Wednesday, May 13, 2015

Dummheit--the return of measles

Evans RG. Dummheit. Healthc Policy. 2015 Feb;10(3):14-22.

Immunizing against influenza is tricky; against measles is not. Influenza comes in many constantly evolving strains, but one measles shot in childhood confers lifelong immunity. Unlike the flu, measles was wiped out. Its return represents an outbreak not of disease, but of stupidity. The matrix of stupidity is, however, reinforced by strong strands of malice, as when Andrew Wakefield's fraudulent 1998 paper linked the MMR vaccine to autism. The fraud was unmasked and the vaccine-autism link disproven, but the evil influence continues. Measles offers an illustration of Virchow's insights that medicine is a social science and that politics is medicine writ large. It is this "inconvenient truth" that is being suppressed by muzzling the Chief Public Health Officer (CPHO) and attacking public health for addressing "social determinants."


  1. The California state senate passed a bill this Thursday under which the exemption allowed to parents on grounds of personal belief allowing them to skip vaccination when proposed for any reason, is eliminated. In turn, this would mean that parents who still want to forego vaccination for reasons of personal belief will have to choose home-school for their kids.

  2. Schoolchildren in California would be required to be vaccinated unless there is a medical reason not to do so under a sweeping bill approved by the State Assembly on Thursday. The measure would end exemptions for personal or religious reasons, routinely requested by parents opposed to vaccines.

    The legislation would make California the largest state by far with such requirements for childhood vaccinations as it joins West Virginia and Mississippi, which have had similar laws for years.

    Public health officials hope other states will follow California’s lead, though similar measures in some legislatures have been defeated this year.

    “We hope and expect we will be a model to get us back to where we should be, which is that cases of measles and other preventable diseases do not need to be something we live with,” said State Senator Richard Pan, a pediatrician who wrote the bill.

    Despite overwhelming evidence that vaccines are an essential public health measure, the number of unvaccinated children in California has been rising, partly because personal or religious exemptions have been easy to obtain. Parents who decline vaccines for their children and take heart from the fact that most other children are protected have helped create pockets in particular schools and communities where the overall immunity level is dangerously low, doctors say.


  3. Jim Carrey left his 14 million Twitter followers in no doubt about his feelings on California's tough new vaccination law on Tuesday.

    The actor believes there is a link between vaccines and autism. He branded California Gov. Jerry Brown a "corporate fascist" after he signed into law one of the strictest immunization programs in the country earlier in the day.

    In a series of more than half a dozen tweets that ended in a flurry of capital letters, the Golden Globe winner insisted he was "pro-vaccine." He was only "anti-neurotoxin," he said, repeating his claim that ingredients such as thimerosal and mercury carry a risk to children...

    Despite lingering fears among some parents, the Centers for Disease Control and Prevention is clear that there is no link between vaccines and autism. Echoing the broad scientific consensus, the CDC says there is "no link between thimerosal-containing vaccines and [autism], as well as no link between the measles, mumps, and rubella (MMR) vaccine and [autism] in children."

    No childhood vaccines distributed in the U.S. contain mercury or thimerosal, CDC says.

    During his Twitter sermon late Tuesday, Carrey also took aim at the CDC, calling it "corrupt" and unable to "solve a problem they helped start."

    The California law comes in the wake of a measles outbreak at Disneyland last year that affected more than 100 people in the U.S. and Mexico. The state joins West Virginia and Mississippi as the only states without a personal-belief exemption for vaccines, according to The Associated Press.

    "The science is clear that vaccines dramatically protect children against a number of infectious and dangerous diseases," Brown wrote in a message accompanying his signature. "While it's true that no medical intervention is without risk, the evidence shows that immunization powerfully benefits and protects the community."


  4. California has decided one large epidemic scare is enough. After the frightening outbreak of measles that started at Disneyland and sickened 147 people, Californians rejected the irrationality of anti-vaccine zealots and decided to restrict parents' ability to exempt their children from school vaccinations.

    The new law signed by Governor Jerry Brown throws out religious and philosophical reasons to exempt. Only health concerns will be permitted and those must be verified by a physician. If you simply don't want to vaccinate your kids, you will have to home school.

    The new law is all to the good. No major religions have heartburn over vaccination. Most see it as an obligation in order to help the community. And philosophical exemptions were nothing but an open door for those who are ill-informed, addicted to misinformation on the internet or just plain selfish.

    The childhood vaccine schedule has been proven safe, and arguments about "dangerous" ingredients have been proven incorrect over and over...

    Liberty is a key value for Americans, as critics of the law now are noting. But they ignore the fact that liberty has to yield when using it puts others at risk. So, just as speed limits protect you and me from reckless drivers, and mandatory car seats and seatbelts protect kids careless parents, mandating vaccination protects kids from lousy parental choices.

