The "Wakefield Generation"

Andrew Wakefield, disgraced anti-vaccine doctor turned documentarian is the gift that keeps giving (not really).  England has reported a decade-high number of mumps cases:

Last year there were nearly five times as many cases of mumps as the year before – 5,042 lab-confirmed cases as opposed to 1,066 in 2018, said PHE. The trend is continuing, with 546 new cases last month, compared to 191 in January last year.

Wales has also reported a significant rise in mumps cases:

Public Health Wales identified 2,695 potential cases of the viral infection last year - up from 519 in 2018.

The areas with the most suspected cases were Cardiff and Swansea, which have large numbers of students.

 And so has Scotland:

There were 281 laboratory-confirmed mumps cases in 2018, which is a decrease compared to 2017 during which 385 cases were reported. From 1 January to 30 September 2019, 534 laboratory-confirmed mumps cases were reported. A number of NHS Boards have experienced clusters of mumps thus far in 2019, mainly in adolescents and young adults.

The mumps portion of the MMR is the least effective so two doses are necessary.  The majority of cases are in unvaccinated young adults in higher education settings which is an ideal opportunity for mumps transmission.  However, some with one dose and fewer that received two doses have also been infected.

Why blame Wakefield?  Because his retracted "study" that was published in 1998 and his subsequent "media tour" playing up the alleged link between autism and the MMR jab drove down vaccination rates in several birth cohorts.

Most outbreaks have been in colleges and universities. “Many of the cases in 2019 were seen in the so-called “Wakefield cohorts” – young adults born in the late 1990s and early 2000s who missed out on the MMR (measles, mumps and rubella) vaccine when they were children,” said PHE in a statement.

Many parents, especially in London, did not take their children for the two shots of MMR vaccine at the ages of 1 and nearly 4, because of the scare around a paper in the Lancet journal by gastroenterologist Andrew Wakefield and colleagues in 1998. The research focused only on a small number of children who had bowel disease and autism, but Wakefield made a link with the MMR vaccination, wrongly claiming that it could “overload” the immune system.

The same trend was observed with measles with an unmistakeable inverse correlation between vaccination rates and infection rates globally.  This trend will undoubtedly continue if parents keep listening to the likes of Andrew Wakefield, Robert F. Kennedy, Jr. and Del Bigtree. 

Andrew Wakefield is the Anti-Vaxx Gift That Keeps Giving

The Minnesota Department of Health has confirmed that at least eight children have measles.  They are all between the ages of 1 year and 4 years old and NONE have been vaccinated against measles although they are age-eligible.  Seven of the eight children belong to the large Somali community in Hennepin County and six have been hospitalised.  There may be more cases given the low MMR vaccine uptake among those in that community and only one case could be traced to a contact.

Andrew Wakefield, professional fraud made at least three trips to the Minnesota Somali community between 2010 and 2011 to pimp his faux concern about autism and measles jabs.  The result was a 50% uptake in the MMR jab as of 2013.  Even before his visits, Wakefield's fraudulent 1998 study linking MMR jabs to autism and visits from other anti-vaxx groups impacted this community and decreased the MMR vaccine uptake from ~90% to 54% sparking an outbreak in 2011 after his visits there.

Andrew Wakefield promised this community he would investigate their autism rate; he never did.  Instead he convinced them to eschew vaccination and gave them measles outbreaks.  That's the Wakefield Touch.

Update 18 April 2017:  The Minnesota Department of Health has confirmed a ninth measles case in Hennepin County in an unvaccinated child.

Update 20 April 2017:  The Minnesota Department of Health has confirmed  eleven cases of measles in Hennepin County all in children ages 1-5 years old, nine confirmed in unvaccinated children and nine in the Somali community.

Update 22 April 2017:  The Minnesota Department of Health has confirmed twelve cases of measles in Hennepin County all in children under 5 years old and all unvaccinated.  The uptake of MMR in the Somali community there is 42% in children under the age of two years old.

Update 25 April 2017:  The Minnesota Department of Health has confirmed twenty cases of measles in Hennepin County now.  One child less than one year old has been infected and 50% of infected children have been hospitalised.  Sixteen children have been confirmed unvaccinated.

Update 27 April 2017:  The Minnesota Department of Health has confirmed 24 cases of measles in Hennepin County.  Twenty-three of the 24 cases have been confirmed UNVACCINATED.  All children infected are five years old and younger. It has been confirmed that NONE of the infected children were vaccinated, 50% have been hospitalised and the infected children are between 10 months and 5 years old.  The outbreak may have emanated from a daycare.

