Tag: Australia

The Timeline of the Measles Epidemic in Samoa

The timeline of the measles epidemic in Samoa seems fairly easy to understand.

Vaccination rates went down, the people in Samoa got caught up in the rise in measles cases and outbreaks happening all over the world, and they soon had a measles epidemic on their hands, with lots of kids dying.

In an outbreak situation, everyone who is not immune would need to get two doses of a measles containing vaccine and that's why you need 215,000 doses of measles vaccine... And despite what Sherri Tenpenny might think, everyone on Samoa is still not vaccinated yet.
In an outbreak situation, everyone who is not immune would need to get two doses of a measles containing vaccine and that’s why you need 215,000 doses of measles vaccine… And despite what Sherri Tenpenny might think, everyone on Samoa is still not vaccinated yet.

Unfortunately, anti-vaccine folks continue to exploit the tragedy, trying to make it sound like vaccines actually caused the epidemic.

“The Samoa Measles Appeal is being launched by the Government of Samoa to receive financial assistance from partners to support national efforts to contain the outbreak, to effectively treat people who contracted measles, and to achieve herd immunity for long term protection of the population.”

National Measles Response and Recovery Appeal

They are even making up conspiracy theories about the money the Government of Samoa is requesting to help control the epidemic and prevent future outbreaks.

The Timeline of the Measles Epidemic in Samoa

Maybe what is happening in Samoa isn’t so easy to understand…

Let’s give it a try!

To truly understand what is happening in Samoa, you have to go back a little further than when the epidemic started.

In fact, we have to go all of the way back to July 2018, when two young children died very shortly after getting their routine MMR vaccines. Although they died because of a mixup between the vaccine diluent and a powerful anesthetic, the tragic deaths led to the suspension of all vaccinations in the country.

Taylor Winterstein was planning an anti-vax workshop in Samoa in June.
Taylor Winterstein was planning an anti-vax workshop in Samoa in June.

And while the suspension was eventually reversed, they continued to hold MMR vaccinations for another nine months, until April 15, 2019.

Bobby Kennedy actually wrote a letter to the Prime Minister of Samoa on November 19th making every effort to blame the epidemic on a defective MMR vaccine, mutant measles strains, or vaccine strain measles.
Bobby Kennedy actually wrote a letter to the Prime Minister of Samoa on November 19th making every effort to blame the epidemic on a defective MMR vaccine, mutant measles strains, or vaccine strain measles.

Combine that with the efforts of anti-vax folks and it is easy to see how immunization rates in Samoa eventually tumbled to a low of just 30%!

What happened next?

On October 9, we got the first report of a measles case in Samoa and that it was related to a someone who visited from New Zealand for a conference at the end of August.

But by the time of that first report, at least 86 people had already been tested for suspected measles!

“Of the 28 specimens of suspected measles cases sent to Victorian Infectious Disease Reference Laboratory Melbourne, Australia on the 30th Sept 2019, twelve (12) results have been received over the week end. Of these twelve there were four confirmed cases; one adult and three children. All have been treated and discharged with no complications.

On the 2nd of October 2019, we sent another 8 specimens of suspected measles cases. Current results received this afternoon of these eight specimens sent revealed three new confirmed cases. Of these three positive cases, two were children under five years and 1 was an adult of 22 years old. All have been treated and discharged.

A total of seven confirmed cases have been reported to date. In anticipation, we now confirm a Measles Epidemic.”

Ministry of Health Press Release 1 – Measles Epidemic (October 16)

With that many cases already, it should be obvious that the measles outbreak in Samoa started in late September. That explains why UNICEF had begun to send measles vaccines and vitamin A to Samoa in early October.

Measles cases in Samoa began in September, which is why UNICEF began sending vaccines in October.
Wait. If the outbreak is caused by the vaccine strain (A genotype), why are folks testing positive for the D8 strain?

And that should put to rest the myth that this is some kind of unnatural, vaccine induced outbreak that got started because of the UNICEF vaccines.

