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CLINICAL REVIEW: Ravindra K Gupta, Jennifer Best, and Eithne MacMahon Mumps and the UK epidemic 2005 BMJ 2005; 330: 1132-1135 [Full text]

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Competing interest

John Stone   (13 May 2005)

Mumps epidemic and immune dysfunctions

Ellen C G Grant   (14 May 2005)

Mumps

Magda Taylor   (14 May 2005)

unusually, an interesting question is posed

Adrian K Midgley   (17 May 2005)

Re: unusually, an interesting question is posed

MAGDA TAYLOR   (19 May 2005)

Re: unusually, an interesting question is posed

Graeme Johnston   (20 May 2005)

Re: Re: unusually, an interesting question is posed

L S Lewis   (20 May 2005)

Re: Re: unusually, an interesting question is posed

MAGDA TAYLOR   (21 May 2005)

Re: Re: unusually, an interesting question is posed

John P. Heptonstall   (21 May 2005)

Re: Re: Re: unusually, an interesting question is posed

John P. Heptonstall   (21 May 2005)

Re: Re: Re: unusually, an interesting question is posed

Bronwyn Hancock   (21 May 2005)

Mumps dissent

Mark Struthers   (23 May 2005)

Re: Competing interest

Jennifer M BEST   (23 May 2005)

False Government Mumps Scare Stories

Clifford G. Miller   (24 May 2005)

Re: Re: Re: Re: unusually, an interesting question is posed

Peter Flegg   (24 May 2005)

Re: Re: Competing interest

John Stone   (24 May 2005)

The Cost of a Rubella Outbreak Would be More than Just Financial

Tony Floyd   (25 May 2005)

H.influenzae Clarification

SM Pearce   (25 May 2005)

Re: Mumps and Rubella

Jennifer M Best, Ravindra K. Gupta, Eithne MacMahon   (25 May 2005)

Re: Re: Mumps and Rubella

John Stone   (26 May 2005)

Re: False Government Mumps Scare Stories - Reprise

Clifford G Miller   (26 May 2005)

False Government Mumps Scare Stories - (Reply to Jennifer Best)

Clifford G. Miller   (26 May 2005)

Re: Re: Re: Re: Re: unusually, an interesting question is posed

John P. Heptonstall   (31 May 2005)

False Government Rubella Scare Stories - Only 20,000 Percent Overstated

Clifford G. Miller   (1 June 2005)

Re: Re: Re: Re: Re: Re: unusually, an interesting question is posed

Peter Flegg   (1 June 2005)

Re: Re: Re: Re: Re: Re: Re: unusually, an interesting question is posed

John P. Heptonstall   (2 June 2005)

Re: False Government Rubella Scare Stories - Only 20,000 Percent Overstated

Louis Z Cooper   (3 June 2005)

Re: Re: Re: Re: Re: Re: Re: Re: unusually, an interesting question is posed

Peter Flegg   (3 June 2005)

False Government Rubella Scare Stories - Reply to Professor Louis Z Cooper

Clifford G. Miller   (6 June 2005)

Re: Re: Re: Re: Re: Re: Re: Re: Re: unusually, an interesting question is posed

John P Heptronstall   (16 June 2005)

Re: The Cost of a Rubella Outbreak Would be More than Just Financial

Tony Floyd   (19 June 2005)

Re: Re: The Cost of a Rubella Outbreak Would be More than Just Financial

John P Heptonstall   (20 June 2005)

False Government Rubella Scare Stories - Now 300,000 Congenital Rubella Cases!

Clifford G. Miller   (20 June 2005)

Re: Re: Re: The Cost of a Rubella Outbreak Would be More than Just Financial

Tony Floyd   (30 June 2005)

Re: False Government Rubella Scare Stories - Now 300,000 Congenital Rubella Cases!

Peter Flegg   (30 June 2005)

Re: The Cost of a Rubella Outbreak Would be More than Just Financial

Theo H Fenton   (30 June 2005)

Rubella Scares - Demonstrating the Figures are False

Clifford G. Miller   (11 August 2005)

Roseola is Confused with Rubella

Clifford G. Miller   (11 August 2005)

Mumps and Hospital Contacts

Monique I Andersson, Peter Muir, David Carrington, Phillipa Moore, Sue Hunt, Matthew Donati   (30 August 2005)

Re: Mumps and Hospital Contacts

John P Heptonstall   (1 September 2005)

