Tag: genotype

Are the Measles Outbreaks in New York a Hoax?

Wait, why do some folks think that the measles outbreaks in New York are a hoax?

There were no confirmed cases in the measles outbreaks in New York, except the 654 measles cases that were confirmed… Some hoax!
There were no confirmed cases in the measles outbreaks in New York, except the 654 measles cases that were confirmed… Some hoax!

Oh, the usual suspects

Are the Measles Outbreaks in New York a Hoax?

Brooklyn, New York had 654 measles cases in the largest measles outbreak in 27 years.

There have been 312 confirmed cases in the measles outbreaks in Rockland, County, New York.

There have been an additional 312 confirmed, reported cases in Rockland County, New York, the longest measles outbreak since the endemic spread of measles was declared eliminated in 2000.

Were they a hoax?

“A total of 654 cases were confirmed, with rash onsets between September 30, 2018 and July 15, 2019. Serious complications included hospitalization (52), intensive unit care (19) and pneumonia (34). Multiple international importations of measles introduced into a community with prevalent delays in vaccination among young children propagated this outbreak.”

2019 Health Alert #26: Update on Measles Outbreak in New York City

Of course not!

The New York State Department of Health advises that on all suspected measles cases, “Viral specimens (nasopharyngeal swaband urine) and serology (IgM and IgG) should be obtained for diagnostic testing and confirmation.”

Were these cases all caused by vaccine strain measles, as Larry Palevesky suggests?

Of course not!

A vaccine strain has never before caused a measles outbreak. And NYC Health Commissioner Dr. Oxiris Barbot, in a press conference, stated that “Yeah, it’s, you can’t get the measles from the vaccine.”

Although anti-vax folks often focus on the measles strain when there is an outbreak, all it really helps you do is figure out where the imported cases came from.

Even though health officials didn’t tell us the specific strains involved in the outbreaks, guess what, they did tell us the sources of the outbreak, so it is basically the same thing.

The cases were imported from Israel, UK, and Ukraine.

And the CDC has told us that “All measles cases this year have been caused by measles wild-type D8 or B3.”

“We have to stop blaming, accusing, targeting, ostracizing, condemning unvaccinated children as a health risk, which would then make this subject completely moot.”

Larry Palevsky

What else do we know about the measles outbreak in Brooklyn?

  • it began in October 2018 “with an unvaccinated child from Brooklyn who acquired measles in Israel”
  • it included 15 neighborhoods in Brooklyn, with most concentrated in Williamsburg, Borough Park, and Sunset Park
  • the majority of cases were in children, including at least 91 cases in infants less than 12 months old
  • the great majority of cases were unvaccinated, with only 27 cases fully vaccinated with two doses of MMR
  • there were 52 hospitalizations, including 16 ICU admissions

And the outbreak cost over $6 million to control!

The Rockland County measles outbreak ended in late September and is also said to have cost over $6 million to control.

At a gathering for the New York Alliance for Vaccine Rights and First Freedoms Community, these folks, including Larry Palevsky (left) are discussing the "alleged" measles outbreaks that New York spent $6 million and 500 staff to contain.
At a gathering for the New York Alliance for Vaccine Rights and First Freedoms Community, these folks, including Larry Palevsky (left) are discussing the “alleged” measles outbreaks that New York spent $6 million and 500 staff to contain.

So why do they think they are a hoax?

“There were over 800 kids who the New York State and New York City Department of Health have said were confirmed cases of measles. The real question is, were these really confirmed as per the CDC recommendations. We do not have that data. In fact, anecdotally, New York State told the physicians not to do the tests.”

Larry Palevsky

Is this about the strains again? Is this about the fact that once you know you are in the middle of a huge measles outbreak, you might be able to start diagnosing kids clinically?

“New York State lied when they said that there were confirmed cases. We don’t know what kind of illnesses the kids had. And there’s a set of papers in the literature that specifically state that if the children are found by analysis to have a measles virus infection that is consistent with a side effect of the vaccine, it is important for the Department of Health to alert the public that it was a vaccine strain that caused the outbreak, because a vaccine strain illness should not be equated with a public health emergency. [Applause]”

Larry Palevsky

Yes, it is about the strains…

“So the reality is that when there is a vaccine strain measles outbreak, meaning that the vaccine itself was not properly attenuated, meaning it was more active and virulent than just simply giving an antibody response in the body, when that occurs an outbreak is almost always very very close to the vest, meaning that would explain why it was only seen in two communities out of 62. And if New York state had done the proper testing of the vaccine to see if it was too virulent and of the children who had the measles infection to see what type of measles virus they had, then in all likelihood this was a vaccine strain measles infection which is known to be a side effect of the vaccine and not a public health emergency.”

