Wednesday, May 31, 2017

CNN FIRES SATANIST KATHY GRIFFIN OVER EVIL PHOTO OF BEHEADED TRUMP - FACEBOOK BLOCKS MY ABILITY TO POST THE LINK



Dear friends -

Facebook has blocked my ability to share the link below.





Silly facebook. Did you really think you could stop me?


SOURCE ARTICLE:
CNN Fires Liberal “Comedian” Kathy Griffin After She Held a Decapitated Head of President Donald Trump
http://www.lifenews.com/2017/05/31/cnn-fires-liberal-comedian-kathy-griffin-after-holding-a-decapitated-head-of-president-donald-trump/


Kathy Griffin is gone at CNN after a gruesome photo shoot depicted her holding a decapitated head of President Donald Trump.

CNN indicated that Griffin will not be back as a co-host of CNN’s annual New Year’s Eve program according to an announcement from the network Wednesday.

“CNN has terminated our agreement with Kathy Griffin to appear on our New Year’s Eve program,” the network said in a statement.

Griffin has apologized for the photos, taken by provocative celebrity photographer Tyler Shields. The comedian posed for the gory shot during a photo session with the famed photogerapher, who’s known for edgy, shocking pics.

“I beg for your forgiveness. I went too far,” she said in a video posted to Instagram late Tuesday. “I made a mistake and I was wrong.”

Admitting the images were “too disturbing,” Griffin said she asked Shields to take down the photo.

Griffin has co-hosted CNN’s annual New Year’s Eve program alongside Anderson Cooper since 2007.

Click here to sign up for pro-life news alerts from LifeNews.com

Some conservatives were already calling on CNN to fire Griffin and disassociate itself from her and the horrid photo:

Griffin has hosted CNN’s New Year’s Eve program since 2007 with AC360 host/friend Anderson Cooper. It’s obvious that CNN isn’t a fan of President Trump as full-fledged cheerleaders of The Resistance, but it’s fair to say that this goes too far.

Care to comment on this, CNN Public Relations? How about you, CNN Media team? Will you pressure your own network to drop Griffin following this photo shoot depicting a beheaded President?

One will think they’d comment, but nothing is really surprising anymore. However, it’s a safe bet all of these groups would if Griffin had done this with a fake Obama head.




Tuesday, May 30, 2017

JEWS WERE EXPELLED FROM AT LEAST 359 LOCATIONS



Source Article:
Jewish Expulsion from 87 Locations Over 350 Times
http://esau.today/jewish-expulsion-from-87-locations-over-350-times/


If a man were accused of a serious crime, tried, and found guilty by a jury of his peers, we would find but little cause to put faith in a claim by him of persecution. However, if he insisted that the reason for his charge of misconduct was only because he believed differently than others, then we might grant him a second trial to assure ourselves he had not been the victim of injustice, believing with confidence that the people would not for a second time find an innocent party guilty of a crime that he did not commit.

If, at the conclusion of the second trial by another jury of peers, the man is found guilty of an offense against the people, we have no reason to listen to or place belief in continued cries of persecution. What does this have to do with the Jew? Quite simple. Since the year 139 B.C., the Jews have, by their own records and count, been expelled from AT LEAST eighty-seven (87) countries, nations or political entities. Let’s see now. Eighty-seven countries, eighty-seven people’s courts, eighty-seven guilty verdicts, and eighty-seven cries of persecution.

The first time, maybe. The second time doubtful. But to have been found worthy of expulsion by the people of AT LEAST eighty-seven different countries for crimes against the people of those countries? Such a claim stretches the limits of human credulity beyond its most liberal bounds of endurance.

When one comes to the realization of the fact that these different peoples in most of these cases did not know of each other, or for that matter had never even heard of the other’s existence, and yet determined, independently, over a two-thousand-seven-hundred year span of time that the Jews were committing such serious crimes that it was necessary to uproot them lock, stock and barrel in order to drive them from their homes, many times with loss of life and great destruction of property, it is then and only then, that one can truly appreciate the gravity of the Jewish Question.

I’ve been compiling this list for over a year now. There may be some reproductions here as I haven’t managed to verify all of them yet, however, I have reliable sources(mostly jewish sources) for 311 (yes, three-hundred-and-eleven) so far. There are also undoubtedly tens – if not hundreds – of expulsions also still missing from this list, so the final total most likely will have to be updated and posted here again in time. However, I think this is a good time to post this (after my post the other day I did a lot more research and source-finding) as it shows the well-known 109 number falls very, very short.

-anon

Save this / Share this / Add to it / Do whatever you want with it. I’ll edit this list with sources when I finish and post it here again in a few months.

http://hollaforums.com/thread/9970067/politics/jews-expelled-359-times-updated-sourced.html

Adamic Amethyst video


Kicked Out 109 Times? Try 359! (High Quality) w/ Sources
https://youtu.be/gRv1-ZyUxus




SouthernFascistFeels writes:

I would argue with the first couple that they were not jewish people at the time, the group in babylon would come back to Jerusalem and then mix with the locals who moved into their old lands, who God in the OT hates with a passion. Talmudism was finally codified in around 300 A.D but the “traditions of the elders” was around a lot longer, and was brought back from Babylon with some stringent groups, its all really complicated, anyway, i would say maybe 357 or so instead of 360, but still it doesn’t fucking matter, this needs to be posted everywhere, everyone needs a copy of this, and everyone needs yo understand its not 110-never again its 350-never again. The numbers are honestly fucking staggering, and yet they claim the old testament is theirs, God said he would make Israel many nations, yet the jews have one nation it’s so fucking preposterous, the book they claim to have written doesn’t even back up their history. What a bunch of delusional megalomaniacs.

Jews are not of the line of Judah. Jews are NOT the descendants of Jacob/Israel. The first 4 on the list are inaccurate.

Zoomable .png browser link'


https://media.8ch.net/file_store/c349a143d128ba79780bf5d9901ffbe2280bacb8f9074256c386a1a35b06aa14.png



https://www.dailystormer.com/8chan-anon-proves-that-jews-were-expelled-from-at-least-359-locations/



Articles written by jews who admit it, but of course make excuses as to why:

https://www.quora.com/Historically-why-have-jews-been-chased-out-of-many-countries-in-which-they-lived-in

http://www.eretzyisroel.org/~jkatz/expulsions.html


Download the excel file here:

359 times


Download the rich text file here with clickable links:

Jewish Expulsions 359 Clickable




Source article by Michael Byron:
Anon Proves That Jews Were Expelled from at Least 359 Locations
https://www.dailystormer.com/8chan-anon-proves-that-jews-were-expelled-from-at-least-359-locations/


For some reason, everyone seems to hate these people.

Most people reading the Daily Stormer should be familiar with the fact that Jews have been expelled from 109 locations around the world. This little piece of information is, after all, one of the sharpest arrows we have in our quiver when debating cuckolds who still believe that the Jews have a right to exist.

Sometimes, however, we underestimate just how thoroughly Jewish the Jews actually are. 109 times in almost two millennia? Yeah, that always did seem a little low to me.



It seems that an anon from 8chan’s /pol/ board felt the same way. Armed with nothing more than a computer, spare time, and the power of autism made manifest, the diligent anti-Semite decided to compile a more in-depth list of locations in which the Jews were expelled.

His number? 359 at minimum.

Yeah, that sounds more like the Jews we all know and love.

Here is the OP (the thread is still available here):





































(Here’s the list with full sources that wouldn’t fit properly on the page.)

I’m not into numerology, but even I can’t overlook the obvious symbolism of the 359 number.

If the Jews are expelled from one more location (e.g. Planet Earth) then, according to this list, they will have been expelled from 360 locations.

360 degrees = a full circle.

The word for “circle” in Yiddish is “keikl.”

“Keikl” is the origin of “kike”!


Lord Kek is still with us, goys. He never left our side for a moment.

Sunday, May 28, 2017

OVER 100 MEASLES VACCINE DEATHS REPORTED IN THE U.S.



Source article:
Zero U.S. measles deaths in 10 years, but over 100 measles vaccine deaths reported
http://www.naturalnews.com/048573_measles_deaths_MMR_vaccine_immunization_dangers.html


(NaturalNews) With the measles and measles vaccine debate reaching a near frenzy on the Internet, it is always nice to throw some cold hard facts on the firestorm currently raging in the measles debate. (Story by Brian Shilhavy, republished from VaccineImpact.com)

So here are some easily verifiable facts regarding deaths associated with measles in the United States for the past 10 years, and deaths associated with measles vaccines during the same 10 year period.

First, the Centers for Disease Control and Prevention (CDC) keeps a weekly tally of disease outbreaks, including deaths. According to a statement made by Dr. Anne Schuchat, the director of CDC's National Center for Immunization and Respiratory Diseases, in an Associated Press story picked up by Fox News on April 25, 2014:

There have been no measles deaths reported in the U.S. since 2003


The weekly CDC Morbidity and Mortality Weekly Reports (MMWR) since that date have not revealed any measles deaths either.

And while health authorities are blaming measles outbreaks in recent years on unvaccinated children, when you mention the fact that nobody is dying from measles in the U.S., they are quick to turn around and claim vaccines have eliminated measles deaths (even though they cannot eliminate the disease itself apparently.)

Besides the obvious contradiction in reasoning with such a claim, the historical evidence just does not support it either:



Image from healthsentinel.com

Death by Measles Vaccines

What about deaths associated with the measles vaccine during the same time period?

The U.S. Government keeps a database of reports called The Vaccine Adverse Event Reporting System (VAERS). The database is available to the public, and there is a search portal the public can use at Medalerts.org.[1]

We ran a search for a ten year period for deaths reported with measles vaccines, including a few that are no longer in production. The search result contained 108 deaths over this period, associated with four different measles vaccines sold in the United States during the past 10 years.