    The actor Jim Carrey is one of a small number of anti-vaxxers who is beside himself at the passage of the tough new law. He has tweeted out to his 14 million twitter followers that the decision to protect the community from measles, mumps, whooping cough and flu is fascism. Not only is Carrey ignorant when it comes to vaccines, he is a fool when it comes to using terms like fascism.

    Fascism is when a government imposes its will upon the people by fiat. Nothing like that has happened in California—not even close. The legislature heard testimony, debated and then voted through the law to end liberal exemptions. Passing a law through the legislature and having the governor sign it is called democracy!

    Democracy turned out to be very good for public health in California this week.


  5. Health officials on Thursday confirmed the country's first measles death since 2003, and they believe the victim was most likely exposed to the virus in a health facility in Washington state during an outbreak there...

    According to the U.S. Centers for Disease Control and Prevention, 178 people from 24 states and the District were reported to have measles from Jan. 1 through June 26 of this year. Two-thirds of the cases, the CDC noted, were "part of a large multi-state outbreak linked to an amusement park in California."

    The woman died in the spring; a later autopsy confirmed that she had an undetected measles infection, the Washington State Department of Health said in a statement. The official cause of death was announced as "pneumonia due to measles."...

    Measles were effectively eliminated in the United States in 2000, according to the CDC. Health officials have said that the disease made a comeback recently, in part because of a growing number of adults deciding to delay or abstain from vaccinating their children. Last year brought the highest number of recorded measles cases since 2000, according to the CDC.

    Courtesy of:

  6. Health officials say the first measles death of an American in more than a decade is a powerful argument for the value of herd immunity.

    Health officials told MedPage Today that though the woman who died this spring in Washington state was likely vaccinated, her immune system was compromised due to other health problems and medications...

    The deceased woman's mother said her daughter had been immunized against the virus, but the mother couldn't find a medical record or remember when the woman was vaccinated, Washington State Department of Health spokesman Donn Moyer told MedPage Today.

    After the woman learned she was possibly exposed to the measles virus, she was given an antibody test, and doctors determined she had "adequate antibodies for a person with a fully functioning immune system to be protected against measles," Moyer said.

    "Regrettably, she did not have a fully functional immune system, as her immune system was suppressed by medications for other health conditions," he said. "This made her particularly vulnerable."

    The woman's official cause of death was pneumonia due to measles, according to the state health department. She did not have the telltale measles rash, and she was diagnosed with the illness after she died.

    The department has stressed that the woman's death demonstrates the importance of herd immunity.

    "The measles virus is thought to be the most transmissible virus we know," William Schaffner, MD, chief of preventive medicine at Vanderbilt University in Nashville, Tenn., told MedPage Today.

    For every one person who has it, it can spread to an average of up to 18 others. The virus is airborne and can linger in a room for up to 2 hours after an contagious person has left and infect someone new, Schaffner said.


  7. Most Americans today have no concept of the terror generated by polio throughout the first half of the 20th century. During epidemics, newspapers and magazines displayed adorable children struggling to walk in braces or entombed in iron lungs, but the disease mostly fell off the national radar after it was eliminated from the country in 1979...

    During the 1952 outbreak, with funds from the March of Dimes, he rushed to develop the earliest vaccine for polio that used a killed, or “inactivated,” form of the virus. In that, he met resistance from more-senior scientists who believed that only a vaccine made from a live virus could provide lifelong protection.

    The public was desperate for a vaccine, yet Salk was afraid these scientists would try to derail his efforts. Objections from one even prompted the famed newscaster Walter Winchell to warn his radio audience not to take the vaccine, because “it may be a killer.” So Salk initially made and tested his vaccine in secret. Thankfully, his promising preliminary results led to the March of Dimes launching the biggest clinical trial in the history of medicine. Beginning on April 26, 1954, with a six-year-old named Randy Kerr from McLean, Virginia, the trial eventually involved 1.5 million children, and had remarkable results: Salk’s vaccine was 80 to 90 percent effective in preventing paralytic polio. It was mass-produced and distributed around the country, and by the end of the decade, it had reduced the incidence of paralytic polio in the United States by 90 percent...

    Salk also campaigned vigorously for mandatory vaccination, putting the health of the public foremost. He went as far as calling the immunization of all the world’s children a “moral commitment.”

    Some parents refuse vaccination, arguing that a healthy lifestyle is enough to protect their children from potentially lethal infections. But studies have shown that the introduction of sanitation actually enhances the circulation of poliovirus, because babies are no longer exposed to the virus in the very small amounts that used to produce lifelong immunity. Poliovirus can spread relentlessly once it gets a foothold in an unvaccinated community.

