Tag: Physicians for Informed Consent

Does Measles Protection from the MMR Vaccine Wane Over Time?

Why do some parents think that measles protection from the MMR vaccine might wane over time?

Yup – misinformation from the usual suspects.

Does Measles Protection from the MMR Vaccine Wane Over Time?

Wait, how can this be misinformation if they are citing a source and it is a study published by the CDC?

“The results, published in Archives of Pediatrics and Adolescent Medicine, show that even after being previously vaccinated twice for measles, about 35% of vaccinated 7-year-olds and 60% of vaccinated 15-year-olds are susceptible to subclinical infection with measles virus.”

Physicians for Informed Consent: CDC Data Shows Immunity from the MMR Vaccine Wanes Over Time

While that doesn’t sound good, that’s not what the study really says!

“A rise in the proportion of persons with low antibody levels suggests an increase in potential susceptibility, but low titers are unlikely to represent the same risk of illness or viral transmission as absent antibodies.”

LeBaron et al on Persistence of Measles Antibodies After 2 Doses of Measles Vaccine in a Postelimination Environment

They are clearly misinterpreting what the study does say and mean.

“In summary, we found that, in a population of children who had received 2 doses of measles vaccine at ages and intervals consistent with US policy and who were unlikely to have been exposed to wild-type measles, potential susceptibility rates were low for as long as 10 years after the second dose.”

LeBaron et al on Persistence of Measles Antibodies After 2 Doses of Measles Vaccine in a Postelimination Environment

The funny thing is that the study is about what happens to vaccine induced immunity in the absence of exogenous boosting.

In other words, what happens when vaccines get diseases under good control so that we are no longer exposed to wild disease which can give our antibody levels a little boost.

So they are highlighting a study that proves that vaccines work and fortunately, it concludes that “measles antibody persists,” even without exogenous boosting.

The other study they cite discusses a measles outbreak in Japan.

In the 2018 outbreak, 99 people got measles.

“A recent outbreak of measles in Okinawa Prefecture, Japan ended with 33 measles cases whose symptoms were masked because of insufficient protection against the disease (modified measles).”

Mizumoto et al on Transmission potential of modified measles during an outbreak, Japan, March‒May 2018

Only 10 were fully vaccinated with two doses of measles vaccine. An additional 20 had one dose.

“Symptoms in modified measles cases are masked, so they do not present with the full (typical) symptoms of measles (fever, maculo-papular rash and catarrhal symptoms such as cough, coryza or conjunctivitis) and their transmission risk is reported to be lower.”

Mizumoto et al on Transmission potential of modified measles during an outbreak, Japan, March‒May 2018

While many vaccines do lead to milder disease, even if the vaccine doesn’t provide full protection, we don’t typically see that with measles, except for rare case reports.

So instead of modified measles, it is possible that many of these folks were simply very recently vaccinated, likely in response to the outbreak, and were having a vaccine reaction.

Remember, measles containing vaccines do commonly cause a fever and rash as a side effect. That’s why we sometimes see vaccine strain measles in outbreak reports. These aren’t typically people with measles or modified measles.

“This case report adds further evidence for lower infectivity of modified measles with no secondary cases and highlights the potential requirement for updated contact tracing recommendations in this scenario. Other case reports have shown that individuals with modified measles and history of prior vaccination have more robust levels of plaque reduction neutralisation (PRN) titre, reflecting an immunity booster response. These case studies also identified no secondary cases. In measles outbreak reports in healthcare workers with two documented MMR vaccines, no onward transmission of measles has been reported.”

Uren et al on Modified measles with an atypical presentation

Still, although it would be better if vaccines prevented disease and you would get sick at all, when they don’t, isn’t a modified case better than getting full blown measles?

And the bottom line is that the so-called Physicians for Informed Consent is once again misleading people if they are trying to make them think that the MMR vaccine will wane and that “Nearly 50% of Vaccinated U.S. Schoolchildren Can Become Infected With and Spread Measles.”

The only school where you will find that nearly 50% of the kids are susceptible to measles is likely a Waldorf school. But that’s only because they won’t be vaccinated and protected.

More on Waning Immunity

Did the BMJ Have a Debate About the Risk of Dying from the MMR Vaccine Vs Measles?

We know the risks of dying from the MMR vaccine (extremely rare) vs measles (low), so why would there be a debate about this in the BMJ?

