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Cervical cancer vaccine - Japan no longer recommends because of side effects concern

(137 Posts)
Crumbledwalnuts Tue 18-Jun-13 06:46:09

there are quite a lot of different places this story is written, this is one of them

It's not being withdrawn but the government isn't recommending it any more. At least for now, while it investigates.

I didn't say anything of the sort. I said I preferred an open and cautious approach to the one adopted at the time of the urabe issues (which doesn't seem to have changed). I didn't say anything about what you think.

Yes it is possible that this vaccine is causing serious side effects and I personally would prefer to have a ministry of health that acted upon concerns rather than ignored them.

Their response seems sensible to me (much as yes my personal reaction would be 'withdraw withdraw' at the first sign of problems because of my own experience with adverse reactions, this seems a sensible middle of the road approach to me - it would highlight to me that I needed to think carefully about risk factors - which is enough, I don't ask public health officials to do more than that.)

noblegiraffe Thu 27-Jun-13 21:21:31

You keep telling me that I think the government should suppress information, that I believe vaccines can't do any damage and I really don't know where you're getting it from.

Vaccines can and do cause damage. No vaccine is 100% safe. It is possible that this vaccine is causing serious side effects. However, the evidence doesn't yet show a causal link. If the evidence is then shown to support a causal link, I fully support a re-evaluation of the recommendation for its use. If the government has serious enough concerns not to recommend it, then I don't think they should be offering it either.

But the decision to withdraw the recommendation doesn't yet seem to be evidence-based as a causal link hasn't been demonstrated. Why withdraw the recommendation but not the vaccine? Someone hedging their bets??

Well I think it could be argued in the case of urabe strain MMR Maybe it was just shocking indifference or a terrible error of judgment, but I think it bordered on a cover up.

It took until 1992 for Britain to stop injecting children with Urabe MMR, replacing it with MMR2, which contains a less potent form of the mumps virus. And, according to the minutes, that action owed more to the decision of the manufacturers of Urabe MMR to cease production. Revoking the licence would have cast light on Whitehall's decision to use Urabe MMR on British children despite disturbing evidence of its potential effects.

Like I said, I prefer an open and cautious approach.

noblegiraffe Thu 27-Jun-13 21:12:25

Who is suggesting a cover-up? confused

We are going to go round and round in circles on this grin

Personally I would prefer to live in a vaccination system overseen in the way the Japanese one is. Much prefer over-cautious to outright denial that vaccinations can ever do any harm (which I think is where we're at).

But less of a mess than a cover up?

noblegiraffe Thu 27-Jun-13 20:29:14

If they had serious concerns then they should have suspended its use. To continue to provide access to a vaccine they have serious concerns about is unethical, no? Not merely withdrawing the recommendation.

But they haven't suspended its use pending investigation. So one is left guessing as to what level of concern they actually do have, seeing as the evidence doesn't yet support a causal relationship and they have said that they may yet reinstate their recommendation.

What a mess.

Comfortable with this actions. I never will be.

And now I am giving up before I hit frigging post again by mistake

Oh FFS this is the only website this happens on

... they had serious concerns about as acting unethically and engaging in a cover up. You clearly do not see it that way & would be c

Bastard phone
I would view a government continuing to recommend a vaccination they had serious c

I don't think we'll ever agree. I would view a government continu

noblegiraffe Thu 27-Jun-13 17:06:36

Sharing concerns would be giving information about the possible side effects that have been noted and that further investigations will be taking place as scientists have as yet been unable to establish a causal link.

Factual and informative. I'm all for it.

Withdrawing the recommendation based on incomplete evidence while still providing the vaccine for free is not simply sharing concerns. It is not factual and informative. In fact it is confusing and possibly scaremongering. They could have waited 6 months.

In withdrawing a recommendation (even if temporarily) they are sharing that they have serious concerns. It would surely be unethical for a public body to have serious concerns but to continue to recommend something?

