Independent Health Experts Will Track Swine Flu Side Effects

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This should add an extra layer of safety to the vaccination process:

WASHINGTON - Independent health advisers will begin monitoring safety of the swine flu vaccine today, an extra step the government promised in this year’s unprecedented program to watch for possible side effects.

Decades of safe influenza inoculations mean specialists are not expecting problems with the swine flu vaccine, because it is made the same way as the regular winter flu vaccine. But systems to track the health of millions of Americans are being tapped to make sure - to spot any rare but real problems quickly, and to explain the inevitable false alarms when common disorders coincide with inoculation.

US health officials have spotted no concerns to date, said Dr. Bruce Gellin, head of the National Vaccine Program Office.

A specially appointed working group of independent experts will track the vaccine’s safety, too. Although the group will deliberate in private meetings, starting today, its charge is to raise a red flag if members feel the feds miss anything.

“Given the rapidity with which this particular vaccine was rolled out, there seems to be an extra-special obligation to make sure things remain as uncomplicated as they have in the past," said Dr. Marie McCormick of the Harvard School of Public Health, who chairs the working group.



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49 comments

Wasn't the 911 Commission independent too?

Yeah. "Independent". Dig a little deeper and you'll probably find big pharma bank rolling it. Don't get that Swine Flu shot until I have a chance to buy stock in Glaxo-Smith-Kline!

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Rape victim approaches Diaper Dave. Diaper Dave's response is to mischaracterize Obama's position, turn his back on her, and run away faster than a chickenhawk from combat duty.
http://www.youtube.com/watch?v=r6YZ1wP1978&fe...

they're going to find a million different problems. the independent analysts.

and the problems will never be reported on mainstream media.

no. way. am I taking this damn thing.

I've lost all trust I could ever have had, in the FDA.

didn't the last batch make a bunch of little kids in England and Japan commit suicide? "oh but that was Tamiflu this one's DIFFERENT!!"

didn't the most recent batch cause people to stumble all over themselves and drool and rep like Terri Schiavo? "oh but thats probably unrelated or they're faking it.."

no way am I taking the damn thing. I really doubt its gonna be the killer people claim its gonna be but if I do catch it I'll just go cough on my enemies and smite them. lol .. but this vaccine's just gonna make a whole new generation and demographic of asperger. yuck. no way.

"didn't the last batch make a bunch of little kids in England and Japan commit suicide? "oh but that was Tamiflu this one's DIFFERENT!!""

Since Tamiflu is a synthetic chemical DRUG that inhibits the spreading of viruses from cell to cell, while a vaccine is something that primes your own innate immune system to combat the virus, yes...it IS different.

"didn't the most recent batch cause people to stumble all over themselves and drool and rep like Terri Schiavo? "oh but thats probably unrelated or they're faking it..""

No. Unless you're talking about the sensationalized case of Desiree Jennings who got sick ten days after taking the seasonal flu shot. Her illness has never been shown to be a result of the vaccination, and millions of other people received the same shot with no ill effects.

"but this vaccine's just gonna make a whole new generation and demographic of asperger."

Given your first two points I guess I shouldn't be surprised that you'd finish the wingnut triple axle with the standard nonsense about autism being linked to vaccines. Not only is there no evidence for a link between vaccines and autism, but there is a mountain of evidence against it. One of the more dramatic examples was a 2002 study in Denmark where they looked at a cohort of over half a million children born between 1991 and 1998. 80% of them had been vaccinated and 20% had not. There was absolutely no difference in the frequency of autism between the two groups.

http://content.nejm.org/cgi/content/abstract/...

Here's another article that lists more of the evidence against a link, including the one I listed above.

http://findarticles.com/p/articles/mi_7591/is...

One of the best quotes from this particular article:

“As a result of public concern about autism and vaccines, thousands of claims have been submitted to the National Vaccine Injury Compensation Program. On February 12, 2009, the U.S. Court of Federal Claims published decisions about these claims, which were considered as a group under the Omnibus Autism Proceeding. The Court found, after reviewing 5,000 pages of transcripts, 939 medical articles, 50 expert reports, and hearing testimony from 28 experts, that the MMR and thimerosal-containing vaccines, independently or together, were not causal factors in the development of autism or ASD (U.S. Court of Federal Claims, n.d.).”

