Tag: Melissa Floyd

If It’s Genetic, Where Are the Older Adults with Autism?

Remember when anti-vaccine folks used to ask why there were no autistic adults?

“Where are all the adults with classic autism? Where are the hand flapping, head banging, self-abusive, spinning, screaming, rocking, stimming, non-verbal and violent 40, 50, 60, 70, 80 and 90 year olds wearing autism helmets and diapers? Where are the grown-ups at the mall experiencing violent tantrums, seizures and GI tract problems?”

Robert F Kennedy, Jr on Is the Autism Epidemic Real?

And we had to point out that there were?

If It’s Genetic, Where Are the Older Adults with Autism?

Well, not surprisingly, they have moved the goal posts.

What’s the new thing they are talking about?

Can Bob Sears sink any lower?
Sadly, most autistic adults don’t live into their 60s…

Where are the older adults with autism?

Where are the autistic senior citizens?

“I am different, not less.”

Temple Grandin (born August 29, 1947)

They are around, if you look for them.

Are they rarer than autistic children or autistic young adults?

Almost certainly, but that, tragically is because most of them have already died. Sadly, most don’t make it into their 60s.

It is well known that the mortality rates of autistic adults are much higher than the general population.

At least it is well known to those who aren’t trying to push anti-vaccine propaganda and who want to continue to make you think that vaccines are associated with autism.

More on Older Autistic Adults

Are Vaccine Laws a Form of State Sponsored Segregation?

Bob Sears doesn’t seem to like that more states are having to strengthen their vaccine laws, making it harder for kids to skip or delay their vaccines.

That seems rather ironic, as many parents likely were scared away from vaccinating and protecting their kids because of the misinformation folks like him continue to push.

Are Vaccine Laws a Form of State Sponsored Segregation?

What the latest?

The idea that vaccine laws are a form of state sponsored segregation…

“If you don’t see the historical parallels, and if it doesn’t concern you that State and now Federal Legislators think that discrimination and segregation are OK again, and you don’t realize that this is all a carefully-crafted PR campaign to sell the idea that some children are dirty and dangerous, when decades ago all kids were considered equal, then you are blind.”

Bob Sears

Bob Sears isn’t the first to try and conflate skipping vaccines into a civil rights issue, but he is certainly the one being the most obvious about it…

Now when were all kids really considered equal in the United States?

Was it the late 1980s, when Bob thinks everyone had it so great?

Remember, that was just before the big measles outbreaks from 1989 to 1991, when 123 people died. During those three years, there were also 28 deaths from pertussis, 6 deaths from mumps, 13 deaths from rubella and 77 cases of congenital rubella syndrome!

Life was good?

I was a little older than 10 in 1988 and remember that folks still died of all of these diseases, so added that to this nice infographic so you get the real perspective.

Is this the worst thing Bob has ever posted?

Well, there is that time he talked about unvaccinated kids wearing yellow stars

“…So I tell them they don’t have to whisper. They can say it loud and clear, with confidence. Ya, I guess you don’t want to advertise it around the neighborhood – that will come soon enough. Scarlet “V” anyone? No, not scarlet. Let’s make it yellow. And not a V – a star would be better. That way everyone can know at first glance who is safe to be around and who is not. That way, if your old doctor and his children are walking down the street, they can easily identify your kids and quickly cross to the other side before they get too close.

Ask your Assemblyperson which color and shape they think would be most appropriate.

Disclaimer: This post is not intended as a reference to a holocaust. Rather, it’s intended to raise the issue of prejudice and discrimination. Others have likenend vaccine injury to a holocaust. Instead, we are talking about families who choose to not vaccinate. No holocaust here.”

Dr. Bob Sears on The Vaccine Whisperers

So which historical parallel is Bob talking about this time?

Equating real problems of discrimination and segregation to the issue of parents wanting to keep their kids unvaccinated and unprotected is not only silly, but it is also offensive.