Even Peter Gøtzsche calls out the arguments of the Physicians for Informed Consent for being spurious and absurd.
Even Peter Gøtzsche calls out the arguments of the Physicians for Informed Consent for being spurious and absurd.

Oh, there isn’t…

You might think that there is because the so-called Physicians for Informed Consent issued a press release touting an electronic comment (a rapid response) to the editor of the BMJ.

Rapid responses are basically electronic letters to the editor, but anti-vaccine folks treat them like they are peer-reviewed articles that have gotten published in a medical journal.
Rapid responses are basically electronic letters to the editor, but anti-vaccine folks treat them like they are peer-reviewed articles that have gotten published in a medical journal.

Are dueling letter’s to the editor considered a debate?

Interestingly, even Peter Gøtzsche, who has raised concerns about HPV vaccines and who has never gotten a flu shot, thinks that Shira Miller’s arguments against the measles vaccine are spurious and absurd.

Maybe that’s why she has to use fake press releases to try and persuade folks that her ideas aren’t ridiculous.

Of course, that just more obviously marks them as anti-vaccine propaganda.

More on the Risk of Dying from the MMR Vaccine Vs Measles

Vaccine Induced Measles

Why are anti-vaccine folks still pushing the idea that vaccine induced measles is a thing?

This study is not about vaccine induced measles.
This study is not about vaccine induced measles.

In yet another example of anti-vaccine folks inappropriately using a real vaccine study, the ironically named Physicians for Informed Consent continues to push the idea that many measles cases are caused by the MMR vaccine.

Vaccine Induced Measles

They aren’t…

The study they are citing, Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR, simply talks about how to “distinguish between measles cases and vaccine reactions.”

“During measles outbreak investigations, rapid detection of measles vaccine reactions is necessary to avoid unnecessary public health interventions.”

Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR

While many of these people do test positive for a vaccine strain, they do not actually have measles. They typically just have a rash and/or fever, with a concern that they might have measles because they are in the middle of a measles outbreak.

But if they have a rash and fever and test positive for measles, even if it is a vaccine strain, why shouldn’t we just say that they have measles?

Because measles isn’t just about having a rash and fever. It is having a specific pattern of a high fever for 3 or 4 days, then developing a rash, and continuing to have a fever. People with measles also typically have other symptoms, including irritability, cough, coryza, and conjunctivitis.

Confirmed Case Counts in Measles Outbreaks

Still, since these measles vaccine reactions can get confused with real measles cases, do they inflate the measles case counts in our outbreaks?

Testing helps to make sure that only real cases of measles are included in outbreak case counts.
Testing helps to make sure that only real cases of measles are included in outbreak case counts.

They don’t.

While we occasionally do see a “confirmed” case later change as further testing is done, it is important to realize that most cases are thoroughly evaluated to see if they are in fact really measles.

Most case counts are made up of confirmed cases and don’t include suspected cases that might be someone who has a rash after their MMR vaccine or some other viral infection.

“Vaccine‐associated measles is a possible, but extremely rare event.”

Sood et al on Vaccine‐associated measles in an immunocompetent child

Anyway, vaccine induced or vaccine associated measles is extremely rare.

What about the fully vaccinated woman in New York who developed measles, getting four other people sick in 2011?

Didn’t she have vaccine induced measles?

Nope.

“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. “

Rosen et al on Outbreak of Measles Among Persons With Prior Evidence of Immunity, New York City, 2011

She had the D4 strain of measles – not a vaccine strain.

Who Gets Measles?

Most people who get measles are unvaccinated, often intentionally unvaccinated.

Trying to get you to think that many people in an outbreak have a vaccine strain is just another propaganda technique to scare you away from vaccinating and protecting your kids.

Don’t fall for it!

Two doses of MMR are the best protection against measles.

Vaccines are safe, with few risks, and they are obviously necessary.

More on Vaccine Induced Measles

Can You Treat Tetanus Without a Tetanus Shot?

Why would anyone want to try and treat tetanus without a tetanus shot?

That’s a good question…

Misinformation about tetanus from the PIC.

Why would a doctor tell others that tetanus could be treated without a tetanus shot?

That might be a question for a state medical board…

Can You Treat Tetanus Without a Tetanus Shot?

As most people will notice, even looking at the ironically named Physicians for Informed Consent’s own post, you don’t treat tetanus without a tetanus shot.