Update 1 May 2017:  The Minnesota Department of Health has confirmed 32 cases of measles, 30 in Hennepin County and has spread with one in Ramsey County and one in Stearns County.  Of the 32 measles cases, only one child has received a single MMR jab, all others are UNVACCINATED.

Update 5 May 2017:  The Minnesota Department of Health has confirmed 41 cases of measles which has spread to Crow Wing County involving another unvaccinated child.  The stats of this outbreak are:
• 1 involves an adult and the rest are children age 10 or younger
• 39 involve people who were not vaccinated against the disease
• 34 are from Minnesota's Somali community
The case previously reported from Stearns County was ruled out as measles with confirmatory testing.
Anti-vaxx groups continue to stoke unfounded fears of vaccines causing autism among the Somali community in Hennepin County.

Update 8 May 2017:  The Minnesota Department of Health has confirmed the measles outbreak is up to 48 cases.

• 45 in Hennepin County
• 2 in Ramsey County
• 1 in Crow Wing County
• 45 confirmed to be unvaccinated
• 1 had 1 dose of MMR
• 2 had 2 doses of MMR
• 41 of the cases are Somali Minnesotan 

Update 11 May 2017:  The Minnesota Department of Health has confirmed the measles outbreak is up to 51 cases:

• 47 confirmed to be unvaccinated
• 1 had 1 dose of MMR
• 2 had 2 doses of MMR
• 1 case has unknown vaccination status
• 48 in children (ages 0-17 years)
• 3 cases in adults
• 46 of the cases are Somali Minnesotan 

Update 15 May 2017:  The Minnesota Department of Health has confirmed the measles outbreak is up to 58 cases:

• 49 in Hennepin County
• 3 in Ramsey County
• 4 in Crow Wing County
• 2 in Le Sueur County
• 55 confirmed to be unvaccinated
• 1 had 1 dose of MMR
• 2 had 2 doses of MMR
• 55 in children (ages 0-17 years)
• 3 cases in adults
• 49 of the cases are Somali Minnesotan

Additionally, the cost of this outbreak is estimated to be ~$1 Million Dollars.

Update 22 May 2017:  The Minnesota Department of Health has confirmed the measles outbreak is up to 66 cases:

• 56 in Hennepin County
• 4 in Ramsey County
• 4 in Crow Wing County
• 2 in Le Sueur County
• 62 confirmed to be unvaccinated
• 1 had 1 dose of MMR
• 3 had 2 doses of MMR
• 63 in children (ages 0-17 years)
• 3 cases in adults
• 57 of the cases are Somali Minnesotan 

Update 2 June 2017:  The Minnesota Department of Health has confirmed the measles outbreak is up to 73 cases.

• 64 in Hennepin County
• 3 in Ramsey County
• 4 in Crow Wing County
• 2 in Le Sueur County
• 68 confirmed to be unvaccinated
• 2 had 1 dose of MMR
• 3 had 2 doses of MMR
• 70 in children (ages 0-17 years)
• 3 cases in adults
• 60 of the cases are Somali Minnesotan

Aliana is dead

Aliana has passed away from SSPE, a severe, always fatal measles complication, this morning - in a short statement on their Facebook page, her father writes:

Our litte angel went on her way this morning. The last months were a hard time, she fought a lot, but sadly she lost. She went from us really peacefully with a beautiful smile on her lips. This is going to be a hard time for us, but Aliana has decided that she will be better where she is now, without suffering and without pain. We thank everyone who supported us until now and are still supporting us. Please light a candle, so we can accompany Aliana on her way to a better place.

I am tired. How often do we need to report on preventable deaths? My thoughts and deepest condolences are with her family. Please light a candle. Please vaccinate your children.

18 month old, unvaccinated, previously healthy toddler dies of measles in Berlin outbreak

Berlin, Germany's capital, has seen a very large measles outbreak on the past months. Since October 2014, 574 measles cases had been reported.

Today, the Berlin health senator confirmed that on 18 February 2015, an 18 month old toddler, who had not been vaccinated against measles, and did not have any chronic disease, died after having been treated for measles infection in the Charité hospital for 5 days. While the child was vaccinated against some diseases, according to the German media, he had not received the recommended MMR. In Germany, the first MMR is usually given between 11 and 14 months and the second is recommended between 15 and 24 months.