And for perspective, in 1988, not only did more people get vaccine-preventable diseases, more people died with vaccine-preventable diseases.

Did we freak out about it? Of course not. We worked towards an immunization plan to control and eliminate more of these diseases.

How can Bob Sears be blind to all of this?

More on Vaccine Laws and State Sponsored Segregation

Bob Sears on Hiding in the Herd

How do some intentionally unvaccinated kids get away without getting sick?

Mandatory vaccination laws still don't mean forced vaccination.
Mandatory vaccination laws still don’t mean forced vaccination.

How does a pediatrician get away without seeing kids harmed by vaccine-preventable diseases?

Bob Sears on Hiding in the Herd

Most folks know the answer

“And in my 20 years of pediatric practice, I have never once seen a child seriously harmed by a vaccine-targeted infection. Oh sure, I’ve seen kids get sick. And they all get better. And this is in a practice where most of my patients don’t vaccinate (or don’t anymore after one child suffers). So if anyone should be seeing kids get harmed from infections, it should be me, right? But not even one. “

Bob Sears

There are a few simple reasons that all of Dr. Bob’s intentionally unvaccinated kids all get better when they get sick.

In addition to respiratory problems (think iron lungs), polio causes muscle atrophy.
In addition to respiratory problems (think iron lungs), polio causes muscle atrophy. (CC BY-NC 4.0)

For one thing, vaccine-preventable diseases don’t kill every single person that gets them! Even in the pre-vaccine era, most kids did recover. Tragically though, not all did. And not all did without complications.

That’s why we say that you have to earn your natural immunity.

Even more importantly though, since most other parents vaccinate their kids, his intentionally unvaccinated kids are simply at less risk to get a vaccine-preventable disease.

They are hiding in the herd – free-riding and benefiting from the herd immunity that’s provided by those of us who do vaccinate and protect our kids.

Mostly though, Dr. Bob has been lucky.

185 kids, mostly unvaccinated, died with the flu last year.
185 kids, mostly unvaccinated, died with the flu last year.

And so have his patients.

They are especially lucky that more folks don’t listen to him and instead understand that vaccines are safe, with few risks.

“Here’s the thing…it doesn’t matter if vaccines played a role in reducing the incidence of certain diseases in industrialized nations 60 years ago. Yep, I said it. ***Decades have passed and we’re STILL vaccinating like we are in a developing country and it’s the year 1900.***”

Melissa Floyd

Remember, it wasn’t that long ago that kids were dying from Hib meningititis, Hib epiglotittis, pneumococcal disease, meningococcal disease, hepatitis B, and rotavirus. You don’t have to go back 60 years or all of the way to 1900!

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

And that so many people do get vaccinated is the only thing keeping these diseases from coming back at even higher numbers.

Even Dr. Bob used to know that…

More on Bob Sears on Hiding in the Herd

What is the Natural Immunity Model?

It’s becoming a little clearer why some folks think it is safe to not vaccinate their kids, leaving them at risk to get vaccine-preventable diseases.

Who's calling the measles outbreaks a national emergency?
Who’s calling the measles outbreaks a national emergency?

Their idea of a natural immunity model of getting disease simply involves hiding in the herd and any outbreaks they trigger magically stopping.

What is the Natural Immunity Model?

Bob Sears thinks he has exposed some big news, that not everyone who gets measles dies.

Fortunately, that’s very true and something folks have always known.

With a death rate of about 1 in 1000 cases, you wouldn’t expect to have had any deaths after just 50 or 60 cases. But you never know. It’s not like every 1000th case dies. It could be the second case, the 562nd, or the 3043rd.

The hospitalization rates work the same way. They are statistical averages of what typically happens when people get measles.

That’s why measles was once called a “harmless killer.” It is often harmless, if you call having a high fever and feeling miserable for a week harmless, but it is sometimes a killer.

So is what we are seeing in Washington “what an outbreak looks like with the natural immunity model,” when no one is vaccinated and protected?

