Monday, January 4, 2016

INDIVIDUALIZED APPROACH TO VACCINATION CAN PREVENT AUTOIMMUNE DISEASE ONSET IN SUBSET OF POPULATION WITH GENETIC TESTING TO RULE OUT RISK FACTORS

This is my final research paper for a class this term. Has not been graded. The research is firm. Feel free to share. (the formatting didn't translate well the blog. )

INDIVIDUALIZED APPROACH TO VACCINATION CAN PREVENT AUTOIMMUNE DISEASE ONSET IN SUBSET OF POPULATION WITH GENETIC TESTING TO RULE OUT RISK FACTORS
Written by Kaire Downin January 04, 2016 

Abstract
It is increasingly clear that scientific literature has been able to identify risk factors associated with adverse events following the administration of vaccinations in individuals who develop autoimmune disorders as a result of the vaccination. A comprehensive analysis of available literature shows that genetic markers have been identified for people who are susceptible for developing autoimmune diseases and that this population of people require an individualized approach to vaccinations to prevent serious adverse events and even death. Even though vaccines have been shown to be safe for a broad population, when evidence is found that would prevent the small subset that have predispositions to autoimmune diseases from developing serious complications, it is the duty of our medical community to become knowledgeable and take precautions as to not cause harm to the patients they serve.  Autoimmune disease that is not present before vaccination, can be realized after vaccination due to the combination of genes, adjuvants, and molecular mimicry that creates the environmental conditions for autoimmune disease to occur resulting in debilitating, life-long disease and sometimes death.
Intro
Comprehensive systematic review findings are being exposed at alarming rates in the previous few years regarding the incidence of autoimmune diseases and the link they have to vaccinations. Neither scientists nor doctors seem to have a clear understanding of the risk factors included in administering vaccinations to people who have a proven autoimmune disorder or if autoimmune disorders are negatively affected by vaccines, or even in some cases, caused by them. This paper will seek to identify vaccines that have a higher incidence of reports to Vaccine Adverse Event Reporting System (VAERS) for autoimmune disease onset after administration and to identify what groups of people may be at a higher risk of these events. The results will show where the scientific studies need to be directed to assure safety of our most vulnerable population, the children and infants receiving these vaccinations and ways to prevent the sudden onset of autoimmune diseases or the exasperation of preexisting autoimmune conditions.
            The Food and Drug Administration (FDA) recommends routine vaccinations starting at birth. At this time there is no clear way to identify if a newborn infant is genetically predetermined to have any kinds of autoimmune disease without doing genetic testing or waiting to see how the baby’s body develops before administering vaccinations. The FDA and World Health Organization (WHO) believe that vaccinations are the most effective way to prevent infectious diseases and have determined that vaccination must be started in early infancy to protect the population from any outbreaks. However, the long term effects and nature of autoimmune disease can take days to years to manifest in the body (Guimarães, Baker, Perricone, & Shoenfeld, 2015), complicating the identification of the possible cause being a result of the vaccination. At this time, the fact that autoimmune disorders can be caused by or exasperated by the routine use of certain vaccines is considered rare, but possible (Geier & Geier, 2004; Girard, 2005; Schattner, 2005; Waisbren, 2008; Israeli, Agmon-Levine, Blank, & Shoenfeld, 2011; Israeli, Agmon-Levin, Blank, Chapman, & Shoenfeld, 2012; Gatto, et al., 2013; Guimarães, Baker, Perricone, & Shoenfeld, 2015) and is called Autoimmune Syndrome Induced by Adjuvants (ASIA) (Agmon-Levin, Paz, Israeli, & Shoenfeld., 2009).
            Autoimmune conditions come in many forms. The American Autoimmune Related Disease Association estimates over 50 million Americans suffer from autoimmune diseases, however, the National Institute of Health (NIH) only reports numbers associated with 24 diseases that have enough epidemiological studies. Autoimmune diseases are listed in the top 10 causes of death among female children and adults up to 64 years old.  Research has shown autoimmune diseases to have a genetic component (Niewold, Goulielmos, Tikly, & Assassi, 2012) and to have the ability to interact with environmental influences (Oksenberg & Brassat, 2006). The most frequently used and available immune-suppressant treatments can cause debilitating side effects, including higher rates of infections for influenza and pneumonia (Gluck & Muller - Ladner, 2008). The initial signs and symptoms are often unspecific and often don’t occur until the disease has affected the body systems enough to become acute. The United States has the least amount of research on the mechanisms, causes, and treatments of autoimmune disorders. To compare the severity of this problem, the NIH recognizes 23.5 million Americans living with autoimmune disease; as opposed to 9 million living with cancer, and 22 million living with heart disease. Despite these numbers, cancer funding is at $6.1 billion compared to $591 million for Autoimmune diseases in 2003 (AARDA, 2004-2015).  To add one more comparison, the vaccine industry funds $1.4 billion for US vaccine research and development annually, 46% comes directly from vaccine sales (pharmaceutical companies), 36% from taxpayers (government agencies), and 18% from risk capital (private donors) (National Vaccine Advisory Committee*, 1997).  Figure one has a list of the most relevant associations between Vaccines and Autoimmune Diseases (Guimarães, Baker, Perricone, & Shoenfeld, 2015).

