Thursday, August 21, 2008

Measles cases on the rise

The local paper where I live posted a story by the Associated Press that says measles cases are on the rise. A reader pointed to this article as to why she would not delay or refuse to give her child immunization shots.

Here's the story on the Journal Star's website:

The number of measles cases in the U.S. is at its highest level since 1997, and nearly half of those involve children whose parents rejected vaccination, government health officials reported Thursday. The number of cases is still small, just 131, but that's just for the first seven months of the year and doctors are troubled by the trend.

There were only 42 cases for all of last year. "We're seeing a lot more spread. That is concerning to us," said Dr. Jane Seward, of the U.S. Centers for Disease Control and Prevention. Pediatricians are frustrated, saying they are having to spend more time convincing parents the shot is safe. "This year, we certainly have had parents asking more questions," said Dr. Ari Brown, an Austin, Texas, physician who is a spokeswoman for the American Academy of Pediatrics.

The CDC's review found that a number of cases involved home-schooled children not required to have the vaccines. Measles, best known for a red skin rash, is a potentially deadly, highly infectious virus that spreads through contact with a sneezing, coughing, infected person.

It is no longer endemic to the United States, but every year some Americans pick it up while traveling abroad and bring it home. Measles epidemics have exploded in Israel, Switzerland and some other countries. But high U.S. childhood vaccination rates have prevented major outbreaks here. In a typical year, only one outbreak occurs in the United States, infecting perhaps 10 to 20 people.

So far this year through July 30 the country has seen seven outbreaks, including one in Illinois with 30 cases, said Seward, deputy director of the CDC's Division of Viral Diseases. None of the 131 patients died, but 15 were hospitalized.

-NewsAnchorMom Jen

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Maria said...

Less than half are not vaccinating and no one knows if the others are on an alternate schedule. The article on CNBC indicates that many were under 1-- the age in which they would have received a vaccination. The article also says that 63 of the cases opted out of vaccination, 50 some with an unknown status, 11 had at least one dose.

Numbers aside, what stands out to me was the doctors in the article are annoyed at answering questions. Doctors are not Gods or even worthy of Idol status. Questioning the status quo is good for science.

Shannon said...

I have felt for a long time that the companies who produce the vaccines are missing out on an opportunity...

In my experience, a number of people who opt to delay the MMR would not hesitate to give at least the measles component and possibly the other two components as well if they were only separated. It has become nearly, if not completely, impossible to get those vaccines in separate forms.

A lot of parents who choose to delay do so because they are concerned about the volume of agents being introduced in the combination shots and to minimize that concern, they delay certain shots to spread that out more. Whether or not those concerns are medically validated is really irrelevant, it is about the parents' comfort level, imho.

I believe a number of parents would be willing to pay more money to have them separated out, alleviating some of the concerns of the MMR itself while getting the child vaccinated, the companies more money for their product, and the concerned parents a little peace of mind.

I know there are many who do not vaccinate for other reasons and I certainly don't mean to speak for anyone else, but again - in my experience - there are a number of parents who would gladly take this option if it were available.

Knight in Dragonland said...

The MMR vaccine has been on the market for decades. Over half a BILLION doses have been administered worldwide, and its safety record is outstanding. In its first 20 years in the U.S.(reference here), the MMR vaccine has prevented 52 million cases of the disease, 17400 cases of mental retardation from measles encephalitis, and 5200 deaths. It has also saved the healtchare system over $5 billion ... and those estimates seems very low to me.

Lets see what happened in the U.K. after Andrew Wakefield's disastrous and monstrously unethical campaign against the MMR vaccine. From Wikipedia ...
After the MMR vaccine controversy began, the MMR vaccination compliance dropped sharply in the United Kingdom, from 92% in 1996 to 84% in 2002. In some parts of London, it was as low as 61% in 2003, far below the rate needed to avoid an epidemic of measles[3]. By 2006 coverage for MMR in the UK at 24 months was 85%, lower than the about 94% coverage for other vaccines.[4]

After vaccination rates dropped, the incidence of two of the three diseases increased greatly in the UK. In 1998 there were 56 confirmed cases of measles in the UK; in 2006 there were 449 in the first five months of the year, with the first death since 1992.[5] Cases occurred in inadequately vaccinated children.[5]. The age group affected was too old to have received the routine MMR immunizations around the time the paper by Wakefield et al. was published, and too young to have contracted the natural disease as a child, and thus to achieve a herd immunity effect. With the decline in infection that followed the introduction of the MMR vaccine, these individuals had not been exposed to the disease, but still had no immunity, either natural or vaccine induced. Therefore, as immunization rates declined following the controversy and the disease re-emerged, they were susceptible to infection.[6][7] Measles cases continued in 2006, at incidence rates 13 times greater than 1998 levels.[8] Two children were severely and permanently injured by measles encephalitis despite undergoing kidney transplantation in London.[9]

Disease outbreaks also caused casualties in nearby countries. 1,500 cases and three deaths were reported in the Irish outbreak of 2000, which occurred as a direct result of decreased vaccination rates following the MMR scare.[9]

In 2008, for the first time in 14 years, measles was declared endemic in the UK, meaning that the disease was sustained within the population. This was caused by the preceding decade's low MMR vaccination rates, which created a population of susceptible children who could spread the disease. In May 2008, a British 17-year-old with an underlying immunodeficiency died of measles.

