Vaccine tragedy in Mexico due to improper handling

As I suspected when I first heard that the accident was due to “external contamination”, the tragedy in Mexico appears to have been due to Staph. species bacterial contamination on the outside of the vial, or on the hands of someone involved in the process of administering the vaccines. I was mocked for making the statement “sounds like someone didn’t wash his hands” but that’s exactly what it sounds like– perhaps a little oversimplified. No, you do not have to handle the needle to transfer bacteria, simply handling the baby and not following hygiene protocol would be enough to give the bacteria entry into the skin.

According to the Mexican government agency IMSS, the species found was Staphylococcus hominis, a very common bacteria that colonizes human skin. It can cause severe sepsis in newborns. The antibiotic resistant strain is transmitted by healthcare workers, but it is not clear which strain was found in the infants in Chiapas. The bacteria was also isolated from the children, and their clinical symptoms were consistent with an infection from this bacteria.

They concluded that the infections were a result of handling and administration, since the vaccines were apparently properly stored and the vials themselves were not contaminated.

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A Former Off-Grid, Homeschooled Child’s Thoughts on the Naugler Family

Breckinridge, KY — Started reading about this today and it is just appalling. Coming from a few years of “homesteading” experience (homesteading-lite), having a background in natural resources and land management, and being a CASA volunteer, this situation strikes me on so many levels. This is probably the best summary of the REAL issues that can be observed at the Naugler family homestead just by looking at the pics. I’m glad this author chose to focus on the pond because that was one of the first things that stuck out to me as well. The pond is a scummy, open pit sitting just a few hundred yards away from the family’s tent (12 people living in a tent!!). It is clearly a health and safety hazard, but in one interview the mom explains its condition as being “green” due to “letting it go back to nature” or something. Degraded conditions do not spontaneously improve. The ignorance– and I say that honestly, not intending to hurl insults– of this family makes this situation totally unsafe for children. It’s one thing if adults want to live backcountry style in a situation like this (and I wouldn’t mind the camping, minus the poor land stewardship), but it’s another thing entirely to have a very large family with babies and toddlers living like this.

This just hurts my heart… and being supportive of large families, and homeschooling and homesteading and off-the-grid living, I feel in a way sort of responsible to point out why this is so wrong. It’s probably readily apparent to most people. To some, the problems may not be so clear, especially if you generally support some of the marginalized choices this family has made. But this is not ok. It’s just not.

Keeping things neat and tidy on a farm/homestead with kids is not easy and it doesn’t always have to look pretty, but it does have to be safe.

It is not necessarily even about poverty. The family has received tens of thousands of dollars in gifts from people who support and clearly care for them, but so far it is unclear whether that money will actually be used to clean up the property and invest in a real dwelling in order to have their children returned to them.

From the article:
“This has been framed as a “off the grid” issue. It is not. “Off the grid” does not mean, by default: dangerous, filthy, ignorant of basic food preparation and safety, anti Government and anti documentation. “Off the Grid” living can be done safely, cleanly, and in full compliance with all local laws and regulations (in many states). I know. I lived it.

This has been framed as a homeschool issue.

It is not.

Kentucky has very open homeschooling laws. It’s legal. Heck, “un-schooling” is legal there too.

The children were taken because it was unsafe. VERY unsafe, not because they were homeschooled.”

Homeschoolers Anonymous

CC image courtesy of Flickr, Paul Jerry.

The following post is written by Gary. The author’s name has been changed to ensure anonymity. “Gary” is a pseudonym. Also by Gary on HA: “The Deep Drone of Unseen Cicadas” and “Hurts Me More Than You: Gary’s Story”.

To begin with I would like to state several things.

1. I do not know the Naugler family. I have never met them. All of the following observations are based solely from the information this family posted, publicly, on their blog and public Facebook page.

2. Much of the “information” being spread about the internet in regards to this family is clearly, factually incorrect. This can be seen through simple observation of posts on the family’s public Facebook page and blog.

Most of the information people are referencing is based only from the first few photos and/or posts on the family’s blog and Facebook page. For instance, the cover photo…

View original post 2,640 more words

A mock catch-up schedule for an unvaccinated 5 year old

Let’s say you chose not to get your child vaccinated while s/he was an infant, and now you’re considering enrolling them in a public school where certain vaccines are required. You may be terrified at the thought of your child receiving all of those vaccines at once, but rest assured, the catch up schedule for a 5 year old is nothing to fret over. The following work up is based on the Louisiana Department of Health and Hospitals Immunization Schedule and it will vary depending on your location and your pediatrician’s office. However, since this schedule makes the process more clear than even the CDC’s published catch up schedule, I’m going to use this one as an example.