Of course not!

In a natural immunity model, up to 90% of the people who are exposed to someone with measles get sick!

In the pre-vaccine era, everyone got measles. That's the natural immunity model.
In the pre-vaccine era, everyone got measles. That’s the natural immunity model.

In a natural immunity model, everyone gets measles.

Not everyone survives having measles though.

Remember, the last measles death in the United States was during a 2015 outbreak in Washington. A immunocompromised women got caught up in an outbreak of mostly unvaccinated people, got measles, and died.

That’s the natural immunity model.

This family didn't have a choice about their son getting sick - he was too young to be vaccinated when he was exposed to an unvaccinated child with measles.
This family didn’t have a choice about their son getting sick – he was too young to be vaccinated when he was exposed to an unvaccinated child with measles.

Not having a choice about getting measles.

That’s the natural immunity model.

Worry about your child with leukemia after an exposure to measles…

That’s the natural immunity model.

“Well, what does this mean? Much like the outbreak in 2014 in a large Amish community (around 400 cases), and the recent NY outbreak in an orthodox Jewish community (around 100 cases), these types of outbreaks are centralized and self-limiting—which means they don’t spread like wildfire. These cases are also almost exclusively in communities who are CHOOSING not to be vaccinated. In other words, they are not random people “victimized” by measles. #dontfeelsorryforthem”

Melissa Floyd

Do anti-vaccine folks really think that these outbreaks are self-limiting? That they just stop on their own?

Do they not understand that the only thing that keeps them from “spreading like wildfire” is the intensive work of the local and state health departments, efforts to get folks vaccinated, and quarantines?

The Disneyland measles outbreak, for example, was hardly centralized or self-limited. It spread to Arizona, Nebraska, Utah, Colorado, Washington, Oregon, Mexico, and Canada.

And like many other large outbreaks, it cost millions of dollars to contain.

“Measles outbreaks can be very costly to communities, a new report suggests. For example, the 2013 measles outbreak in New York City cost the city’s health department nearly $395,000 and more than 10,000 personnel hours, according to a report in JAMA Pediatrics. And there were other non-monetary costs, including the loss of a pregnancy, researchers reported.”

Measles outbreaks come with serious consequences

That hardly sounds like something that is harmless or self-limited.

“Now, the ACIP is preparing to add a 3rd dose for all college-age students to try to stop adults from getting and spreading measles—THAT’S how common adults cases are. Yet in Washington, there were only three??”

Melissa Floyd

Not only is there no call for a third dose of MMR to help stop the spread of measles, the CDC actually says a third dose isn’t necessary.

“In the event that a HCP who has 2 documented doses of MMR vaccine is tested serologically and determined to have negative or equivocal measles titer results, it is not recommended that the person receive an additional dose of MMR vaccine. Such persons should be considered to have presumptive evidence of measles immunity.”

Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Any talk about a third dose of MMR has to do with outbreaks of mumps…

“Is this all a coincidence my friends? Is the panic generated because of motive rather than data? In other words, could the media actually be encouraged to shift public beliefs on an issue to help pass legislation with a vested interest? #HerdImmunityDoesntApplyToVaccines”

Melissa Floyd

It’s not a coincidence that we are seeing so much anti-vaccine measles panic and propaganda these days. Outbreaks always bring it out.

Why?

It becomes harder to justify your decision to leave your kids unvaccinated and unprotected when you actually start to see that intentionally unvaccinated kids are getting sick.

More on the Natural Immunity Model

Dr. Bob Puts the Nail in the Coffin of the Herd Immunity Argument

Dr. Bob Sears, who actually wrote a book about vaccines, seems to think that he and his podcasting sidekick have put the nail in the coffin “of trying to use the herd immunity argument to justify coerced vaccinated.”

Dr. Bob seems to think that herd immunity doesn't apply to vaccines.

