Vaccines and Fear: It's Time for Society to Say Enough is Enough

Fear of vaccines is perhaps the classic example of the "perception gap," the phenomenon I've written about here before, where we are either more afraid of a lesser risk or not afraid enough of a bigger one, based on the best available evidence, and the gap itself creates danger. The fear of vaccines is causing significant risk to the public. It is time for society to act and regulate the behavior of people whose perceptions of the risk of vaccines are putting other people at risk.

The psychology of this perception gap can be explained, but first, a few facts about the danger the fear of vaccines is creating.

• The European Center For Disease Control reports outbreaks of measles in many countries where vaccination rates have gone down: As of June -- France (12,699 cases in 2011, more than in all of 2010 already, including six deaths); Spain (2,261); Italy (1,500); Germany (1,193, one death). There have already been 550 measles cases in England and Wales this year compared with 33 all of last year.
• The U.S. has had 156 cases of measles as of mid-June, compared to a total of 56 cases per year from 2001-2008. The Centers for Disease Control and Prevention has an emergency health advisory for measles, a disease officially declared eradicated in the United States in 2000.
• A 2008 study in Michigan found that areas with "exemption clusters" of parents who didn't vaccinate their kids were three times more likely to have outbreaks of whooping cough than where vaccination rates matched the state average. In 2010, as California suffered its worst whooping cough outbreak in more than 60 years (more than 9,000 cases, 10 infant deaths) Marin County, one of the richest and most educated areas in California, had one of the lowest rates of vaccination statewide and the second highest rate of whopping cough.

The risk is not just to people who have opted out of vaccination. Of the 156 measles victims in the U.S. as of June, nearly 1 in 5 of them had been vaccinated but the vaccine didn't work, or had weakened. Infants too young to be vaccinated are getting sick, and some of them are dying, when exposed to diseases like whooping cough in communities where "herd immunity" has fallen too low to keep the spread of the disease in check. Unvaccinated people cost the health care system millions of dollars, and local and state government millions more, as they try to chase down each outbreak and bring it under control. A recent economic analysis found that "...vaccination of each U.S. birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease, with net savings of nearly $14 billion in direct costs and $69 billion in total societal costs."

In other essays (The Los Angeles Times, BigThink.com) I have laid out a more detailed case, including ideas that society might want to discuss about how to regulate the behavior of people who put the greater community at risk because they decline to vaccinate themselves or their children (make it harder to opt out of vaccinations, favor vaccination with discounts on the cost of health insurance or penalties for those who opt out, restrict the social/community facilities unvaccinated people can use or activities in which they can participate). Here, I'd like to describe a little of the underlying psychology that helps explain why the fear of vaccines exists, why it is so strong and why no amount of communication, discussion or reason will get people deeply worried about vaccines to stop worrying. Which is why society has to step in and act.

• Control. Risks are scarier when we don't have a sense of control. It is entirely understandable that any parent of an autistic child wants answers, hope and a sense of control over the fate they've been cruelly dealt. Powerlessness makes things feel worse.
• Risks to Kids. They always feel bigger than other risks
• Risk vs. Benefit. We intuitively weigh risks against benefits, so it is understandable for a parent to decline vaccinations they fear might be a greater risk to their kids than the diseases the vaccines have largely (but not entirely) eliminated.
• Imposed or Voluntary. A risk imposed on us worries us more than if we engage in it voluntarily, so it's understandable that people are troubled by state-mandated vaccination (though the individual liberty argument rings hollow against the fact that in 21 states people can opt out of having their kids vaccinated for "philosophical reasons," and in 48 states for religious reasons -- without any proof that their faith actually bans vaccination).
• Trust. We fear risks from institutions we don't trust, like the pharmaceutical industry, government and even, for some of us, big business generally.
• Cultural Cognition. Some people feel that society should be more fair and flexible than it is and that people should not be constrained by rigid social or economic class hierarchies. These people, known in the study of cultural cognition as egalitarians, oppose the major institutions of the modern economy -- big corporations and their products -- which egalitarians blame for contributing to unfair and restrictive class structures. (Egalitarians are commonly politically liberal, like the population in Marin County.)

