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

The importance of relative risk in understanding vaccine effectiveness

A while back I noticed that Greg Beattie was deceiving his readers about pertussis vaccine efficacy by misrepresenting NNDSS data.

Yes, the same Beattie with the bogus claim that vaccines did not reduce infectious diseases. He dresses this up with misleading graphs comparing mortality from vaccine preventable disease to the introduction of X vaccine. These graphs are also bogus in that he omits the impact of vaccine introduction. The stunning success of the vaccine itself and the elimination of infection is always absent from his peculiar artwork.

Beattie’s claim back in 2012 was that the pertussis vaccine failed because high numbers of notifications had been vaccinated against pertussis. This is thunderously misleading in that it’s at the same level as dismissing seat belt safety because most fatalities on our roads involve seat belt wearing occupants. He also avoided explaining all reasons as to why notifications were high. Increased awareness, testing and follow up, pockets of low vaccination driving an epidemic, low booster uptake.

You can check the post here to follow my review of the same data table Beattie used. But it’s pretty simple. By 2011 close to 95% of 0-4 year olds were fully vaccinated by age 2 [NCIRS]. Using the table provided it turns out those not fully vaccinated made up 27.2% of notified infections. Fully vaccinated notifications equal 56.7%.

Relatively speaking a child fully vaccinated against pertussis has a notably reduced chance of being infected. Conversely, the small number who are not fully vaccinated have a frightfully high chance of being infected. To be sure, if 56.7% of notifications collected over 2008 – 2011 are from fully vaccinated children one can argue the vaccine could (and needs to be) more effective. But when the 5% who are not fully vaccinated make up 27.2% of infections, then the claim the vaccine is not effective is patently absurd. A dangerous and irresponsible lie.

Basically this is a story of relative risk being falsely presented as absolute risk. Choose some data and omit other data and the claim looks sound. But the post itself is limited in examining Vaccine Effectiveness vs Relative Risk (Risk Ratio – see screenshot). Understanding related and relative data sets is crucial in grasping how vaccine efficacy can be misrepresented. Regrettably many falsehoods peddled by the anti-vaccine lobby stem from such misrepresentation.

Fortunately an excellent piece addressing this was recently published on The LymphoSite by kill3rtcell. Headed But most of the people who got the disease were vaccinated for it! the post comprehensively addresses vaccine effectiveness, risk ratios and even provides interactive calculators. These crunch values of vaccine effectiveness, vaccination rates and resultant cases in the unvaccinated or vaccinated.

Do head over and read what is an excellent contribution to the deconstruction of misinformation peddled by antivaccinationists.

The screenshot below helps explain what this post accomplishes.

relative risk

© kill3rtcell – The LymphoSite

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Parrot Pareidolia?

You may swear this parrot was a female model.

And indeed be right.

Or if you would swear this female model was a parrot…

Pareidolia parrot

Then enjoy the brilliant work of Italian body painting artist, Johannes Stoetter.

Video at YouTube here.

False Balance: Where dissidence does not belong

Due weight.

Two simple, but arguably very important words in that they can be found in the Editorial Guidelines of the British Broadcasting Corporation. Journalistic guidelines regularly refer to due impartiality, and rightly so. Consumers subject to the bias of reporters are in for something like the pure fancy that comes from End Time Radio, Natural News or (where “freedom of choice is not free”) Vaccination News.

Under Impartiality – Breadth and Diversity of Opinion, the BBC Guidelines include:

4.4.1

Across our output as a whole, we must be inclusive, reflecting a breadth and diversity of opinion.  We must be fair and open-minded when examining the evidence and weighing material facts.  We must give due weight to the many and diverse areas of an argument.

Under Impartiality – News, Current Affairs and Factual Output:

4.4.12

News in whatever form must be treated with due impartiality, giving due weight to events, opinion and main strands of argument.  The approach and tone of news stories must always reflect our editorial values, including our commitment to impartiality.