This assumes the use of MMRV and Pediarix, two combination vaccines that can be used for children up to 7 years old and which most offices will probably stock because they significantly reduce the number of injections needed (reducing the risk of administration error, as well). I will include some notes at the end.

So this is how it goes:

First visit: 2 shots (+2 optional)
DtaP-IPV-HepB, MMR-Var, (+HAV, flu)
1 month later
2nd visit: 2 shots (+1 optional)
DTaP-IPV-HepB, MMR-Var (+flu)
1 month later
3rd visit: 1 shot
DTaP
6mos later
3rd visit: 1 shot (1 optional)
DTaP-IPV-HepB, (HAV)
That’s it. 4 visits, 9 months, 6-10 shots (6 required for school). Now your child meets all of the requirements for kindergarten and is protected from up to 9 illnesses that could lead to serious complications, or spread to others for whom these illnesses might be deadly.

There are some factors that can increase the number of shots. For example, if you have already started some vaccination series with an incompatible vaccine, then it may not be possible to finish the series with Pediarix. There is a preference among some practitioners or parents, as recommended by the CDC, to separate the first MMRV  into the individual vaccines, MMR and Varicella, for the first dose in children under 5. There are also additional vaccines recommended for children under 5 who are catching up, in order to protect them from serious diseases like meningitis.

The reason I wanted to write this is because I often see parents who have decided to get a child caught up, fretting over the idea that the child will have to receive “all n doses at once!” That just doesn’t happen. There is a required time period to space each dose in a series of vaccinations.

Many of the fear mongering websites that hype up the number of doses that children receive are obsessively separating individual vaccine components, like the D, T and P in DTaP and considering those “3 doses”, or “3 vaccines”, instead of one. That makes catching up look like a fearsome and insurmountable chore full of risk and horror (especially if you see these described in a meme implying a serious problem, or worse, one with a skull and crossbones accompanying the outrageous number of doses.)

With all that said, younger children do receive more vaccines than older children because they are much more vulnerable to illnesses like Hib meningitis, and epiglottitis, and Pneumococcal meningitis, sepsis and pneumonia. These serious diseases warrant vaccination for youngsters. So if you have a child under 5, don’t shy away from catching them up just because the vaccine schedule appears more manageable for a 5 year old. Your younger child should be vaccinated according to the recommendations for his or her age.

No further word from Mexico

Without further word from the Mexican government, we’re all left to speculate on the numerous places where the vaccination campaign in La Pimienta might have gone wrong.

At this point, it seems mostly agreed that “external contamination” means external contamination in the vial. It’s anyone’s guess how it happened but if it didn’t come from the manufacture, then something went wrong with the preservatives (e.g. there weren’t any) or the vial being damaged or improperly handled and stored– as in, a multi-dose vial being used and then stored for a longer period than is acceptable, allowing time for significant bacterial growth.

Vaccines are medical products that have to be manufactured, stored and administered safely. When any part of that goes wrong, they can be more risky. Even so, in many cases, storage and administration errors do not cause serious problems. This case is an exception, and there are a handful of other cases like this over the past few years. It is heartbreaking and it should not happen. Transparency, which the Mexican government claims they are committed to in this process, means presenting a full conclusion about where this process went wrong and committing to the prevention of similar errors in the future. I think that is the only answer here. I’m curious about whether we will hear from them again, but it is early yet.

A vaccine-related tragedy in Mexico

Recently there was a news report from the region of Chiapas, Mexico, where two infants died and (according to the official report) 29 are still hospitalized with 6 in critical condition. The deaths and illness followed vaccination with BCG, Hep B, and rotavirus vaccines by Mexican health workers. According to Latin Post, the parents received the vaccinations voluntarily.

The vaccinations were offered on Friday when officials came to La Pimienta, where access to medical care is difficult to come by; they announced over loudspeakers that the shots would be given to newborns, local residents told CNN México.

There are no hospitals or clinics in the area, and residents flock to a small cinder-block health center with a tin roof whenever a doctor passes through the community.

“A small selection of paracetamol and other pills sits on dusty shelves inside,” CNN said of the health centers.

Vaccination campaigns have been suspended only in the region where this occurred, as the Mexican government does not see any risk to children outside of the region. The government is paying for the care of the children and their parents while they recover.

