Friday, April 16, 2010

My rationale for vaccination vrs against those who opposed of it...

Simply go to Youtube, and key in the word "side effects of cervical cancer vaccine",  the page that appears is full of videos clips of claims of its hazardous side effect, death, complication, whether or not a person should be vaccinated or not.. it's just simply overwhelming.
I thought to myself for a while, and I guess the best way to change the mindset of public perception on this vaccine would be to publish a mail which I've received today, and the reply that I wrote.
I am from India and am 42yrs old.
I had my daughter of 18yrs vaccinated with the first course of Gardacil on 10th April 2010.
I was very worried when i read articles is the local newspapers doubting the efficacy of the vaccine and its side-effects. I was in mental torture after watching the youtube videos against the HPV vaccine.
Please kindly advice about the side-effects and dangerous risks(infertillity, blood clots etc) associated with the vaccine as mentioned online in reports.
Thank You very much,
Your help in the matter will be sincerely appreciated.


After reading his mail, I thought his worries are totally unnecessary. But who wouldn't after so much hype the public created? So, my reply was this:-
Dear respected Mr ***,
First and foremost, I would like to express my sincere thanks and appreciation for writing in to inquire regarding HPV vaccine. The sole purpose of me writing a blog on HPV vaccine is to reach out to the public, local or foreign to educate and to create an awareness regarding this vaccine.
I understand completely the psychological trauma you are bearing at the moment. With each YouTube video that you watch, it felt like the worries you already have kept on piling up. I am sure at a given time, you had wondered why isn't there any video on the positive side of these vaccine? I am a father to 2 daughters, and I can imagine being in your shoes. You are not alone,Mr*** . I am glad you write in to inquire concerning the efficacy and potential side effects of this vaccine. I sincerely wish more people would be as inquisitive as you,Mr ***.
First and foremost, Mr ***, i would like you to know that as a medical practitioner, I personally feel the duty of a doctor is beyond treating the sick.In addition to that, we are responsible to create an awareness and to dispel any form of misinterpretation and misunderstandings on a certain disease or drugs stemming from rumours, friends, personal experiences, etc. I will speak to you as friend, rather than a doctor-patient relationship.
I sincerely hope you will be assured and have a better understanding about this vaccine after reading this mail.
Since the launch of the first anti cervical cancer vaccine, Gardasil in 2006, it was was received with much controversies. Some believed that this vaccine gives the false sense of security and encourage sexual promiscuity among the recipients. Personally, I felt this is a unjustified and unwarranted, as it is entirely depends upon the upbringing of the individual, and not the vaccine. A well brought up individual would know for themselves the impact and consequences of health and morality issues on promiscuous sex, irrespective of being vaccinated or not.
The total amount of reported "side effects" that was more than 12,000 cases so far is rather far fetched and exaggerated.
The side effects such as pain, muscle weakness, fitting episodes, convulsions,epilepsy, Bell's palsy, lost of sight, dizziness, blood clots, infertility, auto immune diseases, etc are being highlighted and repeatedly being portrayed as "definitely hazardous" by many.
But Mr ***, as in other given vaccines that provide protection against viral diseases, it acts by stimulating our immune system, thus creating antibody against the disease. I am sure you are aware on the fact that in our lifetime, we never get flu from the same virus twice.
Initially when our body is being infiltrated by pathogens,eg bacteria and virus.. our immediate immune response would be non specific characterized by fever, nasal congestion, running nose,  basically the feature that you see when you fall sick.
To understand that these claims of so called "dangers" or "hazards", you would need to understand a little about immune response.
Initial body response to infiltration of pathogens would be a non specific response to deter the propagation of the pathogen. What at the features? Lets look at them one by one.
1.Fever. Mechanism of Fever and why?
Our normal body temperature is 37.4 degree Celsius. Incidentally, it happens to be the optimum temperature of which bacteria and virus flourish. So, as a pre programed immediate response, our temperature control centre located in the brain would reprogram itself to increase the norm from 37.4 to a higher temperature, say 38.5C. So now, 38.5C is perceived as normal in sick patients.
2.Running nose, sorethroat,

