Facts, not Fantasy

Tuesday, November 29, 2011

Harpocrates Speaks: Varicella Vaccination Among Older Kids Protects Infants

Another timely article from Todd W.

Varicella Vaccination Among Older Kids Protects Infants

Turning on the news this morning, I was greeted with a story that caught my ear. Published online, ahead of print, a new study in the journal Pediatrics, "Varicella in Infants After Implementation of the US Varicella Vaccination Program", looked at the incidence of varicella (chickenpox) among infants under 12 months of age.

The varicella vaccine was approved in 1995 and is recommended for all children aged 12 months to 12 years. It is a "live" virus vaccine, meaning that the vaccine uses intact, though weakened, virus particles that grant immunity without causing full-blown disease. Vaccines of this sort are generally more effective than "killed" virus vaccines, which only use part of the virus. Because of the approved age range for the vaccine, it does not provide direct protection to infants under 12 months of age, but it can provide protection through herd immunity.

So what did the researchers find?

In the observational study, the authors looked at chickenpox incidence among infants under 12 months of age from 1995 to 2008. The population was broken up into 0-5 months and 6-11 months. They found that incidence among the total infant population fell 89.7% over the period examined. They also noted that complications and severity of disease was lower in the younger age group vs. the older group. The authors speculate that this may have been due to maternal antibodies (which generally provide some protection to infants for about 6 months).

Monday, November 28, 2011

Dr Bob is only looking out for you (or himself)

The Sears' website has been modified again, and here is Dr. Bob himself, explaining the origin of his alternative vaccination schedule. It is really all about parental concerns (not about his own flirtations with the anti-vaccine crowd, or the fact that his "alternative" schedule almost doubles the number of office visits for vaccine purposes at $75 to $200 dollar a pop). Good to know, right?

Saturday, November 26, 2011

Death due to lack of immunity

I don't think I can, or need to say anything else about this video:

Saturday, November 19, 2011

Harpocrates Speaks: The Sequelae of Pox

A follow up to a post by Todd W.  And I am recovering beautifully from my surgery thank you.

The Sequelae of Pox

A couple weekends ago, something of a firestorm erupted among skeptical bloggers. Namely, the news about parents sending pox-laden lollipops through the mail. It was covered by Mike the Mad Biologist, Emily Willingham, Reuben, Tara Smith, Orac and Phil Plait. Largely, the various bloggers, myself included, condemned the parents in the original story because they were knowingly sending infectious material in the mail.

Some folks in the comments of the various articles made the observation that every day, people lick envelopes, handle packages in perhaps less than sterile conditions and so, perhaps unwittingly, leave unintended presents for the recipients, not to mention the delivery personnel. How is that any different from what these parents have done?

First off, I will readily admit that what the parents were doing probably would not lead to anyone contracting chicken pox. Since the virus does not remain viable for very long at all in the environment, it would most likely be rendered harmless given the amount of time it takes the package to be mailed. Even if the pox package managed to reach its target quickly, fomites like lollipops and spit-soaked rags also are unlikely to cause an infection, as the virus is primarily spread via the respiratory system. The oral route is a bit rough on the bug, and it would likely be destroyed before it could actually cause an infection.

Saturday, November 12, 2011

The Vaccine Times: Why Kids Need the Chickenpox Vaccine

The Vaccine Times pointed me at this article, so I am doing the same as they are.

Dr. Mallika's 5 Fast Facts: Why Kids Need the Chickenpox Vaccine

A new trend finds some parents giving their children candy coated with chickenpox germs in an attempt to build their immunity without a chickenpox vaccine. Here, Everyday Health's medical director explains why that's not a good idea — and why it's so important to vaccinate your kids.

FRIDAY, Nov. 11, 2011 — You may have heard about a disturbing new trend making headlines these days — one that involves parents who buy and sell contaminated items meant to intentionally sicken their kids. Parents who don’t want to give their children the varicella vaccine for chickenpox are purchasing mail-order lollipops that have been sucked by children with chickenpox, hoping to build their kids’ immunity against the disease “naturally.” Besides being illegal, this is incredibly dangerous. First, there’s no telling what other germs or bacteria are being spread through these “pox pops.” And second, exposing your kids to the varicella virus — assuming it can even survive on the candy, which isn’t clear at this point — puts them at risk for developing chickenpox, which can be serious or, in some cases, even deadly.

The pox pops trend is a variation on the decades-old tradition of “pox parties,” where healthy kids are invited to play with infected kids to expose them to the virus. Invitations to such events have been posted on Craigslist, Facebook, and even designated pox party Web sites. The idea is certainly popular — but that doesn’t mean it’s good.

