Tuesday, July 29, 2014

Vitamin K deficiency in babies

"Vaccines save lives; fear endangers them. It's a simple message parents need to keep hearing." — Jeffrey Kluger, American journalist and author of scientific books

A NEW and dangerous round of anti-vax hysteria is making the rounds that's persuading parents of infants to forgo getting a routine shot that will prevent a rare but deadly vitamin K deficiency.

Here's the story from Mother Jones.

In May, the Tennessean reported on a truly shocking medical problem. Seven infants, aged between seven and 20 weeks old, had arrived at Vanderbilt University's Monroe Carell Jr. Children's Hospital over the past eight months with a condition called "vitamin K deficiency bleeding," or VKDB. This rare disorder occurs because human infants do not have enough vitamin K, a blood coagulant, in their systems. Infants who develop VKDB can bleed in various parts of their bodies, including bleeding into the brain. This can cause brain damage or even death.

There is a simple protection against VKDB that has been in regular medical use since 1961, when it was recommended by the American Academy of Pediatrics: Infants receive an injection of vitamin K into the leg muscle right after birth. Infants do not get enough of this vitamin from their mother's body or her milk, so this injection (which is not a vaccine, but simply a vitamin being delivered via a shot) is essential, explains pediatrician Clay Jones on the latest installment of the Inquiring Minds podcast (stream below). It's also quite safe.

So then why are some parents refusing to get it, leaving their infants vulnerable to a potentially devastating condition? It's difficult to understand the phenomenon outside the context of a growing fear, in general, about vaccines in the US. 

"There's a lot of overlap with that anti-vaccine mentality," says Jones. 

Indeed, reporting on the Vanderbilt VKDB cases, the Tennessean explained that "Vanderbilt doctors believe incidences are on the rise because of the anti-vaccine movement."

VKDB comes in two versions, an "early" form (occurring in the first week of life) and the much more dangerous "late" form, which tends to strike infants between two and 12 weeks old who have not received Vitamin K, and who are "exclusively breastfed" by their mothers. 

The problem, writes Jones, is that "levels of vitamin K in breast milk are low, much lower than in infant formula."

According to the Centers for Disease Control and Prevention, infants who do not receive a vitamin K injection have an 81 times greater chance of coming down with late stage VKDB. Even then the risk remains small: Between 4.4 and 7.2 infants out of every 100,000. But a Vitamin K injection is "virtually 100 percent protective," Jones explains.

Such are the facts, yet nonetheless, parents interviewed by the CDC after bringing in their infants with VKDB showed concerns about the injection. "Reasons included concern about an increased risk for leukemia when vitamin K is administered, an impression that the injection was unnecessary, and a desire to minimize the newborn's exposure to 'toxins,'" observes a CDC report. These concerns are scientifically questionable at best. "Earlier concern regarding a possible causal association between parenteral [injected] vitamin K and childhood cancer has not been substantiated," states the American Academy of Pediatrics.

A quick Google search returns a number of dire warnings about vitamin K shots circulating on the Internet. One of the top results is an article at TheHealthyHomeEconomist.com, which urges readers to "Skip that Newborn Vitamin K Shot," before going on to list an array of "dangerous ingredients in the injection cocktail." (The site also calls vaccines "scientific fraud.")

The case for the vitamin K shot is irrefutable, says Jones, "especially when you take into account just how ridiculously safe these intramuscular injections are."

And then there's physician Joseph Mercola (whose popular website calls vaccinations "very neurotoxic" and suggests they are associated with a list of conditions, including autism). In another article on his site, Mercola suggests there is a "Potential Dark Side" to the vitamin K shot. "A needle stick can be a terrible assault to a baby's suddenly overloaded sensory system, which is trying to adjust to the outside world," it reads. (Although Mercola himself rejects and debunks the alleged leukemia link.) Mercola instead suggests administering vitamin K orally, claiming it's "safe and equally effective."

In a written statement provided for this article, Mercola elaborated on his views. He said that as a doctor, he has personally seen "direct evidence of trauma from injections," and he cited risks from aluminum preservatives contained in vitamin K shots. "It is incomprehensible to me how any rational individual could even consider arguing the use of vitamin K injections over a simple and inexpensive, painless oral dose that has never been shown to fail," Mercola wrote.

Jones disagrees. "We have decades of data from a number of countries, some of which have oscillated between doing the [intramuscular injection], doing the oral, and doing nothing," he says. "And so we have good data that shows that while oral is certainly better than nothing, it is not as effective as intramuscular dosing." 

In particular, with oral vitamin K, there are problems involving making sure that people take the right dose and stick to the regimen—and then of course added problems if a baby vomits up the dose. 