This are due to inflammation of the mucosa of the lining epithelium(the cellular layer than lines that inner surface of body) and vasodilatation(widening of blood vessel to increase blood flow to the effected area).
The inflammation response is a result of cascade of chemical reactions characterized by increased local temperature, redness, tenderness, swelling. This in fact do increase the blood flow to the infected or affected area as white blood cell(our body defense "soldier" that defends against bacteria) contained in the blood would be channeled to the site.
All these response are non specific and does not last. They are pre- programed with the intention of providing an initial defense before a more specific response takes place. Remember that I mentioned that early non specific response is mainly inflammation as a result of cascades of chemicals being released into the blood circulations particularly histamine,bradykinin, serotonin, leukotreines, and prostaglandins.
These non specific defense response takes place before a more specific target orientated long term response develops, upon completion which renders the patient having the long term protection against the same pathogen in future, by which the patient becomes immune toward a second attack from the same pathogen,.
As the initial response is non specific, it involves the entire body system. Some exaggerated immune response would result in allergies. Similar to asthma.
It is this non specific inflammatory response that attribute to the so called complication upon administration of vaccine into an individual. As these vaccines are made up of protein from the capsid of the virus, is doesn't contain virus DNA hence IT DOESN'T CAUSE HPV INFECTION. So by this, it dispels the argument that the vaccine is the cause of HPV infection as highlighted in this YouTube presentation.
The report of patient develop epilepsy, seizures, convulsions upon the administration of HPV vaccine, to my humble opinion isn't valid. No one "develops" epilepsy. It's not a disease that one contracts. It's either a person is born with abnormality is the brain's electrical pathway, E.g damaged pathway in Cerebral Palsy, head injury involving the brain, tumour.etc.  Judging from the way these articles are written, one can easily identify the author as non medical background. Fitting, seizure, convulsion. These terms describes the same condition. It it written in such a manner that is easily misinterpreted by the public as if these three words are different entities altogether. One may develop seizure, but not necessarily be an epileptic, but all epileptics have seizures.
Epilepsy is the condition, while seizure is the clinical presentation.

