Saturday, April 2, 2011

2008: Measles in Dr. Bob Sears' Waiting Room

I thought this to be a timely topic given the current measles outbreak that is occurring in a very undervaccinated population in Minnesota.  Thus far, there are 14 cases in Hennepin County, 13 of which are epidemiologically-linked in the Somali population there.  This situation highlights the infectiousness of measles and how easily it can be spread to immunologically-naive people, even with overall high vaccination rates.  Uptake of MMR is estimated to be greater than 95% in 70% of U.S. schools, however, private schools are not surveyed and 12 states were below 95% with some as low as 81%.  There is also geographical clustering of "like-minded" people in communities that leave large numbers of susceptible children at risk for measles.  Additionally, lists of "vaccine-friendly" doctors, like this one provided by Dr. Bob can be geographically-linked to large numbers of school exemptions for vaccines.

This is what can, has and will happen again with the current recommendations that these "vaccine-friendly" doctors make:  In 2008, an intentionally unvaccinated 7 year old child came back to the states from a visit to Switzerland with his parents.
In January 2008, measles was identified in an unvaccinated boy from San Diego, California, who had recently traveled to Europe with his family. After his case was confirmed, an outbreak investigation and response were initiated by local and state health departments in coordination with CDC, using standard measles surveillance case definitions and classifications.* This report summarizes the preliminary results of that investigation, which has identified 11 additional cases of measles in unvaccinated children in San Diego that are linked epidemiologically to the index case and include two generations of secondary transmission. Recommendations for preventing further measles transmission from importations in this and other U.S. settings include reminding health-care providers to 1) consider a diagnosis of measles in ill persons who have traveled overseas, 2) use appropriate infection-control practices to prevent transmission in health-care settings, and 3) maintain high coverage with measles, mumps, and rubella (MMR) vaccine among children.

The index patient was an unvaccinated boy aged 7 years who had visited Switzerland with his family, returning to the United States on January 13, 2008. He had fever and sore throat on January 21, followed by cough, coryza, and conjunctivitis. On January 24, he attended school. On January 25, the date of his rash onset, he visited the offices of his family physician and his pediatrician. A diagnosis of scarlet fever was ruled out on the basis of a negative rapid test for streptococcus. When the boy's condition became worse on January 26, he visited a children's hospital inpatient laboratory, where blood specimens were collected for measles antibody testing; later that day, he was taken to the same hospital's emergency department because of high fever 104°F (40°C) and generalized rash. No isolation precautions were instituted at the doctors' offices or hospital facilities.

The boy's measles immunoglobulin M (IgM) positive laboratory test result was reported to the county health department on February 1, 2008. During January 31--February 19, a total of 11 additional measles cases in unvaccinated infants and children aged 10 months--9 years were identified. These 11 cases included both of the index patient's siblings (rash onset: February 3), five children in his school (rash onset: January 31--February 17), and four additional children (rash onset: February 6--10) who had been in the pediatrician's office on January 25 at the same time as the index patient. Among these latter four patients, three were infants aged less than 12 months. One of the three infants was hospitalized for 2 days for dehydration; another infant traveled by airplane to Hawaii on February 9 while infectious.
Just the Vax reported earlier that the index case (the intentionally unvaccinated boy travelling from Switzerland) was Dr. Bob Sears' patient.   But there is now more.  That boy, the index case, infected four other children in the waiting room of his paediatrician's office.  The office of Dr. Bob Sears.  I suspected this was the case and it was confirmed when Dr. Bob appeared on the Dr. Oz Show, "What Causes Autism" with Dr. Ari Brown who stated:
"...And as an example, there was a 2008 measles outbreak in San Diego where an unvaccinated child developed measles, was in the doctor's waiting room where other unvaccinated children then got measles.  In fact one of those children was too young to be vaccinated and contracted measles and ended up in the hospital.  And I think those were actually Dr. Bob's patients."
Dr. Bob did not deny this.

In reality however, there were three infants and one toddler who contracted measles in his waiting room.  Here is the story of the one who ended up in the hospital:
If you hear "106 degrees" you probably think "heat wave," not a baby’s temperature. But for Megan Campbell’s 10-month-old son, a life-threatening bout of measles caused fevers spiking to 106 degrees and sent him to the hospital.

"After picking our son up at child care because he had a fever," says Megan, "we went straight to our pediatrician who said our baby had a virus. Two days later, his fever hit 104 degrees and a rash appeared on his head."

The rash quickly crept down to his arms and chest. Megan and husband Chris turned to the Internet. Finding pictures of measles that looked like their son’s rash, they rushed him to the local children’s hospital.