Larry Palevsky

Is any of that true?

Since we have never had an outbreak of measles from an MMR vaccine that wasn’t properly attenuated, I’m guessing no, it isn’t. Also remember that to control the outbreak, they gave lots and lots of MMR vaccine to unvaccinated folks in those communities…

What about his explanation for why we only saw outbreaks in Brooklyn and Rockland Counties? Well, for one thing, we didn’t. Other areas of New York and of course, around the country have seen a rise in measles. And the outbreaks in Brooklyn and Rockland Counties were caused when unvaccinated folks traveled to Israel, UK, and Ukraine and returned to an area with low immunization rates. They weren’t caused by a bad batch or mutant strains of measles in the MMR vaccine.

“So the New York State Department of Health failed to do their job and instead they lied and said the cases were confirmed and they didn’t do their due diligence to actually evaluate all the possible reasons that an outbreak could have occurred. It’s very strange that two communities where there are lots of people moving through those communities that are non-Jewish, that are outside of the state that are coming through and why just those communities got the illness. That should have raised the red flag that something else was going on and your state failed us.”

Is it possible that those other people moving in and out of those communities in Brooklyn and Rockland County were vaccinated and protected against measles?!?

One thing should be very clear.

Brooklyn may have stopped their measles outbreak, but New York still has a public health emergency on their hands.

Well, not just New York. We need to stop this kind of propaganda if we want to keep parents from being scared to immunize and protect their kids.

More on Measles in NY

Should I Blame the Vaccine If I’m Sick and I Just Got Vaccinated?

We all know the saying, correlation equals causation, right?

So if you get an MMR vaccine and get the measles a week later, it has to be the vaccine, right?

Should I Blame the Vaccine If I’m Sick and I Just Got Vaccinated?

Actually, no.

“Correlation does not imply causation.”

Although it would be very easy to blame the vaccine, if you keep in mind that the saying is actually “correlation does not imply causation,” maybe you will do a little investigating and see if something else is to blame.

Some things to consider and ask yourself:

  1. Do I really have measles? Remember that it is not uncommon to develop a fever and a rash about 7 to 12 days after getting an MMR vaccine. This is a very common, mild vaccine reaction. It doesn’t mean that you have measles or even a mild case of the measles.
  2. Was I recently exposed to someone with measles? If you were vaccinated because you were exposed to measles during an outbreak, then there is a good chance that the vaccine hasn’t had a chance to work yet and you actually developed measles from being exposed to the wild virus.
  3. Do I have the wild type or a vaccine strain of measles? Testing can be done to tell which strain of measles you have and to see if it is a wild type or vaccine strain.

Are there any examples of folks having wild type disease if they get sick shortly after being vaccinated?

Not surprisingly, there are a lot of these types of examples.

“Vaccine strains are poorly or not transmissible and prompt differentiation between wild-type and vaccine strains allows for optimal management and public health action.”

Pabbaraju et al on Simultaneous Detection and Differentiation between Wild-Type and Vaccine Measles Viruses by a Multiplex Real-Time Reverse Transcription-PCR Assay

What about examples of folks getting sick with vaccine strain measles and other diseases? Not so many.

The clinical diagnosis could just as easily have been wild type measles and not a vaccine strain, as there was a lot of measles in the the UK in 1988.
The clinical diagnosis could just as easily have been wild type measles, as there was a lot of measles in the the UK in 1988.

Most of the published examples are case reports without evidence of a vaccine strain.

What about the kid in Canada that got measles after her MMR vaccine?

“We describe a case of vaccine-associated measles in a two-year-old patient from British Columbia, Canada, in October 2013, who received her first dose of measles-containing vaccine 37 days prior to onset of prodromal symptoms.”

Murti et al on Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013.

She had symptoms of measles and a vaccine strain and was reported as “the first case of MMR vaccine-associated measles.” Well, at least the first case that occurred so long after getting vaccinated. Still, they note that “clinically significant vaccine-associated illness is rare.”

What about all of the people in California and Michigan who supposedly had vaccine-strain measles?

This is not vaccine strain measles! It is people with a rash or fever after being vaccinated. They don't have measles though.
This is not vaccine strain measles! It is people with a rash or fever after being vaccinated. They don’t have measles though.

Anti-vaccine folks made that up!