Today, one can only purchase a measles vaccine in combination with the mumps and rubella vaccines (MMR Vaccine).

When searching for just the MMR vaccine during the past 10 years, 96 deaths were reported:



Anybody with a computer and Internet access can search this database by visiting MedAlerts.org.[1]

This database reflects only deaths that were reported during the time frame, and therefore probably reflects a much lower number than actual deaths, since most doctors and health authorities believe vaccines are safe, and would not normally attribute a death to a vaccine and actually report it.

The U.S. Government Settlements on Measles Vaccine Injuries

The other place to find facts regarding injuries and deaths due to the measles vaccine is to look at U.S. Government settlements for MMR vaccine injuries and deaths. The U.S. public is largely unaware that manufacturers of vaccines have been given legal immunity from being prosecuted in civil court for vaccine injuries and deaths, since 1986. If someone is injured or killed by a vaccine, they have to sue the U.S. Government in a special "vaccine court."

The Department of Justice issues quarterly reports[2] on claims and settlements, and one can search for specific vaccines settlements at the United States Federal Courts website.[3]

As search here[3] for "measles" returns a result of 111 claims settled for the MMR vaccine since 2004. Some of them are for settlements due to deaths related to the MMR vaccine, as determined by the judge.



We did not click on and read each decision to find out how many resulted in deaths, but if we get a few reports from others who are willing to do so, and the numbers match, we will update this story with the actual death figure.

It takes many years to win a case in this vaccine court, so this probably represents only a tiny fraction of actual injuries and deaths due to the MMR vaccine.

Conclusion: Measles Vaccine Enthusiasm based Largely on Fear and Beliefs

We fully realize that those who believe in the value of vaccines will probably not be persuaded by these facts, which anyone with a computer and Internet access can verify from U.S. Government sources.

Having now published a few stories on the measles issue, and having received many hundreds of comments, it has become very clear to us that those who have strong opinions on the measles vaccine are based more on fear and beliefs, than they are on facts or science. Any attempt by these vaccine proponents to force their beliefs on the rest of the U.S. public should be vigorously opposed.

Read more at VaccineImpact.com.

Sources:

[1] http://www.medalerts.org

[2] http://vaccineimpact.com

[3] http://www.uscfc.uscourts.gov

http://truthwiki.org/Vaccine_Fanaticism

http://truthwiki.org/Medical_Fascism


Tuesday, May 23, 2017

SNUFF PORN PEDOPHILIA - THE JEWISH RAPE AND MURDER OF WHITE CHILDREN FOR MONEY



Satanic Jews must be permanently removed from our realm. They are a sexually depraved, psychotic bunch and a menace to all life forms.

EXCERPT: Are people in the West aware of the Jewish role in producing the filthiest child porn imaginable?

With the full connivance of the American government, Jews pursue this foul trade in the San Fernando valley, California, otherwise known as “Porn Valley”. (See here). No, the public largely remains unaware of these iniquitous facts, for the simple reason that the media covers up the facts.

The situation in Russia is even more extreme, with the majority of Russians totally unaware of the historical crimes committed against them by Jews in the Communist era. Here is Dr Pierce’s incendiary comment, and we must make allowances for his white-hot anger:

"The Jews are lucky they still control most of the television and other mass media in Russia—because if the Russian people ever are fully awakened to what the Jews are still doing to them, they will rise up and kill every Jew in Russia—every Jew—every Jew!—and they will be fully justified in doing so."

Whatever you do, don’t miss this electrifying video before it is banned.



Dr. William Pierce - White Children Are In Danger
https://www.youtube.com/watch?v=Srz31gIFm50


Source Article by Lasha Darkmoon:
Snuff Porn Pedophilia: Killing Children for Sexual Pleasure
https://www.darkmoon.me/2017/snuff-porn-pedophilia-killing-children-for-sexual-pleasure/


Before providing the gruesome details of the sadistic cruelties inflicted on sexually exploited children, many of them toddlers kidnapped from orphanages in Russia and tortured to death, it is necessary to set out the basic statistics: the principal facts and figures of the worldwide porn industry.

BEYOND THE PALE

“This is a sick world we are living in.”
— Dr William Pierce (in video below)

These notes come from an unpublished article of mine written a few years ago which I have just found among my papers after misplacing them. I have updated the figures wherever possible, but I wouldn’t be surprised to learn they are in some cases an underestimate. This is because porn addiction sucks millions of new victims into its net every year. There were only 670 million internet users worldwide in 2002, for example, but by 2013 this figure had soared to 2.7 billion. (See here). In other words, the pool of potential victims of porn addiction has grown much larger with each passing year.

Most of the figures cited below, except those with separately numbered references within the text, are sourced from Family Safe Media’s Pornography Statistics. Otherwise, they will be found in Top Ten Reviews’ Internet Pornography Statistics.

Total world revenues per annum from pornography amount to $100 billion, with $3,100 spent on porn internationally every second. These revenues are larger than the revenues of the top technology companies combined: Microsoft, Google, Amazon, eBay, Yahoo, Apple, Netflix and EarthLink.

There are 7 billion people in the world spread over 200 countries. It would be of interest to know which countries are most given to porn consumption on a per capita basis. Given the inseparable link between pornography and masturbation, the citizens of those countries could then be justly regarded as the “most lustful in the world” — or, at any rate, as the world’s most prolific masturbators.

These are the top 10 countries most given to masturbatory lust, based on per capita expenditure on pornography: (1) South Korea ($527 per capita). (2) Japan ($157 pc). (3) Finland ($115 pc). (4) Australia ($99 pc). (5) Brazil ($53 pc), (6) Czech Republic ($44.9). (7) United States ($44.6 pc), (8) Taiwan ($43.4 pc), (9), U.K. ($32 pc). (10) Canada ($30 pc).



Why the South Koreans and Japanese spend such enormous amounts of money on porn, compared to other nations, is subject matter for a sensational PhD thesis which I hope some eager doctoral student will write one day. For 11 years in a row, South Korea has ranked at No. 1 in the suicide rate among OECD nations. Whether there is any correlation between high porn consumption and high suicide rates is a fascinating conundrum which academic researchers might wish to solve.

Though China spends more on porn than any other nation in the world (a whopping 28 percent of total pornography revenues compared to America’s 14 percent), this is only because of China’s enormous population of 1.3 billion people. In spite of the fact that porn is officially “illegal” in China, a country sometimes described as “a land where porn doesn’t exist”, the Chinese appear to have easy access to pornography imported from Japan.

The annual expenditure on pornography in two countries alone, China and Japan, would be enough to feed the world’s hungry for an entire year.



There are over 4 million porn websites in the world, growing by the thousands every day. There are 68 million pornographic search engine requests a day, 25 percent of the total. Four out of 10 internet users view porn sites regularly. There are 100,000 websites offering illegal child pornography. The largest consumers of internet porn, surprisingly, are children aged 11-17. There are 40 million regular users of porn in the US, and 20 percent of these are accustomed to peek at porn sites at work when they think no one is looking.

A new porn site is being created in the US every 40 minutes. The most expensive domain name ever purchased (site link deleted) cost $14 million: an indication of the enormous profits accruing to porn.

Roughly one in three visitors to porn sites are women, with almost one in six women (17 percent) admitting to a serious porn addiction. In the pre-internet age, women were relatively safe from the devastating effects of pornography. No longer. In the last three years alone, online porn viewership for women has quadrupled. It is a myth that women have different preferences to men and show less appetite for hardcore pornography.

A 2008 study found that women showed signs of arousal watching pretty much anything: masturbation, straight sex, girl-on-girl, guy-on-guy, bonobo chimps, everything — everything except pictures of naked men, which did not float a woman’s boat.

Average age of the first internet exposure to pornography is 11 years old. 90 percent of 8-16-year-olds have viewed porn online, mostly while doing homework.

Over half of global child porn (55%) is produced in the US, mostly in the Los Angeles area. There are 100,000 websites offering illegal child porn. Annual child porn revenues range from a low of $3 billion to an unrealistically high $20 billion. Daily Gnutella “child pornography” requests are 116,000 and keep growing. Even more disturbingly, there is strong evidence that an addiction to “normal” adult pornography can lead in time to an appetite for child porn.

Between 2005 and 2009, there was a huge and unexplained 432 percent increase in child pornography use, taking this new sex plague to pandemic levels. [Link lost]

The top video porn producers are found in the US, with Brazil and the Netherlands coming in second and third. The top six US erotica cities are Los Angeles, Las Vegas, New York, Chicago, San Francisco and Miami.

The fully employed female porn star can earn $100k-300k a year, three times more than the average male porn star. The more unnatural the sex is, the higher the rates. An actress who gets $500 for a session of straight vaginal sex can demand $1000 for a session of anal sex and $2000 for “double anal sex”. Celebrity porn stars naturally get paid much more. (Link lost). A criminal pedophile willing to molest a child in front of a live webcam can earn $1000 a night.

The top ten countries most opposed to porn are the Islamic countries, viz., Saudi Arabia, Iran, Syria, Bahrain, Egypt, UAE, Kuwait, Malaysia, Indonesia, and Singapore.

Almost 90 percent of the world’s internet porn pages are produced in the US for distribution to other countries, so the US can be seen as the world’s premier sex emporium.

The big players in the porn distribution market are now the major corporations, and, ultimately, the fabulously rich and faceless executives who control them. These are Fortune 500 companies such as AOL Time-Warner, AT&T, and General Motors. Through their cable and satellite subsidiaries they have distributed, and continue to distribute, vast quantities of pornographic material worldwide.