—update–

The latest update indicates bacterial infections were the cause of injury, and the government has stated that the contamination was not in the vaccines but apparently from the environment. There have not been reports of anyone else in the community being ill, only the vaccinated infants, but 21 infants who were vaccinated the same day did not fall ill or have any adverse effect.

The contamination risks that are posed in isolated, rural villages or densely populated refugee camps in unstable regions are not the same risks that people in wealthier nations face when getting vaccinated. The risk does not translate to children in urban and suburban California. The problems are in the circumstances, not the vaccines.

This type of situation gets used repeatedly by people in other parts of the world (like here in the US) eager to point out the dangers of vaccines. There is this similar report several years ago where 5 infants died from an unknown bacterial infection in a remote village of Chiapas, not associated with a vaccination program. It may be that healthcare worker’s visit and the children’s illnesses coincided– they happened at the same time. An hopeful speculation could be that the health care workers visited the remote region, and perhaps that is why the illnesses were observed in the first place, and the majority of the children were able to receive prompt care. That is called coincidence, and coincidence is both random and very common. As I said, though, it’s only speculation at this point.

In a case where the process truly was at fault, in Syria, vaccines were reconstituted with a muscle relaxant that killed over a dozen children (reports varied widely on the actual number). An overdose of atracurium was the cause of death, and it was a mixup that could have been made with any injectable drug. The error was compounded by the fact that by necessity the small clinic stored preventive vaccines alongside dangerous, but lifesaving emergency drugs.

So what is the point of distinguishing the vaccines- a medical product- from the process of vaccination delivery and administration? Is it just to absolve vaccines, and say they never do any harm? I’ll answer my own rhetorical question– that no, vaccine injuries are not denied for the pure joy of saying “it wasn’t the vaccine.” These injuries are most often denied because it actually wasn’t the vaccine.

First, you make the distinction simply to know how to respond. If the vaccination is inherently dangerous, then it is unethical to use it or to advocate its use. We’ve seen over and over again that vaccination is not inherently dangerous, although there are specific risks that are inherent in the vaccine. These inherent risks need to be considered independently when advocating for, or recommending the use of vaccines. This is where the term “unavoidably unsafe” is used, because of the specific risks that the vaccine itself poses, which can not be ameliorated without negating the entire purpose of vaccination. In other words, vaccines stimulate the immune system to develop immunity, and there is always small risk to that– a risk much reduced compared to immunity provoked by the disease itself.

So again, a safe product that is delivered with negligence, sabotage or with accidental carelessness is still a safe product. Yet, it might be inappropriate to administer the safe product under circumstances where associated dangers can not be remedied.

Can contamination, drug mixups and other errors be avoided? Yes, they can. Vaccines and vaccine programs both remain safe and lifesaving, even when rare (but often highly publicized) tragedies do occur.

If the error occurs during vaccine administration, such as a mixup or post-manufacturing contamination due to improper storage, then that needs to be addressed. Often, situations like that can be controlled and prevented with standardized storage and administration protocol. Reuse of needles is a dangerous practice that can occur with injections, and has occurred with vaccines, injected vitamins and other injected drugs. The problem– needle reuse– can be addressed without pointing the finger at the vaccine campaign, because vaccines can be safely administered without reusing needles. Hygeine during administration is also important, and may have been an issue in the situation in Mexico, as the government has stated that contamination was found outside of the vaccine– presumably meaning the vaccine vial. In that case, it sounds like someone didn’t wash his hands and subsequently handled the child and/or the vaccine. Again, speculation.

The crux of the issue is whether or not the problem is inherent in vaccines– do 60-80% of children who are vaccinated have to worry about severe reactions such as these? No, absolutely not. Rare, isolated clusters of error, improper administration and contamination are not applicable to the entire pediatric population.

Each regions its own risks, and in the US and other developed nations, storage procedures are such that the risks are mostly 1) the wrong vaccine is given, which uncommonly causes any problems at all and 2) the vaccine is ineffective due to improper storage, which is a serious problem because people will not be immune and may not realize it, but it is not a vaccine safety problem in the sense that the vaccine itself does not cause harm in that instance.

By discussing the real problems here, it doesn’t mean that those tragedies don’t matter, but that they have to be resolved honestly and not by indefinitely halting vaccination or placing the blame on unrelated issues, such as vaccine science or manufacture, or advocacy for aid in the form of preventive vaccines, when those are not the problems.