The best and safest way to protect your kids and build their immunity is to give them the chickenpox vaccine, which the U. S. Centers for Disease Control and Prevention (CDC) recommends for all young people ages 12 months to 12 years. Some 6 percent of parents choose not to vaccinate their children against chickenpox out of either fear or principle, according to a recent study in Pediatrics, but research shows that’s a risky decision.

Here, five reasons to skip the pox pops and parties and get your kids vaccinated:

1. Getting the chickenpox vaccine is much safer than getting the disease. Many parents wonder whether it’s better for their child to get infected with chickenpox or to get the vaccine, and there really should be no question. The vaccine, which is given in two doses at least three months apart, usually around age 1, is made up of a weakened version of the virus that cannot cause full-blown disease. Adverse reactions are the exception, not the rule — and when they do occur, they’re generally very mild. About 20 percent will have temporary soreness or redness at the injection site, and 10 percent will have a slight fever. More serious problems like seizures are exceedingly rare: Less than .1 percent of kids who get the vaccine experience such a response, compared with 10 percent of kids who don’t get the vaccine and require medical attention for serious complications associated with chickenpox.

2. Chickenpox is no picnic — for you or your child. Even mild cases are uncomfortable and inconvenient. Most children with chickenpox first develop cold-like symptoms, followed by a fever and then as many as 500 itchy, fluid-filled blisters that begin on the head or chest and quickly spread to the rest of the body. Some unlucky kids may also experience vomiting or diarrhea. This can last for up to 10 days, during which time your child will be unable to attend school and will need to be cared for and watched for signs of infection. About 1 in 10 children will develop a complication such as pneumonia, secondary skin lesions, dehydration, or, in rare cases, encephalitis (swelling of the brain). A few may even die.

3. Not vaccinating your children puts other children at risk, too.


Friday, November 11, 2011

World Health Day

Just a quick post for world health day:

Flu Hits 90 Million Children Under 5 Each Year

Global tally also includes 20 million kids with flu who develop potentially deadly pneumonia

FRIDAY, Nov. 11 (HealthDay News) -- Although it can be prevented with a vaccine, roughly 90 million children worlwide who are younger than 5 get the flu each year, resulting in about 1 million hospital admissions, a new study indicates.

Published in the Nov. 11 online edition of The Lancet, the research also revealed that flu-related pneumonia claimed the lives of up to 111,500 children in 2008. According to the report, 99 percent of these deaths occurred in developing countries.
Rather depressing, isn't it?

Tuesday, November 08, 2011

Just the Vax: Angelina is Dying

An incredibly sad story that could easily have been prevented!

And another SSPE case: Angelina is dying

I had seen girl previously on a board, but the parents had not gone public until now, after Natalie's death.

Angelina caught measles in 2006 from an adult, when she was 7 months old. She recovered well - this is her before SSPE broke out:

This is her now:

Gina, Angelina's mum says (my translation):

"In February of this year, we noticed pronounced problems with our daughter. She kept falling off her bike, and had speech blockades. When this was getting worse, we went to the clinic. The diagnosis SSPE was a shock for us. Our child became dependent on care within 8 weeks. She cannot walk nor speak and needs to be tube fed. She would have entered school this year. This blow of fate is very hard for us all."

According to Sean Monks, spokesperson of the German Association of Pediatricians, this is the third case of SSPE from measles infection in infants in 2006 - in 2006 a total of 313 infants with measles were reported to the RKI (German CDC equivalent) in Berlin. One of these children died in 2007, another has been suffering from SSPE since 2009, and now Angelina is the third victim from that year.

Monday, November 07, 2011

WTF?! Pox by Mail

I have restrained from overtly using profanity on this site (unlike my personal site), but upon hearing about this, I was flabbergasted!  And I am not the only one.  Again, I am going to turn to Todd W because he said it most in alignment with how I would have said it if I had not been having surgery for removing my palm from  my face...

Pox by Post

Something came to light today that made me despair for the human race. I first read it at Mike the Mad Biologist's blog. It was also covered by Emily over at The Biology Files, where Emily took a look at just who the people were that were involved. Reuben wrote about it at The Poxes Blog and Tara discussed it at Aetiology.

What could have gotten the medical and skeptical blogosphere in such an uproar? This story.

You may have heard of pox parties. These little bits of idiocy involve parents bringing their children who have not had the chickenpox over to the house of another family whose child is currently sick with chickenpox. The intent is to purposefully infect their little darlings with a disease that can become quite serious, with hospitalization rates that could be as high as 2-3 per 1,000 cases among healthy children. The reason they do this is because they have an irrational distrust of vaccines and the mistaken belief that natural infection is actually better, because, y'know, actually getting the disease and risking all the very real complications is better than a shot that makes you immune without getting ill or suffering the much more common secondary nastiness from the wild virus.

