H1N1 Influenza Deaths in Children with Neurological Disorders and Anti-Vaxx Autism Groups Don't Care

This past Wednesday, 29 August 2012 a CDC press release, Children with Neurological Disorders at High Risk of Death from Flu was issued.  LeftBrain/RightBrain was the first I could see who relayed this information on 29 August 2012.  In the past couple of days, Disability Scoop, History of Vaccines,  Autism Science Foundation and a plethora of news outlets have reported this.  The original study can be found in the most recent edition of Pediatrics.

Of the 336 children (defined as people younger than 18 years) with information available on underlying medical conditions who were reported to have died from 2009 H1N1 flu-associated causes, 227 had one or more underlying health conditions. One hundred forty-six children (64 percent) had a neurologic disorder such as cerebral palsy, intellectual disability, or epilepsy. Of the children with neurologic disorders for whom information on vaccination status was available, only 21 (23 percent) had received the seasonal influenza vaccine and 2 (3 percent) were fully vaccinated for 2009 H1N1.

“We’ve known for some time that certain neurologic conditions can put children at high risk for serious complications from influenza,” said Dr. Lyn Finelli, chief of the surveillance and outbreak response team in CDC’s Influenza Division. “However, the high percentage of pediatric deaths associated with neurologic disorders that occurred during the 2009 H1N1 pandemic was a somber reminder of the harm that flu can cause to children with neurologic and neurodevelopmental disorders.”

Remarkably absent from reporting this are the "usual suspects" of anti-vaccine and autism crankery.  The National Vaccine Information Center (NVIC) has absolutely nothing mentioned about this finding.  This is an organisation that prides itself on "informed consent":

The National Vaccine Information Center (NVIC) is dedicated to the prevention of vaccine injuries and deaths through public education and to defending the informed consent ethic in medicine.

As an independent clearinghouse for information on diseases and vaccines, NVIC does not advocate for or against the use of vaccines. We support the availability of all preventive health care options, including vaccines, and the right of consumers to make educated, voluntary health care choices.

Emphasis added.  Yet not a single word about this study for parents of high risk children, in particular to make an informed choice.

Let's take a look at Dr. Joseph Mercola's website, the "alternative practitioner" who actively railed against the potential dangers of H1N1 influenza vaccination and vocally dissuaded his readers from getting the vaccine for themselves and their children no matter what.  Nope, not a word there either about this study.

Surely Dr. Bob Sears another proponent of "informed consent" for vaccines has something about this study.  He is after all a paediatrician and DAN! doctor who takes care of medically-fragile children.  One would think that this is very important information to share with his readers and patients.  Sixty-four percent of the H1N1-related deaths in 2009 were among children with cerebral palsy, intellectual disability, or epilepsy and only 3% were fully vaccinated for H1N1.  No, complete silence there too.  Except of course to register his outrage over California's AB2109 bill which requires informed consent before opting out of vaccines.  At least he is consistently against informed consent by not providing his own patients with any.  Dr. Sears also shares his extraordinary knowledge of H1N1 vaccines, vaccine testing and his ability to sling conspiracy theories around with the best of them. 

Another obvious place to look would be Dr. Jay Gordon's website since he is so terribly concerned with vaccines and vaccine-preventable diseases.   I would imagine that Dr. Jay also has medically-fragile children in his practice and would want their parents to know about how such underlying conditions can be risk factors for things like complications from flu.  No, nothing there either but he is certainly not shy about promoting his interview with Anderson Cooper and letting us know what a particular colour of poop means. Dr. Jay is also against AB2109.  Dr. Jay also had some truly brilliant insights regarding H1N1 pathology, vaccination and epidemiology.

This CDC press release was embargoed which essentially means that their media contact will pre-release it to certain parties in order for them to prepare a story for when the story is released.  It is considered really bad manners to break an embargo.  Needless to say, many anti-vaccine/autism groups have really bad manners and think nothing of breaking embargoes when it suits them.  One of the most egregious anti-vaccine/autism sites, Age of Autism not only minded the embargo but seems to have extended it by not mentioning a word of it.  The only "stories" there were the usual wailing and gnashing of teeth over genetics studies, conspiracy theories and how the IACC won't recommend study directives for vaccinesdidit.

This is clearly inconvenient information for those who take every opportunity to denigrate vaccines, lie about the true risks of vaccine-preventable diseases and vaccines or are just too dumb to disseminate factual information regarding vaccines and the diseases they can prevent.  The true believers will never be swayed and completely miss the point that there are medically-fragile children who are at a greater risk for disease complications and intentionally withholding this information by so-called autism and vaccine-safety organisations and healthcare practitioners is tantamount to lying.

Addendum 9.1.12:  Commenter lilady linked to Dr. Jay Gordon's views on H1N1 vaccines and disease shortly after H1N1 began circulating.  I added that and Dr. Bob Sears' views as well.  Thank you lilady; I now feel stupid for reading those.

Washington State Pertussis Outbreak

There is an outbreak of pertussis in Washington state that has produced a prevalence that hasn't been seen in decades.  In fact, 1942 was the last time this many cases was recorded.  So far there have been 3400 reported cases and the age groups most affected are infants less than one year old and children ages 10-13 years old.  This outbreak, as in California two years ago has demonstrated the reduced duration of efficacy and to some extent, the overall efficacy of diphtheria, tetanus and acellular pertussis toxoid vaccines (DTaP).  This has led to anti-vaxxers exploiting these outbreaks as a demonstration that DTaP vaccines are useless.  Whereas nothing could be farther from the truth.

