RIP Charlie Haden

The world renowned jazz double bass player Charlie Haden passed away yesterday. How is that relevant for this blog?

Charlie Haden was a gifted singer, performing from the age of 2 years in his family's radio show, until he caught a form of bulbar polio as a teenager - this left him with weak vocal cords and unable to control his pitch. He picked up his brother's double bass and turned out to be one of jazz' greatest double bass players, pairing with Ornette Coleman, Paul Bley, Paul Motian, Carla Bley, Dewey Redman, Bill Frisell and others.

In 2010, Haden got struck by post-polio syndrome, leaving him extremely ill, and, cruelly, nearly unable to swallow. His wish was to play the bass again. Charlie Haden passed away after his long illness with his wife and four children at his side. Our thoughts go out to them.

image credit: Bassist Charlie Haden at radio station KJAZ in Alameda CA, 1981. Photo by Brian McMillen / contact: brianmcmillen@hotmail.com

KISS 2/24/14 Media storm about "polio like illness"

I was just about to write about this, since less than 24 hours after the embargo was lifted on a meeting presentation on a handful of children presenting, over the course of a year, with irreversible paralysis of the limbs, and of whom 2 were found to harbour an enterovirus, the first conspiracy theories have already popped up (this is just polio by another name, yada yada).

However, the Skeptical Raptor has done a perfect job - so please read this

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.

Polio Nearing Eradication

Last week Angola announced there were no new cases of polio since July 2011.

LAUNDA, 10 August, 2012 – Today, Angola marks a year without a new wild poliovirus case, moving the world a step closer to the final global goal of eradicating this contagious crippling disease forever.
After a concerted effort to stop polio transmission the number of polio cases dropped from 33 in 2010 to five in 2011 and no cases registered in 2012. Laboratory results have confirmed that the last case of wild poliovirus was a 14-month-old child from Uige Province in the country's Northwest in July 2011.

This marks a victory for the polio eradication initiative as Angola experienced a resurgence of polio in the last 6 years.

Angola, which eliminated polio from 2001 to 2004, has been plagued by the re-emergence of this crippling disease since May 2005. The disease has since spread from Angola to Namibia (2006), the Democratic Republic of Congo (2006, 2008 and 2010), and the Republic of Congo (2010).

Religious opposition and the U.S. CIA's use of a sham vaccine campaign have caused setbacks in some African and Middle East countries.  However UNICEF is working closely with religious leaders, particularly in Pakistan which has recorded one of the highest number of polio cases in the world.

Several other countries have no polio cases on record thus far for 2012 making only four countries recording polio cases for this year, Afganistan, Nigeria, Pakistan and Chad.  This is good news for global vaccine efforts and the eradication of polio in sight.

Polio in China

As of 13 September 2011, nine cases of polio have been reported in the Xinjiang region.  There has been one death.  All of the cases had wild-type polio 1 (WPV-1) which originated from Pakistan.  Xinjiang shares a border with Pakistan where polio is endemic, along with other neighbouring countries, India, Afghanistan and Tajikistan that are also polio-endemic.

Four children between the ages of four months and 2 years were infected in July, data for the other five are unknown but appear to be all infants, including the one fatality.  This is the first outbreak of polio in China since 1999, when an importation from India was identified.  The last indigenous case was in 1994.  An intense surveillance and vaccination programme has been launched in the region in hopes that the spread can be contained.  However, given that paralytic polio occurs in ~1% of polio cases and of that, 5-10% result in death and there were at least four cases of paralysis and one death, it is more than likely that hundreds, if not thousands of cases have gone undetected.

This outbreak demonstrates the vulnerability of populations who are not adequately vaccinated and the relative ease at which an infectious disease can cause an outbreak even in a country previously certified as polio-free.