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Outstanding Package Insert Quotes 1

I’m sure I have said it a million times, “read the package insert, read the package insert, read the package insert!”

Here are a few excerpts from the DTap, Gardasil and Varivax package inserts. All indented material is quoted directly from the insert which you can find a link to at the bottom of the page. Enjoy! I know I did.

If using a combination vaccine, such
 as Pediarix, then your baby will likely
 get three shots and RotaTeq, an oral
 vaccine, at her/his two- and four-month-old
 well child checkup.

 Photo © Vincent Iannelli, MD
DTap -  Pediarix (GSK)

(The pediatric DTap is administered to children at 2 months, 4 months, 6 months, 15 months, 4-6 years old. The Tdap vaccine is then administered at 11 years old and for pregnant mothers- check out this new 2012 recommendation here. The Td vaccine is given every 10 years.)





"The role of the different components produced by B. pertussis in either the pathogenesis of, or the immunity to, pertussis is not well understood. There is no established serological correlation of protection for pertussis."


14 Clinical Studies

The efficacy of the pertussis component, which does not have a well established correlate of protection, was determined in clinical trials of INFANRIX.


This could explain why there is a large population of vaccinated individuals acquiring pertussis. (this post gives several examples ‘So an Unvaccinated Child Got Your Kid Sick?) . The vaccine does not even attempt to lay claim in endowing “immunity” to pertussis. What a crock.






HPV - GARDASIL (Merck)



Now that's what I call a shot!

The number one warning and precaution listed in package insert (Quoted directly)

5.1 Syncope

Because vaccines may develop syncope, sometimes resulting in falling with injury, observation for 15 minutes after administration is recommended. Syncope, sometimes associated with tonic-clonic movements and other seizure-like activity, has been reported following vaccination with GARDASIL. When syncope is associated with tonic-clonic movements, the activity is usually transient and typically responds to restoring cerebral perfusion by maintaining a supine or Trendelenburg position.



Syncope is a fancy term for fainting – but don’t forget “other seizure-like activity”. The CDC made Merck add this to their package insert after being on the market for several years.[1]


          

Recipients of Gardasil should be closely observed for 15 minutes after vaccination. 



This minor change took Merck three whole years to put into place.

Merck has stated that these seizures are not epileptic in nature, however, even they have to admit that a faint followed by tonic-clonic movement and seizure like activity, which ever way they dress it up, is really saying in the broad sense, a child could have a seizure after having a Gardasil vaccination.[2]

The Epilepsy Foundation describes a seizure, in the same way as Merck is now describing on their new labeling as “seizure-like”.[3]

Vaccines have been linked to seizures as far back as 1950.[4][5][6][7]



6.1 Clinical Trials Experience


12.1 Mechanism of Action

…safety was evaluated using vaccination report cards (VRC)-aided surveillance for 14 days after each injection


That’s what I call a long term safety study.  



8.1 Pregnancy

There were 45 cases of congenital anomaly in pregnancies that occurred in women who received GARDASIL and 34 cases of congenital anomaly in pregnancies that occurred in women who received AAHS control or saline placebo.

For pregnancies with estimated onset within 30 days of vaccination, 5 cases of congenital anomaly were observed in the group that received GARDASIL compared to 1 case of congenital anomaly in the group that received AAHS control or saline placebo.

(congenital anomalies included pyloric stenosis, congenital megacolon, congential hydronephrosis, hip dyplasis, and club foot)



8.3 Nursing Mothers

In a post-hoc analysis of clinical studies, a higher number of breast-feeding infants whose mothers received GARDASIL has acute respiratory illnesses within 30 days post vaccination of the mother as compared to infants whose mothers received AAHS control.


Friggin’ crazy.



11 Description

Each 0.5mL dose of the vaccine contains approximately 225 mcg of aluminum (AAHS), 9.56 mg of sodium chloride, 0.78 mg of L-histidine, 50 mcg of polysorbate 80, 35 mcg of sodium borate.


Interested to learn more about aluminum adjuvants? Check this out.



12.1 Mechanism of Action

HPV only infects human beings, Animal studies with analogous animal papillomaviruses suggest that the efficacy of L1 VLP vaccines may involve the development of humoral immune responses. Human beings develop a humoral immune response to the vaccine, although the exact mechanism of protection is unknown.


Hello! Might as well state, “We’re not sure what the hell is going on.”



14 Clinical Studies

CIN 2/3 and AIS are the immediate and necessary precursors of squamous cell carcinoma and adenocarcinoma of the cervix, respectively.  Their detection and removal has been shown to prevent cancer; thus, they serve as surrogate markers for prevention of cervical cancer. …CIN 2/3 and AIS were the efficacy endpoints to assess prevention of cervical cancer.


