Tag: mortality rate

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

We Know Vaccines Work

We know vaccines work.

How well do they work?

In addition to eradicating smallpox, did you know that vaccines have helped eliminate four other now vaccine-preventable diseases?

  1. diphtheria
  2. neonatal tetanus
  3. polio
  4. congenital rubella syndrome

And unlike measles, which was declared eliminated in 2000, we really don’t see these diseases anymore.

We Know Vaccines Work

How well do vaccines work?

Let’s look at the disease counts (morbidity data), how many kids got sick, just before we developed a vaccine and where we are now:

DiseasePre-Vax EraNow% Decrease
Smallpox110,672last case 1977 100%
Diphtheria30,508199.9%
Pertussis265,26913,43994.9%
Tetanus6012096.7%
Neonatal Tetanus1,000+0100%
Polio21,269last case 1993100%
Measles763,094372 99.9%
Mumps212,9342,25198.9%
Rubella488,796599.9%
Congenital Rubella Syndrome20,0000100%
Hib invasive18,0002799.9%
HepB300,0002,79999.1%
Perinatal HepB16,20095294.1%
Pneumococcal invasive64,40098698.5%
HepA254,51811,16695.6%
Varicella5,358,5956,89299.9%

Sandra Roush and Trudy Murphy provided us with pre-vaccine baselines for 13 vaccine-preventable diseases in their article, Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States.

“A greater than 92% decline in cases and a 99% or greater decline in deaths due to diseases prevented by vaccines recommended before 1980 were shown for diphtheria, mumps, pertussis, and tetanus. Endemic transmission of poliovirus and measles and rubella viruses has been eliminated in the United States; smallpox has been eradicated worldwide. Declines were 80% or greater for cases and deaths of most vaccine-preventable diseases targeted since 1980 including hepatitis A, acute hepatitis B, Hib, and varicella. Declines in cases and deaths of invasive S pneumoniae were 34% and 25%, respectively.”

Roush et al on Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States.

Their study, which came out in 2007, used morbidity (2006) and mortality (2004) data that was recent at the time. The data has held up very well since then, looking at 2018 statistics in the National Notifiable Infectious Diseases Weekly Tables (see below), even with talk of waning immunity for some vaccines.

But can’t you explain all of this decline away by talking about better hygiene, sanitation, and nutrition?

Of course not!

“…for those trained in pediatrics in the 1970s, Hib (Haemophilus influenzae type b) was a horror.”

Walter Orenstein, MD

The pre-vaccine era for Hib was just before 1988, when the first Hib vaccine came out. We had good hygiene, sanitation, and nutrition in the 1980s and yet, a lot of kids died from Hib meningitis and epiglottitis. At least they did until he got a vaccine to prevent it.

And if it was better hygiene and sanitation, etc., why did it affect every disease at a different time? And why hasn’t better hygiene and sanitation stopped RSV, HIV, norovirus, Zika, and all of the other non-vaccine-preventable diseases?

Although there was a decline in mortality rates at the beginning of the 20th Century for all diseases thanks to better hygiene, sanitation, and nutrition, that effect plateaued by the mid-1930s. And since a lot of people were still getting sick, remember everyone used to get measles, even if a small percentage would die, it would add up to a lot of deaths!

Vaccines aren’t perfect, but they are safe, with few risks, and work well. Get vaccinated and protected if you want to keep from getting and bringing back these now vaccine-preventable diseases.

More on We Know Vaccines Work

More About Measles Deaths in the United States

Anti-vaccine folks like to talk about death and measles, as long as they can talk about vaccine deaths, something they seem to think happens commonly.

“Over the past ten years in the U.S., there has been one reported death from the measles, and it is unclear based on the medical history of the patient whether and how measles played a role in their death. During the same time period (based on Vaccine Adverse Event Reporting System (VAERS) reports), there have been 105 reported deaths associated with the MMR or MMRV vaccinations.”

Measles Madness: Dr. Brian Hooker’s Statement to WA Legislators

There are two big problems with this statement, that is so often repeated that it is clearly a PRATT – a point refuted a thousand times.

The reports in VAERS about deaths after MMR are not proof of a cause-and-effect relationship.

“Reports of all possible associations between vaccines and adverse events (possible side effects) are filed in VAERS. Therefore, VAERS collects data on any adverse event following vaccination, be it coincidental or truly caused by a vaccine. The report of an adverse event to VAERS is not documentation that a vaccine caused the event.”

Guide to Interpreting VAERS Data

In fact, studies have shown that most of the reports of deaths submitted to VAERS are coincidental and not causally associated with a vaccine.

But what about deaths following a natural measles infection?

There are plenty of those that anti-vaccine folks love to ignore.

Wide-ranging Online Data for Epidemiologic Research = WONDER
Wide-ranging Online Data for Epidemiologic Research = WONDER

Where are they?

There were actually 5 SSPE deaths and 2 measles deaths in 1999, but I started the list from 2000, as that was when the endemic spread of measles was eliminated in the United States.
There were actually 5 SSPE deaths and 2 measles deaths in 1999, but I started the list from 2000, as that was when the endemic spread of measles was eliminated in the United States.

