppressed, in relation to vaccine-covered diseases for which Law 119/2017 provides for a vaccination obligation, is limited in rare cases only to measles, mumps, rubella and chicken pox (MPRV) but these subjects are still exposed to a number very high of other infections.
This vaccine-centric approach poses serious dangers for the community. To think that a subject with severe immunological deficit is protected only by vaccination, his and / or other subjects, "is like exposing yourself to machine gun bursts with a helmet on your head", citing Giorgia's effective words.
Vaccination, in rare cases, is absolutely not recommended for immunocompromised individuals for those live virus vaccines, such as MPR (or MPRV) but this opens another problem: if we read the technical data sheets and the official indications of the vaccination containing live attenuated virus, in fact , it reads that "once vaccinated, your baby should try to avoid for at least 6 weeks after vaccination, as far as possible, close contact with:
- individuals with reduced disease resistance,
- pregnant women who have not had chickenpox or who have not been vaccinated against chickenpox.
- newborn babies from mothers who have not had chickenpox or who have not been vaccinated against chickenpox. "
MPRV vaccination in very rare cases can lead to the development of the infection and therefore transform the vaccinated subject into a potential vector of the disease. It is obvious that this does not mean that the vaccinated subject automatically becomes an incubator of the pathogen and therefore to be locked up in isolation, but it is also true that the immunosuppression problem is extremely more complex than is intended.
What is the first place of infection?
All these viruses and bacteria have a favorite place in Europe and Italy to proliferate. The place where it is more possible to contract infections is precisely the place that should most protect the person with immune deficiency and no, it is not the school, but the hospital facilities. The Istituto Superiore di Sanità reminds us that:
"Hospital infections are the most frequent and serious complication of healthcare."
Healthcare has undergone profound changes in recent years. While previously hospitals were the place where most of the care interventions took place, starting from the XNUMXs, both hospitalized patients in serious conditions (therefore at high risk of hospital infections) and places of extra care increased -hospital (nursing homes for the elderly, home care, outpatient care). Hence the need to extend the concept of hospital infections to that of infections related to health and socio-health care (ICA).
Here are the main transmission mechanisms of ICAs:
- direct contact between a healthy person and an infected person, especially through the hands;
- droplets emitted in the act of coughing or sneezing from an infected person to a susceptible one who is less than 50 cm away;
- indirect contact through a contaminated vehicle (e.g. endoscopes or surgical instruments);
- transmission of the infection to several people at the same time, through a contaminated common vehicle (food, blood, infusion fluids, disinfectants, etc ...)
- by air, through microorganisms that survive in the air and are transmitted remotely.
These are all transmission risks that the immunosuppressed subject runs not only in the hospital, but everywhere, in every place and with an enormous number of people because from the grandmother, to the parents, to the teachers, to his doctor, to the neighbor, etc. all are potential vectors of pathogens, both preventable with vaccinations and not preventable with vaccinations. These infectious risks that cannot be vaccinated do not belong to the culture of the “herd effect” but belong to a health awareness that the patient himself has towards the surrounding environment, awareness without official recommendations. 10 or 20 vaccines do not change their protection, indeed, as seen with the MPRV vaccine, the risk of contagion increases compared to a natural contagion of the disease itself.
Use your brain: immunosuppressed pupils are not put at significant risk by the vaccination status of other schoolchildren.
Rubin LG, Levin MJ, Ljungman P et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014 Feb; 58 (3): 309-18.
- PE Fine, Herd Immunity: History, Theory, Practice Epidemiol Rev, 15 (1993), pp. 265-302; S. Salmaso, Vaccines as a prevention tool, cit.
- See I. Cavicchi, Vaccini. It is not enough to reduce the number of mandatory, a therapeutic alliance is needed, in the Healthcare Daily, 3 July 2017, http://www.quotidianosanita.it/studi-e-analisi/articolo.php?articolo_id=52302&fr=n, where it is radically contested, comparing both the WHO indices and the most accredited scientific literature, the indication of the 95% threshold for the flock effect by the ISS.
- http://www.gazzettaufficiale.it/do/atto/corte_costituzionale/caricaPdf?cdimg=17C00192000300001&dgu=2017-08- 09&art.dataPubblicazioneGazzetta=2017-08-09&art.codiceRedazionale=17C00192&art.num=3&art.tiposerie=S1
- https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet? pdfFileName=footer_000200_038200_FI.pdf&retry=0&sys=m0b1l3
- Goldman GS, King PG. Review of the United States universal varicella vaccination program: Herpes zoster incidence rates, cost-effectiveness, and vaccine efficacy based primarily on the Antelope Valley Varicella Active Surveillance Project data. Vaccines 2013; 31:1680–94.
