Tuesday, October 25, 2011

Testing Anthrax vaccines in children?!

I came across this piece in the Washington Post today:

Possible study of anthrax vaccine’s effectiveness in children stirs debate

Apparently, a "key working group of federal advisers" endorsed testing in September, to see whether the anthrax vaccine would safely protect healthy children against a bioterrorism attack.

What bioterrorism attack? The possibility of the use of anthrax by (foreign) terrorists was one of the fears addressed post 9/11. However, the only documented use of anthrax in the United States with the intention to harm in the past 10 years happened a week after the 9/11 attacks, when "letters containing anthrax spores arrived at several media offices and two Senate offices, killing five people and sickening 17 others. The FBI eventually concluded that the letters were mailed by Bruce Ivins, a disgruntled scientist at Fort Detrick in Maryland who committed suicide in 2008, although some experts question the FBI’s findings."

As a consequence of the anthrax bioterrorism fears, 2.6 million US military personnel were vaccinated with the anthrax vaccine, and the federal government has spent $1.1 billion to stockpile the vaccine to protect Americans in the event of an attack. This is in addition to treatment option by antibiotics.

The Washington Post reports:

Unlike with measles, mumps and other diseases, the chance that children will be exposed to anthrax is theoretical, making the risk-benefit calculus of testing a vaccine on them much more questionable.

“It’s hard to believe that it’s something that makes a great deal of sense,” said Joel Frader, a pediatrician and bioethicist at Northwestern University’s Feinberg School of Medicine. “It would be difficult to justify testing it on kids simply on the hypothetical possibility that there might be an attack.”

In addition to these ethical considerations, I have several other concerns, this paper sums one up well:

In response to the attacks on Sept 11, 2001 (9/11), and the related security concerns, the USA and its coalition partners began a war in Afghanistan and subsequently invaded Iraq. The wars caused many deaths of non-combatant civilians, further damaged the health-supporting infrastructure and the environment (already adversely affected by previous wars), forced many people to migrate, led to violations of human rights, and diverted resources away from important health needs. After 9/11 and the anthrax outbreak shortly afterwards, the USA and other countries have improved emergency preparedness and response capabilities, but these actions have often diverted attention and resources from more urgent health issues. The documentation and dissemination of information about the adverse health effects of these wars and about the diversion of resources could help to mitigate these consequences and prevent their recurrence.

Given the publicly available data, there is only a "theoretical" anthrax threat to US children. The current disease burden for them, for all we know, is zero. Anthrax vaccine trials and/or general vaccination programmes for children would be a very hard sell to the general public and would significantly support anti-vaccine sentiments. Ultimately, it would detract funds from essential health care research and provision in areas of actual need (i.e. where a measurable disease risk and burden exists), and it may erode vaccination compliance for the essential childhood vaccinations (measles, anyone? Pertussis?).

Saturday, October 22, 2011

Follow up on my post about Natalie and SSPE

There were two reactions to my post about Natalie's entirely preventable death from SSPE that I had put up yesterday.

One that invariably came from pro-vaccine minded parents, which was "oh, how horrible, the poor child/parents" and sometimes included "can we go after those vaccine-refusing parents"

and one that invariably came from anti-vaccine minded parents, which was "oh, how horrible, how can you call our children potential murder weapons" and sometimes included "you must be paid to post this" pharmashill accusations.

So here are some clarifications:

I don't know much about the parents who took their unvaccinated 11 year old to that pediatrician's practice. I can say with some conviction that neither Andrew Wakefield nor Jenny McCarthy had anything to do with their decision, since this happened in Germany in 1999 and their son was 11 then, so their anti-vaccine decision must have happened 10 years earlier, when neither Wakefield nor McCarthy were a topic (and they never really became one in Germany anyway). We don't know what made them not vaccinate. I am pretty sure they did not intend this to happen.

There is no provision to sue these parents in German law. The new Infektionenschutzgesetz was passed after this all got started and it only regulates intentional transmission of reportable infectious diseases. I think it would be very difficult to prove intent here. Also, I don't know about Natalie's parents, but Micha's family are devout Christians. While they are obviously sad and burdened, they do not seek punishment for that other family.

I posted a link to this blog on Mumsnet and that caused quite an upheaval amongst non-vaccinating parents. There was a lot of profanity (seemingly caused by the -wrong- assumption that I was addressing people directly, while being fully aware of the children's medical histories), but I am accepting this:

A lot of non-vaccinating parents made their decision after careful thought and deliberation with their health professional. They are aware of the risks of their non-vaccine decision and they are not necessarily comfortable with those risks. However, for them, the risks of not vaccinating outweighs the risks of vaccinating their children. To be told that they are turning their kids into potential murder weapons and to scare them with what is certainly a) a very unlikely and b) the most catastrophic outcome of a family not vaccinating deals them an unfair blow and it is not really helpful. This was not my intention and I have apologised to one mum there and hereby do to any parent in the above situation here.

That said: if you are thinking about not vaccinating your child and you are currently weighing the pros and cons: have a look at my previous blog and previous post on this situation and weigh this into your decision.

Thursday, October 20, 2011

So predictable - so sad, Natalie dies of SSPE

We had previously reported the case of Natalie, one of the children who contracted measles from an unvaccinated preteen in their pediatrician's practice in 2000. Natalie was 11 months old at the time. She came down with SSPE in 2007 (that is actually the average time lag between measles infection in infancy and the development of this fatal measles complication), she deteriorated, fell into a "wake coma" and now passed away due to organ failure.

Micha, one of the other babies infected by the same 11 year old is still dying... Measles vaccination and the resulting herd immunity for babies saves lives. Vaccine refusers turn their children into potential murder weapons.