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?

More on Remembering Measles

Fact Checking an Anti-Vaccine Measles Outbreak Quiz

Anti-vaccine folks have gotten pretty good at pushing propaganda to keep you scared to vaccinate and protect your kids.

Now, they even have quizzes to help test how much of that misinformation you remember!

Fact Checking an Anti-Vaccine Measles Outbreak Quiz

A quiz about measles outbreaks by the ironically named Physicians for Informed Consent was recently promoted by Dr. Bob Sears.

How did Dr. Bob get 12 out of 12 correct if most of the answers are really wrong?
How did Dr. Bob get 12 out of 12 correct if most of the answers are really wrong?

Let’s take a look at some of the questions and the anti-vaccine answers

There is only so much that better hygiene, sanitation, and nutrition can do, which is why about 400 to 500 people were dying of measles in the 1950s and early 1960s just before the first measles vaccines were developed.
There is only so much that better hygiene, sanitation, and nutrition can do, which is why about 400 to 500 people were dying of measles in the 1950s and early 1960s just before the first measles vaccines were developed.

While mortality rates did indeed decline for most diseases and conditions in the early part of the 20th century because of advancements in living conditions, nutrition, and health care, that effect had plateaued by the mid-1930s.

Being unvaccinated and unprotected is the main reason why people in underdeveloped countries die from measles, not low vitamin A…

It is true that vitamin A deficiency increases the risk for more severe complications and death from measles, which is why it can be more deadly in undeveloped countries where malnutrition is a big problem.

“Because of gaps in vaccination coverage, measles outbreaks occurred in all regions, while there were an estimated 110 000 deaths related to the disease.”

Measles cases spike globally due to gaps in vaccination coverage

Unfortunately, the other big problem in many of these countries is that these kids are unvaccinated because of a lack of access to vaccines.

This child doesn’t appear to have measles…

Immune globulin is a treatment option if you have been exposed to measles, but it is not actually a treatment once you have measles. And high dose vitamin A mainly benefits those with a vitamin A deficiency, which is unlikely in an industrial country, like the United States.

The only benefit of having measles, which you have to earn by having measles and surviving without complications, is that you will have developed immunity to measles.

In addition to having no other benefits, you will then be at risk for SSPE and may have wiped out your immune system for a few years.

While you are at risk for encephalitis and seizures after a natural infection, after getting a dose of MMR, one risk is a febrile seizure, which is typically thought to be benign.

The risk of having a febrile seizure after the first dose of the MMR vaccine is about 1 in 2,500 doses. There is also a small risk of having a febrile seizure if the flu vaccine is given at the same time as a Prevnar or DTaP vaccine.

It is important to note that vaccines are not the only reason that children have febrile seizures. Many infections, including vaccine preventable infections, can trigger febrile seizures, in addition to causing more serious types of non-febrile seizures.

This is not true.

It is very unlikely that any of the kids who develop febrile seizures after a vaccine will later develop epilepsy.

“Febrile seizures can be frightening, but nearly all children who have a febrile seizure recover quickly, are healthy afterwards, and do not have any permanent neurological damage. Febrile seizures do not make children more likely to develop epilepsy or any other seizure disorder.”

Febrile Seizures Following Childhood Vaccinations, Including Influenza Vaccination

Without any risk factors (parent or sibling with epilepsy, having complex febrile seizures, or abnormal development), a child with febrile seizures has the same risk of developing epilepsy has any other child.

Do anti-vaccine folks really read the inserts?

Like many other vaccines, the package insert for MMR does say that it has “has not been evaluated for carcinogenic or mutagenic potential, or potential to impair fertility.” That doesn’t mean that it hasn’t undergone safety studies for its potential to cause cancer, genetic mutations, and impaired fertility though.

Wait, what? Yeah, all vaccines have preclinical toxicology studies, including single and/or repeat dose, reproductive and developmental, mutagenicity, carcinogenicity, and safety pharmacology. If any issues are found, further studies are done.

The only way to think that a natural measles infection is safer than the MMR vaccine is if you believe that all reports to VAERS have been confirmed as being caused by the vaccine (they aren’t) and you don’t think about the fact that relatively few people get measles any more (so you don’t see or hear about many measles deaths) because most folks are vaccinated and protected!

How did you do on the quiz?

Did you easily spot all of the anti-vaccine propaganda?

More on Fact Checking an Anti-Vaccine Measles Outbreak Quiz

Did 79.4% of the Reported Child Deaths to VAERS Get a Vaccine on the Day They Died?

We know that reports to VAERS are unverified.

“When evaluating data from VAERS, it is important to note that for any reported event, no cause-and-effect relationship has been established. 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

They can’t be used to prove causality or definitively say that an adverse reaction or side effect was caused by a vaccine.

Did 79.4% of the Reported Child Deaths to VAERS Get a Vaccine on the Day They Died?

Still, it might be surprising to learn that in the majority of reports to VAERS about deaths in children, most had been vaccinated on the day they died.

Did 79.4% of the Reported Child Deaths to VAERS Get a Vaccine on the Day They Died?
The study is easy to find…

Is that true?