Well I'm not sure what you're saying then, because the Japanese ministry of health have concerns and have shared them and you have said they shouldn't have done that.

noblegiraffe Thu 27-Jun-13 16:50:56

I never said that they shouldn't share concerns. Please don't put words in my mouth.

Well personally I wouldn't give my 13 year old dd the jab but would educate her on when she needs to start thinking about whether she wants it (and tbh I think for is she's old enough to have sex she's old enough to decide for herself whether she wants the vaccination or not). I realise that isn't a popular view, but it just comes back to me seeing vaccination as a decision to be made on an individual risk-benefit analysis, rather than a population one.

I don't have dd's - but if one of my younger sons turns out to be gay I will certainly tell them about the vaccination and HPV, despite it not being offered to boys/men. DS1 won't ever be having sex so it's not something relevant to him - and even if it does start to be offered to all boys he won't be getting it (my decision), because as someone who won't be having sex it is not something he needs. I suspect if it is offered to boys he will be expected by public health bods to have it - even though he will not even be having sex. They're not filtering out where it's needed and where it isn't. Again individual risk factors and individual risks/benefits being different than population ones.

This is all very specific though. The broader question is should health bodies share concerns. You don't think so, I do. We're never going to agree because as I said above I see it as a matter for individual health (therefore you need all the information) you see it as a matter for public health (so don't need all the information).

noblegiraffe Thu 27-Jun-13 15:15:50

No, to remove a recommendation and to say that healthcare professionals cannot recommend it is not the same thing as saying that they are investigating possible side effects. It's a much stronger statement than that.

Re establishing that you are a high risk of HPV - well, the vaccine is offered to 13 year old girls, consent given by parents. How on earth do you establish that a 13 year old girl is going to be a low risk of HPV for the rest of her life? A 13 year old cannot say she will never have sex. Sex with a condom isn't good enough, lots of couples have unprotected sex and besides, you need unprotected sex to get pregnant. Maybe you should delay until just before you have sex to get the jab. Shit, I've just had unexpected sex and now it's too late? And at 13 committing yourself to regular smears starting over a decade in the future is just a bit ambitious don't you think?

No you can't decide whether you are at high risk of a side effect, but you can establish whether you are at particularly high risk of HPV and make a decision based on that. Whether it's have the decision or delay for further information.

Surely that is what they have said btw? They don't recommend it at the moment, its available if you want it, and they're investigating further. Not sure what the problem is unless you assume at this stage that they shouldn't share that they have fears - even for serious side effects. I would have thought that HPV is exactly the sort of vaccination where it was important to share that information because it is possible to establish whether you are at high risk for HPV and therefore the risk-benefit is going to vary from person to person.

Anyway we'll go round in circles on this. It comes down to I prefer to be given all the information available, for concerns to be taken seriously and to be communicated, and for the process to be transparent.

noblegiraffe Thu 27-Jun-13 14:34:30

The governing body doesn't feel there are high numbers of side effects, it is investigating a possible causal link with some serious side effects, for which the current evidence can't establish a causal link.

How can you decide if you are at a high risk of adverse events if it isn't even yet established that these are side effects of the vaccine?

Like I said, they could have said they were investigating possible side effects, and would withdraw the recommendation if a link was established. Withdrawing the recommendation and saying it might be reinstated is just confusing.

noblegiraffe Thu 27-Jun-13 14:29:39

Oh, and you have misrepresented my position.

1)I didn't say that concerns shouldn't be shared. It would be perfectly proper for the government to say it was investigating reports of possible side effects and firm evidence would be expected in 6 months. People could hold off it they wanted to.
Withdrawing a recommendation is easily seen recommending against it. But they are still offering the vaccine. What on earth are people supposed to conclude, when the evidence doesn't yet show any causal link? It's just chaos, and not for a really good reason, as you might expect when lives are at stake.

