"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 Their non-profit status was revoked last year and they have been sanctioned by the Australian Health Care Complaints Commission.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.

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.

Vaccinated vs. Unvaccinated Part 4 - The Legal Perspective

This is the final installment of the vaccinated vs. unvaccinated series. If you haven't read the other articles, in part 1 I discussed the general shape of prospective, randomized, placebo-controlled study to answer the question of whether or not vaccines play a causative role in autism. In part 2, I provided an overview of the history of ethics in medical research, particularly discussing three key documents: the Nuremberg Code, the Declaration of Helsinki and the Belmont Report. And in part 3, I examined whether or not the study would be ethical. In this post, I will look at whether the study could legally be conducted. Before continuing, please go read the first three parts. The full series can be found here.

The primary reference I'll use for this post is 45 CFR 46, the set of regulations that governs research involving human subjects. In particular, I will refer to subparts B and D (sections 46.201-46.207 and 46.401-46.409), which provides for special protections for research involving newborns and children.

In part 3, I established that our study would be greater than minimal risk. While that does not preclude conducting it, it does mean that certain additional legal requirements must be satisfied before the study can be approved and move forward. I also showed that regardless of legalities, the study would be unethical. Only by some strange, alternate sense of ethics could one argue that it would be okay to go ahead with the study. But, supposing that we live in bizzaro world and the ethics are not a hindrance, could our study be conducted legally? Let's take a look.

Vaccinated vs. Unvaccinated Part 3 - Ethical Evaluation

In part 1 of this series, I went over the general description of a prospective randomized, placebo-controlled clinical trial (RCT) to study vaccinated vs. unvaccinated children. In part 2, I reviewed some of the history of medical research ethics, including three foundational documents that have helped to shape the current human research landscape: the Nuremberg Code, the Declaration of Helsinki and the Belmont Report. If you have not yet read those posts, I strongly encourage you to do so now. They should provide a decent basis for understanding part 3. The full series of posts can be found here.

Just to recap certain aspects of the design of a prospective vaccinated vs. unvaccinated RCT to determine whether or not vaccines cause or contribute to autism, we would need to follow the subjects from birth through at least 4 or 5 years of age. In order for the results to be clear and show a definite cause, several thousand children would need to be enrolled in both the group receiving vaccines and the group not receiving any vaccines (who would get a saline shot instead, to keep it blinded). Subjects in the vaccinated group would need to be matched to the placebo group as closely as possible on a range of factors, such as parental age, ethnicity, birth order/# siblings and so on - in short, any factors which may play a confounding role in the analysis and outcomes of the study.

In the remainder of this post, I will apply the ethical considerations and regulations introduced in part 2 to some of the specifics of the type of study discussed in part 1. Since I am most familiar with U.S. regulations, when discussing legalities, I will be referring in large part to 45 CFR 46, the set of regulations that govern research involving human subjects. This is probably going to be pretty long, so bear with me.

Vaccinated vs. Unvaccinated Part 2 - A History of Medical Research Ethics

In my last post, I provided a basic overview of what a vaccinated vs. unvaccinated study would look like. The general form would be a prospective, double-blind, randomized, placebo-controlled trial. The big question that I asked in my previous post was what is stopping someone from conducting a trial like this in children, and my short answer was ethics.

Within the context of scientific research involving humans, ethical protections of subjects is a relatively recent thing. For most of human history, the systematic investigation of some question involving humans has taken the attitude that the answer being sought was of the utmost importance. The well-being of the people being experimented upon was secondary, if it was thought of at all. Compounding matters was the dehumanizing view that certain populations were viewed in the same way that we tend to view animals: chattel to be exploited. Criminals, the mentally incompetent, even women and children in some cases, were viewed as a means to an end.

So, what changed?

Vaccinated vs. Unvaccinated Part 1 - An RCT Overview

This article is something I've been thinking about writing for quite a while, now. In discussions about vaccines, the question of whether they relate to autism (they don't) and research, the idea of a study looking at vaccinated vs. unvaccinated children often comes up. Typically, the call for such research comes from those who are opposed to vaccines or who are scared or uncertain about vaccines, either completely or just in terms of how they are currently administered. Certainly, such a study would pretty definitively answer the question once and for all. Granted, there would still be some die-hards who, if the study were to show that vaccines do not cause autism, would come up with some excuse. They may say that the study was flawed in some unspecified manner. Perhaps they would assert some conflict of interest that may or may not be real. And I've already heard some state, before such a study has even been done, that the vaccines that the parents received are to blame. That last one could potentially go on and on ("well, it must be the vaccines the grandparents/great-grandparents/etc. received!").