Mistrust, lack of control, risks that seem to outweigh benefits, risks that are imposed and not voluntary. Given these powerful instincts, the fear of vaccines is understandable, even if it flies in the face of overwhelming evidence. And while many may insist that denial of the evidence is irrational, it is also irrational for the health care community and policy makers to ignore the overwhelming evidence that risk perception is subjective, a mix of facts and how those facts feel. It's irrational for these "rationalists" to continue to expect that an evidence-based argument alone will change vaccine opponents' minds.

So it is time for us to act, to recognize that the risk of the "perception gap" must be managed just as much as the risk of disease and to regulate the behavior of those who refuse to vaccinate themselves or their children. This is not a call to create more government to intrude farther into our lives. There is already too much of that. This is a call for government to do what it's there for in the first place: to protect us from the actions of others when we can't protect ourselves as individuals. We do this in countless ways already: drunk driving laws, public smoking bans, even laws allowing for quarantines that curtail civil liberties during disease outbreaks. It is appropriate, and urgent, that we act to protect ourselves from those whose fear of vaccines are putting the rest of us at risk and do the same thing we do whenever one person's behavior endangers the greater community. We make them stop.

The concept of The Perception Gap was first proposed in "How Risky Is it, Really? Why Our Fears Don't Always Match the Facts"

 

 

 

Follow David Ropeik on Twitter: www.twitter.com/dropeik

Comments

[John Richard Smith]

05:54 AM on 08/10/2011

Non Specific Events

Interesting associations - Measles vaccination and DTP

http://www.ncbi.nlm.nih.gov/pubmed/17484223

http://www.ncbi.nlm.nih.gov/pubmed/21093496

http://www.sciencedirect.com/science/article/pii/S0264410X0601111X

The Nonspecifi­c Effects of Vaccines and the Expanded Program on Immunizati­on
Oxford Journals - Journal of Infectious Diseases.

Editorial

"There is now clear evidence that the simplistic convention­al model of immunizati­on is invalid. We can no longer assume that a vaccine acts independen­tly of other vaccines, or that it influences only infections caused by the target disease."

* Vaccine interactio­n is much more complex than we thought.

* A vaccine shot is not an "independe­nt" medical event

* Vaccine have effects we didn't expect.

The Good

"Measles vaccine reduces mortality from infections other than measles."

The Bad

"However, there is worrying evidence that whole-cell diphtheria­-tetanus-p­ertussis vaccine (DTP) may increase mortality from infections other than diphtheria­, tetanus, or pertussis in high-morta­lity areas."

" * A single dose of DTP vaccine not only doubled the mortality rate in infants, but more than quadruped the rate after the second and third DTP doses.

* Vaccines and vitamin supplements have unexpected, long-term effects – good and bad – on the immune systems of children.

* There is a definite increased mortality risk to girls of combining DTP and measles vaccines.

* Girls were 41 percent more likely to die if they were given vitamin A at birth, while boys seemed to slightly benefit from the supplement."

[John Richard Smith]

06:48 AM on 08/10/2011

Sex Difference­s

"These nonspecifi­c effects of BCG, measles vaccine, and DTP are generally stronger in girls"

For Instance

"Randomize­d trials show that measles vaccine has strong nonspecifi­c effects. Providing it is not given after vitamin A or followed by DTP, measles vaccine reduces mortality from diseases other than measles by 45% when given at 4.5 months of age [9], and by 47% when given to girls at 9 to 10 months of age [1]. "

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http://jid­.oxfordjou­rnals.org/­content/20­4/2/182.fu­ll

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DTP

"No randomized trial has demonstrat­ed that it is safe to give DTP to young infants in high-morta­lity areas, and there is now worrying evidence that DTP may increase mortality under these circumstan­ces"

Randomized Trial of BCG Vaccinatio­n at Birth to Low-Birth-­Weight Children: Beneficial Nonspecifi­c Effects in the Neonatal Period?

The Spectacula­r

"In this period, BCG reduced mortality by 45% (95% CI, 11%–66%); there were fewer deaths from sepsis and acute respirator­y infection, and no deaths from tuberculos­is"

"This spectacula­r reduction in mortality is consistent with the results of 6 controlled trials performed in 45,662 children inthe United States and the United Kingdom in the 1940s and 1950s"

The Worrying

"When DTP was first introduced into Guinea-Bis­sau, despite the absence of herd immunity, mortality was 5.1 deaths per 100 person-yea­rs among children who did not receive DTP but 11.3 deaths per 100 person-yea­rs among children who did receive DTP"

[Heather XW]

07:27 AM on 08/31/2011

Great Links!