Over the past couple of years, discussions about mandatory vaccination had come up in Germany, some child care centers had begun to only accept vaccinated children, and discussions are unlikely to subside now. The question is whether parents, who are already afraid/suspect of the government could be convinced by a mandate - suggestions are welcome how to reach them better.

Meanwhile, our heartfelt thoughts go to the boy's family and everyone whose lives he touched. Another preventable measles death too many.

The Measles Vaccines (MMR and MMRV) Protect Against Measles

Photo: http://imgbuddy.com/measles-virus-picture.asp

A new anti-vaxx myth has surfaced which seems to have been developed as a result of my recent blogpost Disneyland Measles Outbreak is Due to Measles which discussed the measles genotype responsible (hint: it wasn't the vaccine strain).  Some, with no knowledge of virology nor immunology are spreading the myth that since the measles strain in the MMR vaccine is genotype A that it couldn't possibly protect against measles genotype B3 which is the genotype responsible for the latest U.S. outbreak and has spread to Mexico and Canada.  I will discuss how and why MMR vaccines are cross-protective for wild-type measles strains.

First there is some terminology which must be understood to follow along:

Serotype: Microorganisms of the same species can be further divided into serotypes, serovars or sub-groups based upon their surface antigens.

Antigen: A structural protein on the surface of a pathogen that is able to recognise cell receptors on the surface of a host cell.  The antigen is also the part of the pathogen which provokes the host adaptive immune response that generates antibodies.

Epitope: The very specific part of the antigen which antibodies attach to.

Genotype: The nucleotide sequence of certain regions of a viral genome which classifies differences.

The measles virus has only one serotype and causes measles unlike Human Papillomavirus which has dozens of serotypes and can cause different diseases.  This is why we see multiple serotypes included in the HPV vaccine and only one strain in each of the available measles vaccines which are all genotype A.

Many of the attenuated strains in use are derived from the Edmonston strain isolated in 1954, including the Schwartz, the Edmonston-Zagreb, and the Moraten strains. Other strains which are not derived from Edmonston strain include the CAM-70, TD 97, Leningrad-16, and Shanghai 191 (Ji-191) strains.

Measles virus genotypes are based upon their nucleotide sequences at the least conserved regions of the viral genome:

Wild-type measles viruses have been divided into distinct genetic groups, referred to as genotypes, based on the nucleotide sequences of their hemagglutinin (H) and nucleoprotein (N) genes, which are the most variable genes on the viral genome.

The 450 nucleotides encoding the carboxy-terminal 150 amino acids of the nucleoprotein has up to 12% nucleotide variation between genotypes. The 450 nucleotides that encode the carboxy-terminal region of the nucleoprotein (N–450) are required for determination of the genotype. The measles genotyping protocol is available from CDC.

Photo: http://download.thelancet.com/images/journalimages/0140-6736/PIIS0140673610623525.gr3.lrg.jpg

What this means is that whenever a measles case occurs, a sample (throat or nasal swab) is taken from the patient, submitted to RT-PCR (reverse transcription-polymerase chain reaction) and PCR (polymerase chain reaction) which are molecular techniques to essentially isolate amplify the number of DNA copies so that they can be sequenced.  DNA sequencing determines the nucleotide sequences of specific genome regions and then compared to other isolates to see where the measles virus came from and also mutations that may have accumulated.

Recovered measles viruses are constantly monitored, tested and characterised to identify areas of the genome which may antigenically-drift.  Circulating measles viruses have also been tested against vaccine-derived antibodies to ensure vaccines will cross-protect against the numerous genotypes that are imported.  This is achieved through virus neutralisation assays for example.  This is a test that combines measles genotypes with serum samples of people either vaccinated or previously infected with wild-type measles to determine if antibody binding occurs.  A fluorescent tag is added and then the antibody-antigen complex is measured. Results of various assays demonstrate that vaccine-derived antibodies protect against many different measles genotypes:

The serum samples from recently vaccinated persons neutralized both the Moraten and Chicago-I viruses equally well (table 1): There was a less than 2-fold difference in neutralization titers. In contrast, serum samples from persons with a recent wild type infection were able to detect antigenic differences between the viruses. Sera in this set had neutralization titers against Chicago-l that were 4-8 times higher (average, 5.1) than the titers against the vaccine strain.

Very specific antibodies called monoclonal antibodies (MAbs) are also developed and tested against measles viruses including the vaccine strains to monitor vaccine efficacy and antigenic drift of measles genotypes:

Overall, the antigenic data indicated that some epitopes have been conserved between the vaccine strain and the recent wild type viruses, while others are unique to the recent wild type virus. The H and F proteins are responsible for the induction of a neutralizing antibody response to measles virus. Therefore, the antigenic differences were most likely due to variation in these surface glycoproteins. 