The number of pornographic websites owned by American Jews is of course a closely guarded secret—this is one politically incorrect statistic Wikipedia is unlikely to supply—but it is common knowledge that Jews dominate the porn industry (See also here and here). Indeed, it is also common knowledge that six Jewish-owned companies own 96 percent of the world’s media and that Big Media and Big Porn are interlocking and overlapping concerns.

The Jewish Role in Child Murder and Snuff Pornography

If 55 percent of the world’s child pornography is produced in the US—according to the British charity National Children’s Homes—23 percent of the world’s child porn is produced in Russia. (Link suppressed)

Whether or not Russian child porn is dominated by Russian Jews remains a nebulous issue. There is a high probability that it is, given that there is substantial evidence of Russian Jewish involvement in sex trafficking, kidnapping, pedophilia, and even child murder in the production of snuff porn movies.

Let me now quote from a news report first published in October 2000. I will intersperse snippets of this report — “JEWISH GANGSTERS RAPED, KILLED CHILDREN AS YOUNG AS TWO ON FILM” — with comments on the same case by Dr William Pierce which you can listen to yourself in the video at the end of this article:

ROME, ITALY — Italian and Russian police, working together, broke up a ring of Jewish gangsters who had been involved in the manufacture of child rape and snuff pornography.

Three Russian Jews and eight Italian Jews were arrested after police discovered they had been kidnapping non-Jewish children between the ages of two and five years old from Russian orphanages, raping the children, and then murdering them on film.

Mostly non-Jewish customers, including 1700 nationwide, 600 in Italy, and an unknown number in the United States, paid as much as $20,000 per film to watch little children being raped and murdered.


Here is what Dr William Pierce has to say:

“I suggest that if you asked your favorite Jewish media boss why his report of the police raids in Italy and the arrest of the child pornographers in Moscow didn’t get more news coverage in the United States, he’ll tell you that such news would only generate hatred against the Jews. And you know, he’d be right.

“My view is that such people should SIMPLY BE KILLED ON THE SPOT whenever and wherever they are found. More than that, the people who promote and encourage the extreme individualist mindset through their control of the media SHOULD BE EXTERMINATED ROOT AND BRANCH AS A CLASS.”


(Video transcript, emphasis added)

The news report concludes:

Jewish officials in a major Italian news agency tried to cover the story up, but were circumvented by Italian news reporters, who broadcast scenes from the films live at prime time on Italian television to more than 11 million Italian viewers. Jewish officials then fired the executives responsible, claiming they were spreading “blood libel.”

Though AP and Reuters both ran stories on the episode, US media conglomerates refused to carry the story on television news, saying that it would prejudice Americans against Jews.


Dr Pierce is naturally outraged at these dirty tricks to conceal from the public the heavy Jewish role in snuff porn pedophilia: the systematic torture and murder of little children by Jewish pornographers in order to sate the jaded appetites of sexual perverts in the West:

“If there’s any group of people on this planet who have valid reasons for hating the Jews, it’s the Russians…. The Jews bled Russia dry with 70 years of Marxist rule and and murdered tens of millions of Russians—the best Russians—in the Communist slave labor camps or in the basements of the secret police headquarters or beside the shooting pits in forests all over Russia and Ukraine.

They have forced thousands of the prettiest young Russian women into prostitution and slavery after the fall of Communism; and now they kidnap Russian children and rape and sexually torture them in front of a camera in order to make child porn for rich perverts in the West.”


(Video transcript)



Are people in the West aware of the Jewish role in producing the filthiest child porn imaginable?

With the full connivance of the American government, Jews pursue this foul trade in the San Fernando valley, California, otherwise known as “Porn Valley”. (See here). No, the public largely remains unaware of these iniquitous facts, for the simple reason that the media covers up the facts.

The situation in Russia is even more extreme, with the majority of Russians totally unaware of the historical crimes committed against them by Jews in the Communist era. Here is Dr Pierce’s incendiary comment, and we must make allowances for his white-hot anger:

The Jews are lucky they still control most of the television and other mass media in Russia—because if the Russian people ever are fully awakened to what the Jews are still doing to them, they will rise up and kill every Jew in Russia—every Jew—every Jew!—and they will be fully justified in doing so.

(Video transcript)

Whatever you do, don’t miss this electrifying video before it is banned.

VIDEO : 8.48 mins


Dr. William Pierce - White Children Are In Danger - Oct. 7, 2000 (with CC)
https://youtu.be/Srz31gIFm50

Tuesday, May 16, 2017

JEWISH ANIMAL SACRIFICE ON THE STREETS OF NEW YORK CITY



Animal sacrifice is alive and well on the streets of New York City thanks to SATANIC JEWS that feel they have a right to make the streets run red with blood for their sick, sadistic rituals. The Jewdicial system supports this madness as well as other forms of evil like blood sucking circumcision rituals by members of this same satanic cult.

When do we say enough folks? How long are we going to let these filthy Luciferian, devil-worshippers walk free in America?


JEWISH ANIMAL SACRIFICE ON THE STREETS OF NEW YORK
https://vid.me/BjUd


Mirrored video originally posted at: https://www.facebook.com/theirturn/videos/1802576783326044/

Monday, May 15, 2017

STUDY ON HEALTH OF VACCINATED VS. UNVACCINATED 6-12 YEAR OLDS SCRAPPED FROM THE INTERNET



They have attempted to hide this information. Let's do our part to keep it moving. Please copy, paste, post on your own blogs, and share.

Excerpt:

The vaccinated were less likely than the unvaccinated to have been diagnosed with chickenpox and pertussis, but more likely to have been diagnosed with pneumonia, otitis media, allergies and NDD. After adjustment, vaccination, male gender, and preterm birth remained significantly associated with NDD. However, in a final adjusted model with interaction, vaccination but not preterm birth remained associated with NDD [neurodevelopmental disorders], while the interaction of preterm birth and vaccination was associated with a 6.6-fold increased odds of NDD (95% CI: 2.8, 15.5). In conclusion, vaccinated homeschool children were found to have a higher rate of allergies and NDD than unvaccinated homeschool children. While vaccination remained significantly associated with NDD after controlling for other factors, preterm birth coupled with vaccination was associated with an apparent synergistic increase in the odds of NDD.


Source:
Study on Health of vaccinated and unvaccinated 6 to 12 year olds
http://vaccinationdanger.blogspot.com/p/study-on-health-of-vaccinated-and.html


Study on Health of vaccinated and unvaccinated 6 to 12 year olds
Pilot comparative study on the health of vaccinated and unvaccinated 6- to 12- year old U.S. children
Anthony R Mawson
Professor, Department of Epidemiology and Biostatistics, School of Public Health, Jackson State University, Jackson, MS 39213, USA
Brian D Ray
President, National Home Education Research Institute, PO Box 13939, Salem, OR 97309, USA
Azad R Bhuiyan
Associate Professor, Department of Epidemiology and Biostatistics, School of Public Health, Jackson State University, Jackson, MS 39213, USA
Binu Jacob
Former graduate student, Department of Epidemiology and Biostatistics School of Public Health, Jackson State University, Jackson, MS 39213, USA
DOI: 10.15761/JTS.1000186


Abstract

Vaccinations have prevented millions of infectious illnesses, hospitalizations and deaths among U.S. children, yet the long-term health outcomes of the vaccination schedule remain uncertain. Studies have been recommended by the U.S. Institute of Medicine to address this question. This study aimed 1) to compare vaccinated and unvaccinated children on a broad range of health outcomes, and 2) to determine whether an association found between vaccination and neurodevelopmental disorders (NDD), if any, remained significant after adjustment for other measured factors. A cross-sectional study of mothers of children educated at home was carried out in collaboration with homeschool organizations in four U.S. states: Florida, Louisiana, Mississippi and Oregon. Mothers were asked to complete an anonymous online questionnaire on their 6- to 12-year-old biological children with respect to pregnancy-related factors, birth history, vaccinations, physician-diagnosed illnesses, medications used, and health services. NDD, a derived diagnostic measure, was defined as having one or more of the following three closely-related diagnoses: a learning disability, Attention Deficient Hyperactivity Disorder, and Autism Spectrum Disorder. A convenience sample of 666 children was obtained, of which 261 (39%) were unvaccinated. The vaccinated were less likely than the unvaccinated to have been diagnosed with chickenpox and pertussis, but more likely to have been diagnosed with pneumonia, otitis media, allergies and NDD. After adjustment, vaccination, male gender, and preterm birth remained significantly associated with NDD. However, in a final adjusted model with interaction, vaccination but not preterm birth remained associated with NDD [neurodevelopmental disorders], while the interaction of preterm birth and vaccination was associated with a 6.6-fold increased odds of NDD (95% CI: 2.8, 15.5). In conclusion, vaccinated homeschool children were found to have a higher rate of allergies and NDD than unvaccinated homeschool children. While vaccination remained significantly associated with NDD after controlling for other factors, preterm birth coupled with vaccination was associated with an apparent synergistic increase in the odds of NDD. Further research involving larger, independent samples and stronger research designs is needed to verify and understand these unexpected findings in order to optimize the impact of vaccines on children’s health.

Key words

acute diseases, chronic diseases, epidemiology, evaluation, health policy, immunization, neurodevelopmental disorders, vaccination


Abbreviations:

ADHD: Attention Deficit Hyperactivity Disorder; ASD: Autism Spectrum Disorder; AOM: Acute Otitis Media; CDC: Centers for Disease Control and Prevention; CI: Confidence Interval; NDD: Neurodevelopmental Disorders; NHERI: National Home Education Research Institute; OR: Odds Ratio; PCV-7: Pneumococcal Conjugate Vaccine-7; VAERS: Vaccine Adverse Events Reporting System.