[Dyson]

04:08 AM on 08/03/2011

I can pick cherries along with the worst of them, and what’s more I am clever enough to provide links to the studies…..

Lower risk of atopic disorders in whole cell pertussis-vaccinated children.
http://www.ncbi.nlm.nih.gov/pubmed/14680086
“Vaccinated children had a reduced risk of atopic disorders. Whole cell pertussis vaccination is associated with a lower risk of atopic disorders, though other vaccine components (diphtheria, tetanus, poliomyelitis) or other vaccinations may also be involved.”

Allergic disease at the age of 7 years after pertussis vaccination in infancy: results from the follow-up of a randomized controlled trial of 3 vaccines.
http://www.ncbi.nlm.nih.gov/pubmed/14662571
“Pertussis vaccination in infancy with any of these vaccines was not associated with allergic manifestations at the age of 7 years, apart from a higher prevalence of positive skin prick test results after an experimental 2-component vaccine, which is no longer in use.”

[John Richard Smith]

07:34 AM on 08/03/2011

What readers would be more interested in is what you think your studies mean to you ?

[Dyson]

05:45 PM on 08/07/2011

These and the other studies I linked to mean that there is ample contradictory evidence for your own cherry-picked study (which implied pertussis vaccine caused allergy/asthma).

Plain obvious I would have thought.

Presenting just one side of an issue, particularly when it is the minority and less evidenced view, in an attempt to cast vaccines in poor light, is dishonest.

But you already know that. Yet you just keep on doing it. You can't seem to stop yourself.

[N0NDescript0]

06:57 PM on 08/07/2011

What does this question/statement even mean?

[Dyson]

04:07 AM on 08/03/2011

Some more...

Routine vaccination against pertussis and the risk of childhood asthma: a population-based cohort study.
http://www.ncbi.nlm.nih.gov/pubmed/19255024
This study provides no evidence of an association between vaccination against pertussis in infancy and an increased risk of later wheeze or asthma and does not support claims that vaccination against pertussis might significantly increase the risk of childhood asthma.

A randomized controlled trial of the effect of pertussis vaccines on atopic disease.
http://www.ncbi.nlm.nih.gov/pubmed/9701130
“We found no support for a drastic increase in allergic manifestations after pertussis vaccination. There was a positive association between whooping cough and asthma by 2 1/2 years of age. There seems to be little reason to withhold pertussis vaccination from infants, irrespective of family history of allergy.”

Diphtheria tetanus pertussis poliomyelitis vaccination and reported atopic disorders in 8-12-year-old children.
http://www.ncbi.nlm.nih.gov/pubmed/16368169
“The DTP-IPV vaccination was not related to reported atopic disorders at primary school age.”

[John Richard Smith]

09:35 AM on 08/03/2011

Early childhood infections and immunisation and the development of allergic disease in particular asthma in a high-risk cohort: A prospective study of allergy-prone children from birth to six years.

Those with at least three episodes of gastroenteritis showed an increased risk (crude RR 2.36, 95%CI 1.41 3.95; adjusted RR 2.03 95%CI 1.50 2.75) for the later development of asthma at age 6.

Of the scheduled immunisations, Sabin immunisation in the second year had a reduced risk of asthma at 6 yr (crude RR 0.60, 95%CI 0.37 0.98; adjusted RR 0.63 95%CI 0.39 1.02).

Combined diphtheria and tetanus (CDT) immunisation in the first year had an increased risk of asthma at 6 yr (RR 1.76, 95%CI 1.11 2.78; adjusted RR 1.88 95%CI 1.28 2.77). Recurrent gastroenteritis in early childhood is associated with a later risk of asthma.

This may reflect a cause and effect relationship, or exposure to common risk factors. In contrast, Sabin immunisation in the second year is associated with a decreased risk of asthma in later childhood.

CDT immunisation in the first year may be a risk factor for asthma, but the need for CDT immunisation may also be a marker of increased risk of asthma in later childhood.

http://www.ncbi.nlm.nih.gov/pubmed/20337970

Ongoing evidence of the interplay of immune system , gastroenterology aspects and vaccines associated with atopic disorders.