Protection against the current circulation measles genotype, B3 has been elucidated.  In other words, studies have been and are conducted to test antibodies derived from vaccination against numerous wild-type measles viruses.  Measles genotype B3 which is the currently circulating strain in the U.S., is neutralised by vaccine-derived antibodies.  That, in turn, means that the virus can't bind to host (human) cell receptors and cause disease.

On the basis of the sequences of their N and H genes, MeVs can be assigned to 1 of 23 genotypes and 1 provisional genotype [11, 12]. All vaccine strains and their wild-type progenitors are assigned to genotype A. Experiments with monoclonal antibodies have defined antigenic differences between the H proteins of genotype A vaccines and the H proteins of wild-type viruses grouped in other genotypes [62, 188, 189]. However, there is only 1 serotype for measles, and serum samples from vaccinees neutralize viruses from a wide range of genotypes, albeit with different neutralization titers [188, 190] More importantly, despite the presence of different endemic genotypes, vaccination programs with standard measles vaccines have been successful in every country where they were performed adequately [191–193]. Suboptimal seroconversion after vaccination is likely the result of inadequate coverage; improper administration, transport, or storage of vaccine; or age of the vaccine recipients [194–196].

It's a bit of a complex issue to digest but some key points are that measles vaccines induce many different antibodies against measles antigens.  There is some antigenic drift that renders a single antibody insufficient binding to a single antigen from some wild-type measles viruses but over all, vaccines protect us from many different genotypes including the currently circulating B3 genotype. The epidemiology of the measles outbreak also demonstrates the effectiveness of the MMR vaccine.  To date there have been 141 cases confirmed (dozens more reported) by the CDC. Measles is one of the most infectious diseases known and this interactive graphic demonstrates how measles can spread in variable susceptible populations.  If the vaccine did not proffer cross-protection, there would be tens of thousands of cases to date.  Obviously this is not the case as the majority of cases are unvaccinated.

A more easily-digestible version of this has been posted at The Scientific Parent.

Your freedom of choice - somebody else's baby

I am having discussions with my non-vaccinating friend at the moment, who describes herself as "pro-choice" when it comes to vaccination. What seems absolutely impossible to grasp for vaccine refusers is that their choice makes other parents' children ill, and, potentially, kills them. The parents whose babies contract measles did NOT get a choice, NO say in their children's infection. That is the effect of vaccine refusal:

The below is Mobius - there are 24 hours between those pictures - the photographer, a friend of Mobius' family, Donavan Freberg, describes their feelings (shared from Refutations against Anti-Vaccine Memes page with kind permission of Mobius' mum):

This is Mobius Loop. He is the son of my dear friends Ariel Loop and Christopher Loop. He has measles. It was just confirmed. This is real, this is awful and these two photos are 24 hours apart. The good news? He's getting better. Quarantine ends tonight and the baby seems to be recovering well. The bad news? This was caused by one thing only, total and complete ignorance and selfishness of the anti-vaxxers. Because of people not vaccinating their kids (and when I say "people", I mean much of the upper crust westside of Los Angeles) this little sprout (who was too young to be protected) fell sick to a HIGHLY CONTAGIOUS epidemic that up until recently, had been a thing of the past. This is infuriating, sad and worst of all, needless. The Loops are dear friends, long time photo clients and informed, smart people. Ariel is a nurse. You don't just vaccinate your kids to protect them, you do it to protect other's who are too wee to get the shots. You are doing it as a selfless act. Please send good thoughts and prayers to this little muppet and to his parents, who are truly some of the best people I know.

Side note: I was scheduled to photograph this sweet everlasting gobstopper, but then this happened. I intend to photograph him the moment he has fully recovered and will be donating 100% of my shoot fees to charity to raise awareness of the necessity of vaccines. As a photographer, I must do everything within my power to document this and see that the awareness of this spreads faster than the disease in question. To all people reading this and for those who may be on the fence about vaccinating your kids, please, for Mobius and for all those who are affected by this terrible and PREVENTIBLE disease, DO IT. Vaccinate!!!! Don't even think twice. Just think.

