As I write this post, a large outbreak of mumps is ongoing in Columbus, Ohio. The city, which on average sees a single case each year, has seen over 250 since February. To put things in further perspective, only about 440 cases are normally diagnosed in the entire United States annually. The outbreak began on the campus of Ohio State University, where about 150 cases have been identified, but no information about the index case has been reported thus far.
Although the current outbreak will likely smolder for months, the total number of cases thus far is considerably fewer than the worst of the past decade. A 2009-2010 outbreak in New York and New Jersey ended up affecting about 3,000 people. In 2006, about 6,500 college students throughout the Midwest were infected. It is unlikely we will see these kinds of numbers in Ohio, but even our worst in recent years pale in comparison to those that have occurred in England over the past decade, where there was a peak of about 56,000 documented cases in 2005.
The diagnosis of only a few hundred cases per year is a clear victory of the mumps vaccination program, which started in 1967. Prior to the widespread adoption of the vaccine, 186,000 cases were seen in the United States annually. That works out to a decrease in cases of over 99%. This reduction didn’t occur because of improved sanitation, cleaner water, or even sunspots. It occurred because of the hard work and dedication of vaccine researchers, medical professionals and the widespread public acceptance of a safe and effective vaccine.
Mumps doesn’t get the kind of press that measles outbreaks do. There are a number of reasons why this is true and reasonable. I will get into more detail, but essentially mumps, although it can result in significant morbidity, just isn’t as sexy and it isn’t a good candidate for anti-anti-vaccine poster child. Measles wins in that regard, and let’s hope it stays that way. I am terrified at the thought of HiB meningitis returning. But that doesn’t mean that mumps outbreaks can’t serve as fodder for educating the public on vaccines. First though, a primer on mumps.
We saw it coming. The re-emergence of vaccine-preventable disease should surprise no-one that’s been following the anti-vaccine movement.
Rebutting anti-vaccine rhetoric feels like a Sisyphean struggle. Steven Novella likened it to a game of whack-a-mole, where the moles are the same old tropes that keep popping up, no matter how often they are refuted with facts. Vaccines are a remarkable success of modern medicine: They are health interventions that are both demonstrably effective and remarkably cost-effective. Vaccination has likely prevented more deaths in the past 50 years than any other health intervention. Smallpox was a ruthless killer that took 300 million lives, just in the 20th century alone. Today it’s gone – eliminated forever. And now there are now over two dozen diseases that are vaccine-preventable. They should be an easy sell, and to most people, they are. But the control of vaccine-preventable disease relies in part on herd immunity – sufficient immunization to stop the spread of infection (no vaccine offers 100% protection) and protect those that cannot be immunized. Even a modest number of unvaccinated individuals can lead to reemergence of disease. None of this matters to antivaccinationists, to whom vaccines are bad. Viewing anti-vaccine websites for only five to ten minutes can increase the perception of risk of vaccination, and decrease the perceived risk of omitting vaccines. It also lowers vaccination intentions. By changing perceptions of safety, the willingness to vaccinate decreases. Now imagine that someone you believe to be a health professional openly questioned the efficacy and safety of vaccines – would it reduce your willingness to vaccinate? The evidence says it does. And that’s why the modern practice of naturopathy or “naturopathic medicine” is so concerning. Naturopaths have opposed vaccinations since the invention of naturopathy – starting with smallpox: (more…)
Rotavirus is the leading cause of severe diarrhea in infants and children worldwide, leading to more than half a million deaths each year in children under the age of 5. Before the introduction of the rotavirus vaccine, almost all children in the US were infected by the age of 5, and rotavirus infections were responsible for 400,000 doctor visits, 200,000 ER visits, 55,000-70,000 hospitalizations, and 20-60 deaths each year. The first rotavirus vaccine, RotaShield, was found to have an association with intussusception. Two newer vaccines, Rotateq and Rotarix, were thought not to carry that risk, but two new trials have shown that they do. Still, the risk is small and the benefits of the vaccines are great.
What is intussusception?