Well, the recklessness of people like this has gone up a notch. You see, thanks to vaccines, the rate of infection with the varicella virus has declined dramatically, so that it is much more difficult today to find a child with the chickenpox. This makes pox parties a bit harder to find. These paragons of wisdom (that's sarcasm, in case you missed it) have decided to mail the virus to each other. That's right. They're sending lollipops, spit, toys and other contaminated crap to each other. What could possibly go wrong?

Well, for starters, they're breaking the law. Varicella is classified in biosafety risk group 2, meaning the those working with it must be trained in how to handle it and follow certain protocols to prevent inadvertently letting it out into the environment. In order to ship material like this, the sender must be trained in proper packaging and handling of the material, and trained carriers with a permit can transport the package. Clearly, though, the law does not matter to these twits, since in response to someone pointing out that it was a Federal offense, one woman answered:
"Tuck it inside a zip lock baggy and then put the baggy in the envelope :) Don't put anything identifying it as pox."
But it isn't just the law about which they are clueless. They have absolutely no thought to the risk involved. These items may be carrying more than just the varicella virus. Hepatitis A and B viruses, meningococcal bacteria and other baddies may also be lurking on that tempting lolli they just received. They are putting their children at significant risk of very serious injury or, yes, even death, all because they think they know better than people who have spent their lives studying biology, immunology and infectious diseases.

But it isn't just their kids that they are putting at risk. They are also jeopardizing the mail carrier who picks up the package, the postal workers sorting things to the right trucks, the drivers that transport the packages, the mail carriers at the receiving end--in short, everyone who handles it along the way. Should any of their ziplock baggies fail, so much for containing the contagion. And what about the external packaging? I'm guessing these people are not practicing the best of sterile handling techniques. They have no clue whether the people who handle their mail may be immune compromised. If they have HIV, are on immunosuppressants due to receiving a transplant or have suppressed immune systems due to age or cancer treatment, they are at very high risk of serious complications from being infected. Even worse, these nitwits aren't content to leave it at just chickenpox; there are some who are even looking to get measles, mumps or rubella samples by mail.

The sheer arrogant ignorance of these people enrages me, to the point that I'm going to do something that I try to avoid, at least on the blog. I try to keep my language clean, but these assholes have no clue what the hell they're doing and the kind of shitstorm they could potentially unleash. For anyone that thinks that this is a good idea, I have just one question for you:

[This bit redacted, now that I've had a little bit of time to cool down. Just imagine a cursing, slug-related insult here, with apologies to slugs.]

I seriously hope that the police and FBI are investigating this issue and will bring the full force of law to bear on these sad wastes of human intellect. And who do we have to thank for thinking like this? People like Jenny McCarthy, Barbara Loe Fisher and the NVIC, Generation Rescue and Age of Autism and all the other anti-vaccine activists out there who advocate for natural infection and preach fear of vaccines. Any harm that comes of this idiocy can be laid at your feet.

Saturday, November 05, 2011

Harpocrates Speaks: A Little Bit of Poison in a Sweet, Inviting Wrapper

I will avoid Delta Airlines if I can from now on.  They may be entitled to their own opinions, but not their own facts, and they get a lot of facts wrong as Todd W. outlines in this post:

A Little Bit of Poison in a Sweet, Inviting Wrapper

If you follow me on Twitter (and if you don't, why aren't you?), you have likely already heard about a PSA put out by the National Vaccine Information Center (NVIC) and Mercola.com, two slick anti-vaccine organizations. The PSA is being run on Delta Airlines flight. You can read more about it at Skepchick and Respectful Insolence. The Skepchick article includes steps you can take to combat the propaganda, including a link to a petition to get Delta to stop showing it on their flights.

The video is available on YouTube (Update: It looks like NVIC removed the video at that link, but it is still up here and here [Update: looks like it has been removed from Facebook, now, too]), but cannot be embedded. Comments have also been turned off, perhaps to avoid inconvenient critiques from science-minded individuals. On the surface, it appears to be pretty good advice, so why all the fuss?

Because the PSA includes some iffy information and, more importantly, directs people to the NVIC web site, which is rife with misinformation and distortions of fact.

Tuesday, November 01, 2011

The Vaccine Times: Herd Immunity

This is a BRILLIANT article at The Vaccine Times.  It does a great job of explaining what herd immunity is, and why it is important.  I can't just copy part of it here and call it good, this is just too important.  I urge you to go over to The Vaccine Times and support them in any way you can.