One needs to remember that a person who is epileptic may get a seizure which can be triggered by various factors, including flashes of bright lights, not enough sleep, restlessness, anxiety, stress, missed medication, etc. Whether or not these reported seizure post vaccination were epileptic to begin with isn't being reported, as while awaiting for their turn for vaccination and pain induced by the intramuscular injection may trigger it off. Hence, by that, one cannot attribute the seizure as the result of the vaccine.
Non specific inflammation response towards introduction of pathogen or any particle that is recognized as  being foreign is a pre programed response developed within the physiology of the human body as a result of million of years of evolution that involves a gradual slow process of adaptation towards becoming a perfect being within the surrounding environment. As the definite, long term, and specific defense mechanism(
immunity) which is a characteristic of  creature of higher level of evolution takes time, hence the immediate response towards detection of pathogen would be generalized and often systemic. As I had mentioned earlier, inflammatory response is a main feature in a non specific response.
When inflammation involves the nervous systems, where it interferes with the transmission of electrical signal along the nerve, the motor and sensory response would obviously be affected. Hence this accounts for the reported cases of Bell's Palsy,hemiparesis, numbness or hypersensitivity of the extremities, muscle weakness, temporary loss of sight, temporary paralysis, transient loss of hearing.
As for autoimmune disease, I believe the susceptibility of a person to develop autoimmune disease is pre determined by gene. Very often viral infection or vaccines that triggers an immune respond may trigger an acute episode in these individuals, which can be controlled by steroids. However, the report of
vaccine causing an auto immune disease has not been  reported. It may trigger an acute attack on patient who are known and already being diagnosed earlier, or may trigger a first clinical attack on genetically susceptible individuals. However, one should understand that this is being observed on various auto immune disease like Systemic Lupus Erythematosus, Guillain -Barre Syndrome, Multiple Sclerosis, myopaties, vasculitis, rheumatoid arthritis,etc.. where its been observed that  vaccine have a different spectrum of susceptibility in triggering attacks on each of the listed auto immune disease. Some are not related, while some may trigger the attack but the degree of correlation between vaccine triggering attacks is inconsistent to be listed as a contraindication. In cases of Guillain Barre Syndrome, one needs to be careful and observe for an acute attack, but not in any way, a contraindication. Click here for reference. Instead of jumping into the bandwagon in the effort to protest against vaccination for HPV, these correlations of "complications" post vaccination doesn't apply to HPV vaccine alone, but also for Hepatitis B, Hepatitis A, and the various Influenza vaccines in the market.
The process of manufacturing and mechanism in development of immunity is the same for all these vaccines, but it doesn't make sense as to why is HPV being a topic or a much heated argument and controversies?
Very often, Mr ****, man by nature are psychologically creature of convenience. What seemed acceptable to them despite all the risk involved is received without much debate, while another with similar risk, when an opinion has been formed in the minds of people, every trivial temporary effects will be highlighted.
In the beginning when Gardasil was first launch, besides being expensive, medical practitioners have difficulties to even introduce the vaccine to parents of potential recipients, as cervical carcinoma is often being associated with multiple sex partners. Patient often felt offended when a doctor suggest this vaccine to them as they have the impression that they are thought to sexually promiscuous.
The protest against vaccination  as it gives a false sense of security and promotes sexual promiscuity is an excuse, rather than a reason. What has promiscuity got to do with medicine? It's psychological rather than a medical condition.
The following are based upon my own observation, and not in any given time have I claim to be an expert in psychology. My opinion are not to be taken as facts, but rather perceived as an opinion from an individual.
I observed that 90-95% of the so called reported side effects comes from developed countries such as US, UK, and certain European countries. The epidemiology of cervical cancer indicated that its occurrence is significantly higher in developing and third world countries.
Once, a well known Consultant gynaecologist and obstetrician, Professor Dr B.K Lim, quoted in a symposium held by a giant pharmaceutical company, that the incidence of cervical cancer is so low in UK that training hospitals for future Gynaecologist have a hard time obtaining cases for training purposes. I would rationalized that since it has such a low incidence rate, the community do not see the degree of importance and significance of these vaccines to them compared to us who are from developing countries where cervical cancer is ranked top three among death due to malignancy, where the benefits of the vaccine far outweighs the potential side effect.
In the US, the incidence back in 2009 was just over 11,000 with mortality just over 4000 cases, compared to Asian countries where more than half of the overall global cases are from us.
The low incidence of cervical cancer in UK and US is attributed to the availability of an advance screening method, where more than 90% of screening done in US today is through Thin Prep Pap Smear.
Why only HPV vaccine be the much heated and controversial subject today? Why not Influenza Vaccine be the topic of debate when the method of manufacturing these vaccines are the same? While some says that efficacy of HPV vaccine is "
questionable" as it hasn't been through the test of time.
Then, for the same reason, H1N1 vaccine was developed and it wasn't being subjected to the similar "test of time" nor its long term complications is known, but everyone is rushing to the nearest clinic to get themselves vaccinated? As a matter of fact, H1N1 vaccine was developed urgently and has not being subjected to sufficient test to established it's safety, but why wasn't it being debated upon? Why the discrimination?
It's because H1N1 that originated from Mexico City spread at an exponential rate to countries irrespective of whether it's developed, developing, or third world. Then, the UK and US general public demanded the vaccine despite it being at its infancy. News reports with photos showing people queuing up all the way out of the hospital premises still remain fresh in my mind. Why weren't there any debate? Because to them, the benefits far outweighs the potential side effects.
Based on this Mr ***, I see an element of discrimination and bias over the report and controversies involving this vaccine. The potential side effects are exaggerated and repeatedly highlighted.
Suddenly so called "experts" started popping out everywhere voicing their
"human rights NOT to  subject their children to unnecessary life threatening risk" which I find it rather hypocritical just because they don't face the same degree of incidence as other countries.
 In my opinion, the so called side effects of this vaccine seemed more high risk simply because of media and public perception. Most of the doctors who have a bad impression of these vaccines are individual opinion.
FDA of US and UK's NHS will not approved these vaccine if the safety aren't being established. If the vaccine is at all that hazardous as it is being portrayed, then why would the health authority of these countries approved of it then? These countries are:-
Australia,Brazil,Canada,Denmark,Finland,France,Hungary,Germany,Iceland,Ireland,Italy,Japan,Korea,Luxembourg,Norway,New Zealand, Sweden,Switzerland,UK,US,Uruguay,India, Malaysia.....the list goes on.
I hope this would give you some assurance, Mr ****. Have a good day.

Warmest regards,

So, guys, now you tell me, what is your opinion on this vaccine now?

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