Intussusception is a “telescoping” of the intestine where one section slides inside another section. This can cut off the blood supply, block the intestine, and cause tears, infections, and death. Most cases are in young children. They have severe abdominal pain (intermittent at first), and pass blood in the stool, typically mixed with mucus and having the appearance of currant jelly. A barium enema can confirm the diagnosis and simultaneously treat it. Sometimes surgery is needed. (more…)
There used to be a time when I dreaded Autism Awareness Month, which begins tomorrow. The reason was simple. Several years ago to perhaps as recently as three years ago, I could always count on a flurry of stories about autism towards the end of March and the beginning of April about autism. That in and of itself isn’t bad. Sometimes the stories were actually informative and useful. However, in variably there would be a flurry of truly aggravating stories in which the reporter, either through laziness, lack of ideas, or the desire to add some spice and controversy to his story, would cover the “vaccine angle.” Invariably, the reporter would either fall for the “false balance” fallacy, in which advocates of antivaccine pseudoscience like Barbara Loe Fisher, Jenny McCarthy, J. B. Handley, Dr. Jay Gordon, and others would be interviewed in the same story as though they expressed a viewpoint that was equally valid as that of real scientists like Paul Offit, representatives of the CDC, and the like. Even if the view that there is no good evidence that vaccines are associated with an increased risk of autism were forcefully expressed, the impression left behind would be that there was actually a scientific debate when there is not. Sometimes, antivaccine-sympathetic reporters would simply write antivaccine stories.
I could also count on the antivaccine movement to go out of its way to try to implicate vaccines as a cause of the “autism” epidemic, taking advantage of the increased media interest that exists every year around this time. Examples abound, such as five years ago when Generation Rescue issued its misinformation-laden “Fourteen Studies” website, to be followed by a propaganda tour by Jenny McCarthy and her then-boyfriend Jim Carrey visiting various media outlets to promote the antivaccine message.
Antivaxxers spread misinformation. This does not have to be the case – I can envision those who wish to function as watchdogs on the vaccine industry or prioritize personal freedom over government programs (even good ones), but who strive to be logical and evidence-based. The culture within the anti-vaccine movement, however, is not logical and evidence-based. Rather, they spread whatever misinformation supports their rather extreme ideology – that vaccines do not work and are dangerous.
Countering anti-vaccine misinformation can be almost a full time job. It is the proverbial game of whack-a-mole, especially in the social media age where old debunked anti-vaccine memes can resurface over and over again on Facebook or Twitter. The game is also rigged in that it is easier to spread fear with misinformation than to reassure with accurate information. Even if we address every anti-vaccine trope, parts of the public can be left with the vague sense that there is something dangerous about vaccines, or that the government is not playing entirely straight with us.
In any case, here is this week’s edition of whack the anti-vaccine mole. The particular varmint that popped its head up recently is the claim that 2-5% of children who receive the MMR vaccine (mumps-measles-rubella trivalent vaccine) contract measles from the vaccine. This specific claim was made on the realfoodeater blog (another thing you should know about the anti-vaccine community is the broad overlap with the natural, alternative medicine, and conspiracy subcultures). The blogger gave as a reference a conversation she had with an unnamed doctor at DeVos Children’s Hospital. (more…)
Parents have a fundamental right to guide the upbringing of their children protected under the Due Process Clause of the U.S. Constitution. This includes the choice of medical care for the child. They also have a First Amendment right to the free exercise of their religious beliefs, including the right to care for their children in accordance with the tenets of their religion. In a better world, these rights would be exercised in a manner that is consistent with a reasoned selection of medical care among choices supported by the best available scientific evidence. If, for example, deeply religious parents choose to forego a treatment that had only a minimal chance of extending their child’s life and terrible side effects in favor of palliative care because they believe that their child would be better off in heaven we could all agree that their choice is constitutionally protected.
