Genotypes, Serotypes and the MMR: Cognitive Dissonance in Action

Many of those who have bought into the anti-vaccine message seem to hold very tightly to their chosen belief. The more emotionally invested they are, the more likely they will go to great lengths to justify or rationalize their position. True, this is not unique to anti-vaccine activists or those closely associated with them, but it quite commonly dictates their reaction to evidence that challenges their beliefs. Evidence that contradicts their worldview, causing cognitive dissonance, leads to different mechanisms to cope with the psychological discomfort that results. The less entrenched individuals may look at the evidence, accept it as valid, and change their prior beliefs to fit with the new evidence. Some may simply ignore the evidence and pretend it doesn't even exist (e.g., "vaccine have never been studied for safety" despite numerous studies doing exactly that). But more commonly, they will invent rationalizations to explain away the contradicting.

The most recent example of this is the current outbreak of measles that started at Disneyland in California, and to a lesser extent last year's historic case count (644 cases) that hasn't been seen in the past 20 years and surpassed the number of measles cases from the previous five years combined. The Disney outbreak has resulted in 125 cases (through February 8) in just over one month (141 cases in two outbreaks as of February 13) resulting in 17 known hospitalizations. The majority (88%) of cases were either unvaccinated (45% of the total) or had unknown or undocumented vaccination status (43% of the total). The unvaccinated have been a significant contributor to the size of this outbreak and the speed with which it has spread. And the media has taken notice, with the majority of outlets putting the blame right where it belongs: on the anti-vaccine movement.

So how have anti-vaccine types responded?

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.

Brian Hooker's Paper on Increased risk of ASD in African American Boys Retracted

Just a very quick post to let my readers know a bit of recent news about that whole Hooker-MMR-CDC coverup nonsense. The journal that originally published Brian Hooker's paper originally issued a statement of concern about the conclusions and possible undeclared conflicts of interest. Yesterday, October 3, 2014, the journal fully retracted Hooker's paper. Here is their statement regarding the retraction:

The Editor and Publisher regretfully retract the article [1] as there were undeclared competing interests on the part of the author which compromised the peer review process. Furthermore, post-publication peer review raised concerns about the validity of the methods and statistical analysis, therefore the Editors no longer have confidence in the soundness of the findings. We apologise to all affected parties for the inconvenience caused.

I sent an email to the journal asking for more details. If I get a response, I will update this post accordingly.

When Vaccine Injury Isn't Vaccine Injury

A couple weeks ago, I wrote about an incident in Syria in which it was reported that a large number of children had died after receiving the measles vaccine. As I noted, the anti-vaccine community went wild, pointing to this as an example of vaccines being dangerous. This, of course, was before many details were known. I speculated that the vaccine itself was not the cause of the injuries. It was an educated guess, based on the very, very good track record of the measles vaccine. After all, the risk of a serious reaction, like a severe but non-fatal allergic reaction, has a roughly 1 in 1 million chance of occurring. The chances of one child dying after MMR were slim. The chances of dozens in that short a time frame? Next to zero.

The most likely cause was some sort of contamination. One guess floating around at the time was that the vaccines were intentionally poisoned by Syria's Bashad al-Assad as a way to subvert the rebellion. Given the situation in that country, it was not that crazy of an idea. Some suggested bacterial infection with Staphylococcus aureus. Only lab tests would confirm the presence of the bacteria. Another guess was that the vaccines were expired. If that were the case, however, the vaccine would simply have been less effective, not more likely to cause an adverse reaction. And then there were preliminary reports that there was a mixup, with the muscle relaxant Atracurium being used instead of the sterile diluent.

Now we have an interim report from the World Health Organization.