Introduction

Vaccines are among the greatest achievements of biomedical science and one of the most effective public health interventions of the 20th century [1]. Among U.S. children born between 1995 and 2013, vaccination is estimated to have prevented 322 million illnesses, 21 million hospitalizations and 732,000 premature deaths, with overall cost savings of $1.38 trillion [2]. About 95% of U.S. children of kindergarten age receive all of the recommended vaccines as a requirement for school and daycare attendance [3,4], aimed at preventing the occurrence and spread of targeted infectious diseases [5]. Advances in biotechnology are contributing to the development of new vaccines for widespread use [6].

Under the currently recommended pediatric vaccination schedule [7], U.S. children receive up to 48 doses of vaccines for 14 diseases from birth to age six years, a figure that has steadily increased since the 1950s, most notably since the Vaccines for Children program was created in 1994. The Vaccines for Children program began with vaccines targeting nine diseases: diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b disease, hepatitis B, measles, mumps, and rubella. Between 1995 and 2013, new vaccines against five other diseases were added for children age 6 and under: varicella, hepatitis A, pneumococcal disease, influenza, and rotavirus vaccine.

Although short-term immunologic and safety testing is performed on vaccines prior to their approval by the U.S. Food and Drug Administration, the long-term effects of individual vaccines and of the vaccination program itself remain unknown [8]. Vaccines are acknowledged to carry risks of severe acute and chronic adverse effects, such as neurological complications and even death [9], but such risks are considered so rare that the vaccination program is believed to be safe and effective for virtually all children [10].

There are very few randomized trials on any existing vaccine recommended for children in terms of morbidity and mortality, in part because of ethical concerns involving withholding vaccines from children assigned to a control group. One exception, the high-titer measles vaccine, was withdrawn after several randomized trials in west Africa showed that it interacted with the diphtheria-tetanus-pertussis vaccine, resulting in a significant 33% increase in child mortality [11]. Evidence of safety from observational studies includes a limited number of vaccines, e.g., the measles, mumps and rubella vaccine, and hepatitis B vaccine, but none on the childhood vaccination program itself. Knowledge is limited even for vaccines with a long record of safety and protection against contagious diseases [12]. The safe levels and long-term effects of vaccine ingredients such as adjuvants and preservatives are also unknown [13]. Other concerns include the safety and cost-effectiveness of newer vaccines against diseases that are potentially lethal for individuals but have a lesser impact on population health, such as the group B meningococcus vaccine [14].

Knowledge of adverse events following vaccinations is largely based on voluntary reports to the Vaccine Adverse Events Reporting System (VAERS) by physicians and parents. However, the rate of reporting of serious vaccine injuries is estimated to be <1% [15]. These considerations led the former Institute of Medicine (now the National Academy of Medicine) in 2005 to recommend the development of a five-year plan for vaccine safety research by the Centers for Disease Control and Prevention (CDC) [16,17]. In its 2011 and 2013 reviews of the adverse effects of vaccines, the Institute of Medicine concluded that few health problems are caused by or associated with vaccines, and found no evidence that the vaccination schedule was unsafe [18,19]. Another systematic review, commissioned by the US Agency for Healthcare Research and Quality to identify gaps in evidence on the safety of the childhood vaccination program, concluded that severe adverse events following vaccinations are extremely rare [20]. The Institute of Medicine, however, noted that studies were needed: to compare the health outcomes of vaccinated and unvaccinated children; to examine the long-term cumulative effects of vaccines; the timing of vaccination in relation to the age and condition of the child; the total load or number of vaccines given at one time; the effect of other vaccine ingredients in relation to health outcomes; and the mechanisms of vaccine-associated injury [19]. A complicating factor in evaluating the vaccination program is that vaccines against infectious diseases have complex nonspecific effects on morbidity and mortality that extend beyond prevention of the targeted disease. The existence of such effects poses a challenge to the assumption that individual vaccines affect the immune system independently of each other and have no physiological effect other than protection against the targeted pathogen [21]. The nonspecific effects of some vaccines appear to be beneficial, while in others they appear to increase morbidity and mortality [22,23]. For instance, both the measles and Bacillus Calmette–Guérin vaccine reportedly reduce overall morbidity and mortality [24], whereas the diphtheria-tetanus-pertussis [25] and hepatitis B vaccines [26] have the opposite effect. The mechanisms responsible for these nonspecific effects are unknown but may involve inter alia: interactions between vaccines and their ingredients, e.g., whether the vaccines are live or inactivated; the most recently administered vaccine; micronutrient supplements such as vitamin A; the sequence in which vaccines are given; and their possible combined and cumulative effects [21]. A major current controversy is the question of whether vaccination plays a role in neurodevelopmental disorders (NDDs), which broadly include learning disabilities, Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). The controversy has been fueled by the fact that the U.S. is experiencing what has been described as a “silent pandemic” of mostly subclinical developmental neurotoxicity, in which about 15% of children suffer from a learning disability, sensory deficits, and developmental delays [27,28]. In 1996 the estimated prevalence of ASD was 0.42%. By 2010 it had risen to 1.47% (1 in 68), with 1 in 42 boys and 1 in 189 girls affected [29]. More recently, based on a CDC survey of parents in 2011–2014, 2.24% of children (1 in 45) were estimated to have ASD. Rates of other developmental disabilities, however, such as intellectual disability, cerebral palsy, hearing loss, and vision impairments, have declined or remained unchanged [30]. Prevalence rates of Attention Deficit Hyperactivity Disorder (ADHD) have also risen markedly in recent decades [31]. Earlier increases in the prevalence of learning disability have been followed by declining rates in most states, possibly due to changes in diagnostic criteria [32]. It is believed that much of the increase in NDD diagnoses in recent decades has been due to growing awareness of autism and more sensitive screening tools, and hence to greater numbers of children with milder symptoms of autism. But these factors do not account for all of the increase [33]. The geographically widespread increase in ASD and ADHD suggests a role for an environmental factor to which virtually all children are exposed. Agricultural chemicals are a current focus of research [34-37]. A possible contributory role for vaccines in the rise in NDD diagnoses remains unknown because data on the health outcomes of vaccinated and unvaccinated children are lacking. The need for such studies is suggested by the fact that the Vaccine Injury Compensation Program has paid $3.2 billion in compensation for vaccine injury since its creation in 1986 [38]. A study of claims compensated by the Vaccine Injury Compensation Program for vaccine-induced encephalopathy and seizure disorder found 83 claims that were acknowledged as being due to brain damage. In all cases it was noted by the Court of Federal Claims, or indicated in settlement agreements, that the children had autism or ASD [39]. On the other hand, numerous epidemiological studies have found no association between receipt of selected vaccines (in particular the combined measles, mumps, and rubella vaccine) and autism [10,40-45], and there is no accepted mechanism by which vaccines could induce autism [46]. A major challenge in comparing vaccinated and unvaccinated children has been to identify an accessible pool of unvaccinated children, since the vast majority of children in the U.S. are vaccinated. Children educated at home (“homeschool children”) are suitable for such studies as a higher proportion are unvaccinated compared to public school children [47]. Homeschool families have an approximately equal median income to that of married-couple families nationwide, somewhat more years of formal education, and a higher average family size (just over three children) compared to the national average of just over two children [48-50]. Homeschooling families are slightly overrepresented in the south, about 23% are nonwhite, and the age distribution of homeschool children in grades K-12 is similar to that of children nationwide [51]. About 3% of the school-age population was homeschooled in the 2011-2012 school year [52]. The aims of this study were 1) to compare vaccinated and unvaccinated children on a broad range of health outcomes, including acute and chronic conditions, medication and health service utilization, and 2) to determine whether an association found between vaccination and NDDs, if any, remained significant after adjustment for other measured factors. Methods

Study planning

To implement the study, a partnership was formed with the National Home Education Research Institute (NHERI), an organization that has been involved in educational research on homeschooling for many years and has strong and extensive contacts with the homeschool community throughout the country (www.nheri.org). The study protocol was approved by the Institutional Review Board of Jackson State University.

Study design

The study was designed as a cross-sectional survey of homeschooling mothers on their vaccinated and unvaccinated biological children ages 6 to 12. As contact information on homeschool families was unavailable, there was no defined population or sampling frame from which a randomized study could be carried out, and from which response rates could be determined. However, the object of our pilot study was not to obtain a representative sample of homeschool children but a convenience sample of unvaccinated children of sufficient size to test for significant differences in outcomes between the groups.
We proceeded by selecting 4 states (Florida, Louisiana, Mississippi, and Oregon) for the survey (Stage 1). NHERI compiled a list of statewide and local homeschool organizations, totaling 84 in Florida, 18 in Louisiana, 12 in Mississippi and 17 in Oregon. Initial contacts were made in June 2012. NHERI contacted the leaders of each statewide organization by email to request their support. A second email was then sent, explaining the study purpose and background, which the leaders were asked to forward to their members (Stage 2). A link was provided to an online questionnaire in which no personally identifying information was requested. With funding limited to 12 months, we sought to obtain as many responses as possible, contacting families only indirectly through homeschool organizations. Biological mothers of children ages 6-12 years were asked to serve as respondents in order to standardize data collection and to include data on pregnancy-related factors and birth history that might relate to the children's current health. The age-range of 6 to 12 years was selected because most recommended vaccinations would have been received by then.

