# Vaccination: Does it really prevent?



## Poodlebeguiled (May 27, 2013)

Disease decline before introduction of immunisation


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## peccan (Aug 26, 2014)

The time of rapid disease death reductions was the birth of modern medicine, and such ground-breaking things as...
* knowledge of microbes and their relation to diseases
* basic medical hygiene (washing hands prior to assisting childbirth or doing surgery...)
* antiseptics
* professionalisation of nursing
* epidemiology

which surely dealt a lot of major blows to death rates from disease.

I find hard to trust any text that fails to acknowledge this immense medical revolution's effect on the matter.


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## fjm (Jun 4, 2010)

As peccan says, the diseases listed were very much those made worse by poor food, housing, sewers, and all the other things that improved immensely across the time period shown - children still caught them, but most survived. Vaccination has massively reduced their incidence, further reducing deaths to the point that many people have forgotten just how dangerous they can be. I can remember how frightening polio was when I was a child; meningitis was a rare but deadly complication of measles; I had an aunt who nearly died from TB, and smallpox was still a significant threat when I travelled as a student. I think there is an argument to be made that we repeat vaccination and immunisation more often than is necessary in animals, but I don't think that should blind us to the huge reductions in childhood illness and mortality they have brought.


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## shantikeyz (Mar 4, 2016)

Not sure what the link, human vaccines, has to do with dogs but personally, I believe in vaccinating dogs. Puppies after weaning 2 rounds. After that an annual booster. Then I only vaccinate once every 5 years because in my research and talking with my vet, every year is not necessary. Over vaccinating dogs can cause harm, which it did in one of our dogs causing autoimmune problems. 
We get the 3 year rabies. 
I saw dogs die from distemper, parvo and other preventable diseases back in the 60s and 70s when few people bothered with vaccines. I never want to see a dog of mine go through something so unnecessary. 

Sent from my XT1055 using Tapatalk


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## Poodlebeguiled (May 27, 2013)

I just don't know where the evidence is that vaccines prevent disease. Like you say Fjm, there were many, many other variables and it's hard to know which thing or things slowed the diseases. What this has to do with dogs? It has to do with them like it has to do with us, except that they have shorter life spans and a set of vaccines probably lasts them a life time where they all might not with humans.

And of course Peccan...you're absolutely right about all those things having to do with reducing diseases. But where is the evidence that vaccinations are really preventing disease? So much of what is presented and assumed is correlative, not causation or proof of causation. I'm just interested and curious about some kind of better science than I've come across, though I haven't really spent a whole lot of time looking into it yet.


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## CharismaticMillie (Jun 16, 2010)

I absolutely believe in vaccinating. It's the best way to prevent a number of potentially fatal diseases and there are challenge studies that show that most vaccines do indeed prevent a vaccinated individual from developing that infection. In my mind, the only real concern is vaccinating beyond what is necessary to create immunity. For example, people are not repeatedly vaccinated every 1-3 years throughout their lifetime for the same core vaccines that they receive as children and that have been proven to provide long term immunity. There is no reason that we shouldn't apply the same logic to dogs. Vaccinate to create immunity, but once long term immunity is established, it doesn't make any sense, and can cause harm, to continue to vaccinate without questioning whether it is actually necessary.


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## lily cd re (Jul 23, 2012)

My Ph.D. is in immunology (from an Ivy League institution). I teach microbiology to undergraduate college students.

Improvements in public health have resulted from improvements in nutrition, advancements in medical practice, the availability of antimicrobial drugs and greater access to clean drinking water in many parts of the world (along with other social, political and economic changes). However to assert that immunizations played no part in the declines in many dangerous infectious diseases we enjoy today is not only an indication of being ill informed, it is dangerous.

Immunization is essential to maintaining public health. Even when not all members of a population are immunized the population at large benefits through what is called herd immunity. As we encounter the emergence of antimicrobial drug resistance at a time that big pharma is rather disinclined to develop novel antimicrobial drugs to treat existing cases of disease and have to cope with the emergence of novel infectious diseases such as Ebola or Zika virus development of immunizations and planning effective vaccine campaigns is vital.

Here are links to scholarly publications regarding the actual and potential publications risks of failure to maintain immunization programs. While these citations concern human diseases, canine, feline and agricultural animal immunization programs have the same effects.

Epidemic Diphtheria in the Newly Independent States of the Former Soviet Union: Implications for Diphtheria Control in the United States

Pinkbook | Diphtheria | Epidemiology of Vaccine Preventable Diseases | CDC

Here are links to scholarly publications regarding the 20th century successful immunization campaign to eradicate small pox and the current effort to eradicate polio through immunization (for which we are currently in the end game strategic phase.

WHO | Smallpox

Global Polio Eradication Initiative > Home

While the first vaccines against rabies given to humans are attributable to Louis Pasteur, efforts at improving canine and human rabies vaccines now have led to the potential to eradicate this disease that has long been a global scourge.

WHO | New global framework to eliminate rabies


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## lily cd re (Jul 23, 2012)

CharismaticMillie said:


> I absolutely believe in vaccinating. It's the best way to prevent a number of potentially fatal diseases and there are challenge studies that show that most vaccines do indeed prevent a vaccinated individual from developing that infection. In my mind, the only real concern is vaccinating beyond what is necessary to create immunity. For example, people are not repeatedly vaccinated every 1-3 years throughout their lifetime for the same core vaccines that they receive as children and that have been proven to provide long term immunity. There is no reason that we shouldn't apply the same logic to dogs. Vaccinate to create immunity, but once long term immunity is established, it doesn't make any sense, and can cause harm, to continue to vaccinate without questioning whether it is actually necessary.


Immunity can wane in adulthood. This is why college students in New York State are required to show proof of immunization for measles, mumps and rubella. When I reached graduate school I was titered for my immunity to those three and other immunization preventable diseases. I was required to get a measles booster since I had no serological evidence of being protected. There is currently an important public health campaign to have adults immunized against whooping cough (_Bordatella pertusis_) because many studies show that titers wane in early adulthood and whooping cough is not a trivial infection when it occurs in very small children. There have also been outbreaks of whooping cough on college campuses.

Campus Health at the University of Pennsylvania


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## Poodlebeguiled (May 27, 2013)

I'm not saying I'm all for or all against. I simply am playing devil's advocate, the idea that vaccines destroy our immune systems in many instances and may not be doing all that is claimed. There _are_ other schools of thought. I'd love to see some real proof. I know people who get vaccinated and dogs too and it doesn't do any good in every situation. I also see so much harm. I like to vaccinate my puppies because I do think there are some diseases that are just too over whelming for their immune systems, even if they are healthy immune systems (before they're damaged by mercury and other chemicals) but I don't believe that they need to be repeated over and over. I'm at a place where, at this time I do very minimal and will likely titer them. But they're also quite isolated now that I'm not showing. Our life style makes it quite unlikely that they'll come in contact with any over whelming disease.


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## lily cd re (Jul 23, 2012)

I think there are plenty of opportunities for us and our dogs to come in contact with infectious agents. Where I live we have plenty of Lyme disease and leptospirosis along with anaplasmosis. Lily and Peeves both had _Bordatella _a couple of years ago brought home by Lily and acquired at an obedience trial site. We have West Nile virus and potential for malaria if it were to be imported locally.

This summer Zika virus will be a concern through the southern US.

This isn't to say that I would tell anyone to immunize without questioning the need. Asking for titers instead of automatic reboosts is a good option as is separating immunizations to different dates.

shantikeyz, somehow I missed your question about the relationship between human and animal vaccines earlier. Our immune systems and those of our dogs work exactly the same way and effective infection prevention in people and dogs is based on nearly identical public health strategies.


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## Carolinek (Apr 2, 2014)

peccan said:


> The time of rapid disease death reductions was the birth of modern medicine, and such ground-breaking things as...
> * knowledge of microbes and their relation to diseases
> * basic medical hygiene (washing hands prior to assisting childbirth or doing surgery...)
> * antiseptics
> ...


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## Poodlebeguiled (May 27, 2013)

Carolinek said:


> peccan said:
> 
> 
> > The time of rapid disease death reductions was the birth of modern medicine, and such ground-breaking things as...
> ...


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## fjm (Jun 4, 2010)

I found these charts both interesting and perhaps indicative of why we have forgotten just how prevlent these diseases used to be!
Battling Infectious Diseases in the 20th Century: The Impact of Vaccines - WSJ.com


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## peccan (Aug 26, 2014)

I do have some doubts on the yearly vax routine thing you have in the States, mainly because up in here we have three-year intervals. The US healthcare system makes me pretty cynical when it comes to that...


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## Carolinek (Apr 2, 2014)

The CDC is a great, impartial source, and exactly the type of data we need to look at- and remember. You don't have to read too deeply into these charts to see the public health benefit. It's one thing to look at Schultz and Dodds and follow reduced vaccinations for our animals. But it's a whole other thing to put the health of the human public at risk by not giving important vaccines to canine or human. 

I have seen changes in attitudes in my area. In years past, my students just accepted that vaccines were an important part of health care, and the was no controversy. Around 6-7 years ago, it changed, and students started presenting their anti vaccination rationales in class when we discussed it. Some were very passionate- and resistant to actual data. Much of that was fueled by the media. Now I'm seeing the pendulum swing the other way- where students are concerned about the anti- vaccination movement- Thank God. 

Certainly I think the debunking of the link between autism and vaccines has helped fuel the change. But you can have all the data you want, and if the media spins it a certain way, you're screwed. It will take a long time to repair the damage caused by this anti vaccination trend. The average citizen doesn't read data from the CDC, and often relies on Facebook, Twitter, and sensationalistic media to make life decisions- which is really very scary.


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## Carolinek (Apr 2, 2014)

peccan said:


> I do have some doubts on the yearly vax routine thing you have in the States, mainly because up in here we have three-year intervals. The US healthcare system makes me pretty cynical when it comes to that...


We may be doing as lousy a job here in the US with our animals as we are with people, compared to our peers overseas. This is despite spending more money than any other country in the world- but that's a whole other topic deserving of a forum of its own- and I'm sure they are out there. 

Questioning policy and status quo is great, but people need to know how to question. Always question- but use some critical thinking and do it effectively!


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## TrixieTreasure (May 24, 2015)

shantikeyz said:


> Not sure what the link, human vaccines, has to do with dogs but personally, I believe in vaccinating dogs. Puppies after weaning 2 rounds. After that an annual booster. Then I only vaccinate once every 5 years because in my research and talking with my vet, every year is not necessary. Over vaccinating dogs can cause harm, which it did in one of our dogs causing autoimmune problems.
> We get the 3 year rabies.
> I saw dogs die from distemper, parvo and other preventable diseases back in the 60s and 70s when few people bothered with vaccines. I never want to see a dog of mine go through something so unnecessary.
> 
> Sent from my XT1055 using Tapatalk



I used to get the dogs vaccinated every year, and then found out how unnecessary it was. I would get reminder notices every year, and finally, I made an appointment to talk candidly with our vet, and he told me that every year wasn't necessary. He made sure that I understood though that health checks were very necessary every year. So of course we still made our appointments for that. Just not for vaccinations.


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## Critterluvr (Jul 28, 2014)

I think vaccines are important in preventing some diseases but I think in a lot of instances they are over done and have become a money grabber.... 
I do not believe in yearly vaccinations for animals and my vet admitted that every 3 years now is what she recommends.

Flu shots are the big thing now, at least here in B.C., they are constantly being pushed through aggressive advertising for the general population. I work in the medical field and while they are not mandatory our company has a nurse that comes around to administer them in the fall. My coworkers get them while I do not. Every year my coworkers are off sick from the flu.... I have not had a cold or the flu in years. (Knock on wood). They both have decided they aren't getting the vaccine anymore.
I see patients on a daily basis and the general consensus is that the flu shot makes them either feel unwell for a while or they end up with a bad case of the flu anyway. Go figure........ I think somebody somewhere is making a big pile of money here.


