Measles Vaccination: make an informed choice

Recently in Melbourne Australia, the wanderings of a baby infected with measles prompted Victoria’s Chief Health Officer Dr Rosemary Lester to name certain venues and alert the public. The 11 month old had, while infectious, visited four major shopping complexes, two restaurants, a cafe, a children’s play centre, a church and a chemist. Dr. Lester stressed those who attended these venues should ensure they pay extra attention to symptoms such as;

…common cold symptoms such as fever, sore throat, red eyes and a cough. The characteristic measles rash usually begins 2-5 days after the first symptoms, she said, generally starting on the face and then spreading to the rest of the body.

A bit of a rash, sore throat and temperature then. I’ve heard groups who insist vaccines don’t work or aren’t needed pass measles off as nothing to worry about. Yet the article also included this from Dr. Lester;

“Anyone developing these symptoms is advised to ring ahead to their GP or hospital and alert them that they have fever and a rash,” Dr Lester said. “If you know you have been in contact with a measles case please alert your GP or hospital emergency department. The GP or hospital will then be able to provide treatment in a way that minimises transmission.”

Hmmm. Maybe hospitals in Victoria are running drills this month. Practising for something serious with this little rashy-coughy thing. After all a Slovakian micro-palaeontologist had described it as a simple “right of passage”. And if anyone would know about infectious disease in Australia it is a Slovakian micro-palaeontologist, not a mere Chief Health Officer of a state holding around six million people. But then the piece by the paper’s Health Editor went on to state measles is highly infectious. It is particularly dangerous for young children and young adults.

Those most at risk of getting the disease are people who have not been vaccinated, particularly adults between 33 and 47 years because many in this age group did not receive measles vaccine, and people whose immune systems have been compromised because of cancer treatment, for example.

Perhaps, as they say, this is not a drill. I remember reading material from those against vaccination. They spend a lot of time and caps lock justifying why vaccines are dangerous, or useless, or part of a conspiracy. The claim that vaccines are useless is backed by graphs which plot disease induced mortality against time and contend X vaccine was introduced well after mortality reached zero. Clean water, nutrition and better living standards stopped these infectious diseases they insist, not vaccines. So I decided to check the measles graphs drawn up by renowned antivaccinationist Greg Beattie.

Beattie_measles1Greg Beattie’s “Figure 1” from Fooling Ourselves

The above graph is from Beattie’s Fooling Ourselves. The Australian Vaccination-sceptics Network is littered with this and many others from Beattie. Material published by the AV-sN has been independently examined and discredited in the preparation of a public statement and warning by the NSW Health Care Complaints Commission. It appears then, Beattie’s graphs have been examined and discredited in an official capacity. There is no mistake as to why the HCCC warned the public to exercise caution in viewing “misleading” material. It is important to focus on Beattie’s intent here. Namely that vaccines had no impact or an irrelevant impact on the control of infectious disease. In part this post challenges the intent of Beattie’s graphs by presenting independent data that show vaccines most certainly had a powerful effect in controlling the spread of vaccine preventable disease. Thus Beattie’s cunning use of mortality rate above, is met with absolute and predicted numbers. Greg Beattie cites the Australian Bureau of Statistics, Commonwealth Year Books and “data published by the Commonwealth” in Cumpston’s 1927 The History of Diptheria, Scarlet Fever, Measles and Whooping Cough in Australia. One notes the first problem is his reliance on mortality and not morbidity. Death as a consequence of a vaccine preventable disease is a limited indicator of how effective vaccination has been in reducing infection. Overall morbidity (infection) offers a more realistic picture. Indeed the anti-vaccine lobby are today only too quick to point to the number of pertussis notifications in those vaccinated, when launching attacks on the efficacy of the vaccine or the need to be vacccinated. They concomitantly avoid noting pertussis mortality in Australia hits the unvaccinated. The vaccinated cop a less dangerous, and to date, non-lethal infection. [Update] Children not vaccinated against pertussis are 24 times more likely to be infected with the wild strain, than those who are vaccinated. Below is another graph from Communicable Diseases Intelligence. I’ve boxed in measles in red and used coloured horizontal lines to link mortality to years pre and post introduction of the measles vaccine. It’s clear that the greatest gap – or in fact drop – in mortality follows the introduction of measles immunisation. Thereafter reductions are smaller and more evenly spaced. Diptheria tetanus polio measles highlight Could there be more important facts left out by Beattie? Clearly his graph is designed to visually convince the reader that the measles vaccine was introduced when measles was all but eradicated. Thus Beattie contends vaccination had no impact on its control. So what of Beattie? Do we afford him the benefit of the doubt? You be the judge. Immediately after the graph he writes in Fooling Ourselves.

The graph for measles (Figure 1) shows us that the five-yearly death rate, 100 years before the vaccine was introduced, was around 170. One hundred years later, and immediately prior to introducing the vaccine, it was less than one. That’s a reduction of 99.5%—before the vaccine arrived. The remainder of less than 1% is therefore the only portion of the decline to which the vaccine can possibly lay claim, because it simply was not around for the first 99.5%. […]
Let’s check that again: One hundred years later, and immediately prior to introducing the vaccine, it (the five year mortality rate from measles) was less than one. Looking at the CDI graph above, and countless others that can be wheeled out from developed nations around the world he is simply misinforming his readers. Less than one for five years? Whilst the CDI graph plots 150 from 1966 – 1975. An excellent way to further debunk Beattie’s “vaccines-didn’t-save-us” mess is through statistical estimation of the deaths that would have occurred without immunisation. Cost effectiveness and the money saved through improved health is vital. Love it or loathe it the cost of running a vaccine-conspiracy would be monumental. The savings to be made in controlling infectious disease are also wonderfully impressive and much time and energy goes into ensuring we invest in what pays for itself. The figure loving, graph scribing, number crunching chaps at Applied Economics are deft hands at such dark arts. In a semantic flick of the bird to antivaccinationists they write;