Each of those studies cited have conflicts of interests as the reporters work for entities which have a vested interest in not facing litigation for the damage caused.

They used epidemiological studies to manipulate the statistics until they got the result they wanted.

You got any evidence for any of those claims there?

The alleged vaccine/autism link was fabricated out of whole cloth by Andrew Wakefield and others in an attempt to a) extort money from vaccine makers through the legal system and b) support the sales of various types of quack autism 'treatments' such as chelation therapy.

By continuing to spread it, you make yourself an accomplice to on-going fraud.

There's no shortage of nutty websites spreading disinformation and hysteria about vaccines. The most ridiculous example, in my opinion, is all the hysteria about squalene as an adjuvant. Most of which ignores the fact that it's already present in the human body as a precursor to hormones and vitamins, including vitamin D which is (ironically) now being pushed as a quack alternative to vaccination. Some health food companies even sell squalene capsules to people who believe it lowers cholesterol levels.

I'm not one for coo-coo conspiracy theories, but I'm almost inclined to believe that rival companies to Novartis are spreading the rumor that squalene is bad for you. Novartis thought they had a winner when they discovered you could use squalene as an adjuvent as a substitute for the older, metal-based adjuvants, because squalene was a naturally occurring compound already found in blood serum. But since it was patented by Novartis no other company could add it. So, I wouldn't be surprised if some of the other companies are behind some of this disinformation about squalene.

The VICP vaccine court has also made things much worse by granting out of court settlements to people like Hannah Poling, when there was no evidence that her condition was caused by a vaccination.

http://content.nejm.org/cgi/content/full/358/...

Extra precaution is always a good thing, particularly with a major undertaking like this. That said, the vaccine paranoia is really sickening--literally.

It also seems the War On Science isn't only being waged by the Right--we have plenty of logic/reality deniers and irrational paranoids in our camp, too. Here's a very good article about the REAL science of it:
http://www.wired.com/magazine/2009/10/ff_waro...

We've already lost one professor at my small college and a student or two to H1N1--I can pretty much guarantee that's more than would be killed by any vaccine on earth, and it hasn't even gotten going full strength yet. Me, I'm in line as soon as it's available.

You know, if the smallpox vaccine had been invented today, half the country would probably not take it. Tragic, to put it mildly.

Thanks Mark.

Burnt, where do you get your information??? Everybody I know who has had the H1N1 vaccine has not had any problem whatsoever. It's like any other vaccine.

I thought the vaccine wasn't available yet?

We've decided not to get the shot though.

We're taking a daily dose of 5000 IU of Vitamin D3 instead. When Swine flu is prevalent in our area, we're going to bump up to 15000 IU daily.

We bought it for our kids and told them not to get the shot. They're taking it - and I bought it for a few other people I knew could not afford it - even though it's very cheap on the internet.
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???

Why would Vitamin D3 protect you from a viral infection? Especially a virus you haven't been exposed to?

No doubt it about, this anti-science drivel is very frustrating. Look no further than the start of this thread and its first few comments to see full blown lunacy/persecution complexes in full swing. Good grief. Can people even think for themselves anymore?

Phil Plait can:

http://blogs.discovermagazine.com/badastronom...

http://blogs.discovermagazine.com/badastronom...

The reason we are not getting the shot has nothing to do with the science, or even that we feel the vaccine is a SERIOUS concern.

We're not getting it because we don't need to - we're taking vitamin D3 instead.

However - we do feel there are concerns about this particular vaccine. Outside of our family we don't advise anyone on the swine flu vaccine though.
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You just benignly post it on the internet. While some studies have shown that Vitamin D3 can be effective at preventing flu there is no evidence it has had any significant effect at curbing pandemic flu.

In fact the FDA has ordered some retailers to stop marketing Vitamin D3 products as swine flu preventatives. (http://www.fda.gov/ICECI/EnforcementActions/W...). Even the Vitamin D Council recommends being vaccinated against swine flu (http://www.vitamindcouncil.org/newsletter/h1n...). Refusing to acknowledge that the vaccine has been clincally shown to be safe and effective at preventing infection despite all the evidence to the contrary, then embracing alternative medicine therapies of unknown safety and effectiveness is pretty much the very definition of antiscience.

Two weeks ago I was lucky enough to get one of the 400 swine flu vaccines offered by our county health dept. It was just like any other flu shot. So far so good.