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## lily cd re (Jul 23, 2012)

I don't think much of anybody makes much money from flu shots. New batches need to be made every year to adjust for changes in the viruses that are circulating. If there are left over doses they have to be thrown away. No manufacturers in the US produce flu vaccines, although there is flu vaccine production in Canada (as of my last checking), most vaccine is made in Europe. The process for producing flu vaccines is simultaneously involves complex and archaic technology.

Big money can be made in biotech based vaccines which have a long shelf life and that don't need readjustments like flu shots do.

While it may not be necessary to immunize dogs (and cats) as often as we tend to, immunizations have saved many more lives than have been damaged in any way by their use. We would never have eradicated small pox, be close to eradicating polio or have a plan to eradicate rabies without immunizations campaigns as the foundations of those history changing publich health milestones.


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## N2Mischief (Dec 3, 2012)

I get the flu shot every year without fail. I have not had the flu in MANY year and never after a flu shot. My daughters both get the shot and have stayed well. My husband and my son on the other hand refuse to get the shot and both are sick every year.

I should add that it is very scary for people with weakened immune systems to be around people who refuse to get the vaccine.


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## ericwd9 (Jun 13, 2014)

vaccine production, research and development on vaccines has never been a part of the culture (no Pun intended) in major drug companies. More money is to be made treating disease and symptoms of disease than in prevention. One shot prevention in fact is counterproductive in profitability. A vaccine for HIV would have saved millions of lives and cost the drug companies billions of dollars. Most vaccines are developed and manufactured by government agencies with public monies. It is in the interest of nations with public health schemes to prevent disease and the costs of treatment and absenteeism. It would not surprise me if those who profit from disease are the very ones who spread and encourage the sheep like people who not only question the efficacy of vaccines but dismiss them without thought. I lost 1/2 of my class of school beginners in 1952 to diphtheria. Should that happen today hell would be raised. Yet with rates of vaccination for this disease falling this could happen soon. About 10% of children in some areas were affected by poliomyelitis. Chicken-pox, measles and other disease took out up to 2%. No first world population would allow this today. Parents of children in Australia receive no public health benefits if their children are not vaccinated. There is talk of compulsory vaccination for some diseases. It is precisely those who do not have their pets vaccinated who endanger the pets of others and per_pet_uate this lacrimonious litany of lies.
Eric


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## Click-N-Treat (Nov 9, 2015)

N2Mischief said:


> I should add that it is very scary for people with weakened immune systems to be around people who refuse to get the vaccine.


I've been a chemotherapy patient for 10 years. I rely on herd immunity for my own safety. Live virus vaccines are too dangerous for me to have. I just found this out the hard way.

My dog Francis got the nasal bordetella vaccine and promptly sneezed in my face. I thought nothing of it. A few days later, I came down with the most wicked cough I have ever had. It lasted for a month. I lost my voice for a month after that. The cough was so violent, I came close to vomiting every day. I am better now, but still not 100%.

Then... I found out that the bordetella vaccine is a zoonotic live vaccine, meaning humans can get infected, too. Most people are not at risk, but as a long term chemo patient, I'm not most people. My immune system is less than half of normal. 

I got sick a few days after Francis was vaccinated. Correlation does not equal causation. However, the timing, the intensity of the infection, the coughing, and the exposure to the live vaccine, makes me wonder if a dog vaccine gave _ME_ kennel cough! Bordetella pneumonia in a person from dog vaccine | Worms & Germs Blog

I know one thing. I will ask my vet flat out, is this a live vaccine and is it zoonotic. If it's live and zoonotic, my dog is relying on herd immunity. Risking my health to prevent an illness my dog may never get makes no sense to me.


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## Girlnotboy (May 28, 2014)

ericwd9 (and others), thank you for reminding us of the reality of the pre-vaccination world. Yes, improved sanitation has helped eradicate some diseases, but there are dangerous infections easily acquired through airborne or aerosolization means for which vaccines have proven effective and should be used. Click-N-Treat, I would've thought live attenuated vaccines would be contraindicated in your situation anyway. As to the risk of zoonosis you described, I believe it for your situation. I like the blog you linked to.


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## Critterluvr (Jul 28, 2014)

N2Mischief said:


> I get the flu shot every year without fail. I have not had the flu in MANY year and never after a flu shot. My daughters both get the shot and have stayed well. My husband and my son on the other hand refuse to get the shot and both are sick every year.
> 
> I should add that it is very scary for people with weakened immune systems to be around people who refuse to get the vaccine.



I work with chemotherapy patients, HIV positive patients, transplant patients and many other immune compromised patients on a daily basis. Just because I do not receive the flu shot does not mean that I am putting these patients at risk. If it did mean that our company would absolutely make the flu vaccine mandatory to our staff. If I do get sick for whatever reason then I do not go to work...simple as that. I have not been sick in over 5 years.
As a matter of fact it is to the contrary......the staff members who have received the flu vaccine have ended up with a bad case of the flu and one had to take 2 weeks off of work because of it. This is why many of them have decided not to receive it anymore. Many of our patients have also gotten sick from it....


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## N2Mischief (Dec 3, 2012)

Wow, that is amazing that they could get the flu from a killed virus! 

My daughter is an R.N. and their flu shots are mandatory. 

I have Myasthenia Gravis, if I found out one of my health care workers had not gotten the vaccine, I would insist that they stay away from me. You can be contagious days before the symptoms appear....


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## Critterluvr (Jul 28, 2014)

N2Mischief said:


> Wow, that is amazing that they could get the flu from a killed virus!
> 
> My daughter is an R.N. and their flu shots are mandatory.
> 
> I have Myasthenia Gravis, if I found out one of my health care workers had not gotten the vaccine, I would insist that they stay away from me. You can be contagious days before the symptoms appear....


Any of your health care workers could be contagious and you not know it, flu vaccine or not. It's a gamble.
Having the vaccine does not mean you are guaranteed immunity from all that is out there.....there are many many different strains. 
I work for an extremely reputable medical company that is known for it's high accuracy and excellent quality control....believe me if it were an issue the vaccine would be mandatory.

The flu vaccine that is a nasal spray (and a common way of administering it) is actually a live virus (weakened) and can cause flu like symptoms.


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## N2Mischief (Dec 3, 2012)

No, it is not a guarantee, obviously. But it does improve my chances of not getting it. Getting the flu could make me VERY sick, if I go into crisis it could be fatal. I find it sad that someone who works with immune compromised patients would not want to improve the chance of not infecting others.


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## Critterluvr (Jul 28, 2014)

Not sure how it's sad.....but whatever. As I say I never get sick so I guess I'm doing something right, and will continue to believe what I believe. Been doing this 27 years, my patients come first, they know it, I know it, that's what counts.


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## nifty (Aug 2, 2013)

N2Mischief said:


> I should add that it is very scary for people with weakened immune systems to be around people who refuse to get the vaccine.


Yes. Personal experience with this. 

To answer the OP question - IMO Yes.

Yes for humans and yes for canines.


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## Carolinek (Apr 2, 2014)

In NY, health care facilities tried to make the flu shot mandatory for all health care workers. It didn't fly- the American Civil Liberties Union and labor unions fought it. Now, it is optional but anyone who declines has to wear a mask the entire time they are at work. Can I say I don't see people wearing masks? It was a pretty effective negative reinforcer! Is that truly a negative reinforcer- LOL- that's another post!

Kidding aside- I get the flu shot every year. I don't get the flu but still get sick sometimes. There are a lot of flu- like illnesses around that can make you feel pretty crappy- but they are not influenza. Nor do they carry the same mortality rate as influenza. That's the underlying issue- people die from flu every year.

Critterlvr- What do you think about questioning those people who say they had the flu to see if their provider actually did a nasal swab that tested positive for flu type A or B? Then you know they really had the flu, not just some random virus that made them feel really lousy so they thought it must be the flu!

When I did patient care, I worked in a bone marrow transplant unit- these folks were clearly some of the most immunocompromised patients in our system. I always figured I didint have the right to put them at risk- one minor infection can easily kill them. If I was sick, I stayed home, but never crossed my mind not to get a flu shot. To me, it goes against the ethics of the nursing profession.


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## lily cd re (Jul 23, 2012)

What Carolinek said! Plus, there are a number of different flu immunizations. The ones that are killed virus can't give you the flu. Attenuated live virus vaccines might, but do so rarely. As pointed out by Carolinek there are plenty of other winter season viral (and other illnesses) that can make you quite sick and will seem very much like the flu. In the absence of testing specifically for influenza virus one cannot say with any certainty that an illness is the flu. The bottom line about much of this is that science demands evidence, not anecdote and that coincidence is not the same as causality.


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## Poodlebeguiled (May 27, 2013)

Well, thanks guys for your stimulating discussion. There is sure a correlation that appears in the numbers. But I am still not 100% proof positive that those diseases like small pox weren't already in decline before the vaccine. And while they may set up an immune response, I believe they also can damage the immune system. I suspect many health problems we see are _caused_ by vaccines just like some too strong for us to fight off and vaccines may help. Maybe a double edged sword.


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## ericwd9 (Jun 13, 2014)

*A pox upon you!*

Are you trying to stir up the worms?
Smallpox is one particular disease that was completely eradicated by the means of vaccination. Lois Pasture pioneered this approach to prevention of disease. Before vaccine many thousands died each year from Smallpox. The pathogen is now only found in laboratories. There has been call for it to be destroyed, since now the population is largely not vaccinated for this virulent and often fatal disease. There are two schools of thought. One that if the cultures are lost then vaccine production in a new epidemic would be delayed too long without them. The other that if the "bug" gets out it will decimate populations again. Smallpox is the one particular disease, which if you were to suggest that means other than vaccination or natural immunity were to be the factors causing this disease to be eradicated, would have the most violent effect to the contrary in those involved in health issues. I do wish people would at least research their thoughts, if only on the web. Some diseases do lose their grip on humanity with time and mutation. The very suggestion that smallpox might have done this is absurd and makes me quite angry.:2in1:
Eric.


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## Poodlebeguiled (May 27, 2013)

The links here are very long but of course, I like to read a lot. As I've said, it _does _correlate and I'm sure they're of some use. But I see no absolute evidence that vaccines prevent all diseases they're meant to. They _probably_ do some help. Maybe they did wipe out diseases but where is the evidence that that's what caused the declines? Correlation is not causation. Where's the scientific method that was used? That I don't know. I haven't come across any. So I get why everyone flocks around vaccines, assuming they're wonderful... because the medical establishment, the government and big pharma says so. It's human nature to see a correlation and bam, conclusion! A decline happened around the time the vaccines came to be. But not in all cases. Some of those diseases began to decline before the vaccine was created. I get it about the immune system and how it works. And I'm sure they prevent full blown traits of the disease in an acute way. But there is the school of thought that some of the fall out we know about with vaccines is simply the disease presented in a more chronic way... the immune system diseases. And in many cases, those who get vaccinated don't seem to be protected. They get it anyhow. So all good? All bad? It's not abundantly clear to me yet. Would I rather have a disease that the vaccine was suppose to prevent or would I like to get chronic diseases that haunt me for a longer time. Some suspected issues, of course are things like skin problems, allergies, myasthenia gravis is suspected to be brought on by the flu shot. Addison's disease is suspect, as are many, many other health problems the immune system, if left undamaged might be able to take care of. I _question_ whether the damage they cause the immune system is worth it in _all_ cases. I _question._ I haven't concluded positively yet. If that makes me wrong or unpopular and you don't like my post, then perhaps read another thread that doesn't cause you such stress. 

Oh and by the way, I _do_ have a pox on me you'll be happy to know, as will those who applaud you...right on my larynx.

A couple snippets and the links below for anyone who might possibly be remotely interested in another _possibility_:



> In this article we present new evidence regarding smallpox in London, using age- and cause-specific data from the large parish of St Martin-in-the-Fields. This evidence is used to assess the extent of smallpox exposure in London's migration sphere, and to examine the causes of the apparent fall in smallpox mortality in the late eighteenth century, before vaccination.





