Dr. Bob is Really Only Doing it for the Worried Parents

not because of any own concerns over vaccine safety. The Sears' website has been modified again, and here is Dr. Bob himself, explaining the origin of his alternative vaccination schedule. It is really all about parental concerns (not about his own flirtations with the anti-vaccine crowd, or the fact that his "alternative" schedule almost doubles the number of office visits for vaccine purposes at $75 to $200 dollar a pop). Good to know, right?

Immunity

I came across this on Ratbags.com - a very short movie by Jasmine Marosvary - this made me think of Nelyn. I met his mum Lynne on ivillage some years ago. The first mother my age, who had lost a child to a vaccine preventable disease. Lynne was lobbying for the licensing of pertussis vaccine for adults, which has since happened. Vaccination saves lives:

And another SSPE case: Angelina is dying

I had seen girl previously on a board, but the parents had not gone public until now, after Natalie's death.

Angelina caught measles in 2006 from an adult, when she was 7 months old. She recovered well - this is her before SSPE broke out:



This is her now:



Gina, Angelina's mum says (my translation):

"In February of this year, we noticed pronounced problems with our daughter. She kept falling off her bike, and had speech blockades. When this was getting worse, we went to the clinic. The diagnosis SSPE was a shock for us. Our child became dependent on care within 8 weeks. She cannot walk nor speak and needs to be tube fed. She would have entered school this year. This blow of fate is very hard for us all."

According to Sean Monks, spokesperson of the German Association of Pediatricians, this is the third case of SSPE from measles infection in infants in 2006 - in 2006 a total of 313 infants with measles were reported to the RKI (German CDC equivalent) in Berlin. One of these children died in 2007, another has been suffering from SSPE since 2009, and now Angelina is the third victim from that year.

Importantly, this shows that the risk of SSPE is much higher than previously thought. Overall risk for SSPE had recently been adjusted to about 1 in 11'000 notified cases of all ages, and "at least" 1 in 2'000 for infants (German pdf). From 2005 to 2010, 27 patients died of SSPE in Germany, although measles incidence had been sinking to reported numbers under 2000/year for some time. The current cluster of SSPE cases indicates that the risk of SSPE for infants who contract measles lies closer to 1 in 200.

Research has not yet identified the causative mutation for SSPE (see for example here) nor found strains with a particularly high risk of causing SSPE which could explain this high incidence. What is clear is that all cases in which measles virus has been amplified from the brain of SSPE victims, it was the wild type rather than the vaccine virus, and that with increasing vaccination coverage, SSPE incidence sank (see for example here and here, for review here).

The only way to prevent more SSPE cases is to vaccinate your child against measles (2xMMR) and to check your own immunity if you are unsure of your history of measles/measles vaccination. Your immunity protects those too young or too sick to be vaccinated. Your decision not to vaccine could cost lives, not necessarily yours.

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?).

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.

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.

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.