The reason I’m focusing on the BBC is because of a direct link to false balance. Australia’s ABC have no parallel and our Australian Broadcasting Standards don’t contain specific attenuation of minority views getting a free ride on the coat tails of the prevailing or scientific consensus. That’s not to say either set of standards is not a useful device in underscoring or complaining about the mess of false balance. It’s just that the BBC have shall we say… history.

Presenting Wonders of the Solar System in 2010, Professor Brian Cox was explaining the impact Jupiter’s gravity has on Earth. He delightfully included in his narration, “Despite the fact astrology is a load of rubbish…”. Dedicated followers of woo complained. One stressed Cox didn’t allow the “alternative opinion”. And before you smirk dear reader, it is that astrologers use “observation and knowledge built over thousands of years”. Oooh yeah. They haz Appeal to Antiquity.

Cox provided a statement to the BBC, which they decided not to publish.

I apologise to the astrology community for not making myself clear. I should have said that this new age drivel is undermining the very fabric of our civilisation.

This example of how complete nonsense is put forward as equal, or even superior, to schools of thought and theories that are in fact completely settled opens the December 2011 BMJ Editorial by Trevor Jackson, When balance is bias. [Dropbox] [BMJ 2011;343:d8006 doi:10.1136/bmj.d800].

The BBC asked Prof. Steve Jones, emeritus professor of human genetics at University College London, to review the BBC’s impartiality and accuracy of their coverage of science. As one might guess from scanning Australian and British journalistic codes with their liberal peppering of “impartiality”, it was the impact of “due impartiality” that worried Jones. He found the guidelines:

… had a distorting effect, creating a sense of equivalence where there was none, and privileging maverick and dissident views so that they appeared as valid as established scientific fact.

Jones found in areas of science that journalists risked giving the impression there were two equal sides to a story when there were certainly not. By insisting to bring “dissident voices” into settled debates within science, the BBC was guilty of giving an unbalanced view to these same areas.

Jackson’s editorial notes the disastrous effect Andrew Wakefield’s fraudulent paper had on the uptake of MMR is in part due to media impartiality. The BMJ reported in 2003 on a study that indicated the media effectively misled the public.

The BBC reported in part:

Most people wrongly believed that doctors and scientists are equally divided over the safety of the measles, mumps, and rubella (MMR) vaccine, according to new research carried out during the high profile public debate over the vaccine last year.

At the height of the media coverage the impression was created that medical scientists were split down the middle over the vaccine’s safety, including reports of links with autism, say the study’s authors, from Cardiff University.

The report found that 53% of those surveyed at the height of the media coverage assumed that because both sides of the debate received equal coverage, there must be equal evidence for each.

It said only 23% were aware that the bulk of evidence favoured supporters of the vaccine. The authors said their survey would revive the debate about media coverage of MMR and how journalists deal with “minority voices” within science.

The belief that scientists were divided over the safety of MMR was a direct result of journalists seeking balance and led to what we now know as false balance. Face palmingly, head deskingly, infuriatingly, unacceptably in the case of vaccines, it is still underway today. Even worse journalists are dusting off long settled topics and where they should be stressing deception, suggest “debate”. In the video below an individual who is effectively a public health menace was appallingly labelled as an “expert”.

Even if these terms are not utilised in the straight out fashion Channel 7’s Weekend Sunrise recently did, everything is in place for the public to be misled into thinking actual scientific dissent exists over the safety and benefit of vaccination. Indeed today, the moral bankruptcy that accompanies antivaccinationists exceeds those who were taken in by Wakefield. The science is clear. There is no debate to be had. This places the antivaccinationist in a very unique position. A position of denial and deception buttressed by repeated claims of corporate conspiracies and so-called natural alternatives.