Gardasil does not prevent cancer, instead it was shown to decrease CIN 2/3 and AIS. Most cases of CIN regress and are eliminated by the immune system without intervention. Most (90%) regress within 2 years.[8][9]


Interestingly enough, the majority of women who develop CIN are 25 to 35 years old.[8][9]

Progression of CIN typically takes 15 (in some cases 40) years.[9]

Risk factors that have been shown to increase a woman's likelihood of developing CIN, including poor diet, poor personal hygiene, multiple sexual partners, lack of condom use, and cigarette smoking.[10][11]



14.8 Immunogenicity



The duration of immunity following a complete schedule of immunization with GARDASIL has not been established.


According to the National Cancer Institute’s website, Gardasil might only protect against HPV for four years. The duration of immunity is not yet known. Research is being conducted to find out how long protection will last. Studies thus far have shown that Gardasil can provide protection against HPV 16 for 4 years.”

The vaccine is administered at the age of 9 years old. Again, the majority of women who develop CIN are 25 to 35 years old.






Varivax Merck & Co., Inc.







No placebo-controlled trial was carried out the VARIVAX using the current vaccine


That’s reassuring.



no placebo-controlled trial was carried out in adolescents and adults



More reassuring information.




A boost in antibody levels has been observed in vaccines following exposure to natural varicella which could account for the apparent long-term persistence of antibody levels after vaccination in these studies. The duration of protection from varicella obtained using VARIVAX in the absence of wild-type boosting is unknown.


Please read that excerpt again – hello!

Elevated antibody levels are not from the vaccine, but instead from the exposure of wild, natural chicken pox!?!

And who knows how long protection will last in the absence of wild-type varicella.

Does anyone else read this stuff? I don’t get it.



Post-marketing experience suggests that transmission of vaccine virus may occur between healthy vaccinees who develop a varicella-like rash and healthy susceptible contacts. Transmission of vaccine virus from vaccinees who do not develop a varicella-like rash has also been reported.

Ok, so you could get chicken pox from someone that has received the vaccine whether or not they have a rash or not. Ugh.



Vaccine recipients should attempt to avoid, whenever possible, close association with susceptible high-risk individuals for up to six weeks.

(immunocompromised individuals, pregnant women, newborns)


Six weeks!




Varicella (vaccine strain)



What a joke. Aren’t parents administering the vaccine to avoid varicella. Not only did they get chicken pox, but they caught it from the vaccine!


Reye’s Syndrome



Clinical Pharmacology; One-Dose Regimen in Children

Physicians advised varicella vaccine recipients not to use salicylates for six weeks after vaccination.


Salicylates occur naturally and artificially. Aspirin, of course, is a salicylate – but also strawberries are extremely high in salicylates. Other foods extremely high in salicylates are: raisins, oranges, honey, and all varieties of tea.[12]



Indications and Usage

The duration of protection of VARIVAX is unknown.


Again – does any manufacturer have a clue?  


In highly vaccinated populations, immunity for some individuals may wane due to lack of exposure to NATURAL varicella.[emphasis added]



The hell with herd immunity – if you reach high levels of vaccinated levels then you might not be protected. So, in part, this is saying we need unvaccinated people around to keep kids who have been vaccinated protected! What a friggin’ joke!




Links to package inserts:







References

[1]FDA-Vaccines, Blood & Biologics. Information Pertaining to Labeling Revision for Gardasil


[2]England, Christina. Merck admits the vaccine Gardasil, can cause faints and seizures. American Chronicle. Jun 14 2009 The  

[3] The Epilepsy Foundation.Website. Glossary Page

[4]Baraff LJ et al (1988). Infants and children with convulsions and hypotonic-hyporesponsive episodes following diphtheria-tetanus-pertussis immunization: follow-up evaluation. Pediatrics 81(6):789-94 1988. Department of Pediatrics, University of California, Los Angeles, School of Medicine.

[5]Cizewska S, Huber Z, Sluzewski W, "[Prophylactic inoculations and seizure activity in the EEG]," Neurol Neurochir Pol 1981 Sep-Dec;15(5-6):553-557. [Article in Polish]

[6]Coplan J, "Seizures following immunizations," J Pediatr 1983 Sep;103(3):496

[7]Jacobson V et al (1988). Relationship of pertussis immunization to the onset of epilepsy, febrile convulsions and central nervous system infections: a retrospective epidemiologic study. Tokai J Exp Clin Med 13 Suppl:137-42 1988. Department of Neurology,
UCLA School of Medicine.

