Tag: Philippines

Why Do Anti-Vax Folks Get Excited About Polio Outbreaks?

At least two things happen whenever we hear about a new polio outbreak. And yes, I said polio outbreak.

One is that many people assume it is wild polio and that we are moving further away from finally eradicating polio.

Hopefully folks understand that polio outbreaks wouldn't just stop if we stopped vaccinating...
Hopefully folks understand that polio outbreaks wouldn’t just stop if we stopped vaccinating…

And the other?

Anti-vax folks assume that it is an outbreak of vaccine strain polio and very wrongly use this as a reason to try and scare parents away from vaccinating and protecting their kids.

“The polio outbreak in the Philippines is confirmed to be from a circulating vaccine-derived poliovirus type 2. This is of particular concern, as wild poliovirus type 2 was certified as globally eradicated in 2015. Poorly conducted immunization activities, when too few children have received the required three doses of polio vaccine, leave them susceptible to poliovirus, either from vaccine-derived or wild polioviruses. Full immunization protects them from both forms of the virus.”

WHO, UNICEF and partners support Philippine Department of Health’s polio outbreak response

As expected, that’s the response we are seeing from anti-vax folks to news of the latest outbreak of polio in the Philippines.

Why Do Anti-Vax Folks Get Excited About Polio Outbreaks?

But isn’t bad that the polio vaccine can actually cause outbreaks?

Of course!

No one wants people to get sick after getting vaccinated. And that’s why we are moving towards stopping the use of the oral polio vaccine that causes vaccine derived polio.

It is also very important to consider the alternative. A lot more people getting wild polio!

“As recently as 30 years ago, wild poliovirus paralysed more than 350,000 children in more than 125 countries every year. In 2018 there were fewer than 30 reported cases in just two countries – Afghanistan and Pakistan.”

“Zero polio transmission and health for all”, WHO Director-General gives new year’s wish to the people of Afghanistan and Pakistan

We also need to remember the reason we typically see outbreaks of vaccine strain polio. It is because vaccination rates have dropped in an area!

Wait, what?

Yes, that’s right. The polio vaccine, in addition to protecting you from wild polio can prevent you from getting the vaccine strain polio too.

But isn’t the polio vaccine causing many more cases of polio than the actual polio virus?

Bob Sears recently shared an article that was two years old about mutant strains of polio causing outbreaks

It once was, but that’s simply because we are getting very close to eradicating polio and there were fewer cases of wild polio!

While there were far more cases of vaccine derived polio than wild polio last year, there were more cases of wild polio earlier in 2019 and it is now about even.

Tragically, we are starting to see more and more cases of wild polio.

Science event in Washington, D.C. reminding folks that Vaccines Work.
Pediatricians at the March for Science event in Washington, D.C. reminding folks that Vaccines Work.

Still, we are no where near the numbers of cases of polio and kids getting paralyzed when polio was epidemic in most countries.

And the outbreaks of vaccine derived polio?

They demonstrate what happens when we don’t keep up our immunization rates. And how anti-vax folks either don’t understand or intentionally try to misinform parents about how vaccines work.

More on Polio Outbreaks

Dengvaxia for Dengue Fever

Dengvaxia was recently approved by the FDA after being available in other countries since about 2015.

“Indicated for the prevention of dengue disease caused by dengue virus serotypes 1, 2, 3 and 4. DENGVAXIA is approved for use in individuals 9 through 16 years of age with laboratory-confirmed previous dengue infection and living in endemic areas.”

Wait.

Dengue is endemic throughout the tropics and subtropics, including most of the Caribbean.
Dengue is endemic throughout the tropics and subtropics, including most of the Caribbean.

It’s only for people who have already had a dengue infection before?

Dengvaxia Controversy

Unfortunately, Dengvaxia “performs differently in seropositive versus seronegative individuals.”

“In areas of 70% dengue seroprevalence, over a 5-year follow-up, for every 4 severe cases prevented in seropositive, there would be one excess severe case in seronegative per 1,000 vaccinees; for every 13 hospitalizations prevented in seropositive vaccinees, there would be 1 excess hospitalization in seronegative vaccinees per 1,000 vaccinees.”

WHO on Questions and Answers on Dengue Vaccines

If you have never had dengue before and you are vaccinated, you are at risk for a severe infection if you do get dengue. On the other hand, if you are unvaccinated, you are at even greater risk of getting dengue, a life-threatening infection. Fortunately, the first episode of dengue is usually fairly mild.

The problem occurs if your antibody levels have dropped enough, which can cause you to have a severe case of dengue the second time. The process is called antibody-dependent enhancement and has to do with antibody levels, either natural or vaccine induced. So it can occur whether or not you are vaccinated, although getting Dengvaxia, an attenuated, live vaccine, can act as a primary dengue infection.

“These differing epidemiological features support the conclusion that antibody dependent enhanced (ADE) dengue disease occurred in seronegatives who were sensitized by vaccine. As hospitalizations continue to occur in all age groups Dengvaxia consumers should be warned that sensitized vaccinated seronegatives will experience enhanced dengue disease into the forseeable future.”

Scott Halstead on Dengvaxia sensitizes seronegatives to vaccine enhanced disease regardless of age.

It is something that dengue researcher Scott Halstead warned folks about as soon as he saw the first published study on Dengvaxia.

But why would you need a vaccine if you have already had dengue?

“In humans recovery from infection by one dengue virus provides lifelong immunity against that particular virus serotype. However, this immunity confers only partial and transient protection against subsequent infection by the other three serotypes of the virus. Evidence points to the fact that sequential infection increases the risk of developing severe dengue.”

WHO on Dengue control

There are four serotypes of dengue.

So if you aren’t vaccinated, you are at risk to get dengue multiple times.

