Vol. 212 May 1, 2019 MMR Vaccination Updated and DTaP Explained

May 1, 2019

An eleven year study of 657,000 Danish children showed that those who received the MMR vaccine had no increased incidence of autism. In fact, the girls who received the vaccine had a 5% reduction in their risk for autism. In Denmark all vaccinations are free of charge and voluntary. When 95% of children in a community are vaccinated against measles the 5% of unvaccinated children are protected through “herd-immunity” due to the reduction of exposure to the highly contagious measles virus.

Measles was declared “eradicated” in 2000. Since then we have had unexpected U.S. measles outbreaks in 2014 and presently we are breaking all records for new cases (78 cases just this very week). Since January 1, 2019 the U.S. has had 465 cases in 19 states. Recent U.S. measles outbreaks in Brooklyn, NY, Portland, Oregon, and Rockland County, NY were caused by unvaccinated visitors to an annual Jewish pilgrimage in the Ukraine returning to their unvaccinated orthodox Jewish communities in the U.S.

Surrounded by states with nearly 700 new measles cases Dayton, Ohio is voicing concern about a measles outbreak in their city. Of the 9 counties in Ohio 8 have measles vaccination rates between 90 – 93%. Montgomery County, Dayton is the county seat, has a rate of only 88%. Remembering that herd immunity is achieved at 95%, Ohio, which requires proof of vaccination within 14 days of school attendance, is considering rewriting their current reasons for exemption (about 9% in Montgomery County) of “religious, medical, or reasons of conscience.”

The “T” in the DTaP vaccine stands for tetanus. Tetanus is not a contagious disease like measles. It is caused by wound contamination with a bacteria that causes intense, painful muscle spasms, clenched jaw (“lockjaw”), and extremely unstable vital signs.  The tetanus vaccine is the only protection against tetanus.  It is rare because most children receive the tetanus vaccine. Oregon in 2017 reported its first case of tetanus in thirty years. An unvaccinated 6 year old sustained a cut on his forehead while playing on a farm and developed tetanus. His 2 month hospitalization cost $800,000. The total bill for his care including rehab services and transportation exceeded $1 million. Upon discharge the parents continued to refuse any immunizations for him  including a tetanus vaccine booster to complete their child’s protection!

The “P” in DTaP immunization stands for pertussis and the standard recommendation is to get 4 DTaPs before age 18 months ,starting at 2 months, with a booster at 6 years and as a teenager. Our periodic pertussis outbreaks can not be blamed wholly on anti-vaxxers who refuse immunizations because the pertussis vaccine is not as effective as other vaccines in maintaining protection; the immunity created by the vaccine wanes over time. The little “a” in front of the “P” stands for “acellular”. The acellular vaccine has less of the side effects of injection site pain, temporary fatigue, and a fever than the earlier vaccine that contained cells of the bacteria. But, this newer vaccine (introduced in the late 1990s) produces a smaller increase in and a shorter duration of immunity. “P” vaccinated people can get pertussis, but unvaccinated children and adults are 8 times more likely to get pertussis.

Pertussis immunization is now recommended for all pregnant women since protective antibodies pass through the placenta to the unborn child affording protection to the infant in the first months of life. Pertussis can be diagnosed in some one with a persistent cough by a simple nasal swab done in the office, and it can be treated effectively with antibiotics.

Diphtheria is a bacterial disease with a terrible sore throat. When severe it can form a membrane in your throat that blocks off your air and sometimes it produces a toxin that attacks the heart, causing death.  In 1921 the U.S. had 206,00 cases of diphtheria with 15,420 deaths.  The diphtheria vaccine is so effective that such cases are extremely rare in the U.S. Herd immunity is important in diphtheria. The CDC estimates that 94% of kindergarten pupils in U.S. are immunized against it. The Soviet Union, India, and Yemen remain areas with large numbers of diphtheria cases.

“Good ole” Montgomery County, Ohio had one of the last reported U.S. diphtheria cases; a teen age girl with a bad sore throat in 2014. That rare event got lots of press coverage which might be why Montgomery County is a particularly skittish about a possible measles outbreak in 2019.