Competing interest 13 May 2005
John Stone, none London N22 Send response to journal: Re: Competing interest	The Division of Immunology, Infection and Inflammatory Diseases (DIIID), Guy's, King's and St Thomas's School of Medicine, has received grants from GlaxoSmithKline and Aventis, defendants in the MMR case [1]. [1][1] Annual Report p.7: http://www.kcl.ac.uk/depsta/medicine/divisions/diiid/DIIIDAnnualReport.pdf Competing interests: Parent of an autistic child
Mumps epidemic and immune dysfunctions 14 May 2005
Ellen C G Grant, physician Kingston-upon-Thames, KT2 7JU, UK Send response to journal: Re: Mumps epidemic and immune dysfunctions	Why is all the focus on the adverse effects of mumps in the unvaccinated rather than what is needed to confirm a well-functioning immune system which theoretically would protect against the risk of either viral encephalitis or vaccine-induced complications? Why is verification and correction of deficiencies of zinc and copper, or other essential nutrients, regarded as esoteric? Why are young girls encouraged to take immuno-suppressive progesterones? Why is tobacco smoking and alcohol drinking so prevalent among the young? Competing interests: None declared
Mumps 14 May 2005
Magda Taylor, Director The Informed Parent, P O Box 4481,Worthing, BN11 2WH Send response to journal: Re: Mumps	So now the threat of measles epidemics is taking a rest, mumps is in the spotlight. It is interesting that there is now so much concern and fear being promoted about mumps, if it is so bad then why did it not become a notifiable disease until 1988? Cases of measles, whooping cough, diphtheria, for example, were reported from the mid 1800s - why not mumps? Upto the introduction of MMR the majority of parents were not too worried about a case of mumps, it was mostly viewed as a benign childhood infection. However as soon as the MMR came into use, mumps suddenly became a more dangerous illness with a list of complications. All illnesses have the potential to lead to complications, but this is rare, and due to the state of health of the individual, ie their lifestyle, diets, physical and emotional stability etc., and also the mismanagement of the disease. If the illness is left to run it's course, without suppression, a reasonably healthy child will sail through mumps, as they would with measles and rubella. Mumps was known as a CHILDHOOD illness, and this would be the normal and appropriate time to be developing such a disease. Now it is occurring in UNDER immunised young adults, which seems to be another problem caused by vaccination programmes - shifting the age of incidence to an inappropriate time. So the push to give them another dose of MMR is presented as the answer. How many doses will be necessary before they will be classed as sufficiently immunised? And how will the authorities know, when even the world health experts of the day do not even fully understand immunity, it is certainly not simply about levels of antibodies. If, as the authors state, 'People born before 1982 are not susceptible, with up to 98% seropositivity rates, owing to early natural infection in the pre-MMR era,'then it appears that the MMR has not improved the situation, but instead may have suppressed the child's ability to develop mumps leading them to become susceptible as a young adult instead. Hardly an achievement! Competing interests: None declared
unusually, an interesting question is posed 17 May 2005
Adrian K Midgley, GP, Exeter EX1 2QS Send response to journal: Re: unusually, an interesting question is posed	Although as usual, it is posed as an attack. The question of course is better phrased as:- "Why was Mumps made a notifiable disease in 1988". Assuming it was, and not in 1989, and noting that Mumps vaccines had been around since 1948 so to present it as simply following the introduction of a vaccine would be over simplistic, it does point up something about the presentation of official information on the Web. I suspect that the answer to the question is fairly simple, that this was the time when someone considered infectious diseases, and decided that this particular one was sufficiently serious; that other notifiable diseases were now at sufficiently low rate not to create an unreasonable burden in reporting them, and for the reports to lead to something actually being done about outbreaks or cases; and that therefore it could and should be added tot eh list. This is conjecture. Since the Freedom of Information Act of course such conjectures can be answered, by asking for official documents relating to them from the Department of Health (www.dh.gov.uk) or more prosaically but perhaps less satisfyingly to conspiracists by asking one of the still living people involved in the decision what particularly brought them to that decision. I don't know any of them, but probably some of them still read the BMJ or know people who do. Since the Web of course, documents that announce that a disease is notifiable could quite reasonably be expected to have a link to such obvious questions' answers. But in the end, the answer is going to be "because it seemed sensible". And it does. Competing interests: None declared
Re: unusually, an interesting question is posed 19 May 2005