[8]Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. pp. 718–721.


[9]Bosch FX, Burchell AN, Schiffman M, Giuliano AR, de Sanjose S, Bruni L, Tortolero-Luna G, Kjaer SK, Muñoz N (August 2008). "Epidemiology and natural history of human papillomavirus infections and type-specific implications in cervical neoplasia". Vaccine 26 (Supplement 10): K1–16.. 18847553.

[10]Murthy NS, Mathew A. (February 2000). "Risk factors for pre-cancerous lesions of the cervix". European Journal of Cancer Prevention 9 (1): 5–14. 
[11]Hogewoning CJ, Bleeker MC, van den Brule AJ, Voorhorst FJ, Snijders PJ, Berkhof J, Westenend PJ, Meijer CJ. (2003-12-10). "Condom use promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: a randomized clinical trial.". Int J Cancer 107 (5): 811–6.

[12]Adams, Maria MS,MPH, RD. Low-Salicylate Diet. Aug 11 2011  

The following adverse reactions have been reported since the vaccine has been marketed:

Clinical Pharmacology; Two-Dose Regimen in Adolescents and Adults

Unbiased Info on Vaccines and Disease

If you are looking to expand your knowledge about vaccines and disease then the NVIC website has you covered!


The National Vaccine Information Center marks 30 years of dedication to the prevention of vaccine injuries and deaths through public education and defending the informed consent ethic in medicine. 

Mission

Barbara Loe Fisher is co-founder
and president of the National
 Vaccine Information Center
NVIC does not advocate for or against the use of vaccines. They support the availability of all preventive health care options, including vaccines, and the right of consumers to make educated, voluntary health care choices.[1] Amen to that!


This organization, located in Virginia, works to protect the freedom for citizens to exercise the human right to voluntary, informed consent to any medical intervention or use of pharmaceutical product, such as a vaccine, which carries a risk of injury or death.[1] 


Ask 8

If you are thinking about getting a vaccine or administering them to your child, NVIC recommends asking 8 questions:[2]


1. Am I or my child sick right now?

2. Have I or my child had a bad reaction to a vaccination before?

3. Do I or my child have a personal or family history of vaccine reactions, neurological disorders, severe allergies or immune system problems?

4. Do I know the disease and vaccine risks for myself or my child?

5. Do I have full information about the vaccine’s side effects?

6. Do I know how to identify and report a vaccine reaction?

7. Do I know I need to keep a written record, including the vaccine manufacturer’s name and lot number, for all vaccinations?

8. Do I know I have the right to make an informed choice?

Click here to learn more about the role of informed consent in vaccination. 


Newsletter

NVIC also publishes a free online NVIC Vaccine eNewsletter to keep consumers informed of the latest information about vaccines and infectious diseases and offers tools like NVIC's Advocacy Portal that helps consumers protect vaccine choice in their state and the Vaccine Ingredient Calculator to assist consumers in becoming knowledgeable about vaccines, existing safe standards for toxins found in vaccines and a printable vaccination plan to facilitate parent-health provider dialogue.

Also, be sure to visit the NVIC Diseases and Vaccines webpage, which provides information on risks and benefits associated with vaccines. This page is great resource.


Freedom Wall 

Do you have a harassment story to share? Answer the Vaccine Harassment Reporting Form. Your personal identity will be kept confidential. You can read through others stories as well, just click here .


Memorial 

The National Vaccine Information Center has created a Memorial to honor individual vaccine victims.[3]

The Memorial also offers families around the world the opportunity to post stories and photos about what happened to their loved ones so that others can become educated about the signs and symptoms of vaccine reactions in order to prevent vaccine injuries and deaths.

The hope is that, by honoring those who are casualties of mass vaccination policies, there will be greater public awareness of the need to value and care as much about those who are harmed by the complications of vaccines as we care about those who are harmed by the complications of infectious diseases.

This International Memorial for Vaccine Victims is offered to the world as testimony of the need to protect the biological integrity of life on this planet.[3]


Happy 30 years NVIC!!!!



[1] http://www.nvic.org/about.aspx

[2] http://www.nvic.org/Ask-Eight-Questions.aspx

[3] http://www.nvic.org/Vaccine-Memorial.aspx

Baby Led Weaning and Delaying Solids

No need to dust off that blender (unless you plan on making a strong margarita) and you can toss out those ice cube trays – that’s right, here’s my take on Baby Led Weaning and Delaying Solids!

With my first child, we made all of her baby food from scratch starting around 4.5 months. This starting point was advocated by her pediatrician at the time.


