What Have We Learned From Last Year’s Measles Outbreak?
Last year the United States experienced a large, multi-state measles outbreak that was largely responsible for 189 measles cases that spread across 24 states and the District of Columbia. It’s believed that the outbreak started from a traveler who contracted measles overseas and then visited the Disneyland amusement park in California while infectious. Widespread media coverage of the outbreak helped elevate public concerns related to the dangers of measles infection, the consequences of a growing number of school vaccine exemptions and the risks of disease among those who were too young or medically unable to be vaccinated.
At this time last year, it seemed as though we were experiencing a tipping point; a growing number of people were beginning to realize that vaccine refusal had consequences that could threaten our nation’s public health. The fact that the personal decisions of a select few people was able to threaten herd immunity and the health of many unsuspecting families and communities was worrisome.
It was believed that more parents (including some who had previously refused vaccines) were seeking and accepting vaccination for their children as a direct result of the outbreak. However, to determine whether clinicians were experiencing any real or lasting changes in vaccine acceptance, Medscape conducted a survey of vaccine providers to find out.
The survey, conducted in July of 2015, included 1577 physicians, nurse practitioners and physician assistants who worked in pediatrics, family medicine and public health. Responses confirmed that the measles outbreaks induced more acceptance of the measles vaccine and vaccines in general. The survey also indicated that, for some parents, a greater acceptance of vaccines was directly related to the fear of the disease, the consequence of being denied admission to schools, daycares or camps, and a greater knowledge about vaccines as a result of more reading on the subject. However, in some cases there was no change.
Every Child By Two also experienced a heightened amount of interest in the months during and immediately following the outbreak with a record number of inquiries from parents. Most were asking for information about the dangers of measles infection and for clarification of the MMR (measles, mumps and rubella) vaccine schedule. There were many parents who were specifically inquiring as to the possiblity of vaccinating their children before the recommended age in order to protect them during the outbreak. Shot of Prevention blog posts that included content specific to measles infection and MMR vaccination had record numbers of views in the early months of 2015, and personal stories relating to the outbreak, were widely shared on social media.
One story that drew a lot of attention was an open letter by Dr. Tim Jacks, whose two children had to be quarantined after they were both exposed to measles at a Phoenix Children’s Hospital clinic. His 3-year-old daughter Maggie had a compromised immune system as a result of fighting acute lymphoblastic leukemia (blood cancer), while his 10 month old son Eli had received all his recommended vaccines, but was still too young for his first dose of MMR vaccine. While neither of his children ended up contracting measles, the frustration he expressed in his letter entitled “To the parent of the unvaccinated child who exposed my family to measles” hit a nerve with a lot of people.
The Focus of Immunization Rates Fades as Cases Dwindle
In reaching out to Dr. Jacks this week, it appears that the attention on vaccinations that was raised during last year’s outbreak appears to have been rather short-lived. He explained,
“As a pediatrician, I regularly discuss vaccines, exemptions, and last year’s outbreak. The cold facts and data only reach so many, so my family’s story adds a personal angle to the issue that questioning parents rarely consider. After the media exposure, many families were aware of our situation. However today, the measles issue is not on as many people’s minds. Vaccine exemption is however a hot issue in Arizona. The Arizona political arena is considering avenues to encourage vaccination and I am hopeful that the coming year will produce progress in that regard.”
Today, a little over a year since the outbreaks began, the good news is that there have only been two reported measles cases so far in 2016. However, it also appears that history may be destined to repeat itself.
Consider, for example, the reports out just this week about a California charter school student who tested positive for measles after returning home from traveling overseas. With just 43% of kindergarteners at the Yuba River Charter School being up-to-date on their MMR vaccine, the California Department of Public Health has attempted to prevent a measles outbreak by first closing the school to all students, and then remaining closed to those without a measles vaccine until April 8 as long as no new cases are documented.
Despite overwhelmingly high vaccination rates across the country, with a mere 1.7% national vaccine exemption rate among kindergartener’s for the 2014-2015 school year, and a 90%+ coverage of MMR vaccine among 19-35 month old children, these small pockets of unvaccinated children continue to present a risk of future measles outbreaks. Read more…
Every Child By Two is pleased to launch another article in their Expert Commentary series featuring guest writer Joel A. Harrison, PhD, MPH, a retired epidemiologist who has worked in the areas of preventive medicine, infectious diseases, medical outcomes research, and evidence-based clinical practice guidelines. Dr. Harrison volunteers his time to provide in-depth and expert analysis of articles which ultimately make false claims about the safety of vaccines. His articles are summarized here on Shot of Prevention with links to the full response on the Every Child By Two website.