By all means, continue to question a vaccine whose safety and efficacy has been established over three decades and hundreds of millions of administered doses. You can also question whether the earth is round and revolves around the sun, if you wish. Just know that you're helping to push us all down a slippery slope to the return of endemic measles in the U.S.

I don't have a serious problem with dividing the vaccine, as long as that does not mean delaying vaccination for measles, mumps & rubella (1st doses 12-15 months, boosters at 4-6 years). I know that Merck still produces individual vaccines that could be ordered by a pharmacy, although stocks are limited. However, I would not recommend dividing the vaccine since the scientific evidence is clear that dividing the doses actually increases your risk of side effects (although these risks are quite small to begin with). Any individual whose immune system is so weak that it would be "overwhelmed" by the MMR vaccine would also be "overwhelmed" by an encounter with the wild virus.

dayoub said...

to paraphrase Mark Twain (who was unvaccinated)

IF you don't read the NY Times, you are UNinformed

if you DO read the NYT, you are MISinformed

I am not an MMR expert, but I can render an opinion/comment

1) cases in children <1 y/a may be due to waning maternal antibodies which normally provide protection during infancy. There is evidence that the new generation of moms are MMR vaccinated and have lower quality measles antibodies than acquired via natural infections that occurred naturally without vaccines.....the infants born today may be at greater risk because of weaker maternal antibodies and the fact that MMR vaccine is not given until 12 months age.....

2) If this is the largest number of measles cases since 1996, why were there more cases in 1996 (508) than this year?

3) there were 123 reported measles cases in the US the first half of this year, or about a 250/year clip. There are 300 million US population
that is one case of measles illness per 12 million people......therefore there would not likely be a single measles case in springfield, or in why the fuss?

How many cases of autism are there? Much more then 1 in peoria. How many have died within 24 hours of a vaccine? (Hint: more than 1)
SO name your poison, autism or an illness like measles that has not killed anyone in the USA in the last 6 months? Autism carries a double mortality rate over the general population, not to mention a horrible morbidity.

4) Harris Gardner says: "Many of these parents say they believe vaccines cause autism, even though multiple studies have found no reputable evidence to support such a claim."

But look at the CDC's table...closely

79 cases were >5 years age......the majority of them would have normally received a MMR vaccine at a time the autism-MMR link was not even what does Harris mean by "Many of these parents say they believe vaccines cause autism, ". That cannot be a reason why a 20 year old skipped out on vaccines?!!!

5) Harris says this:
"Nonetheless, vaccination rates have remained relatively high in the United States. In 2006, 95 percent of school-age children received at least one shot of the combined measles,mumps and rubella vaccine, according to the C.D.C. But such surveys are often years behind vaccination trends, and government officials say the growing number of measles outbreaks suggests that overall vaccination rates may be on the decline"

Herd immunity requires >90% coverage which we have what is happening to the herd? Does the rising numbers mean that coverage rates are dropping? yet they have no proof? this is an assumption.

6) Harrris says: "In the decade before the measles vaccination program began, each year nearly 4 million people in the United States were infected, 48,000 were hospitalized, 1,000 were chronically disabled and nearly 500 died."

now lets look at the BIG picture, here is data from England:

measles cases plummeted over 95% BEFORE there was even a vaccine available! so the vaccine did almost nothing...not as much as improving diet, food, water, sanitation, etc, by far the greater contribution to child health than vaccinations

7) no deaths in the USA this year from measles? Fact: More children died in MVA's on their way to the pediatricians office to get MMR shots than from measles!

8) Did you know that Japan stopped using MMR combo vaccines in 1993 because of aseptic meningitis in 1 in 2000 recipients, as i recall?

9)NYT: “All pediatricians are spending more time speaking with parents about the rationale for vaccines,” said Dr. Andrew D. Racine, director of the division of general pediatrics at the Children’s Hospital at Montefiore in the Bronx."

it is a pity that when these kids regress into autism after an MMR, the pediatrician no longer has any desire to care for them and sends them to a psychiatrist for drugs

10) Harris says:
"Responding to parents’ concerns, manufacturers in 2001 almost entirely removed a preservative containing mercury from all routinely administered childhood vaccines. The incidence of autism has shown no drop."

fact: the removal was nothing to do with parents, they didn't even know that Thimerosal was in was the CDC, AAP and PHS decision in July, 1999........not a single parent had anything to do with this decision.

fact: the lie unabated-today kids get more flu shots than ever before and it still has mercury, in spite of mercury free formulas because of this a child by 5 y/a can get 53% OF THE PEAK DOSE IN 2000!.....maybe autism is still rising because MMR is still given? what does this last statement have to do with MMR? never had thimerosal in it, or is he just trying to get in a last political jab?