> With respect to the impact of smallpox on death rates outside the metropolis, our analysis indicates, together with Razzell's evidence of a north–south divide, a geographically uneven pattern of smallpox epidemics and susceptibility in the period before 1775. After 1775 the disappearance of young adult smallpox victims suggests that the average age of smallpox infection probably fell everywhere, contributing to further declines in mortality of young adults and older children, but increasing the smallpox risk at the youngest ages. However, it is clear that inoculation was popular in many rural areas, and this may have been sufficient to counter any rise in smallpox infectiousness. Therefore a genuine reduction in smallpox risk may have occurred at all ages in rural populations that could not be detected in our London data. In this respect it is curious that the timing of declines in age-specific mortality rates from the Cambridge Group reconstitution sample shows little evidence of any impact of either inoculation or vaccination.93


The decline of adult smallpox in eighteenth-century London

The decline of adult smallpox in eighteenth-century London. - PubMed - NCBI


http://www.medicinekillsmillions.co...warn-dangers-of-vaccination-immunisation.html


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## ericwd9 (Jun 13, 2014)

There is no known difference between the effects of vaccines and the effects of exposure to the pathogen. The stimulation of the immune system is the same. The effects on the immune system are the same. It can be said that to vaccinate those who will not encounter the disease is counter productive to their health but in the end the herd effects are positive. However in the case of the vaccine few ill effects are evident. If you were exposed to small pox it is virtually certain that disease would result. Vaccination would show a much reduced and rarely fatal result. The disease itself would not be anything you might like and you might not survive. However if you did survive you would have the same or better immunity to smallpox. I don't think you would volunteer to try this out. Some vaccines (especially in the past) were egg and horse related since those animals were used to culture the disease and produce globulin's giving some immunity. Reactions to egg and horse serums have caused negative effects in a few. But overall it is certain that vaccines have prevented a lot of disease that were previously not preventable and possibly fatal. not to mention those who were rendered incapacitated for years in the past.
Eric.


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## Poodlebeguiled (May 27, 2013)

A New Look At Vaccines | ANHC Education Programs


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## fjm (Jun 4, 2010)

I am not sure that the ANHC can be considered a non-biased source, PB. I do get more than a bit concerned about the "Natural=good" versus "science=unnatural=bad" world view. As Eric says, vaccines and diseases stimulate the immune system; the purpose of immunisation is to stimulate it to produce antibodies to a disease without the danger of first having to contract the full blown disease. Where a disease is endemic many people will be exposed to it, and some will acquire immunity - some may even have a protection through their genetics - because many, many others did not survive it. Witness what happened when Europeans reached the Americas and spread new bugs. I am sure the virulence of infection waxes and wanes over time - different strains of flu have shown that - but I for one would not like to rely on hoping that my child would survive diptheria or polio! Or that my puppy would throw off parvo. Yes, vaccination carries a risk - anything that has an effect on the body carries a risk, which is why I am sceptical of any treatment that claims to be 100% risk free. But historical trends, challenge tests, and all the scientifically tested evidence points to the answer to your original question being a firm Yes. Other things have contributed to reduction of disease - clean water, better living conditions, etc, etc - but vaccination and immunisation remain a very significant factor.
WHO | Vaccination greatly reduces disease, disability, death and inequity worldwide
How vaccination saves lives - vaccinations - NHS Choices
https://www.sciencebasedmedicine.or...us-intellectual-dishonesty-at-its-most-naked/


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## Carolinek (Apr 2, 2014)

PBG- I confess that I did not read all 55 pages of the Pubmed article, but I did skim it. The authors raised some interesting points, with some data analyses. However, they also pointed out the limits of historical research. 

My concern is that this article has been cited by other authors who make the leap that small pox would have been eradicated without vaccination. I don't think that was the intent of this article; I think they wanted to point out that there are a multitude of factors that contribute to population health, and we need to understand all factors.

Disease prevention has to be a multi- pronged approach. We do like quick fixes- which is the appeal of the pharmaceutical industry. However, to prevent spreading the flu, not only do I need to get the vaccine, I also need to wash my hands, isolate infected patients, protect the immunocompromised, educate patients, families and health care workers etc, etc. The vaccine is an important link, but the other stuff has to be done as well. 

We do have much data from the 20th century identifying the importance of the small pox vaccine in worldwide eradication. This was a huge accomplishment. Polio is next on the list for eradication, and its disappearance from most of the world is due in large part to vaccination. However, you hear reports of the polio vaccine causing disease- and that is true. Recently, there have been a small amount of cases from the vaccine, but when you dig a little deeper, most of those cases were in countries who could not afford to give the killed vaccine and were using the cheaper live vaccine. This should not be used as a condemnation of the vaccine. We need to instead push for better funding to developing countries so they can buy the killed vaccine. 

I get very concerned when questionable data is used to inflame controversy about vaccines. It's always good to question. The written word does not equal truth, and we need to look at the validity of the claims. In the ANHC article, Neil Miller was used repeatedly as a source. Miller is not a scientist, he has an undergraduate degree in psychology and is a medical journalist. While he may be able present information well, I question why he would be used as a primary source for this topic. Where are the actual studies that support this argument? What is cited is pretty weak evidence in my opinion, and makes me very scared that someone would not vaccinate for terrible diseases based on this "evidence."


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## lily cd re (Jul 23, 2012)

What Eric, fjm and Carolinek have said here represents the best of what needs to be said. They have evidence from science that has been widely vetted by peer review. This is the tried and true methodology of evaluating scientific evidence. Anyone can put up any claims they want to on the internet and if they get cited enough times they become perceived as experts despite not having credentials, nor having produced any evidence on their own.

Small pox is widely regarded by medical historians and anthropologists as the worst disease known to mankind. Questioning the schedule for giving vaccines, being aware of your own immunological status and risks regarding certain immunizations and the like are reasonable when based on data. Questioning the overarching value of immunizations (along with things like hand hygiene, better food preparation and storage, etc.) in the establishment and maintenance of public health is just foolish and dangerous.


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## Carolinek (Apr 2, 2014)

Yes Catherine, I agree. There are terrible dangers to public health in the anti- vaccine propaganda. I think it's good this topic comes up as it is an opportunity to talk about what's real and what's not. Below is a link to a very sad case that illustrates the dangers of not giving the Hib vaccine. It's one thing to endanger your own life, but endangering those around you, or your own children, is truly a tragedy. 

Toddler died after parents 'treated his meningitis with maple syrup' | Metro News


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## lily cd re (Jul 23, 2012)

Carolinek I had a neighbor many years ago whose father was a chiropractor. Their children never had any immunizations. One winter when both the mom and one child had terrible strep infections there was no consideration to giving antibiotic treatment. The child could have developed rheumatic fever, or worse... It was months before either of them looked healthy. We have used chiropractic to advantage to deal with back problems like sciatica, but wouldn't forego a cardiologist if one of us had cardiac issues.

As the OP seems to insist here many infectious diseases started to decline before there were vaccines, but we all know that is because of advancements in medical practice, nursing practice and public health infrastructure such as clean drinking water alongside advancements in biomedical knowledge that allowed medical scientists like Pasteur (rabies and anthrax vaccines) and Jenner (smallpox) to develop the life saving vaccines associated with huge advances in public health. Also noteworthy is that small pox protection through immunization goes back hundreds of years in China.


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## fjm (Jun 4, 2010)

I think it should be noted that the decline prior to vaccination was in deaths, NOT incidence - death rates in general were declining at that period with improved sanitation, nursing and, eventually, antibiotics.


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## Poodlebeguiled (May 27, 2013)

Poodlebeguiled said:


> A New Look At Vaccines | ANHC Education Programs


I totally get what this guy is saying too. And not only he, but his references aren't quacks.

I vaccinated my children, my dogs and I just got a shingles vaccine a year ago. I'm not against vaccination. I just think people need to look at the whole thing and some of the dangers associated with it. It may save lives from immediate, over whelming diseases. But it also damages the immune system and creates major health problems. That article above explains that. Injecting those horrible adjuvants into the blood stream can't be good. The CDC always says things like they're perfectly safe. I don't trust the medical establishment anymore. How can injecting mercury and aluminum be safe? I don't believe everything these so called experts say. I think these things are directly related to cancers and other horrible immune system problems. Being exposed gently to diseases, if they don't kill you is different from being injected, directly into the blood stream poisonous chemicals and heavy metals. 

I have read about many potential cures for cancer and other diseases which have been suppressed by big pharma, the medical establishment and the government. I do not believe our best interests are always in their minds. It's all about business. So, when they say something is safe, I don't necessarily believe it. And that's all I have to say. That link above explains it better than I do. This really isn't that big of a thing to me. I vaccinated my dogs but I sure won't be repeating them in their short life spans. I am almost sure and titers will tell me for sure, that they've got immunity. I did my research and talked with a highly respected vet who doesn't see a need to vaccinate repeatedly through their lives.


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## lily cd re (Jul 23, 2012)

Carolinek said:


> Yes Catherine, I agree. There are terrible dangers to public health in the anti- vaccine propaganda. I think it's good this topic comes up as it is an opportunity to talk about what's real and what's not. Below is a link to a very sad case that illustrates the dangers of not giving the Hib vaccine. It's one thing to endanger your own life, but endangering those around you, or your own children, is truly a tragedy.
> 
> Toddler died after parents 'treated his meningitis with maple syrup' | Metro News



Adherence to pseudoscientific notions and anti-scientific dogma is not only stupid, but dangerous as the linked story reveals.


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## ericwd9 (Jun 13, 2014)

First: thank you to the OP for opening this discussion. All that applies to humans in this equally applies to our dogs and discussion is needed to weed out the differences in the two camps. Hopefully this will enable us to all make educated decisions based on the facts.

It is interesting to note that recent research into diseases of the brain have revealed lesions thought to be caused by the action of childhood infections. These lesions have been shown to be the cause of later cases of Epilepsy and Parkinson's Disease among others. It has been partly this fact that has changed the thinking concerning childhood infection and vaccination. Many once believed, with some good reason, that better immunity was afforded if a healthy child contracted the disease and recovered with the immunity that would provide. With the dangers of lasting harm proved to be caused by childhood disease, Vaccination is now the norm.
Eric


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## Carolinek (Apr 2, 2014)

PBG- we feel very differently about this, and that's OK. It is important to discuss this issue. Pritcairn has a lot of good stuff, and I own his book, but the linked commentary holds very credence in my book. There is some nice rhetoric, but not one research study to support his premise, and there is a notable lack of peer reviewed sources. Some nice anecdotal stories, and he may be on to something, but to change practice, I think we need evidence.

Contrast this to the work done by Schultz and Dodds- there's a world of difference! That's a reason to change practice. When I became aware of their research, it totally changed how I cared for my animals. It was something I could sink my teeth into and be confident that the decisions I made for my animals was grounded in evidence. 

And I worry about this anti-vaccine movement. Distrust in our health care system is unfortunately an understandable response to the mess we have on hand. However, let's not throw out the baby with the bath water. Catherine's analogy of the chiropractor and cardiologist is a good example. There's a place for many different approaches- each one strengthening the other.... But only if we do it right. 

I think none of us want to bring back hospital wards of kids in iron lungs- but that's a very real possibility if enough parents stop vaccinating. I do not think that image is alarmist- more cautionary, and hopefully will never happen. 

For now, parents who do not vaccinate have a false sense of security, as there is still enough herd immunity to protect their unvaccinated kids- but we see glimmers of that changing. There have been measles cases at colleges in my area and as I mentioned in another post, a friend and colleague of mine came down with pertussis (whooping cough) this winter. She cannot get the vaccine due to an allergy and was probably protected by herd immunity up until now. I suspect herd immunity is probably waning. 

I hope this thread is educational and not inflammatory. If people read it and take a step back to analyze their beliefs- than it has done its job:act-up:


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## lily cd re (Jul 23, 2012)

Carolinek we have also had pertussis on our campus, but so far no measles (we don't have dorms though). Immunity to those definitely wane by the time people reach their early 20s and efforts at adult re-immunization are important. The public health effort at getting adult _Bordatella_ immunization is clearly in full swing around me with lots of TV public service announcements.