[nowGo4ward]

07:20 PM on 08/08/2011

I'm not sure if this has already by posted, but here seems to be another study that observes a relationship between autism, GI symptoms, and immune function:

http://www.ncbi.nlm.nih.gov/pubmed/21803429

Children with autism spectrum disorders (ASD) who exhibit chronic gastrointestinal (GI) symptoms and marked fluctuation of behavioral symptoms exhibit distinct innate immune abnormalities and transcriptional profiles of peripheral blood (PB) monocytes.

Jyonouchi H, Geng L, Streck DL, Toruner GA.

Abstract

Innate/adaptive immune responses and transcript profiles of peripheral blood monocytes were studied in ASD children who exhibit fluctuating behavioral symptoms following infection and other immune insults (ASD/Inf, N=30). The ASD/Inf children with persistent gastrointestinal symptoms (ASD/Inf+GI, N=19), revealed less production of proinflammatory and counter-regulatory cytokines with stimuli of innate immunity and marked changes in transcript profiles of monocytes as compared to ASD/no-Inf (N=28) and normal (N=26) controls. This included a 4-5 fold up-regulation of chemokines (CCL2 and CCL7), consistent with the production of more CCL2 by ASD/Inf+GI cells. These results indicate dysregulated innate immune defense in the ASD/Inf+GI children, rendering them more vulnerable to common microbial infection/dysbiosis and possibly subsequent behavioral changes.

[John Richard Smith]

06:01 AM on 07/31/2011

Reported pertussis infection and risk of atopy in 8- to 12-yr-old vaccinated and non-vaccinated children.

To assess the association between pertussis infection and atopic disorders in pertussis-unvaccinated children and in pertussis-vaccinated children

In the unvaccinated group, there were no significant associations between pertussis infection and atopic disorders. In the vaccinated group, all associations between pertussis infection and atopic disorders were positive, the associations with asthma [odds ratio (OR) = 2.24, 95% confidence interval (CI(95%)): 1.36-3.70], hay fever (OR = 2.35, CI(95%): 1.46-3.77) and food allergy (OR = 2.68, CI(95%): 1.48-4.85) being significant.

There was a positive association between pertussis infection and atopic disorders in the pertussis vaccinated group only.

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Measles, mumps and rubella infections and atopic disorders in MMR-unvaccinated and MMR-vaccinated children.

Using data from a previously conducted study on the relationship between the diphtheria-tetanus-pertussis-(inactivated) poliomyelitis vaccination in the first year of life and atopic disorders, the study population of 1872 8-12-yr-old was divided as children MMR-unvaccinated and children MMR-vaccinated in the first year of life. Within each group the association between MMR infections and atopic disorders (reported by the parents) was assessed.

We found a statistically significant positive association between measles infection and 'any atopic disorder' [adjusted odds ratio, OR (95% confidence interval, CI): 1.77 (1.20-2.61)] in the MMR-vaccinated group, mainly because of the relationship with eczema.

[John Richard Smith]

06:57 AM on 07/31/2011

The immune response in autism: a new frontier for autism research
University of California

"Recently, increasing research has focused on the connections between the immune system and the nervous system, including its possible role in the development of ASD.

These neuroimmune interactions begin early during embryogenesis and persist throughout an individual’s lifetime, with successful neurodevelopment contingent upon a normal balanced immune response.

Immune aberrations consistent with a dysregulated immune response, which so far, have been reported in autistic children, include abnormal or skewed T helper cell type 1 (TH1)/TH2 cytokine profiles, decreased lymphocyte numbers, decreased T cell mitogen response, and the imbalance of serum immunoglobulin levels.

In addition, autism has been linked with autoimmunity and an association with immune-based genes including human leukocyte antigen (HLA)-DRB1 and complement C4 alleles described.

There is potential that such aberrant immune activity during vulnerable and critical periods of neurodevelopment could participate in the generation of neurological dysfunction characteristic of ASD."

[John Richard Smith]

07:14 AM on 07/31/2011

Children with autism have distinctly different immune system reactions compared to typical children

"Immunologists from UC Davis M.I.N.D. Institute find clear biological component to perplexing childhood neurological disorder

A new study ... demonstrate that children with autism have different immune system responses than children who do not have the disorder.

This is important evidence that autism, currently defined primarily by distinct behaviors, may potentially be defined by distinct biologic changes as well.

"Understanding the biology of autism is crucial to developing better ways to diagnose and treat it,"

.... isolated immune cells from blood samples taken from 30 children with autism and 26 typically developing children aged between two and five years of age.

