Tylenol, Fevers, & Chickenpox

[cobluegirl]

Posted with permission of author, Hilary Butler

Archives: Chickenpox, Tylenol and Necrotising Fasciitis. Also, Paracetamol for NZ'rs.
An old post to a doc...

Can we discuss Chickenpox, tylenol and the vaccine please?

You said two things recently - that additives in vaccines were to the rate of 1 part per million, and, that chickenpox kills.

First, Additives in the chickenpox vaccine.

A nurse rang me yesterday, because she was threatened that if her child was not vaccinated against chickpox, she would lose her job in a old people's home. No, the logic of that escapes me too, but never mind. She had rung the local immunisation people and asked what was in the vaccine. She was told she didn't need to know, because it was perfectly safe, which annoyed her, so she rang me. I read to her from the Varivax sheet, because that is the one the doctor wanted her daughter to have. This sheet says:

"Each 0.5 ml dose contains the following; a minimum of 1350 plaque forming units of Oka/Merck varicella virus when reconstituted...12.5mg hydrolyzed gelatin, 3.2mg sodium chloride, 0.5 mg monosodium L-glutamate, 0.45mg of sodium phosphate dibasic, 0.08 mg of potassium phosphate monobasic, 0.08 mg of potassium chloride; residual components of MRC-5 cells including DNA and protein; and trace quantities of sodium phosphate onobasic, EDTA, neomycin and fetal bovine serum."

Firstly, she was surprised by the neomycin, because the manual says that this is never to be given internally - it is for external use only. I could not explain this rather obvious contradiction in the published literature.

She wanted to know what MRC-5 was, and how much was trace quantities. I explained to her that each dose of Varivax has 2 nanograms of "modified mammalian DNA (Pg 522, Journal of Paediatrics, Volume 127, No4, October 1995) and that this tissue came from aborted foetal tissue which was cultured (immortalised). I also explained that studies had showed that this tissue had a 7:12 chromosome translocation, but that the FDA's assessment was that the risk of MRC-4 DNA's inducing a malignant transformation in vaccinees was exceedingly low. What that meant, I did not know.

Then she asked what fetal bovine serum was, and whether it was safe. I told her that it was blood from unborn calves, removed at the meatworks, and could not be guaranteed totally safe, because commercial lots used in MMR were found to contain bovine diarrhoeal pestiviruses which had been known to cause problems in humans (Journal of Clinical Microbiology, June 1994, pg 1604-1605) and that usually it was not picked up in manufacture, because it didn't cause any cell changes in the culture medium. And also, the trascripts I have of many of the other cell substrate international meetings have listed a whole range of problems for fetal bovine serum which don't actually get into the medical literature...I also read out from other known contaminants of fetal bovine serum from some WHO documents. I could not specify what trace amounts are.

I also pointed out that medical literature was indicating that allergic reactions to the MMR were now "thought" to be from modified gelatin, and since this one had 12.5 milligrams of that too, there was a very small potential, theoretical risk from that, especially as her daughter was an asthmatic.

She asked where the Oka strain came from, and I told her it was obtained from a Japanese boy and made weaker by passage through human embryonic lung fibroblasts (again, aborted fetal tissue), then guinea pig embryonic cells, then two different human aborted fetal lines called WI-38 and MRC-5. the vaccine is then manufactured in bulk by infecting the aborted foetal line called MRC-5.

We also discussed the procedures involved in reducing the human DNA to 2 nanograms in each dose.

These things are not 1 part per million, as you stated..... though I realise that your statement was a very broad generalised thought... but it was not fact, for any vaccine, and you, as a paediatrician, should know that.

This nurse considered all this, and decided not to vaccinate her allergic child. I guess she will have to have a few words with her boss. As a health professional, she chose not to do it.

My husband has three children from his first marriage. (His first wife was killed in the Erebus aeroplane crash in Antartica a long time ago.) One family has three children, so we have three grandchildren. Two of them have been vaccinated with Varivax (the third is too young) - to them, vaccines are compulsory.

So I was very surprised when her children came down with quite bad chickenpox, and she came around saying "Wasn't it wonderful that we had vaccines, because without them, her children would have died".

We took out the photographs of our children when they had chickenpox which showed far less severe and fewer spots. We also pointed out that she was around at that time, in case she didn't remember, and neither of them were vaccinated.

What's more we pointed out that neither of them had mild encephalitis as did her younger one. She just sat there. And then incredibly, said: "Well I think the vaccine saved my children's lives".

What could we say? When people won't listen, they won't listen.

Second - you said that recently, it has been shown that chickenpox can kill . I have looked at all the recent cases of serious chickenpox cases, and in all cases the alert that I take from the literature is not so much to chickenpox, but the use of tylenol or Ibuprofen. Which I know, in your country, is what every nurse tells every mother to give every child with a temperature. In this country, we use a similar thing called Paracetamol. Some chickenpox cases got necrotising fasciitis, (Ped Infect Dis J 1995 Jul;14(7): 588-94)....again ....why?

We all know that NSAIDS like tylenol and iboprofen are implicated in necrotising fasciitis.

