KISS 11 June 2014: Vaccination protects from severe pertussis

An ongoing outbreak of pertussis in Oregon, spanning from 2010 to 2012 and 624 cases, offered the exceptional opportunity to analyse disease severity. Vaccination history, treatment, demographic, and outcome information was available for almost all (98.7%) of the patients, of which 45% were up to date with currently recommended vaccinations. The paper finds:

Ever-vaccinated cases were significantly less likely to be hospitalized or develop severe illness (adjusted odds ratio [aOR], 0.2; 95% confidence interval [CI], .1-.8 and aOR, 0.4; 95% CI, .2-.9, respectively). ACIP up-to-date patients stopped coughing significantly more rapidly than unvaccinated patients (adjusted hazard ratio, 1.7; 95% CI, 1.3-2.2). [my bold]

 Read more here.

Routine vaccination leaves man quadriplegic? Open Letter to Channel Nine

Like several other outlets, Channel Nine News reported the story of Ben Hammond, a Western Australian father of five, who came down with a debilitating episode of what is purported to be ADEM after a whooping cough booster. Now the Northern Rivers Vaccination Supporters have written an Open Letter to Channel Nine, which I am reposting here with kind permission, since it is, in contrast to Channel Nine's piece, evidence based and factual and important.

AN OPEN LETTER REGARDING A RECENT CHANNEL NINE NEWS STORY, THEIR INACCURATE PORTRAYAL OF VACCINE RISK, AND THE IMPORTANCE OF THE ADULT WHOOPING COUGH BOOSTER.

A news story that aired nationally on 2nd and 3rd June, 2014 on the Channel Nine News network and the Today Show was inaccurate and grossly irresponsible.

The story featured Perth father Ben Hammond, who received a Diptheria/Tetanus/Pertussis booster, and became seriously ill eleven days afterwards. Ben’s condition was said to be ADEM (Acute Disseminated Encephalomyelitis), a rare auto immune condition. This disease lead to Ben becoming quadriplegic for several months.

First of all, we wish to express our sorrow and sympathy for everything this man and his family have been through. By all accounts they have suffered a great deal physically, emotionally, and financially.
We are not writing to challenge or diminish what has happened to the Hammonds. This family deserves the support and generosity of the public to help them get back on their feet. We support a full investigation into the cause of his illness, so there is transparency on the facts of whether the vaccine caused it and the risks.
However the story breaches the Australian Communications and Media Authority Code of Practice (1):

• Section 4.3.1: The article was not factual or accurate and did not represent
  viewpoints fairly. It did not state:
    o How rarely, if ever, it has been shown that ADEM can be
       caused by vaccination
    o Any evidence to support this allegation
    o Why adults require the Whooping Cough (pertussis)
       booster
    o The relative risk to babies of whooping cough, versus
        the risk of the alleged vaccine reaction
• Section 4.3.2: It could cause public panic about vaccines and place
  newborn babies at risk

Why adults require Whooping cough boosters:
The Hammonds were offered a free booster during the time that Australia was experiencing the world’s largest Whooping Cough epidemic. This peaked at 38,500 cases in 2011. In response to thousands of babies being hospitalised and tragically over ten babies dying nationally, State governments have distributed millions of doses of the vaccine for free to new parents since 2009. Without the program, the number of grieving families would have been significantly higher.
Our group includes families whose babies have died from Whooping Cough, and who have worked hard to raise awareness of the need for adult boosters. This has saved lives, particularly of vulnerable premature babies.

Adults need a booster because of waning immunity, this happens both after the vaccine, and following ‘natural’ infection. Recent research has shown that this can occur as quickly as after four years(2). Unfortunately, nationally, less that 12% of adults have had a Whooping Cough booster (3). This means if there is an outbreak, an adult is susceptible to catching the disease, and passing it on to others. For most adults, this causes an irritating coughing illness that can last for months and lead to rib fractures and pneumonia; in young infants it can be deadly. Babies cannot have their first dose of protective vaccine until they are 6 weeks to 2 months old, so these very young babies must rely on adults being up-to-date with their boosters to be protected (4).

Risk of whooping cough to babies:
The story did not state the relative risk of acquiring ADEM after a vaccination, when compared to the risk of a baby catching whooping cough.

