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Ignorance and Misinformation Assist in Measles Resurgence

21 Mar

 

 

Measles cases are on the rise again in the US. Why is it that this ‘eradicated’ (in the USA) virus is still causing harm?

ImageIt’s been about 15 years since Andrew Wakefield first suggested that:

We have identified a chronic enterocolitis in children that may be related to neuropsychiatric dysfunction. In most cases, onset of symptoms was after measles, mumps, and rubella [(MMR)] immunisation. Further investigations are needed to examine this syndrome and its possible relation to this vaccine.(1)

Wakefield clarified this statement in an interview with Brian Deer:

I have to say that there is sufficient anxiety in my own mind of the safety, the long term safety of the polyvalent, that is the MMR vaccination in combination, that I think that it should be suspended in favour of the single vaccines. (2)

Reading the initial publication, there is not a very convincing argument made for the vaccine causing autism. And it would be curious why Wakefield would make such a connection –  except that he was also in the process of forming a company with a patented test for “autistic enterocolitis” that could produce $43 million (US) in revenue for investors according to the prospectus.(3) That might be reason enough. Further, the primary interest that lead to the investigation of whether the MMR vaccine might cause autism came not from a sound scientific hypothesis, but from lawyers willing to pay for study results that could be used in their ongoing prosecution of drug manufacturers. According to the British Medical Journal, Wakefield received $674,000 in compensation as payment for doing this research and also in support of Wakefield’s new diagnostic company, Carmel Healthcare Ltd. (4)

Over the years Wakefield has bobbed and weaved like a boxer shifting his hypotheses on how MMR vaccine causes autism from Measles proteins migrating from the location of the shot, to the gut and then to the brain – to the Mercury preservative, thimerosal – to the number of antigens (immune-stimulating particles) children are faced with as they receive their first vaccines. Nevertheless, his results have not been duplicated (to the extent that they were shown to begin with) and no additional evidence has come forward supporting any of these speculations.

The resulting controversy dealt a heavy blow to immunization efforts in the UK. Meanwhile, in the United states, which officially eradicated Measles in 2000, record numbers of cases are now being reported. So far 20 cases of the disease have been reported in New York (5), while another 32 have been reported in California which “allows parents to opt out of vaccinating their children if they fill out a form stating they don’t believe in vaccinations.”(6)

ImageThanks, Dr. Wakefield. Most of us have forgotten what Measles looks like. Now we can remember.

For more information about Measles, see the WHO fact sheet:

  • Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
  •  In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year.

 

 

References:

1. RETRACTED: "Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children" AJ Wakefield, SH Murch, A Anthony, J Linnell, DM Casson, M Malik, M Berelowitz, AP Dhillon, MA Thomson, P Harvey, A Valentine, SE Davies, JA Walker-Smith The Lancet  28 February 1998 (Volume 351 Issue 9103 Pages 637-641 DOI: 10.1016/S0140-6736(97)11096-0)
2. http://briandeer.com/wakefield/royal-video.htm
3. http://www.cnn.com/2011/HEALTH/01/11/autism.vaccines/
4. "Secrets of the MMR scare: How the vaccine crisis was meant to make money" 2011. http://www.bmj.com/content/342/bmj.c5258
5. "Measles Outbreak Now Up To 20 Cases In New York City"20 March 2014. http://www.huffingtonpost.com/2014/03/19/measles-new-york_n_4994100.html?utm_hp_ref=mostpopular
6. "Surge in measles cases continues: California now has 32 in 2014" 14 March 2014. http://www.scpr.org/news/2014/03/14/42809/measles-cases-continue-to-rise-in-california/
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12 Comments

Posted by on March 21, 2014 in Uncategorized

 

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12 responses to “Ignorance and Misinformation Assist in Measles Resurgence

  1. Ratabago

    March 22, 2014 at 12:37 am

    I feel rather uncomfortable “liking” this, as it is so tragic. But I certainly remember what measles looks like. I spent over two years of my childhood in Malaysia, quite some time ago. During that time I remember two outbreaks of measles, and one of whooping cough. Seems I can’t bring myself to narrate the details of this anecdote (I tried, but couldn’t), but they are nasty, and traumatic, and involve the deaths of many young children. I do wish I could drag the anti-vaxxers back there to experience it though. Maybe the sadly empty kampongs could get through to them, even if no amount of evidence can.

