John Oliver on Vaccines

Of course, how could we not share another great John Oliver video that covers an ID topic even if it's NSFW. One of the more insightful sections starts around 6:00, where he admits he understands why people are afraid of vaccines, since they are "getting injected by a needle filled with science juice." He also describes antibiotics as "poison used to murder things living in you." Now wouldn't antimicrobial stewardship be easier if patients and physicians thought of antibiotics as poisons and not just magical pills that have few side effects? What if we treated antibiotics like cancer chemotherapies?

Freedom of contagion

This blog tries not to be “political” (too many trolls). But who’d have predicted that infection prevention would suddenly become a partisan political issue? Wow. 

I was tempted to write a post about how misguided the anti-vaccine movement is (or how selfish, depending as it does on the responsible majority for herd immunity). But now I think I’m starting to get it. It’s all about freedom! For too long the heavy hand of government has oppressed us with mandates to prevent infection. Thom Tillis (R-NC) nailed it with his devastating criticism of requirements that restaurant employees wash their hands. Let the free market do its work instead! As long as there is transparency, of course:

While we’re at it, what right does the government have to restrict my ability to make a right turn on a red light? Or obey traffic signals and speed limits at all? Freedom!

I blame the social contract, that outdated theory positing that individuals should surrender some of their freedoms to achieve other benefits. Sure, life might be “solitary, poor, nasty, brutish and short” in the absence of the social contract—but at least it’s free.

Media False-equivalency and the Disneyland Measles Outbreak

Many of us have watched from the sidelines as the anti-vaccine and other science-denier movements have grown through the explicit and implicit support of large media corporations. Even if 99% of scientists support the safety of vaccines, a false balance gives the anti-vax view equal time. Others have written eloquently on false-equivalency in the media and how this anti-science attitude endangers public health. There is no better example of the misguided media support of anti-science than anti-vaccine torchbearer Jenny McCarthy. Since 2007, she has made numerous false claims about vaccines on Oprah, Good Morning America and other venues. One need only to read Michael Specter in the New Yorker (2013):

Jenny McCarthy, who will join “The View” in September, will be the show’s first co-host whose dangerous views on childhood vaccination may—if only indirectly—have contributed to the sickness and death of people throughout the Western world. (See jennymccarthybodycount.com.) McCarthy, who is savvy, telegenic, and pulchritudinous, is also the person most visibly associated with the deadly and authoritatively discredited anti-vaccine movement in the United States. She is not subtle: McCarthy once essentially threatened the actress Amanda Peet, who has often spoken out about the obvious benefits of childhood vaccinations, by warning Peet that she had an angry mob on her side. When people disagree with her views on television, McCarthy has been known to refute scientific data by shouting “bullshit.”

While McCarthy's 1-year stint on "The View" has now ended, she now appears annually on "Dick Clark's New Year's Rockin' Eve with Ryan Seacrest." FYI, we're considering changing the blog name to Dan Diekema's Controversies in Infection Prevention with Mike and Eli. Parsimony is so 2014.

In addition to implicit support of anti-vax folks, there are many other examples of corporate support for anti-science beliefs. For example, in November Curt Schilling (ESPN analyst and former pitcher) took to Twitter to rail against evolution. In the wild-west that is social media, ESPN baseball writer Keith Law quickly responded with a defense of evolution and science in general. As you can imagine, only one of the ESPN "discussants" was suspended - science supporter Keith Law.

So why mention these specific examples, as there is nothing surprising about ESPN backing an ex-baseball player over a writer? The irony is that The Walt Disney Corporation owns ABC (The View, Dick Clark, Good Morning America) and ESPN. And of course Disney owns Disneyland where a seven-state outbreak of measles with at least 85 cases began. While it might be true that select anti-vax folks remain "unmoved" by the latest outbreak (it's their right to decide what eliminated diseases come roaring back), this outbreak might awaken media corporations with large amusement parks to the downside of anti-vax false equivalency. It can't help the bottom line and public image of Disney that scared parents and public health officials are recommending calling off trips to the park.

One might feel a bit sorry for Disney if they hadn't played some role in setting the stage for this and other vaccine-preventable outbreaks. However, my main concern is for the many children too young to receive the vaccine or those with suppressed immune systems whose herd-immunity shield has been needlessly laid down. "It's a Small World" will never sound the same.