    Such was the case shortly after Salk’s vaccine was released in 1955. Massachusetts closed its vaccination program because a manufacturing error led to some contaminated shots. Even though the mishap was quickly corrected, the state did not reopen its program. That summer, Massachusetts suffered one of its largest epidemics. Four thousand people contracted polio, and 1,700 were paralyzed—mostly children.

    Does the public want to repeat history? I think Jonas Salk would plead with them to learn lessons from our past. Californians did with the recent measles outbreak, which affected more than 130 people, the majority of whom were unvaccinated. This helped spur the state to join Mississippi and West Virginia by mandating childhood vaccination, despite an outcry from several groups. Now if only 47 other states would follow suit.

  8. The Illinois Department of Public Health says the state has 73 known mumps cases right now and more than 2/3 are in Champaign County. State and local health officials say the number of cases in the Champaign area is at 50 and could climb.

    Health officials tell the News-Gazette that most of the cases are linked to the University of Illinois campus. And thousands of students who are away are expected to be back on campus in the next few weeks for fall classes.

    Dr Robert Palinkas is director of the McKinley Health Center. He said mumps outbreaks happen periodically on campus. But he said the current outbreak is the largest in more than a decade. Palinkas said the university is working to isolate students who have mumps.

  9. Carly Fiorina believes parents should make the choice whether to vaccinate their children.

    "When in doubt, it is always the parents' choice," Fiorina told a rural Iowa audience Thursday evening.

    Later that night, she added that, "when you have highly communicable diseases where we have a vaccine that's proven, like measles or mumps, then I think a parent can make that choice." She added, though, that a "school district is well within their rights to say: 'I'm sorry, your child cannot then attend public school.'"

    "So a parent has to make that trade-off," she told reporters, including The Washington Post's Jenna Johnson...

    During a February measles outbreak in 14 states, Christie told an anti-vaccine supporter that he thinks parents "should have some measure of choice" in vaccines. Around that same time, Paul said, "I’ve heard many tragic cases of walking, talking normal children who wound up with profound mental disorders after vaccines."

    Clarifications from both candidates soon followed.

    Christie's spokesman said the candidate only meant there should be greater scrutiny on states' different levels of vaccination requirements, but that for "a disease like measles," there's "no question" children should be vaccinated.

    Paul, an eye doctor, said he didn't intend to make a connection between mental disorders and vaccines:"I do think that vaccines are a good idea." He soon was pictured on Twitter getting a booster shot.

    And a few months later, in April, Christie seemed to land on the other side of the issue, telling a woman in New Hampshire who was concerned about vaccines that, "You can't count on me for that. I would err on the side of protecting public health through vaccine unless that vaccine has proven to be harmful to the public."

    What Christie and Paul realized is that siding with religious liberty when it comes to vaccines is a political pitfall. The science is decided on this: Vaccines save lives, and suggestions that they might cause things like autism are baseless.
    Courtesy of:

  10. By contrast, tea party darling and acclaimed neurosurgeon Ben Carson avoided the vaccine trap during that measles outbreak. He said he thought vaccines and the role they play in public health is "extremely important in our society."

    So the political science seems pretty decided on this issue too. Christie, Paul and Carson all calculated the political costs of questioning vaccines to please the very limited number of vaccine skeptics wasn't worth it.

    Fiorina sought to cover herself by saying that schools could refuse vaccinated children. And that's certainly a key bit of nuance that she could emphasize if she is pressed on this issue. If unvaccinated children aren't in school, she could argue, the risk of communicable diseases spreading is less of an issue.

    She could also note that many states have laws allowing for some degree of religious and philosophical exemptions from vaccines.
    Courtesy of:

  11. “The patient is placed on the sliding bed, shoved into the cabinet and the shield tightly locked. A rubber collar, which fits so snugly that almost no air can pass, is adjusted about the patient's neck. A switch is turned, and the cabinet begins its work.”

    This is how a 1930 article in “Popular Mechanics” described an “an artificial lung on wheels.” Better known as a tank respirator or iron lung, the machine pictured above was once a cutting-edge and living saving treatment for victims of polio. And it is a chilling reminder of what life without vaccines looked like -- and why we should worry about efforts to prevent kids from getting the shots that protect them, and other children, from diseases like measles.

    It might seem odd that we’re still arguing about vaccination – a quick glance at history shows vaccination's incredible social benefits, and no scientific research has ever supported the primary argument of vaccination opponents, that vaccines cause autism. The one 1998 paper that did support such a connection between the measles-mumps-rubella (MMR) vaccine and autism was retracted from the public record. Yet myths about the harms of vaccination persist, especially online, and the past year has seen a sudden surge in measles cases as parents, particularly in California, chose not to get their children vaccinated.