When It’s a Wild-Type Virus

What’s the most obvious evidence against the idea that vaccines and shedding are responsible for causing outbreaks?

For one thing, despite the recent uptick, cases of vaccine-preventable diseases are way down from the pre-vaccine era. That’s not what you would expect if vaccine-induced disease was common or if contacts of those who were recently vaccinated could easily get sick from shedding.

And we have evidence against vaccine induced disease.

When kids get chicken pox shortly after being vaccinated, they often have a wild strain. They don’t have breakthrough chicken pox.

“All of 57 vaccinees with breakthrough varicella, clinically diagnosed on the basis of a generalized maculopapular or vesicular rash, in which there was amplifiable DNA [corrected], had wild-type VZV infection based on analysis of viral DNA. “

LaRussa on Viral strain identification in varicella vaccinees with disseminated rashes.

Same thing with measles.

Want to avoid these situations in which you could get a wild strain of a vaccine-preventable disease?

Don’t skip or delay your child’s vaccines!

More On Wild-Type and Vaccine Measles Viruses

Is a Vaccine Strain Causing The Latest Measles Outbreak?

What’s the first question anti-vaccine folks start asking whenever we see a large outbreak of measles?

No, it’s not how can I get my kids vaccinated and protected so that they don’t get measles…

It is whether or not it a vaccine strain of measles started the outbreak.

That’s not how any of this works…

Where do folks get all of this stuff about genotypes and vaccine strains? I wonder…

Dr. Bob had no facts, but still posted that a vaccine strain of measles could have killed a woman who got caught up in the last measles outbreak in Washington.

Yup.

The usual suspects.

Is a Vaccine Strain Causing The Latest Measles Outbreak?

Why do folks who intentionally don’t vaccinate their kids desperately want these measles outbreaks to be caused by a vaccine strain?

Because then it isn’t their fault that their kids are at risk of getting a life-threatening disease!

It’s never a vaccine strain though.

Remember the Disneyland measles outbreak. A lot of folks were talking about vaccine strains when it first started.

“…California patients were genotyped; all were measles genotype B3, which has caused a large outbreak recently in the Philippines…”

Measles Outbreak — California, Dec 2014–Feb 2015

It wasn’t a vaccine strain.

OutbreaksYearGenotype
Minnesota2017B3
Tennessee2016B3
California2015B3
Florida2013D8
California2014B3, D8
Brooklyn2013D8
North Carolina2013D8
Minnesota2011B3
Washington, Illinois2008D5, D4

For example, during 2011, 222 cases of measles and 17 outbreaks were reported in the United States, with most cases originating from just five countries (France, Italy, Romania, Spain, and Germany). Six different genotypes were identified, including B3, D4, G3, D8, H1, and D9. No vaccine strains…

And no, it doesn’t matter that the vaccine strain of measles, genotype A, differs from all of the wild strains of measles we see in the outbreaks.

“Vaccine induced immunity protects against all virus strains. Measles is considered a monotypic virus despite the genetic variations.”

Factsheet about measles

Unlike the flu, HPV, and pneumococcal bacteria, in which vaccines only protect against different serotypes, in the case of measles, the genotype simply helps us figure out where the measles case came from.

And no, the latest outbreak, wherever it is, wasn’t caused by shedding from a vaccine.

But if it isn’t the vaccine strain, then why do they that is it important to rapidly identify wild strains vs vaccine strains?

“During measles outbreaks, it is important to be able to rapidly distinguish between measles cases and vaccine reactions to avoid unnecessary outbreak response measures such as case isolation and contact investigations.”

Roy et al on Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR

That’s easy to answer.

Outbreaks typically trigger a lot of folks to get vaccinated. While that’s great, one possible problem is that some of those folks might develop a fever and/or rash after their MMR vaccine. So it is important to quickly figure out whether they are part of the outbreak and have a wild strain (maybe they were exposed before their vaccine could start to work) or are having a common, mild vaccine reaction.

But couldn’t they have vaccine-associated measles if they have a rash and fever and a vaccine strain? Theoretically, but then they would likely have true measles symptoms. And even in these rare case reports, the children didn’t spread the measles to anyone else.

So why are you waiting to know the genotype of the measles strain causing the outbreak in your area? Hopefully, it isn’t to help you decide whether or not to vaccinate and protect your kids. While it is interesting to know where the outbreak originated, you can bet that it isn’t a vaccine strain.

