As hard as it is to believe, it’s been nearly two years since the infamous Disneyland measles outbreak, which occurred after the holidays in 2014. It was an outbreak whose spread was facilitated by unvaccinated children and that had far-reaching implications. For one thing, in its wake, California passed SB 277, a law eliminating nonmedical exemptions to school vaccine mandates. Opposition to the bill was fierce, and opposition to the law remains fierce, among motley coalition of antivaccine nuts, the vaccine averse, and conservative-leaning anti-government types, with rhetoric routinely invoking Nazis and the Holocaust, as though the law were the first step on the road to the gas chambers and ovens; that is, when it isn’t claiming that vaccines are a plot by white pharmaceutical companies to make African-American boys autistic. Indeed, it was the unholy union of SB 277 and the “CDC whistleblower” conspiracy theory that brought together antivaccine “hero” Andrew Wakefield with Polly Tommey and Del Bigtree to make the antivaccine “documentary” VAXXED: From Cover-Up to Catastrophe, spawning the VAXXED Bus, with Bigtree and Tommey (and sometimes Wakefield) traveling the country to spread the gospel of St. Andy, cast doubt on the safety and efficacy of vaccines, and in general spread antivaccine conspiracy theories to the masses. They were even recently right here in my very city and state. At time, the rhetoric has even gotten violent.
One of the arguments frequently made by antivaccine activists is what I like to call the “appeal to The Brady Bunch” or, sarcastically, “argumentum ad bradi bunchium.” The basic fallacy is simple and named after a 1969 episode of The Brady Bunch in which all the kids caught the measles and enjoyed a week off from school without appearing too sick and the whole thing was played for laughs and a “battle of the sexes” in which the boys want a male doctor and the girls want a female doctor,. Antivaccinationists claim that vaccine-preventable diseases are harmless childhood diseases that really don’t need to be vaccinated against, that they are no big deal, and point to that episode of The Brady Bunch or other old pre-MMR sitcom episodes in which the measles was played for laughs. Indeed, our old friend Dr. Jay Gordon has made just that argument, as has Dr. Bob Sears. Coupled with that, they like to claim that vaccines cause autism, ADHD, and all manner of auto-immune diseases ranging from asthma to much more severe conditions. They even falsely claim that vaccines cause sudden infant death syndrome. As I’ve described many times before, though, vaccines do not cause autism or any of these things, nor is measles a “harmless disease.” Last weekend, we got more evidence supporting both of these contentions. The evidence came in the form of scientific presentations at IDWeek, the annual joint meeting of four professional infectious disease medical societies. Now, I realize that these are currently just abstracts, and, since I didn’t attend IDWeek (not being an infectious disease doctor), I can’t go much beyond what’s in the abstracts and news reports. That’s why I will eagerly look forward to the full publication of these results. In the meantime, I make do with what I can.
First up, there were several news stories like this one by Lena Sun in The Washington Post entitled New data shows a deadly measles complication is more common than thought:
A complication of measles that kills children years after they have been infected is more common than previously thought, according to disturbing data released Friday.
The research, presented at IDWeek, the annual meeting of four professional infectious disease organizations, underscores the critical importance of vaccination for everyone who is eligible. Such widespread vaccination, which results in herd immunity, protects children who can’t be immunized. Particularly vulnerable are babies younger than 12 months, who because of their age cannot get the vaccine known as MMR, for measles, mumps and rubella.
The complication is a neurological disorder that can lie dormant for years and then is 100 percent fatal. Researchers don’t know what causes the virus to reactivate, and there is no cure once it does. The only way to prevent the disorder is by vaccinating everyone possible against measles.
Those of you who pay attention to these issues will likely immediately recognize that the neurological complication being discussed is subacute sclerosing panencephalitis (SSPE). According to the study:
The first MMR dose is administered at 12 to 15 months of age. Babies younger than that can be infected with measles and later develop this complication, which is called subacute sclerosing panencephalitis, or SSPE.
Scientists once thought the risk of developing SSPE was about 1 in 100,000. Recent research in Germany among children who got measles before they turned 5 identified a rate as low as 1 in 1,700. But the new findings, by researchers at the David Geffen School of Medicine at the University of California in Los Angeles and the California public health agency, found that for babies who get measles before being vaccinated, the rate is 1 in 609.
Until quite recently, it was thought that the risk of SSPE after measles is 1-2 per 10,000 cases. So how did the study authors derive their new, much higher estimate? Well, here’s the abstract, Subacute Sclerosing Panencephalitis: the Devastating Measles Complication is More Common than We Think:
Background: Subacute sclerosing panencephalitis (SSPE) is a fatal complication of measles. Thought to be rare, SSPE incidence decreased with routine measles vaccination, but infants with measles remain at highest risk of this complication. We reviewed SSPE cases in California from 1998-2016 to understand current risk factors for SPPE.