MAGDA TAYLOR, Director of The Informed Parent P O Box 4481, Worthing, West Sussex, BN11 2WH Send response to journal: Re: Re: unusually, an interesting question is posed	My question was simply a question. And there was no assuming about when mumps was made a notifiable disease, it was published in the Department of Health book 'Immunisation against Infectious Disease'- 'Mumps was made a notifiable disease in the UK in October 1988.'(Page 52, 1990 edition.) As regards to a mumps vaccine being around since 1948, stated in Dr Midgley's Rapid response. In 'Vaccines' by Plotkin and Mortimer 1994 edition, it states: An experimental inactivated vaccine developed in 1946 was tested in humans in 1951.' There appears to be no further discussion on that particular vaccine, and the text then leads to 1967 when a live virus mumps vaccine was introduced in the USA. Interestingly enough it states that following the introduction of this vaccine that: 'the number of reported mumps cases in the United States decreased steadily, from 152,000 cases in 1968, to 2982 cases in 1985, a record. However, this downward trend was reversed in 1986-1987, when a relative resurgence of mumps occurred in the United States. The resurgence appears to have been the result of incomplete vaccination coverage of adolescents and young adults in the years following the introduction of the live virus vaccine, In 1991, 4264 cases of mumps were reported, a 67% decrease from 1987; this total still EXCEEDS the number of cases reported annually between 1983 and 1985.' (My emphasis.) If one looks at all these childhood infectious diseases these declines were occurring regardless of when vaccination programmes were introduced. Measles, whooping cough, diphtheria are fine examples of this. Both the morbidity and mortality were in major decline well BEFORE vaccines were introduced, and had mumps been notifiable at an earlier time no doubt the same trend would have followed. Interestingly, another point to note is that the textbook description of mumps in the pre-vaccine era was not alarmist, unlike its present day description. For example in The MacMillan Guide to Family Health, 1982 edition, it simply runs through the general description, with lines such as 'Mumps is generally a mild disease. The usual outcome is complete recovery within about 10 days.' Even regarding orchitis, it comments that this is more common in adults and that invariably the swelling goes down after a few days leaving no after effects, and that it is excessively rare for the swelling to cause sterility. And as I remarked in my previous Rapid Response complications are more likely to occur from the general healthstyle of the individual or the mismanagement of the illness. As regards to 'satisfying conspiracists' I always find it puzzling that when anyone starts asking simple questions or making valid points, suddenly they become conspiracists. I am not interested in conspiracies, I prefer to study a subject in depth, which in turn provokes further questions. And to broaden my knowledge I like to ask questions. Why?...because it seems sensible, and it is! Competing interests: None declared
Re: unusually, an interesting question is posed 20 May 2005
Graeme Johnston, Student MK7 6AA Send response to journal: Re: Re: unusually, an interesting question is posed	Most people know that the alleged risk of mumps causing sterility is largely an "old wives tale". However, mumps can cause meningitis -- and mumps was therefore quite a common cause of permanent deafness before the vaccine was widely used. Magda Taylor asserts that "complications are more likely to occur from the general healthstyle of the individual or the mismanagement of the illness". How does she recommend that a patient with mumps avoids the complication of deafness? And what instructions would she give his/her doctor? Incidentally, although mumps may have become less common before the vaccine was introduced, the graphs on pages 129-131 of the 1996 Green Book are impressive. Competing interests: None declared
Re: Re: unusually, an interesting question is posed 20 May 2005
L S Lewis, GP Surgery, Newport, Pembrokeshire, SA42 0TJ Send response to journal: Re: Re: Re: unusually, an interesting question is posed	Magda, Your responses are perfectly reasonable enquiries, and your information is impressive. Unfortunately this whole vaccine debate is now besmirched with stereotype, prejudice, conspiracy-theory and unreason, yet your contribution showed none of these. I agree that many diseases were in decline before Vaccination was introduced. The great example we are all taught at Medical School was that of TB, which had been declining long before effective antibiotics and BCG vaccination were developed. But as the Department of Health book 'Immunisation against Infectious Disease' shows, in it's many graphs - that is not a reason to doubt the considerable contribution of vaccination as an added value.. Whooping Cough resurgence, and subsequent suppression is a good case in point. I have always felt that the authoritarian stance on vaccines taken by the DH has been a major political mistake. Separate vaccines should have been permitted, as should parental choice. That way the conspiracists on both sides would have been marginalised. The DH now sees the upsurge in Mumps to be a vindication of it's beliefs, and presses for more MMR vaccination in adults. I'm happy with the evidence-base for this - if that's what the patient wants ! But in my area I find that many of the teenagers now getting Mumps have actually had the MMR 10-15 years ago, unlike their parents who have lifelong immunity from Mumps infection in childhood. This raises the interesting questions:- 'How long does MMR immunity last ?' 'How often will it need to be repeated ? ' 'Might it be better to encourage wild mumps in childhood ? ' The harms of Mumps meningitis, rather than Orchitis, would be more relevant to my mind. The fact that Mumps is now notifiable will considerably assist in coming to a reasoned response. Yours sincerely, Dr Sam Lewis. Competing interests: I get paid to vaccinate children as a GP