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## Carolinek (Apr 2, 2014)

There's pretty much no initiative in my area to re- vaccinate adults for pertussis. Something we probably need to think about- particularly as we have had a case in our faculty. I wasn't aware that immunity wanes so early, and it is certainly not on the radar here. Learn something new every day! 

We do have dorms on campus and there has been much illness in the students this year, but nothing out of the ordinary has been been reported. Just a couple blocks up the street though, at another campus, there have been two cases of measles in recent years. 

Around 2000, it was thought measles was eradicated in the US- so much for that now.


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## lisasgirl (May 27, 2010)

There's been a campaign in my area to get adults who care for infants vaccinated for whooping cough, since it can be really devastating for young children. A boss of mine came down with it a year or two ago and she had to take quite a bit of time off work, but recovered just fine. But if she had had young children at home - or worse, if we were a daycare business or something - it could have been pretty scary.

As for vaccines generally, for both dogs and people, if the source of your distrust is the money-making aspects of health care, then I don't see why that would apply to well-established vaccines. Those are very much not moneymakers. In fact, they can cost quite a lot to produce and are increasingly offered for low or no cost. It's possible for a new vaccine that's still under patent to be lucrative, and that's also going to be the phase where long-term side effects are least understood. So I understand suspicion there. But it's important to remember that looking at something critically doesn't mean that you just dismiss everything.


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## N2Mischief (Dec 3, 2012)

When my grand daughter was born my daughter insisted if anyone wanted to cuddle, hold, take care of, feed, etc., they MUST have the TDAP vaccine at least 2 weeks before. We all did it willingly. Even my other daughter's boyfriend who has a needle phobia, got the vaccine. My son refused, and wasn't allowed near the baby.


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## Poodlebeguiled (May 27, 2013)

Well, this has been a stimulating and informative conversation. I think it's good to look at not only the good, but also the bad and the ugly side of vaccinations, which I know, some people don't acknowledge or believe...how they prevent some disease, yes it is a good thing. But also how some, IMO can have some pretty devastating side effects and long lasting immune system destruction, causing some of the immune type health problems we see today. Thanks all, for your input. :wink:


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## Girlnotboy (May 28, 2014)

There are definitely well-documented serious and long-lasting adverse vaccine reactions. (The same can be said for vaccine-preventable infections.) I think what people are saying is on whole, the benefits far outweigh the risks, but it may be different on a case-by-case basis. My poo is up-to-date on all her vaccines and has been boosted twice on schedule. I have asked about titering in lieu of boosting again, but I've gotten very quizzical looks and met some resistance.


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## ericwd9 (Jun 13, 2014)

*On-line vaccination info?*

The below is not available to non member, non professional people and is password protected. hence it will be presented here in full rather than a link.

*Comparing the Quality of Pro- and Anti-vaccination Online Information*

*A Content Analysis of Vaccination-Related Webpages*

Gabriele Sak; Nicola Diviani; Ahmed Allam; Peter J. Schulz
BMC Public Health. 2016;16(38) 
*Abstract *

*Background:* The exponential increase in health-related online platforms has made the Internet one of the main sources of health information globally. The quality of health contents disseminated on the Internet has been a central focus for many researchers. To date, however, few comparative content analyses of pro- and anti-vaccination websites have been conducted, and none of them compared the quality of information. The main objective of this study was therefore to bring new evidence on this aspect by comparing the quality of pro- and anti-vaccination online sources.
*Methods:* Based on past literature and health information quality evaluation initiatives, a 40-categories assessment tool (Online Vaccination Information Quality Codebook) was developed and used to code a sample of 1093 webpages retrieved via Google and two filtered versions of the same search engine. The categories investigated were grouped into four main quality dimensions: web-related design quality criteria (10 categories), health-specific design quality criteria (3 categories), health related content attributes (12 categories) and vaccination-specific content attributes (15 categories). Data analysis comprised frequency counts, cross tabulations, Pearson's chi-square, and other inferential indicators.
*Results:* The final sample included 514 webpages in favor of vaccination, 471 against, and 108 neutral. Generally, webpages holding a favorable view toward vaccination presented more quality indicators compared to both neutral and anti-vaccination pages. However, some notable exceptions to this rule were observed. In particular, no differences were found between pro- and anti-vaccination webpages as regards vaccination-specific content attributes.
*Conclusions:* Our analyses showed that the overall quality of pro-vaccination webpages is superior to anti-vaccination online sources. The developed coding scheme was proven to be a helpful and reliable tool to judge the quality of vaccination-related webpages. Based on the results, we advance recommendations for online health information providers as well as directions for future research in this field.
*Background*

According to the International Telecommunication Union,[1] currently almost 40 % of the global population (approximately 3 billion people) and 78 % of the developed world's population is online. Thanks to the Internet's persuasive force produced by the intersection of mass media and interpersonal communication elements, online health information seeking is becoming a recurrent activity of people's everyday life.[2–4] The majority of US internet users who have gone online to retrieve health information searched for health contents related to a particular disease or medical problem, and as a second most frequent "surfing activity" they looked for web sources describing a specific medical treatment or procedure.[4] The same portion of internet information seekers reported that their online health session started via a general search engine such as Google.[4] As Internet health consumers are now able to get access to multiple sources of health information without much effort, their level of knowledge and their social roles in the health domain might be affected. Depending on the quality of the information retrieved, the latter can impact people's attitudes toward a specific health topic and condition either beneficially or deleteriously.
The quality of health contents disseminated on the Internet has been a central focus for many researchers in the last decades. A systematic review showed that 70 % of 79 studies included found the general value of the information retrieved to be low, and another 20 % found it to be mediocre.[5] In response to criticism describing online health information as misleading, biased, highly technical, dated and fraudulent, different international and national bodies issued various codes of conduct in order to regulate and monitor the quality of health contents,[6,7] providing "a wide range of tools to assist site developers to produce quality sites and for consumers to assess the quality of sites" ([8] p. 598). Even though these protective initiatives often make use of rather similar quality criteria and set up similar ethical standards (e.g., disclosure of sources of information), their scope and application slightly differ.[9] These quality instruments can be grouped into five overarching types: "codes of conduct, quality labels, user guides, filters, and third party certification".[8] If, on the one hand, this emphasizes the growing need to assess the value of online health information, on the other hand it highlights the lack of consensus on the evaluation process that should be selected.[10] 
Past evidence showed that vaccination is among the topics most frequently searched online.[11] Previous content analyses have shown that search engines list approximately as much anti-vaccination as pro-vaccination content.[11–13] However, to date, no evidence exists on differences in quality among pro- and anti-vaccination web contents. If the information disclosed by anti-vaccination web sources is of poor quality, there is a risk that part of the online population is exposed to wrong and hazardous information. Since "consumers may lack the motivation and literacy skills to evaluate information quality of health webpages",[14] the anti-vaccination movement might contribute to increasing unjustified fears, an insufficient vaccination uptake (when it is not a compulsory procedure), and a reemergence of infectious diseases that had almost disappeared in the advanced countries of the world. As a matter of fact, monitoring and assessing the value of online vaccination information appears to be a fundamental step in enhancing the quality of web-based health contents, which might consequently enable individuals to make better health decisions and adopt healthier behaviors.
To date, few content analyses of online vaccination websites have been conducted. As they are often narrowly aimed towards single immunizations (e.g., specifically on HPV vaccination:[15–17]), and as all past assessments on the typology of online vaccination information found a growing amount of anti-vaccination content,[11,18–21] the current study intends to define and compare the quality attributes of pro- and anti-vaccination sources, and in doing so to include multiple types of immunizations.


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## ericwd9 (Jun 13, 2014)

*2*

*Source of Data (Webpages)*

In order to reach our aim, an adequate and comparable number of both pro- and anti-vaccination webpages was needed. Our objective was therefore not to get a representative sample of vaccination-related webpages, but to be able to systematically analyze a large and equal number of pro- and anti-vaccination online sources, to ultimately compare their quality. For this purpose, a pre-determined number of vaccination-related webpages (_N_ = 1394) was obtained from two research studies conducted at the Institute of Communication and Health (ICH) at the Università della Svizzera italiana (USI), based in Lugano, Switzerland.[22] These studies had the main objective to investigate user's knowledge and beliefs toward immunizations after having been exposed to vaccination-related content (i.e., 10 min online session). The independent category was exposure to different combinations of HONcode-certified websites of high quality and webpages with anti-vaccination content. Anti-vaccination sites were retrieved via a customization1 of the Google search engine, using keywords such as "vaccination and autism"; "vaccination side effects"; "anti-vaccination movement". In order to assure traceability of the data set obtained, and ultimately conduct further investigations, the researcher archived the URLs of all the webpages processed in the studies (_N_ = 1394). All webpages retrieved for these two studies (i.e., pilot study and experiment) formed the sample for the present content analysis. Webpages were accessed and reviewed between 15 October 2013 and 15 December 2013.
*Exclusion Criteria*

Webpages were excluded from analyses if they were duplicates (_N_ = 19), not written in English (_N_ = 0), not anymore available or retrievable (_N_ = 40), if they redirected to other web sources (e.g., index pages providing links to articles or news; _N_ = 100) or to a URL other than the one originally shown (_N_ = 5), if they did not or only marginally treat the topic of vaccination (_N_ = 28), had an insufficient amount text to evaluate (_N_ = 38), or were delivered via .pdf or similar formats (_N_ = 71). Pdf or similar formats were not considered for the present study due to their static nature. This amounted to 300 discarded webpages, which left 1093 webpages for analysis. The exclusion rate of 21.5 % was comparable to those of past studies of the field.[23–25] 
*Coding Instruments*

In light of the lack of content analyses focused on quality in the past, a new tool was developed specifically for the purpose of the present study. The tool consisted of three related coding instruments: 1) Online Vaccination Information Quality (OVIQ) codebook; 2) OVIQ code-sheet; and 3) OVIQ checklist. The checklist was designed to simplify raters' coding efforts by providing a clear and comprehensive graphical view of the entire set of quality indicators and relative values. However, especially in the initial phase of the webpage evaluation, it was highly important that coders understand properly the coding rules stated only in the codebook. The final version of the quality assessment instrument included 40 categories, mostly having a dichotomous value (i.e._, 0 = not available/not stated/not detected, and 1 = available/stated/detected_). The other categories either were of qualitative nature (e.g., _Ease of Use, Functioning of Links_) or again quantitative, but with a further degree of specification (e.g., _Type of Information, Bar Menu_).
*Information Quality Categories*

The information quality categories included in the coding scheme were derived from relevant literature pertaining to general health information quality and from research conducted on vaccination information.[3,5,7,10,12–14,19,21,23,26–48] Additionally, guidelines developed in the context of several online health information quality initiatives were retrieved through the support of the academic article written by Wilson,[8] and considered for the present investigation (The Health On the Net Foundation, HONcode);[49] URAC2; Netscoring3; eHealth Code of Ethics4; Web Medica Acreditata;[50] and Standford Persuasive Tech Lab[51]).
All relevant categories were segmented into _design_ and _content_ attributes. _Design quality attributes_ incorporated both criteria considered as fundamental when analyzing webpages in general, irrespective of their subject (i.e., _web-related design quality criteria,_ first 10 categories), and criteria that are more indicative of the quality status of online health resources (3 categories). _Content quality attributes_ were subsequently divided into health-related content attributes pertaining to general health information (12 categories), and vaccination-specific content attributes (15 categories). Figure 1 provides a visual representation of the systems and subsets of categories developed for this study.