Diphtheria can be treated effectively with antibiotics and anti-toxins. Any contacts of the person with diphtheria can also be treated to prevent spread of the disease. A simple skin test (Schick test) identifies people with no immunity to diphtheria, so efforts to control its spread can be highly targeted.

My previous blog suggesting that one way to change the behavior of anti-vaxxers would be to sue the parents of an unvaccinated child for neglect to recover the cost of the medical treatment, loss of wages of caretakers, loss of school performance, continued rehabilitation of complications, etc. of any person who then got measles from the unvaccinated case. Perhaps that might send an effective message to anti-vaxxers of a personal financial risk where scientific data holds no sway. What if the parents of the Oregon tetanus-afflicted child were sued by tax payers in Oregon to “recover” the medical care costs of nearly a million dollars presumably borne by Oregon’s tax payers?

Vol. 37 January 15, 2011 Let’s Call A Quack a “Quack”

January 14, 2011

“Since the introduction of the first vaccine, there has been opposition to vaccination…Since the 18th century, fear and mistrust have arisen every time a new vaccine has been introduced.Ultimately, society must recognize that science is not a democracy in which the side with the most votesor the loudest voices gets to decide what is right.”
– The Age-Old Struggle against the Antivaccinationists, Poland and Jacobson, NEJM 1/13/11, p.97

It is time to call a Quack a Quack! Dr.. Andrew Wakefield’s bad science suggesting a link between measles vaccination and autism has been revealed to be also fraudulent! Besides faking and altering data on the 12 (yes, only twelve) patients in his original report, Dr. Wakefield received close to $643,000 for helping lawyers sue pharmaceutical companies working on rival vaccines. “Quackery” is usually defined as selling for profit a medical notion, or lotion, whose benefits are not supported by reason or knowledge.

The U.K. Grand Medical Council has “erased” his name from the medical register. This is the same as stripping him of his medical license, and don’t you just love the British for describing it as an “erasure”. In another quaint British linguistic quirk the act of actually administering the vaccine was often called a “jab”, and so the proponents of giving the vaccine were labeled as “The Jabbers”. The charges and counter charges can get a bit murky, but this several minute annotated video of Dr. Wakefield’s own statement clarifies the issues very well.  Dr. Wakefield currently resides in Texas continuing to attract desperate parents with autistic children, but does not have a U.S. medical license.

It seems incredible to me that his assertions based on 12 patients has stood up for so long in the face of several studies of thousands of children in different countries, numerous peer reviews, and, even, a U.S. federal court decision debunking the connection between measles vaccine and autism. Will this new revelation of false data and fraud quench the voices of superstition?

I doubt it. A recently published book, The Panic Virus by Seth Mnookin explores the reasons this particular superstition has persisted.  His list includes (1) :

1.the democratization of information via the Internet,
2.Americans’ negative response against anything “perceived as infringing on individual liberty”,
3. skepticism of the medical establishment,
4. shoddy shock-seeking journalism,
5. the romance of lone-wolf skeptics tilting against establishment windmills,
6. the development of a sense of community among anti-vaccine activists,
7.journalism that not only tolerated misinformation but also validated “the notion that our feelings are a more reliable barometer of reality than the facts.”

Quackery, of course, existed and thrived a long time before the Internet, before America, before journalism, and even before the establishment of a “medical establishment” though that it is what actually defined it, so this contemporary list fails to fully explain the phenomenon. Professor Michael Shermer, editor of Skeptic Magazine, lists 25 fallacies that lead us to believe weird things (2). Michael Barrett MD explains in detail how quackery sells.

People who continue to rail against MMR vaccinations due to the fear of autism are no longer quaint nor merely superstitious. They should be called “quacks”. They put hundreds of children, and themselves as young adults having their own children, needlessly at risk of a preventable disease with serious complications..

1. The Panic Virus: A True Story of Medicine, Science, and Fear, Seth Mnookin, Simon & Schuster , 2010
2. Why People Believe Weird Things, Michael Shermer, 1997

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