ETA: Mobius' mum, Ariel, also weighs in:

I have a lot of mixed feelings right now, but ultimately I'm relieved that Mobius is doing so well. The horrific cough aside, he's doing way better than anyone expected at this point.
However, I'm furious that we're now part of the problem. While he's up to date with his vaccines, at 4 months he isn't old enough for the one that should have made this whole outbreak almost impossible. During the four days he was contagious before his rash appeared, we went out to eat twice, ran countless errands, and have potentially infected other kids who are too young to have to go through this. That kills me. And might kill one of them.

I understand that vaccines are scary. Having to hold him tight while a stranger hurts him is hard. Having three people hold him still to get the blood to test him for measles, however, was infinitely harder. Even at the time I had this passing thought of, "Am I being paranoid? Am I putting him through more trauma while he's sick for no reason?" I found myself almost hoping it was measles then so at least having to torture him would be "worth it."
It isn't, though. He shouldn't have had to go through any of it. I shouldn't have had to set alarms for myself in the middle of the night to make sure he was still breathing. It's bittersweet--I can't be as comforted by his recovery as it is clouded with guilt and fear that we might put another family through this.
Please, don't put other families through this.

Disneyland Measles Outbreak is Due to Measles

The current measles outbreak primarily emanating from Disneyland in California is up to 100 cases but not all are epidemiologically-linked to the Disneyland outbreak.  As is usual with measles outbreaks, most were completely unvaccinated, some were too young to be vaccinated.  There are numerous articles highlighting this well-known fact and that has anti-vaxxers on the defensive.  In fact, this screed by Laura Hayes appeared on the anti-vaxx, autism-hating blog Age of Autism:

1.  Has there been any laboratory confirmation of even one case of the supposed measles related to Disneyland?  If yes, was the confirmed case tested to determine whether it was wild-type measles or vaccine-strain measles?  If not, why not?  These are important questions to ask. Is it measles or not? If yes, what kind, because if it's vaccine-strain measles, then that means it is the vaccinated who are contagious and spreading measles resulting in what the media likes to label "outbreaks" to create panic (strange how they've completely missed the Autism outbreak going on for the past 25 years). It would be what one might call vaccine fallout.  People who receive live-virus vaccines, such as the MMR, can then shed that live virus, for up to many weeks...and can infect others.  Multiply that in your head by all of the people who receive not only the MMR live-virus vaccine, but many others. Other live-virus vaccines include the nasal flu vaccine, shingles vaccine rotavirus vaccine, chicken pox vaccine, and yellow fever vaccine.

That's right, apparently Laura Hayes is really good at asking the really dumb questions but not too adept at finding the answer before postulating what measles strain is circulating amongst those infected.  Hint: it isn't the vaccine strain.  This wasn't hard to find and is very specific about the genotypes:

Measles genotype information was available from 9 measles cases; all were genotype B3 and all sequences linked to this outbreak are identical. The sequences are also identical to the genotype B3 virus that caused a large outbreak in the Philippines in 2014. During the last 6 months, identical genotype B3 viruses were also detected in at least 14 countries and at least 6 U.S. states, not including those linked to the current outbreak.

And even more information regarding the differences in wild-type strains and vaccine-strains can be found here:

Genetic Characterization and Sequencing

Wild-type measles viruses have been divided into distinct genetic groups, referred to as genotypes, based on the nucleotide sequences of their hemagglutinin (H) and nucleoprotein (N) genes, which are the most variable genes on the viral genome.

The 450 nucleotides encoding the carboxy-terminal 150 amino acids of the nucleoprotein has up to 12% nucleotide variation between genotypes. The 450 nucleotides that encode the carboxy-terminal region of the nucleoprotein (N–450) are required for determination of the genotype. The measles genotyping protocol is available from CDC.

For each genotype, a reference strain is designated for use in genetic analysis (phylogenetic analysis), usually the earliest known virus isolation of that group. The means of referring to the genotypes has been standardized using alphabetical designations for the main groupings (clades). Within the main clades, numerals are added to identify the individual genotypes.
The following 19 genotypes have been detected since 1990:

A*, B2, B3, C1, C2, D2, D3, D4, D5, D6, D7, D8, D9, D10, D11, G2, G3, H1, H2

*Vaccine strains Moraten, Edmonston, Zagreb are all genotype A.

 There were 2 putative wild-type cases of measles identified as genotype A in 2008.

During 2011, 8 genotypes were identified by global surveillance:
B2, B3, D4, D8, D9, D11, G3, H1

Gosh that was simple.  Laura Hayes asks a lot more dumb questions and fills in the answers with her own fact-free assertions but there is too much stupid and not enough time to take them apart.  The important point here is that measles outbreaks are caused by measles viruses (not vaccine-strain) and a critical mass of anti-vaxxers clustering and causing large gaps in herd immunity. 

sadly - another: Aliana has SSPE

While social media are a-buzz with stories of a CDC whistleblower - let's remind ourselves why everyone should vaccinate their children (and themselves).