Recruitment and informed consent

Homeschool leaders were asked to sign Memoranda of Agreement on behalf of their organizations and to provide the number of member families. Non-responders were sent a second notice but few provided the requested information. However, follow-up calls to the leaders suggested that all had contacted their members about the study. Both the letter to families and the survey questions were stated in a neutral way with respect to vaccines. Our letter to parents began:

“Dear Parent, This study concerns a major current health question: namely, whether vaccination is linked in any way to children's long-term health. Vaccination is one of the greatest discoveries in medicine, yet little is known about its long-term impact. The objective of this study is to evaluate the effects of vaccination by comparing vaccinated and unvaccinated children in terms of a number of major health outcomes …”

Respondents were asked to indicate their consent to participate, to provide their home state and zip code of residence, and to confirm that they had biological children 6 to 12 years of age. The communications company Qualtrics (http://qualtrics.com) hosted the survey website. The questionnaire included only closed-ended questions requiring yes or no responses, with the aim of improving both response and completion rates.

A number of homeschool mothers volunteered to assist NHERI promote the study to their wide circles of homeschool contacts. A number of nationwide organizations also agreed to promote the study in the designated states. The online survey remained open for three months in the summer of 2012. Financial incentives to complete the survey were neither available nor offered.

Definitions and measures

Vaccination status was classified as unvaccinated (i.e., no previous vaccinations), partially vaccinated (received some but not all recommended vaccinations) and fully vaccinated (received all recommended age-appropriate vaccines), as reported by mothers. These categories were developed on the premise that any long-term effects of vaccines would be more evident in fully-vaccinated than in partially-vaccinated children, and rare or absent in the unvaccinated. Mothers were asked to use their child’s vaccination records to indicate the recommended vaccines and doses their child had received. Dates of vaccinations were not requested in order not to overburden respondents and to reduce the likelihood of inaccurate reporting; nor was information requested on adverse events related to vaccines, as this was not our purpose. We also did not ask about dates of diagnoses because chronic illnesses are often gradual in onset and made long after the appearance of symptoms. Since most vaccinations are given before age 6, vaccination would be expected to precede the recognition and diagnosis of most chronic conditions.

Mothers were asked to indicate on a list of more than 40 acute and chronic illnesses all those for which her child or children had received a diagnosis by a physician. Other questions included the use of health services and procedures, dental check-ups, “sick visits” to physicians, medications used, insertion of ventilation ear tubes, number of days in the hospital, the extent of physical activity (number of hours the child engaged in “vigorous” activities on a typical weekday), number of siblings, family structure (mother and father living in the home, divorced or separated), family income and/or highest level of education of mother or father, and social interaction with children outside the home (i.e., amount of time spent in play or other contact with children outside the household). Questions specifically for the mother included pregnancy-related conditions and birth history, use of medications during pregnancy, and exposure to an adverse environment (defined as living within 1-2 miles of a furniture manufacturing factory, hazardous waste site, or lumber processing factory). NDD, a derived diagnostic category, was defined as having one or more of the following three closely related and overlapping diagnoses: a learning disability, Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) [53].

Statistical methods

Unadjusted bivariate analyses using chi-square tests were performed initially to test the null hypothesis of no association between vaccination status and health outcomes, i.e., physician-diagnosed acute and chronic illnesses, medications, and the use of health services. In most analyses, partially and fully vaccinated children were grouped together as the “vaccinated” group, with unvaccinated children as the control group. The second aim of the study was to determine whether any association found between vaccination and neurodevelopmental disorders remained significant after controlling for other measured factors. Descriptive statistics on all variables were computed to determine frequencies and percentages for categorical variables and means (± SD) for continuous variables. The strength of associations between vaccination status and health outcomes were tested using odds ratios (OR) and 95% Confidence Intervals (CI). Odds ratios describe the strength of the association between two categorical variables measured simultaneously and are appropriate measures of that relationship in a cross-sectional study [54]. Unadjusted and adjusted logistic regression analyses were carried out using SAS (Version 9.3) to determine the factors associated with NDDs.

Results

Socio-Demographic characteristics of respondents

The information contained in 415 questionnaires provided data on 666 homeschool children. Table 1 shows the characteristics of the survey respondents. Mothers averaged about 40 years of age, were typically white, college graduates, with household incomes between $50,000 to $100,000, Christian, and married. The reasons for homeschooling for the majority of respondents (80-86%) were for a moral environment, better family relationships, or for more contact with their child or children.



The children as a group were similarly mostly white (88%), with a slight preponderance of females (52%), and averaged 9 years of age. With regard to vaccination status, 261 (39%) were unvaccinated, 208 (31%) were partially vaccinated, and 197 (30%) had received all of the recommended vaccinations. All statistical analyses are based on these numbers.

Acute illness

Vaccinated children (N=405), combining the partially and fully vaccinated, were significantly less likely than the unvaccinated to have had chickenpox (7.9% vs. 25.3%, p <0.001; Odds Ratio = 0.26, 95% Confidence Interval: 0.2, 0.4) and whooping cough (pertussis) (2.5% vs. 8.4%, p <0.001; OR 0.3, 95% CI: 0.1, 0.6), and less likely, but not significantly so, to have had rubella (0.3% vs. 1.9%, p = 0.04; OR 0.1, 95% CI: 0.01, 1.1). However, the vaccinated were significantly more likely than the unvaccinated to have been diagnosed with otitis media (19.8% vs. 5.8%, p <0.001; OR 3.8, 95% CI: 2.1, 6.6) and pneumonia (6.4% vs. 1.2%, p = 0.001; OR 5.9, 95% CI: 1.8, 19.7). No significant differences were seen with regard to hepatitis A or B, high fever in the past 6 months, measles, mumps, meningitis (viral or bacterial), influenza, or rotavirus (Table 2).

Chronic illness

Vaccinated children were significantly more likely than the unvaccinated to have been diagnosed with the following: allergic rhinitis (10.4% vs. 0.4%, p <0.001; OR 30.1, 95% CI: 4.1, 219.3), other allergies (22.2% vs. 6.9%, p <0.001; OR 3.9, 95% CI: 2.3, 6.6), eczema/atopic dermatitis (9.5% vs. 3.6%, p = 0.035; OR 2.9, 95% CI: 1.4, 6.1), a learning disability (5.7% vs. 1.2%, p = 0.003; OR 5.2, 95% CI: 1.6, 17.4), ADHD (4.7% vs. 1.0%, p = 0.013; OR 4.2, 95% CI: 1.2, 14.5), ASD (4.7% vs. 1.0%, p = 0.013; OR 4.2, 95% CI: 1.2, 14.5), any neurodevelopmental disorder (i.e., learning disability, ADHD or ASD) (10.5% vs. 3.1%, p <0.001; OR 3.7, 95% CI: 1.7, 7.9) and any chronic illness (44.0% vs. 25.0%, p <0.001; OR 2.4, 95% CI: 1.7, 3.3). No significant differences were observed with regard to cancer, chronic fatigue, conduct disorder, Crohn’s disease, depression, Types 1 or 2 diabetes, encephalopathy, epilepsy, hearing loss, high blood pressure, inflammatory bowel disease, juvenile rheumatoid arthritis, obesity, seizures, Tourette’s syndrome, or services received under the Individuals with Disabilities Education Act (Table 3). Table 3. Vaccination status and health outcomes – Chronic Conditions


Partial versus full vaccination

Partially vaccinated children had an intermediate position between the fully vaccinated and unvaccinated in regard to several but not all health outcomes. For instance, as shown in Table 4, the partially vaccinated had an intermediate (apparently detrimental) position in terms of allergic rhinitis, ADHD, eczema, and learning disability.

Table 4. Partial versus full vaccination and chronic health conditions



Gender differences in chronic illness

Among the vaccinated (combining partially and fully vaccinated children), boys were more likely than girls to be diagnosed with a chronic condition – significantly so in the case of allergic rhinitis (13.9% vs. 7.2%, p = 0.03; OR 2.1, 95% CI: 1.1, 4.1), ASD (7.7% vs. 1.9%, p = 0.006; OR 4.3, 95% CI: 1.4, 13.2), and any neurodevelopmental disorder (14.4% vs. 6.7%, p = 0.01; OR 2.3, 95% CI: 1.2, 4.6) (Table 5).

Table 5. Chronic conditions and gender among vaccinated children



Use of medications and health services

The vaccinated (combining the partially and fully vaccinated) were significantly more likely than the unvaccinated to use medication for allergies (20.0% vs. 1.2%, p <0.001; OR 21.5, 95% CI: 6.7, 68.9), to have used antibiotics in the past 12 months (30.8% vs. 15.4%, p <0.001; OR 2.4, 95% CI: 1.6, 3.6), and to have used fever medications at least once (90.7% vs. 67.8%, p <0.001; OR 4.6, 95% CI: 3.0, 7.1). The vaccinated were also more likely to have seen a doctor for a routine checkup in the past 12 months (57.6% vs. 37.2%, p <0.001; OR 2.3, 95% CI: 1.7, 3.2), visited a dentist during the past year (89.4% vs. 80.5%, p <0.001; OR 2.0, 95% CI: 1.3, 3.2), visited a doctor or clinic due to illness in the past year (36.0% vs. 16.0%, p <0.001; OR 3.0, 95% CI: 2.0, 4.4), been fitted with ventilation ear tubes (3.0% vs. 0.4%, p = 0.018; OR 8.0, 95% CI: 1.0, 66.1), and spent one or more nights in a hospital (19.8% vs. 12.3%, p = 0.012; OR 1.8, 95% CI: 1.1, 2.7) (Table 6). Table 6. Vaccination status, medication use and health services utilization



Factors associated with neurodevelopmental disorders

The second aim of the study focused on a specific health outcome and was designed to determine whether vaccination was associated with neurodevelopmental disorders (NDD) and, if so, whether the association remained significant after adjustment for other measured factors. As noted, because of the relatively small numbers of children with specific diagnoses, NDD was a derived variable combining children with a diagnosis of one or more of ASD, ADHD and a learning disability. The close association and overlap of these diagnoses in the study is shown in the figure above (Figure 1). The figure shows that the single largest group of diagnoses was learning disability (n=15) followed by ASD (n=9), and ADHD (n=9), with smaller numbers comprising combinations of the three diagnoses.