"No one there had seen or tested for measles for about 17 years," says Megan. "And no one expected it in the year 2008 in the United States. The next day, an infectious disease specialist confirmed measles.

"We spent 3 days in the hospital fearing we might lose our baby boy. He couldn’t drink or eat, so he was on an IV, and for a while he seemed to be wasting away. When he began to be able to drink again we got to take him home. But the doctors told us to expect the disease to continue to run its course, including high fever—which did spike as high as 106 degrees. We spent a week waking at all hours to stay on schedule with fever reducing medications and soothing him with damp wash cloths. Also, as instructed, we watched closely for signs of lethargy or non-responsiveness. If we’d seen that, we’d have gone back to the hospital immediately."

Thankfully, the baby recovered fully.

Megan now knows that her son was exposed to measles during his 10-month check-up, when another mother brought her ill son into the pediatrician’s waiting room. An investigation found that the boy and his siblings had gotten measles overseas and brought it back to the United States. They had not been vaccinated.

"People who choose not to vaccinate their children actually make a choice for other children and put them at risk," Megan explains. "At 10 months, my son was too young to get measles, mumps, rubella (MMR) vaccine. But when he was 12 months old, we got him the vaccine—even though he wasn’t susceptible to measles anymore. This way, he won’t suffer from mumps or rubella, or spread them to anyone else."

This story is one of many recounted in the fact sheets series, Diseases & the Vaccines that Prevent Them.
For other true stories, see Vaccines: Unprotected Stories.
I wonder if Dr. Bob and his merry band of "disease-friendly doctors" provide information to their vaccine-refusal clients shown in the links above, let alone tell parents of his own practice's patient who was infected while waiting for his well check-up.  Unfortunately, this isn't all to that story.  It appears as though Dr. Bob or one of his practice partners doesn't even know what measles looks like:
First Generation (1 Case Spread to 8)
On January 13, 2008, the 7-year-old male index patient returned from Switzerland, asymptomatic but incubating measles. He transmitted infection to his 9-year-old unvaccinated sister and 3-year-old unvaccinated brother. On January 24, 2008, after 2 days of fever and conjunctivitis, the index patient attended charter school A. Forty-one of the 377 students (11%) at charter school A were unvaccinated for measles because of personal beliefs, and 2 children became infected. The next day, the index patient developed a rash and was taken to an internist who diagnosed an upper-respiratory infection and prescribed amoxicillin. No airborne-infection isolation precautions were taken; adults in the waiting room were exposed, but none of them became infected. Later the same day, the index patient was taken to pediatric clinic A, where scarlet fever was diagnosed; again, amoxicillin was prescribed. No respiratory precautions were taken, 6 children were exposed, 5 were unvaccinated, and 4 were infected (3 infants too young for vaccination and a 2-year-old whose parents had intentionally delayed measles vaccination). The next day, after telephone consultation with a pediatrician, the child was taken for measles serology testing. No respiratory precautions were taken in the clinical laboratory, and no records were kept to permit identification of potentially exposed persons. With worsening fever, the index patient was taken to a children’s hospital emergency department, where measles was clinically diagnosed. The patient was triaged, placed in a negative-airflow waiting room, and then examined in a room with curtain-separated beds and no negative airflow, all without wearing a mask. Thirteen children were potentially exposed, and 5 were unvaccinated infants; none of them were infected.
Emphasis added.  A disease-friendly physician, such as Dr. Bob should know what measles looks like, and certainly be able to distinguish it from Scarlet Fever; there are tests for both.  Even after this incident, Dr. Bob still recommends delaying MMR until 4 years old and recommends only a single dose.  The parents of the index case are certainly not without fault as they intentionally left their child unvaccinated for measles, at the very least, travelled to an area with a relatively high prevalence of measles, in fact during that time, a record number of measles cases since mandatory reporting began in 1999 and then don't even know what measles looks like themselves, eventually exposing hundreds of people.  The eventual cost of Dr. Bob's (or practice partner's) failure to properly inform parents, identify measles in his patient and the parents narcissistic decision to leave their child unvaccinated and traipse him about, was $124 517.00 in order to prevent third generation transmission.  Cost to parents who refused post-exposure prophylaxis vaccination for their children and were placed in voluntary quarantine was ~$19 375.00.  Cost  to parents whose children were too young to be vaccinated and placed in voluntary quarantine was ~$37 200.00.