The cells from both groups were then exposed to bacterial and viral agents that usually provoke T-cells, B cells and macrophages - primary players in the immune system.

Of the agents tested in the study - tetanus toxoid, lippopolysaccharide derived from E. coli cell walls, a plant lectin known as PHA, and a preparation of the measles, mumps and rubella vaccine antigens - the researchers found clear differences in cellular responses between patients and controls following exposure to the bacterial agents and PHA.

[Dyson]

02:42 PM on 08/03/2011

What readers would be more interested in is what you think your studies mean to you?

And why no links to the studies?

[John Richard Smith]

05:59 PM on 08/03/2011

1. Lack of space ie word count

2. Most people if interested can simply use google or any other familiar research tool.

http://www.ncbi.nlm.nih.gov/pubmed/18086216

http://www.ncbi.nlm.nih.gov/pubmed/18266826

http://www.ncbi.nlm.nih.gov/pubmed/16698940

http://www.ucdmc.ucdavis.edu/newsroom/releases/archives/mind/2005/immune_sys5-2005.html

[John Richard Smith]

10:38 PM on 07/29/2011

Developmen­t of Newborn and Infant Vaccines

Guzman Sanchez-Sc­hmitz Children’s Hospital Boston
Ofer Levy Harvard Medical School

"Vaccines for early-life immunizati­on are a crucial biomedical interventi­on to reduce global morbidity and mortality, yet their developmen­tal path has been largely ad hoc, empiric, and inconsiste­nt.

Immune responses of human newborns and infants are distinct and cannot be predicted from those of human adults or animal models.

Therefore, understand­ing and modeling age-specif­ic human immune responses will be vital to the rational design and developmen­t of safe and effective vaccines for newborns and infants."

[John Richard Smith]

04:10 AM on 08/03/2011

Vaccine safety in special populations.
Klein NP.

Kaiser Permanente Vaccine Study Center, Oakland, CA.
Abstract

"Studies evaluating the safety of vaccines routinely administered to a population of healthy infants and children may not provide adequate reassurance for members of special populations such as premature infants and children with chronic conditions.

However, evaluating the safety of vaccines administered to special populations presents a host of challenges, including limited numbers of subjects, lack of appropriate comparisons groups and substantial complexity in both collecting and evaluating the data. Improving the available immunization safety data for those in special populations will provide substantial benefit to the clinicians caring for these vulnerable patients."

[Heather XW]

09:01 AM on 08/03/2011

Wow! I'm so glad they are at least talking about this.

[N0NDescript0]

12:10 PM on 07/29/2011

Anti-vaccers of the world, Rejoice!

Apparently, a flu super-vaccine is in the works!

http://www.bbc.co.uk/news/health-14324901

And here is the actual paper:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3060888/pdf/ciq015.pdf

[John Richard Smith]

10:37 PM on 07/29/2011

The focussed reason that clinical trials are undertaken is safety ... all medications inclusive of vaccines need to be safe and efficacious.

Our understanding of vaccines and medications on the human body is still not complete and this is emphasised by the following statements ...

"Vaccines have non-specif­ic effects (NSE) on subsequent morbidity and mortality from non-vaccin­e related infectious diseases. Thus NSE refers to any effect that cannot be accounted for by the induction of immunity against the vaccine-ta­rgeted disease.

These effects are sex-differ­ential, generally being more pronounced in females than males.

Furthermor­e, the NSE are substantia­l causing greater than fifty percent changes in all cause mortality in certain settings, yet have never been systematic­ally tested despite the fact that millions of children receive vaccines each year.

As we strive to eliminate infectious diseases through vaccinatio­n programmes­, the relative impact of NSE of vaccines on mortality is likely to increase, raising important questions regarding the future of certain vaccine schedules. "

Department of Molecular Microbiolo­gy and Immunology­, Johns Hopkins

Department of Growth and Reproducti­on, Copenhagen­, Denmark

Department of Biology, University of North Carolina

Institute for Medical Immunology­, Université Libre de Bruxelles

University of Massachuss­ets Medical School

University Health Network & Department of Immunology­, University of Toronto

London School of Hygiene and Tropical Medicine

Bandim Research Group

[N0NDescript0]

10:45 AM on 07/30/2011

John said:

"The focussed reason that clinical trials are undertaken is safety..."

That's what the focus of a phase 1 and phase 2 clinical trial is. The purposes of a phase 3 and phase 4 are to evaluate efficacy.