The term “herd immunity” elicits strong responses from some in the anti-vaccine camp. Perhaps some do not like the use of the word “herd” because of its association with sheep, or other such animals that do the bidding of their herders. Or perhaps, and this is my belief, it is because the very idea of herd immunity rests upon the premise that vaccines are effective at stopping disease progression, and vaccine efficacy is one of the major things anti-vaxers deny.

Many times they demand proof that herd immunity exists. In and of itself, that request is not unreasonable. After all, scientific proof is the standard by which we measure claims; so what sort of support is there for the idea of herd immunity?
What is herd immunity?
First and foremost let us quickly define what herd immunity is. Basically the idea of herd immunity says that in large groups of individuals, in regards to contagious diseases (those that spread from individual to individual), if a large enough number of individuals is immune to the disease, the chances that a chain of disease transmission will be interrupted are very high, resulting in self-contained, small outbreaks that will die out quickly. Thus, even individuals that are not immune will be protected by the wall that is set up by the vaccinated ones. The herd’s immunity shields those that have no individual immunity.

The herd immunity threshold (the number of immune individuals in a herd at which level the disease cannot persist) varies depending on how contagious the disease in question is, how efficacious the vaccine is, the exposure rates etc. For example, the herd immunity threshold for pertussis is 92-94%, whereas for diphtheria it is 85%.

Here is a nice infographic from the National Institute of Allergy and Infectious Diseases showing the concept of herd immunity at work:

Credit: NIAID
The Idea of Herd Immunity Makes Sense
Let us think of two extreme scenarios.

Scenario 1 – No One is Immune
If 100% of the population has no immunity, the disease will spread rapidly. Everyone who is exposed will get sick, and besides those individuals who are completely isolated from society, everyone will get sick.

Scenario 2 – Everyone is Immune
If 100% of the population is immune, the disease will not spread and it will die off quickly. Every person who is exposed to it will be safe and no one will get sick.

In reality, the level of immunity in a given population, a.k.a herd, will be somewhere in between 0% and 100%, and the level of disease spread will be somewhere in between “everyone will get sick” and “no one will get sick”. In other words some will get sick. The closer you are to either extreme scenario the closer the “some” will be to that extreme’s outcome. Therefore the less people are vaccinated, the more the disease will spread. Vice-versa, the more people are vaccinated the less the disease will spread.

So from a logical point of view, if you accept that vaccines are efficacious in protecting against disease, you must reach the conclusion that herd immunity must exist, to some extend.

But what kind of proof do we have that in reality such protective effects do exist whenever we vaccinate large numbers of individuals?
The Math of Herd Immunity
Now, some folks can doubt the idea of herd immunity, but I think they will not doubt math. We can infact use math to come up with a formula for herd immunity.  Here are the details:

R0 (The Basic Reproduction Number of the disease) - The average number of other individuals each infected individual will infect in a population that has no immunity to the disease. (for example, each infected individual on average will infect 13 others)

S - The proportion of the population who are susceptible to the disease, i.e. neither immune nor infected (for example, 15 % of the population)

In order for a disease not to die off, at the very least each infected individual should infect another individual. Now, R0 tells us the number of people that our infected person would infect, if everyone he came in contact with had no immunity. However in real life some of his contacts will be immune, and only S of those contacts will have no immunity. So our infected individual will come in contact with S vulnerable people, of which only R0 will get infected. Since we said that we need at least 1 new infection to keep the disease spread alive that means that:
R0 x S = 1
Anything above 1 and the disease will grow and become an epidemic; anything below 1 it will eventually die off.

Remember, what we’re trying to calculate is the herd immunity threshold. Let us denote that by HI. Keep in mind that HI denotes the percentage of the population that is immune to the disease (for example 78% or 0.78). Also keep in mind that S denoted the percentage of the population that is not immune to the disease (for example 22% or 0.22). Therefore, if we add HI and S up we get the full population, which in percentage terms is 1.
HI + S = 1
Or, alternatively:
S = 1 – HI
Substituting (1-HI) for S in our first equation you get:
R0 x ( 1 – HI ) = 1
Solving for HI in this equation give us:
HI = 1 – 1/R0
So let’s assume that for disease X, R0 = 10. In other words if everyone was not immunized, an infected person could be expected to infect another 10 people. This formula would tell us that the Herd Immunity threshold would have to be:
HI = 1 – 1/10 = 0.9   or alternatively 90%
If we assume that vaccine efficacy is 95%, this would mean that we would have to vaccinate at least 95% of the population to reach the required herd immunity threshold (because 0.95 * 0.95 = 0.90).