Another one (Infect Med 16 (5):307, 1999 noted severe Group A beta-hemolytic strap in children who had had antipyretic medication.

MMWR, May 15, 1998, Vol 47 No 18 listed chickenpox cases too. But these parents don't appear to have been asked about Nonsteroid anti-inflammatories, or - tylenol. Why is that? Youu know it is the most common co-factor to Necrotising Fasciitis under any circumstance. Or, if you don't know that, why dont you know that?

Pediatrics Vol 103, No 4, April 1999, pg 783+ again noted the association of ibuprofen with serious complications - and elsewhere in the same issue.

We have on file medical articles which show that if you take antipyretics you can

1) Prolong the flu

2) Worsen the outcome of malaria.

3) Induce pneumonitis

4) Acta Paediatri Jpn 1994 Aug;36(4):375-8 shows that administration of any antipyretic drugs in children with infectious diseases worsens their illnesses.

5) Provoke a simple disease like Chicken-pox into a killer disease in normal children. It can already do that in immuno compromised children without tylenol. But there is a specific reason for them, as a sub-group for it to be dangerous. Even a simple cold can kill an immunosuppressed child. But we are talking about supposedly "normal" children, are we not?

6) We also have evidence on file to show that it is a major factor in provoking mild meningitis into serious meningococcal meningitis.

Why? Because it appears that anti-pyretics down-regulate the immune response.

This is only natural, since the reason for a fever is to switch on certain cytokines, and push the immune system up from the fourth gear to the tenth (simplistically put as an imagery picture, here), to help deal with the problem.

There is very clear evidence that tylenol creates an ineffective immune system[b] in some children, and as Ped Infect Dis 1996:15: 355-53 points out about the immune system in general - not in particular to Tylenot - [b]"an ineffective immune response to certain organisms can result in life-threatening infection."

Better yet, a Journal called Family Practice, Volume 3, No 2, 1996 stated:

"Paracetamol prescribing is reaching epidemic proportions and the potential dangers of hepatotoxicity and the inhibition of the immune response in children are discussed."

He goes on to say:

"Despite our lack of knowledge about its therapeutic mechanism, it has been claimed to be a safe drug, especially for children...there is mounting evidence that paracetamil is not the benign drug that it was formally thought to be... We would question the whole rational of prescribing the drug in near epidemic proportions...there is little concern about its use in the short term as an ANALGESIC, there is considerable controversy over its use as an antipyretic...tylenol/paracetamol may decrease antibody response to infection and increase morbidity and mortality in severe infections....too many parents and health workers think that fever is bad and needs to be suppressed by paracetamio, when indeed, moderate fever may improve the immune response."

In another earlier study in the Lancet March 9, 1991 pg 591 it was stated "Studies have clearly shown that fever helps laboratory animals to survive an infection whereas antipyresis increases mortality (death). Moreover, there is considerable in-vitro evidence that a variety of human immunological defences function better at febrile temperatures than at normal ones."

It is a natural thing to say that if your child was vaccinated against chickenpox, they won't get it (....? maybe) so you then wouldn't have to worry about the use of tylenol.

My feeling is that tylenol should never be used in any case of infectious disease, for several reasons - first, it suppresses the immune system. Second it makes most children sleepy. Third - the combination of those two factors can mask critical symptoms which would alert a parent to a problem, so that as in the case of many if not most of the recent chickenpox cases - by the time they get to hospital, the situation is very severe indeed.

Do you think then, in the light of the literature, all parents should be warned that while they can use Tylenol, or paracetamol as as ANALGESIC - or pain relief, that they should never use it for infectious diseases? And also, why is it that nurses always tell mothers to do this? Is it to shut them up? It is always Give them tylenol, and if you are still worried tomorrow, ring the surgery...." This is a poor substitute for good clinical management, don't you think?

Secondly, in the context of the cases where the use of ibuprofen or tylenol has changed chickenpox into serious secondary fatal bacterial infections, isn't that a case, not for a vaccine, but for iatrogenic mistakes to be investigated? After all, it wasn't the
parent's fault.

Thirdly, since I cannot find any evidence to show that all the ingredients in the Varivax vaccine are safe, will not cause problems, and will not cause cancer, I think that before anyone used these vaccines, they should know exactly what is in them, that this research has not been done, and the long-term dangers are therefore unknown. Don't you?

What I want to discuss here is the need for all facets of issues to be discussed. So often your posts are very simple, but this might not always reflect the complete picture.

What do you think?

__________________________________

She never replied




There will be some double up from above. This is a post I put up ages ago, on Parent's place, when a different doc, not a paediatrician, challenged me about a statement that the routine use of paracetamol by mothers for everything from teething to mother's little helper (it is a great tranquilliser!!!) was child abuse. .

Needless to say, again I got no reponse. I gathered later, however from an associate of this doctor who was prepared to talk to me, that she was totally shocked, since she had never read any of the medical literature on the immunological aspects of antipyretics.

Which is pretty common. Very few paediatrin nurses here (and I know, as I have done talks on the subject to post-grad paediatric nurses) have a clue as to either the immune system, and how it works (what little we know of that - and much of that is sheer speculation) or the ramifications of the use of anti-pyretics.

______________________________________________