"There's a lot of factors that could potentially interfere with the ability of the oral dosing to work," adds Jones. 

"Intramuscular is the best way to do it." (For Jones' more thorough rebuttal to Mercola, read here.) A 2003 statement from the American Academy of Pediatrics makes a similar point, citing evidence that "oral prophylaxis" may fail more often than an injection in preventing late VKDB. (Here's a paper discussing the cases of several infants in the Netherlands who received oral Vitamin K, but still came down with late VKDB.)

Science aside, evidence presented by the CDC suggests that refusal of vitamin K shots may be a major phenomenon to contend with. In Tennessee, the CDC found that at the hospital with the highest rate of missed vitamin K injections, 3.4 percent of infants were discharged without receiving one. At birthing centers in the state (a hospital alternative, often run by nurse-midwives), the number was much higher: 28 percent. (The agency also hinted that medical staff may not be adequately informing parents about the need for the shot.)

To prevent any more horrific brain bleeds in infants, that has to stop. The case for the vitamin K shot is irrefutable, says Jones, "especially when you take into account just how ridiculously safe these intramuscular injections are."

Although there have been those skeptical of vaccination since it was first discovered as a disease preventative, the latest surge in the anti-vax movement started when Andrew Wakefield, a British physician and researcher, published a study in 1998 alleging a link between the MMR (measles, mumps and rubella) vaccine and autism.

Since then his research has been proven to be unreproducible, unethical, fraudulent and dangerous to his his study participants and society, and he has been barred from practicing medicine in the UK

And just so you can know just how dastardly this guy is, here's some of his history from Wikipedia:

After the publication of his paper, other researchers were unable to reproduce Wakefield's findings or confirm his hypothesis of an association between the MMR vaccine and autism or autism and gastrointestinal disease.

A 2004 investigation by Sunday Times reporter Brian Deer identified undisclosed financial conflicts of interest on Wakefield's part. The British General Medical Council (GMC) conducted an inquiry into allegations of misconduct against Wakefield and two former colleagues. 

The investigation centred on Deer's numerous findings, including that children with autism were subjected to unnecessary invasive medical procedures such as colonoscopy and lumbar puncture, and that Wakefield acted without the required ethical approval from an institutional review board.

On 28 January 2010, a five-member statutory tribunal of the GMC found three dozen charges proved, including four counts of dishonesty and 12 counts involving the abuse of developmentally challenged children. Wakefield was struck off the Medical Register in May 2010, with a statement identifying deliberate falsification in The Lancet research, and he is barred from practising medicine in the UK.

In January 2011, an editorial accompanying an article by Brian Deer in the British Medical Journal identified Wakefield's work as an "elaborate fraud". In a follow-up article, Deer said that Wakefield had planned to launch a venture on the back of an MMR vaccination scare that would profit from new medical tests and "litigation driven testing".

Wakefield's study and his claim that the MMR vaccine might cause autism led to a decline in vaccination rates in the United States, United Kingdom and Ireland and a corresponding rise in measles and mumps, resulting in serious illness and fatalities, and his continued warnings against the vaccine have contributed to a climate of distrust of all vaccines and the reemergence of other previously controlled diseases.

Here's the real deal: According to the CDC, the rates of complication from vaccines are so low that the benefits of vaccination are as much as 10,000 times the risk. 

For example the rate of developing pneumonia as a complication of measles is 6 in 100, 1 in 1000 for encephalitis and an average of 2 deaths per 1000 occur, whereas the rate of encephalitis or severe allergic reaction to receiving the MMR vaccine is 1 in 1,000,000.

Complication rates from having the mumps are 1 in 7 for testicular atrophy in men and 1 in 4 for miscarriages for women in the first trimester of pregnancy.

The pro-vaccine website called antivaccinebodycount tallies the number of vaccine-preventable illnesses and deaths (compiled from weekly CDC reports) at 136,242 preventable illnesses*, 1397 preventable deaths* and 0 autism diagnoses scientifically linked to vaccination.*

*in the US from June 3, 2007 to July 12, 2014 


  1. At the end of this post, the information on complications is very confusing. I don't understand it. The use of complete sentences might help.

  2. I can't help but be furious about these anti-vaxxers. They are not only impacting their own families but others as well. It's ignorant and frankly, I'd like to see the proponents of the movement punished with more than losing their medical license. I forget the name of the woman who used to be on The View spewing her message. She has an autistic son and fell for the 'expert's' stories. I understand that her fury and fear over her son's condition led her to believe things she didn't understand. The part that angers me about her is that she NEVER came back and admitted her error or corrected her stories. Yet she's still employed in a public forum. She still has a platform. Yeah, it's FOX but still. Oh! It was Jenny McCarthy.