For decades, public health agencies have been focusing on demonstrating the reduction in vaccine-preventable disease incidence following the introduction of vaccination programs, while disregarding the unintended consequences such programs may have had on overall infectious disease epidemiology and long-term levels of the population’s immunity. Such unintended consequences include the phenomenon of strain replacement, the rise in clinically similar diseases caused by unrelated viruses, and the increase in disease severity due to shifting the risk of infection into more vulnerable age groups. Here we will highlight these phenomena.
Non-vaccine strains of viruses or serotypes of bacteria can replace their vaccine-targeted counterparts. Examples:
Human papillomavirus: The human papillomavirus (HPV) vaccination campaign targeting only a handful of HPV strains, has been heralded as a public health measure aimed at the reduction of cervical cancer associated with unresolved high-risk HPV infections. Yet, a 2015 study in Human Vaccine Immunotherapy concluded that “vaccinated women had a higher prevalence of high-risk non-vaccine types.” A 2016 study in Oncology Letters corroborated that “there may be a continuous shift in the prevalence of HPV types as a result of vaccination” and that “it may be important to monitor non-vaccine HPV types in future studies.” Thus, although vaccine-targeted strains of HPV infections have declined, the increase in non-vaccine HPV strains will likely negate cervical cancer reduction efforts in a long-term.
See also our HPV page.
Haemophilus influenzae: Haemophilus influenzae includes multiple serotypes capable of causing invasive bacterial disease, such as meningitis and pneumonia. Serotype replacement has been observed following the introduction of the Hib vaccine, which targets only type b of H. influenzae. According to a study published in Vaccine, “[f]ollowing routine childhood vaccination against Haemophilus influenzae type b (Hib) disease in Brazil in 1999, passive laboratory surveillance reported increasing numbers of non-b serotypes and nontypeable H. influenzae (NTHi) from meningitis cases.” Similarly, a study done in Canada spanning the years of 2003-2006, noted that “incidence rates of non-Hib invasive disease were similar to the rates of Hib disease in the pre-Hib vaccine era.” Thus, Hib mass vaccination efforts have resulted in no net reduction in invasive H. influenzae disease, despite their celebrated effect on Hib.
Rise In Clinically Similar Diseases
Unrelated infections causing clinically similar diseases are associated with the use of some vaccines. Examples:
OPV and Acute Flaccid Paralysis (AFP): In recent decades, India has been a target for wild poliovirus eradication by means of intensive oral polio vaccination (OPV). A report published in Pediatrics in 2015 revealed the gory outcome of these efforts: “The incidence of polio AFP in India has decreased. However, the nonpolio AFP rate has increased since 2000,” and “35.2% of [nonpolio AFP] patients were found to have residual paralysis, and 8.5% had died.” While the culprit behind nonpolio AFP, which is clinically indistinguishable from polio AFP, remains to be announced to the public, the wild poliovirus eradication campaign in India has neither reduced human suffering nor eliminated death from paralysis. The rise in the incidence of AFP negated the efforts in wild polio eradication. Furthermore, the Polio Global Eradication Initiative (PGEI) has documented only 22 and 11 cases of wild polio worldwide in the year of 2017 and the first half of 2018, respectively, while also stating that there are more than 100,000 AFP cases detected and investigated every year around the world. Why is the overwhelming burden of AFP not being addressed and global efforts continue to focus solely on eradication of wild poliovirus?
TIV and non-influenza respiratory viral illness: A 2012 placebo-controlled study found a significant increase in non-influenza respiratory viral illness in children receiving trivalent inactivated influenza vaccine (TIV). The authors of the study concluded: “TIV recipients may lack temporary non-specific immunity that protected against other respiratory viruses.” The most prominent susceptibility of TIV recipients in the study was to the Coxsackie/echovirus family of viruses, known to be capable of causing aseptic meningitis.
See also our Flu page.
Age Shift In Disease Risk
High vaccination compliance can still fail to prevent outbreaks in communities, leaving the vulnerable unprotected or potentiating a more serious form of disease. Examples:
Measles: Mass vaccination against measles, which started in 1963, has produced unintended consequences on the next generation of babies. Referring to the years of 1989–1991, when measles started to disproportionately affect infants, the Centers for Disease Control and Prevention (CDC) states the following reason for the observed phenomenon: “The mothers of many infants who developed measles were young, and their measles immunity was most often due to vaccination rather than infection with wild virus. As a result, a smaller amount of antibody was transferred across the placenta to the fetus, compared with antibody transfer from mothers who had higher antibody titers resulting from wild-virus infection. The lower quantity of antibody resulted in immunity that waned more rapidly, making infants susceptible at a younger age than in the past.”