    In April, a new study was published that should end this debate once and for all. The Journal of the American Medical Association published a study of nearly 100,000 children in which researchers found no link between the MMR vaccine and autism spectrum disorders -- even among children who had autistic siblings and thus a higher risk for the disorders.

    In rare cases, some vaccines can cause adverse effects – such as anaphylaxis, an allergic reaction. But beyond this, vaccines cause very few health problems (and autism is not one of them). The far greater danger is the illnesses that they are designed to protect us against – diseases that ravaged America not so many decades ago.

  12. Jain A, Marshall J, Buikema A, Bancroft T, Kelly JP, Newschaffer CJ. Autism
    occurrence by MMR vaccine status among US children with older siblings with and
    without autism. JAMA. 2015 Apr 21;313(15):1534-40.

    Despite research showing no link between the measles-mumps-rubella (MMR) vaccine and autism spectrum disorders (ASD), beliefs that the vaccine causes autism persist, leading to lower vaccination levels. Parents who already have a child with ASD may be especially wary of vaccinations.
    To report ASD occurrence by MMR vaccine status in a large sample of US children who have older siblings with and without ASD.
    A retrospective cohort study using an administrative claims database associated with a large commercial health plan. Participants included children continuously enrolled in the health plan from birth to at least 5 years of age during 2001-2012 who also had an older sibling continuously enrolled for at least 6 months between 1997 and 2012.
    MMR vaccine receipt (0, 1, 2 doses) between birth and 5 years of age.
    ASD status defined as 2 claims with a diagnosis code in any position for autistic disorder or other specified pervasive developmental disorder (PDD) including Asperger syndrome, or unspecified PDD (International Classification of Diseases, Ninth Revision, Clinical Modification 299.0x, 299.8x, 299.9x).
    Of 95,727 children with older siblings, 994 (1.04%) were diagnosed with ASD and 1929 (2.01%) had an older sibling with ASD. Of those with older siblings with ASD, 134 (6.9%) had ASD, vs 860 (0.9%) children with unaffected siblings (P < .001). MMR vaccination rates (≥1 dose) were 84% (n = 78,564) at age 2 years and 92% (n = 86,063) at age 5 years for children with unaffected older siblings, vs 73% (n = 1409) at age 2 years and 86% (n = 1660) at age 5 years for children with affected siblings. MMR vaccine receipt was not associated with an increased risk of ASD at any age. For children with older siblings with ASD, at age 2, the adjusted relative risk (RR) of ASD for 1 dose of MMR vaccine vs no vaccine was 0.76 (95% CI, 0.49-1.18; P = .22), and at age 5, the RR of ASD for 2 doses compared with no vaccine was 0.56 (95% CI, 0.31-1.01; P = .052). For children whose older siblings did not have ASD, at age 2, the adjusted RR of ASD for 1 dose was 0.91 (95% CI, 0.67-1.20; P = .50) and at age 5, the RR of ASD for 2 doses was 1.12 (95% CI, 0.78-1.59; P = .55).
    In this large sample of privately insured children with older siblings, receipt of the MMR vaccine was not associated with increased risk of ASD, regardless of whether older siblings had ASD. These findings indicate no harmful association between MMR vaccine receipt and ASD even among children already at higher risk for ASD.

  13. Vaccine exemption levels among US kindergarteners are low in most states and vaccination rates among infants aged 19 to 35 months are high nationally, according to two reports released today by the Centers for Disease Control and Prevention (CDC).

    "Overall the news is gratifying. The overwhelming majority of parents continue to protect their children with recommended vaccinations," Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, said during a media briefing.

    Nonetheless, "pockets of children who miss vaccinations exist in our communities and they leave these communities vulnerable to outbreaks of vaccine-preventable diseases," she said.

    Both reports were published in the August 28 issue of Morbidity and Mortality Weekly Report.

  14. The Australian government said on Wednesday that it will pass a law that would withhold child care and other payments from families that fail to immunize their children.

    The "No Jab, No Pay Bill" introduced to Parliament would also remove a category of "conscientious objector" that allowed parents to remain eligible for full government benefits despite not immunizing their children.

    "The choice made by some families not to vaccinate their children is not supported by public policy or medical research, nor should such action be supported by taxpayers in the form of family payments," Social Services Minister Scott Morrison told Parliament.

    Families would lose up to 15,000 Australian dollars ($11,000 US) per child per year in tax and child care benefits from Jan. 1, 2016, unless their children are vaccinated.

    Exemptions would apply only for valid medical reasons.

    The legislation is likely to be passed by Parliament without any amendments. Public reaction to the proposed change has been overwhelmingly positive.

    While 97 per cent of Australian families that claim tax benefits for their offspring are vaccinated, the number of children under 7 years old who are not vaccinated because their parents are objectors has increased by more than 24,000 over the past decade to 39,000, the government said.