*Figure 1.*
Systems and sub-sets of categories


After redundant categories were discarded, the final codebook included 40 categories as listed in (see Additional file 1: Table S1 http://static-content.springer.com/.../MediaObjects/12889_2016_2722_MOESM1_ESM.docx).
*Raters and Reliability*

Two coders carried out the coding process: the first author of the study (GS) and an undergraduate communication scholar familiar with content analysis and trained in applying the coding system (two training sessions of about 2 h each). In a pilot test phase both raters independently applied the codebook to 20 webpages randomly selected from the full sample. This phase was completed without any major glitches (except the need to better specify a few coding rules), and the majority of categories were considered as comprehensible and easily applicable for both raters. A formal reliability assessment phase was then conducted. As results were satisfactory, the undergraduate rater was employed to evaluate additional 150 vaccination-related webpages of the initial sample (_N_ = 1394).
The reliability index applied was Cohen's Kappa[52] because it is conservative and accounts for chance agreement,[53] and because all the relevant categories of the coding instrument had a nominal status. Implementing the recommendations provided by Lombard and colleagues,[53] the minimum acceptable level of agreement was set at .60.
For testing inter-coder reliability, 100 webpages were randomly selected from the initial sample of 1394 web-links.
As displayed in Additional file 1: Table S1, http://static-content.springer.com/.../MediaObjects/12889_2016_2722_MOESM1_ESM.docx almost all categories had moderate to perfect agreement levels. Among the quality attributes pertaining to the design macro section, the specific category _Ease of Use (navigability)_ had to be excluded from the computation of indices due to its low level of agreement (_k_ = .45). Also excluded were the target audience sub-option _caregivers_ (_k_ = .57) from the specific section health-related content attributes, and the category _risk of not getting vaccinated_ (_k_ = .33) from the vaccination-specific section. The entire coding instrument (OVIQC) had a high level of agreement (_k_ = .89).


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## ericwd9 (Jun 13, 2014)

*3*

*Data Processing and Analysis*

The independent category of this study was the _general tone_ of the webpage, which could be pro-vaccination, anti-vaccination, or neutral. General tone was measured as a global assessment of the website's position in the vaccination controversy. The major dependent category was the presence or absence of the different quality indicators. Categories created to highlight content features that are peculiar either to pro-vaccination online pages only or exclusively for the opposite anti-vaccination contents are not used for comparison purposes. For instance the category labeled as _how to get vaccination exemptions legally_ was clearly designed to evaluate contents opposed to the vaccination practice.
The following indices were computed:


Webpage Design Index was computed from three of the ten original Web-related design quality criteria, plus the three from the Health-specific design quality criteria, and ranged from 0 to 6.
Interactivity Index was computed from two of the ten original Web-related design quality criteria, and ranged from 0 to 6.
Health-Related Content Quality Index was computed from eleven of the twelve original Health-related content attributes, plus two from the original Web-related design quality criteria, and ranged from 0 to 13.
Vaccination-Specific Content Index was computed from five of the fifteen original Vaccination-specific content attributes, and ranged from 0 to 9.
 *shows the four different indices along with the categories that make them up. The four indices were summed up to form a Total Aggregated Quality Index, ranging from 0 to 34. Based on this index, webpages were classified as poor quality (<15 point), medium quality (15–22 points), and high quality (>22 points).*



*Table 1. Online vaccination information quality indices*

Webpage design Interactivity Health-related content Vaccination-specific content • Functioning of links (first 3)a 
• Bar menua 
• Ease of Use (navigability) ab 
• Search toolbar
• Images
• Videos
• Graphs/tables/diagramsa • Interactivity presence and requirementsa 
• Interactivity type
a) E-mail/newsletter
b) Chat rooms
c) Forum
d) Post comments
e) Other interactive services or tools (e.g., share on FB) • Presence of title
• Medical ownership
• Target audiencea 
• Date of creation
• Date of last update
• References of original contentsa 
• Contacts and feedback mechanisma 
• Accreditationsa 
• Advertising presencea 
• Complementarity statement
• Readability (Flesch-Kincaid Grade Level)a 
• Language/s
• Privacy Policy • Disease information
• Treatment information
• Benefits and risks of vaccination
a) Benefits of vaccination
b) Low risks of vaccination
c) Severe risks of vaccination
• Definition of terms or (Q&A)
• Links to other vaccination related websites
a) Links to pro-vaccination websites
b) Links to Anti-vaccination websites
c) Links to other online health information resources aQuality categories holding values that need to be recoded along with the dichotomous values _0 = not_ stated/not avaliable/not detected/poor; and 1 = stated/available/detected/valuable
bDiscarded category after inter-coder reliability tests

Data analysis included frequency counts, cross tabulations, Pearson's chi-square, and other inferential indicators.
*Results*

*Descriptive Analysis*

*General tone of the webpage.* Of the final sample of 1093 webpages, 514 were pro-vaccination (47 %), 471 were anti-vaccination (43 %), and the residual 108 were neutral or with an undefined tone toward the vaccination practice (10 %). The majority of anti-vaccination pages had radical and opposing viewpoints towards vaccinations (_N_ = 430), whereas a minor part adopted a more moderate view on specific immunizations (_anti-vaccination: reformist_ 5; _N_ = 41). Due to the small number of moderate sites, the two anti-vaccination categories were collapsed in the comparative analysis. It has to be noted that the more or less even split between pro- and anti-vaccination webpages is a consequence of our sampling strategy and is functional at easing the comparison of the two subsets for the present analysis, but should not be taken as an indication about the prevalence of pro- and anti-vaccination views on the web.
*Non-quality Attributes of Pro- and Anti-vaccination Online Information.* Pro-vaccination webpages were mainly holding the following Domain Name Systems: .gov (46.7 %), .com (27.6 %), and .org (13.4 %). Strictly linked to this previous finding, half of the webpages were owned by governmental, public, and international institutions (54.1 %), followed by commercial (22.2 %), and not-for-profit organizations (13.4 %). On the other hand, anti-vaccination web sources were mainly published via the following DNSs: .com (48.8 %), .org (33.1 %), and .to (12.3 %). Slightly more than half of the anti-vaccination pages were owned by not-for-profit organizations (56.3 %), and by private individuals (14.4 %). For a consistent portion of anti-vaccination web sources the ownership type of the website was not mentioned clearly (21.7 %). Almost all the pro-vaccination webpages were inserted into general health information web portals (94 %), followed by general vaccine information websites (5.3 %), and the remaining 3 webpages were promoted via specific vaccine websites (0.6 %). Anti-vaccination webpages were mainly published either via general vaccine information websites (47.6 %) or into general health information web portals (49.7 %), and, for the remaining 13 webpages; the raters were not able to detect the scope of the websites that were including them.
For both subsets of the sample, the majority of the contents published were intended for lay people (patients or informal caregivers; 83.9 % of pro- vs. 98.9 of anti-vaccination webpages). However, roughly 30 % of the pro-vaccination pages delivered contents for healthcare professionals (29.2 %), whereas only 6 anti-vaccination pages delivered contents for this audience (1.6 %).
Approximately, 77 % of pro- and 80 % of anti-vaccination web sources offered information about more than a single injection. Barely 7 % of the pages in favor of vaccination provided contents about alternative or natural medicine (or treatments). On the other hand, slightly less than one fourth of the anti-vaccination webpages published those specific contents (23.6 %; less frequent than[19,41]). Just about 15 % of pro- and only 5 % of anti-vaccination web sources exposed the target audience's Vaccination Recommendation Schedule (VRS). Out of the 514 webpages being in favor to vaccines, as expected, only three explained to users how to get vaccination exemptions legally (0.6 %). This information was present on slightly less than one-fifth of the anti-vaccination webpages (18.4 %; lower frequency than[19,41]). Around 14 % of pro-vaccination pages advanced the theme of parents' rights and amplified responsibilities, especially when they decide not to get vaccinated their children. On the contrary, 37 % of anti-vaccination sources claimed the fact that parents' (or patients') rights are violated due to the strict health policies emanated by government bodies with public health executives (less frequent than[19,41]). 43 % of the web sources opposed to the vaccination practice (lower frequency than[41]), and only 4 % of pro-vaccination pages advanced the fact that potential conflict of interests between health professionals (e.g., physicians) and the pharmaceutical industry might be present. Both pro- and anti-vaccination webpages frequently provided contents about other immunization-related topics (e.g., vaccination information for travelers, health policy change; 56.2 % vs. 58.2 % respectively). The frequency scores for all evaluated attributes fulfilled by pro- and anti-vaccination webpages can be consulted in (see Additional file 2: Table S3 http://static-content.springer.com/.../MediaObjects/12889_2016_2722_MOESM2_ESM.docx).


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## ericwd9 (Jun 13, 2014)