Waning vaccine-induced immunity and a fraction of the population that develops very low levels of protective antibodies after vaccination (low vaccine responders) are driving the ‘measles paradox,’ which Poland & Jacobson described in their publication back in 1994: “The apparent paradox is that as measles immunization rates rise to high levels in a population, measles becomes a disease of immunized persons.” Predictably, outbreaks of measles in Quebec, Canada and Zhejiang province, China have occurred even when vaccination compliance was in the highest bracket (95-97% and greater than 99%, respectively). Thus, a highly vaccinated population does not ensure the protection of its immunologically vulnerable individuals, including infants born to non-immune mothers, from a disease outbreak.
Does any vaccine create community immunity to help protect vulnerable individuals indirectly? See Community Immunity? for answers.
Chickenpox and shingles: The reduction in the circulation of varicella (chickenpox), continuous exposure to which is necessary to prevent a more serious form of disease in adults (shingles), can lead to the rise of the latter. The rise in shingles has been observed in the USA following the introduction of routine childhood vaccination against chickenpox. A 2013 report in Vaccine states: “Universal varicella vaccination has not proven to be cost-effective as increased HZ [shingles] morbidity has disproportionately offset cost savings associated with reductions in varicella disease.” For this reason the National Health Service (NHS) has prudently decided against adding the chickenpox vaccine to the UK childhood schedule. See the NHS’s Chickenpox vaccine FAQs.
The unintended consequences of mass vaccination on overall epidemiology of infectious disease and the population’s immunity, coupled with the human and financial burden of managing vaccine injury by affected individuals, may have by far outweighed the benevolent but nebulous intentions of mass vaccination programs, resulting in an overall sicker, more disabled, and fear-driven population we now have.
For the shift in perspective from vaccine-centered to the immune system-centered paradigm of health, please see the 2017 Future of Immunity lecture by immunologist Tetyana Obukhanych, PhD in Lynnwood, WA.
© Informed Choice WA 2018. All rights reserved. Contributing authors: Drella Stein, Bernadette Pajer, and Tetyana Obukhanych, PhD.
Guo et al. “Comparison of HPV prevalence between HPV-vaccinated and non-vaccinated young adult women (20–26 years).” Hum Vaccin Immunother 2015; 11(10):2337-44. www.ncbi.nlm.nih.gov/pubmed/26376014
Fischer et al. “Shift in prevalence of HPV types in cervical cytology specimens in the era of HPV vaccination.” Oncology Lett 2016; 12(1):601-10. www.ncbi.nlm.nih.gov/pubmed/27347187
Zanella et al. “Changes in serotype distribution of Haemophilus influenzae meningitis isolates identified through laboratory-based surveillance following routine childhood vaccination against H. influenzae type b in Brazil.” Vaccine 2011; 29(48):8937-42. www.ncbi.nlm.nih.gov/pubmed/21945960/
Tsang et al. “Characterization of invasive Haemophilus influenzae disease in Manitoba, Canada, 2000-2006: invasive disease due to non-type b strains.” Clin Infect Dis 2007: 44(12):1611-4. www.ncbi.nlm.nih.gov/pubmed/17516405
Vashisht et al. “Trends in nonpolio Acute Flaccid Paralysis incidence in India 2000 to 2013.” Pediatrics 2015; 135(Suppl1). pediatrics.aappublications.org/content/135/Supplement_1/S16.2
Polio Global Eradication Initiative. “Global Wild Poliovirus” polioeradication.org/wp-content/uploads/2018/06/global-wild-poliovirus-2013-2018-20180612.pdf ; “Acute flaccid paralysis case under investigation in Venezuela” polioeradication.org/news-post/acute-flaccid-paralysis-case-under-investigation-in-venezuela/.
Cowling et al. “Increased risk of noninfluenza respiratory virus infections associated with receipt of inactivated influenza vaccine.” Clin Infect Dis 2012; 54(12):1778-83. www.ncbi.nlm.nih.gov/pubmed/22423139
Goldman & King. “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.” Vaccine 2013; 31(13):1680-94. www.ncbi.nlm.nih.gov/pubmed/22659447
National Health Service. “Chickenpox vaccine FAQs.” www.nhs.uk/conditions/vaccinations/chickenpox-vaccine-questions-answers
Centers for Disease Control and Prevention. “Epidemiology and Prevention of Vaccine-Preventable Diseases: Measles.” p.215 www.cdc.gov/vaccines/pubs/pinkbook/downloads/meas.pdf
Poland & Jacobson. “Failure to Reach the Goal of Measles Elimination: Apparent Paradox of Measles Infections in Immunized Persons.” Arch Intern Med 1994; 154(16):1815-20. www.ncbi.nlm.nih.gov/pubmed/8053748
De Serres et al. “Largest measles epidemic in North America in a decade–Quebec, Canada, 2011: contribution of susceptibility, serendipity, and superspreading events.” J Infect Dis 2013; 207(6):990-8. www.ncbi.nlm.nih.gov/pubmed/23264672
Wang et al. “Difficulties in eliminating measles and controlling rubella and mumps: a cross-sectional study of a first measles and rubella vaccination and a second measles, mumps, and rubella vaccination.” PLoS One 2014; 9(2):e89361. www.ncbi.nlm.nih.gov/pubmed/24586717