The meme he shared even includes the hashtag stating that herd immunity doesn’t apply to vaccines.

Dr. Bob Puts the Nail in the Coffin of the Herd Immunity Argument

While arguing against the idea of herd immunity and for coerced vaccination are common among anti-vaccine folks, neither is true.

Herd immunity is real and no-one is going to force anyone to vaccinate their kids. Vaccine mandates do not mean forced vaccination.

What about the idea that “all vaccines wane within about 2-15 years, leaving vaccinated children & adults unprotected?”

If that were true, then wouldn’t everyone who got sick in latest outbreaks be vaccinated? Why are most folks unvaccinated?

So we are either getting a lot of outbreaks because of waning immunity or your titers are getting boosted because you are getting exposed to so much natural disease. Got it?

While waning immunity is an issue for some vaccines, like mumps and pertussis, the primary and secondary failure rates are still not as bad as Dr. Bob suggests, which is why, in an outbreak, the attack rate of disease is always higher among those who are unvaccinated and unprotected.

The numbers don't always add up correctly when anti-vax folks try to do math.
The numbers don’t always add up correctly when anti-vax folks try to do math.

Is herd immunity the main argument that’s made when experts suggest we need stronger vaccine laws? I always thought the main argument is that folks should just vaccinate and protect their kids, but maintaining herd immunity so that your intentionally unvaccinated kids don’t put everyone else at risk is a good reason too.

Does everyone see the problem with Melissa Floyd’s math? This probably won’t be on the SAT, but you still want to get this right…

Like many others are doing right now, she used state level data. Since many of the folks who don’t vaccinate their kids cluster together in the same communities and schools, the “2% of those filing for exemptions” end up making up 10, 20, or even 30% of some school’s student population.

“This means if you are a primary non-responder, you are walking around every day with a false sense of security, clinically unvaccinated for that particular disease.”

Melissa Floyd

This is the whole point of herd immunity!

Because vaccines aren’t 100% effective, we can walk around all day without actually thinking about it much, hoping that we can rely on the fact that most other people are also vaccinated and protected. That keeps disease out of our community or herd.

The system typically breaks down though, not because vaccines aren’t effective enough, but because too many folks don’t get vaccinated.

“A 2011 article in “Vaccines”, edited by Stanley Plotkin, says, “Much of the early theoretical work on herd immunity assumed that vaccines induced solid immunity against infection…” Theoretical… Assumed…”

Melissa Floyd

She should have read the whole article, or at least used the whole quote…

“Much of the early theoretical work on herd immunity assumed that vaccines induce solid immunity against infection and that populations mix at random, consistent with the simple herd immunity threshold for random vaccination of Vc = (1-1/R0), using the symbol Vc for the critical minimum proportion to be vaccinated (assuming 100% vaccine effectiveness). More recent research has addressed the complexities of imperfect immunity, heterogeneous populations, nonrandom vaccination, and freeloaders.”

Herd Immunity: A Rough Guide

It doesn’t say what she thinks it says…

“Indeed, one might argue that herd immunity, in the final analysis, is about protecting society itself.”

Herd Immunity: A Rough Guide

So why haven’t we eradicated measles like we said we would?

“What’s funny is after the measles vaccine was licensed in 1963, the medical community declared a goal of eradicating measles by 1967. But 1967 came and went and it still wasn’t gone, 1977, 1987, 2000… the dates kept getting pushed, and the result was always the same. Meanwhile they continued to increase the hypothesized “herd immunity threshold”, eventually winding up at the extremely high 95% you hear today. “

Melissa Floyd

That’s actually a good question.

What happened to the previous goals of eliminating measles?

“In 1966, the USA began an effort to eradicate the disease within its own borders. After a series of successes and setbacks, in 2000, 34 years after the initial goal was announced, measles was declared no longer to be endemic in the USA.”

Orenstein et al on Eradicating measles: a feasible goal?