Figure 1. The overlap and distribution of physician-diagnosed neurodevelopmental disorders, based on mothers’ reports.

Unadjusted analysis

Table 7 shows that the factors associated with NDD in unadjusted logistic regression analyses were: vaccination (OR 3.7, 95% CI: 1.7, 7.9); male gender (OR 2.1, 95% CI: 1.1, 3.8); adverse environment, defined as living within 1-2 miles of a furniture manufacturing factory, hazardous waste site, or lumber processing factory (OR 2.9, 95% CI: 1.1, 7.4); maternal use of antibiotics during pregnancy (OR 2.3, 95% CI: 1.1, 4.8); and preterm birth (OR 4.9, 95% CI: 2.4, 10.3). Two factors that almost reached statistical significance were vaccination during pregnancy (OR 2.5, 95% CI: 1.0, 6.3) and three or more fetal ultrasounds (OR 3.2, 95% CI: 0.92, 11.5). Factors that were not associated with NDD in this study included mother’s education, household income, and religious affiliation; use of acetaminophen, alcohol, and antacids during pregnancy; gestational diabetes; preeclampsia; Rhogham shot during pregnancy; and breastfeeding (data not shown).

Table 7. Unadjusted analysis of potential risk factors for neurodevelopmental disorders

*Numbers may not add to column totals due to missing or incomplete data.
**Note that Odds Ratios are the cross-product ratios of the entries in the 2-by-2 tables, and are an estimate of the relative incidence (or risk) of the outcome associated with the exposure factor.


Adjusted analysis

After adjustment for all other significant factors, those that remained significantly associated with NDD were: vaccination (OR 3.1, 95% CI: 1.4, 6.8); male gender (OR 2.3, 95% CI: 1.2, 4.3); and preterm birth (OR 5.0, 95% CI: 2.3, 11.1). The apparently strong association between both vaccination and preterm birth and NDD suggested the possibility of an interaction between these factors.

In a final adjusted model designed to test for this possibility, controlling for the interaction of preterm birth and vaccination, the following factors remained significantly associated with NDD: vaccination (OR 2.5, 95% CI: 1.1, 5.6), nonwhite race (OR 2.4, 95% CI: 1.1, 5.4), and male gender (OR 2.3, 95% CI: 1.2, 4.4). Preterm birth itself, however, was not significantly associated with NDD, whereas the combination (interaction) of preterm birth and vaccination was associated with 6.6-fold increased odds of NDD (95% CI: 2.8, 15.5) (Table 8).

Table 8. Adjusted logistic regression analyses of risk factors and NDD*

*Number of observation read 666, number of observations used 629. NDD=47, Not NDD = 582


Discussion

Following a recommendation of the Institute of Medicine [19] for studies comparing the health outcomes of vaccinated and unvaccinated children, this study focused on homeschool children ages 6 to 12 years based on mothers’ anonymous reports of pregnancy-related conditions, birth histories, physician-diagnosed illnesses, medications and healthcare use. Respondents were mostly white, married, and college-educated, upper income women who had been contacted and invited to participate in the study by the leaders of their homeschool organizations. Data from the survey were also used to determine whether vaccination was associated specifically with NDDs, a derived diagnostic category combining children with the diagnoses of learning disability, ASD and/or ADHD.

With regard to acute and chronic conditions, vaccinated children were significantly less likely than the unvaccinated to have had chickenpox and pertussis but, contrary to expectation, were significantly more likely to have been diagnosed with otitis media, pneumonia, allergic rhinitis, eczema, and NDD. The vaccinated were also more likely to have used antibiotics, allergy and fever medications; to have been fitted with ventilation ear tubes; visited a doctor for a health issue in the previous year, and been hospitalized. The reason for hospitalization and the age of the child at the time were not determined, but the latter finding appears consistent with a study of 38,801 reports to the VAERS of infants who were hospitalized or had died after receiving vaccinations. The study reported a linear relationship between the number of vaccine doses administered at one time and the rate of hospitalization and death; moreover, the younger the infant at the time of vaccination, the higher was the rate of hospitalization and death [55]. The hospitalization rate increased from 11% for 2 vaccine doses to 23.5% for 8 doses (r2 = 0.91), while the case fatality rate increased significantly from 3.6% for those receiving from 1-4 doses to 5.4 % for those receiving from 5-8 doses.

In support of the possibility that the number of vaccinations received could be implicated in risks of associated chronic illness, a comparison of unvaccinated, partially and fully vaccinated children in the present study showed that the partially vaccinated had increased but intermediate odds of chronic disease, between those of unvaccinated and fully vaccinated children, specifically for allergic rhinitis, ADHD, eczema, a learning disability, and NDD as a whole.

The national rates of ADHD and LD are comparable to those of the study. The U.S. rate of ADHD for ages 4-17 (twice the age range of children than the present study), is 11% [31]. The study rate of ADHD for ages 6 to 12 is 3.3%, and 4.7% when only vaccinated children are included. The national LD rate is 5% [32], and the study data show a rate of LD of 3.9% for all groups, and 5.6% when only vaccinated children are included. However, the ASD prevalence of 2.24% from a CDC parent survey is lower than the study rate of 3.3%. Vaccinated males were significantly more likely than vaccinated females to have been diagnosed with allergic rhinitis, and NDD. The percentage of vaccinated males with an NDD in this study (14.4%) is consistent with national findings based on parental responses to survey questions, indicating that 15% of U.S. children ages 3 to 17 years in the years 2006-2008 had an NDD [28]. Boys are also more likely than girls to be diagnosed with an NDD, and ASD in particular [29].

Vaccination was strongly associated with both otitis media and pneumonia, which are among the most common complications of measles infection [56,57]. The odds of otitis media were almost four-fold higher among the vaccinated (OR 3.8, 95% CI: 2.1, 6.6) and the odds of myringotomy with tube placement were eight-fold higher than those of unvaccinated children (OR 8.0, 95% CI: 1.0, 66.1). Acute otitis media (AOM) is a very frequent childhood infection, accounting for up to 30 million physician visits each year in the U.S., and the most common reason for prescribing antibiotics for children [58,59]. The incidence of AOM peaks at ages 3 to 18 months and 80% of children have experienced at least one episode by 3 years of age. Rates of AOM have increased in recent decades [60]. Worldwide, the incidence of AOM is 10.9%, with 709 million cases each year, 51% occurring in children under 5 years of age [61]. Pediatric AOM is a significant concern in terms of healthcare utilization in the U.S., accounting for $2.88 billion in annual health care costs [62].

Numerous reports of AOM have been filed with VAERS. A search of VAERS for “Cases where age is under 1 and onset interval is 0 or 1 or 2 or 3 or 4 or 5 or 6 or 7 days and Symptom is otitis media” [63] revealed that 438,573 cases were reported between 1990 and 2011, often with fever and other signs and symptoms of inflammation and central nervous system involvement. One study [64] assessed the nasopharyngeal carriage of S. pneumoniae, H. influenzae, and M. catarrhalis during AOM in fully immunized, partly immunized children with 0 or 1 dose of Pneumococcal Conjugate Vaccine-7 (PCV7), and “historical control” children from the pre-PCV-7 era, and found an increased frequency of M. catarrhalis colonization in the vaccinated group compared to the partly immunized and control groups (76% vs. 62% and 56%, respectively). A high rate of Moraxella catarrhalis colonization is associated with an increased risk of AOM [65].

Successful vaccination against pneumococcal infections can lead to replacement of the latter in the nasopharyngeal niche by nonvaccine pneumococcal serotypes and disease [66]. Vaccination with PCV-7 has a marked effect on the complete microbiota composition of the upper respiratory tract in children, going beyond shifts in the distribution of pneumococcal serotypes and known potential pathogens and resulting in increased anaerobes, gram-positive bacteria and gram-negative bacterial species. PCV-7 administration also correlates highly with the emergence and expansion of oropharyngeal types of species. These observations have suggested that eradication of vaccine serotype pneumococci can be followed by colonization of other bacterial species in the vacant nasopharyngeal niche, leading to disequilibria of bacterial composition (dysbiosis) and increased risks of otitis media. Long-term monitoring has been recommended as essential for understanding the full implications of vaccination-induced changes in microbiota structure [67].

The second aim of the paper focused on a specific health outcome and sought to determine whether vaccination remained associated with neurodevelopmental disorders (NDD) after controlling for other measured factors. After adjustment, the factors that remained significantly associated with NDD were vaccination, nonwhite race, male gender, and preterm birth. The apparently strong association between both vaccination and preterm birth and NDD suggested the possibility of an interaction between these factors. This was shown in a final adjusted model with interaction (controlling for the interaction of preterm birth with vaccination). In this model, vaccination, nonwhite race and male gender remained associated with NDD, whereas preterm birth itself was no longer associated with NDD. However, preterm birth combined with vaccination was associated with a 6.6-fold increased odds of NDD.