No spring break for measles

If you’re a regular reader, you may have noticed the blog has been on break for a little while. While I was trying to relax with my morning coffee last week in Sarasota, I kept running across reports of measles outbreaks in New York City, British Columbia, and California. As usual, these outbreaks can be sourced to those who refuse immunizations, perhaps because of long-discredited fears about autism, or (as in the case of the BC outbreak) because they are getting confusing messages from the person who speaks for their deity. 

I have nothing to add to this commentary by a New England pediatrician, which refers to a depressing study out of Dartmouth that suggests our current messaging around vaccine acceptance is ineffective. For a great recent example of good messaging, see this post by Tara Smith, entitled, “Why I vaccinate my kids”.

But if factual, rational messages fail to sway vaccine deniers, what other options are available? How to respond, for example, to those who base their vaccine denial on religion? So I spent the better part of my time away in prayer and meditation, seeking revelations from all the major deities. I’m happy to announce that they all were in favor of immunization. The main point each of them made to me (aside from pointing out that all the others I communicated with were false deities, not worthy of my time), was that they gave humans an astonishing intelligence and reasoning capacity for a purpose. 

Thus I implore you to go forth and get immunized. The only true god of your choice commands it.

Why is the public health community losing to Jenny McCarthy?

There is word of a huge pertussis epidemic in the state of Washington. So far this year, there have been 640 reported cases through March compared to 94 cases during the same period in 2011. If my math is correct, that's a 649% increase, which is quite possibly more than even Apple's stock increased over the same period.* Per a report in the Seattle Times, if the trend continues, this would equal an outbreak not seen since the 1940's! The article also contains a telling anecdote describing a mother who passed pertussis to her one-month old infant, who turned blue and had to spend a week in the ICU and a month in the hospital.

This outbreak isn't limited to Washington. In 2010, whooping cough killed 10 infants and infected over 9,000 in California, which was the state's worst outbreak in 60 years.

Why is this happening?  I won't go into all of the reasons, as we've had plenty of posts on the topic over the years. I'll just refer you to Red Sox fan and PLoS co-founder Michael Eisen's tweet from yesterday. In an earlier tweet he mentioned that 34% of the parents in his daughter's school don't fully vaccinate their kids.  I agree that this is all Jenny McCarthy's fault and anyone who listens to her or gives her a voice.  It is clear that after years of neglect, the public health community is so weak that it can't even compete with Jenny 'Effin' McCarthy.

*By law, nothing is allowed a larger percent increase than Apple's stock.

Attending Super Bowl after refusing super-effective vaccine is super-stupid

Not much new to say about this that we haven’t already covered. If vaccine refusal becomes increasingly prevalent, imagine the consequences when highly communicable viruses meet hundreds of thousands of congregating susceptible hosts.

I’ll outsource my outrage to Charles Pierce.

h/t to our regular reader Noel Eldridge for linking us to the Slate piece on this.

Best news ever! A Norovirus vaccine that works!

As a parent or two young kids, I dread the slightest hint of nausea. Now, perhaps, I might have one less pathogen to fear and perhaps in old age, I can even take a cruise.

In the recent NEJM there is a report of an RCT assessing the safety, immunogenicity, and efficacy of an intranasal norovirus viruslike particle (VLP) vaccine. The study was conducted in adults aged 18 to 50. They received two doses of either vaccine or placebo and were subsequently inoculated with Norwalk virus during an inpatient challenge with 10 times the infectious dose and monitored for infection and gastroenteritis symptoms for a minimum of 4 days. (No way I'd ever volunteer for this study)

The study included 98 patients with 90 completing both injections. A Norwalk virus–specific IgA seroresponse was found in 70% of vaccine recipients. This level of response is  similar to my old Maryland colleague Samer El Kamary's 2010 JID paper that showed a 79% response rate. Vaccination significantly reduced the frequencies of Norwalk virus gastroenteritis (occurring in 69% of placebo and 37% of vaccine recipients, P=0.006) and Norwalk virus infection (82% of placebo and 61% of vaccine recipients, P=0.05). Not perfect, but still a great result.