Two weeks ago I was "lucky" enough to get the flu. Now I don't need the vaccine. The flu itself wasn't that bad, I've been sicker with other flu strains. The sinus infection I developed afterward kicked my butt before I went to the doctor for some antibiotics.

To be honest, I was figuring I would get the flu before the shots would be available. And I did.

Same thing happened to me, but I don't know for sure it was H1N1, the symptoms matched up. Interestingly, I was guessing I would get sick before the vaccine was available in my area too. Go figure.

It was very wide-spread even before the vaccine was available at all.
*

We need to get a better influenza vaccine production system on-line; what we have now takes an average of six to nine months from the initial isolation of the strain to the delivery of vaccine in quantity. If and when we face a flu pandemic of the severity of the 1918 Spanish Flu, millions of people are going to die before we can get vaccine out there. And it's a near certainty we'll see it eventually -- influenza A has a simple genome and prodigious mutation rate. Eventually it will again click over into a combination capable of killing tens of millions of people.

After reading the inserts for these vaccines, i'd honestly rather get Swine Flu than take one of these.

What ingredients are you concerned about? How much of those ingredients are present in the vaccine?

In addition to the aluminum and squalene (MF-59 in some countries) there is the mercury.

EPA Guidelines for adult exposure of ingested mercury are .1mcg/Kg/day (0.1 mcg gram per kilogram per day and remember this is injected mercury rather than ingested). That comes from:
Mahaffey KR, Rice G, et al. An Assessment of Exposure to Mercury in the United States:Mercury Study Report to Congress. Washington, DC: U.S. Environmental Protections Agency; 1997. Document EPA-452/R097-006.

Depending on the manufacturer current flu vaccines contain 25-50mcg of preservative mercury per shot.

A 200lb adult weighs about 91kilograms

so .1mcg/kg/day x 91kg = 9.1mcg/day

since most shots are 25mcg that works out to be
25/9.1=2.7x over the exposure rate for a 200lb adult
50/9.1=5.5x over

The average weight for a 10 year old (male) is about 30kg
.1 x 30 = 3mcg/day
25/3=8.3x over for a 10 year old boy

One thing to consider is the use of "mercury free" vaccines in press or by doctors. This is actually not a true statement. If you read the manufacturers info they are careful NOT to use that wording. They use "preservative free". Why? because these shots still contain mercury left over from the manufacturing process. They just didn't add more in for the "preservative" use. If you do the math on what is considered a "trace" by government guidelines it still puts infants and newborns over the government standards for safe exposure limits for ingested mercury (remember this in injected mercury for which they have no safety studies).

Studies looking at the so called "half-life" of ethyl mercury only looked a bloodstream concentration. They did not look at the fate of mercury and simply assumed since it wasnt in the bloodstream that it left the body. An NIH funded study after that by Burbacher, et al looked at the fate of the mercury. It found that the vaccine form (ethyl mercury) was converted to inorganic and conc'd in the brain.

Several recent studies from Poland, Peru and New York looked at animal models and found neurodevelopmental problem in those animal models.

The studies cited by health officals only look at epidemiology - data sets. The data sets are manipulated to the desired outcome and data sets not shared with other researchers for verification (you just have to take their word on it).

but arent you comparing a one time exposure (granted way above the rec. levels) from the vaccine, to daily exposure?
Am I missing something?

I remember when contact lens solution contained Thimersol, nobody told me it was mercury.

Four things:

1) You are simply wrong about the dosage; that's the amount of thimerosol in an entire 10-dose vial, not a single does.

2) You're misrepresenting the research on ethyl mercury. The CDC's studies on the subjects have used urine sampling to confirm that it clears the body.

3) The composition of the pandemic swine flu vaccine is identical to the seasonal flu vaccine except for the fact that it contains a single strain instead of the normal three. If the composition was so problematic, then there would be serious ongoing problems... which there aren't, except in the heads of the anti-vax crowd.

4) Removal of thimerosol from the normal childhood vaccination series eight years ago had no detectable effect on autism rates or any other neurological condition.