    Sorry this is so depressing. I think I’ll go off and have a little cry now.

     
    • downhousesoftware

      March 22, 2014 at 9:30 am

      There really isn’t a ‘I Like this Post About Something I don’t Like’ button, is there? I’m personally right at the cutoff, where people just slightly older than me have seen many of these diseases first hand, while I was one of the first generations to be spared.
      Regions of the UK seem to be the most impacted by Wakefield’s work. A lot of people talk about it here in the states, but the numbers of vaccinated children hasn’t suffered appreciably (except in small groups).
      I believe you once said you were in Australia, is that correct? Regardless, how has this changed attitudes where you live currently?

      (and, as always, thank you for adding your comment – I always look forward to hearing them)

       
      • ratabago

        March 22, 2014 at 2:08 pm

        You’re right, I am in Australia. And I think I’m just straddling that divide you mention. My cohort got polio vaccinations when very young, tetanus/diphtheria/pertussis vaccinations at 2 years, 6 years, and 11. The girls also got rubella vaccinations at 11. And everybody just came down with measles, and mumps, and chickenpox. But we were well nourished, fit, and had access to good health care. For most of us it was just an inconvenience. But a few suffered nasty effects, including brain damage, and/or visual and hearing impairments. And there was also the rare death.

        My own immunisation record is kind of weird. I got the above, and also immunisations for TB, smallpox, cholera, and typhoid, before going to Malaysia. Goodness knows why smallpox, it was effectively (but not officially) extinct by then.

        MMR vaccinations were patchy to non-existent for males in Australia prior to 1980, and then immunisation rates for MMR slowly crept up to 85% for school aged children by the beginning of the 1990s. But coverage was very patchy, and there was a large and prolonged measles outbreak in Australia during 1992/93. So, a national measles coverage campaign was developed, with a target vaccination rate set at 95%. We never quite reached that target, hitting 94% by 1998, and trending downwards to 83% for school age children from 1998 to 2007, when the incoming Labour Government pushed for higher vaccination rates. By 2013 we were back up to over 91% MMR immunisation rates for 1 to 5 year olds. Our current Prime Minister has made very pro-immunisation statements, and criticised his immediate predecessor’s record (unfairly, but that’s politics). With any luck he’ll maintain the funding for this. (Percentages up to 1998 from an old article by Lyn Gilbert of Sydney University, more recent figures from the Australian Broadcasting Corporation News Fact Finding Service. They should be “good enough for government work”).

        I don’t know what impact Wakefield had on MMR immunisation rates in Australia at the end of the 90s. Our press coverage of the issue was unusually balanced, and seemed to cause little panic. I think lackadaisical Liberal Federal Government support may have been just as much to blame[1]. Our local council was certainly finding it hard to get their immunisation program fully funded. But Wakefield caused a lot of stress, guilt, and anxiety for young parents, most of whom had no way to objectively and accurately judge this sort of information. Most of them end up immunising.

        We do have a network of active anti-vaxers. Wakefield is their hero, and a martyr. They spout all the usual lies and misinformation, and organise “conscientious objector” drives to get parents to refuse all vaccinations for their children. They have succeeded in getting thousands of parents to register as objectors, and not immunise their children. Where they have been most active there are pockets of low immunisation rates. We have had small outbreaks of measles in some of these regions. Worse, some of them have the cynical notion that their children will be protected by herd immunity due to those parents that do immunise. This is part of the reason we see thousands of cases of whooping cough every year. We use acellular pertussis vaccine in Australia, it gives good protection to the individual, in that relatively few vaccinated people exposed to the bacteria will develop clinical symptoms, and in those that do the symptoms are usually mild. But it seems from recent work that it gives poor herd immunity. An example: http://www.pnas.org/content/111/2/787, ” Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model.” Those that are immunised can pass on the illness. Those that aren’t immunised are at risk. He says, preaching to the choir.