Note: These data were also presented at earlier IDSA (2010) and ICAAC (2011) meetings.

Source: RL Atmar et al. NEJM Dec 8, 2011

Update: This news is pretty good too. (Massive drop in in-hospital deaths...in Canada)

Paul Offit and the Dangers of the Anti-vaccine Movement

Paul A. Offit, MD, talks with Eli Y. Adashi MD, Brown University and Medscape, about the history and hazards of the anti-vaccine movement. "Residual damage, 40% of parents are now delaying or withholding one or more vaccines from the children." You can read our prior posts on Dr. Offit here.

Collateral damage: The ongoing measles epidemic in Quebec.

IOM: 667 reasons why vaccines are generally safe

It's actually 667 pages.  The IOM has just released a report titled: "Adverse Effects of Vaccines: Evidence and Causality."  I've pasted a summary table (click to enlarge) of the major conclusions below, which you can also find, and read more easily, in the IOM Brief Report.  I hope this has an impact and convinces families that vaccines are safe, but somehow I get a feeling that it might have been better if instead of saying "favors rejection" for the vaccine link to autism, they might have said "nada" or "got nothing." I didn't realize this, but apparently the IOM has reviewed the safety of vaccines 11 times at the request of Congress since 1986. Well, should be a good read for my flight back from Seattle.

CLICK TO ENLARGE

Full IOM report (here)

WaPo article on the IOM Report 8/25/2011

MMWR - Field notes from the Minnesota measles outbreak

Dan posted last week on the ongoing measles outbreak in Minnesota and he provided many links to useful resources.  Today the MMWR published a "Notes from the Field" that summarizes the 13 epidemiologically linked cases that have been identified as of April 1.  Five children were too young to receive the MMR. 

Measles in Minnesota

So there is another measles outbreak, this time in Minnesota. Unlike recent experience with mumps, in which outbreaks are associated with vaccine failure (over 60% of cases occurring among recipients of two mumps vaccines), measles outbreaks occur primarily among the unvaccinated, and are sustained by those who reject or avoid the MMR (see prior posts here and here). Of the 13 confirmed Minnesota cases, 5 were too young to be vaccinated, 6 should have been vaccinated but were not, and 2 so far are of unknown vaccine status. Regular updates can be found on the Minnesota Department of Health website. There’s also an interesting article in the Star-Tribune about resistance in the local Somali community to receipt of MMR, out of fears of….you guessed it, autism.

We’ve covered this ground before—go here for our prior posts on the anti-vaccine movement. We recently had some local news coverage of a pediatrician who was declining patients if the parents refused vaccinations. I believe this is a perfectly reasonable position for a pediatrician to take. In fact, if a pediatrician does accept anti-vaccine families, he or she has a duty to warn all the other patients in the practice of the increased risk to infants or immunocompromised children from being in that office waiting room.

Collateral Damage

Source: Doonesbury by Gary Trudeau

"[T]here are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns – the ones we don't know we don't know."

-Donald Rumsfeld 

This comic was circulated today via a hospital epidemiology email list, so I had to post it here. We keep no secrets.  I don't know why I included the quote above, other than when I think of collateral damage, he comes to mind. In infection prevention, I think there are a lot of unknown unknowns masquerading as known knowns, but that is another post for another day...

Why are parents anti-vaccine?

Just a quick post from the road. My friend Anna Reisman has a nice post on Slate reviewing Seth Mnookin's new book The Panic Virus: A True Story of Medicine, Science and Fear. enjoy

Bill Gates pledges $10 billion to vaccinate children

Source: Gizmodo.com

Bill Gates spoke with Sanjay Gupta (CNN) recently and is pledging $10 billion over 10 years to vaccinate children worldwide.  Gates' plan:

"Over this decade, we believe unbelievable progress can be made, in both inventing new vaccines and making sure they get out to all the children who need them. We could cut the number of children who die every year from about 9 million to half of that, if we have success on it. We have to do three things in parallel: Eradicate the few that fit that profile -- ringworm and polio; get the coverage up for the vaccines we have; and then invent the vaccines -- and we only need about six or seven more -- and then you would have all the tools to reduce childhood death, reduce population growth, and everything -- the stability, the environment -- benefits from that."