Rob Schneider, Censorship and Free Speech...and Measles

What is it with the anti-whatever mindset and claims of censorship? It seems to be a feature of these types of people, that they claim their free speech rights are being infringed upon when other criticize what they say or call for them to face reasonable consequences for their actions. I've written about this before, in the case of Jenny McCarthy, when she was being considered to join The View. Jenny McCarthy, as regular readers will know, was, for a time, the celebrity face of the anti-vaccine movement. She held rallies, gave interviews and was all around a very vocal proponent of anti-vaccination tropes. When the news came out that she was going to be on The View, many in the health and science community were concerned that she was being given a platform on which to spew her nonsense, lending her a legitimacy that she had not earned or deserved. They made their opinions known to the producers of the show. The anti-vaccine community, predictably, went into a frenzy, accusing science advocates of infringing on McCarthy's free speech rights and trying to censor her.

The latest D-list celebrity face of anti-vaccinationism is comedian Rob Schneider. He has not been shy, at all, about voicing his opinions on how bad he thinks vaccines are, whether on Twitter or in radio interviews. His public pronouncements on vaccines recently came back to bite him in the butt. And, once again, the tired old false arguments about free speech were trotted out and dusted off.

Arsenic and Old Lace Does Not Vaccine Injury Make

Arsenic and Old Lace

In 1939, playwright Joseph Kesselring wrote a play titled Arsenic and Old Lace, which was made into a film released in 1944. The basic plot of the comedy surrounds a family whose members are insane killers, including two elderly aunts who give their elderly male guests elderberry wine laced with arsenic, strychnine and cyanide, then bury the bodies in the basement. It is a classic piece of theatre and film, whose events may have been inspired by the sort of real life events discussed in Deborah Blum's book, The Poisoner's Handbook.
While the events of the play set the stage for a dark comedy, the real-life equivalents are no laughing matter. In fact, as recently as 2010, someone in Maine poisoned members of their church by lacing coffee with arsenic. Sixteen people tried the coffee, complaining of its bitter taste. Symptoms came on quickly, causing thirteen of the coffee drinkers to seek medical attention, with eight of them requiring hospitalization. One person died from acute arsenic poisoning. The perpetrator committed suicide five days after the event. It's an example of the deliberate contamination of something normally benign to inflict serious injury and death. No reasonable person would look at this incident and claim that coffee is harmful and should be avoided.

Anti-vaccine activists, on the other hand, aren't exactly reasonable people.

MMR, the CDC and Brian Hooker: A Guide for Parents and the Media

The anti-vaccine community has been in a tizzy lately over a supposed "CDC whistleblower", Dr. William W. Thompson, who, according to them, revealed fraud at the United States Centers for Disease Control and Prevention (CDC). To bolster their claim, they point to a new study from one of their own, Brian S. Hooker, that purports to show evidence of an increased risk of autism among African American boys who receive their first MMR vaccine late. However, the claims appear to be hollow and unfounded, and so they have chosen to rely on emotional arguments that may sound convincing to those who are not familiar with the issues and people involved. In a truly egregious fashion, they have erroneously and cynically compared this whole thing to the Tuskegee syphilis study, and equated the CDC with Adolf Hitler, Josef Stalin and Pol Pot, combined.

With that in mind, here is a brief FAQ for parents, news media and others to help them understand what the claims are and what the evidence actually says. The questions below have been raised or implied by anti-vaccine activists. Hopefully, this will prevent inaccurate reporting and help parents feel reassured about the MMR vaccine.

Andrew Wakefield Tortures History

I've written before about how the anti-vaccine movement regularly gets the science wrong (see, for example, here and here). Most often, it involves how they interpret (or, rather, misinterpret) studies that they think support their view that vaccines are the root of all evil, causing all manner of disorders. They regularly misrepresent and torture the scientific literature to fit their agenda. But occasionally, it involves actually attempting to do science themselves, the latest of which being a study [Edited to Add: this study has been fully retracted by the journal.] recently published by Vaccine Injury Compensation Program petitioner, Brian Hooker, PhD and funded by the anti-vaccine group Focus Autism. This study has been examined by an epidemiologist, another epidemiologist, and a cancer researcher. The players have also been examined by a dyslexia consultant and autism advocate (see also here). This study, in addition to being of questionable validity, has spawned quite the brouhaha among anti-vaccine activists. In short, Hooker took a dataset that was analyzed by a group of CDC investigators. Their finding was that age at first vaccination with MMR did not appear to [edited to clarify and correct] affect the risk of be associated with autism [ETA: cases (those with autism) were no more or less likely to have been vaccinated with MMR than controls before 18, 24 and 36 months; the study design could not establish causation, only correlation]. The results of their study were published as a case-control study. Hooker used the same dataset to create a cohort study and found that there was no increased risk of autism in any of the groups (i.e., MMR does not cause autism) except one: African American males, for which he puportedly found a 3.36-fold increased risk of autism when they were vaccinated between 24 and 31 months. Read the two posts by those epidemiologists for why his analysis is suspect.

