Perverse effects of vaccination

Perverse effects of vaccination occur when a vaccination program causes more harm than it cures. This can happen if too few are vaccinated, allowing the disease to spread, albeit more slowly than in an unvaccinated population. This raises the average age of infection, which in some cases can increase the number of serious health problems associated with the disease.

In mathematical modelling in epidemiology, there is a critical threshold value (denoted "q_c") at which enough people are immune to the disease that its spread through the population (even to unvaccinated susceptible individuals) is stopped. This effect is commonly known as herd immunity. If a vaccination program does not attain "q_c", its effect is not to prevent the spread of the disease across the unvaccinated population; instead it delays the spread and so increases the average age at which individuals are infected. This is called an "epidemiological shift". In a disease like rubella, which has an increased severity or risk of complications with increased age, a vaccination program that causes an epidemiological shift can in some cases have the unintended consequence of increasing the number of deaths and problems caused by the disease, even if it protects vaccinated individuals. [cite book |author= Anderson RM, May RM |title= Infectious Diseases of Humans: Dynamics and Control |year=1991 |publisher= Oxford Univ. Press |isbn=0-19-854040-X]

Perverse effects arose in congenital rubella syndrome (CRS) cases in Greece following the introduction in 1975 of rubella vaccination for young children. [cite journal |author= Panagiotopoulos T, Antoniadou I, Valassi-Adam E | title=Increase in congenital rubella occurrence after immunisation in Greece: retrospective survey and systematic review | journal = BMJ | date=1999 |volume=319 |issue=7223 |pages=1462–7 |pmid=10582926 |url=http://www.bmj.com/cgi/content/full/319/7223/1462] This vaccination program failed because it did not attempt to protect adolescents and young women, and did not attempt to obtain high coverage. The resulting epidemiological shift caused rubella to infect more pregnant women and cause more CRS, showing that rubella vaccination programs should not be halfhearted.cite journal |journal=BMJ |year=1999 |volume=319 |issue=7223 |pages=1448–9 |title= Vaccination policies: individual rights v community health. We can't afford to be half hearted about vaccination programmes |author= King S |pmid=10582910 |url=http://www.bmj.com/cgi/content/full/319/7223/1448] A claim has been made that similar perverse effects occurred in the U.S. in the early 1970s, [cite book |author= Diodati C |title= Immunization: History, Ethics, Law and Health |year=1999 |publisher=Integral Aspects |isbn=0-9685080-0-6] but this misrepresents the overall pattern of U.S. CRS incidence, which fell from an estimated 20,000 in the 1964 epidemic to 7 in 1983, with a large drop in CRS incidence the early 1980s [cite journal |journal= Am J Epidemiol |year=1989 |volume=129 |issue=2 |pages=349–61 |title= Congenital rubella syndrome in the United States, 1970–1985. On the verge of elimination |author= Cochi SL, Edmonds LE, Dyer K "et al." |pmid=2912045] and with rubella eliminated in the U.S. by 2004. [cite journal |journal=Pediatrics |year=2006 |volume=117 |issue=3 |pages=933–5 |title= Elimination of rubella from the United States: a milestone on the road to global elimination |author= Meissner HC, Reef SE, Cochi S |doi=10.1542/peds.2005-1760 |pmid=16510677 |url=http://pediatrics.aappublications.org/cgi/content/full/117/3/933]

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