*4*

*Comparative Analysis: The Quality of pro- vs. Anti-vaccination Pages*

*Webpage Design Index.* Webpages holding a favorable view of the vaccination practice showed on average more webpage design features compared to the opponent and neutral vaccination-related sources. There was a statistically significant difference (_p_ < .01) when comparing the scores on the aggregated Webpage Design Index of the three groups based on the webpage's _general tone_ [F(2.1090) = 15.35, _p_ < 0.001]. Post hoc comparison using the Tukey HSD test showed that the mean Webpage Design Index score for pro-vaccination webpages (M = 3.65, SD = 0.87) was significantly higher than both the anti-vaccination pages (M = 3.27, SD = 1.36, _p_ < 0.001), and the neutral (or undefined) set of webpages (M = 3.29, SD = 1.09, _p_ = 0.007).
In more detail, pro-vaccination webpages offered better _functioning links_ (_p_ = 0.01)_,_ more often a _bar menu_ (_p_ < 0.001), or a _search toolbar_ (_p_ < 0.001). Indeed, 13 out of 15 webpages coded as having from medium to poor quality of links had an anti-vaccination tone. Roughly, one quarter of all the anti-vaccination and neutral webpages did not provide the menu bar feature, and 40 % of the total anti-vaccination subset did not have a user-friendly search toolbar (i.e., 19 % of the neutral webpages neither had this design feature). Images were present on about 60 % of both pro- and anti-vaccination online sources. Many pro- and anti-vaccination pages exposed pictures of people (42 % vs. 35 % respectively), followed by other kind of visuals (e.g., books; 28 % vs. 31.6 % respectively), and about one-fifth of both subsets showed images of drugs and medical equipment (18.7 % vs. 20.6 % respectively). Only about 12 % of pro- and around 8 % of anti-vaccination web sources provided information-supporting formats, such as graphs, tables or diagrams. Remarkably, the anti-vaccination subset provided more video formats than anti-vaccination webpages (27.6 % vs. 10.3 % respectively).
_Videos_, however, can be found most often on anti-vaccination webpages, _p_ < 0.001. Almost 28 % of the webpages opposing vaccination included a video format, while only 10 % of pro-vaccination webpages incorporated video formats.
*Interactivity Index.* Websites holding a favorable or neutral view toward the vaccination practice provide more interactive services and tools compared to the opponent sources. A statistically significant difference (_p_ < .05) was observed when comparing the three groups based on the webpage's _general tone_ on the aggregated Interactivity Index [F(2.1090) = 4.43, _p_ = 0.01]. Post hoc comparison using the Tukey HSD test showed that the mean Interactivity Index score for both pro-vaccination webpages (M = 3.71, SD = 0.96, _p_ = 0.047), and the neutral (or undefined) subset (M = 3.86, SD = 1.74, _p_ = 0.040) was significantly higher than the webpages which were against the vaccination practice (M = 3.49, SD = 1.70). None of the webpages evaluated fulfilled all the 6 categories grouped in this specific index. More specifically, 15 % of the anti-vaccination webpages did not provide any of the _interactive tools or services_ coded for the present study while only 3 % of the pro-vaccination subset did not have interactivity, _p_ < 0.001. _E-mail or newsletter_ services were lacking in 17 % of the anti-vaccination webpages, and on 16 % of the neutral ones: _p_ < 0.001. Interestingly, almost one quarter of the neutral web sources reviewed included _forum_ interactions, whereas both anti- and pro-vaccination pages offered forums in only 6.6 and 4.7 % of the cases, respectively (_p_ < 0.001). A chance to _post comments,_ however, was more often offered on neutral (37 %) and anti-vaccination sites (31.8 %) than on the webpages of the pro-vaccination subset (11,5 %) (_p_ < 0.001).
*Health Related Content Index.* Webpages holding a favorable view of the vaccination practice endorse more health information quality principles compared to the opponent and neutral vaccination-related online sources. The three groups based on the webpage's _general tone_ presented significant differences (_p_ < .01) on the aggregated Health Related Content Index mean score [F(2.1090) = 244.21, _p_ < 0.001]. Post hoc comparison using the Tukey HSD test showed that the mean Health Related Content Index score for pro-vaccination webpages (M = 8.00, SD = 1.78) was significantly higher than both the neutral (or undefined) set of webpages (M = 6.32, SD = 1.77, _p_ < 0.001), and the anti-vaccination links (M = 5.62, SD = 1.60, _p_ < 0.001). Here the maximum score was obtained by the following pro-vaccination webpage: Polio Vaccine, which fulfilled all the 13 content quality attributes included in the Health Related Content Index.
The specific categories which played an important role generating this significant effect were: _medical ownership6 _–80 % of the pro-vaccination webpages were affiliated with a medical organization, compared to only 5.7 % of anti-vaccination pages, and 30 % of the neutral subset – (_p_ < 0.001); _target audience_ – one quarter of all the pro-vaccination webpages explicitly stated their intended target audience compared to only 9 % of the anti-vaccination, and 11 % of the neutral subset – (_p_ < 0.001); _date of last update_ –available on half of the pro-vaccination subset, compared to only 12 % of the anti-vaccination and 13 % of the neutral webpages – (_p_ < 0.001); _accreditations_ – 100 out of 109 accredited webpages evaluated had a favorable view toward the vaccination practice – (_p_ < 0.001); _advertising presence_ – out of the total number of 114 webpages displaying unclear distinction between core contents and advertising, 107 were anti-vaccination – (_p_ < 0.001); _privacy policy_ – roughly 90 % of the pro-vaccination webpages properly stated the relative policies about the treatment of confidential data submitted by end-users, compared to only 60 and 77 % reported by the anti-vaccination and the neutral (or undefined) sets of the sample, respectively – (_p_ < 0.001); and _complementarity statement_ – available on 80 % of the pro-vaccination subset compared to only 56 % of the anti-vaccination, and 40 % of the neutral webpages – (_p_ < 0.001). The exception is the _date of creation_, which was indicated more often on both neutral (or undefined) and anti-vaccination webpages (60, and 45 %, respectively) than on the pro-vaccination subset (32 %), (_p_ < 0.001). Scientific references of the original contents disclosed were lacking on around 38 % of the pro- and on almost half of the anti-vaccination pages (49 %). Only 27 pro-vaccination pages did not offer contacts information about the owners of the website (5.3 %), while this information was lacking on roughly 17 % of the anti-vaccination subset, resulting impossible for users to contact the responsible person. Only 2 % of pro- and around 3 % of anti-vaccination web sources delivered 'easy-to-read' contents (i.e., readability score below or equal the 6th grade levels). One-fifth of both pro- and anti-vaccination webpages showed medium levels of readability (19.1 % vs. 21 % respectively). Indeed the current study showed that the majority of the pages promoted vaccine-related contents that were proved to be difficult to read (i.e., readability score equal or above the 10th grade levels; 79.2 % of pro- vs. 76.2 % of anti-vaccination sources). The provision of another language other than English was adopted by nearly 46 % of pro- and 38 % of anti-vaccination webpages.
Only 180 webpages were judged to target _healthcare professionals_. The majority of them (83.3 %) held a favorable general tone toward immunizations. Neutral (or undefined) and anti-vaccination web sources accounted for 13.3 and 3.4 % of webpages targeted to healthcare professionals respectively. Figure 2 provides a visual representation of the mean Health-Related Content index scores obtained by the three different subsets of the sample.


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## ericwd9 (Jun 13, 2014)

*5*

*subsets of the sample.







Figure 2.
Average health-related content index scores obtained by the three different sub-sets of the sample


Vaccination-specific Content Index. Web sites holding a favorable view toward the vaccination practice provide more vaccination-specific information themes compared to the neutral vaccination-related online sources. The anti-vaccination subset, however, has proved to include vaccination-specific information and services features as much as the other two subsets without significant differences. Comparing the scores on the aggregated Vaccination Specific Content Index of the three groups based on the webpage's general tone, a statistically significant difference (p < .05) was observed [F(2.1090) = 3.59, p = 0.028]. Post hoc comparison using the Tukey HSD test showed that the mean Vaccination Specific Content Index score for pro-vaccination webpages (M = 5.95, SD = 2.06, p = 0.02) was significantly higher than the webpages that were neutral (or undefined) toward the vaccination practice (M = 5.37, SD = 2.60). Remarkably, the maximum score achievable and reported of fulfilling all the 9 vaccination-specific categories was attained by the anti-vaccination subset of webpages (e.g., Prison Planet.com » Myth busted: Vaccinations are not immunizations). In detail, neutral webpages conveyed less disease information (40 %) than both pro- and anti-vaccination subsets (58 and 52 %, respectively), p = 0.001. Treatment information was delivered more by the pro-vaccination subset (83 %), compared to both anti-vaccination and neutral (or undefined) webpages (64 and 63 %, respectively), p < 0.001. Benefits, and risks of vaccination were present in both pro-, and anti-vaccination webpages (79 and 83 %, respectively), but not as much for the subset being neutral (or undefined) in regard to vaccination (56 %), p < 0.001. As expected, benefits of vaccination were persistently treated by pro-vaccination webpages (75.3 % of the total sample's subset). About 30 % of neutral, and 10 % of anti-vaccination webpages delivered the benefits derived by immunizations, p < 0.001. Conversely, severe risks of vaccination were insistently promoted by anti-vaccination webpages (78 % of the total subset of the sample), followed by the neutral (or undefined) subset (50 %). One fifth of pro-vaccination webpages advanced the sub-topic (or theme) of the serious complications potentially caused by several immunizations, p < 0.001. The provision of terms' definitions and Q&A formats was significantly less frequent in anti-vaccination webpages (only 16 %), as compared to both pro-vaccination (29 %) and neutral subsets (35 %), p < 0.001. The inclusion of external links to other vaccination-related web sources was, as estimated, a central component for all the subsets of webpages investigated (around 85 % to 90 % each subset). In particular, a positive relationship was observed between a favorable tone toward the vaccination practice and the provision of external links to other pro-vaccination sources (77 %), p < 0.001. About half of neutral (or undefined), and one quarter of anti-vaccination webpages reviewed were externally linked with further pro-vaccination websites. On the other hand, external links to supplementary anti-vaccination websites were positively correlated with the negative tone of the webpage (83 %), p < 0.001. About 60 % of neutral (or undefined), and only 4 % of pro-vaccination webpages offered links to external anti-vaccination websites.
Total Aggregated Quality Index. Webpages holding a positive tone toward the vaccination practice fulfilled consistently more quality criteria included in the present content analysis when compared to the opponent and neutral vaccination related online sources. It has however to be noted that none of the three different subsets obtained average scores falling into the high quality range (>22 points). The analysis revealed significant differences (p < .01) when comparing the scores on the Total Aggregated Quality Index of the three groups based on the webpage's general tone [F(2.1090) = 66.49, p < 0.001]. Post hoc comparison using the Tukey HSD test showed that the mean Total Aggregated Quality Index score for pro-vaccination webpages (M = 21.31, SD = 3.64) was significantly higher than both the anti-vaccination links (M = 18.25, SD = 4.57, p < 0.001), and the neutral (or undefined) set of webpages (M = 18.84, SD = 5.30, p < 0.001). By taking a deeper look at these findings, it has to be observed that none of the webpages included in the final sample of the present study comprehensively fulfilled all the 34 information quality categories coded. The maximum score reported was 31 categories fulfilled by the following pro-vaccination webpage: Childhood vaccinations/.
Figure 3 offers a graphical representation of the mean Total Aggregated Quality Index scores acquired by the three subsets of webpages.







Figure 3.
Average total aggregated quality index scores obtained by the three sub sets of webpages*



*Discussion*

The main aim of this study was to compare the quality of pro- and anti-vaccination webpages. Our analyses highlighted significant differences between pro-vaccination, anti-vaccination, and neutral (or undefined) webpages along all four quality dimensions: webpage design, interactivity, health-related content, and vaccination-specific content. Generally speaking, pro-vaccination webpages resulted to be qualitatively superior to both anti-vaccination and neutral (or undefined) web sources (Total Aggregated Quality Index). However, on some quality features, neutral and/or anti-vaccination webpages showed better results than the pro-vaccination subset.
According to our analyses, higher quality of pro-vaccination websites might be explained by higher professionalism of their owners, who were more often internationally recognized medical institutions (e.g., WHO, CDC), while anti-vaccination websites were often operated by activists of the anti-vaccination movement, that is private citizens expressing their personal views on the topic. This difference makes it likely that anti-vaccination websites are less often designed professionally and may have difficulties to keep up to date with regard to quality standards. However, it has to be noted that various counterexamples were observed with regard to the quality levels of some anti-vaccination webpages. Eighty-seven anti-vaccination webpages reviewed obtained high quality scores, satisfying between 23 and 29 of the quality attributes. For instance, the following anti-vaccination webpage: Many Parents Are Now Aware of Dangerous Vaccine Side Effects obtained a total aggregated quality score of 29 attributes out of 34. The website is administered by a well-known American doctor and activist (Dr. Joseph Mercola), and it promotes a wide range of health information such as wellness, dietary, and vaccines. The website has been ranked by Alexa.com the 'World's first Natural Health Website'. A further well-known counterexample is represented by the National Vaccine Information Center (NVIC), which is a non-profit organization advocating mainly vaccine safety (National Vaccine Information Center - Your Health. Your Family. Your Choice.).


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## ericwd9 (Jun 13, 2014)

*6*

Past research[39] has claimed that the most reliable domain name systems to retrieve quality health information might be the following three: .gov, .org, and .edu. However, given that the .org domain was also frequently the DNS of anti-vaccination web sources in our sample, we suggest that in the context of online vaccination information this should be limited only to the .gov and .edu domain options. In light of this, international and national bodies monitoring online vaccination information have to stress the positive relationship between governmental institutions (i.e., holding the .gov domain) and the provision of quality contents related to vaccination. For end-users, the identification of the DNS might be a simple and quick way to infer the credibility of a webpage disclosing information on immunizations (governmental or public affiliation).
With respect to aspects relating to webpage design, pro-vaccination web information was disclosed through well-organized web portals with highly operative internal links (i.e., increasing application of menu bars, and search toolbars), and, as a matter of fact, have to be considered aesthetically more pleasant to navigate than anti-vaccination webpages (i.e., lack of distracting promotional messages). Remarkably, the adoption of "two-way communication" formats resulted to be high (90.6 % of the final sample), and on average webpages being pro-vaccination satisfied this aspect better than the opponent subset. This finding may highlight the difficulties of web editors administering anti-vaccination webpages in designing modern and dynamic online platforms, which force end-users to consume contents only in a static traditional fashion.
The most notable exception to the quality gap between pro- and anti-vaccination websites occurred for the vaccination-specific information section. In this dimension, pro- and anti-vaccination websites were found to be equally informative. But does this mean the information on anti-vaccination websites is as good as on pro-vaccination-sites? Not necessarily so. The indicators employed in this study used the presence of information as criterion, not its relevance, not its substance, not its truthfulness. These are the ultimate quality criteria, nevertheless they are very difficult to measure and next to impossible to assess on a large-scale quantitative basis. This is why our study and its forebears use proxies and shortcuts aiming at the presence of information. We have to keep in mind that what is present need not necessarily be helpful or truthful.
Consistently with previous research on health information quality (e.g.,[7,14,23]), the findings of the present study confirmed the average quality level of pro- and anti-vaccination information available online. This result could be taken as an indication that not much progress was made with regard to the quality of health related websites since the earlier studies were fielded. Moreover, according to the readability assessment tool applied (Flesch-Kincaid Grade Level), the majority of webpages reviewed were written in a demanding manner. Indeed, webpages' readability levels were higher than the average American reading level, which is set between 7th and 9th grade (see:[36]). This latter negative result, which is coherent with past research evaluating online health information (e.g.,[7,45]), emphasizes the potential shortcomings of the Web as a complementary source of health information, and especially as a medium to retrieve and exchange vaccination-related information. As advanced by Fagerlin, Wang and Ubel,[54] given the complex nature of health information, websites promoting vaccination have to carefully design their messages in a way that are in line not only with the target audience's needs and "prior knowledge but also with their capacity to process the information, such as numeracy and health literacy, as well as their preferences for how information is presented" (as cited in,[12] p. 3731).
*Implications for Online Health Information Providers*