One would think this would be a humbling and educational experience for someone like Dr. Bob, but it wasn't.  In his 2008 blog about the San Diego measles outbreak, he callously dismissed the measles outbreak:
The recent measles outbreak (if you can call it that) in San Diego last month, in which twelve children came down with the illness after an unvaccinated family brought the disease back with them from Switzerland, raises awareness of a growing trend among families to decline certain vaccines.
Perhaps Dr. Bob could benefit from EpiRen's Epidemiology Night School where he discusses what constitutes an outbreak for Dr. Bob's pal Dr. Jay Gordon.
WHAT IS AN OUTBREAK?
Traditionally, an outbreak has been defined as "one case over the expected rate (or number) of cases for a given location in a period of time." In Minnesota, they have seen 22 cases over the last 14 years (22/14=1.6 cases per year in all Minnesota). Rounding up, we can say that two cases per year is what is expected. Three cases in 2011 would mean an outbreak. What was that in 2010, you ask? Well, 19 cases in 13 years give us a rate of 1.5 cases per year. It would also be an outbreak situation, especially if the three cases were epidemiologically linked. That information is not yet available from the MDH, but it will be interesting to read later on.
Let's look at the numbers; in 2005, the whole state of California had 4 cases, in 2006, California had 6 cases, in 2007, 5 total cases, in 2008, 14 cases, 12 of which were epidemiologically linked to the included index case and 4 cases occurred right in Dr. Bob's office.  The whole county of San Diego had not had a single measles outbreak since 1991.  All of California went back down to 9 total cases in 2009.  That was an outbreak as defined by epidemiology.  Unless Dr. Bob would like to claim that an average of 3 or 4 cases of measles occurs in his waiting room on an annual basis.  This is what he also callously claims regarding the ten month old infant infected in his waiting room and ended up in the hospital:
I believe our nation can tolerate a certain percentage of unvaccinated children without risking the overall public health in any significant way. Since most children are vaccinated, our nation has enough “herd immunity” to contain outbreaks like this one.
However, in the San Diego case, some infants caught measles before they were old enough to even be vaccinated. Fortunately, all cases passed without complications, as is usually the case with measles.
I beg to differ that the Campbell's son, hospitalised for 3 days and then several more days at home with constant monitoring is "uncomplicated".   Perhaps he hopes that no one will remember the children infected during this outbreak should any develop SSPE in the next few years.   Dr. Bob also doesn't get herd immunity, no need for scare quotes, herd immunity is real and assumes equal distribution of susceptibility to work.  He has helped to create the clustering effect which allowed foreign measles strains to spread until contact tracing and quarantining of exposed individuals was implemented by public health officials.  But that is just fine according to Dr. Bob:
Public health officials will be there to help clean up the mess that disease-friendly doctors like Dr. Bob create, instead of promoting prevention.  I am fully supportive of parents' right to choose vaccination schedules, however, choices need to be more responsible and "vaccine-friendly" doctors need to stop disseminating false information and validating poor vaccine choices.  To use the words of anti-vaxx spokesperson, Jenny McCarthy:
I do believe sadly it's going to take some diseases coming back to realize that we need to change and develop vaccines that are safe. If the vaccine companies are not listening to us, it's their f___ing fault that the diseases are coming back. They're making a product that's s___. If you give us a safe vaccine, we'll use it. It shouldn't be polio versus autism.
Except it isn't going to work out the way she thinks when some physicians and parents wilfully contribute to large gaps in herd immunity.  When a child does die or become permanently injured from measles, or a child is born with congenital rubella syndrome because the mother sat in a waiting room of someone like Dr. Bob Sears, or wild-type polio is ever diagnosed in the Western Hemisphere again, there will be a backlash.  Sears, Gordon and all of the other disease-friendly doctors won't get to re-define nomenclature and won't get to heartlessly disregard outcomes.

The next time you are looking for a measles party, or chicken pox, rubella, Hib, pertussis or mumps, no need to organise it with your local mummy forum, just stop by Dr. Sears' office or one of his disease-friendly associates offices on his list.  But you may want to go see a more competent physician if you actually want a proper diagnosis after the fact.  And even better, one who makes house-calls.



EDITED BY Catherina ON 6/6/2011 to add a comment from Dr. Bob made on his Facebook group:



Seems he lucked out there...

18 comments:

  1. Can we please start processing the paperwork to have this "dr" lose his license? He is obviously negligent, and ignorant (not to mention dangerous to the public good)...

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  2. Larian raises a good point. Why is there no professional body to ensure disciplinary action can be taken against the spread of dangerous misinformation by qualified Drs?