Along the way, we have gone from an estimated 100 million cases and 5.8 million deaths in 1980 and an estimated 44 million cases and 1.1 deaths in 1995 to “just” 7 million cases and 89,780 deaths in 2016.

“Under the Global Vaccine Action Plan, measles and rubella are targeted for elimination in five WHO Regions by 2020.”

Measles

While there is doubt that we can truly eradicate measles with the current vaccine, we can certainly control and eliminate measles if folks stop listening to anti-vaccine propaganda and they get vaccinated and protected.

More on Dr. Bob and His Herd Immunity Arguments

Vaccinated vs Unvaccinated – Measles Outbreak Edition

There are two big reasons that we are still having to talk about how it’s mainly unvaccinated folks that get sick in measles outbreaks.

Some folks keep spreading misinformation about measles, such as how most of the people who got sick in the Disney outbreak were vaccinated!?!

And other folks believe them!

Vaccinated vs Unvaccinated – Measles Outbreak Edition

Fortunately, misinformation about the number of vaccinated vs unvaccinated in an outbreak is among the easiest things to fact check.

Although folks will try to misrepresent this slide, as you can easily see, most of the folks in the Disneyland outbreak were unvaccinated.

That’s not how any of this works…

For example, if you wanted to assume that the 20 people who said that they were vaccinated really were, then you have to assume that the rest of those folks weren’t. And you also have to raise the number of folks who had their immunization status verified.

But you really shouldn’t make assumptions. All you can really say for sure from this data is that 15 (13 + 2) of the people, out of the 131 cases, were fully vaccinated.

What about the New York outbreak in 2011? Was it really started by someone who was fully vaccinated?

Surprisingly, it was!

“This is the first report of measles transmission from a twice-vaccinated individual with documented secondary vaccine failure. The clinical presentation and laboratory data of the index patient were typical of measles in a naive individual. Secondary patients had robust anamnestic antibody responses. No tertiary cases occurred despite numerous contacts.”

Rosen et al on Outbreak of measles among persons with prior evidence of immunity, New York City, 2011.

And it was a very big deal because it was the first time it had ever been reported as happening!

“During 2011, a provisional total of 222 measles cases were reported from 31 states. The median age of the patients was 14 years (range: 3 months to 84 years); 27 (14%) were aged <12 months, 51 (26%) were aged 1–4 years, 42 (21%) were aged 5–19 years, and 76 (39%) were aged ≥20 years. Most patients were unvaccinated (65%) or had unknown vaccination status (21%).”

Measles — United States, 2011

That’s in contrast to all of the other measles cases that year. Remember, there were a total of 222 measles cases in the United States in 2011. Few were vaccinated.

What about other measles outbreaks?

Only 4% of people in the Rockland County measles outbreak have been fully vaccinated.
Only 4% of people in the Rockland County measles outbreak have been fully vaccinated.

As much as folks try and report that most of the people in recent outbreaks are vaccinated, they aren’t.

Only one person, out of 53 cases of measles, is known to have had a dose of MMR in the Clark County measles outbreak.

What about other measles outbreaks?

OutbreaksYearVaccinatedUnvaccinatedUnknown
California – 24 cases201724
Minnesota – 75 cases20175682
Tennessee – 7 cases201616
Ohio – 383 cases2014534038
California – 58 cases2014112518
Texas – 21 cases2013165
Florida – 5 cases20135
Brooklyn – 58 cases201358
North Carolina – 23 cases20132183
Minnesota – 21 cases2011183
San Diego – 12 cases200812

We don’t even have to do the math.

“The majority of people who got measles were unvaccinated.”

Measles Cases and Outbreaks

It is easy to see that most folks in these outbreaks are unvaccinated!

Get vaccinated and stop the outbreaks. Vaccines are safe, with few risks, and necessary.

More on Vaccinated vs Unvaccinated – Measles Outbreak Edition

Why Haven’t We Eradicated Measles Already?

The first measles vaccine was developed in 1963.