The findings of this study, based on a large sample size (_N_ =1'093), allow us to draw several conclusions that can be translated into advice to online health information providers on how to make vaccination-related webpages more accurate, complete, attractive, and easy-to-navigate.
First, it is evident that to be supportive, complementary, and beneficial for everyone, health information available on the Internet has to be written below the average reading level (between 7th and 9th grade level) (e.g.,[7,36]). The increasing availability of online readability assessment tools (e.g., http://www.readability-score.com/) opens the door to web editors to easily implement this first and relevant suggestion. Another way to assure understandability of the information provided might be the adoption of "Question and Answer" (or FAQ) formats.
Second, given that the frequency of inclusion of pictures related to vaccination preventable diseases' (VPDs) effects resulted to be low, future educational vaccination-related web sources, in order to stress the perceived severity of VPDs, might include more often visual representations. Another feature, which is now missing across webpages, and most likely represents a useful aid to consumers seeking online vaccination information, is the target audience's "vaccination recommendation schedule". Additionally, the large number of videos available on anti-vaccination websites might be balanced by pro-vaccination pages providing more visual recordings that enable users to understand in a vivid manner the positive effects of vaccinations, and the risk derived by contracting a vaccine-preventable disease (e.g., showing, in form of narrative, a sad mother which lost her son due to a VPD).[12] Moreover, in order to facilitate understandability of the contents provided, the application of videos/animations is especially suited for low health literate individuals.[55] Third, the so-called "_post comment_ on this page" feature is still missing on a large portion of webpages being in favor to immunizations. This type of interactive service has the potential to increase users' involvement, and, consequently, the relative effect of messages on them[56,57] as well as attention, knowledge, perception of being socially supported, and ultimately positive health outcomes.[58,59] 
Fourth, since secondary ethnic groups are present in many English-speaking countries, vaccination web sources might offer the selection of a further language (e.g., Spanish).
*Limitations and Further Research*

The present study has some limitations. First, as the nature of Internet information is purely dynamic (updating processes), the currency of the results gained from this content analysis may have been already challenged. Secondly, while some of the webpages were retrieved with the original Google search engine, the rest of them were obtained through two manipulated versions of the same engine. In particular, one engine was filtered (with a set of predefined keywords) to only search for vaccination-related links holding a negative tone, and the other to yield only pages from reputable sources (mixes of HONcode certified sites). Thus, some of the webpages reviewed might not have been retrieved by typical online end-users. However, the applied keyword strategy considered a set of numerous terms, which could have been easily used by consumers on a normal online information seeking session. The initial sample represented also another constraint for the results of the current study. Pro-vaccination webpages were obtained through the application of a filter manipulating the original Google search engine to yield sources of online health information certified by the Health On the Net Foundation (HON) and other highly credible online sources. This aspect has directly influenced our descriptive, and with minor impact, our comparative findings that have to be interpreted with caution_._ Last, it has to be noted that the final sample of 1093 web links included various webpages owned by the same website (e.g., www.cdc.gov webpages were around 100).
The findings of the present study can be extended to future comparative analyses in other fields7. In fact other qualitative categories apart from the core one ("_general tone"_ of the webpage) can be employed in the same way as the principal construct. For instance, mean scores of the four aggregated indices can be calculated, among others, for the category labeled as "_scope of information of the website_", or again for the "_domain name system_" (DNS) construct.
Our content analysis did not code the specific type of vaccination (e.g., HPV) or related disease (e.g., mumps) presented by the different webpages reviewed. We recommend future studies evaluating vaccination-related web sources to include this data to ultimately conduct more sophisticated comparative analyses. Future studies are also necessary to build solid findings that both test the instrument's usability, and reconfirm the strong inter-rater agreement (_k_ = .89) attributed to the present assessment tool.


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## ericwd9 (Jun 13, 2014)

*7*

Conclusions
*An evaluating instrument has been designed for assessing the quality of vaccination webpages. Pro-vaccination webpages on average yielded better results than the anti-vaccination subset in term of design *

, interactivity, and health information quality, but not on the specific degree of inclusion of common and relevant vaccination themes. This content analysis alarmingly showed that reading levels of online vaccination information are moderately high, thus disrespecting the recommended viable levels emanated by numerous public health organizations. This negative and significant trend confirms, perhaps, one of the most evident shortcomings attributed to the "hyperlinked" World Wide Web when accessing health information.
*Endnotes*

1"The customization of the search engines was done by limiting their search coverage to different pre-defined sets of websites […]. This manipulation was realized by configuring the context and annotation files of Google custom search engine".[22] Google custom search engine is available at: https://developers.google.com/custom-search/ 
2American Accreditation HealthCare Commission: https://www.urac.org/ 
3NetScoring quality criteria: NetScoring: criteria to assess the quality of Health Internet information </FONT> 
4Internet Healthcare Coalition: eHealth Code of Ethics 
5As explained by Hobson-West,[43] the anti-vaccination group labeled as reformist is composed by those people "who are critical of vaccines but likely to provide at least partial support to vaccination".
6For the current study the category _medical ownership_ was specifically designed to depict if on the page evaluated the name of a doctor or a medical corporation was present. However, it has to be noted that no disctinctions were made in case the webpage was affiliated with a single medical doctor or an internationally well-known health institution.
7The developed evaluating tool (OVIQC) can be obtained by e-mail at the following address ([email protected]).
*References*

1. International Telecommunication Union (ITU). Measuring the Information Society: Report 2014 Highlights. 2014. http://www.itu.int/en/newsroom/Documents/MIS-2014-Highlights.pdf. Accessed 05 Feb 2015.
2. Hesse B, Nelson D, Kreps G, Croyle R, Arora N, Rimer B, et al. Trust and sources of health information. Arch Intern Med. 2005;165(22):2618–24.
3. Lustria MLA. Can interactivity make a difference? Effects of interactivity on the comprehension of and attitudes toward online health content. J Am Soc Inf Sci Technol. 2007;58(6):766–76.
4. Fox S, Duggan M. Health online 2013. Information Triage. (Pew Internet and American Life Project Report). 2013. Information Triage | Pew Research Center. Accessed 11 Apr 2015.
5. Eysenbach G, Powell J, Kuss O, Sa E. Empirical studies assessing the quality of health information for consumers on the World Wide Web. J Am Med Assoc. 2002;287(20):2691–700.
6. Risk A, Dzenowagis J. Review of internet health information quality initiatives. J Med Internet Resources. 2001;3:4:e28.
7. Berland GK, Elliott MN, Morales LM, Algazy JI, Kravitz RL, Broder MS, et al. Health information on the Internet: accessibility, quality, and readability in English and Spanish. J Am Med Assoc. 2001;285:2612–21.
8. Wilson P. How to find the good and avoid the bad or ugly: a short guide to tools for rating quality of health information on the Internet. Br Med J. 2002;324(7337):598–602.
9. Lopes CT, Ribeiro C. Data Certification Impact on Health Information Retrieval. In: Holziger A, Simonic KM, editors. Information Quality in E-Health: 7th Conference of the Workgroup Human-Computer Interaction and Usability Engineering of the Austrian Computer Society, USAB 2011, Proceedings. Graz, Austria: Springer; 2011.
10. Barnes C, Harvey R, Wilde A, Hadzi-Pavlovic D, Wilhelm K, Mitchell PB. Review of the quality of information on bipolar disorder on the Internet. Aust N Z J Psychiatry. 2009;43:934–45.
11. Betsch C, Brewer NT, Brocard P, Davies P, Gaissmaier W, Haase N, et al. Opportunities and challenges of Web 2.0 for vaccination decisions. Vaccine. 2012;30(25):3727–33.
12. Davies P, Chapman S, Leask J. Antivaccination activists on the world wide web. Arch Dis Child. 2002;87(1):22–5.
13. Jones AM, Omer SB, Bednarczyk RA, Halsey NA, Moulton LH, Salmon DA. Parents' source of vaccine information and impact on vaccine attitudes, beliefs, and nonmedical exemptions. Advances Prev Med. 2012;2012:1–8. doi: 10.1155/2012/932741.
14. Stvilia B, Mon L, Yi YJ. A model for online consumer health information quality. J Am Med Assoc. 2009;60(9):1781–91.
15. Habel MA, Liddon N, Stryker JE. The HPV Vaccine: A content Analysis of Online News Stories. J Women's Health. 2009;18(3):401–7.
16. Goff SL, Mazor KM, Gagne SJ, Corey KC, Blake DR. Vaccine counseling: a content analysis of patient-physician discussions regarding the human papilloma virus vaccine. Vaccine. 2011;29(43):7343–9.
17. Madden K, Nan X, Briones R, Waks L. Sorting through search results: a content analysis of HPV vaccine information online. Vaccine. 2012;30(25):3741–6.
18. Bean SJ. Emerging and continuing trends in vaccine opposition website content. Vaccine. 2011;29(10):1874–80.
19. Wolfe RM, Sharp LK, Lipsky MS. Content and design attributes of antivaccination web sites. J Am Med Assoc. 2002;287(24):3245–8.
20. Wolfe RM, Sharp LK. Vaccination or immunization? The impact of search terms on the Internet. J Health Commun. 2005;10(6):537–51.
21. Kata A. Anti-vaccine activists, Web 2.0, and the postmodern paradigm – an overview of tactics and tropes used online by the anti-vaccination movement. Vaccine. 2012;30(25):3778–89.
22. Allam A, Schulz PJ, Nakamoto K. The impact of search engine selection and sorting criteria on vaccination beliefs and attitudes: two experiments manipulating Google output. J Med Internet Resources. 2014;16:4:e100. doi:10.2196/jmir.2642.
23. Guardiola-Wanden-Berghe R, Gil-Peréz JD, Sanz-Velero J, Wanden-Berhge C. Evaluating the quality of websites relating to diet and eating disorder. Health Inf Libr J. 2011;28:294–301.
24. Martın Martınéz B. Valoracion de la calidad de las paginas Web en gastroenterologıa, hepatologıa y nutricion infantil [Doctoral Thesis]. Barcelona: University of Barcelona, Faculty of Medicine; 2007.
25. Dellavalle RP, Hester EJ, Heilig LF, Drake AL, Kuntzman JW, Graber M, et al. Information science. Going, going, gone: lost Internet references. Science. 2003;302:787–8.
26. Wang RY, Strong DM. Beyond accuracy: what data quality means to data consumers. J Manag Inf Syst. 1996;12(4):5–34.
27. Jadad AR, Gagliardi A. Rating health information on the Internet: navigating to knowledge or to Babel? J Am Med Assoc. 1998;279(8):611–4.
28. Alexander JE, Tate MA. Web wisdom: How to evaluate and create information quality on the web. Mahwah, New Jersey: Erlbaum; 1999.
29. Kim P, Eng TR, Deering DJ, Maxfield A. Published criteria for evaluating health related web sites: review. Br Med J. 1999;318:647.1.
30. Stevenson FA, Wallace G, Rivers P, Gerrett D. It's the best of two evils': a study of patients' perceived information needs about oral steroids for asthma. Health Expect. 1999;2:185–94.
31. Dedeke A. A conceptual framework for developing quality measures for information. In: Proceedings of 5th International Conference on Information Quality. 2000. p. 126–8.
32. United States Department of Health and Human Services (USDHHS). Saying it clearly. 2000. http://webarchive.library.unt.edu/eot2008/20090117183210/http://www.talkingquality.gov/docs/section3/3_4.htm. Accessed 18 May 2013.
33. Holmes-Rovner M. Patient choice modules for summaries of clinical effectiveness. Br Med J. 2001;322:664–7.
34. Department of Health (UK). Toolkit for producing patient information. London: HMSO; 2002.
35. Gagliardi A, Jadad AR. Examination of instruments used to rate quality of health information on the Internet: chronicle of a voyage with an unclear destination. Br Med J. 2002;324(7337):569–73.
36. National Center for Education Statistics. National Assessment of Adult Literacy (NAAL). 2003. National Assessment of Adult Literacy (NAAL) - What is NAAL?. Accessed 18 May 2013.
Moult B, Franck LS, Brady H. Ensuring Quality Infor


