Wednesday, April 6, 2011

Pertussis Closes Waldorf-Based Private School in Virginia

A whooping cough outbreak hitting more than half (23 of 45) their pupils has led to the closure of that small private school for a week. The local Health Care Director unambiguously stated that lack of vaccinations caused this outbreak and that the children who were affected were unvaccinated (7 adult contacts also got the disease).

This outbreak is demonstrating two things - disease outbreaks happen in "pockets" of unvaccinated children, and, those "pockets" are often found in Waldorf/Steiner oriented institutions (for a comprehensive critical introduction into Anthroposophy, read the three part series on DC's Improbable Science blog). Indeed, the last whooping cough outbreak I personally saw was in the Steiner Kindi in two streets down from where we lived in Germany. The daycare director interpreted the outbreak as "the children seeking disease, because they needed a break" and proposed to close the Kindi for three weeks (a plan curbed by the working moms whose children attending the facility had been vaccinated and were just fine). What a break that was, with several children needing a 3 week residential rehab to learn how to breathe normally again... I'd rather pay money for a break than health, but that may be just me.

Similarly, quite impressive measles outbreaks in (mostly German speaking) countries have started in Steiner schools and Kindergartens and were sometimes specifically centered around Anthroposophical doctors with an anti-vaccine vaccine-critical outlook. Steiner himself deemed rashy diseases, like measles and Scarlet fever, which in his life time each killed a large percentage of the annual birth cohort, important for the development of proper karma and the shedding of bad miasms (don't ask - read link above, it is weirder than you think and weirder than you would expect any contemporary parent to believe and doctor to peddle).

The good news is that school and parents are complying with the suggested quarantine and/or treatment measures to limit transmission. Hopefully, some of them will research the "crunchy, holistic" philosophy behind their school and their vaccine refusal a bit more carefully, too.

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.
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...