One particularly notorious anti-vaxxer, Joseph Mercola has used the California outbreak to triumphantly announce that the majority of those infected with pertussis were fully vaccinated.  Well duh, the majority of children are fully vaccinated, but more on that later.  He also cherry-picks an editorial that was published in Pediatrics written by eminent pertussis researcher J.D. Cherry earlier this year.  Mercola only lists the contributing factors for the increase in pertussis prevalence and overestimation of vaccine efficacy but leaves out the contributing factors for underestimating vaccine efficacy and his conclusions.  For instance, Dr. Cherry writes:

Of nasopharyngeal specimens from patients with cough illnesses sent to a commercial laboratory for PCR testing, during the 3-year period 2008–2010, it was found that 14% of the positive specimens were IS1001 positive, indicating B parapertussis infection.(14) In 2010, the positivity rate was 16.5%. These cases would appear as vaccine failures when they are not, as protection against B parapertussis is not expected from current pertussis vaccines.

And:

Vaccine use has resulted in genetic changes in PT, PRN, and FIM in circulating B pertussis strains, and it has been suggested that this has led to increased vaccine failure rates.(22) At the present time, however, there is no evidence to support the hypothesis that evolution is allowing circulating B pertussis strains to escape from vaccine-produced antibodies.(23) If it were to occur, I would expect it to occur first in Denmark, where a PT toxoid vaccine has been in use for ∼15 years; this, as yet apparently has not happened.

Given that Joe Mercola is a salesman, not a researcher and doesn't even know the difference between viruses and bacteria, I'm a bit more inclined to rely upon the expertise of a globally-recognised pertussis researcher who concludes:

To overcome the problem, it needs to be recognized that B pertussis is circulating in all age groups and, therefore, for herd immunity there is a need to universally vaccinate all age groups at frequent intervals.(24) New vaccines should be considered for development that include changes to enhance efficacy but retaining a low reactogenicity profile. This could be DTaP vaccines with multiple additional components and perhaps containing less PT. An alternative would be to develop DTP vaccines with detoxified lipopolysaccharide (the cause of reactions to whole-cell vaccines). It has also been suggested to develop “live vaccines.”(25) There are data available (not presented here), however, that indicate that immunity from DTP vaccines is better than that after infection; therefore, I do not think “live vaccines” are a worthwhile approach. Clearly, additional investments and innovations in pertussis vaccine development are needed to remove pertussis from its position as the leading vaccine preventable disease in the United States.

It is obvious from the California pertussis outbreak in 2010 and the current Washington state as well as the rest of the U.S. currently, that more effective and durable vaccines are needed, certainly not returning to the "good ol' days" of the pre-pertussis vaccine era that begot thousands of infant deaths annually.

Another fallacy that Joe Mercola propagates along with his witless followers is that more vaccinated than unvaccinated have been infected with pertussis.  When one simply looks at the raw data, it appears that way but those claiming more vaccinated than unvaccinated are being infected are either being wilfully dishonest, epidemiologically-ignorant or both.  Let's look at the raw statistics from the CDC as of 20 July 2012 and the Washington Department of Health as of 4 August 2012 (in the format presented by Medical News Today):

• There have been a total of 3,400 cases reported statewide through week 31, compared to 287 reported cases in 2011 during the same time period. That is a 1085% increase for the same time period.
• The overall incidence year to date is 50.5 pertussis cases per 100,000 Washington residents with a rate in infants under one year of age of 241.7 per 100,000. Two hundred and fourteen infants under one year of age were reported as having whooping cough and forty-three of them were hospitalized. Of those hospitalized, thirty-five (81%) were very young (three months of age or younger). Adolescents aged 10-13 years old also have a high incidence rate, 238.2 per 100,000, and comprise 24% of the total cases.
• 75.8% of patients aged from 3 months to 10 years were up-to-date with their childhood diphtheria and tetanus toxoids and acellular pertussis (DTaP) doses.
• 43.1% of patients aged 11 and 12 years and 77.2% of 13 to 19 year olds were up-to-date with their TDaP booster shots.
• 93.2% of children aged from 19 to 35 months had received three or more doses, while 81.9% had received four or more in 2010.
• No deaths caused by whooping cough have been reported.

Using these data, demographic/epidemiological data from Table 2. WA State pertussis cases by age group, 2012 YTD and Washington State School Vaccine Exemption data age stratified attack rates and rate ratios were estimated.  These are crude estimates as the age stratification for pertussis incidence reports and vaccination status overlapped.  The state of Washington reported a statewide 5% vaccine exemption for kindergarten through twelfth grade and this was used to estimate the un/undervaccinated populations.  Attack rates for vaccinated (ARv) and un/der vaccinated (ARn) are as follows:

Ages 5-9:    (ARv) 500/411023 x 100 = 0.12%

                     (ARn) 159/21633 x 100 = 0.73%

Ages 10-13 (ARv) 356/329076 x 100 = 0.11%

                      (ARn) 469/17320 x 100 = 2.7%

Ages 14-18 (ARv) 477/431968 x 100 = 0.11%

                      (ARn) 141/22735 x 100 = 0.62%

As we can see, more un/undervaccinated children have been infected with pertussis than fully vaccinated across all age bins.  This translates to children ages 5-9 un/der vaccinated children are 6 times more likely to become infected with pertussis than fully vaccinated. Children ages 10-13 un/der vaccinated are 25 times more likely to become infected with pertussis than fully vaccinated. And un/der vaccinated children ages 14-18 are 6 times more likely to become infected with pertussis than fully vaccinated.

Two hundred and fourteen infants under the age of one year were infected and 43 hospitalised.  Twenty four percent of those three months to one year were un/undervaccinated.  Of those hospitalised, 35 or 81% were three months or younger.  This is appalling that these children suffered needlessly; we need to do more to protect this vulnerable population and people need to stop buying into anti-vaccine lies.