Max, Micha and Natalie have already died. Angelina, who turned 9 years last week, is still fighting. We know their names, because the measles vaccine has significantly reduced the incidence of SSPE, the fatal complication, that shrinks a child's brain, many years after infection.
Now, another girl has been diagnosed - learn her name - celebrate her life - vaccinate your kids, so not one more child has to join the exclusive club:

Aliana was born in early 2010 - a "good measles year" in Germany, with "only" 780 cases. Aliana was one of them - she fell ill as a 6 months old infant, it is not clear who infected her. Then she recovered, at least so it appeared. Aliana grew, she was an open, friendly girl. She quickly found friends, because everyone liked to play with her. In retrospect, she maybe fell more than her peers, but then again, she was still little. But suddenly, Aliana started to forget everything, she couldn't speak as well as she used to. Then, motor problems started, she stumbled, and fell. Unfortunately, the original diagnosis of epilepsy was wrong and 4 weeks ago, Aliana was diagnosed with SSPE. Her grandmother describes the indescribable [my translation from the German]:

I am the granny of a girl who loved life, played games, was friendly to all, and so kind. When I sang songs with her, she immediately knew the lyrics by heart. I could tell you so much more about this little girl, but it breaks my heart how slowly, everything gets lost.

This has to stop! Every case of SSPE, a fate like Aliana's and her family's heartache can be avoided. Check your and your children's vaccination records. Everyone should get/have gotten 2x MMR to protect themselves and babies like Aliana from measles.

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.

Welcome on the blo(g)ck Vaxplanations

There is a new blog on the block - Vaxplanation sets out to explain the myths around vaccination (we can never have enough of those). Their first post takes down a sad denialist piece which trivialised the dangers of measles and propagated loads of old anti-vaccine lies, well, myths. The piece is not only eloquent, but also spiked with the right amount of information, snark and some lovely memes, driving home the essentials - vaccination is safe, not vaccinating is the wrong choice.

Welcome Vaxplanations - looking forward to your next!

KISS 3/18/14 - measles then

Anti-vaccine propagandist like to point out "historic" accounts of measles and co. where the diseases totally were no big deal. Well, I see your Brady Bunch and I raise you poor Captain Hamilton:

He "was not vouchsafed a hero's death upon the field of glory, he was none the less a hero, dying of pneumonia, following an attack of measles."

I am sure his mom did everything wrong and gave him tylenol or something...

Anniversary

the third anniversary of Angelina's diagnosis. Just before, she had been a completely healthy six year old:


then SSPE, the late and invariably fatal measles complication became overt. This video by the German Association of Pediatricians explains the stages - watch it, you'll get the gist - at first, she is "only" clumsy and falls, then the seizures start, and very few months later Angelina was incapable to doing anything. This is the condition she has been in for the past 2.5 years:




Angelina's mother wonders at the end of this video, why parents do not vaccinate their children, while they are all buckling them up in the car. She does support mandatory vaccination (no shots, no school does not exist in Germany).

I agree with the doctor in this video:

Parents - go get your children vaccinated, especially against measles, mumps and rubella. If you are not immune, talk to your doctor and get yourself up to date.
If you are afraid to vaccinate, talk to your doctor and work with him/her on "unscaring" yourself. Then vaccinate your child/yourself. Thank you.

You are an anti-vaccine activist? Have a careful look at that film clip. It shows the results of not vaccinating. Measles could have long been eradicated, where it not for pro-disease activists like you. Please realise that the risk of infecting a baby with measles is something you cannot control.

Measles Madness

no really - absolutely madness. Do parents in the US not realise how good they have it with measles not circulating and their babies protected? We are 10 weeks into the year, not quite 20% and the CDC reports 71 cases of measles. SEVENTYONE! In 10 weeks! That is as many as in the entire year 2009 and more than in 2010 and 2012.

7 cases in Orange County. 19 in New York - 5 of those hospitalised - that is a quarter. Honestly? What is this? The Middle Ages? The potential for further spread and infection of vulnerable, young, old, sick, immuno-suppressed is horrendous - look at this from the Orange County outbreak:

SEVEN possible exposures in 5 different hospitals/doctors' practises, TWO different schools exposed, with 1 (only - luckily) and 13 kids with philosophical exemptions respectively. What will it take for people to sober up? For uneducated C-rated starlets to shut up and get their child appropriate medical care? Will a child have to die?