(Guimarães, Baker, Perricone, & Shoenfeld, 2015)


Methods
                Research databases were used to find full text articles about the risks involved of autoimmune diseases being caused by vaccinations.
            Using the JSTOR database and searching for (vaccinations cause autoimmune) pulls up 234 search results. Some of these are about vaccine research regarding trying to immunize against autoimmune diseases. The ones chosen for this paper were (Seppa, 1997;T. Gluck, 2008; Lankes, 2009).
Another search term in the same database (vaccinations autoimmune side effects) yields 4,204 results with no studies that were attempting to find links between autoimmune disease and vaccination.
The ACHS database returned 637,000 results with the terms “autoimmune diseases and vaccinations.” Pubmed retrieves 3128 results.  (Shoenfeld, 2000)
Pubmed retrieves 26 responses to “autoimmune disease side effect of vaccination,” however, not all of them fit the criteria for this meta-analysis. The ones that did were (Bedard, 2010; Guimarães LE, 2015).
Google search for “VAERS database autoimmune” returns 78,600 results. (Geier, 2004)
Using the Oregon State University library database online search resulted in 285 results directly related to the search terms “Vaccines and Autoimmunity.” (Israeli, Agmon-Levin, Blank, Chapman, & Shoenfeld, 2012), (Agmon-Levin, et al., 2014), (Gatto, et al., 2013).
After evaluating research, some citations were pulled from the original articles and further expanded on including information about autoimmune statistics, adjuvants, and previous research available about connects between autoimmunity and vaccinations.

Results of findings
           
Positive correlational findings
            The most recent comprehensive literature reviews and systematic analysis studies have identified Autoimmune (auto-inflammatory) Syndrome Induced by Adjuvants (ASIA) to include fibromyalgia (FM) and chronic fatigue syndrome (CFS) that occurs after the administration of vaccines. These conditions are part of a spectrum that includes irritable bowel syndrome (IBS) and temporomandibular joint disorders (TMJ).  All of these conditions are difficult to diagnose as they effect many systems in the body, have common symptoms, and can have a major impact on the quality of life for the patient (Agmon-Levin, Paz, Israeli, & Shoenfeld., 2009; Agmon-Levin, et al., 2014; Guimarães, Baker, Perricone, & Shoenfeld, 2015).
            The Hepatitis B vaccine is mentioned in several studies where adverse reactions that were reported included autoimmune diseases, such as Multiple Sclerosis (Oliveira, Mota, Santos-Neto, & et al., 2014), Macrophagic myofaciitis (Israeli, Agmon-Levine, Blank, & Shoenfeld, 2011), Guillain-Barre´ syndrome (Geier & Geier, 2004; Agmon-Levin, Paz, Israeli, & Shoenfeld., 2009), multiple antigenic mediated autoimmunity (MAMA) syndrome, rheumatoid arthritis (RA) and many more (Waisbren, 2008; Agmon-Levin, et al., 2014). It is shown that the combination of molecular mimicry of the antigens, the adjuvant(s) and genetic predispositions are the perfect storm for a result of autoimmune disease acquired by vaccinations (Geier & Geier, 2004; Waisbren, 2008; Israeli, Agmon-Levin, Blank, Chapman, & Shoenfeld, 2012; Agmon-Levin, et al., 2014; Shaw, 2014; Guimarães, Baker, Perricone, & Shoenfeld, 2015) The Hep B vaccine is commonly given within the first few days of birth, before any kind of genetic testing is performed to determine safety of administration of the vaccine. The majority of adverse events reported to VAERS for the Hep B vaccine were experienced by adult male and female patients within a few weeks of receiving the vaccine. The most common reported problem being a positive re-challenge of RA or arthritis in women in their 30’s, the most disabling event is neuropathy (Waisbren, 2008).
            The Human Papilloma Virus (HPV) vaccines, Gardasil and Cervarix, have been associated with the onset of debilitating autoimmune conditions such as systemic lupus erythematosus (SLE) and death (Guimarães, Baker, Perricone, & Shoenfeld, 2015) in otherwise healthy individuals. The studies conducted for safety, paid for by the pharmaceutical company GlaxoSmithKline, included control groups that were given the adjuvant aluminum. These studies show no significant difference and allowed the vaccine Cervarix to hit the market. In the studies for Gardasil, reports were made about the serious adverse effects, including venous thrombosis (which was occurring at higher rates than expected), hypersensitivity reactions, anaphylaxis, motor neuron disease, and even deaths. Autoimmunity was found to occur post-vaccination (Gatto, et al., 2013).  Furthermore, the incidence of autoimmune disease in adolescent girls is 53 in 100,000 and 389 per 100,000 in women aged 19-30, the target for these vaccines (Verstraetena, et al., 2008).
           
