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Association of BCG, DTP, and measles containing vaccines with childhood mortality: systematic review

BMJ 2016; 355 doi: (Published 13 October 2016) Cite this as: BMJ 2016;355:i5170

Re: Association of BCG, DTP, and measles containing vaccines with childhood mortality: systematic review--Response to Frank Shann

Frank Shann writes with authority and exasperation when he asserts that DTP doubles all-cause mortality in under-5s in the least developed countries, to the tune of an extra half-million deaths annually; he calls for immediate deletion of the 18-month booster from WHO's schedule and urgent trials of a second BCG dose with the last priming dose of DTP at 14 weeks....Some of us in the developed world were exasperated when no action was taken in response to the Danish observation that hospital admissions for any infections were 60% higher for children given DTaP-IPV-Hib vaccine during the 12-15 month interval instead of MMR (Sorup & Aaby, JAMA 311:826, 2014. Goldblatt, JAMA 311:804, 2014).

One of the reasons vaccine bullying by U.S. officialdom is exasperating to some of us is because no effort seems to be being made to study non-specific vaccine effects or the rare, serious adverse effects that are delayed. The long-term observational studies that are done overestimate effectiveness and underestimate adverse effects, largely because of healthy user bias (Fine & Chen, Am J Epidem 136:121, 1992). In 2000 Ken McIntosh warned that annual flu vaccine for children should not become routine until large, multi-center, randomized trials over several seasons were carried out to provide evidence that the vaccine would do more good than harm (Editorial, NEJM 342:275, 2000). His advice was ignored, and after many millions of vaccine doses in American children we still do not know where the balance truly lies. This is just one example of our cavalier attitude to vaccine safety and effectiveness.

The Higgins study is very important, and Dr. Shann's comments are an important and forceful addition to help us put vaccines in proper perspective for the sake of children everywhere.

Competing interests: No competing interests

19 October 2016
Allan S. Cunningham
Retired pediatrician
Cooperstown NY 13326 USA