   • Nearly all babies that catch whooping cough require care in hospital.
   • It tragically proves fatal in 1 in 200 who catch it (5).
   • There is no cure for whooping cough. Babies face months of disease, and once it takes hold, the only treatment is supportive, with oxygen, and for critical cases, ventilation and ECMO (life support that, at best, also carries a very high mortality) (6).

Thankfully new research has shown that if a woman gets vaccinated when pregnant, this may halve the risk of the baby catching whooping cough (7). However, we are concerned your program will negatively impact on the uptake of this vital public health measure.

The facts about ADEM:
The news story should have featured a medical expert, to provide some facts about ADEM. Without the context of how rarely ADEM occurs after a vaccination, this omission could greatly damage public confidence in the vaccination program.

The alarmist headlines used such as “Routine vaccination almost fatal” “Vaccine danger” “Man becomes quadriplegic following routine vaccination” “One shot left him crippled” “Destroyed his life” and “Vaccination nightmare” were not counterbalanced with any information portraying the real-life risk of developing ADEM. Instead, we were solely given the Hammonds' own assertion of it’s cause.

ADEM may or may not be associated with some vaccines. We know that it occurs at such an extremely low rate it is impossible to determine causality with any scientific accuracy.
Indeed it is so rare the risk is something like 8 out of 1 million risk to the general population. Out of those cases, less than 5% follow immunisation, and it is much more likely to follow infection by one of the vaccine preventable diseases (8). There are many common and not-so-common bacteria and viruses that induce ADEM at much higher rates than those associated with vaccination.
The only vaccine proven to induce ADEM is the Semple form of the rabies vaccine. Other vaccines have all been implicated, most commonly the MMR vaccine, but the majority of the studies that correlate vaccination with ADEM onset use small samples or case studies (because there are so few cases to begin with). Large scale epidemiological studies have not shown an increased risk of ADEM following vaccination.

Also misleading was the implication Mr Hammond had “no immune system" and “no kidney or liver function” from the vaccine. ADEM should not cause organ dysfunction or immune suppression (although medication used to treat it can), and the paralysis it causes is usually temporary.
We take vaccine safety and transparency about that safety very seriously, and support the Hammond's use of the media to highlight the rare possibility of adverse vaccine reactions. The family deserves respect, and privacy, and we understand their need for financial assistance. We hope Ben’s case highlights the importance of a no-fault vaccine injury compensation program in Australia, for when adverse reactions to vaccines do occur.

However, unnecessarily scaring people away from vaccination programs such as against whooping cough could deter adults from having a booster, and place vulnerable newborns at high risk. News reports regarding vaccination should be clear and balanced. They need to present the relative risks of an adverse reaction to a vaccine when compared with the risks from vaccine preventable diseases. The media’s role in public perception of healthcare, risk of disease, and vaccine safety should not be underestimated, nor the responsibility taken lightly.


1: http://tinyurl.com/ltbyrl4
2: Wendelboe, A. M., Van Rie, A., Salmaso, S., & Englund, J. A. (2005). Duration of immunity against pertussis after natural infection or vaccination. The Pediatric infectious disease journal, 24(5), S58-S61
3: http://www.aihw.gov.au/publication-detail/?id=10737418409
4: http://www.chainofprotection.org/adultimmunisation
5: http://tinyurl.com/pwfthsw
6: http://tinyurl.com/msyg6pg
7: http://tinyurl.com/k3rp7t3
8: Huynh, W., Cordato, D. J., Kehdi, E., Masters, L. T., & Dedousis, C. (2008). Post-vaccination encephalomyelitis: literature review and illustrative case. Journal of Clinical Neuroscience, 15(12), 1315-1322.

Measles Vaccine = Cancer Cure?

Several news outlets reported today that a woman with multiple myeloma has been the first to go into full remission after receiving a "high dose" measles vaccine.  The Star Tribune and Washington Post also report that Stacy Erholtz who had been battling multiple myeloma, a blood cancer, for ten years went into full remission after receiving a single intravenous infusion of an engineered measles virus (MV-NIS).  The measles virus concentration was enough to inoculate ten million people.

Ms. Erholtz reported that it was the easiest treatment by far she had received and experienced a "bad headache" and fever which quickly resolved.  The treatment was performed last year on Ms. Erholtz and another multiple myeloma patient, both selected because they were immune-compromised.  Unfortunately, the other patient's cancer returned after nine months.