And there you have it, an admittedly over-simplified, bare bones, dirty calculation of the herd immunity threshold, and how it depends on the reproduction number of the given disease. In real life, scientists must take many more variables into account, things such as Average Age at which the disease is contracted, Average Life Expectancy etc, but this gives you a good idea of the general way in which those herd immunity levels are calculated. The numbers are calculated based on existing statistical information; they are not pulled out of thin air.

So far we’ve shown that the concept of Herd Immunity makes sense and can be derived mathematically. But we still need to show that it works in the real world. Do we have examples, studies showing the herd immunity at work?
The Scientific Evidence
Infant Rotavirus Vaccination May Provide Indirect Protection to Older Children and Adults in the United States, The Journal of Infectious DiseasesPublished by Oxford University Press on behalf of the Infectious Diseases Society of America 2011. DOI: 10.1093/infdis/jir492

This is a study which looked at rotavirus discharge and cause-unspecified gastroenteritis hospital data from a sample of 1,000 hospitals in 42 states in the U.S. Pre-vaccine era (2000-2006) discharge numbers were compared with the first full vaccination year (2008) data. Here are some of the key findings, but keep in mind that, as of that time, the only age group with any significant vaccine coverage was the < 1 years old. Coverage for older children was negligible, a.k.a the other age groups were unvaccinated, thus providing an excellent test sample for herd immunity.
  • Rotavirus discharges saw significant reductions. Specifically by age group:
    • 0-4 – 78% reduction
    • 5-14 – 71% reduction
    • 15-24 – 65% reduction
  • Cause-unspecified gastroenteritis discharges also saw a statistically significant reduction. Specifically by age group:
    • 0-4 – 39% reduction
    • 5-14 – 29% redictopm
    • 14-24 – 8% reduction
How do we interpret these results? This study suggests that vaccinating children aged 1 year or less against rotavirus, provides indirect protection to other age groups not only towards rotavirus itself but also towards all-cause gastroenteritis. It appears that vaccinating young children reduced disease spread in the other, non-vaccinated groups, therefore this study provides direct support to the idea of herd immunity.

Of course, since they had only one full year of vaccination data to work with (2008) it is possible that it could have been a fluke year, an unusually low rotavirus activity year to begin with, so we must be careful not to say that this study proved the protective effects of herd immunity.  As we know, one study never proves anything, and these results will need to be replicated (with respect to the rotavirus vaccine). Readers are welcome to leave links in the comments to other studies that have looked at herd immunity.
So how do we know that herd immunity exists?

First and foremost, if one accepts that vaccines are effective in stopping disease, it is an inevitable logical conclusion.  If many, many people are immune the disease will not spread too far. Those that are not vaccinated, and are surrounded by a wall of immune people, will most likely not be exposed to the virus as the spread will stop before reaching them.

Secondly, we can show mathematically how to calculate the herd immunity threshold, by taking into account well established concepts such as the basic reproduction number of the disease.

Lastly, a study was presented that showed increased protection on unvaccinated populations after introduction of the rotavirus vaccine.

To sum it up the idea of herd immunity is biologically plausible, makes sense logically, can be mathematically modeled based on uncontroversial factors and simple algebra, and is supported by scientific observations and studies.

In other words, to deny herd immunity is to deny biology, logic, common sense, math and science, all in one swoop.

Harpocrates Speaks: Just Answer the Question

Todd W. (yes, that Todd W.) runs a site called Harpocrates Speaks, and he has a brilliant entry that starts of in a manner that I myslef find a great deal of confusion on.  Hexactly how deluded are these people, and do they even realize that they are that deluded!

Just Answer the Question

There are times that I am truly amazed at just how seemingly clueless a person can be. Often, in dealing with alternative medicine or other pseudoscientific belief systems, individuals go to great lengths to avoid answering questions that are asked. The honest believers give it a good go, doing their best to support their beliefs with what they think are legitimate sources. Sometimes, reason breaks through and plants a little seed of critical thinking, and the believer realizes that they've fallen for a lie. On the other hand, the dishonest (and by that I mean the ones who outright lie or misrepresent things) go to great lengths to dodge direct questions. They build straw men, answering questions that were never asked. They deny and obfuscate facts. They work so incredibly hard to convince everyone that the naked emperor over there is actually clothed. Generally, they have some financial stake in it, and when push comes to shove, they quietly slink away, only to trot out their erroneous claims another day.

I found particularly amusing Todd W.'s summation of quakery arguments as:
  • X causes Y
  • Some people with autism have Y
  • Therefore Y causes autism
  • Buy my book

And I went with just generic X and Y arguments, because they do seem to come out of the woodwork with all sorts of crackpot ideas.