So why do we still have measles?

Shouldn’t measles be on the list with all of the other eradicated diseases, like smallpox and, well smallpox…

Why Haven’t We Eradicated Measles Already?

Eradicating a disease is not as simple as developing a vaccine.

If it were, a lot of diseases would have been eradicated already.

Hopefully, we will add more to the list of eradicated diseases, but there are some that will never be eradicated. Tetanus, for example, is ubiquitous in soil, so would be nearly impossible to eradicate. Other diseases, like rabies and yellow fever, would be hard to eradicate because they can infect animals or insects.

What about measles?

Anti-vaccine folks do not understand herd immunity.

While there was never a goal to eradicate measles by 1967, we have missed several deadlines to get measles under better control.

What was the first deadline?

“Recent successes in interrupting indigenous transmission of measles virus in the Americas and in the United Kingdom prompted the World Health Organization (WHO), Pan American Health Organization (PAHO), and CDC to convene a meeting in July, 1996 to consider the feasibility of global measles eradication.”

Measles Eradication: Recommendations from a Meeting Cosponsored by the World HealthOrganization, the Pan American Health Organization, and CDC

Folks started talking about measles eradication in 1996.

Before that though, there had been a goal to eliminate measles in the United States.

“An effort is underway to eliminate indigenous measles from the United States; a target date of October 1, 1982 has been set.”

Although we missed that initial target date, we weren’t too far off.

“In 1978, the US Public Health Service initiated a Measles Elimination Program with the goal of eliminating measles from the United States by 1982. The goals of this program included (1) maintenance of high levels of immunity,(2) careful surveillance of disease, and (3) aggressive control of outbreaks. Unfortunately, the program failed, predominantly because of the failure to implement the recommended vaccination strategy and because of vaccine failure. An increase in measles cases was sustained from 1983 through 1991 and was particularly dramatic from 1989 through 1991.”

Poland et al on Failure to Reach the Goal of Measles Elimination

There is also the fact that measles is just so dang contagious!

Improving vaccination rates and a two-dose MMR schedule helped decrease measles rates even further and finally eliminate the endemic spread of measles in the United States in 2000.

What were some other deadlines and goals?

  • In 1989, the World Health Assembly resolved to reduce measles morbidity and mortality by 90% and 95%, respectively, by 1995, compared with disease burden during the prevaccine era.
  • In 1990, the World Summit for Children adopted a goal of vaccinating 90% of children against measles by 2000.
  • Regional measles-elimination goals have been established in the American Region (AMR) by 2000, the European Region (EUR) by 2007, and the Eastern Mediterranean Region (EMR) by 2010.
  • A regional measles-elimination goals have been established in the Western Pacific (WPR) by 2012.
  • In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan with the objective to eliminate measles in four World Health Organization (WHO) regions by 2015 – the Region of the Americas, EUR, EMR, and WPR.
  • Countries in all six WHO regions have adopted goals for measles elimination by 2020.

Obviously, we haven’t hit all of the goals and deadlines on time.

What have we done?

We have tremendously reduced the number of children who get measles and who die with measles. For example, instead of meeting the 2010 goals of decreasing global measles mortality by 90% over 2000 levels, we have decreased it by 74%. The world has gone from an estimated 100 million cases and 5.8 million deaths in 1980 and an estimated 44 million cases and 1.1 million deaths in 1995 to “just” 7 million cases and 89,780 deaths in 2016.

There is still some work to be done though, especially with the uptick in cases and deaths in the last few years.

“Eradication of both measles and rubella is considered to be feasible, beneficial, and more cost-effective than high-level control.”

Orenstein et al on Measles and Rubella Global Strategic Plan 2012–2020 midterm review report: Background and summary

Work that we can still do if everyone makes the commitment to implement their elimination plans.

And folks vaccinate and protect their kids!

What’s the alternative?

To go back to when even more kids got sick and died with measles?

More on Eradicating Measles