I mean, after all, China is making this vaccine for us.
And we all know how careful they are when it comes to importing things into our country. They would 'never' do anything to hurt us. Or our children. Or our pets. Just shut up and take your vaccine. If you don't you're an unpatriotic conspiracy theorist. And we know how China handles 'those' kinds of people, don't we? Maybe we should adopt their control structure and just drink the damn vaccine as well. Give it to me in a shot glass. I wanna see my savior elixer before it goes down my gullet. Mmmm, i bet it tastes like rebirth. Or, afterbirth. Either way it'll be yummy!

Where did you get the idea that China was making the H1N1 vaccine for us? As far as I know, the companies that are licensed to make the H1N1 vaccine for use in the U.S.A. are:

MedImmune LLC (Maryland USA)
Novartis (Switzerland)
Sanofi Pasteur (France) and
CSL Limited (Australia)

Its a matter of trusting pharmaceutical companies. It's good that we don't have enough vaccines to go around cause I'll take a wait and see attitude toward it. I refuse to be a guinea pig.

The swine flu pandemic vaccine is a strain change from the seasonal flu vaccine... same way they do it every year. If you'd like to argue that it's really actually different, how about some evidence?

The vaccine, manufactured by GlaxoSmithKline, contains an immune-enhancing chemical compound, known as an adjuvant, whose side effects are not yet entirely known. Then, after a report was leaked to the German media last week, the Interior Ministry confirmed that it had ordered a different vaccine, Celvapan, for government officials and the military. Celvapan, which is made by the U.S. pharmaceutical giant Baxter, does not contain an adjuvant and is believed to have fewer side effects than Pandemrix.

http://www.time.com/time/health/article/0,859...

Articles like this prevent me from getting flu shot right away.

The article doesn't say. Does the author know, or does the author know someone who read it from some post on the internet?

Yes, I do think it's safe. The vaccines are made the same way as the traditional flu vaccine.

There are thousands of people in my community who have already been hit with H1N1. A good percentage of them have missed ~1 week of work or school. H1N1 is contagious and nasty. I'll put my trust in modern medicine rather than in the anecdotal evidence I find on the internet.

"The vaccines are made the same way as the traditional flu vaccine."

that should concern people right away iof they just go back and look at the track record of contamination and additives.

And then there are always issues like this:
http://www.kmbc.com/newsarchive/18445420/deta...

The case you cite is a) one case and b) contains no evidence of a causal link. Do you have some data you'd like to cite, or is anecdote the best you can do?

A lot of the reason for that was so rumsfelds company who made the drugs to fight it. They made a lot of money from it. I wonder if this is any different. Here is a good article. My daughter thinks this Dr Mercola is a top notch person. Here is a link to an article and a video interview with a research Dr. http://articles.mercola.com/sites/articles/ar...

Personally I am unsure of what to do. My wife was in a very bad car accident almost two years ago and I only have one kidney left.
I wonder if we should get this or not.
republicanism/conservatism is a mental illness!

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...on the swine flu vaccines. (7 minute interview)

http://www.youtube.com/watch?v=nTgyakGAddM&fe...

Rauni Kilde said swine flu vaccine is bioweapon!

Seems like a pretty balanced take:

http://www.theatlantic.com/doc/200911/brownle...

"...On November 1, 2005, President George W.Bush pronounced pandemic flu a “danger to our homeland,” and he asked Congress to approve legislation that included $1billion for the production and stockpiling of antivirals. This was after Congress had already approved $1.8billion to stockpile Tamiflu for the military, a decision that was made during the tenure of Defense Secretary Donald Rumsfeld. (Before joining the Bush Cabinet, Rumsfeld was chairman for four years of Gilead Sciences, the company that holds the patent on Tamiflu, and he held millions of dollars’ worth of stock in the company. According to Roll Call, an online newspaper covering events on Capitol Hill, Rumsfeld says he recused himself from all government decisions involving Tamiflu. Gilead’s stock price rose more than 50 percent in 2005, when the government’s plan was announced.)"

As they have done with the autism issue, they will bury any problems with epidemiological based statistics. Water down and dilute any problems.

Just keep promoting that money maker and deny there is any problem with putting mercury in vaccines and giving it to children and pregnant mothers.

http://www.ncbi.nlm.nih.gov/pubmed/19747466?i...

http://www.scielo.org.pe/scielo.php?script=sc...

http://www.ageofautism.com/2009/09/blockbuste...

The vaccine/autism link was fabricated by Andrew Wakefield and accomplices for purposes of extortion and promoting quack autism 'cures'.