Methods: SSPE cases had a clinically compatible illness and either 1) measles IgG antibody detection in the cerebrospinal fluid; 2) characteristic pattern on electroencephalography; 3) typical histologic findings in brain biopsy; or 4) medical record documentation of SSPE-related complications. Cases were identified though a state death certificate search, reports from the Centers for Disease Control and Prevention, or through investigations for undiagnosed neurologic disease. Measles IgG detection was performed using indirect enzyme immunoassay at the California Department of Public Health (CDPH) or by immunofluorescence assay at clinical laboratories.
Results: Seventeen SSPE cases were identified. Males outnumbered females 2.4:1. Twelve (71%) cases had a clinical history of a febrile rash illness compatible with measles; all 12 had illness prior to 15 months of age and measles vaccination. Eight (67%) children were living in the United States when they had measles. SSPE was diagnosed at a median age of 12 years (range 3-35 years), with a latency period of 9.5 years (range 2.5-34 years). Many cases had long-standing cognitive or motor problems prior to diagnosis. Among measles cases reported to CDPH during 1988-1991, incidence of SSPE was 1:1367 for children less than 5 years, and 1:609 for children less than 12 months at time of measles disease.
Conclusion: SSPE cases in California occurred at much higher rate than previously published among unvaccinated children who were infected with measles in infancy. Protection of infants younger than 12-15 months of age, when measles vaccine is routinely administered, requires avoidance of travel to endemic areas, or early vaccination prior to travel. Clinicians should be aware of the possibility of SSPE in patients with compatible symptoms, even in older patients with no specific history of measles infection. SSPE demonstrates the high human cost of “natural” measles immunity.
I always say, whether it’s about screening asymptomatic patients for disease or almost anything else, the harder you look for something, the more of it you will find, and this study is yet another example. Case ascertainment for a disaease like SSPE can be difficult, and cases likely slip through the cracks or aren’t aggregated in a central database. This is how it can be pointed out in the news story above that there was a German study reporting a risk of SSPE of 1 in 1,1700, and now this study with an even higher risk. Be that as it may, these are frightening data, showing a risk of SSPE considerably higher than previously thought, particularly in children under 12 months of age. Since the first MMR dose is usually not administered before that, these are the patients who rely on herd immunity, which is degraded and rendered ineffective whenever a certain percentage of the population is unvaccinated. Because measles is so contagious, it’s generally thought that vaccination coverage of 90-95% to attain herd immunity for measles.
Remember, SSPE has a long latency period. In this study, it was 9.5 years after measles infection and could be as long as 34 years. That makes measles the horrible gift that can keep on giving, even after the child has grown up. Antivaccinationists like to claim that measles is “harmless,” a childhood disease that we all endured before the vaccine, but we know better, and this study shows why we know better.
There was another surprising finding not reported in the abstract but reported at IDWeek:
An additional suprising finding is that Asians are disproportionately affected by SSPE, Cherry said. He is not sure why but suspects the disorder could behave like some other diseases, such as influenza, which seem to hit Asians harder and cause higher mortality than other ethnic groups.
So let’s recap. Measles is not harmless, and Asians appear to be at higher risk for its deadliest complication, SSPE.
That’s not all, though. Not only is measles not harmless, but, contrary to what you will read on antivaccine websites, we already know that vaccines do not cause autism, thanks to numerous studies. This study is yet another one showing that vaccines are not associated with SIDS or ADHD, either:
Annual infant mortality rates from SIDS were obtained from the National Vital Statistics Reports for 2007–2013. ADHD prevalence at the state-level were obtained from the National Survey of Children’s Health for 2003, 2007, and 2011. The analyses were adjusted to control for variation due to sociodemographic factors.
The data showed mean incidence for SIDS was 39.9 per 100,000 live births and 8.9 per 100 children for ADHD. The rates for SIDS declined over time from 55.6 to 38.7 per 100,000 live births (P=0.4), whereas ADHD diagnoses increased from 7.8% to 11.0% (P=0.3). Mean coverage for each of the 5 vaccines significantly differed, from 47.7% to 95.1% (P<0.01).
Dr. Shaw stated, “State-level vaccination coverage was not found to be associated with SIDS or ADHD rates for each of the vaccines evaluated (P>0.22).”
Overall, the study showed that neither SIDS nor ADHD rates were influenced by vaccination coverage.
Science, people. It is your friend. It is also the friend of vaccines. It is not, however the friend of antivaccinationists. Not only that, but, as I’ve described before, the measles vaccine protects against more than the measles, because the price of “natural immunity” is a two to three year period of immunosuppression with an increased risk of death.
As I said before, I’ll look forward to the publication of the full versions of both of these studies, but in the meantime, here’s some more ammunition to counter antivaccine pseudoscience. Don’t say I never gave you anything.