It's Past Time to Pay the Piper

In the story The Pied Piper of Hamelin, the German town of Hamelin suffers from an infestation of rats. When things are looking bleak, along comes a piper dressed in bright colored clothes. He claims that he can rid the town of the rats. The mayor makes a deal, promising to pay a handsome sum of money if the piper should accomplish this feat. At once, the piper sets to the task, playing his magic flute. The rats begin streaming out of the houses and shops, following the piper to the nearby Weser River, where all of the rodents drown. Having held up his end of the deal, the piper goes to collect his due, but the mayor shirks his responsibility. He reneges on the deal and refuses to pay the piper the agreed upon sum. Angry, the piper leaves, vowing to have his revenge. He returns later and once more plays his magic flute. This time, all of the children of the village flood the streets to follow the piper out of the village, never to return.

The story inspired a lovely phrase, "pay the piper", to describe those situations where one must accept the unpleasant or undesired consequences of one's actions. It's a phrase that is particularly appropriate when talking about the anti-vaccine movement, their enablers and the current, and distressing, measles outbreak originating at Disneyland. For years and years, anti-vaccine activists and the handful of physicians who eschew their professional obligations in order to pander to them have downplayed the risks of vaccine-preventable diseases like measles, exaggerated the risks of the vaccines, and done their damnedest to bring down vaccination rates across the country. The natural consequence of this is that we are seeing the return of diseases that we eliminated from endemic circulation.

Dr. Jay Gordon and "Irrelevant" Vaccines

This past weekend I was at the Northeast Conference on Science and Skepticism (NECSS). This was their sixth year, and the fourth that I've attended. I was going to work on my review of the conference last night, but something popped up that I just had to address. So, the NECSS 2014 review will have to wait a little longer.

I realize that I just wrote about Dr. Jay Gordon back on April 1 when he mistakenly tried to say that the incidence of measles in the latest outbreak in California could be calculated by dividing the cases by the total population of the state rather than by the susceptible population. But I made the mistake of checking Twitter to see if Dr. Jay Gordon had responded to a couple questions/comments I directed to him, as well as to see if anyone else said anything. I've noticed that he's taken to pretty much ignoring me when I point out his mistakes or clarify something he's said, so I wasn't surprised that he hadn't responded to me. What caught my attention, though, was a brief video shared by someone else.

Dr. Jay's Magical Math

You would expect pediatricians, especially Fellows of the American Association of Pediatrics, to know at least a little bit about epidemiology and to give others a proper, fact-based picture of what vaccine-preventable diseases can do. At the very least, you would not expect them to get things so spectacularly wrong that you wonder how they ever managed to get their license, let alone their degree. Yet that is exactly what one pediatrician does on a fairly regular basis. In fact, the things I'm about to describe I actually wrote about three years ago. I'm speaking of Jay Gordon, MD, FAAP, and in the time since that 2011 post, he doesn't seem to have learned anything. You'll see what I mean in a bit.

For those who don't know, Dr. Gordon is a California pediatrician who regularly downplays the risks of disease and advocates alternative vaccination schedules, as well as skipping vaccines altogether as "unnecessary". He is a darling of the anti-vaccine movement, since he supports their views that vaccines may be, somehow, dangerous. In fact, he is (or was) the pediatrician for Jenny McCarthy's son. Jenny, as you may or may not known, made quite a name for herself as the celebrity spokesperson for the anti-vaccine group Generation Rescue. Yet Dr. Gordon also appears to desperately crave the acceptance of his science-based peers.

A Bowl of Measles? Super!

Last November, there was a flurry of blogging and news about a rather strange approach to children's health: mailing chicken pox-contaminated lollipops with the aim of infecting one's child. All the problems of violating laws regarding the sending of infectious materials by mail aside, there are numerous other reasons that giving someone else's used lollipop to your kid in order to get them sick. The most obvious is that if the virus actually survives, an infection with the varicella zoster virus is not without risks. A successful infection promises the likely recurrence of the virus later in life in the form of shingles. These are all much higher risks than from the vaccine. The other big concern with posted pox pops is that you don't know what other viruses or bacteria may be present. Food-borne viruses, like Hepatitis A, might just be waiting for an unsuspecting victim.