At any rate, there are two basic ways to go about such a study. First, there is a retrospective epidemiological study. This kind of study would look at populations that already received or did not receive vaccines, taking the form of case-control studies or cohort studies. There likely would be no randomization. There would be no placebo control. Individuals would probably be matched by age and a host of other factors. There are a lot of potential variables, though, that could confound the results. As I'm not an epidemiologist, I won't get into the difficulties involved in this sort of study. René Najera over at The Epi Times has a series of posts [Unfortunately, an anti-vaccine activist's actions forced René to take his site down] on epidemiology that may help inform readers of the considerations involved in this kind of research. Prometheus also wrote about vaxed vs. unvaxed over at Photon in the Darkness [Sadly, Prometheus took down his site for financial reasons.] back in 2008, touching on the logistical nightmare of finding enough subjects to enroll.

The second approach would be to conduct a prospective, double-blind, randomized, placebo-controlled trial.

Of Earth and Water, Past and Present

When I was a kid, I used to dig trenches along the edge of my parents' garden, grab the hose, and run water down my little channel. Boats of leaves or grass would get swept along, sometimes slowly, peacefully, sometimes quickly and chaotic. Now and then, I would erect dams, using sticks or dirt. If they held, the water quickly overflowed the banks of my little river. Other times, the water would slow for a moment, build up some energy, then brush aside my small attempts to contain it.

This morning, watching the news, I saw an image that reminded me of my innocent childhood activity. Except this time, rather than filling me with a sense of whimsy, I felt fear and sadness. As I watched, water from a tsunami swept over coastal areas of Japan, sweeping cars and houses away like my little grass boats, larger structures like my dams.

A Brief Look at Homeopathy for the Children

A while back, I wrote about the recall of Hyland's Homeopathic Teething Tablets. The U.S. Food and Drug Administration issued the recall because their labs, during routine testing of the product, found "inconsistent amounts of belladonna," a plant more commonly known as "deadly nightshade" and which, apropos to its common name, is rather poisonous, though it does have some medicinal uses. The FDA had also received reports of adverse events that fit with belladonna toxicity in children who had taken the tablets. Now, keep in mind that, because Hyland's Homeopathic Teething Tablets are homeopathic and sold over the counter, they were not required to go through the typical clinical trial process for safety and effectiveness.

Thinking back on this recall, I began to wonder, what other homeopathic products are out there for children? I decided to start with a look at Hyland's other products to see what they offered for use in kids.

Deaths in Japan

I thought I'd hit this topic in an attempt to stem wild speculation and fear-mongering. In Japan, four children died after receiving vaccines made by Pfizer and Sanofi Pasteur. Authorities there have temporarily suspended use of Pfizer's Prevenar and Sanofi's ActHIB while they investigate the deaths. At present, there is not enough information to determine whether the vaccines played a causal role or were coincidental. Let me say that again, we do not know if the vaccines caused these deaths or, like an innocent person suspected of a crime, were simply in the wrong place at the wrong time.

Now some background info, as far as we have it.

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.

Measles Outbreak in Boston

As some of you may have heard, there is a small measles outbreak in Boston. So far, five two cases have been confirmed and three more are suspected. The first case was a 20-something intern at the French Consulate in Boston. She most likely contracted the disease while traveling abroad. According to the Boston Globe, she had not been vaccinated. The second confirmed case was another 20-something woman who lives in the same building as the index case, and a third case ate at the same restaurant as the first case.

New Name: Harpocrates Speaks

Over the past year, my topics have drifted away from focusing solely on comments that have been censored by the moderators over at Age of Autism blog. While I still think that people should have a place to copy their comments, to have their voices heard, I want to broaden the scope of this blog. With that in mind, I have decided to rename Silenced by Age of Autism.

After asking for suggestions and racking my own brain for ideas, I stumbled onto something that I think is quite appropriate: Harpocrates Speaks.