“The deceased child of one year two months was admitted on the 8th October 2019 with a history of febrile convulsions, cough and skin rash typical of measles associated with severe dehydration. Verification of immunization status for this child revealed that he has not been vaccinated against measles.”

Ministry of Health Press Release 1 – Measles Epidemic

Tragically, we very soon saw the first measles death (October 15) in Samoa, an unvaccinated toddler. With continued cases, they soon declared a measles epidemic on October 16.

With continued cases and deaths, the Government of Samoa closed all preschools and daycare centers on October 31.

On November 8, they lowered the age to get the first dose MMR in Samoa to 6 months.

It wasn’t long before the Government of Samoa declared a full fledged state of emergency (November 15), closing schools, restricting children from gathering in public, and making vaccination mandatory.

“The outbreaks in Samoa and Tonga are caused by the D8 strain (genotype) of measles virus. Measles vaccine coverage varies in Pacific island countries and areas, ranging from 31% in Samoa to 99% in the Cook Islands, Nauru and Niue.”

Measles Outbreak in the Pacific – Situation Report No 1, 22 November, 2019

It was at this time that more help came from New Zealand, 12 nurses to help administer vaccines. Australia also soon sent a team of 34 doctors and nurses to help at Samoa’s main hospital in the capital Apia.

“Samoa’s government is warning anyone trying to discourage people from getting measles vaccinations to stop it.”

Measles Update: Samoa warns against anti-vaxxers; issues new emergency orders

And now, although there have been some roadblocks put up by anti-vaxxers both in and out of Samoa, with lots of help, they are hopefully getting their epidemic under control.

“As of December 6th, 2019, approximately 89% of all eligible people in Samoa have been vaccinated against measles.”

National Emergency Operation Centre: Update on the measles outbreak (Press Release 21) December 7, 2019

In fact, many people were vaccinated when the Government of Samoa shut down on December 5th and 6th.

“On 03/12, the Government announced that a nationwide mass vaccination will take place on Thursday and Friday (05 + 06/12) and all public services (excluding power and water, police, and health services) as well as the private sector (with few exceptions) will be shut down from 7 am – 5 pm to enforce the mass vaccination programme. Citizens were asked to stay at their residences and await the visit of mobile vaccination teams. There are 128 teams carrying out the mass vaccination campaign during this period.”

National Measles Response and Recovery Appeal, 6 December 2019

During the door to door mass vaccination campaign, families were told to stay home and hang red flags outside their homes if they needed to be vaccinated.

Photo courtesy of the Government of Samoa.
Photo courtesy of the Government of Samoa.

Amazingly, with all of the cases and deaths, some folks resisted and didn’t want to be vaccinated and protected.

Still wondering why some parents are scared and don't want their kids vaccinated?
Still wondering why some parents are scared and don’t want their kids vaccinated?

They turned the vaccination teams away!

So much for the idea of forced vaccination, right?

There have been 70 deaths in the measles epidemic in Samoa.
An update from Samoa on December 9th.

Most have gotten vaccinated and protected though.

They understand that while traditional healers might still be popular in Samoa, they can not be used for life-threatening diseases such as measles.

In addition to overloading kids with vitamin C, a traditional healer working with Jim Meehan was arrested for making many claims that scared people away from getting vaccinated and protected.
In addition to overloading kids with vitamin C, a traditional healer working with Jim Meehan was arrested on December 6 for making many claims that scared people away from getting vaccinated and protected.

So what’s next?

The measles epidemic in Samoa has greatly slowed down as most folks are now vaccinated and protected.
The measles epidemic in Samoa has greatly slowed down as most folks are now vaccinated and protected.

While it isn’t over yet, hopefully we are in the ending stages of their epidemic, as many people have now been vaccinated and protected with at least one dose of a measles containing vaccine.

And hopefully everyone has learned a big lesson and this epidemic will serve as a warning to everyone to vaccinate and protect their kids.

Samoan children should have been vaccinated and protected.
Samoan children should have been vaccinated and protected.

They have hopefully also learned to not listen to anti-vax folks, especially those who would try and exploit this kind of epidemic to push their propaganda.