I didn’t think to question when to start feeding her since everyone else seemed to agree that around 4 months was the appropriate time to introduce solids (via purees). It couldn’t have been further from the truth. But to understand why it’s essential to wait (until at least 6 months-some say to even a year!) to introduce solids, we should review the digestive system of our little tots.

Open Gut

Babies from the age of birth until approximately 6 months of age have what is referred to as an “open gut”. This terms simply means that the cells that line the small intestines have spaces in between them that allow macromolecules (which includes proteins and pathogens) to pass directly in the bloodstream. This open gut is beneficial in many ways which allows the antibodies from the breast milk to pass directly into the infant’s blood while also being coated with IgA antibodies from the milk to provide passive immunity. However, this also means that whole proteins from foods (which may carry pathogens) can pass right through as well.[1][2]


Digestive Enzymes

Digestion is a complex process that breaks down food beginning in the mouth and continues throughout the digestive tract with the stomach, pancreas, liver and intestines. Digestive enzymes are found in the intestines and pancreas that aid in digestion and absorption of nutrients.

Get this – there are many different, specific types of enzymes for particular types of food. Some enzymes are present in extremely low levels or are entirely absent from a baby’s digestive system.

For example, amylase, which is a key player in the digestion of carbohydrate, is virtually nonexistent in the pancreas until at least six months of age. Or ptyalin, an enzyme in the saliva that breaks down carbohydrates, is not present until around 12 months of age.[3][4]


Many other carbohydrate enzymes (maltase, isomaltase and sucrase) do not reach optimal levels until around 7 months.[3]


Why Wait?

When food is introduced to a baby’s system before it is able to correctly digestive and absorb them then you will see certain reactions, such as constipation, gas, fussiness, diarrhea, and digestive upset.  


CLICK TO ENLARGE


Concerns

But My Doctor Says It’s Ok
You might want to ask a second opinion from a nutritionalist considering pediatric course work may only include one semester of understanding the nutritional needs of infants and babies

A few organizations recommending delaying solids until at least 6 months:[4]

World Health Organization
UNICEF
US Department of Health & Human Services
American Academy of Pediatrics
American Academy of Family Physicians
American Dietetic Association
Australian National Health and Medical Research Council
Royal Australian College of General Practitioners Health Canada


What About Iron Levels
Very true – breast milk has low levels of iron compared to formula. But consider this – the level of iron in breast milk is exactly the right amount for your baby and the level in formula and rice cereal is extremely elevated compared to normal levels.

This is because iron is more readily absorbed from breast milk (at a rate of 49% compared to only 4% of iron in formula or rice cereal). This absorption of iron is aided because of the elevated levels of lactose and vitamin C in human milk. It is also important to note that high levels of iron in formula and enriched cereals are lost in the bowels (no wonder that poo stinks).[5]


What Is BLW?

Baby Led Weaning (BLW) is skipping purées and not feeding your baby with a spoon. Consider if you wait until at least 6 or 7 months, your baby is old enough to feed themselves – hence, no need for purees.

***The big difference between BLW and traditional weaning is the order that babies learn to eat.

With purees, babies learn to swallow first and then chew. With BLW, babies learn to chew first and then swallowing eventually comes some time later.


Why Weaning Styles Are Important

According to a very recent article in the BMJ, weaning style impacts food preferences and health in early childhood. Infants that are weaned through a baby-led approach learn to regulate their food intake in a manner which leads to lower BMI and a preference for healthy foods.[6]


My Take and What We Decided

My youngest, Charlotte is just over 6 months now and we have given her some food to experiment with during dinner time (such as slices of avocado and a whole banana).


It is quite messy but the thing I love most about BLW is its emphasis on families eating together. It has been amazing to watch her discover food and show so much concentration in meeting new textures and exploring new tastes.

For me, it still seems so soon and she doesn’t seem completely ready (she is just barely sitting up by herself). I do feel tons of pressure to feed  and introduce her to foods but right now we’ll go days between providing her food to play with and I am all right with that.

I am very glad we did wait until past the 6 month mark – and I plan on taking it very slow with the introduction of foods.

Oh yeah – and yippie for no purees!!!