Unfortunately, that is not the case. Religious believers and those whose “philosophy” favors pseudoscience in child medical care (surveys bloviating about the popularity of CAM to the contrary) are in fact a tiny minority of the American population who influence public policy in a manner that far exceeds their actual numbers. This influence allows these special interest groups to cause needless suffering and death among children and their families. As well, their actions siphon off medical and legal resources that could more properly be directed toward the common good when states and medical institutions are put in the position of having to go to court to protect children from their parents. And, by giving parents false choices between a belief in magic and standard medical care, unnecessary complications are introduced into what are already difficult and heart-wrenching decisions by parents who truly want to act in the best interests of their children. (more…)
This is about antivaccine happenings ten years’ time ago. Unfortunately, it’s also about antivaccine happenings now. The reason, and what links the two, is that antivaccine happenings, particularly myths, never seem to die. They just keep coming back over and over again. One myth that’s been recycled since at least 2005 is the one that claims that there’s been a study that has vindicated Andrew Wakefield. Stories pop up every so often that look for all the world as though they’re new claiming that the results of Andrew Wakefield’s original Lancet case series has been replicated. Sadly for Wakefield (and happily for the rest of the world), it’s just not true. I have a Google Alert for vaccines set up, so I see these stories when they pop up periodically. Sometimes they even make an appearance on Facebook and/or Twitter as antivaccine memes.
This time around, what’s happening is not exactly the same thing. The “Wakefield was right” news stories appear to arise organically every so often. I have no idea why. This particular story is one that’s being desperately pushed by antivaccine mavens—again. It’s one that has been desperately promoted dating back to a decade ago, as you will see. Unfortunately, like Jason or Michael Myers in a classic slasher flick, just when you think it’s dead is the time to be vigilant because it’s not. I’m referring to a myth that I’ve been covering on and off for nearly a decade that the Centers for Disease Control (the CDC) has been “hiding evidence” that mercury in vaccines is a major cause of the “autism epidemic.” It’s not true, of course. Indeed, my very first post for this blog lo these six years ago referred to the hypothesis that mercury in the thimerosal preservative that used to be used in childhood vaccines as a failed hypothesis. And so it is—and remains.
In a recent post I shared a bit of my personal, near-death experience with measles during the US epidemic of 1989-1991. As I describe in that post, I contracted a very serious measles infection at the end of medical school, and was highly infectious when I interviewed for a residency position at Seattle Children’s Hospital. Like others my age who received an ineffective, killed measles vaccine between 1963 and 1967, I had not been adequately protected. The MMR vaccine was not yet available, and no boosters were recommended at the time. Unfortunately, though my measles titers (a test of immunity to measles) were checked when I entered medical school, the school’s student health department failed to notice or respond to the results – I was not immune and did not receive a booster dose at that time, as I should have. That mistake was huge, and could have cost me my life. It also caused me to potentially sicken many vulnerable children during my tour of the hospital, as well as others I may have inadvertently exposed during the window of communicability as I walked the streets of Seattle. The Department of Health had to be called to trace all of my steps and attempt to track down and protect any potential contacts.
I don’t think it can be repeated too many times during flu season: People can die of the flu.
The flu vaccine is one of the two vaccines most easily demonized by the antivaccine movement. The first, of course, is Gardasil (or Cervarix), the vaccine against HPV. The reason why Gardasil is so easily demonized is because it protects against an infection whose end result of cancer is many years in the future. Alt-med fans frequently castigate “conventional medicine” for not emphasizing prevention enough, but HPV vaccines put the lie to that. HPV vaccines protect against an infection that is usually fairly harmless in and of itself but has the long term effect of vastly increasing the risk of at least one potentially deadly cancer, and likely several others. Also, HPV infections are commonly sexually transmitted, allowing the moralistic wing of the antivaccine movement and misguided religious people in essence to “slut shame” the vaccine by arguing that it will encourage promiscuity by removing one of the consequences of sexual intercourse, one of the stupidest arguments against the HPV in existence. (Seriously, does anyone think teens and young adults, when their hormones are raging, worry about maybe the possibility of maybe getting cancer 20 years down the road when on the verge of a night of passion now? I don’t.) (more…)