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  3. I just don't know what the answer is. The line seems to be blurred between ethical and an actionable offence. Perhaps public health departments can start billing these parents and physicians for outbreak tracing and containment. But that too is a slippery slope. I wouldn't be surprised if some lawsuits get filed by parents whose children were infected with a VPD by an intentionally unvaccinated child. The ultimate answer, may be for better education of these parents and also, for the AAP to start being more proactive and aggressive speaking out directly against the likes of Bob Sears and Jay Gordon.

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  4. How stupid of the parents of the baby who already suffered a life-threatening bout of measles at 10 months to vaccinate him against measles at 12 months!

    Since he survived the measles, he already had proven immunity, so he was no longer in danger, nor was he any longer in danger of spreading measles to anyone else!

    Since all vaccines come with some risk, it was foolish to take that risk with a baby who had proven immunity!

    By the way, my child suffered a vaccine-induced developmental disability, but we missed the time frame for even trying to "prove it."

    Even if we had, we can barely find the help we need. Don't waste any tears over that, though.

    Just go after parents who don't want to take stupid risks, and decide to vaccinate against something their baby had 2 months ago!

    Have you ever heard of checking titers, rather than risking another vaccine?

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  5. Terri,

    how wise of the parents to protect their son against mumps and rubella, included in the MMR they gave him, especially if they are in the catchment area (pun intended) of a doctor whose practice (another intended pun) is conducive to the spread of VPDs.

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  6. @ Terri,

    Your lack of knowlege about vaccination is showing. Yes the child, had measles, but as the MMR vaccine is not available as separate components (nor should it be), the parents choice was to either vaccinate with the MMR or leave their child susceptible to mumps and rubella (the other two components of MMR). Additionally, there is no risk (over the baseline risk, ie. allergic reaction to one of the vaccine components) to vaccinating after having had the disease.

    I am sorry about your child's disablity, but if you "missed the time frame for even trying to "prove it" (that it was vaccine induced), then how can you be so sure that it was vaccine induced and not some other cause. In fact I am not even sure what "missing the time frame" might mean. As is said, "correlation does not equal causation".

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  7. My last comment: How can I be so sure the vaccination caused it?

    Listed right before me I have the National Childhood Vaccine Injury Act, current Vaccine Injury Table.

    One of the listed adverse events for MMR is encephalopathy ("disorder or disease of the brain") during a time interval 5 to 15 days from the time of the shot.

    My son had a high fever after this shot, he wasn't himself, he was listless. Did this occur precisely during the 5 to 15 day "acceptable" period? I can't say with certainty, but it was certainly within a week, or two or three. Then he got a bit better, and we assumed he'd "dodged a bullet."

    Later, he continued to show "sequela" from this event, and I can safely assume it was from this event for several reasons:

    First, the sequela ("pathological condition resulting from disease, injury, or other trauma") clearly began to show itself within the appropriate time frame (0-6 months). This is not to say that his problems were clear-cut to us at that point, nor were we able to identify precisely what was going on. But he began to show regression in physical ability (loss of skills previously shown), loss of language, and a clear regression in sleep patterns. He also had bowel disease, and by that I mean a period of three and four times daily diarrhea (developing slowly within this same time period) from no known cause.

    (Oddly, this "sequela" is noted as "not applicable" on the Vaccine Injury Table, although it is listed as an adverse event. I guess this is where it falls on parents to prove it.)

    Second, there was no other probable cause for what was happening. There had been no trauma to the head, there had been no other significant illness during this time period.

    Third, the progression of symptoms was almost exactly what I have now (years later) heard described by thousands of other parents whose children deteriorated mentally, physically, or both after a vaccination or a series of vaccinations.

    Fourth, there were no genetic causes uncovered to explain his problems (yes, we looked) and he was not having seizures or other detectable brain issues--no tumor, no history of seizures, nothing. Nor could his problems be ascribed to a traumatic birth, given the relative suddenness of his decline and the good development which preceded it.

    One in every one hundred children now has autism. One in every ten children now has a developmental delay classified as either PDD-NOS, ASD, ADHD or ADD.

    Encephalitis ("acute inflammation of the brain") and encephalopathy (again, "disorder or disease of the brain") are known possible outcomes of vaccination, yet when they happen, the first response (and often the last) is typically that "it couldn't have been the vaccine."

    Of course it could have been the vaccine, since these are known to be adverse, well-documented vaccine reactions.

    When the brain injury then begins to show itself as a warping of personality, loss of skills, ongoing difficulty in communication and the formation of relationships (roughly the definition of autism and autism spectrum disorders) we refuse to see what happened because it would be too inconvenient to confront the dark side of vaccination.