Tragically, about 800,000 children in the Philippines were given Dengvaxia in a universal immunization program without checking to see if they had dengue first. And it likely led to some severe cases of dengue and deaths. This led to the vaccine being banned in that country and is thought to be one of the causes behind their current measles outbreak, as their Dengvaxia controversy led to more vaccine hesitancy.

And it will lead to more folks getting dengue. Instead of a ban, they should likely be more picky about who they give the vaccine to, either confirming that recipients have already had dengue (titer test) or only giving the vaccine to older kids.

Dengvaxia for Dengue Fever

Do you need Dengvaxia?

Remember, Dengvaxia is only for those living in endemic areas and in the United States, dengue is only endemic in the U.S. territories of American Samoa, Guam, Puerto Rico, and the U.S. Virgin Islands.

Do you need Dengvaxia if you are simply traveling to one of these areas?

Since Dengvaxia is not approved for those who haven’t had a dengue infection before, you likely wouldn’t get it just for traveling to an endemic area, unless perhaps you routinely travel to an endemic area and have had dengue already. A titer test can confirm a previous dengue infection, but there is no indication to get vaccinated for travel yet.

Also, while in other countries it is available for use between 9 and 45 years, in the United States, Dengvaxia is only approved for children between 9 and 16 years of age.

More on Dengvaxia for Dengue Fever

Where Is Measles on the Rise?

We have been hearing a lot about ongoing measles outbreaks in the United States this year.

Brooklyn. Rockland County. The Pacific Northwest.

Think 2018 was a big year for measles? It was the second highest number of cases since 1996.

How will 2019 shape up?

Consider that it isn’t even the end of January yet is only May and we have already had more cases, 74 92 273 900+, than we had any years since 1994.

Not surprisingly, this isn’t just happening in the United States.

Where Is Measles on the Rise?

In fact, if you understand that the endemic spread of measles was eliminated in the United States in 2000 and that outbreaks are started by folks with measles who travel in or out of the country, then it makes sense that more measles here likely means that there is more measles somewhere else.

Unfortunately, this year, that somewhere else seems to be just about everywhere.

Japan is off to the fastest start in 10 years, with 486 cases so far this year, surpassing 2009, when they ended up with over 700 cases.
Japan is off to the fastest start in 10 years, with 486 cases so far this year, surpassing 2009, when they ended up with over 700 cases.

Are you planning a trip to Europe anytime soon?

With so many measles cases in Europe, it shouldn’t be a surprise to anyone that there are so many deaths.

You should know that their measles outbreaks aren’t over. There are ongoing outbreaks in France, Lithuania, Poland, Romania, Bulgaria and Germany.

“Between 1 April 2018 and 31 March 2019, 30 EU/EEA Member States reported 11 383 cases of measles, 8 396 (74%) of which were laboratory-confirmed. None of the countries reported no cases. The highest number of cases were reported by Italy (2 107), France (2 028), Romania (1 390), Greece (870), United Kingdom (860), Poland (828), Germany (733) and Slovakia (714)…

Twenty-two deaths attributable to measles were reported to TESSy during the 12-month period in Romania (14), Italy (5), France (2) and Greece (1).”

Monthly measles and rubella monitoring report May 2019

Where else are we seeing measles?

  • at least 4,100 cases in Israel, 2 deaths, and a case of encephalitis since 2018, with the majority of cases in Jerusalem, Beit Shemesh, Safed, and Betar Illit
  • over 31,056 cases and 415 deaths in the Philippines (2019)
  • nearly 2,000 cases in Vietnam (2018) and cases are increasing in Hanoi and Ho Chi Minh City already in 2019
  • in Madagascar, as of 3 of April there were 122,840 registered cases, and 1,233 reported deaths
  • at least 517 confirmed cases in the UK (through the 3rd quarter of 2018)
  • India remains the country with the most cases, with over 65,600 cases in 2018
  • a large outbreak in Thailand, with at least 4,327 cases and 4 deaths
  • an ongoing outbreak in Malaysia with over 1,934 cases and 6 deaths (2018)
  • an outbreak in Myanmar with over 1,300 cases and one death
  • at least 79 cases in the Republic of Korea (2019)
  • Ukraine continues to see a lot of cases, over 24,000, and some deaths
  • over 2,200 cases in Russia
  • Australia – 102 cases (2019)
  • Canada – 45 cases (2019)
  • outbreaks in Yemen, Nigeria, Sudan, and DR Congo
Conflict zones plus vaccine hesitancy contribute to measles outbreaks in the Philippines.
Conflict zones plus vaccine hesitancy contribute to measles outbreaks in the Philippines.

And over 16,000 confirmed measles cases, including 86 deaths, were reported in 12 countries of the Region of the Americas in 2018: Antigua and Barbuda (1 case), Argentina (14 cases), Brazil (9,898 cases, including 13 deaths), Canada (29 cases), Chile (2 cases ), Colombia (171 cases), Ecuador (19 cases), Guatemala (1 case), Mexico (5 cases), Peru (38 cases), the United States of America (350 cases), and the Bolivarian Republic of Venezuela (5,643 cases, including 73 deaths).

So far this year, cases have been reported from Argentina, the Bahamas, Brazil, Canada, Chile, Colombia, Costa Rica, Mexico, the United States of America, and the Bolivarian Republic of Venezuela.

Does it seem like measles is on the rise everywhere?

That’s because it basically is.

Since 2017, there has been a measles resurgence in three regions of the world and measles elimination milestones have not been met.

And as you can see, in almost all of these places where we are seeing more measles, we are seeing more people dying of measles?

That’s why it is important to get vaccinated.

There is even a recommendation to get an early MMR if you will be traveling out of the United States. Get vaccinated. Don’t bring home measles and start an outbreak.

More on the Resurgance of Measles

Updated May 17, 2019