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## ericwd9 (Jun 13, 2014)

*8 and final*

1. Information for Patients: development and preliminary validation of a new instrument to improve the quality of written health care information. Health Expect. 2004;7:165–75.
2. Bernstam EV, Shelton DM, Walji M, Meric-Bernstam F. Instruments to assess the quality of health information on the World Wide Web: what can our patients actually use? Int J Med Inform. 2005;74:13–9.
3. Food and Drug Administration (FDA). Defining Data Quality: The FDA Perspective. 2005. http://www.fda.gov/ohrms/dockets/ac/05/briefing/2005-4193b1_02_BIMO Background.pdf. Accessed 4 May 2013.
4. Knight S, Burn J. Developing a framework for assessing Information Quality on the World Wide Web. Inform Sci J. 2005;8:159–72.
5. Zimmermann R, Wolfe R, Fox J, Nowalk M, Troy J, Sharp L. Vaccine criticism on the World Wide Web. J Med Internet Res. 2005;7:2:e17.
6. Selman TJ, Prakash T, Khan KS. Quality of health information for cervical cancer treatment on the Internet. BMC Women's Health. 2006;6:9.
7. Hobson-West P. Trusting blindly can be the biggest risk of all: organized resistance to childhood vaccination in the UK. Sociol Health Illness. 2007;29(2):198–215.
8. Calero C, Caro A, Piattini M. An applicable data quality model for Web portal data consumers. World Wide Web. 2008;11(4):465–84.
9. Walsh TM, Volsko TA. Readability assessment of internet-based consumer health information. Respir Care. 2008;53(10):1310–5.
10. Nagappa AN, Sam KG, Zarrin F, Saurabh H, Partha G, Pathak K. Evaluation of web sites for quality and contents of asthma patient education. J Young Pharm. 2009;1(3):278–83.
11. Kata A. A postmodern Pandora's box: anti-vaccination misinformation on the Internet. Vaccine. 2010;28(7):1709–16.
12. CDA, Collaborative Learning Project. Feedback Mechanisms In International Assistance Organizations. Cambridge, MA: CDA. Inc. 2011. http://www.hapinternational.org/poo...mechanisms-in-international-organisations.pdf. Accessed 18 May 2013.
13. The Health On the Net Foundation (HON). The HON code of conduct for medical and health web sites (HONcode). 2013. http://www.hon.ch/HONcode/Conduct.htm. Accessed 7 Jan 2013.
14. Web Médica Acreditata (WMA) Decalogo para el uso de webs de salud. 2007. http://wma.comb.es/es/wma/principis-bona-practica.php. Accessed 7 Jan 2013.
15. Standford Persuasive Tech Lab. What makes a website credible?. 2010. SLIDES: WHAT MAKES A WEBSITE CREDIBLE? – Persuasive Tech. Accessed 7 Jan 2013.
16. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.
17. Lombard M, Snyder-Duch J, Bracken CC. Content analysis in mass communication: assessment and reporting of intercoder reliability. Hum Commun Res. 2002;28(4):587–604.
18. Fagerlin A, Wang C, Ubel PA. Reducing the influence of anecdotal reasoning on people's health care decisions: is a picture worth a thousand statistics. Med Decis Mak. 2005;25:398–405.
19. Meppelink CS, van Weert JCM, Haven C, Smit EG. The effectiveness of health animations in audiences with different health literacy levels: an experimental study. J Med Internet Res. 2015;17:1.
20. Eysenbach G. Medicine 2.0: social networking, collaboration, participation, apomediation, and openness. J Med Internet Res. 2008;10:3:e22.
21. Petty RE, Cacioppo JT. Communication and persuasion: central and peripheral routes to attitude change. New York: Springer; 1986.
22. Murray E, Burns J, See TS, Lai R, Nazareth I. Interactive Health Communication Applications for People with Chronic Disease, Cochrane Database of Systematic Reviews. 2005. In: Eysenbach G, editor. Credibility of health information and digital media: New perspectives and implications for youth. Digital media, youth, and credibility. Cambridge, MA: The MIT Press; 2008. p. 123–54.
23. Wantland DJ, Portillo CJ, Holzemer WL, Slaughter R, McGhee EM. The Effectiveness of Web-Based vs. Non-Web-Based Interventions: A Meta-analysis of Behavioral Change Outcomes. Journal of Medical Internet Research. 2004; 6: e40. In: Eysenbach G, editor. Credibility of Health Information and Digital Media: New Perspectives and Implications for Youth. Digital Media, Youth, and Credibility. Cambridge, MA: The MIT Press; 2008. p. 123–54.

*Abbreviations* 
HON: health On the net foundation; OVIQC: Online Vaccination Information Quality Codebook; OVIQ: Online Vaccination Information Quality
*Acknowledgements* 
The authors wish to thank Anna Piccoli for her help in the coding of the webpages.
BMC Public Health. 2016;16(38) © 2016 BioMed Central, Ltd. 



I thank those who were interested to read this far? and apologize for the length of this work.


Regards Eric:amen:


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## Arya's Toys (Feb 24, 2016)

shantikeyz said:


> I believe in vaccinating dogs. Puppies after weaning 2 rounds. After that an annual booster. Then I only vaccinate once every 5 years .


I agree with this, however, after searching through about 6 different insurance policies to cover my dogs with, I find that each of them say that insurance claims wont be covered if dogs are not current on vaccinations. One policy also said a yearly teeth cleaning was required. How do you get around this?


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## MiniPoo (Mar 6, 2014)

Arya's Toys said:


> I agree with this, however, after searching through about 6 different insurance policies to cover my dogs with, I find that each of them say that insurance claims wont be covered if dogs are not current on vaccinations. One policy also said a yearly teeth cleaning was required. How do you get around this?


I think PetPlan says that you have to do what the vet recommends. If you do not vaccinate as often as he recommends and your dog gets that disease, then the dog may not be covered. I would image that my vet would say some years my dogs do not need to have their teeth cleaned, but I am going to check on this particular issue because I do not want to anesthesize Dakota every year to do a dental.

I am glad you raised this issue, Arya, so that I can double check things because Dakota is due for his first annual vaccination this year. So I have to make a decision in the next month or so.

*UPDATE:* I just checked the PetPlan Policy and Arya is right about the vaccinations. But note that it requires an annual dental *exam*, not an annual dental cleaning. So they are leaving that up to the vet to decide. Since my vets are reasonable, I think that means he may not have to have yearly cleanings, but I will take that as it goes.

Since I will not vaccinate Dakota for Lepto, then that means if he gets it, all the medical expenses will not be covered. So I just have to keep that in mind.

7. CARE FOR YOUR PET
a. In order for your policy to remain valid you must take care of your pet and arrange and pay for your pet to have the following:
i. An annual health check.
*ii. An annual dental exam.*
iii. Any treatment normally suggested by a vet to prevent illness or injury.

_-- and another ---_

To be afforded coverage for the diseases listed below, you must keep your pet vaccinated at your expense, as recommended by your vet. We will not pay any claims that result from or are related to any illness that is listed below that a vet recommended vaccine would have prevented.
i. Canine distemper.
ii. Canine adenovirus 2 (canine viral hepatitis).
iii. Canine parainfluenza.
iv. Canine parvovirus.
v. Leptospirosis.
vi. Rabies.


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## Tiny Poodles (Jun 20, 2013)

MiniPoo said:


> I think PetPlan says that you have to do what the vet recommends. If you do not vaccinate as often as he recommends and your dog gets that disease, then the dog may not be covered. I would image that my vet would say some years my dogs do not need to have their teeth cleaned, but I am going to check on this particular issue because I do not want to anesthesize Dakota every year to do a dental.
> 
> 
> 
> ...



Dental exam just means that the Vet looked in the dog's mouth at their annual examine, and did not note any problems or that they needed a cleaning. Petplan paid for huge dental bills only months after my girls were signed on without them ever having specific dental examines, just whatever the vet wrote as part of a routine exam.
And FYI, I asked, since my girls are always at the Vet for something more than once a year, do they need to have an addition visit JUST for wellness, and they said no, as long as the vet documents all the points that they traditionally do on an exam, a "not-well" visit would count as the annual.
And as far as the vaccines go, it says "vet recommended vaccine" - so if your Vet recommended Lepto, and documented that they did so and you refused, then you would have a problem, but if they never recommended it, then you would be fine.
My Vet does not recommend lepto, and she does recommend titers, so I have no worries if my dogs got any of those diseases. I am a little worried about bordatella because she documented "refused bordatella - does not go to the groomer"
Does that mean that she agrees that if they do not go to the groomer, that she agrees with the refusal? I hope that Petplan would read it that way. When I told her that they don't go to the groomer is when She stopped arguing with me that they need it...


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## shantikeyz (Mar 4, 2016)

Arya's Toys said:


> I agree with this, however, after searching through about 6 different insurance policies to cover my dogs with, I find that each of them say that insurance claims wont be covered if dogs are not current on vaccinations. One policy also said a yearly teeth cleaning was required. How do you get around this?


I don't use pet insurance. It's just another money making business. I'd rather put money away in a savings account. 
Plus over vaccinating a dog can be horrible. One of my dogs has autoimmune problems because of annual vaccines. I'd never over vaccinate again, especially for some insurance company. 
That's just how I feel from my own experiences. 

Sent from my XT1055 using Tapatalk


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## Tiny Poodles (Jun 20, 2013)

shantikeyz said:


> I don't use pet insurance. It's just another money making business. I'd rather put money away in a savings account.
> Plus over vaccinating a dog can be horrible. One of my dogs has autoimmune problems because of annual vaccines. I'd never over vaccinate again, especially for some insurance company.
> That's just how I feel from my own experiences.
> 
> Sent from my XT1055 using Tapatalk



To each his own, Petplan has saved me in the neighborhood of 15-20 thousand dollars in the past 3 1/2 years.


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## seminolewind (Mar 11, 2016)

Since my chickens were exposed to a virus that causes cancer, I did a lot of research on vaccines. I've heard arguments about building resistance without vaccination. Etc. And viruses are viruses, and to this day they don't have a vaccine for the common cold or HIV. There is no way to build resistance except by exposure to the virus or bacteria.

Vaccines are actually a natural way of building resistance. A vaccine is an altered piece of the real disease. It's altered so that it won't cause the illness , but just expose the animal's immune system to it to build resistance with antibodies. . By the time the animal becomes exposed to the real disease, it's already got enough antibodies to fight off the disease. 

Overvaccinating is overkill. It depends on how many antibodies are produced from exposure to the vaccine, and how long that exposure will be good. Like Tetanus is a good vaccine, but 10 years later the immune system has to be "refreshed" to bring the level of antibodies up again. 

I've heard a lot of wild stories about vaccines, and sometimes a person can see what's too much or too little by understanding what a vaccine is. 

Pure and simple, resistance is created by exposing an immune system to a virus or bacteria so it will build antibodies that are specific to the disease. It would be great to build resistance (antibodies) before exposure to the disease. A vaccine is an altered piece of virus or bacteria that safely exposes the immune system and causes production of antibodies without giving the animal the disease.


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