        Seems I’ve written an essay again.

        ——————————————————————————————————-
        [1] Confusingly, our conservative party call themselves the Liberal Party.

         
  2. downhousesoftware

    March 22, 2014 at 4:58 pm

    Thanks, Ratabago – that’s a great summary of your country’s vaccination program, which is always interesting to me. Also, thanks for clarifying Australia’s confusing political party naming. That’s something I wouldn’t have guessed.

    I’ve heard some anti-vaxers here say that they rely on herd immunity as well. To the extent that any medication, from aspirin to vaccines, may be harmful (and they certainly think it is), it’s a very self-centered way of getting benefit without putting themselves at ‘risk’ from the vaccine. Ironically, they are still taking on the higher risk burden, while still looking bad doing it.

    One last thing that I forgot to put into my original post is that there are a lot of anti-vaxers here who will have ‘chickenpox’ (or other disease) parties. The idea is that they bring all the kids together with one or more who have just come down with the virus and encourage close play. This gets all the kids infected in a way that is more ‘natural’ and therefore induces ‘better’ immunity.

    Prior to the development of the vaccine, I wouldn’t have had much of a problem with the chickenpox parties. Everyone (in the US at least) used to get it at some point and it’s generally thought to be milder in young children. However, with the advent of the vaccine, it’s hard to see a benefit to this ‘natural method’ as it sets these kids up for getting Shingles later in life, while their immunized counterparts will never have to deal with this recurrence of Chickenpox as they age.

     
    • ratabago

      March 24, 2014 at 1:54 am

      Glad you liked it. The name of the Liberal Party throws a lot of people. I think it was derived from some sort of right wing libertarian philosophy.

      (Sigh) chickenpox parties. Probably a good idea prior to 1995, as long as you can keep the attendees away from kids under 2 years of age, pregnant women, and anyone who might be immune compromised.

      The chickenpox vaccine is much loved by the Australian Vaccine Network, a large, (small e) evangelical, and very active anti-vaccination group. This is probably because of the perception that chickenpox is harmless, and most people have forgotten it used to hospitalise about one and a half thousand children a year in Australia, kill a handful of children, is dangerous to pregnant women, and can cause horrendous birth defects. The data on it is very complicated, and so is easily misrepresented. Here is the AVN’s claim on vaccination and shingles:

      Whilst it used to be very rare for a child to get shingles, today, we are seeing increasing numbers of children contracting this painful and potentially disfiguring condition due to their having been vaccinated against chicken pox. In fact, it is now possible to get shingles without ever having had a previous chicken pox infection due to the use of the live-virus varicella vaccine.

      Here is the same issue considered in The Australian Immunisation Handbook:

      Herpes zoster (HZ) has been reported rarely in vaccine recipients and has been attributed to both the vaccine strain and to wild-type varicella virus reactivation. Reactivation of the vaccine virus resulting in HZ is rare and most cases of HZ in vaccine recipients can be attributed to reactivation of wild-type virus following unrecognised prior infection. The risk of developing HZ is currently thought to be lower after vaccination than after natural varicella virus infection, and reported cases have been mild. Rates of herpes zoster in children 0–9 years of age after natural VZV infection were estimated to be between 30 and 74 per 100 000 per year, while a rate of 22 per 100 000 person-years was reported in a 9-year follow-up of 7000 varicella vaccinated children.

      So, somehow a decrease in a well reported condition has become an increase in that condition. The continuing incidence is largely associated with “natural” infections, not with the live vaccine, despite data to the contrary. Apparently it is undesirable to get the milder case of shingles on those rare occasions that the attenuated vaccine strain re-activates, better to get the wild type. And we have the weasel words ” without ever having had a previous chicken pox infection”, as if sub-clinical infections are unheard of, and untestable.