It is time for vaccinating parents to speak up. Stop being tolerant of your friends' and neighbours' vaccine denial. Tell them that what they are doing is unacceptable and dangerous. Start asking questions at your daycare centers, schools, doctors' offices - how many of their pupils/patients are unvaccinated out of personal choice. Tell them it is not acceptable and dangerous to be complacent. Speak up.

KISS 3/3/2014 The Dreamboat

Measles love to travel

These days, you can catch them on planes and buses, but also in a very posh location - the Concordia class cruise liner Costa Pacifica has had 7 confirmed cases of measles amongst its crew members, 40 are in quarantine in Italy, where the boat made an unscheduled stop.
Check your vaccination records now, unless you want to bring home a souvenir...

KISS 2/27/14 Good and bad measles news

1. PSA: If you work in a cancer center, get your MMRs

A research student at the Hillman Cancer Center infected with measles has exposed 300 co-workers and cancer patients to this highly contagious disease. 15 unvaccinated colleagues have been asked to stay at home until next week, over 100 non immune patients were seen and some have had to be treated with anti-measles immunoglobulins to prevent infection. This is a total nightmare scenario, easily prevented by getting your MMRs. So if you are about to start work in a cancer research center (or hospital, or nursery, or school), or you are planning to travel abroad, check that you have had 2x MMRs. Do not be that index case!

2. Carribean has not seen measles transmission since 2002

Not that I would encourage anyone to travel unvaccinated, but you would be unlikely to bring back measles from the Carribean, as PAHO reports today. Before the establishment of PAHO/WHO’s Expanded Immunization Program in 1977, more than 250,000 measles cases and 12,000 deaths were recorded yearly in the Americas, so this is an amazing, life saving success of measles containing vaccines/MMR.

KISS 2/23 More measles in California

Crowne Hill Elementary reports two more cases of measles amongst the 10 unvaccinated students excluded from the school last week. I wonder whether we'll ever learn how many were patients of Bob Sears, whose practise lies a mere 58 miles from the school?

In any case, let's hope none of the patients have a little sibling in River Springs Charter Kindergarten, 7 miles away, where a whopping 22% of pupils, 117, have a personal belief exemption from vaccination:

KISS 2/22 : Mostly measles with a side of flu

Since both ScienceMom and I are strapped for time at the moment, I thought we'd try to do a series of short posts on current vaccine related themes - keeping it short and simple KISS.

1. Max is dead

Parents of children with SSPE, the always fatal measles complication, are getting more vocal in their support for vaccines, and therefore, we get to know the names of their children. Max caught measles in late 1994, when he was just half a year old, probably from older kids in his brother's daycare. He recovered seemingly well, but in 2004, 10 years later, he suddenly had memory lapses and was diagnosed with SSPE soon after. In 2006, Max fell into a wake coma - the family took care of him at home as long as possible, but in early January, Max was in such bad, intractable pain that his family placed him in hospice care. They write:

Maxi's condition has constantly worsened over the past weeks. He is barely reacting to his environment and if even he does, he would often start crying and screaming at things that definitely could not cause any pain such as music, wind or when you just caress him.

We are at the end. We cannot get the pain under control, we dare hardly just to touch him. For us parents it means a torture and for Maxi an absolutely intolerable situation. We have therefore decided to give Maxi in the care of a small hospice not far from here. It is a beautiful house, almost like a living community, located in a residential area. We very much hope that they will find the right pain management and that he no longer has to suffer. Today is the day.

Almost nine years of caring for Maxi within his family are coming to an end. We are very sad and it breaks our hearts, but we just can go on no more.

On the 12th of February 2014, Max passed away. Finally. He never had a chance.

2. Increase in measles cases in California

Really, this should not happen at all, however, unvaccinated adults and children are exposing Californians to measles. I wonder whether we'll ever learn whether the Temecula measles case was Dr. Bob's patient, like the patient who started the 2008 San Diego outbreak. As a reminder - check your immunity for measles. If you are not immune, get the MMR.

3. 2013/14 Flu vaccine effectiveness released

The CDC has released the preliminary vaccine effectiveness for this year's flu season (approximately 61%). Tara Haelle at Red Wine and Apple Sauce has summarized the situation in a thorough blog: Flu is really bad this year - and the vaccine's pretty good.

