Stand Up for Parents' Rights to Accurate Information on Vaccines

A few years ago, California's legislature took steps to ensure that parents who wished to opt out of getting their children immunized for school or day care understood what their decision meant. Assembly bill AB 2109 required that before a philosophical exemption could be granted, parents had to get a health care provider to sign the exemption form, indicating that the parent received information on the risks and benefits of vaccination. In order for parents to make an informed choice, they ought to have good, science-based information on which to base that choice. SB 2109 seemed like a bill that should have had unequivocal support from the anti-vaccine, sorry, "pro-vaccine-choice" movement. Instead, they vehemently opposed it, led by the National Vaccine Information Center (NVIC). Despite NVIC's lobbying, AB 2109 passed.

The latest unprecedented outbreak of measles, starting in California and up to 132 cases in that state as of March 6, has led several state legislatures to consider bills that would tighten up school vaccine exemptions and improving parent education regarding immunizations. Naturally, this led to claims that government was trying to remove choice and personal belief. Some of those complaints are against bills aimed at removing non-medical exemptions. And some oppose bills similar to AB 2109, like Minnesota's SF380/HF393.

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.

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

New Measles Cases in Minnesota

The Minnesota Department of Health reported on August 19, 2011 that there are two new cases of measles in that state. The index case is a 12-month-old infant who was infected while on a trip to Kenya. The second case is a 15-month-old child who acquired the measles virus after exposure to the first infant. Neither child, both residents of Dakota County, had been vaccinated against the disease. Both children have been hospitalized. The Shakopee Valley News and the Columbus, IN paper The Republic, as well as news station KARE11, report that the 12-month-old child is in critical condition. These cases are not connected with the measles outbreak in Hennepin County earlier this year, which resulted in 21 cases, almost all unvaccinated, with 14 hospitalizations.

Although both children were unvaccinated, it should be noted that they are right around the age when the first dose of MMR is recommended, according to the CDC schedule (PDF). Sources do not report any reason for the infants being unimmunized; it may be that the parents simply had not scheduled the appointment yet. It is also possible that the parents had avoided the MMR due to misinformation promulgated over the past several years in Minnesota by anti-vaccine activists which has negatively impacted herd immunity.

I will try to keep an eye on this situation, in case any further cases arise.

UPDATE: The 12-month old who has been hospitalized since August 10 appears to finally be recovering. Measles left Mahi Abdallah susceptible to a secondary pneumonia infection that very nearly killed him. He has been cared for in the pediatric ICU at Children's Hospital in Minneapolis. His mother, Nuria Koto, had planned to have him vaccinated against measles, but he was only 9 months old when the family left to visit Kenya. She thought he was too young to receive the MMR (typically recommended to first be given at 12 months) and was unaware of travel recommendations that allow for administration of the vaccine as young as 6 months old. I urge those considering whether or not to delay vaccinating against MMR to read his story. No parent should have to go through this, and my heart goes out to Nuria, Mahi and the rest of their family.
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Related Posts:
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

Disease Burdens More Than Just the Patient

Often, when we talk about infectious diseases and outbreaks, the focus tends to be on those who got sick: the symptoms they experienced, how likely they might have been to infect others and so forth. We may talk about whether or not they were vaccinated, what complications they may have suffered and the costs that they bore through lost work/school days or how much treatment cost. Only occasionally do people think about the effects of an infection or outbreak on the government. After all, infections only have a direct impact on the person who has the disease and maybe those around them, right? How could a disease have any significant impact on a government. They're big, faceless things that just kind of exist in the background, except when there's a problem or it's election season.

The fact of the matter is, outbreaks of infectious disease actually have quite an impact on governments, particularly local ones. As just one example, I recently received the following from an anonymous reader:

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.

"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

Climbing Numbers in Minnesota Measles Outbreak

Note: For further updates on the numbers, follow the post Minnesota Measles Outbreak by the Numbers: A Timeline.

Update: As of the morning of April, 2011, the total cases are up to 15. See the link above for the total numbers. According to the Minnesota Department of Health, 12 of the cases are linked to the index case of the infant who acquired the measles infection in Kenya. One case was infected in Florida, and one person was infected in India.

Update: As of the morning of March 30, 2011, there have been 14 confirmed cases of measles in Minnesota. The latest case is a 51-year-old of unknown vaccination status. For those keeping track, there have been, to date, 5 infants too young to be vaccinated, 6 children old enough to be vaccinated but who were not and 3 people (two adults) with unknown vaccination history. Of the 14 confirmed cases, 8 have been hospitalized.

Update: On the afternoon of March 29, 2011, the outbreak has reached 13 confirmed cases, and 2 more have been hospitalized. The newest case was too young to be vaccinated. The totals are now: 5 too young to be vaccinated, 6 of age for the vaccine but not vaccinated and 2 of unknown vaccination status. A total of 8 have been hospitalized.

Update: As of March 28, 2011, there are 12 confirmed cases of measles in Minnesota. Four children were too young to be vaccinated, 6 were old enough but were not vaccinated and two have unknown vaccination status. There have been 6 hospitalizations so far.

Update: On March 25, 2011, the MDH stated that the total number of hospitalizations in the outbreak has risen from 5 to 6. Thankfully, there are still no deaths.

Update: As of this afternoon, MDH has reported an 11th case of measles in a 35-year-old. The latest case has unknown vaccination status.

This morning, the Minnesota Department of Health (MDH) updated their information page on the current measles outbreak. Since February, there have been ten confirmed cases of measles in the Minneapolis area. According the the MDH, the outbreak most likely began when an infant returned from a trip to Kenya. The infant, too young to be vaccinated, had contracted the infection. Since then, it has spread to nine others. The ages of the children range from 4 months to 4 years.

I decided to look at the history of measles cases in Minnesota. Thankfully, the MDH has a handy table and links to the details of past outbreaks.

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.

Autism in Certain Minnesota Populations

Minnesota, the land of 10,000 lakes (quite a misnomer, as there are significantly more than 10K lakes), the land of sky-blue waters. Many people have the idea that Minnesota is a frozen wasteland, where people wear parkas year round and say "Ya, sure" a lot. The movie Fargo went rather far in perpetuating these myths. Well, I guess I can't argue with the "Ya, sure" bit, but the weather in Minnesota can be downright brutally hot in the summer. Overall, though, the seasons are pleasant and bearable if you know how to dress for them. It has a thriving music and theatre scene, as well.

The people are generally nice, too. But there is something about the population that most out-of-staters (and possibly even some Minnesotans) might not know. Minnesota is home to a rather significant Somali community.