      The Australian Immunisation Handbook, by the way, comes with supporting references for its claims. It’s a good place to start if you ever have reason to wonder about the vaccination regime in Australia: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home. I won’t link to the AVN, they don’t deserve the boost to their search ranking.

       
      • ratabago

        March 24, 2014 at 3:11 am

        “The continuing incidence is largely associated with “natural” infections, not with the live vaccine, despite data to the contrary.”

        Two “dumb guy” points for me, I wrote that the wrong way around:

        The data shows the continuing incidence is largely associated with “natural” infections, not with the live vaccine, despite claims to the contrary. –Fixed That For Me.:)

         
  3. Mehron

    March 23, 2014 at 12:47 pm

    I think this is a good example of an actual conflict of interest producing bad research. Often, conspiracy types like to point out that big pharma, Monsanto, or some industry paid for all of the studies that don’t fit the conspiracy. The implication is that this research is therefore invalid. The problem with this claim is that they haven’t first shown any fault with the research. If the studies weren’t conducted properly or the results were reported incorrectly, it could make sense to start looking for reasons why this was the case. However, if the research was sound, the results have been replicated and stand up to scrutiny, I would say the funding sources are mostly irrelevant.

    In Wakefield’s case, his findings didn’t stand up to scientific scrutiny. It then made sense to go back and look into the conflict of interest. I’m not well versed on the case, but I imagine that’s how it was found that he actually committed fraud.

    I imagine that another example could be a case of one study that went against the scientific consensus on some topic and was funded by a party with a vested interest. In that case, the conflict of interest might be a clue to help figure out why the findings were surprising.

     
  4. downhousesoftware

    March 24, 2014 at 8:18 am

    Jeff Gerber and Paul Offit wrote an excellent review of the many anti-vas claims and data examining each of these assertions in http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908388/?log$.. I like to present this article along with Wakefield’s original (now retracted) paper in my Microbiology class. Sometimes I find myself wishing that Wakefield’s paper was clearer in its argument against vaccination because it is hard to look at it and see how he came to his conclusion from the data there. Mostly, I just ask the class what they’ve heard in the news or from rumors before we examine data on the safety of vaccines. Otherwise the paper doesn’t provide enough information to set up any rational interrogation.

    Thanks for the link to the Australian site. I’ll look into that for comparison to the US schedule.

    I’ve never heard of any Shingles resulting from the vaccine, but it’s something I will have to explore because it’s one of the things that comes up in discussion regularly. I kinda wish it was a virus-like-particle or killed virus. Perhaps that shows that I’m more of a Salk than a Sabin at heart.

     
    • ratabago

      March 24, 2014 at 1:22 pm

      Nice article. I’ve added it to my bookmarks.

      I’ve found it very frustrating trying to find reliable figures on rates of shingles caused by vaccine strains. Prior silent infections, and breakthrough infections by the wild type complicate things. I did come across figures, in information pamphlets for parents, of something like 3 cases per million doses per year for the vaccine versus 2000 cases per million per year for those infected with the wild-type, numbers that don’t quite agree with The Australian Immunisation Handbook. But they never seem to point me to a canonical source for the figures. If those figures are close to correct though I suspect immune compromise may be largely to blame. I have read a couple of studies of varicella vaccine use in the immune compromised. They do see shingles associated with the vaccination strain, at a much higher rate than for the general population, but still lower than for the wild-type. Something to think about, anyway.

      I also would prefer it if we could get the same practical results from virus-like particles, or killed virus. It might lower the emotional resistance to vaccination. I do find the thought of sticking foreign genomes into myself or my kids kind of “icky”. But I can also recognise how much greater the benefits are than the risks. A lot of parents just have to take it on faith, and hope for the best.

      One thing about reading your blog, it makes me think carefully about things that I’ve been ignoring for far too long. It also makes me realise how rusty I’ve become. (I also miss having easy access to a University Library).

       
  5. Mehron

    April 8, 2014 at 9:48 pm

     
  6. Mehron

    April 8, 2014 at 9:48 pm

     

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