- Donzelli A, Demicheli V. Anticaricella vaccination: scientific arguments for possible strategies different from the current ones. Epidemiol Prev 2018; 42 (1): 65-70.
- Harder T, Siedler A. Systematic review and meta-analysis of chickenpox vaccination and risk of herpes zoster: a quantitative view on the "exogenous boosting hypothesis". Clin Infect Dis, ciy1099, https://doi.org/10.1093/cid/ciy1099
- Donzelli A, Bellavite P, Demicheli V. Pertussis epidemiology and prevention strategies: problems and perspectives. Epidemiol Prev 2019; in press.
- Wendelboe AM, Elisabeth Njamkepo E, Bourillon A et al. Transmission of Bordetella pertussis to young infants. Pediatr Infect Dis J 2007; 26: 293-99.
- Fedele G, Carollo M, Palazzo R et al. Parents as source of pertussis transmission in hospitalized young infants. Infection 2017; 45: 171-78.
- Thomas RE, Jefferson T, Lasserson TJ. Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions. Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No .: CD005187.
- Donzelli A. Obligation to vaccinate health professionals? InfoFarma 2017; 4: 21-22.
- Pezzotti P, Bellino S, Prestinaci F et al. The impact of immunization programs on 10 vaccine preventable diseases in Italy: 1900-2015. Vaccine 2018; 36: 1435-43.
- Kulkarni PS, Jadhav S, Dhere RM. Horizontal transmission of live vaccines. Human Vaccines & Immunotherapeutics 2013; 9: 1,197.
- Cassini A, Diaz Högberg L, Plachouras D et al. Attributable deaths and disability-adjusted life- years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modeling analysis. Lancet Infect Dis 2019; 19 (1): 56-66.
- Special Eurobarometer 445. Antimicrobial Resistance. It Reports. June 2016.
- De Mei B, Cadeddu C, Luzi P, Spinelli A. Movement, sport and health: the importance of policies for promoting physical activity and the impact on the community. Istisan reports 2018; 18/9.
- Aune D, Keum N, Giovannucci E et al. Nut consumption and risk of cardiovascular disease, total cancer, all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective studies. BMC Med 2016; 14 (1): 207.
- Aune D, Giovannucci E, Boffetta P et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality - a systematic review and dose-response meta-analysis of prospective studies. Intern J Epidemiol 2017; 46 (3): 1029-56.
- Aune D, Keum N, Giovannucci E et al. Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta- analysis of prospective studies. BMJ 2016; 353: i2716.
- Siani P. R&P 2018; 34: 225-28.
- Rubin LG, Levin MJ, Ljungman P et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014 Feb; 58 (3): 309-18.
- Smetana J, Chlibek R, Hanovcova I et al. Decreasing Seroprevalence of Measles Antibodies after Vaccination ± Possible Gap in Measles Protection in Adults in the Czech Republic. PLoS ONE 2017; 12 (1): e0170257.
- Cherry JD, Zahn M. Clinical Characteristic of Measles in Previously Vaccinated and Unvaccinated Patients in California. Clin Infect Dis 2018; 67: 1315-19.
- Bergamini M, Comodo N, Gasparini R et al. Prevalence of diphtheria toxin antibodies in human sera from a cross-section of the Italian population. Vaccine 1999; 17: 286-90.
- S Vygen S, A Fischer A, Meurice L et al. Waning immunity against mumps in vaccinated young adults, France 2013. Euro Surveill. 2016; 21 (10): pii = 30156.
- Fields VS, Safi H, Waters C et al. Mumps in a highly vaccinated Marshallese community in Arkansas, USA: an outbreak report. Lancet Infect Dis 2019; Jan 8. pii: S1473-3099 (18) 30607-8. doi: 10.1016 / S1473-3099 (18) 30607-8.
- Chaves SS, Gargiullo P, Zhang JX et al. Loss of Vaccine-Induced Immunity to Varicella over Time. N Engl J Med 2007; 356: 1121-29.
- Centers for Disease Control and Prevention. Recommendations of the Advisory Committee on Immunization Practices (ACIP): use of vaccines and immune globulins in persons with altered immunocompetence. MMWR. 1993 Apr; 42 (No. RR-04).
- Ercan TE, Soycan LY, Apak H, Celkan T, Ozkan A, Akdenizli E, Kasapçopur O, Yildiz I. Antibody titers and immune response to diphtheria-tetanus-pertussis and measles-mumps-rubella vaccination in children treated for acute lymphoblastic leukemia. J Pediatr Hematol Oncol. 2005 May; 27 (5): 273-7.