As foolish as mailing chicken pox-laced items by post is, what really surprised me was that people were actually looking for measles as well! Chicken pox is generally mild, and the serious complications tend to be a bit rarer, but measles can be quite dangerous. I imagine that if a cereal like Rubeoleos, tasty Os sprinkled with rubeola virus, actually existed, these parents who have been so frightened away from vaccines and led to believe that childhood diseases are benign by organizations like NVIC or Age of Autism would be gobbling it up, so to speak. While a hearing trumpet (or hearing aid) could be included in the box, parents would probably have to collect box tops for the medical attention their children may require should they suffer more serious complications. Yet in spite of the dangers of the disease, an underestimation of the virus' risks and ability to spread quickly would not stop them from serving up a big bowl to their dear little darlings. A super bowl, perhaps.

Which brings us to Indiana.

Minnesota Measles Outbreak - A Recap

UPDATE: On June 8, 2011, the Minnesota Department of Health declared that the measles outbreak in Hennepin County is considered over. The outbreak involved 20 individuals who were all connected to a child who was infected in Kenya. In addition there were two unrelated cases reported this year.

I just thought that I would provide a brief update on the measles outbreak in Minnesota. According to the Minnesota Department of Health, as of this writing, the last update was on April 27, 2011. Here's what they report:

Situation Update (4/27/11)
There have been 23 confirmed cases of measles reported in Minnesota, ranging in age from 4 months to 51 years old.

Infection acquired:

• Twenty of the cases have been linked to a case that acquired infection in Kenya (21 total)
• One case acquired infection in Florida
• One case acquired infection in India

Vaccination status:

• Seven of the cases were too young to receive vaccine
• Nine were of age but were not vaccinated
• One was vaccinated
• One was vaccinated prior to the recommended age
• Five have unknown vaccine status

There have been fourteen hospitalizations and no deaths.

Acute Thrombocytopenic Purpura, the MMR and Natural Infection

Twitter's a great tool for rapidly disseminating information. With a large network of followers, a simple message can spread like wildfire. This can be great for getting important facts out to a wide audience, like instilling a bit of rationality around the fear-infused media exaggerations of the events at the Fukushima Daiichi nuclear plant in Japan.

Of course, like all decent tools, there can be a bad side to Twitter, as well. Just as rational facts can be spread quickly, so, too, can misinformation. Given the character limits on tweets, a lot of the nuance and complexities of a given subject are often left out, resulting in messages that, on the surface, may instill readers with a sense of unease or outright anger. The careless may inadvertently scare people about a certain topic, while the nefarious use the limitations of Twitter to their advantage, purposefully spreading partial-truths or even outright lies to promote their agendas.

Such was a tweet I saw just the other day.

"Soft" Hospitalizations in Minnesota Measles Outbreak?

UPDATE: On June 8, 2011, the Minnesota Department of Health declared that the measles outbreak in Hennepin County is considered over. The outbreak involved 20 individuals who were all connected to a child who was infected in Kenya. In addition there were two unrelated cases reported this year.

The other day, Orac, at Respectful Insolence, wrote about Dr. Jay Gordon's absurd and insensitive Tweet making light of the measles outbreak in Minnesota. Gordon joked about an episode of The Brady Bunch in which measles was the punchline:

In the comments, Jay made several statements that are, well, just plain wrong. For example, he said that we would never be able to eradicate measles. Since measles only exists in humans, if enough individuals are immunized, the virus will not be able to find a susceptible host in which to replicate, and eventually, the last viruses will be wiped out, much like the eradication of smallpox in 1979 or, more recently, the 2010 eradication of rinderpest, a disease that plagued cattle.

There was one other thing that Dr. Gordon mentioned that piqued my curiosity.

Minnesota Measles Outbreak by the Numbers: A Timeline

UPDATE: On June 8, 2011, the Minnesota Department of Health declared that the measles outbreak in Hennepin County is considered over. The outbreak involved 20 individuals who were all connected to a child who was infected in Kenya. In addition there were two unrelated cases reported this year.

I thought it might be useful to have a timeline of the measles outbreak in Minnesota. I will update this as the Minnesota Department of Health releases more information.

April 27, 2011:

• 23 confirmed cases
• 7 too young to have been vaccinated
• 9 old enough to be vaccinated but were not
• 1 vaccinated
• 1 vaccinated before recommended age
• 5 unknown vaccination status
• 14 hospitalizations

Measles Outbreak in New South Wales, Australia

Australia generally has a much better situation, regarding popular views of vaccination, than the U.S. Over there, the primary anti-vaccine group, the Australian Vaccination Network, is openly called an anti-vaccine organization by the mainstream media. Their non-profit status was revoked last year and they have been sanctioned by the Australian Health Care Complaints Commission. Furthermore, they have been caught breaching copyright law on several counts. There are no major celebrities endorsing antivaccine nonsense.