I'm not going to go into the science behind the studies, because it relies very heavily on statistics, and I'm not a statistician or epidemiologist. As an aside, neither is Dr. Hooker. Instead, I want to focus on some statements made by one Andrew Wakefield, the British doctor who committed scientific fraud, resulting in the full retraction of his 1998 case series study on MMR and the stripping of his medical license. Wakefield boldly added himself to the list of not only torturing science, but now adds to his accomplishments torturing history and ethics (granted, we already knew he was ethically challenged). You see, in his videos (here and here) about the alleged "whistleblower", William Thompson,Wakefield compared the purported "cover-up" to the Tuskegee syphilis debacle. It's a false comparison used simply to inflame people and claim the race card.

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.

Is It More Effective to Delay MMR Vaccination?

Recently, I asked the question is it safer to delay MMR vaccination?  Many of those who are opposed to the current schedule of vaccinations or have heard anti-vaccine claims and fear that vaccines somehow overwhelm an infant's immune system may put off getting their children immunized until well after the age recommended by the CDC and AAP. This decision not only leaves a child at risk of infection for a longer period, but, as I discussed in that post, new research on the MMR vaccine indicates that there is an increased risk of seizures and fever associated with delaying that vaccine. So delaying might not necessarily be safer, at least in terms of adverse reactions to the MMR vaccine. The authors of the recent paper speculated that one probable cause of this increased risk is due to a more robust immune reaction the older a child is when they receive their first dose of measles-containing vaccine.

Another recent study, Measles in Children Vaccinated With 2 Doses of MMR, by F. Defay, G. De Serres, D. M. Skowronski, N. Boulianne, M. Ouakki, M. Landry, N. Brousseau, and B. J. Ward and published online on October 21, 2013 in Pediatrics, asked a related question: does delaying the first dose of measles vaccine improve efficacy? Well, really, the question they asked was, "does age of first MMR vaccination affect vaccine efficacy in children who received 2 doses", but my paraphrase is close enough.

Is It Safer to Delay MMR Vaccination?

Most people follow the recommended schedule of childhood immunizations. They understand the importance of immunization, not only for their own children, but for their communities as well. Certainly, parents put varying degrees of thought into their decision. Some simply go along with whatever their pediatrician recommends, while others thoroughly research the vaccines their child will receive before accepting the science-based recommendations behind the current vaccination schedule. Whatever level of scrutiny they give to the issue, the majority immunize their children fully and on-schedule, barring valid medical reasons to the contrary.

Then there's the minority, the parents who either delay vaccines, spreading them out over a much greater timeframe than recommended by the Centers for Disease Control and Prevention and the American Academy of Pediatrics, the parents who only allow some vaccines, and those who eschew vaccines altogether. Some are strongly committed to the ideology that vaccines cause all manner of maladies, often becoming quite vocal about it. Their views stem from misunderstanding of the science, confusing correlation with causation, and distrust of large corporations and the government. Some parents have simply been misled by those anti-vaccine activists. The arguments resonate on an emotional level, despite being void of scientific validity. And finally there are those who delay or skip vaccines because they lack access or the resources to keep up. They cannot afford insurance to cover the vaccines. They may not be able to take the time off from work to take their children to the doctor's office. In short, through failures of the health care system, rather than any fear or distrust of vaccines, their children are under- or unimmunized.