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  8. Terri,

    people with Huntington's Disease develop normally for decades. The final decline into the disease does not need a trigger. Neither does regressive autism, no seizures or other detectable brain issues--no tumor, no history of seizures, nothing necessary. One in 100 children has always had autism (or how do you explain the 1 in 100 autistic adults that surveys find?). It is rather convenient to blame "the dark side of vaccines" for autism (and anything that happens with a child after vaccination), but none of the associations pan out. For example "age at first concern" was identical before and after the introduction of the MMR (about 19 months).

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  9. Terri

    Also keep in mind that the vaccine injury table was created without adhering to the rigors of a scientific study, it has an intentionally low bar for evidence of injury due to vaccination in order to assure that no child who could possibly (within reason) have been injured due to vaccination, be left without compensation.

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  10. You talked a lot about measles as though everyone should be deathly afraid of it, but in reality it is rarely a dangerous disease, and if children are cared for properly at home (rest, warmth, hydration, and no Tylenol or Ibuprofen), the vast, vast majority recover without incident and have gained permanent immunity and a stronger immune system. I had measles in 1963 when I was six, and had a high fever, a splotchy rash, etc., my parents put me in a bathtub of water in the middle of the night to lower the fever, and after a week and a half I recovered, the way everyone did at that time. All the children in my school got measles, and they all recovered. I think you should add to your article the numbers of children who have died from measles in the U.S. in the last twenty years. Several hundred have contracted measles, and to the best of my knowledge, none of them died.
    MMR, on the other hand, disables a significant percentage of the children who get it for the rest of their life.

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  11. Anonymous, You confuse your own experience with what is reality on a population level. And that is, a case-fatality rate of 1-3/1000-3000. Up to 30% will have complications ranging from pneumonia to encephalitis. There is also SSPE which is a separate registry and will affect more than 1/100000 and 18/100000 in children less than a year old. Death is not the only outcome of interest.

    I'm glad you had an uncomplicated course, but you do not speak for nor represent those who cannot relay the same experience because they are dead or permanently, neurologically impaired. Which happens far more frequently (orders of magnitude in fact) than with complications from the vaccine. So bring measles, mumps and rubella back?

    Here is some relatively current information on the measles outbreaks in the EU: http://news.patient.co.uk/newspaper.asp?ss=10&pc=63845 and during the last large-scale U.S. outbreak, the corrected case fatalities were 259 and mostly in previously healthy children and adults. Your claim that "MMR disables a significant percentage of children", needs to be supported with something other than your say-so because the stats pale in comparison to wild-type measles, mumps and rubella infections.

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  12. URL for U.S. outbreak: http://jid.oxfordjournals.org/content/189/Supplement_1/S69.long

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  13. @Anonymous

    after a week and a half I recovered, the way everyone did at that time

    Except for the 350 or so who died from measles in 1963, out of just shy of 400,000 (that's around 1 in 1,000 death rate, as expected). There were over 400 deaths the each in 1962 and 1964, too.

    But, as Science Mom said, death isn't the only bad result of getting the measles.

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  14. We delayed my daughter's MMR until she was 4.5 because of a severe reaction in the family. When we found out we were moving to Switzerland, we decided to vaccinate her because of the measles outbreak here. The vax-friendly pediatrician who gave my daughter the shot told me that since she was older than 4, she would only need one.

    At her 6 year visit, the doctor in Switzerland told me that they recommend 2, even if the child is older than 4 when she gets her first one. I guess that rule is the old recommendation?

    Oh, and I am very thankful my kids are vaccinated. I had to take my daughter to the children's hospital because she bumped her head on the radiator and I saw a girl covered with a rash. I smiled at her when she looked at me but I was just hoping she didn't have measles.

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  15. Megan - the MMR isn't anymore effective at age 4 than at earlier ages. We have blogged about that here:

    http://justthevax.blogspot.com/2009/08/seroconversion-after-measles-or-mmr.html

    Ignore the snark at the beginning - scroll down for the numbers and thanks for stopping by :)

    Catherina

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  16. Interesting you chose to update the end but not the title. It's hard to take someone seriously who writes an entire blog piece passed around personal speculation and not fact. Then even when you find out you were wrong you don't retract the sensational but untrue title.

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  17. Catherina merely reported what Dr. Bob claimed, which is also speculation. Dr. Bob has had numerous opportunities to declare Dr. Brown's accusation that the index case was in his waiting room and where the transmission occurred. He hasn't. He also didn't admit that the index case was his patient until it was discovered by Seth Mnookin. So whom shouldn't you take seriously?

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  18. See also http://blogs.plos.org/thepanicvirus/2012/03/26/bob-sears-bald-faced-liar-devious-dissembler-or-both/

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