Considering your self-proclaimed credentials, I expect you to know this basic information. Perhaps you should brush up on the basics of clinical trials:

http://clinicaltrials.gov/ct2/info/understand

[John Richard Smith]

10:44 AM on 07/29/2011

http://www.nytimes.com/2011/07/29/opinion/useless-pharmaceutical-studies-real-harm.html

Useless Studies, Real Harm
By CARL ELLIOTT
Published: July 28, 2011

"LAST month, the Archives of Internal Medicine published a scathing reassessment of a 12-year-old research study of Neurontin, a seizure drug made by Pfizer. The study, which had included more than 2,700 subjects and was carried out by Parke-Davis (now part of Pfizer), was notable for how poorly it was conducted. The investigators were inexperienced and untrained, and the design of the study was so flawed it generated few if any useful conclusions. Even more alarming, 11 patients in the study died and 73 more experienced “serious adverse events.” Yet there have been few headlines, no demands for sanctions or apologies, no national bioethics commissions pledging to investigate. Why not? "

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It's just not a good time to be associated with the pharmaceutical industry or the Murdoch media for that matter. Scandal after scandal.

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Glaxosmithkline

"Turning to boardroom matters, Witty is – for the time being – backing embattled BSkyB chairman James Murdoch, a non-executive director at GSK.

‘We were shocked by [News Corporation’s phone-hacking scandal]. But we will want to see the results of the various investigations into these matters, so the facts can be established,’ he said."

Read more: http://www.thisismoney.co.uk/money/markets/article-2019156/GlaxoSmithKline-boosts-UK-recovery-jobs-tax-pledge.html#ixzz1TVPJ03aS

[John Richard Smith]

09:55 AM on 07/29/2011

FDA finds drug research firm faked samples, documents

"Drug companies that had medicines tested by contractor Cetero Research might have to reevaluate results, U.S. regulators warned after the firm was found faking documents and manipulating samples."

http://www.reuters.com/article/2011/07/27/us-fda-research-fake-idUSTRE76Q66L20110727

The FDA inspected Cetero in May and December last year and found falsified records about studies.

"Specifically, in at least 1,900 instances between April 2005 and June 2009, laboratory technicians identified as conducting certain studies were not actually present at Cetero facilities at that time, the FDA said in its May report.

The FDA also said at the time that Cetero might have "fixed" studies to get the desired result, or did not include failed results in their report."

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Company Outline here ....

http://investing.businessweek.com/research/stocks/private/snapshot.asp?privcapId=30749264

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Cetero have replied to the FDA here ... http://www.cetero.com/home/news-and-events/

[John Richard Smith]

09:26 AM on 07/29/2011

David Ropeik (Harvard Centre for Risk Analysis)

http://www.citizen.org/congress/regulations/graham/HCRAfunders.html

Interesting list.

[Dyson]

09:05 AM on 07/27/2011

Risk benefit:

1. France 2011 - 6 deaths from over 12,000 cases of acute measles. (Case fatality = 1 in 2000, and that's in the 21st century in a 1st World country with excellent healthcare).

2. USA 21st century: No deaths from measles- Because thanks to vaccination measles is not endemic and there are usually fewer than 50 cases annually.
Vaccination…..so nobody gets measles, so no deaths from measles. Simple, really.

3. USA, 20th Century before measles vaccination was introduced - 500 deaths each year from measles.
No vaccination…..so everyone gets measles, so many die. Simple, really.

4. UK since 2000 - 2 deaths from acute measles (in unvaccinated teenagers) and several deaths as the result of longterm encephalitis in those who caught measles in the last part of the 20th century.

5. Pertussis outbreak California 2011 - 10 deaths, mainly in infants too young to be immunized. Precisely the group needing the most protection, which better overall vaccination would have provided through herd immunity.

[John Richard Smith]

09:50 AM on 07/27/2011

1. France - Further complicated by ....

a) 14 cases of measles among healthcare workers (HCWs) in Public Hospitals of Marseilles, France that occurred between April and November 2010.

b) Appearance of a novel measles G3 strain in multiple European countries within a two month period, 2010

C) The French patient (Patient I) was a one year-old non-vaccinated infant who lived in the area of Paris, and developed rash on 29 September. (G3 Measles)

d) Three measles-related deaths occurred during the study period: two in 2009 and one in 2010, all among unvaccinated cases......two occurred in young men, aged 23 and 18 years, with underlying immunodeficiency disorders (Crohn and Hodgkin).

e) Since the beginning of 2008, France has been experiencing a resurgence of measles. It started in a religious traditionalist group.

f) Our findings also draw attention to the need to sensitise health professionals and raise their awareness of the issues through medical education. Convincing parents and health professionals reluctant to vaccinate children with MMR vaccine will be a challenge.

g) Outbreaks of measles have been described in several European countries in 2007 and 2008. Travelling played an important role in several of these outbreaks.