This latter rubbish is fed to the public because the natural enemy of the anti-vaccine commentator is scientific consensus. Given an opportunity to deceive the public the antivaccinationist can now introduce a host of irrelevant and false claims which in the context of an interview will create doubt in the minds of the public. In the video below Weekend Sunrise have an unqualified, science illiterate, conspiracy theorist effectively presenting nonsense in response to advice from the Director of Australia’s National Centre for Immunisation Research and Surveillance.

Thanks to Channel 7 and @sunriseon7 members of the public may well have been misled. Farmer’s wife Meryl Dorey wants to “extend the hand of friendship” to the NCIRS and conduct a study into vaccinated vs unvaccinated. Yes that meaningless, shrivelled old cherry again. Quite simply it leaves a scam artist looking as though they have skill when they don’t and offering one side of a balanced debate, when in fact that debate simply doesn’t exist. There is certainly no need for an impossible study, but the public cannot know this.

The previous point is one scientists need to keep in mind when asked to appear alongside unqualified saboteurs of public health. There’s nothing that can be said in a few minutes that can assuage the damage done by elevating a skilled prevaricator to your own level in the eyes of the public.

Trevor Jackson concludes in his BMJ editorial:

Meanwhile, some science journalism will continue to be weighed in the balance and found wanting.

Until the notion of due weight becomes just as, if not more, important than impartiality in journalism and science reporting, we need to ask ourselves if those without any weight or those advancing scam debates deserve to be heard at all. Clearly, and helped along by the precedents outlined here by reasonablehank, the answer is no.

Channel 7 have previously presented a scientist “debating” a proven anti-vaccine zealot. True, these enemies of reason are challenged by journalists as to the flaws in their beliefs. Yet that is not the issue. The more often members of the anti-science lobby are given a pedestal from which to preach, the larger will be the percentage of the community that believes a genuine topic of scientific dissent exists. As with climate science, fluoride in drinking water, evolution, conventional medicine and more. In the case of vaccination there simply is no debate.

Vaccination saves lives.

Peter McIntyre and Meryl Dorey on Weekend Sunrise

http://www.youtube.com/watch?v=6-E4OChkXw4

Medical Observer Interview: Dr. Ken Harvey

Former editor of the Medical Journal of Australia and GP Dr Annette Katelaris interviews Dr. Ken Harvey.

Dr. Harvey originally graduated from the University of Melbourne. Initially specialising in infectious disease and medical microbiology Ken’s interest in antibiotic resistance led to a study of the forces that drive prescription. Ken moved to the School of Public Health at La Trobe University to continue his work on medicinal drug policy.

He now holds the position of Adjunct Associate Professor in the School of Public Health at La Trobe.

INTERVIEW – CAMs regulation and pharmaceutical industry influence – Assoc Prof Ken Harvey – Obserations

Noted public health advocate Associate Professor Ken Harvey on what’s lacking in regulating complementary medicines, and the influence of the pharmaceutical industry on ‘the hand that writes the script’.

Ken talks about his extensive role in prodding Australia’s regulator of complementary medicines and shortfalls in the present system for regulating these “listed” therapeutic products. He is also asked about the personal impact of holding shonky products, advertising and ultimately – dishonest, unforgiving individuals – to account. Ken’s interest in information technology makes him a welcome source of advice to overhaul the TGA’s Electronic Listing Facility.

For a self confessed “stubborn bastard” in chasing blatant advertising breaches, it’s clear that Australian consumers are in Ken’s debt. Ken holds life membership of the Australian Consumers Association, Choice, and is also a member of their Policy Advisory Group. Dr. Harvey is Chair of Health Action International, Asia Pacific (HAIAP). He was a member of the WHO expert group that drafted their Ethical Criteria for Medicinal Drug Promotion. [22 page PDF]

mp3_mic
INTERVIEW AUDIO

Or direct download MP3 here. 21 min 13 sec. 21.4 MB
Listen or download file at chirbit.
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Interview Source – © Medical Observer, Sound Cloud. Published August 26th, 2013.

 

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