In summary, vaccination, nonwhite race, and male gender were significantly associated with NDD after controlling for other factors. Preterm birth, although significantly associated with NDD in unadjusted and adjusted analyses, was no longer associated with NDD in the final model with interaction. However, preterm birth and vaccination combined was strongly associated with NDD in the final adjusted model with interaction, more than doubling the odds of NDD compared to vaccination alone. Preterm birth has long been known as a major factor for NDD [68,69], but since preterm infants are routinely vaccinated, the separate effects of preterm birth and vaccination have not been examined. The present study suggests that vaccination could be a contributing factor in the pathogenesis of NDD but also that preterm birth by itself may have a lesser or much reduced role in NDD (defined here as ASD, ADHD and/or a learning disability) than currently believed. The findings also suggest that vaccination coupled with preterm birth could increase the odds of NDD beyond that of vaccination alone.

Potential limitations

We did not set out to test a specific hypothesis about the association between vaccination and health. The aim of the study was to determine whether the health outcomes of vaccinated children differed from those of unvaccinated homeschool children, given that vaccines have nonspecific effects on morbidity and mortality in addition to protecting against targeted pathogens [11]. Comparisons were based on mothers’ reports of pregnancy-related factors, birth histories, vaccinations, physician-diagnosed illnesses, medications, and the use of health services. We tested the null hypothesis of no difference in outcomes using chi-square tests, and then used Odds Ratios and 96% Confidence Intervals to determine the strength and significance of the association.

If the effects of vaccination on health were limited to protection against the targeted pathogens, as is assumed to be the case [21], no difference in outcomes would be expected between the vaccinated and unvaccinated groups except for reduced rates of the targeted infectious diseases. However, in this homogeneous sample of 666 children there were striking differences in diverse health outcomes between the groups. The vaccinated were less likely to have had chickenpox or whooping cough, as expected, but more likely to have been diagnosed with pneumonia and ear infections as well as allergies and NDDs.

What credence can be given to the findings? This study was not intended to be based on a representative sample of homeschool children but on a convenience sample of sufficient size to test for significant differences in outcomes. Homeschoolers were targeted for the study because their vaccination completion rates are lower than those of children in the general population. In this respect our pilot survey was successful, since data were available on 261 unvaccinated children.

To eliminate opportunities for subjectivity or opinion in the data, only factual information was requested and the questions involved memorable events such as physician-diagnosed diseases in a child. With regard to minimizing potential bias in the information provided by mothers, all communications with the latter emphasized neutrality regarding vaccination and vaccine safety. To minimize recall bias, respondents were asked to use their child’s vaccination records. To enhance reliability, closed-ended questions were used and each set of questions had to be completed before proceeding to the next. To enhance validity, parents were asked to report only physician-diagnosed illnesses.

Mothers’ reports could not be validated by clinical records because the survey was designed to be anonymous. However, self-reports about significant events provide a valid proxy for official records when medical records and administrative data are unavailable [70]. Had mothers been asked to provide copies of their children’s medical records it would no longer have been an anonymous study and would have resulted in few completed questionnaires. We were advised by homeschool leaders that recruitment efforts would have been unsuccessful had we insisted on obtaining the children’s medical records as a requirement for participating in the study.

A further potential limitation is under-ascertainment of disease in unvaccinated children. Could the unvaccinated have artificially reduced rates of illness because they are seen less often by physicians and would therefore have been less likely to be diagnosed with a disease? The vaccinated were indeed more likely to have seen a doctor for a routine checkup in the past 12 months (57.5% vs. 37.1%, p < 0.001; OR 2.3, 95% CI: 1.7, 3.1). Such visits usually involve vaccinations, which non-vaccinating families would be expected to refuse. However, fewer visits to physicians would not necessarily mean that unvaccinated children are less likely to be seen by a physician if their condition warranted it. In fact, since unvaccinated children were more likely to be diagnosed with chickenpox and whooping cough, which would have involved a visit to the pediatrician, differences in health outcomes are unlikely to be due to under-ascertainment. Strengths of the study include the unique design of the study, involving homeschool mothers as respondents, and the relatively large sample of unvaccinated children, which made it possible to compare health outcomes across the spectrum of vaccination coverage. Recruitment of biological mothers as respondents also allowed us to test hypotheses about the role of pregnancy-related factors and birth history as well as vaccination in NDD and other specific conditions. In addition, this was a within-group study of a demographically homogeneous population of mainly white, higher-income and college-educated homeschooling families in which the children were all 6-12 years of age. Information was provided anonymously by biological mothers, obviously well-informed about their own children’s vaccination status and health, which likely increased the validity of the reports. Conclusions

Assessment of the long-term effects of the vaccination schedule on morbidity and mortality has been limited [71]. In this pilot study of vaccinated and unvaccinated homeschool children, reduced odds of chickenpox and whooping cough were found among the vaccinated, as expected, but unexpectedly increased odds were found for many other physician-diagnosed conditions. Although the cross-sectional design of the study limits causal interpretation, the strength and consistency of the findings, the apparent “dose-response” relationship between vaccination status and several forms of chronic illness, and the significant association between vaccination and NDDs all support the possibility that some aspect of the current vaccination program could be contributing to risks of childhood morbidity. Vaccination also remained significantly associated with NDD after controlling for other factors, whereas preterm birth, long considered a major risk factor for NDD, was not associated with NDD after controlling for the interaction between preterm birth and vaccination. In addition, preterm birth coupled with vaccination was associated with an apparent synergistic increase in the odds of NDD above that of vaccination alone. Nevertheless, the study findings should be interpreted with caution. First, additional research is needed to replicate the findings in studies with larger samples and stronger research designs. Second, subject to replication, potentially detrimental factors associated with the vaccination schedule should be identified and addressed and underlying mechanisms better understood. Such studies are essential in order to optimize the impact of vaccination of children’s health.

Competing Interests

The authors declare that they have no financial interests that had any bearing on any aspect of the conduct or conclusions of the study and the submitted manuscript.

Author contributions

AM designed the study, contributed to data analysis and interpretation, and drafted the paper. BR designed the study, contributed to data collection, and edited the paper. AB contributed to data analyses and edited the paper. BJ contributed to data analyses and editing. All authors read and approved the final version of the paper.

Funding sources

This study was supported by grants from Generation Rescue, Inc., and the Children’s Medical Safety Research Institute, charitable organizations that support research on children’s health and safety. The funders had no role or influence on the design and conduct of the research or the preparation of reports.

Acknowledgments

The authors thank all those who contributed critical comments, suggestions and financial support for the project. We also thank the collaborating homeschool organizations and especially the mothers who participated in the survey.

Disclaimer

This study was approved by the Institutional Review Board of Jackson State University and completed prior to Dr. Mawson’s tenure-track appointment at Jackson State University.