Two multiple myeloma patients were chosen because they are immune-compromised, and can't fight off the measles before it has time to attack cancer. Both had limited previous exposure to measles, and therefore fewer antibodies to the virus, and essentially had no remaining treatment options. Of the two subjects in the study, Stacy was the only to reach full remission. The other patient's cancer returned after nine months.

I am reminded of a statement that Dr. Paul Offit made regarding the theoretical antigen capacity that could be handled by a child's immune system and that was described as:

"...babies could theoretically respond to about one hundred thousand vaccines at one time."

Of course that was used by anti-vaxxers as proof that Dr. Offit was evil if he wanted to jab babies with 100,000 vaccines at one time.  But reading comprehension and honesty aren't exactly strong suits of the anti-vaxx disinformation groups.  And now, here we have an immune-compromised woman with multiple myeloma who was given enough measles vaccine that equalled ten million doses intravenously (that's "directly into the bloodstream")...

And it cured her cancer.

In all honesty, it's too soon to predict the success of this new treatment which is entering clinical trials with multiple viruses and types of cancers but for now, one woman is celebrating life cancer-free and there may be new hope for cancer treatments in the near future.

Wakefraud One More Time and Anti-Vaxx Myth-Busting Dr. Iannelli

Since Andrew Jeremy Wakefield aka Wakefraud made another warped bid for attention in the form of threatening a maybe-perhaps-in-the-future-if-he-gets-around-to-it lawsuit against Emily Willingham and Forbes Magazine, it's just as good a time as any to give him the attention he so desperately craves.  C0c0rdance released an educational video which contains Wakefraud's raw real-time PCR data and how it was intentionally altered to achieve measles-positive results entitled "Wakefield's Smoking Gun".  C0nc0rdance's evidence and plain-language explanation leaves no doubt of Wakefraud's intentional fixing of the data to provide his own foregone conclusion.

Next, Vincent Iannelli, M.D. posted an excellent "Vaxopedia" entry "Anti-Vaccine Myths and Misinformation" which will be a handy reference for a quick refutation for the annoying anti-vaxxer you may be arguing with as they will undoubtedly invoke several of the canards debunked by Dr. Iannelli.

"I did my research."

Parents often say that when they are ready to delay or skip vaccines.

Because the idea that vaccines are dangerous is easy to disprove, the anti-vaccine movement surrounds that idea with many myths and much misinformation to confuse parents who are trying to "do their research" on vaccines and how best to keep their children safe and healthy.

This guide to the most common anti-vaccine myths and misinformation will help you understand that vaccines are safe, are necessary, and that getting your kids vaccinated and fully protected against each and every vaccine-preventable disease is the right decision to make.

Please read on for an entertaining rebuttal of 40 anti-vaccine tropes.

Wakefraud: A New Internet Meme is Born

Last week, Andrew Jeremy Wakefield did not like a blogpost on Forbes by Emily Willingham and penned a whiny threat of legal action against her.  His threat appeared on the autism crank blog Age of Autism whose readership consists mainly of rabid anti-vaxx parents of autistic children who hate Emily Willingham with a white-hot passion.  It was a most calculated move by Wakefield as Penumbrage opines:

So why is he doing it? My best guess is that he has issued this threat and published it on Age of Autism to rally the troops and revitalize his flagging support. And why is he doing it to Ms Willingham? Perhaps he thinks she is more vulnerable than CNN or Time Magazine. Maybe he hoped that Forbes would take the corporate view and silence her to fend off a potential troublesome lawsuit. Not for the first time he has been proven wrong. Ms Willingham is an eminent scientist, an educator and an accomplished journalist. Forbes recognize her talent and show no signs of surrendering to Wakefield’s bluster.

Today, Harpocrates Speaks published a hilarious post describing the "Wakefraud".

The sun set long ago, and outside, the world sleeps. Only the occasional passing car breaks the tranquility of the night. Inside, a lone figure sits before a laptop. The lamp on the desk sheds a soft, if weak, light, nearly drowned out itself by the cold illumination of the monitor. The figure's fingers tap out a few final strokes, then move to the mouse. She drags the cursor across the screen and clicks "Publish". A sudden flash of lightning and thunder, then the room goes dark.