This NYT piece is a piece of you know what.....fearmongering at its best

Knight in Dragonland said...

I'll address a few of dayoub's points ...
"cases in children <1 y/a may be due to waning maternal antibodies which normally provide protection during infancy"

Nearly all maternal antibodies transferred through the placenta are out of the infant's system by six months of age, and the protection provided wains significantly after the first 2-3 months.

The immune protection offered by breastfeeding is multi-factorial. Secretory IgA antibodies certainly play a role, but there are numerous other factors (influence on gut flora, transfer of growth factors & cytokines, etc).

There's also the fact that measles, mumps, and rubella are all VIRAL infections, and thus the humoral immune system plays a relatively minor role in defending against them.

"there were 123 reported measles cases in the US the first half of this year, or about a 250/year clip. There are 300 million US population - that is one case of measles illness per 12 million people" AND
"no deaths in the USA this year from measles? Fact: More children died in MVA's on their way to the pediatricians office to get MMR shots than from measles!"

There's a reason for the vanishing rarity of measles in the United States - THE MMR VACCINE!!! You can't use the vaccine's success as an argument against its use! That's exactly the sort of logic that angers me so much on this issue. There would be no support for this INSANITY if people actually had to deal with the consequences of the illnesses prevented by vaccination.

"why the fuss?"

Measles is a highly contagious disease spread by aerosol transmission with a 90% attack rate. That means that if you're exposed and non-immune, your likelihood of acquiring the infection is 90%. Other viruses considered highly virulent have attack rates of 50% or less. Influenza, for example, has attack rates ranging from 20-50%, depending on strain.

"measles cases plummeted over 95% BEFORE there was even a vaccine available! so the vaccine did almost nothing...not as much as improving diet, food, water, sanitation, etc, by far the greater contribution to child health than vaccinations

I do not deny the benefits of adequate nutrition and sanitation. Measles mortality and that of other infectious diseases certainly did plummet in the modern era thanks to innovations in public health & sanitation. The graph you link to is presented at much too large of a scale to note the benefits of vaccination - and they were marked. Also, the graph only looks at mortality - NOT the number of measles cases as you stated. The graph ignores both morbidity and healthcare costs. A single child permanently crippled and mentally incapacitated by measles encephalitis would consume MILLIONS of healthcare dollars over their lifespan in addition to the cost to society of their lost productivity.

"How many have died within 24 hours of a vaccine?"

That's a meaningless figure unless you can prove causation.

Finally ...
"it is a pity that when these kids regress into autism after an MMR, the pediatrician no longer has any desire to care for them and sends them to a psychiatrist for drugs"

That's an absolutely despicable characterization of pediatric practice in regards to autism spectrum disorders. I have yet to boot any child out of my practice once they've received the diagnosis of autism. In fact I've been instrumental in MAKING that diagnosis on more than one occasion. I hardly ever send autistic children to a psychiatrist, although I do often send them to a developmental pediatrician to help coordinate the necessary therapies and educational interventions. I use psychoactive medications sparingly and with careful consideration.

Anonymous said...

Anyone wanting to obtain the MMR vaccine seperately may do so by contacting Hopewell Pharmacy at 1 800-792-6670. They will coordinate with your pediatrician's office to send the vaccines directly to them. You may then have the shots given seperately and have months in between each dose being administered to your child.
Did anyone see the Larry King show that had the parents of a child who had actually just recently won a court case where it was determined that IN FACT, the child became autistic as a result of numerous vaccinations given to her at one time? Of course she had some other genetic propensity toward autism that was triggered by the numerous vaccinations being poured into her body at one time, but who knows if their own child has that same gene or how many vaccines at one time may trigger autism in their child? The arguments are compelling on both sides, but as a parent I chose to have my son vaccinated slowly and receive the MMR as seperate doses. One can never be too careful.

Knight in Dragonland said...

Anonymous ... I think you're acting like you're on a tight rope when you're actually in the middle of a bridge a mile wide.

Courts are extremely poor arbiters of medical facts. The Hannah Poling case is a special circumstance, and it is completely unclear that vaccines had anything to do with her deterioration, despite the fact that they chose to compensate her. She also had multiple infections that temporally coincided with her regression. To my knowledge and with my experience, wild viruses do a lot better job of inflaming the brain than vaccines.

Anonymous said...

I have been working on a blog to compile all the informaiton I've been researching on vaccines. My goal is not to be anti-vax but to inform parents of the dangers of vaccines so they may research them and make an informed decision. There's safer ways to vaccinate our children. As for the MMR, Measles supression might not be a good thing after all. Measles is not life threatening to healthy children with normal immune systems. Our grand parents had measles parties just like our parents had chicken pox parties. There's a REASON why we are meant to get these childhood diseases. I'm still working on more but here's some more info on my blog.
I hope to get the word out about vaccines and the risks and benefits of them.

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