Dutch measles outbreak: 141 more cases this week, no death reported (whew)

The new measles numbers and map have been released, the past week saw 141 new cases of measles for a total of 921. Luckily no death has been reported, and I hope it stays that way.

Have a look at the map - the new cases are red, the old ones grey. See how the majority of the new cases stays along the Bible Belt and only the odd case escapes herd immunity and pops up in areas of >95% MMR coverage. I hope the Dutch are going to release an animated map at some point, because it just so beautifully illustrates the principles of epidemiology.

Measles in the Netherlands: I'll call it

I was tempted last week, when the measles cases in the Dutch Bible Belt topped 600, but then I didn't. It suddenly appeared morbid, petty and like I wanted it to happen. By last Thursday, 780 measles cases had been reported in the current outbreak. So I'll do it.

There'll be a death. Soon.

In Europe, for about every 1000 reported measles cases, there is one death. The latest outbreak was in Wales, it ended last month with 1219 cases and one death, Gareth Colfer-Williams, who died of giant cell pneumonia, a specific complication of measles. But that particular area in the Netherlands has had its own outbreak in 1999/2000, totalling 3292 cases, over 150 hospitalisations and 3 deaths. It is eerie how this pans out to 1 in 1000. As a side note, 94% of patients were totally unvaccinated and only 1 of the 3292 had had 2xMMR. In fact, the vaccine works so well, that unvaccinated individuals were 224 times more likely to acquire measles than were the vaccinated. But I am getting side tracked. I called it. I hope I am wrong.

Meanwhile, measles break out in the Dutch Bible Belt...

The Netherlands do have a "Bible belt" - an area which has a high density of fundamentalist protestants, characterised by their vaccine refusal (and a generally conservative attitude amongst the very liberal Dutch). This has, over the years, given rise to serious outbreaks of vaccine preventable diseases, extending far beyond the belt region. For example, in 1978, a polio outbreak in the Netherlands, totalling over a 100 cases, of which 80 (all unvaccinated) were paralytic and one was fatal, spread to Canada and the United States leading to 14 cases of paralytic polio in unvaccinated Amish, and a further 2 non-paralytic cases in unvaccinated non Mennonite in the area. Apart from the molecular analysis of the virus, showing that the cases were related, the infection chain was also clear:

During the 1978 outbreak, members of the affected religious group traveled from the Netherlands to Canada, where cases subsequently appeared. An Amish family from an Ontario town 15 miles from the affected area moved in late summer 1978 to the Pennsylvania town where the first U.S. Amish case subsequently occurred, in January 1979.

Another polio outbreak struck the area in 1992/3, most of the 71 cases amongst the unvaccinated Bible belt inhabitants. This outbreak also spread to Canada.

In 1999/2000, a measles epidemic struck the Bible belt and neighbouring regions, totalling just under 3300 cases, of which 94% were entirely unvaccinated, and only one patient had had both MMRs. 16% had complications, over 150 were hospitalised, and 3 patients died. Importantly No association was observed between preexisting illness and either reason for admission (P = 0.5) or residual symptoms at discharge (P = 0.5) contradicting the notion that measles are a generally "harmless" disease in "healthy" children.

More recently, in 2004/5, rubella (the "r" in the MMR) swept through in the Bible belt, also spreading to Canada. The consequences were devastating:

In The Netherlands and Canada, 387 and 309 rubella cases were reported, respectively. Of these, 97% were in unvaccinated individuals of orthodox protestant denomination. Reported consequences of rubella in pregnancy were 2 fetal deaths and 14 infants with congenital infection. Of the latter, 11 had clinical defects including deafness in all but eye defects in none. 

The reason should be crystal clear - low vaccination uptake. The Dutch equivalent of the CDC, the RIVM publishes the numbers in handy maps - see the MMR vaccination coverage in the 1998 cohort (as school children, the baby chart was not available) vs measles cases:

The darker, the bad

Now, 13 years after the last big outbreak (enough time for the next generation of unvaccinated Bible belters), the next outbreak has started, with one protestant primary school boasting an impressive 1 in 5 pupils infected:

the "belt" even more visible in infant vaccination gaps

This is an impressive illustration how vaccine refusal (in religious and quasi-religious groupings) leads to large national and international disease outbreaks, causing significant illness, disability and death. These communities effective provide CPR to diseases that should have long been eradicated by providing a "renewable" population of susceptible individuals. Since it may not be possible to change the attitude of certain groups, it is even more important to uphold vaccination coverage around them, to reduce the potential for spread as much as possible.