Roma populations and Irish travellers are some of the susceptible groups for measles transmission. Other susceptible groups ... orthodox Jewish communities.

h) Bulgaria Measles Transmission in medical settings was reported for 326 cases and the hospital was the most frequently reported setting.

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Life is complicated Dyson....

[Dyson]

06:00 PM on 07/28/2011

Glad to see you cannot dispute the extent and seriousness of the European outbreaks.

It's a taster for what may soon happen here, if the antivax campaigners have their way and vaccination rates decline.

[John Richard Smith]

08:36 AM on 07/27/2011

Risk Benefit

1. 6 deaths relating to measles (unknown health status / complications ) in Europe 857 million people.

2. No deaths in the United States from measles since 2003 US population 307 million.

3. In the UK since 2000 1 death attributed to acute measles , any other deaths approx 1 per year or less complicated by serious underlying health issues including congenital immunodeficiency

4. Whooping cough outbreak California

804 (9%) cases were hospitalized 442 (55%) of hospitalized cases were infants

[John Richard Smith]

08:45 AM on 07/27/2011

What is actually missing is the research into

1. Alternative prevention strategies

2. Treatment regimes that alleviate any serious complications.

3. Emergency protocols that alleviate the spread of disease to vulnerable populations most notably infants and children in medical settings.

[John Richard Smith]

03:54 AM on 07/28/2011

California Pertussis Outbreak.

804 (9%) cases were hospitalized 442 (55%) of hospitalized cases were infants

[John Richard Smith]

03:55 AM on 07/28/2011

Ten deaths were reported; 9 were Hispanic infants.

Nine fatalities were infants under 2 months of age at time of disease onset and had not received any doses of pertussis-containing vaccine and the remainder was an ex-28 week preemie that was 2 months of age and had received the first dose of DTaP only

[John Richard Smith]

08:11 AM on 07/27/2011

Risk - Benefit

I suppose the argument has some merit but I was surprised it hasn't been applied in this instance.

1. 6 deaths Measles in Europe from a population of some 857 million people.

2. Since 2003, there have been no measles-related deaths reported in the United States population 307,000,000

3. UK since 2000 there has been one death attributed to acute measles, all other deaths there were severe health complications including congenital immunodeficiency.

4. In regards to Whooping Cough outbreak in California...

804 (9%) cases were hospitalized 442 (55%) of hospitalized cases were infants

[Doybia]

11:46 PM on 07/26/2011

This is an interesting article which goes along with the discussion of influenza vaccines: http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=369945

"A growing number of publications are recommending annual influenza vaccination of healthy children and adults. However, the long-term consequences of repeated influenza vaccination are unknown. We used a simple model of recurrent influenza infection to assess the likely impact of various repeated influenza vaccination scenarios. The model was based on a Markovian framework and was fitted on annual incidence rates of influenza infection by age. We found that natural influenza infection reduced the risk of being re-infected by 15·4% (95% confidence interval 7·1–23·0). Various scenarios of repeated influenza vaccination were then simulated and compared with a reference scenario where vaccination is given from age 65 years onwards. We show that repeated vaccination at a young age substantially increases the risk of influenza in older age, by a factor ranging between 1·2 (vaccination after 50 years) to 2·4 (vaccination from birth). These findings have important implications for influenza vaccination policies."

[Josephius]

01:18 PM on 07/28/2011

Did you read the article? Tell me, what did the authors' do here for their model"

"Various scenarios of repeated influenza vaccinatio­n were then simulated and compared with a reference scenario where vaccinatio­n is given from age 65 years onwards."

What was the reference scenario?

[N0NDescript0]

12:36 PM on 07/29/2011

What is your contention with the paper?

Or do you not have one, and you just wanted to clarify something?

[Dyson]

05:15 PM on 07/29/2011

So tell us, do you think influenza is a serious disease?