My favorite quote (the counterfactual):  "In fact, it is so simple, people often forget what a big deal this is. The 2 million people that would have died from smallpox now don't think, 'Wow, I'm alive today because of vaccinations,' but that's the case."

It will be interesting to see if this effort can lead to 6 or 7 new vaccines.  A key one would be an influenza vaccine that targets a conserved region of the virus, which would eliminate the need for costly annual vaccinations.  I think we will also need a similar effort to identify new antibacterials before too long.

Full transcript and video of Bill Gates interview (CNN.com)

h/t gizmodo

Paul Offit on Science Friday: The anti-vaccine movement

Paul Offit has a new book out called: "Deadly Choices: How the Anti-Vaccine Movement Threatens Us All."  He was on NPR's Science Friday last week to discuss his book and touch on the death and destruction caused by Andrew Wakefield's scientific fraud (see Brian Deer's BMJ report here) and other aspects of the anti-vaccine movement.

Some short clips from the 17-minute piece:



Paul Offit (on the right) with H Fred Clark

Ira Flatow mentioned that when Dr. Offit was on the program in 2008 a women called in and basically said "No amount of research, none of it, done by government or pharmaceutical companies could change her mind about vaccinating her children."  She said "I don't put any faith in anything my government tells me"

In the 2010 interview a caller said: given the "vast number of immunizations that you are requiring at such a young age that really is taking a toll on the immune system, I think that's just logic"

Paul Offitt responds by pointing out that 100 years ago there was one vaccine, the small pox vaccine with about 200 immunological components. Now there are 14 different vaccines in 26 doses and all of these vaccines combined have less components, perhaps 160 immunological components, than the single small pox vaccine.  He also went on to explain how this is not mercury (no longer in kids vaccines). Even with this evidence the caller said "I'm not hearing anything that sounds credible to me as an educated adult."

And that's the concern.  The anti-vaccine movement is a shifty "business".  First it was vaccines = autism.  After numerous studies that showed NO link, they moved on to mercury.  When mercury was removed, they continue to blame it even though it is not there!  Now it is the number of vaccines, which is irrelevant.

If it was the number of vaccines that was causing the problem then Paul Offit points out that we would all be dead.  We are exposed to many more viruses, bacteria and other onslaughts than could possibly be given via vaccines.  But it is silly to argue.  This is not a discussion you can have, nor is it logical, but rather a symptom of the anti-scientific movement. If people don't believe science, you can't convince them with science...

This past weekend's All Things Considered touched on the same topic but they put a more positive spin on the recent developments.  I have posted a link to their piece titled: "As The Facts Win Out, Vaccinations May, Too," below.  Seth Mnookin, a contributing editor at Vanity Fair, discusses his book "The Panic Virus: A True Story of Medicine, Science, and Fear" and the deadly impact that the anti-vaccine movement has had.


Science Friday with Ira Flatow (1/7/2011)

Direct link to interview with Paul Offit on Science Friday (mp3)

All Things Considered (1/9/2011)

The History of Vaccines (new website)

The College of Physicians of Philadelphia, the oldest professional society in the United States, has just launched a new educational website on the History of Vaccines. There is so much information available, that it literally will blow your mind. I should post a picture, it's not pretty. Topics include "The Development of the Immunization Schedule," a timeline of vaccination history from the year 1000, "History of the anti-Vaccination Movements," and "Top 20 Questions about Vaccines." There are already 424 images and videos for your use and education. Wow.

The site has been planned for several years and has been in development for a year. It will officially launch on November 3, 2010, when Stanley A. Plotkin, MD, developer of the current rubella vaccine, and emeritus professor of The Wistar Institute and The University of Pennsylvania, will give the Samuel X Radbill lecture entitled "Four Centuries of Vaccinology" in Philadelphia.

Check out the preview version of the website "The History of Vaccines" and related blog. Just fantastic.

h/t Tara Smith at Aetiology

Anti-vaccine movement gaining strength

Click here to read a very interesting article in Wired.com about Dr. Paul Offit, the pediatric infectious diseases specialist and vaccine expert, who has been hounded by the anti-vaccine movement.