Thursday, June 12, 2014

A year's worth of measles cases in a week - calling it!

The CDC has just reported the measles cases for 2014 to date: 402 (that is four hundred and two) and 65 cases more than last week. The entire year 2010 only saw 63 cases and in fact, the median number between 2000 and 2010 was 60 per year. How can that be?! Very simple: Every year, measles are imported into the US from abroad. If they are imported into communities with low vaccination coverage, they will spread - usually not very far. Just that this time, measles got imported into a much larger pocket of low vaccination coverage - the Ohio population of Amish. And although these are now vaccinating, there are enough non-immune people around to sustain the outbreak, sustain it big time (I am sure we'll hear a luke warm "that's not an outbreak" from Bob Sears at some point though).

image credit nbcnews

In any case - with 402 cases, the time has come to call it - the last really big outbreak of measles in the US was in 1989 to 1991. Around 55000 people got sick, at least 123 died acutely for a mortality rate of 1 reported death in 451 reported cases. We know that there have been at least 11 SSPE cases due to that outbreak, so the death rate is more like 1 reported death in 414 reported cases. We will reach at least one of these numbers next week. That doesn't mean that someone is going to die next week, statistics don't quite work that way. However, it is, at this point, more likely than not that we'll see a death before the end this year.

I am going to call something else: one someone dies, the anti-vax are going to find something "defective" about the victim, and if it isn't something obvious (like the measles victim in Wales, who reportedly was an underweight adult with a past alcohol problem, so "clearly" not like the vaccine refusers' little snowflakes), they are going to make something up (wrong diet, blabla). No number of deaths will be "enough" for them - sad!

Now is as good a time as ever to check your children's and your own immunization records - 2xMMR is extremely effective in preventing measles and saving lives! Just do it.

Wednesday, June 11, 2014

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.

Thursday, June 5, 2014

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.


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)
    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.


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
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.