It’s actually not.

The idea for the statistic comes from a report, Deaths Reported to the Vaccine Adverse Event Reporting System, United States, 1997–2013, that was published in the 2015 issue of Clinical Infectious Diseases.

“No concerning pattern was noted among death reports submitted to VAERS during 1997–2013.”

Moro et al on Deaths Reported to the Vaccine Adverse Event Reporting System

Wait.

How do we get to “no concerning pattern was noted” to 79.4% of the kids were vaccinated on the day they died?

“For child death reports, 79.4% received >1 vaccine on the same day.”

Moro et al on Deaths Reported to the Vaccine Adverse Event Reporting System

All the report is saying is that for kids who were vaccinated, 79.4% of them received more than one vaccine on the same day. It wasn’t the day they died though.

That kids would get more than one vaccine on the same day isn’t surprising. Few parents skip or delay vaccines so much that they just get one shot at a time.

“In our VAERS review, we did not detect any concerning patterns that would suggest causal relationships between vaccination and deaths.”

Moro et al on Deaths Reported to the Vaccine Adverse Event Reporting System

If anything, this report confirms that vaccines are safe and with few risks.

“The number of death reports in children exceeded those in adults in all years, and in both groups the number of reports has decreased in recent years.”

Moro et al on Deaths Reported to the Vaccine Adverse Event Reporting System

It is surprising that anti-vaccine folks would use it to try and scare folks away from vaccinating and protecting their kids.

More on Deaths Reported to VAERS

Behind the Curtain of the Anti-Vaccine Movement

Ever wonder what anti-vaccine folks talk about?

How they do their research?

Behind the Curtain of the Anti-Vaccine Movement

Here you go!

How do you argue the point that vaccines killed off all of the diseases?
That seems like a reasonable question…

There is a good reason that folks have a hard time arguing this point.

Vaccines work.

But let’s see how they do…

It is with her summary that says you can treat cancer naturally and without chemotherapy.
It is with her summary that says you can treat cancer naturally and without chemotherapy.

The idea that we simply renamed diseases to make them disappear has to be the silliest anti-vaccine claim that you will hear. If that’s true, why not come out with an RSV vaccine or an HIV vaccine and rename those diseases?

If smallpox was renamed to monkey pox, then where are all of the kids with monkey pox?
If smallpox was renamed to monkey pox, then where are all of the kids with monkey pox?

The idea that better hygiene, sanitation, and good nutrition made now vaccine-preventable diseases go away is a very good theory, because those things did actually improve the mortality rates for most things in the early part of the 20th century. Unfortunately, those effects plateaued by the 1930s.

When my uncle got polio in Brooklyn in the early 1950s, our family and access to very good hygiene, sanitation and nutrition. It didn’t help. Remember, a lot of people were still dying at the time from polio, pertussis, diphtheria, and measles.

It was vaccines.

Actually, it’s the charts and graphs with declining mortality rates from better hygiene and sanitation in the early 20th century that anti-vaccine folks can use to fool folks into thinking that vaccines don’t work. If they actually look at disease rates, with a few exceptions, they will see that they were mostly unchanged.

Charts with mortality rates won't prove their point, but are their only chance to fool folks. They have no chance if they use disease rates...
Charts with mortality rates won’t actually prove their point, but are their only chance to fool folks. They have no chance if they use disease rates

This is actually an interesting idea. Do viruses and bacteria become attenuated or less dangerous over time? Considering that smallpox was around for thousands of years and was still deadly right up until it was eradicated, in general, there is plenty of evidence against this idea. You can also look at polio, which still paralyzing people.

Scarlet fever has become less dangerous, but no evidence that many other diseases have over time.
Scarlet fever has become less dangerous, but no evidence that many other diseases have over time.
Sanitation, plumbing, clean food, hygiene worked to get rid of diseases - anything but vaccines...
Anything but vaccines…

This is another silly idea. It implies that vaccines actually cause outbreaks of vaccine-preventable disease. If this were true, then as we have been vaccinating more and more people, wouldn’t rates for all of these diseases have been going up over the years? And how did we eradicate smallpox? How are we so close to eradicating polio?

Then why do we see outbreaks in clusters of folks who are mostly intentionally unvaccinated.

Instead, we see outbreaks in clusters of folks who are mostly intentionally unvaccinated and no, it’s not just during “shedding season.”

Witch's brew of vaccines?
Again, anything but vaccines…

Do you really believe that ‘they’ are purposely “releases (sic) these diseases again, to cause hysteria, to get people back in their corner vaccinating again?”

It's a conspiracy! Big Pharma!!!
It’s a conspiracy! Big Pharma!!!
Vaccines are not killing people.
And yet, life expectancy and infant mortality rates are going up…

We know why they are coming back… It ain’t magic.

Are you prepared to argue their point now?

Did they convince you that we renamed diseases, flushing toilets and clean water got rid of all diseases, vaccines cause outbreaks, or that all of the diseases we developed vaccines for just naturally got milder and went away?

Or did they convince you to go out and vaccinate and protect your kids?

More on Behind the Curtain of the Anti-Vaccine Movement