References

Centers for Disease Control and Prevention (CDC) (1999) Ten great public health achievements--United States, 1900-1999. MMWR Morb Mortal Wkly Rep 48: 241-243. [Crossref]
Whitney CG, Zhou F, Singleton J, Schuchat A; Centers for Disease Control and Prevention (CDC) (2014) Benefits from immunization during the vaccines for children program era - United States, 1994-2013. MMWR Morb Mortal Wkly Rep 63: 352-355. [Crossref]
Centers for Disease Control and Prevention (CDC) (2007) Vaccination coverage among children in kindergarten--United States, 2006-07 school year. MMWR Morb Mortal Wkly Rep 56: 819-821. [Crossref]
Centers for Disease Control and Prevention (CDC) (2013) Vaccination coverage among children in kindergarten - United States, 2012-13 school year. MMWR Morb Mortal Wkly Rep 62: 607-612. [Crossref]
http://www.cdc.gov/vaccines/vacgen/whatifstop.htm (Accessed 19 June 2016)
http://www.hhs.gov/nvpo/vacc_plan/index.html (Accessed 19 June 2015).
http://www.cdc.gov/vaccines/schedules/index.html (Accessed 19 June 2016).
Ward BJ (2000) Vaccine adverse events in the new millennium: is there reason for concern? Bull World Health Organ 78: 205-215. [Crossref]
Sienkiewicz D, Kulak W, Okurowska-Zawada B, Paszko-Pateg G (2012) Neurologic adverse events following vaccination. Prog Health Sci 2: 129-141.
Pollard AJ (2007) Childhood immunisation: what is the future? Arch Dis Child 92: 426-433. [Crossref]
[Crossref] Aaby P, Whittle H, Benn CS (2012) Vaccine programmes must consider their effect on general resistance. BMJ 344: e3769.
[Crossref] Cunningham AS (2015) Vaccine mandates in the US are doing more harm than good. BMJ 351: h4576.
Dórea JG. Exposure to mercury and aluminum in early life: developmental vulnerability as a modifying factor in neurologic and immunologic effects. Int J Environ Res Public Health (2015) 12(2):1295-313.
[Crossref] Crowcroft NS1, Deeks SL2, Upshur RE2 (2015) Do we need a new approach to making vaccine recommendations? BMJ 350: h308.
[Crossref] Kessler DA1 (1993) Introducing MEDWatch. A new approach to reporting medication and device adverse effects and product problems. JAMA 269: 2765-2768.
http://www.nap.edu/catalog.php?record_id=11234 (Accessed 19 June 2016).
http://www.cdc.gov/vaccinesafety/pdf/iso-finalscientific_agenda-nov- 10.pdf (Accessed 19 June 2016).
Institute of Medicine (2012) Adverse Effects of Vaccines: Evidence and Causality. The National Academies Press, Washington, DC.
Institute of Medicine (2013) The childhood immunization schedule and safety: Stakeholder concerns, scientific evidence, and future studies. The National Academies Press, Washington, DC.
Maglione MA, Das L, Raaen L, Smith A, Chari R, et al. (2014) Safety of vaccines used for routine immunization of US children: a systematic review. Pediatrics 134: 325-337. [Crossref]
Siegrist CA (2008) Vaccine Immunology. Vaccines. (5th Edtn). Saunders Elsevier.
Benn CS, Netea MG, Selin LK, Aaby P (2013) A small jab - a big effect: nonspecific immunomodulation by vaccines. Trends Immunol 34: 431-439. [Crossref]
Jensen KJ, Benn CS, van Crevel R (2016) Unravelling the nature of non-specific effects of vaccines - A challenge for innate immunologists. Semin Immunol 28: 377-383. [Crossref]
Sørup S, Benn CS, Poulsen A, Krause TG, Aaby P, et al. (2014) Live vaccine against measles, mumps, and rubella and the risk of hospital admissions for nontargeted infections. JAMA 311: 826-835. [Crossref]
Aaby P, Benn C, Nielsen J, Lisse IM, Rodrigues A, et al. (2012)Testing the hypothesis that diphtheria-tetanus-pertussis vaccine has negative non-specific and sex-differential effects on child survival in high-mortality countries. BMJ Open 2: e000707. [Crossref]
Garly ML1, Jensen H, Martins CL, Balé C, Baldé MA, et al. (2004) Hepatitis B vaccination associated with higher female than male mortality in Guinea-Bissau: an observational study. Pediatr Infect Dis J 23: 10861092. [Crossref]
Grandjean P, Landrigan PJ (2006) Developmental neurotoxicity of industrial chemicals. Lancet 368: 2167-2178. [Crossref]
Boyle CA, Boulet S, Schieve LA, Cohen RA, Blumberg SJ, , et al. (2011) Trends in the prevalence of developmental disabilities in US Children, 1997-2008. Pediatrics 127: 10341042. [Crossref]
Baio J (2014) Prevalence of Autism Spectrum Disorder among children aged 8 years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010 Surveillance Summaries. MMWR 63: 1-21.
Zablotsky B, Black LI, Maenner MJ, Schieve LA, Blumberg SJ (2015) Estimated prevalence of autism and other developmental disabilities following questionnaire changes in the 2014 National Health Interview Survey. Natl Health Stat Report 13: 1-20.
Visser SN, Danielson ML, Bitsko RH, Holbrook JR, Kogan MD, et al. (2014) Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. J Am Acad Child Adolesc Psychiatry 53: 34-46.e2. [Crossref]
Cortiella C, Horowitz SH (2014) The State of Learning Disabilities: Facts, Trends and Emerging Issues. National Center for Learning Disabilities, New York:.
Cornwall W (2015) Autism rates are up, but is it really on the rise? Science Magazine.
Landrigan PJ (2010) What causes autism? Exploring the environmental contribution. Curr Opin Pediatr 22: 219-225. [Crossref]
Nevison CD (2014) A comparison of temporal trends in United States autism prevalence to trends in suspected environmental factors. Environ Health 13: 73. [Crossref]
Shaw CA, Seneff S, Kette SD, Tomljenovic L, Oller JW Jr, et al. (2014) Aluminum-induced entropy in biological systems: implications for neurological disease. J Toxicol 2014: 491316. [Crossref]
Sealey LA, Hughes BW, Sriskanda AN1, Guest JR1, Gibson AD1, et al. (2016) Environmental factors in the development of autism spectrum disorders. Environ Int 88: 288-298. [Crossref]
http://www.hrsa.gov/vaccinecompensation/data.html (Accessed 20 June 2016).
Holland M, Conte L, Krakow R, Colin L (2011) Unanswered questions from the Vaccine Injury Compensation Program: A review of compensated cases of vaccine-induced brain injury. Pace Envtl L Rev 28: 480.
Doja A, Roberts W (2006) Immunizations and autism: a review of the literature. Can J Neurol Sci 33: 341-346. [Crossref]
Price CS, Thompson WW, Goodson B, Weintraub ES, Croen LA, et al. (2010) Prenatal and infant exposure to thimerosal from vaccines and immunoglobulins and risk of autism. Pediatrics 126: 656-664. [Crossref]
DeStefano F, Price CS, Weintraub ES (2013) Increasing exposure to antibody-stimulating proteins and polysaccharides in vaccines is not associated with risk of autism. J Pediatr 163: 561-567. [Crossref]
McNeil MM, Gee J, Weintraub ES, Belongia EA, Lee GM, et al. (2014) The Vaccine Safety Datalink: successes and challenges monitoring vaccine safety. Vaccine 32: 5390-5398. [Crossref]
Taylor LE, Swerdfeger AL, Eslick GD (2014) Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine 32: 3623-3629. [Crossref]
Jain A, Marshall J, Buikema A, Bancroft T, Kelly JP, et al. (2015) Autism occurrence by MMR vaccine status among US children with older siblings with and without autism. JAMA 313: 1534-1540. [Crossref]
Gerber JS, Offit PA (2009) Vaccines and autism: a tale of shifting hypotheses. Clin Infect Dis 48: 456-461. [Crossref]
Choi BK, Manning ML (2010) The immunization status of home-schooled children in America. J Pediatr Health Care 24: 42-47. [Crossref]
Ray BD (2010) Academic achievement and demographic traits of homeschool students: a nationwide study. J Acad Leadership 8: 1.
https://www.census.gov/library/publications/time-series/statistical_abstracts.html (Accessed 19 August 2016).
http://files.eric.ed.gov/fulltext/ED505409.pdf (Accessed 22 August 2016).
http://nces.ed.gov/pubs2006/2006042.pdf (Accessed 22 August 2016).
http://eric.ed.gov/?id=ED544174 (Accessed 22 August 2016).
Surén P, Bakken IJ, Aase H, Chin R, Gunnes N, et al. (2012) Autism spectrum disorder, ADHD, epilepsy, and cerebral palsy in Norwegian children. Pediatrics 130: e152-158. [Crossref]
Zocchetti C, Consonni D, Bertazzi PA (1997) Relationship between prevalence rate ratios and odds ratios in cross-sectional studies. Int J Epidemiol 26: 220-223. [Crossref]
Goldman GS, Miller NZ (2012) Relative trends in hospitalizations and mortality among infants by the number of vaccine doses and age, based on the Vaccine Adverse Event Reporting System (VAERS), 1990-2010. Hum Exp Toxicol 31: 1012-1021. [Crossref]
Orenstein WA, Perry RT, Halsey NA (2004) The clinical significance of measles: a review. J Infect Dis 189: S4-S16. [Crossref]
CDC (2013) Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). Recommendations and Reports. MMWR 62: 1-34.
Dhooge IJ (2003) Risk factors for the development of otitis media. Curr Allergy Asthma Rep 3: 321-325. [Crossref]
Siegel RM (2010) Acute otitis media guidelines, antibiotic use, and shared medical decision-making. Pediatrics 125: 384-386. [Crossref]
Casselbrant ML, Mandel EM (2003) Epidemiology. Evidence-based otitis media. BC Decker, Hamilton, ON, Canada. Pp. 147–162.
Monasta L1, Ronfani L, Marchetti F, Montico M, Vecchi Brumatti L, et al. (2012) Burden of disease caused by otitis media: systematic review and global estimates. PLoS One 7: e36226. [Crossref]
Ahmed S1, Shapiro NL, Bhattacharyya N (2014) Incremental health care utilization and costs for acute otitis media in children. Laryngoscope 124: 301-305. [Crossref]
http://www.medalerts.org/vaersdb/findfield.php?TABLE=ON&GROUP1=AGE&EVENTS=ON&SYMPTOMS[]=Otitis+media+%2810033078%29&NUMDAYS[]=0&NUMDAYS[]=1&NUMDAYS[]=2&NUMDAYS[]=3&NUMDAYS[]=4&NUMDAYS[]=5&NUMDAYS[]=6&NUMDAYS[]=7&WhicAge=range&LOWAGE=0.0&HIGHAGE=1.0) (Accessed 25 August, 2016).
Revai K, McCormick DP, Patel J, Grady JJ, Saeed K, et al. (2006) Effect of pneumococcal conjugate vaccine on nasopharyngeal bacterial colonization during acute otitis media. Pediatrics 117: 1823–1829. [Crossref]
Faden H, Harabuchi Y, Hong JJ (1994) Epidemiology of Moraxella catarrhalis in children during the first 2 years of life: relationship to otitis media. J Infect Dis 169: 1312-1317. [Crossref]
Weinberger DM, Malley R, Lipsitch M (2011) Serotype replacement in disease after pneumococcal vaccination. Lancet 378: 1962-1973. [Crossref]
Biesbroek G, Wang X, Keijser BJ, Eijkemans RM, Trzcinski K, et al. (2014) Seven-valent pneumococcal conjugate vaccine and nasopharyngeal microbiota in healthy children. Emerg Infect Dis 20: 201-210.
Goldin RL, Matson JL (2016) Premature birth as a risk factor for autism spectrum disorder. Dev Neurorehabil 19: 203-206. [Crossref]
Padilla N, Eklöf E, Mårtensson GE, Bölte S, Lagercrantz H, et al. (2015) Poor brain growth in extremely preterm neonates long before the onset of autism spectrum disorder symptoms. Cereb Cortex 27: 1245-1252. [Crossref]
Short ME, Goetzel RZ, Pei X, Tabrizi MJ, Ozminkowski RJ, et al. (2009) How accurate are self-reports? Analysis of self-reported health care utilization and absence when compared with administrative data. J Occup Environ Med 51: 786-796. [Crossref]
Fisker AB, Hornshøj L, Rodrigues A, Balde I, Fernandes M, et al. (2014) Effects of the introduction of new vaccines in Guinea-Bissau on vaccine coverage, vaccine timeliness, and child survival: an observational study. Lancet Glob Health 2: e478-e487.