Today we will feature Dr. Harrison’s latest paper,
by Joel A. Harrison, PhD, MPH
A recurrent concern among parents is that the mounting number of vaccines now administered to babies is a major challenge to the infantile immune system. Leading advocate of childhood immunizations, Dr. Paul Offit, has sought on numerous occasions to reassure parents by emphasizing how robust and effective babies’ immune systems are at responding to the daily threats from the enormous number of bacteria and viruses they are exposed to. He has illustrated this by showing how – in theory – a baby’s immune system could cope with the number of epitopes (parts of a microbe recognized by our immune system) represented by 10,000 vaccines at one time. While 10,000 seems like a lot, as Dr. Offit explains, even this number is small compared to the capacity of our immune system and, yet, it is exponentially greater than the epitopes represented by all the vaccines given to children.
Well-organized, well-funded groups have sprung up trying to persuade parents of the alleged dangers of vaccines. Their arguments are mistaken, confused, lacking in scientific rationale and logical cohesion. There is one claim, based on one statement/sentence made by Dr. Paul Offit, repeated umpteen times all over the blogosphere, that I think encapsulates their flawed thinking. This claim takes one sentence out of context, ignoring the entire lead in to it. However, even without the context, antivaccinationist’s use of it contradicts common sense. Rather than doing their homework, they amplify each other in a near hermetically sealed self-reinforcing closed circle.
I believe that there is not a single book or paper that I couldn’t find one or two sentences that I could take out of context in order to prove any point I wish to. The purpose of this paper is to once again explain how our immune systems work, how vaccinations fit in the picture, and to show just how flawed antivaccinationist thinking is. Read more…
Every Child By Two is pleased to launch another article in their Expert Commentary series with links to in-depth articles available on the Every Child By Two website. This series features guest writer Joel A. Harrison, PhD, MPH, a retired epidemiologist who has worked in the areas of preventive medicine, infectious diseases, medical outcomes research, and evidence-based clinical practice guidelines. Dr. Harrison volunteers his time to provide in-depth and expert analysis of articles which ultimately make false claims about the safety of vaccines. Today we will feature Dr. Harrison’s latest paper, Debunking Antivaccinationist John Stone and the CDC “Whistleblower”: A Review of John Stone’s “DeStefano Rides Again: GSK Rotavirus Vaccine Study Loses 80% Of Cases And 18 Deaths”
by Joel A. Harrison, PhD, MPH
I’ve written several articles for Every Child By Two. Each of them shows clearly the poor scholarship, deficient science, and often lack of common sense contained in articles written by antivaccinationists. The bottom line is they don’t know what they are talking about. If people are to decide on whether to vaccinate their children or not, it should be based on scholarly, well-grounded science, and reflect basic common sense, not claims made by people who are deficient in these.
John Stone is the UK editor for the online blog, Age of Autism. In a recent article, Stone writes:
Frank DeStefano, the CDC’s Director of Immunization Safety and the lead author at the centre of CDC whistleblower William Thompson’s allegations about destroying MMR/autism data, is involved in another case of apparently hiding data, this time involving intussusception and death, in a newly published paper concerning the safety of GSK’s rotavirus vaccine, Rotarix.
Last month, Representative Posey revealed to Congress that Thompson told Dr Brian Hooker in a taped telephone conversation regarding the DeStefano MMR paper that:
Sometime soon after the meeting, we decided to exclude reporting any race effects, the co-authors scheduled a meeting to destroy documents related to the study. The remaining four coauthors all met and brought a big garbage can into the meeting room and reviewed and went through all the hard copy documents that we had thought we should discard and put them in a huge garbage can.
The new CDC based study of GSK’s Rotarix vaccine by Haber et al., of which DeStefano is senior author and therefore responsible for research integrity, admits a small association with the serious condition of intussusception (an intestinal obstruction secondary to the inversion of one portion of the intestine within another). The paper states that from February 2008 to December 2014 the Vaccine Adverse Event Reporting System (VAERS) “received 108 confirmed insusceptible reports after RV1” (Rotarix). However, a careful review of the database reveals no less than 565 cases for the period. The paper claims to have excluded only 4 reports as unconfirmed (making a total of only 112). (Stone, 2015a; reposted 2015b)
In an Addendum posted a day after the reposting of his article, Stone writes:
I took this article down for 24 hours to consider the points made by “n davis” and “n davis is correct”. I had overlooked the fact that the paper selects US cases only – that there are only a trickle of cases from the US against a relative flood from abroad – and this is basis of massive selection bias, particularly in relation to deaths. It also shows that the US reporting system while always vastly inadequate is wilting. Pharmaceutical companies are required by law to forward reports from abroad where they come to their attention: there is nothing in n davis’s claim that these reports were unavailable to DeStefano – anyone interested in the safety of the vaccine to US children or any other would have considered all of the reports. (Stone 2015c)