More on the Measles Epidemic in Samoa

Who is Taylor Winterstein?

Some folks got an introduction to Taylor Winterstein when she planned to take her $200 a person anti-vax tour across Australia and New Zealand earlier this year.

Taylor Winterstein planned an anti-vax tour across Australia, New Zealand, and Samoa.

What’s wrong with that?

These are all places that are dealing with very large measles outbreaks

Who is Taylor Winterstein?

And Samoa.

We shouldn’t forget that Samoa was on her International Tour.

What about the choice of those who are put at risk because they are too young to be vaccinated or who can't be vaccinated?
Catchy slogan, but what about the choice of those who are put at risk because they are too young to be vaccinated or who can’t be vaccinated?

You likely remember Samoa because of the vaccine tragedy that happened there. Two infants died after nurses mixed up the diluent for the MMR vaccine with a powerful anesthetic.

Vaccines were already halted in Samoa, but that didn’t keep Taylor Winterstein from planning to go and further scare folks away from vaccinating and protecting their kids.

And where are we now?

Taylor Winterstein was very excited to meet Andy Wakefield.
Winterstein actually went to the Truth About Cancer event, which is basically set up to film “free” seminars that push natural treatments for cancer that they later sell to folks for only $499.

While Taylor Winterstein and her family were in California, meeting Andy Wakefield, there has been an epidemic of measles in Samoa, where at least one unvaccinated infant has already died.

“From 1 January 2019 to 10 October 2019 there have been 1742 confirmed cases of measles notified across New Zealand. 1416 of these confirmed cases are in the Auckland region.”

2019 NZ measles outbreak information

There has also been an awful lot of measles in New Zealand, which was also on her little tour. Two unborn babies have died during these outbreaks, and there are also reports of at least three hospitalizations for encephalitis.

Measles cases are also on the rise in Australia.

Vaccines very rarely cause severe injuries or death.
Vaccines very rarely cause severe injuries or death.

There is a risk to listening to folks like Taylor Winterstein. You have a choice to ignore them and stop spreading their propaganda.

More on Taylor Winterstein

Why Are Vaccinated Australians Now Catching Measles?

Measles is on the rise in Australia, like many other places. But why are vaccinated Australians now catching measles?

More vaccinated Australians are catching measles because there is more measles in Australia.
More vaccinated Australians are catching measles because there is more measles in Australia.

And has this got folks thinking it is because the disease is evolving?

Why Are Vaccinated Australians Now Catching Measles?

Well, apparently it has some folks thinking that.

Remember, Andrew Wakefield has also been talking about mutant measles.

Is that what this story in Australia was about?

No.

“In recent years, 13 Victorians have been hospitalized with measles despite having one or two vaccinations that should have made them immune. Why? Well, experts believe that because measles is so rare in Australia, we pretty much never come into contact with it, so our immune systems are starting to let their guards down and wane a little bit.”

Nathan Templeton on Measles Immunity Concerns

What is he talking about?

It’s the idea of exogenous boosting from being around natural infections. In other words, after you become immune from being vaccinated, you could get a boost in your immune protection if you are around someone with the disease.

“The exogenous boosting (EB) hypothesis posits that cell-mediated immunity is boosted for individuals reexposed to varicella-zoster virus (VZV).”

Talbird et al on Understanding the role of exogenous boosting in modeling varicella vaccination.

While this is thought to happen with chickenpox, we aren’t sure if it happens with measles.

It might, but the “problem” is that it is known that folks can have an amnestic response, so can be immune even though they have low antibody levels.

Mostly though, it is important to keep in mind that most of the people who get measles are unvaccinated, often intentionally unvaccinated.

“The key to measles elimination is increasing vaccination coverage and monitoring of measles antibody status for all ages, as well as enhancing surveillance of both domestic and overseas incidences.”

Inaida et al on Measles elimination and immunisation: national surveillance trends in Japan, 2008-2015.

So how many vaccinated Australians are getting measles?

Overall, there are 154 cases of measles in Australia so far this year.