The results of the testing on this vaccine were reported in the New England Journal of Medicine. It is instructive to learn that the tests for safety and to assess complications lasted only 7 days after the vaccine, an incredibly short period of follow-up. Gullian Barre paralysis can occur even months after a vaccine as can seizures, behavioral problems and neurodevelopmental disorders in children.

It is interesting to note that the authors of the safety study for our swine flu vaccine were all employees of the maker of the vaccine CSL Biotherapeutics and eight held equity interest in the company. This admission is part of the disclosure policy of the New England Journal of Medicine.

Greenberg ME at al. Response after one dose of a monovalent influenza A (H1N1) vaccine-preliminary report. NEJM 2009:361: article number 10.1056/NEJMoa0907413.

1) Guillain-Barre syndrome is so rare in both vaccinated and unvaccinated individuals that it is not possible to make statistically significant correlations.

2) All of the studies allegedly connecting vaccination to seizures, behavioral problems, or neuro-developmental disorders have been either fraudulent or grossly methodologically flawed.

3) The reason that the preliminary testing period on pandemic swine flu vaccination was so short is because it's a strain-change only from the seasonal vaccine.

Here is a link with dozens of MDs, PHDs, Even a doc at the National Institutes of Health. Some folks from : Journal of the American Medical Association. These folks deal with diseases every day. Let's look around the organized outcomes of a good portion of the 'studies' and look at some real time thoughts by professionals who have seen and heard more than any of us, including 'rocketgeek', will ever hear. Here's one of my favorite admissions from the Centers for Disease Control :

"In the United States during the period 1980-1985, 55 cases of paralytic polio were reported. Of these cases, 51 were caused by the oral vaccine...." Sure, it's only 55 cases. But, it looks like more that 90% of the problems were caused by the 'cure'.

Also, if you believe that Jeff Rense is a conspiracy theorist (this is a link to one of his archives)... that's fine. The only thing to see on this page are the massive quotes from those who know better than we. It's quite extensive for only one link :

http://www.rense.com/general7/onlysafe.htm

So, go ahead and call this anecdotal if you wish.
There are far too many questions to be able to make blanket statements like :

Tue, 11/03/2009 - 13:02 — rocketgeek

2) All of the studies allegedly connecting vaccination to seizures, behavioral problems, or neuro-developmental disorders have been either fraudulent or grossly methodologically flawed.

Really? That sounds like a typical teenagers argument : "But, MOM! Everyone is wearing these pants! You HAVE to get them for me!"

Please. ALL of the studies? That starting point only shows you are every bit as biased as those who disagree with you. That,on its' face, is virtually impossible. I guess now i would have to ask you to disprove ALL of the studies? I am sure there isn't the time, or proof enough to do that anyway. But, do it if you wish. Or, don't. All of us are out of the loop of absolute knowledge. But, i guess a good question to ask is a simple one. How did all of those 'plagues' of the past go away? You know, the pandemic ones that happened when we had no Pharma Vaccines to speak of? Never mind. Really. That last question was more sarcasm.

" I guess now i would have to ask you to disprove ALL of the studies? I am sure there isn't the time, or proof enough to do that anyway."

A better place to start would be for you to list any published, scientific studies that DO show a link between vaccinations and seizures, behavioral problems or neuro-developmental disorders, instead of just out of context quotes, anecdotes, and blog sites.

Can you list any published, peer-reviewed studies that show a correlation between vaccinations and seizures, behavioral problems, neuro-developmental disorders, or even autism?

Yep. I call to someone to be responsible for their own words :

------------
Tue, 11/03/2009 - 13:02 — rocketgeek

2) All of the studies allegedly connecting vaccination to seizures, behavioral problems, or neuro-developmental disorders have been either fraudulent or grossly methodologically flawed.

Really? That sounds like a typical teenagers argument : "But, MOM! Everyone is wearing these pants! You HAVE to get them for me!"

Please. ALL of the studies? That starting point only shows you are every bit as biased as those who disagree with you.
--------------

And i get this lazy response :

Wed, 11/04/2009 - 23:35 — Pericles

"A better place to start would be for you to list any published, scientific studies that DO show a link between vaccinations and seizures, behavioral problems or neuro-developmental disorders, instead of just out of context quotes, anecdotes, and blog sites."