A low, quiet chuckle filters out of the laptop as the screen fitfully flickers back to life. On the screen, four words shed an ominous, baleful glow:

The Wakefraud had struck.

Read both Penumbrage and Harpocrates Speaks for more excellent commentary about the Wakefraud.  Wakefield wanted some publicity and attention, well he's got it.

May the Forth... just a friendly reminder

Wakefield Attempts (yet again) to Silence a Critic

Andrew Jeremy Wakefield has issued a letter to blogger Emily Willingham of Forbes accusing her of "malicious defamation" in an article she posted, “Blame Wakefield For Missed Autism-Gut Connection.”

This Pediatrics review of autism and gut disorders found higher rates of constipation, diarrhea, and stomach pain among autistic people. But the authors do not once mention anxiety.
That in spite of the fact that anxiety is a key feature of autism and that research suggests that autism and anxiety are indeed linked.  And that gut conditions like diarrhea and constipation and gut pain are often related to anxiety.
When children aren’t autistic and they have stomach pain or constipation or diarrhea, the frequent conclusion is that stress and anxiety are the cause and predictive of anxiety in adulthood. Indeed, with that little nervous system parked there in our gut, it’s no wonder that things get a little seized up and out of rhythm when the rest of us does.

Pressure (Photo credit: kevin dooley)

So why is it that no one attends to this clear (to me) link when it come to autistic children? Well, the Pediatrics review by McElhanon et al. happens to cite that reason several times:  Wakefield’s MMR/autism/gut red herring and the subsequent noxious cloud that his fraud left over any research examining autism and the gut. So we don’t know anything about the real underlying causes of these digestive problems among autistic children. The Pediatrics authors state it unequivocally:

It is clear that greater clinical and research scrutiny is needed to increase awareness on this topic and thus support development of the best standards of care. Previous controversy surrounding the MMR vaccine and proposed causal link between ASD and infection of the GI tract probably deterred investigators from dedicating resources to examine GI functioning in this population while fostering uncertainty in the ASD community regarding the validity of this line of inquiry.

Another thing for which to thank Andrew Wakefield, a self-described “academic gastroenterologist.” Someone with that specialization would have been the perfect person to make this connection between anxiety in autistic people and gut discomfort. One more among so many opportunities for understanding and intervention missed, even as public health in general and the health of autistic children specifically continue to suffer.
Perhaps now, with this Pediatrics review disconnecting Wakefield from the picture altogether and encouraging genuine investigation, researchers will feel more justified in pursuing this question with valid, testable hypotheses and studies that might lead to effective interventions for GI distress among autistic people.

Wakefield is currently embroiled in a lawsuit against Brian Deer, The British Medical Journal (BMJ) and Fiona Godlee for defamation. Given how TIME magazine has dubbed Andrew Jeremy Wakefield one of the "Great Science Frauds",  or how CNN has called Andrew Jeremy Wakefield's Lancet study "an elaborate fraud" or how the New York Times has called Andrew Jeremy Wakefield "one of the most reviled doctors of his generation" and other journalists and numerous bloggers have "blamed" Andrew Jeremy Wakefield for derailing autism research and reduced uptake of vaccines, it seems rather odd that Wakefield would now single out Emily Willingham and Forbes.

His sad little letter to Dr. Willingham and Forbes has been published on none other than Age of Autism, the revolting den of autistic-haters and Wakefield devotees. Curiously, he penned the threatening letter himself rather than have an attorney draft and send it.

Ms. Emily Willingham
Forbes Magazine
60 Fifth Avenue,
New York, NY 10011.
04.30.14
Re:       Malicious defamation of Dr. Andrew Wakefield