“Tetanus is a medical emergency requiring hospitalization, immediate treatment with human tetanus immune globulin (TIG), agents to control muscle spasm, aggressive wound care, antibiotics, and a tetanus toxoid booster. If tetanus immune globulin is unavailable, Immune Globulin Intravenous (IGIV) can be used.”

CDC on Tetanus for Clinicians

Even in the study that they used as a reference clearly used both tetanus immune globulin and a tetanus shot.

What might be confusing to some folks, is that tetanus toxoid, is synonymous (has the same meaning) as:

  • tetanus vaccine
  • tetanus shot
  • Td (tetanus toxoid + diphtheria toxoid)

So like most people with tetanus, this patient received both tetanus immune globulin and a tetanus vaccine, a fact I tried to point out so that visitors to Physicians for Informed Consent could get true informed consent about their vaccine choices.

The comment that got me banned from posting on Phyicians for Informed Consent.
As often happens on anti-vaccine sites, my comment was quickly deleted and I was banned from posting further messages.

And fortunately, the patient, who’s previous immunization history was unknown, got better!

Treating Tetanus With a Tetanus Shot

Why did he have tetanus?

The case they are talking about occurred in Japan, and again, it isn’t known if the patient had ever received a tetanus vaccine.

“In Japan, tetanus toxoid was introduced in 1968, so elderly adults who were born before 1968 have high risk of tetanus.”

Tomoda et al. on Tetanus without apparent history of trauma

He was born in 1950 and although he had no history of recent trauma, “he grew vegetables in a field as his hobby.”

As most people know, gardening is a risk factor for getting tetanus.

And with such a long incubation period, it is very likely that he had a minor wound or injury while gardening, was exposed to tetanus spores, and later developed tetanus symptoms.

Over 100 years ago, we did treat tetanus with just tetanus immunoglobulin, but that was before the tetanus vaccine was developed.
Over 100 years ago, we did treat tetanus with just tetanus immunoglobulin, but that was before the tetanus vaccine was developed.

The long incubation period is also the reason that giving a tetanus vaccine works to prevent you from getting tetanus even after you have been exposed. Tetanus spores have to germinate, the bacteria have to grow and then produce exotoxins. And then the exotoxins have to travel to different sites in your nervous system, where they act as neurotoxins.

Hopefully, before they do, the dose of tetanus vaccine you got when you pricked your finger on a thorn, stepped on a nail, or cut your leg, etc., will have already induced you to start making antibodies against the exotoxins – antitoxin. Just in case they don’t, in a high risk case, you also would have gotten a dose of tetanus immune globulin for an immediate dose of antitoxin – antibodies against the exotoxins.

The same thing happens if you have already developed tetanus symptoms. A dose of tetanus immune globulin helps to neutralize neurotoxins that haven’t already started doing damage, and you get supportive care until you recover. Plus antibiotics to kill the bacteria so they won’t make more exotoxins and a tetanus shot.

Why not just give tetanus immune globulin, as the post from Physicians for Informed Consent implied you can do?

It is mostly because a tetanus infection doesn’t stimulate any natural immunity and the immunity you get from tetanus immune globulin is temporary, so won’t prevent a relapsing or recurrent case.

Before the use of tetanus vaccines became standard, it was well known that tetanus relapses were possible.
Before the use of tetanus vaccines became standard, it was well known that tetanus relapses were possible.

And because no one would substitute a treatment that is known to work well, a tetanus vaccine with tetanus immune globulin, and switch it out for one that might be riskier and have no extra benefits.

Using immune globulin alone was once the recommended treatment. That was before the tetanus vaccine was developed though. Back then, in the late 19th century and early 20th century, folks with suspected tetanus got treated with anti-tetanic serum that was made in horses. The main problem with this tetanus antitoxin was that it could sometimes trigger serum sickness.

Fortunately, a tetanus vaccine was soon developed and it’s use with tetanus immune globulin helped make deaths from tetanus very rare.

Of course, tetanus is still around. Although it is a vaccine-preventable disease, it will never be eradicated, like smallpox.

“This case had no apparent portal of entry; there was no history of trauma, and no site was found on physical examination. However, this is not uncommon; no obvious entry site was reported in approximately 26% of cases in Japan.”

Tomoda et al. on Tetanus without apparent history of trauma

And not specific to Japan, that you can get tetanus without a history of trauma should be what really concerns folks in this article that the Physicians for Informed Consent has decided to spotlight.

It is a great reminder that vaccines are necessary.

More on Treating Tetanus Without a Tetanus Shot