Negative correlational findings
            The WHO reports,
In a third study, a pooled analysis of data from 11 clinical trials involving nearly 30 000 participants aged >10 years, of which 16 142 received at least 1 dose of Cervarix and 13 811 received either a placebo containing aluminium hydroxide or 1 of 2 different hepatitis A vaccines. No increased risk for the onset of autoimmune diseases after administration of Cervarix was observed in comparison to the control group,” (The Global Advisory Committee on Vaccine Safety, 2014).

           This excerpt from the report, “Global Advisory Committee on Vaccine Safety, report of meeting held on 11-12 December 2013,” shares that the studies they are citing used placebos containing Aluminum Hydroxide which have been proven to cause Macrophagic myofasciitis, an autoimmune disease, that is triggered in genetically susceptible populations  (Agmon-Levin, Paz, Israeli, & Shoenfeld., 2009; Israeli, Agmon-Levine, Blank, & Shoenfeld, 2011). This is one of the conditions that has specific genetic markers that can be identified and used as evidence of contraindications for the use of vaccines containing Aluminum Hydroxide. This is also evidence of the blatant disregard the WHO has for science that explicitly contradicts the universal safety the WHO is trying to claim about administering vaccinations to entire populations of people without consideration for genetic testing. When the control group is receiving one of the possible causes of the autoimmune disorders, there is no doubt that the experimental group and the control group would have similar finding (Verstraetena, et al., 2008; Guimarães, Baker, Perricone, & Shoenfeld, 2015).

People with existing Autoimmune conditions have been given many vaccines due to the high risk of infections among this population. Small pox vaccines have been studied among recipients with rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and spondyloarthritis, with no cases presenting with symptom flare up or adverse reactions (Oliveira, Mota, Santos-Neto, & et al., 2014). Influenza and pneumococcal vaccines have been recommended for people with autoimmune diseases on (Schattner, 2005). immunosuppressant therapies with results that show no adverse reactions among this population.  Among investigation, the average antibody titers measured at one month and one year after vaccination show equal or marginally less in the group of patients receiving immunosuppressant or corticosteroid treatments when compared to the control group.  Another study showed that the levels were low enough not to provide protective responses to the viruses that are being vaccinated against in 33% of patients with RA and 21% of patients with systemic lupus erythematosus (SLE) (Gluck & Muller - Ladner, 2008). 

 

Discussion and Recommendation


Georgetown University along with the Center for Biologics Evaluation and Research (CBER) of the Food and Drug Administration (FDA), is working on a project to identify the mechanisms of how autoimmunity is related to vaccinations using the reports through VAERS database. A problem with this kind of study is that because it is being overseen by the FDA, it holds a conflict of interest due to the way that pharmaceutical companies contribute to funding towards the FDA.

All of the research found for this study claiming a lack of evidence that autoimmune disorders can be caused or exasperated by vaccines has been funded or performed by entities with a direct interest in the successful campaign of vaccinations, including vaccine manufacturing companies. The British Medical Journal reported that, “published influenza vaccine studies sponsored by industry are treated more favorably by medical journals even when the studies are of poor quality,(Jefferson, Pietrantonj, Debalini, Rivetti, & Demicheli, 2009).

Research is available that shows successful trials with plant based vaccines that do not use the same adjuvants that are associated with these adverse reactions and long term injuries acquired through the administration of vaccines (Rybicki, 2014).

There are several states in the US that are now mandating vaccines along the FDA schedule with no mandatory testing to determine if the children being given the vaccines are at risk from receiving them. New protocols must be put into place to assure the safety of the routine schedule with the current vaccine products before blindly injecting children who may have genetic predispositions to autoimmune diseases. The study of Vaccinomics is identifying the “one size fits all” approach as dangerous to the populations at risk and calling for a more individualized approach that includes ruling out the risk factors mentioned in this paper (Goriely & Goldman, 2007; Verstraetena, et al., 2008; (Poland & Kennedy, 2013). Any parent who has a personal or familiar history of autoimmune disorders in their family should be delaying all vaccines until genetic testing can be completed to verify safety.

At this time, in the state of OR and many others, there are ways to get personal exemptions. However, even if the Physician attending to the patient knows of a documentable contraindication to vaccines, they are not allowed to write medical exemptions as per policy of health care provider teams and corporations. If a parent were to no longer be able to care for their child with documented contraindications, and that child was put in the care of another adult or agency that was not aware of or privy to the medical history or research the parent has completed, and there is nothing on that child’s medical file, another attending physician or pharmacist (who are allowed to administer vaccinations without looking at the patients’ medical history) could administer vaccines and injure the child. This is a very dangerous practice for the percentage of individuals with the genetic markers that could be affected due to the administration of vaccines containing adjuvants like aluminum hydroxide.  

The medical community holds that if there is evidence of wide spread success in a drug, it is worth the risk of the smaller incidence of adverse reactions. However, there is more than enough literature to show that there are specific risk factors that should surpass the bias of selective assessment, especially when the diseases most aim to prevent are now so rare and treatment for those diseases is more available (Girard, 2005). Routinely immunizing infants against sexually transmitted diseases and diseases of the blood in a low risk population is counterproductive when the risks of long term debilitating diseases can be ruled out with a simple blood test. 

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