The trend in measles deaths since 1940 reveals a secular decline. This reflects a reduction in case fatality associated with a general improvement in health status as well as the introduction of antibiotics in the late 1940s (Russell, 1988). By fitting a trend to measles deaths for the period 1940–69 and extrapolating it from 1970 onwards, we can estimate the deaths that would have occurred without immunisation. A trend can also be fitted to actual deaths that occurred with immunisation. The difference between these two trend curves is our estimate of the lives saved because of immunisation.

I’ll leave you dear reader to pop over and peer at their graphs revealing the “lives saved because of immunisation”. They also sacrifice many pure white A4 sheets doing the same with Hib vaccination. Nonetheless here is (the businesses end of) the table born of such mysterious chanting and ritual. Pre immunisation years from 1940 are available. The point here is to further debunk the antivaccinationist claim that vaccines did nothing. By analysing pre and post immunisation mortality and morbidity trends, a strong estimate of lives saved and disease prevented can be clearly demonstrated.

 Estimated deaths due to, and notifications of, measles tabulated as with or without immunisation

Consequently estimated lives saved and estimated cases averted based solely on measles immunisation can be calculated as the difference

Deaths Notification
 Year Without Immunisation With immunisation Estimated lives saved Without immunisation With immunisation Estimated cases averted
1970 16 10 6 110,693 77,000 33,693
1971 15 10 5 112,391 67,459 44,932
1972 14 10 4 114,061 59,100 54,961
1973 13 10 3 115,706 51,777 63,929
1974 13 9 4 117,325 45,362 71,964
1975 12 9 3 118,921 39,741 79,180
1976 11 9 2 120,494 34,817 85,677
1977 11 8 3 122,044 30,503 91,542
1978 10 8 2 123,574 26,723 96,851
1979 10 7 3 125,083 23,412 101,671
1980 9 7 2 126,573 20,511 106,062
1981 9 7 2 128,044 17,969 110,075
1982 8 6 2 129,497 15,743 113,754
1983 8 6 2 130,932 13,792 117,140
1984 8 6 2 132,351 12,083 120,268
1985 7 5 2 133,753 10,586 123,167
1986 7 5 2 135,139 9,274 125,865
1987 6 4 2 136,511 8,125 128,385
1988 6 4 2 137,867 7,118 130,749
1989 6 4 2 139,209 6,236 132,973
1990 6 4 2 140,537 5,464 135,074
1991 5 3 2 141,852 4,787 137,065
1992 5 3 2 143,153 4,194 138,960
1993 5 2 3 144,442 3,674 140,768
1994 5 2 3 145,719 3,219 142,500
1995 4 2 2 146,983 2,820 144,163
1996 4 1 3 148,236 2,470 145,765
1997 4 1 3 149,477 2,164 147,313
1998 4 0 4 150,707 1,896 148,811
1999 3 0 3 151,927 1,661 150,266
2000 3 0 3 153,136 1,455 151,680
2001 3 0 3 154,335 1,275 153,059
2002 3 0 3 155,523 1,117 154,406
2003 3 0 3 156,702 979 155,723

 © Applied Economics

These are impressive figures. Lives are saved and disease is averted due to the MMR vaccination. Conversely with no vaccine induced protection from measles lives are lost, disease is spread and disability and suffering ensues. There can be few better examples as to the efficacy of mass immunisation, or indeed, the danger of the anti-vaccine lobby.

Consulting reputable publications we can see that measles is indeed a potentially very serious disease. Health authorities have never denied that vaccination carries a negligible risk. The anti-vaccine lobby is apt to demand vaccines be both 100% effective and 100% safe. As a public we are rather poor at assessing risk-benefit and thus many fall prey to the anti-vaccine slogans and lies.

Encephalitis is a one in a million plus risk as a consequence of measles vaccination. As a consequence of measles it is a one in a thousand risk. In short those who argue “natural immunity” is best subject their children to the risk of brain damage or death at a rate 1,000 times greater than had they chosen MMR. For every ten who contract encephalitis one will die and four will be permanently brain damaged. Around one third of those infected will develop complications that will likely require hospitalisation.

Depending on age, one child dies for every 2,500 – 5,000 cases of measles.

MMR vs infection

© The Encephalitis Society – Access full document here

Recently the vaccine-autism zombie had some life breathed into it. Fortunately it turns out that just as Wakefield perpetrated his original – and ongoing – fraud for money, the author of the latest scam is a member of a group erroneously believing vaccines cause autism and will stop at nothing to mislead the public to this same misconception. The “paper” was withdrawn in one month. A statement has been published by Dr. William Thompson who was deceived into becomming a “whistleblower”.

He was recorded against his will and it appears the anti-vaccine author Brian Hooker had worked for months to get the pro-vaccine Thompson on record as sounding like a whistleblower.

And so it continues. This is indeed not a drill. We do have reasonably healthy rates of vaccination but the return of measles, varicella and other vaccine preventable diseases means there is no room for complacency.

Make an informed decision. Vaccination saves lives.

The history of measles

Australian Immunisation Handbook – 2013

MMR

Measles Fact Sheet – WA Health

NCIRS – events in MMR vaccination practice

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