“In Australia, the majority of measles cases are due to unvaccinated individuals becoming infected while travelling to countries in which measles is either common or there are outbreaks occurring. As measles is highly contagious, these people can then spread the disease to others, causing outbreaks, often before they are aware that they have the virus.”

Australia’s Measles Outbreaks 2019

And just as in the United States and most other countries, most of their outbreaks are started by folks who are unvaccinated.

More on Measles in Australia

Why Are Vaccine Schedules Different in Each Country?

Anti-vaccine folks often point in differences in the immunization schedules in various countries to try and make a case that some countries do things better than others.

Is that true?

Why Are Vaccine Schedules Different in Each Country?

The ACIP and CDC set the immunization schedule in the United States, but it shouldn’t be surprising that other countries have their own systems to set their schedules.

Each country vaccinates according to their own needs, so none of their schedules are wrong, even though they are all a little different.
Each country vaccinates according to their own needs, so none of their schedules are wrong, even though they are all a little different.

And no, just because they are all a little different, that doesn’t mean that any are wrong.

That’s easy to understand once you do just a little research on how these immunization schedules are set up.

The WHO immunization schedule.
The WHO immunization schedule.

The WHO immunization schedule is set by the Strategic Advisory Group of Experts (SAGE) on Immunization.

WHO vaccine position paper development is "a complex, rigorous, multifaceted process."
WHO vaccine position paper development is “a complex, rigorous, multifaceted process.”

It’s basically a summary of WHO position papers.

The WHO recommendations help other countries develop optimal immunization schedules.

The Communicable Diseases Act in Sweden regulates the 13 factors that the Public Health Agency of Sweden must account for when proposing changes in the national vaccination programme to the Government.
The Communicable Diseases Act in Sweden regulates the 13 factors that the Public Health Agency of Sweden must account for when proposing changes in the national vaccination programme to the Government. 

Many countries also have their own National Immunization Technical Advisory Group that sets their immunization schedule.

So their immunization schedule is right for their country, even if it doesn’t match the United States schedule.

Australia’s Vaccine Schedule

In Australia, for example, the National Immunisation Program (NIP) Schedule is set by National Immunisation Committee (NIC), which reports to the Australian Health Protection Principal Committee (AHPPC) of the Australian Health Ministers Advisory Council (AHMAC) through the Communicable Diseases Network Australia (CDNA).

The Australian Technical Advisory Group on Immunisation (ATAGI) also provides technical advice on the operation of the National Immunisation Program.

Combination vaccines mean infants in Australia get fewer shots, but the same number of vaccines.
Combination vaccines mean infants in Australia get fewer shots, but the same number of vaccines.

Notice any differences between Australia’s vaccine schedule and the US schedule?

  • they give the routine second dose of MMR earlier, at 18 months
  • they don’t give a second dose of the chickenpox vaccine
  • they give the routine first dose of the meningococcal vaccine earlier, at 12 months
  • the hepatitis A and flu vaccines are only given to high risk kids

While there are some minor differences, it is fairly similar to the US immunization schedule.

“There is a legislative requirement for all vaccines provided under the NIP or the PBS to undergo a thorough and objective assessment process.”

National Immunisation Strategy for Australia

Why the earlier dose of meningococcal vaccine?

This is a good example of why immunization schedules vary between countries.

“The notification rate for meningococcal disease to the National Notifiable Diseases Surveillance System peaked at 4.3 per 100 000 in 2002 and declined to 0.4 per 100 000 in 2013.”

Meningococcal disease

Meningococcal disease incidence rates in the United States were much lower, about 0.6 per 100,000, when they started giving meningococcal vaccines in Australia (2001).

The UK Vaccine Schedule

But aren’t the immunization schedules from other countries supposed to be a lot different from the US schedule?

Let’s look at another…

The Joint Committee on Vaccination and Immunisation (JCVI) advises UK health departments on immunisation.
The Joint Committee on Vaccination and Immunisation (JCVI) advises UK health departments on immunisation.