With all of that going for Oz, you'd think things would be fine. Not so.

More Cases of Measles in Minnesota, 3 of 4 Hospitalized

UPDATE: On Wednesday, 3/23/11, a 10th case of measles has been confirmed in Minnesota. Like 4 of the other cases, the latest was in a child old enough to be vaccinated but had not been. The current tally is: 4 too young to be vaccinated, 5 old enough but unvaccinated and 1 of unknown vaccination status. Half of the cases have been hospitalized and there are, as yet, no deaths from this outbreak.

UPDATE: On Tuesday, 3/22/11, the Minnesota Department of Health announced that the measles outbreak now includes 9 cases. 4 in children too young to have received the vaccine, 4 in children old enough, but who had not been vaccinated and 1 whose vaccination status is unknown. To date, 5 of the 9 have been hospitalized, but are recovering.

UPDATE: On Monday, 3/21/11, a seventh case of measles, in a 7-month-old, was confirmed. That brings the tally to 3 too young to be vaccinated, 3 old enough but unvaccinated due to fear and 1 with unknown vaccination status.

UPDATE: According to the Star Tribune today, March 18, 2011, the total number of cases is up to six. Three are Somali children. Two of the six were too young to be vaccinated. Four of the six have been hospitalized.

Last Friday, one week ago, I wrote about a Minnesota infant contracting measles. That child, too young to be immunized, was hospitalized. In that post, I also called out Dr. Jay Gordon who, on his own web site, states that he does not give or recommend the MMR vaccine. Well, in the past week, three more cases of measles have been reported in Minnesota. Two of the three new cases, like the initial case, were also hospitalized.

And now it looks like I'm going to have to call out Age of Autism's J.B. Handley and disgraced gastroenterologist Andrew Wakefield, because two of the latest cases are in the Somali community. Two children who, although old enough to be vaccinated, were not because of the fears that Handley and Wakefield fueled in their parents. Two children in a community with declining vaccination rates, thanks to the callous and flat-out wrong nonsense spouted by Handley and his ilk.

Four kids, one too young to be vaccinated, two unvaccinated because of fear of the vaccine and one of unknown vaccination status. Four children, three hospitalized.

Some people, like the aforementioned Dr. Gordon, would suggest that four cases is nothing to worry about, that it is not an outbreak:

The problem here is that we shouldn't be seeing any cases of measles in the U.S. We have an extremely effective (95% or higher) and safe product to prevent measles. Not only that, but measles only infects humans, which means that if enough people worldwide are vaccinated, then, like with smallpox, we would no longer need to use the vaccine.

However, until measles is eradicated worldwide, then, as I've said before, a new infection is just a plane ride away. People like J.B. Handley, Wakefield and the goons at Age of Autism and pediatricians who should know better and do a grave disservice to their patients, like Dr. Gordon, must stop. Through their actions, they promote outbreaks like the ones in Boston and Minnesota. Although currently small, these cases could almost certainly have been prevented through vaccination, either of the children themselves or, in the case of the infant too young to be vaccinated, of those around the kids. Behavior such as suggesting the erroneous notion that vaccines cause autism or actively choosing to tell people that the risks of vaccines outweigh the benefits, despite mountains of scientific evidence to the contrary, is not only reckless and irresponsible, it is abhorrent and despicable.

Vaccinate your children. Protect them, their friends, their families and everyone around them. Do what is right.

Update: Just to put this in perspective, in the past 5 years, there have been six cases of measles. In the past week, there have been 4 6 cases. Let me repeat that: in the past 5 years, only 6 cases; in the past week, 4 6 cases. Got that, Dr. Jay "4 cases is an outbreak?" Gordon?

Update 3/21/11: If there was any doubt that Dr. Gordon displays an amazing level of callousness, he had this to say about the Minnesota measles outbreak and how an outbreak is defined:

Yep, taking "a few extra cases" seriously is "pointless." Stay classy, Dr. Gordon. I'm sure the families of those 6 kids think that it's pointless to take the outbreak seriously.

Minnesota Infant Contracts Measles - Why Immunization Is Important

The other day, I wrote about a measles outbreak in Boston. Public health officials are still investigating the cases, with two confirmed and three suspected, including a professor who had come in contact with 45 students. I was taking a look for updates to the story to see if any more cases had been confirmed or if others have turned up. What I turned up was another case of measles, though it is most likely unrelated to the Boston outbreak.