2&3) vaccination is clearly not always the better option, but the HPV vaccine has been shown to be effective, saves lives, and has been given to millions of people without side effects. No vaccine is completely safe and it is possible that even if a causal effect is shown, the risk might be so low that the vaccine continues to be recommended. Recommendations don't have to be just to have the jab or not, either, when you look at other vaccines, lots of categories come into the recommendations for different at-risk groups.

In which case I would say it was particularly important that if a government body have concerns they share those. With quite simple information people can work out whether they are at high or low risk for HPV infection, and then decide whether it's worth having a vaccination that the govt body feels has a high number of side effects.

As I already said someone high risk may decide it's worth the risk anyway - it's a harder decision for someone low risk.

This isn't about 'right' or 'wrong' decisions (I don't believe such a thing exists anyway). It's about informed consent, so having a vaccination knowing that you have a risk of particular adverse events and accepting those - usually because you have calculated that the potential benefits outweigh the risk. This is not a given though - it will vary from person to person. It becomes problematic in my mind when you have an adverse reaction that you didn't know was a possibility because you hadn't been told - and particularly problematic if the govt knew it was a possibility but decided to suppress that information.

noblegiraffe Thu 27-Jun-13 14:14:14

Saintly, but if you read the paper, it talks about issues with the measles vaccine too, if parents were really using this paper as evidence to avoid the MMR, then why on earth would they go for the single vaccine, which is also linked, in the paper, to developmental problems? And the paper says 'Measles virus and measles vaccination have both been implicated as risk factors for Crohn's disease and persistent measles vaccine-strain virus infection has been found in children with autoimmune hepatitis'.

It wasn't the paper, was Wakefield banging on about single vaccines that started that whole mess. Like I said, people are usually not medical experts who go and examine the evidence themselves and are clever enough to interpret the data.

Actually 'my' medical experts haven't told me that in relation to my younger children at all, but that's a different matter (and one I'm not allowed to mention on here without getting shouted at - unless I am willing to divulge names).

So, sticking to the general point - I think we can summarise.

Your position is:
(1) Concerns that govt bodies such as health ministries have should never be shared until they have been investigated thoroughly and that investigation has reached its conclusion
(2) Until proven otherwise vaccination is always the better option (even for new vaccination where passive surveillance post introduction is effectively part of the safety trials)
(3) Side effects and adverse reactions never outweigh the benefits of whatever it is the vaccination is designed to prevent (even if, as in the case of HPV, you can actually alter your risk of contracting it by behavioural changes).

My position is:
(1) Govt bodies should share concerns, prior to investigations being concluded to allow people to make decisions based on up to date information.
(2) The risk-benefit ratio of a vaccination against HPV is going to vary greatly between individuals depending on their behaviour
(3) Side effects and adverse reactions can have lifelong life changing consequences and therefore informed consent should be given - and can only be given with access to up to date information. This is particularly important for individuals who aren't hugely at risk from HPV because their risk-benefit ratio will be weighted towards the risks.

noblegiraffe Thu 27-Jun-13 13:43:04

Saintly, the paper shouldn't have scared them away from the MMR at all. Any medical expert could have told you that.

It was Wakefield's pronouncement in the press conference that caused the issues, not the evidence.

And it's a pity that those experts didn't count how many had singles instead as the only paper I'm aware of looking into this found that 94% of people had a measles vaccination - either in the form of MMR or single vaccinations. The lowest (mumps) appeared to be related to the single mumps being unavailable (at a guess at 98% opting for singles had measles, 90% had rubella and only 56% had mumps - overall mumps vaccination rate still 92%).

So it seems that the MMR scare didn't scare people away from vaccinating - not according to that paper. It made them choose what they perceived to be a safer means of vaccination. If 94% were choosing a measles vaccination despite a bunch of them having to pay for singles imagine how close they could have got to 100% if the single had been free (or even available to be paid for via GP's).

People on the whole want to protect their children against diseases, but they do want to do it in a safe manner, & imo it remains unethical for a govt ministry to bury their own concerns because 'it might affect the vaccination programme'. Not as much as cover ups that are later revealed.

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