- Feldman S, Gigliotti F, Shenep JL, Roberson PK, Lott L. Risk of Haemophilus influenzae type b disease in children with cancer and response of immunocompromised leukemic children to a conjugate vaccine. J Infect Dis. 1990 May; 161 (5): 926-31.
- Hodges GR, Davis JW, Lewis HD Jr, Siegel CD, Chin TD, Clark GM, Noble GR. Response to in uenza A vaccine among high-risk patients. South Med J. 1979 Jan; 72 (1): 29-32.
- Moss WJ, Clements CJ, Halsey NA. Immunization of children at risk of infection with human immunode ciency virus. Bull of the World Health Organ. 2003; 81 (1): 62,64.
- Barbi M, Bardare M, Luraschi C, Zehender G, Clerici Schoeller M, Ferraris G. Antibody response to inactivated polio vaccine (E-IPV) in children born to HIV positive mothers. Eur J Epidemiol. 1992 Mar; 8 (2): 211-6.
- Centers for Disease Control and Prevention. Manual for the surveillance of vaccine-preventable diseases. 5th ed. Miller ER, Haber P, Hibbs B, Broder K. Chapter 21: surveillance for adverse events following immunization using the Vaccine Adverse Event Reporting System (VAERS). Atlanta: Centers for Disease Control and Prevention; 2011. 1,2.
- US Food and Drug Administration: vaccines licensed for use in the United States. Silver Spring: US Food and Drug Administration; [updated 2018 Feb 14; cited 2018 Feb 27]. https://www.fda. gov / BiologicsBloodVaccines / Vaccines / ApprovedProducts / ucm093833.htm.
- Miller LW, Older JJ, Drake J, Zimmerman S. Diphtheria immunization. Effect upon carriers and the control of outbreaks. Am J Dis Child. 1972 Mar; 123 (3): 197-9.
- Warfel JM, Zimmerman LI, Merkel TJ. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proc Natl Acad Ski USA. 2014 Jan 14; 111 (2): 787-92.
- Cuba IPV Study Collaborative Group. Randomized, placebo-controlled trial of inactivated poliovirus vaccine in Cuba. N Engl J of Med. 2007 Apr 12; 356 (15): 1536-44.
- Thomas RE, Jefferson T, Lasserson TJ. In uenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions. Cochrane Database Syst Rev. 2016 Jun 2; (6) CD005187: 2.
- Ohmit SE, Petrie JG, Malosh RE, Cowling BJ, Thompson MG, Shay DK, Monto AS. In uenza vaccine effectiveness in the community and the household. Clin Infect Dis. 2013 May; 56 (10): 1363.
- Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Hamborsky J, Kroger A, Wolfe S, editors. Washington DC: Public Health Foundation; 2015. 344.
- Centers for Disease Control and Prevention. Protect your baby for life: when a pregnant woman has hepatitis B. October 2010. https://www.cdc.gov/hepatitis/HBV/PDFs/HepBPerinatal- ProtectWhenPregnant.pdf.
- Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Hamborsky J, Kroger A, Wolfe S, editors. Washington DC: Public Health Foundation; 2015. 154-5.
- Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Hamborsky J, Kroger A, Wolfe S, editors. Washington DC: Public Health Foundation; 2015. 177.
- Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Hamborsky J, Kroger A, Wolfe S, editors. Washington DC: Public Health Foundation; 2015. 120.
- Wagenvoort JH, Harmsen M, Boutahar-Trouw BJ, Kraaijeveld CA, Winkler KC. Epidemiology of mumps in the Netherlands. J Hyg (Lond). 1980 Dec; 85 (3): 313-26.
- Centers for Disease Control and Prevention. Reported cases and deaths from vaccine preventable diseases, United States, 1950-2013. Epidemiology and prevention of vaccine- preventable diseases. Hamborsky J, Kroger A, Wolfe S, eds. 13th ed. Washington DC: Public Health Foundation; 2015. Appendix E3.
- de Boer AW, de Vaan GA. Mild course of mumps in patients with acute lymphoblastic leukaemia. Eur J Pediatr. 1989 Jun; 148 (7): 618-9.
- Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Hamborsky J, Kroger A, Wolfe S, editors. Washington DC: Public Health Foundation; 2015. 262,263,265,325,326.
- McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS; Centers for Disease Control and Prevention. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2013 Jun; 62 (RR-04): 17,24.
- Young MK, Cripps AW, Nimmo GR, van Driel ML. Post-exposure passive immunization for preventing rubella and congenital rubella syndrome. Cochrane Database Syst Rev. 2015 Sep 9; (9) CD010586: 3.
- Centers for Disease Control and Prevention. Varicella-zoster immune globulin for the prevention of chickenpox: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR. 1984 Feb; 33 (7): 84-90,95-100.