[Heather XW]

09:12 AM on 07/26/2011

This Just In!

WAKEFIELD'S FINDINGS DUPLICATED TWICE!!

http://www.dailymail.co.uk/health/article-124886/MMR-fears-gain-support.html#ixzz1SxHqp1lg

[John Richard Smith]

10:28 AM on 07/26/2011

Heather I think you've been caught out by the Daily Mail and the way it dates old stories ... this relates to 2004 ? research and I'm not convinced it's robust. I'd set it aside.

Cheers

[Heather XW]

10:44 AM on 07/26/2011

Thank you I will.

Wonder why they put current dates on old editorials. My appoligies if I muddied the waters.

[onionboy]

07:07 PM on 07/26/2011

I know it can take a long time for comments to post, but 7 years ago you wrote this!??

[Heather XW]

07:20 PM on 07/26/2011

LOL! I know, and apologized.

[Dyson]

08:31 AM on 07/27/2011

And not only was this a preliminary report, it was never published.
Guess it didn't pan out for them, or was rejected.

[John Richard Smith]

07:50 AM on 07/26/2011

Ongoing outbreak of mumps infection in Oban, Scotland, November 2010 to January 2011

We report on an ongoing outbreak of 119 cases of mumps virus infection in the Oban area of Scotland, from 29 November 2010 to 31 January 2011. The median age of cases was 20 years, with the highest incidence in the 13-19-year-olds.

A total of 53 cases had received two doses of measles-mumps-rubella (MMR) vaccine, in accordance with the United Kingdom vaccination schedule, while 33 had received only one dose and 30 had not been vaccinated.

* Nearly 45% were fully vaccinated
* A further 28% had one dose vaccine
* 25% were unvaccinated

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Children 18 and under

Only 2 cases out of 54 were unvaccinated

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Not everything follows a simplistic course ...

[John Richard Smith]

08:06 AM on 07/26/2011

In Italy 2011 measles outbreak ...

A total of 1,270 / 2079 cases (61%) were aged 15–44 years

In other words born between 1996 to 1967 ... not really school aged kids here.

Only 155 / 2079 (7.45%) were aged 5 - 9

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In fact 919 (44%) were adults ....

One of the solutions proposed by the author in the LA Times was ....

"There could be restrictions on the community and social activities in which unvaccinated people can participate, like lengthy school trips for kids, etc."

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Unvaccinated adults can't go to the ball game ... I'm sure they'll love that restriction of personal freedoms.

[Josephius]

05:58 PM on 07/26/2011

Your continued method of snipping various parts from different article, without referencing them, of course, and combining them with other articles...then, giving some sort of conclusion that lacks any real analysis of data is very strange.

44 -15 = 29 years. 9 - 5 = 4 years. So, one group has roughly 7 times more years than the other. What are the population sizes for those groups? In light of that data, your attempt to paint some sort of conclusion is meaningless.

[Dyson]

03:53 AM on 07/27/2011

As Josephius says, you have a strange way of introducing (unlinked/unreferenced) red herrings into the topics under discussion, with selective cherry-picking of exerpts of papers trying to prove some point or other, but the thrust of which usually escapes everyone.

I assume you are trying to show vaccination does not always protect the vaccinated - if so that's hardly news.

From the paper:
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19803

"Current vaccination uptake rates for the first dose of MMR vaccine at 24 months (for the year ending 31 March 2010) were 93.7% for Scotland and 91.5% for the Argyll area (in which Oban is located). However, in the years post 1998, following vaccine controversy, which surrounded an alleged link between autism and the MMR vaccine, the uptake rates fell, reaching a low level in Scotland of 88.5% and in Argyll of 85.6% in 2003"

Inference:
Wakefield's fraudulent autism/MMR study impacted vaccination rates, causing unnecessarily large numbers of UK kids to be unimmunized and vulnerable to measles, mumps and rubella. Hardly surprising there is mumps in circulation. Also, considering vax is only around 70% protective for mumps, hardly surprising that introduction of mumps will cause some cases in vaccinated but not immune individuals. Welcome to the real, post Wakefield world.

[John Richard Smith]

05:42 AM on 07/27/2011

73% were vaccinated in Oban

I think the figures speak for themselves ... some conspiracy that Andrew Wakefield is to blame for an outbreak 13 years after the Royal Free team published their paper seems a bit far fetched.

Have you got some robust evidence to support your 'theory" ?