It’s not the easiest schedule to read, but you should notice that vaccines for hepatitis A and chickenpox are missing, but younger children get extra meningococcal shots.

You may also have noticed yet another dosage schedule for the Prevnar 13 vaccine.

While the United States gives a three dose primary series and a booster, many other countries give either a three dose primary series alone or a two dose primary series with a booster.

“A large and growing body of evidence from immunogenicity studies, as well as clinical trials and observational studies of carriage, pneumonia and invasive disease, has been systematically reviewed; these data indicate that schedules of 3 or 4 doses all work well, and that the differences between these regimens are subtle, especially in a mature program in which coverage is high and indirect (herd) effects help enhance protection provided directly by a vaccine schedule.”

Whitney et al on Dosing schedules for pneumococcal conjugate vaccine: considerations for policy makers.

That doesn’t mean that they are all guessing at the dose! All of these schedules are well studied and in this case, there isn’t much difference.

There are even studies that suggest giving only one primary dose, combined with one booster dose might work, but only in areas where pneumococcal disease is already well controlled and infants would be protected by indirect herd immunity.

But that doesn’t mean that other schedules would work just as well too. For example, giving the doses later or on a slower schedule would not be better.

Why not?

Infants are most at risk for many of these diseases, especially Hib and pneumococcal disease, when they are young and delaying when infants get vaccinated simply leaves them unprotected and at risk to get sick for a longer period of time. You also want infants to be protected by the time they lose the passive protection they get from their maternal antibodies.

What about the chickenpox vaccine?

Will the UK get the chickenpox vaccine soon?

While the UK has not added the chickenpox vaccine to their schedule because their models predicted an increase in cases of shingles (which has happened anyway) with a decrease in exogenous boosting (the theory that exposure to chickenpox lowers your risk of shingles), they are now looking at this again.

“This study confirms that severe complications of varicella, including death, continue to occur in the UK and Ireland.”

Cameron et al on Severe complications of chickenpox in hospitalised children in the UK and Ireland

Mostly it has been said that the chickenpox vaccine isn’t on the schedule because they have not thought it to be cost effective.

Iceland’s Vaccine Schedule

When anti-vaccine folks talk about immunization schedules from other countries, they aren’t usually talking about the UK or Australia though.

They are talking about Iceland, the country that they believe gives far fewer vaccines than the United States.

You thought they gave even fewer vaccines in Iceland, didn't you?
You thought they gave even fewer vaccines in Iceland, didn’t you?

Vaccines for flu, chickenpox, hepatitis A, and hepatitis B and also available for those who are considered high risk.

Extra vaccines are available for high risk kids.

Want to follow Iceland’s immunization schedule?

Then you should move to Iceland.

Hopefully you are starting to see that immunization schedules are different in each country because each country has different rates of disease, different populations, and different healthcare systems.

Iceland is a small country (338,349 people), with high vaccination rates, and universal health care. Compare that to the United States, with 327,200,000 people, clusters of unvaccinated people, and lots of people without health care.

It should be easy to see that what works in one country might not work in the other…

Vaccine Schedule Comparison by Country

What about other countries?

Austria’s immunization schedule for 2019 includes all of the same vaccines as the US schedule, plus the vaccine for Japanese encephalitis (if high risk).
Austria’s immunization schedule for 2019 includes all of the same vaccines as the US schedule, plus the vaccine for Japanese encephalitis (if high risk).

On the immunization schedule in Austria, the columns in red are for vaccines that are recommended and free. The blue columns are also recommended, but they aren’t free.

The chickenpox vaccine was just added to Japan's routine vaccine schedule, but they still don't give the combined MMR vaccine. They do still have autistic kids, so does that finally prove that the MMR vaccine is not associated with autism?
The chickenpox vaccine was just added to Japan’s routine vaccine schedule, but they still don’t give the combined MMR vaccine. They do still have autistic kids, so does that finally prove that the MMR vaccine is not associated with autism?

Japan has two separate schedules – the routine schedule for everyone (in dark blue above) and the voluntary schedule, with extra vaccines. Note that the primary series of infant vaccines are given at 2, 3, and 4 months.