Without prejudice

Dear Emily Willingham,
            It has been brought to my attention that on or about April 30, 2014, Forbes ran an online article authored by you entitled, “Blame Wakefield For Missed Autism-Gut Connection.” The article can be found online at:
http://www.forbes.com/sites/emilywillingham/2014/04/30/blame-wakefield-for-missed-autism-gut-connection/
In this letter you made demonstrably false and misleading claims that have the effect of defaming me. Your false and defamatory statements are reckless, stated without due regard to the available evidence, and malicious. Accordingly, pending review by my lawyers, you will be sued for defamation.
            Specifically, your article states, as a matter of fact that:
Wakefield’s MMR/autism/gut red herring and the subsequent noxious cloud that his fraud left over any research examining autism and the gut.
            In making this false and malicious allegation of fraud, you erroneously ascribe the above statement to a “cite” from the authors of an article published in the medical journal Pediatrics when you write:
Well, the Pediatrics review by McElhanon et al. happens to cite that reason several times: Wakefield’s MMR/autism/gut red herring and the subsequent noxious cloud that his fraud… The Pediatrics authors state it unequivocally:
            On any ordinary reading, the intent of your statement is clear: to imply that the authors of the Pediatrics paper cite fraud on my part.  What McElhanon et al actually say is substantially different from your false and defamatory allegation i.e.,
It is clear that greater clinical and research scrutiny is needed to increase awareness on this topic and thus support development of the best standards of care. Previous controversy surrounding the MMR vaccine and proposed causal link between ASD and infection of the GI tract probably deterred investigators from dedicating resources to examine GI functioning in this population while fostering uncertainty in the ASD community regarding the validity of this line of inquiry.[1]
            There has been a substantial amount of inaccurate and misleading reporting regarding me and my work in multiple publications.  Some of the most egregious statements that have been made about me appeared in the British Medical Journal and in publications by Mr. Brian Deer.  As you should be aware, I am suing the British Medical Journal, its editor Dr. Fiona Godlee, and Brian Deer for defamation in state District Court in Travis County, Texas.  The case is Cause No. D-1-GN-12-000003, Dr. Andrew J Wakefield v. The British Medical Journal, et.al.  The case is currently on jurisdictional appeal, a matter that is irrelevant to either the factual merits of the case or to the prosecution of defendants such as you, based, as you are, in the United States.
            The pleadings and other papers on file in that case set forth my position regarding numerous statements made by Brian Deer, Dr. Godlee and the BMJ. I have filed affidavits in that case which support my claim that false and defamatory statements have been made about me.  The documents on file are public records to which you and Forbes have had access for some considerable time. These documents demonstrate that the scientific research conducted by me and published in the Lancet Paper was not fraudulent. It appears that you have failed in the most basic process of due diligence by not availing yourself of this information before making your defamatory statements. Your actions show a reckless disregard for the truth and are clear evidence of malice on your part; pending legal advice, you will be prosecuted accordingly.
            Further, you are advised that there is, in fact, a substantial body of peer reviewed and published work that corroborates the presence of gastrointestinal pathology in a substantial proportion of children with autism. The Lancet Paper was the stimulus for this compelling and important. I suggest that you avail yourself of this body of work in anticipation of legal proceedings against you. The microscopic, cellular, molecular, microbial, and pathophysiological changes that have been reported by independent researchers may prove to be somewhat challenging to your flimsy notion of “anxiety.”
      You are also advised that I live and work in Austin, Texas where my business is headquartered, and that my work is conducted throughout the US. Your defamatory statements about me will undoubtedly cause me to suffer significant personal and financial damage.
            My lawyers are currently dealing with Deer and his co-defendants. They will be turning their attention to you well within the statute of limitations for filing a case against you and Forbes.
Yours faithfully,
Dr. Andrew J Wakefield MB.BS
c.c.
Bill Parrish
James Moody Esq.
Dawn Loughborough DAIR

This is undoubtedly yet another pathetic attempt by Andrew Jeremy Wakefield to silence critics and whip up support amongst his devoted followers.  Dr. Willingham has my support and hope that Forbes will do the right thing by standing behind their bloggers and not caving to such vexatious and frivolous threats.

ETA (5.2.14): Dr. Willingham has posted this addendum in light of Andrew Jeremy Wakefield's threatening letter:

Following publication of this post, Forbes received a letter from Andrew Wakefield claiming that the post contained “demonstrably false and misleading claims” about him. Specifically, Wakefield writes that the post implies “that the authors of the Pediatrics paper cite fraud on my part” and that “what Mcelhanon et al actually say is substantially different from your false and defamatory allegation”. He claims that “there has been a substantial amount of inaccurate and misleading reporting” about him including the report issued by the British Medical Journal, which he is currently suing. Despite dismissal of that suit on jurisdictional grounds, Wakefield insists that documents in that case will show that “the scientific research conducted by [him] and published in the Lancet paper was not fraudulent”. Wakefield provided a full copy of his letter to Age of Autism, which has published it here.