Citations

[1] Bauer, Mary.Infant Digestive System Development. Jun 14 2011

[2] R Wall, R. P Ross, C.A Ryan, S Hussey, B Murphy, GF Fitzgerald and C Stanton. Role of Gut Microbiota in Early Infant Development. Clinical Medicine Insights: Pediatrics. Mar 2009

[3] Wootan, George. Book: Take Charge of Your Child’s Health. Page 122

[4] Why Delay Solids? KellyMom Breastfeeding and Parenting. Apr 3 2010 

[5] Flora-Waterman, Becky. Solids Food: Best Delayed. Breastfeeding Essentials Website. Sept 24 2005

[6]Ellen Townsend and N Pitchford. Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case–controlled sample. BMJ. Feb 6 2012

Vaccine Trials & the Use of Placebos

When reviewing published literature on vaccine safety you’ll undoubtedly find yourself examining vaccine trials.

You can review the safety trials in the package insert which are briefly described for that particular vaccine.

Here is some information in understanding vaccine trials and how they go about proving safety.


What is a clinical trial?

A research study conducted on human volunteers is considered a clinical trial. The trial is designed to answer specific question about a vaccine, such as how safe and effective they are.

The best way to determine if a vaccine or any therapy s effective and safe is to perform and test it in a randomized, controlled, double-blind clinical trial over a substantial period of time. This type is trial is referred to as the gold standard in research and presents the strongest evidence for efficacy.[1]


Clinical trials are conducted commonly in 3 phases. There is a fourth stage which can occur after a vaccine has been licensed, but this stage is not always required or completed.[2]


Vaccine Trial - Phase I

This trial is includes a small group of test subjects (averaging between 20-80 people). When the vaccine is intended for pediatric use, adults are tested and then there is a step down in age range. Interesting to note that the Hepatitis B vaccine given at birth, Merck’s Recombivax was never tested in newborns. [3][4]

Measures of efficacy used in trial phases are assessing the level of T-cells or antibody titers generated.[5]

The ultimate objective in phase I is to evaluate safety and determine the immune response of the vaccine.[2]




Vaccine Trial – Phase II

Once a vaccine has gone through phase I, a larger group participates in testing. This group usually consists of several hundred. Differing dosage levels are tested in this phase.[5]  

The trials in phase II are often randomized and include a placebo group. It is imperative to note that there are no regulations that govern the composition of a placebo. The majority of clinical trials use either another vaccine or a solution with an adjuvant (such as aluminum).

For example, the Pediarix vaccine (DTap+HepB+IPV) given to infants in 3 doses (2mo, 4mo, 6mo) used the following as placebos in its trials: Hib vaccine GlaxoSmithKline, Hib vaccine of Wyth Pharmaceuticals (no longer licensed in the US), Hib vaccine of Merck, Infanrix vaccine, oral poliovirus vaccine (OPV), and a pneumococcal vaccine. None of the placebos used contains a saline solution. [6]


This is not an exception, rather it is the norm.

Another example is Prevnar 13 (the newest Pneumococcal  vaccine) which used the old Prevnar vaccine as the placebo in its 13 clinical trials.[7] You may ask then what the placebo was for the old Prevnar vaccine – the answer is an investigational meningococcal group C vaccine.[8]


The goal of the second phase of vaccine trials is to study safety, dosage, immunogenicity, method of delivery and schedule of immunizations.[2]  



Vaccine Trial – Phase III

These trials may contain thousands of subjects and test the vaccine, again, in a randomized, double blind fashion using the same type of placebos in phase II.

Phase III is important because of it’s utilization of a larger sample size which has the ability to reflect adverse events that might occur in 1 of every 10,000 people. To detect such a statistical variance for such a low-frequency event, the clinical trial must include at least 60,000 subjects, which half of them would be in the control group. [2][9]



Conclusion

I hope this information sheds some light on what clinical trials are, how they are performed and what is assessed at each phase. A fantastic website to review past and current trials used by the government is at clinicaltrials dot gov.  Enjoy – and never stop learning about health!


References
[2] Vaccine Development, Testing and Regulation. The College of Physicians of Philadelphia. http://www.historyofvaccines.org/content/articles/vaccine-development-testing-and-regulation

[3] List of clinical trials for Recombivax from the US National Institutes of Health http://clinicaltrials.gov/ct2/results?term=recombivax


[5] Clinical Trials. Crucell 2009 http://www.crucell.com/R_and_D-Clinical_Trials

[6] GlaxoSmithKline package insert for Pediarix http://us.gsk.com/products/assets/us_pediarix.pdf

[7] Pfizer package insert for Prevnar 13 http://labeling.pfizer.com/showlabeling.aspx?id=501

[8] Pfizer package insert for Prevnar  http://labeling.pfizer.com/showlabeling.aspx?id=134

[9] Plotkin SA et al. Vaccines, 5th ed. Philadelphia: Saunders, 2008

Pictures from drsophiayin.com and hpathy.com