The latest vaccine schedule in Germany.
The latest vaccine schedule in Germany.

Germany also gives their primary series of infant vaccines at 2, 3, and 4 months.

In contrast to the 16 diseases that kids in the US are vaccinated against, Sweden uses vaccines for just 9.
In contrast to the 16 diseases that kids in the US are vaccinated against, Sweden uses vaccines for just 9.

Sweden is the other country that anti-vaccine folks like to talk about a lot. Mostly because they think that Sweden recently banned mandatory vaccination. They didn’t.

And note that kids in Sweden can get vaccinated at school!

The Norwegian immunization program makes heavy use of combination vaccines.
The Norwegian immunization program makes heavy use of combination vaccines.

Norway is studying adding chickenpox and Shingles vaccines to their schedule.

Switzerland now offers a few optional vaccines for folks who want them, including the meningococcal vaccine, HPV vaccines for boys, and the shingles vaccine for seniors.
Switzerland now offers a few optional vaccines for folks who want them, including the meningococcal vaccine, HPV vaccines for boys, and the shingles vaccine for seniors.

Although they only use a two dose primary series, Switzerland gives many of the same vaccines as the United States.

The 2018 vaccination schedule in the Netherlands. New additions in 2020 will be the rotavirus vaccine or high risk infants, Tdap in pregnancy, and MenACWY for teens.
The 2018 vaccination schedule in the Netherlands. New additions in 2020 will be the rotavirus vaccine or high risk infants, Tdap in pregnancy, and MenACWY for teens.

Are you surprised to see that infants in Holland get more vaccines before they turn 12 month old than infants in the United States and an extra set by four months?

While most vaccines are free, you can pay extra to get vaccines that are already on the United States schedule in most other countries.
While most vaccines are free, you can pay extra to get vaccines that are already on the United States schedule in most other countries.

Even if they aren’t routine in other countries, all of the same vaccines that are offered in the United States, including vaccines to protect kids against rotavirus, chickenpox, and hepatitis A, are available in most other countries.

Vaccination schedule for children and adolescents in Israel.
Vaccination schedule for children and adolescents in Israel.

The latest immunization schedule in Israel includes hepatitis B, DTaP, polio, pneumococcal, rotavirus, MMR, chickenpox, HPV, and flu vaccines.

The 2019 Immunization Schedule for South Korea includes almost all of the US vaccines, plus BCG and Japanese encephalitis vaccines.
The 2019 Immunization Schedule for South Korea includes almost all of the US vaccines, plus BCG and Japanese encephalitis vaccines.

What’s missing in South Korea’s immunization schedule? Meningococcal vaccines. But they do have some that we don’t give in the United States.

What’s missing in Denmark?

Vaccines for rotavirus, chickenpox, hepatitis A or B, and meningococcal disease are not offered for free, but are still available in Denmark.

Folks who don’t vaccinate their kids!

Denmark has very high immunization rates – over 97% for infants and toddlers!

In addition to free vaccines, the Danish vaccine program offers these vaccines that folks can ask for and pay for themselves. Some people in high risk groups can get them free.

What don’t these different immunization schedules influence?

Prevalence rates of autism, SIDS, and other things that scare parents away from vaccinating and protecting their kids.

The One Wrong Way to Give Vaccines

Since the immunization schedules from all of these countries are just a little bit different, does that support the idea that an individualized approach to vaccinating kids is a good idea?

There is no science and nothing that says altering any vaccine schedule is a safer or more effective way to do things.
There is no science and nothing that says altering any vaccine schedule is a safer or more effective way to do things.

Of course not!

"Later and slower" is not part of any immunization plan.
“Later and slower” is not part of any immunization plan.

In many countries, even if they are missing protection against a few diseases that we routinely vaccinate against in the United States, many get their vaccines earlier! And all start by three months and don’t split up the schedule to just give one or two vaccines at a time.

Everyone knows that later and slower just leaves kids unprotected for longer periods of time. More risks. No extra benefits.

More on Vaccine Schedules Around the World