More on Vaccine Strains Causing Measles Outbreaks

The Pacific Northwest Measles Outbreak of 2019

Breaking News – There are 2 new cases in Clark County (70 cases), bringing the total case count to 75 cases.

It started with a confirmed case of measles in a child in late December.

The Pacific Northwest measles outbreak on 2019 started when a child exposed others in the area in late December.

There were soon reports of more cases.

The Clark County measles outbreak quickly grew.

And more cases.

The Pacific Northwest Measles Outbreak of 2019

But the measles cases didn’t stay in Clark County.

Two of the unvaccinated kids from Clark County traveled to Hawaii while they were contagious.
Two of the unvaccinated kids from Clark County traveled to Hawaii while they were contagious.

As with other recent large measles outbreaks, cases soon spread to neighboring counties.

As of late January, there are now measles cases linked to this ongoing outbreak in Clark County and King County (Washington) and Multnomah County (Oregon).

The rapid growth of the outbreak led Clark County to declare a local public health emergency and Washington’ governor to declare a State of Emergency in all counties in the state of Washington.

“The measles outbreak and its effects impact the life and health of our people, as well as the economy of Washington State, and is a public disaster that affects life, health, property or the public peace.”

Governor Jay Inslee on proclaiming a State of Emergency

Why so much concern?

Are you familiar with the immunization rates in this part of the country? About the only good thing you can say about Washington’s immunization rates are that they are better than Oregon‘s…

Washington has one of the highest rates of exemptions in the United States.

That’s right.

High non-medical vaccine exemption rates and low vaccination rates. A recipe for very large outbreaks of vaccine-preventable diseases, especially measles which is so highly contagious.

Immunization rates by county in Washington.

And a recipe for disaster. These outbreaks are getting harder to control, are lasting longer, and are getting bigger and bigger.

Also remember that the last measles death in the United States, in 2015, was a woman who got caught up in a measles outbreak in Clallam County. Why didn’t that trigger folks in the area to get Vaccinated?

Pacific Northwest Measles Outbreak of 2019
Clark County (WA)70 cases
King County (WA)1 case
Multonomah County (OR)4 case
 75 cases

How many of them are vaccinated? Anti-vaccine folks are pushing hard to convince folks that everyone in the outbreaks are vaccinated. Don’t believe them!

As in most outbreaks, almost all of the people in this outbreak are unvaccinated.

How many people will get sick in the Pacific Northwest Measles Outbreak of 2019 before it ends?

You will have to make an extra appointment if you followed his immunization plan and left your kids unvaccinated and at risk during this outbreak.
You will have to make an extra appointment if you followed his immunization plan and left your kids unvaccinated and at risk during this outbreak.

Are parents going to keep listening to anti-vaccine folks who push the idea that measles isn’t that bad and make you think that it is riskier to get vaccinated?

Are they going to realize that unless they are malnourished or have a vitamin deficiency, that taking extra vitamin A that you order from someone’s online store will not reduce their risk of severe complications if their unvaccinated child gets measles?

“Please contact your pediatrician or doctor if your child is scary sick, struggling to breathe or unable to eat or very lethargic or otherwise seriously ill. Let them know you are worried they may have measles so they can arrange not to contaminate the waiting room or the whole office.”

Paul Thomas, Integrative Pediatrician

Getting vaccinated can help keep your kids from getting “scary sick” from measles…

“The above recommendations are informational only. Please consult with your doctor before implementing anything you might learn here.”

Paul Thomas, Integrative Pediatrician

The only good advice he gives.

Anti-vaccine misinformation has gotten us to the place where these outbreaks are becoming more common. Vaccinate your kids so they don’t get measles and don’t expose anyone else.

And for the anti-vaccine folks who are asking:

  • it isn’t going to be shedding or a vaccine strain that caused the outbreak
  • everyone or almost everyone in the outbreak is going to be unvaccinated
  • the measles vaccine does work against all the different genotypes of measles
  • more people don’t die from getting the MMR or any other vaccine than from the diseases they protect us against
  • whether the death rate of measles is 1 in 1000 or 1 in 10,000 cases, remember that just before the measles vaccine came out, in the early 1960s, nearly 500 people would die of measles each year. And it isn’t that a person dies after 1,000 or 10,000 cases. With more cases, there is just a higher chance that someone will eventually die.

And you are still worried about the MMR vaccine because anti-folks are still scaring you away from vaccinating and protecting your kids.

Vaccines are safe and necessary with few risks. There is no good reason that we should still have outbreaks like this.

More on The Pacific Northwest Measles Outbreak of 2019

Updated March 3, 2019