Out of context? No published studies?
Did you actually GO to the link I posted?
There are quite a few points that you must have missed.
Here it is again :

http://www.rense.com/general7/onlysafe.htm

Now go see the studies that are listed there. And also see very revealing FACTS, not just 'anecdotes' or 'blog stuff'. Like this very important FACT :

----------
Jonas Salk, inventor of the IPV, testified before a Senate subcommittee that nearly all polio outbreaks since 1961 were caused by the oral polio vaccine.
----------

Wow. You mean to tell me someones vaccine did NOT help someone. In fact, it only did HARM? Impossible! Unless you ask the guy who CREATED THE VACCINE! Oops. Am i yelling? I guess the obvious doesn't seem so obvious to some. The man admitted and testified that his 'vaccine' hurt people. If that's not enough to bring vaccinations into question, then please get yourself on an IV drip of Squalene and thimerisol and get yourself healthy... STAT!

There is so much information that cannot be called 'anecdotal' or 'bloggy stuff' in that above link it is not even funny.
So, now can 'rocketgeek' or 'Pericles' perform the duty to which i called? Back up their own 'FACTS' and prove that:

Tue, 11/03/2009 - 13:02 — rocketgeek

2) All of the studies allegedly connecting vaccination to seizures, behavioral problems, or neuro-developmental disorders have been either fraudulent or grossly methodologically flawed.

Which is what this all started with anyway?
If you can make such a bold statement. THEN BACK IT UP. And, not with a "Oh, yeah? How 'bout YOU prove I'm NOT wrong.." crap.
Hold yourself accountable and prove your words. Otherwise, keep your unsubstantiated 'facts' to yourself. Let the professionals who are quoted, let the reviews and studies listed in the above link. Let the people at the Institutes of Health and the CDC help you understand what may lie in store for us with vaccinations. Or, listen to rocketgeeks 'opinion'. Or, even MY opinion. Which doesn't matter a hill of beans in the end.
I think we should listen to those other folks. Not just crap written here about this stuff. Go find out why people are concerned. And, find out this info from those who have a better understanding than the average C&L poster. Including me. Again, go to :

http://www.rense.com/general7/onlysafe.htm

Read the info, research the people and the information presented. Look through the studies and research, and then forget anything you think you learned here. From me or anyone else.

Yes, I went to your link. It's a collection of quotes, not journal references. THIS is a journal reference:

http://content.nejm.org/cgi/content/abstract/...

Since not every journal publishes their articles as Pdfs, you can also list them in standard form, which I can also look up and verify.

Parental vaccine concerns in Kentucky.
Smith MJ, Woods CR, Marshall GS.J Ky Med Assoc. 2009 Sep;107(9):342-9.

Autism and vaccination-the current evidence.
Miller L, Reynolds J. J Spec Pediatr Nurs. 2009 Jul;14(3):166-72.

Vaccines as a trigger for myopathies.
Orbach H, Tanay A. Lupus. 2009 Nov;18(13):1213-6.

If you're going to assert that there is evidence for a linkage between vaccinations and disorders, you have to cite empirical evidence in the form of a published study, not just quotations and opinions. Without empirical evidence, opinions are still just opinions, even if the opinions come from experts. You can find an expert to give a dissenting opinion on virtually anything.

I need a journal reference for the claim you're making. I can give you journal references showing there is no correlation between vaccinations and some of the things that vaccinations have been claimed to cause, but if you're going to make the clame that there is a possitive correlation between some of those things and vaccinations, you have to give me specific references for studies that I can look up.

I'm aware there has always been problems with the live, oral polio vaccine because it was one of the earliest vaccines invented. While the oral vaccine was very successful in the eradication of polio, it was known to have a small risk of actually giving people polio. But with the 1950s vaccine technology, that was the best they could do. Giving a small number of people polio was considered a small price to pay in exchange for the eradication of what was once a very large problem.

The discussion today is not about whether the original polio vaccine actually did any good, or did more harm than good. Everybody agrees it was very successful, given the technology of the age. The question now is, in light of how successful the eradication of polio was, is it still necessary to immunize people to polio, especially with a vaccine that has a small risk of giving people polio. The consensus is that it's still wise to continue immunizing people with a polio vaccine, just not with the live oral vaccine. An updated, safer version is being proposed as a substitute.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2...

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