These deaths are all in the CDC Wonder database.

Before the death of the woman in Washington in 2015, the CDC caused a lot of confusion by stating that “the last verifiable death in the United States from acute measles infection occurred in 2003 when there were 2 reported deaths.”

Does that mean that the measles deaths in 2005, 2009, 2010, and 2012 didn’t happen?

Of course not!

The information in the CDC Wonder database comes from death certificates that are sent in from all over the United States to the National Vital Statistics System. The system isn’t like VAERS though, where just anyone can send in a report. Still, they are unverified, which is why the CDC doesn’t mention them all.

Still, if anti-vaccine folks are going to push VAERS reports that we know are likely coincidental, then they shouldn’t ignore these measles deaths.

More About Measles Deaths in the United States

Remembering Measles

I don’t remember treating any kids with measles in medical school or residency.

We certainly saw a lot of other now vaccine-preventable diseases when I was in training, from rotavirus and pneumococcal disease to meningococcal disease.

“When I graduated from medical school, many of the current vaccines were either not yet invented or just beginning to be widely used. I still remember what health care was like in the pre-vaccine era, and I remember that there seemed to be at least one child in each neighborhood who spent much of her life in an iron lung because of polio. As a young resident in pediatrics, I heard, on the whooping-cough ward, the coughing and choking of children with pneumonia. I remember the brain damage from encephalitis caused by measles, and the birth defects of babies whose mothers had had German measles during pregnancy. In my first years in pediatric practice, I remember making hospital rounds every morning and treating children with meningitis, and complications of chicken pox and other illnesses that have been either eliminated or lessened in severity by the widespread use of vaccines. Also, I remember more than a decade ago when Great Britain temporarily stopped the routine use of the DTP vaccine because of a reaction scare (which later turned out to be a false alarm) and consequently suffered a resurgence of whooping cough. Because of my “historical” perspective, I have grown to appreciate the value of vaccines as a necessary public-health measure. Currently in our pediatric practice, we follow the vaccine schedule recommended by the American Academy of Pediatrics.”

Dr. William Sears on Ask Dr. Sears: Vaccination/Immunization Concerns

But I trained in the post-elimination era for measles.

Remembering Measles

Although some folks only seem to have the Brady Bunch to use as a guide, fortunately there are many other ways to discover what measles used to be like.

I asked some of my old instructors…

“Typical case of measles – a couple days of high fever, with a sick (miserable) looking kid with running nose, bad cough, and red eyes. You can see Koplik’s spots if you know to look for them on the buccal mucosa (I describe them as grains of salts on red tablecloth). Fever gets higher and rash appears at peak of fever (day 3-4). The rash disappears with a brawny hyperpigmented appearance. The child frequently gets diagnosed with an ear infection. If no complications (ear infection or pneumonia), recovery is quick once the fever resolves, but these kids look really sick, miserable, and sad during the acute phase. They have a measly look.”

Jeed Gan, MD

After reading that account, I’m glad my kids are all vaccinated and protected and hopefully won’t ever get measles, as it sounds horrible.

Although I have never seen it, I can certainly imagine that measly look…

A child with measles and four days of the classic measles rash.
A child with measles and four days of the classic measles rash. Photo by CDC/NIP/ Barbara Rice

What else can you imagine?

“I’ve often called measles ‘the harmless killer’ because, although most youngsters recover uneventfully, the disease a certain amount of really serious damage.”

Dr. Joseph Molner

Can you imagine intentionally leaving your kids unvaccinated and at risk of a harmless killer disease?

In this 1959 article in the Madera Tribune, Dr. Bundesen warns parents to take measles seriously.
In this 1959 article in the Madera Tribune, Dr. Bundesen warns parents to take measles seriously.

It is important to note that even a “mild” attack included a fever that could hit 104F or higher and, altogether the symptoms could last up to 12 days, as the cough often lingers after the rash has cleared up.

Measles is definitely contagious.
Measles is definitely contagious.

And in the pre-vaccine era, everyone ended up having measles, as it was so contagious.

Not everyone survived having measles though.

Even after improved sanitation and hygiene dropped mortality rates for measles and other diseases in the early part of the 20th Century, a lot of kids still died with measles.
Even after improved sanitation and hygiene dropped mortality rates for measles and other diseases in the early part of the 20th Century, a lot of kids still died with measles.

It was once well known that measles was not always so easy on kids.

1953 medical advice column
1953 medical advice column

Why have so many folks forgotten that fact?

Do you think that a 106F fever comes with a mild disease?
Do you think that a 106F fever comes with a mild disease?

Is it because vaccines work so well that we don’t see or hear about measles that much anymore?

Kids with measles feel awful.

At least we don’t hear about them until immunization rates drop and we start having more and more outbreaks.

Is that what it’s going to take to get you to vaccinate your kids? An outbreak in your city? Your child’s school? Or are you going to wait until your kids get sick?

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