Whatever the reasons, the decision to delay or avoid vaccinations carries certain risks. Most readily apparent is the increased risk of infection, contributing to outbreaks in regions of low vaccination. We need only look, for example, at recent measles outbreaks (Minnesota, New South Wales, Australia, Massachusetts, Indiana, North Carolina and New York, Pakistan and Wales, Texas) to see how lack of immunization increases the risks of infection and spread of disease. Not so obvious is that delaying some vaccines increases the risk of not being fully immunized.

And now there's another risk to add to the list, at least as regards measles vaccines.

Follow-up on Journalist Matthew Mientka

Last week, I wrote a post in response to an article by a journalist named Matthew Mientka. His article was an illustration of sloppy, lazy journalism (though I suppose to be charitable, he may also have been overworked by Medical Daily's editors, though that just speaks even worse for the online paper). Mientka's post was so riddle with errors that could have been avoided with just a modicum of basic research. As I ended my post, I said that if he did the right thing and retracted his article, I would write a follow-up post.

Well, his article is no longer up (note I have an update at the end of my post with a link to the cached version). He does, however, have a new article up that includes a little of the original, but goes beyond that to discuss autism, MMR and thimerosal in a more expansive manner. The version that is currently up, however, is not the original.

Matthew Mientka, MMR, Autism and Lazy Journalism

I try to be a patient person. In general, I give people the benefit of the doubt, assume that they are well-intentioned. And for the most part, I think people do try to do what is right. But every now and then, I find that my trust is misplaced. It isn't necessarily that they are malicious. No, they may just be lazy, failing to do due diligence when really they ought to do at least some measure of basic research.

Such was the case recently. I came across an article by Matthew Mientka in Medical Dailty titled Vaccines And Autism: Evidence Shows ‘Strong Link’ Between Autism And MMR Vaccine. When the post originally went up, the title was a bit different: Vaccines And Autism: New Evidence Shows 'Strong Link' Between Autism And MMR Vaccine. Notice the very slight difference? The word "new" was dropped after I called the author on some errors in his article.

Just a Plane Ride Away

He boarded the plane, heading from India back to his home in North Carolina. Around his late twenties or early thirties, he settled in for the long, trans-oceanic flight toward the end of March. He wasn't traveling alone; he had company with him, though he didn't know it at the time. In fact, he was carrying stowaways he'd picked up during his visit, and now they were replicating inside him. It was a long flight. He relaxed and waited while his fellow passengers worked feverishly.

The plane touched down. He collected his bags and started off to his home in Stokes County. Perhaps he was tired from the flight. A few days passed, and his head grew warm to the touch. Runny nose, a bit of a cough. If it weren't for the fever, it could have just been allergies. Probably just a cold picked up on the plane or during his trip. Nothing to worry about.

Also around the end of March, another individual, a Hasidic Jew from New York is flying home from London. He or she lives in a highly religious, insular community in Borough Park, Brooklyn. Just as with the visitor to India, a hitchhiker accompanied them on the flight home. And just as with the fellow further south, several days after returning home, the signs of a cold begin.

Measles Running Rampant in Pakistan and Wales

Whenever I hear someone say that vaccine-preventable diseases are harmless or that they are just a right of passage for children, I can't help but shake my head a bit. Part of the reason behind this mindset is a lack of experience with these diseases. Many young parents have never seen them in action. The most they know is their own childhood experiences with them; they clearly survived and, with death being thankfully uncommon, probably don't know or remember anyone who died of one of these illnesses, especially if anyone contracted a disease at a young age. And then there's the rarity of the diseases thanks to the success of vaccinations. I have to admit that before I developed an interest in vaccines and the manufactroversy surrounding them, I probably would have held a similarly flippant opinion of childhood diseases.

But I learned more about them. I read about their typical presentation, what some of the more serious complications are and how commonly they occur, and how long a person is contagious (often starting before any symptoms appear). I learned that while one needn't panic and run for the hills when there's an outbreak, a healthy respect for the seriousness of vaccine preventable diseases doesn't go amiss. Above all, I've learned that they are worth preventing, if not for one's own health, then for the health of those around them. While I might be healthy and think I might fare well if infected, the same may not be true for others I infect.

To this end, vaccinations are one of the best public health measures in modern medicine. When people avoid or reject them in sufficient numbers, we invariably see outbreaks of disease sooner or later. Outbreaks like the current measles outbreaks in Pakistan and Wales.

Rob Schneider's Hellish Nonsense

Thursday night, I mentioned that Rob Schneider was going to be on Salt Lake City's KXRK morning radio show Radio From Hell to promote his stand-up show Friday night at Wiseguys West Valley City. I joined Skepchick's Elyse Anders in urging people to contact the station if they had a call-in segment during the interview. Orac also put the word out about this appearance.

Well, I was fortunate enough to find time to listen to the show Friday morning via their internet live stream. As noted by Elyse, Schneider had been on the show before, shamelessly spouting a bunch of tired, well-worn anti-vaccine lies and myths. This morning, he was a bit late showing up at the studio, which I don't blame him for; it was early, he mentioned he only had about 3 hours sleep, and we don't know what his travel and traffic situation was.  The hosts, led by Bill Allred, pondered whether they should just rerun the clip (mp3 hosted at Skepchick) from the last time he was on.

At any rate, he finally showed up to sit down for a chat...

More Than Just Infectious Excitement at Super Bowl 46

This past weekend saw a huge annual event here in the United States: the Super Bowl. Two football (that's American football, not the rest of the world's football, aka soccer) teams face off to do battle to determine who will come out on top, and like Highlander, there can be only one. This event draws thousands of people from all over the country, and probably even some from around the world. It is, quite simply, an epic event. They even had a whole "village" erected in the middle of Indianapolis, this year's host to the game. The village provided over a week of activities, both indoors and out, for tourists and fans.

Where's rubeola? (Image by Mike Fender/The Indy Star)

But it wasn't just football fans that paid a visit. Something else had some fun in the village on Friday, February 3, two days before the big game.

Report on MN Measles Outbreak from IDSA

Several weeks ago, from October 20-23, Boston, MA played host to the 49th Annual Meeting of the Infectious Disease Society of America (IDSA). This conference gives physicians, scientists and other health care professionals an opportunity to continue learning about the pathophysiology, diagnosis, treatment and prevention of infectious diseases, as well as to connect with colleagues from around the country. The conference presents speaker sessions, poster presentations, exhibits and networking opportunities.

One of the poster presentations at IDSA covered the measles outbreak in Minnesota earlier this year. Presented by several members of the Minnesota Department of Health (lead author, Pamela Gahr, MPH, Cynthia Kenyon, MPH, David Boxrud, MS, Karen White, MPH and Ruth Lynfield, MD) and Hennepin County Human Services and Public Health (Erica Bagstad, MS, MPH), the poster offered a closer look into how and why measles was able to spread, as well as insight into some of the difficulties involved in investigating and controlling the outbreak.

Third Case Identified in Latest Measles Outbreak in Minnesota

A brief post to provide an update on the latest measles outbreak in Minnesota. On August 26, 2011, the Minnesota Department of Health announced that a third case has been identified. The latest is a 43-year-old woman who was exposed to the index case in a health care setting. She had unknown vaccination status and was identified through follow-up of people who had been exposed to the two initial cases.

As of this writing, the 12-month-old child, who had contracted the illness while in Kenya, is still in critical condition, but the second case, the 15-month-old, has been released from the hospital. Neither of the children had been vaccinated against measles.
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Related Posts:
New Measles Cases in Minnesota
Minnesota Measles Outbreak - A Recap
Acute Thrombocytopenic Purpura, the MMR and Natural Infection
"Soft" Hospitalizations in Minnesota Measles Outbreak?
Minnesota Measles Outbreak by the Numbers: A Timeline
Measles Outbreak in New South Wales, Australia
Climbing Numbers in Minnesota Measles Outbreak
More Cases of Measles in Minnesota, 3 of 4 Hospitalized
Minnesota Infant Contracts Measles - Why Immunization Is Important
Measles Outbreak in Boston