Re: Re: unusually, an interesting question is posed 21 May 2005
MAGDA TAYLOR, Director of The Informed Parent P O Box 4481, Worthing, West Sussex, BN11 2WH Send response to journal: Re: Re: Re: unusually, an interesting question is posed	Firstly, in response to Graeme Johnston's comments. 'Most people know that the alleged risk of mumps causing sterility is largely an "old wives tale".' Unfortunately most parents of today do not know that this is largely an "old wives tale", as this is one of the reasons given to them as to why they should have their children vaccinated. And because this sounds very worrying it has created a fear of mumps. Graeme J. then comments: 'However, mumps can cause meningitis -- and mumps was therefore quite a common cause of permanent deafness before the vaccine was widely used.' Interestingly enough I asked Dr Mike Watson of Aventis Pasteur, about mumps meningitis as the issue was raised in a live Radio 4 discussion (2000) of which I was present. In 1992 two brands of the MMR used in the UK were withdrawn due to the mumps component causing mumps meningitis. However in the mid 1990s one of the withdrawn brands was supplied to the Brazilian health authority to vaccinate the Brazilian children. This vaccine campaign resulted in a high number of cases of mumps meningitis occurring. When this was pointed out to Dr Watson he reacted as if it was no big concern, and said that mumps meningitis was a severe headache that would resolve itself without any treatment, and had no long term consequences. I also pointed out to Dr Watson, after the programme, that it is interesting that one minute mumps meningitis is a dangerous complication of mumps infection, but when the vaccine causes it, then it is only a bad headache. As I have said in my last two responses complications of any nature for any of these childhood infections are due to poor health or mismanagement, ie suppressive treatments. If there are cases resulting in complications then one would need to know full details of the case to be able to understand why the complication has occurred. Graeme then states: 'Magda Taylor asserts that "complications are more likely to occur from the general healthstyle of the individual or the mismanagement of the illness". How does she recommend that a patient with mumps avoids the complication of deafness? And what instructions would she give his/her doctor?' I do not recommend patients since I am not a health practitioner. I do however read widely on health and have a particular interest in naturopathic philosophy, and I have found using naturopathic methods in dealing with various ailments for myself and my family have been very successful. One particular book I have often referred to is from the 1930s 'The Hygienic Care of Children' by Dr Herbert Shelton. His suggestion for the care of a patient with mumps is: Rest in bed with warmth until the temperature is normal and the swelling is gone will hasten recovery. No food and no drugs should be given. There is nothing to the popular superstition that acids should not be taken during this time and if the child refuses to fast, orange or grapefruit juice may be used. As soon as the swelling has subsided fruit may be fed three times a day for the first three days, after which a gradual return to a normal diet may be made. 'Hygienic' care will prevent complications, but if these have developed before this care is instituted, the fast should continue until all swelling and pain are gone.' I have not nursed a case of mumps myself, (I did have mumps myself in my childhood and sailed through it) but I have nursed chickenpox cases, and a severe case of tonsillitis. I used a very similar method for the tonsillitis case and it was extremely successful and the whole illness was over in 12 days. There was never any reoccurrence, and I did not go to the doctors, and I did not use any antibiotics. And in response to how do I instruct my doctor - I rarely go to the doctors, I have not been for a number of years for either myself or my children. But if I did feel the need to go then I would not be instructing anybody I would simply go for a possible diagnosis or to discuss possible ways of dealing with the situation. The graphs in the Green Book do indeed look impressive but I find them limited. With the mumps meningitis graph - fortunately there were low numbers in the period indicated, but why were these cases occurring in the first place, what were the circumstances of those cases? How reliable are laboratory confirmed cases? Sometimes certain so-called 'disease-causing' microbes can not be isolated in a patient, and in other situations individuals can be 'infected' with microbes and yet not display any symptoms of disease. Interesting that from 1988 -1992 the age group receiving the MMR were developing more cases than the >4 year olds, you might have expected it to be the other way round. Also interesting that the mumps meningitis suddenly stops in 1992, the same year the two brands of MMR were withdrawn. Maybe all those cases from 1988 were caused by the vaccine? It is a pity that the immunisation status of the cases is not included in this data. The other graph 'Annual incidence of mumps infections'is questionable, since mumps was not a notifiable disease until 1988, so how accurate are the figures pre-1988? As there is no reason why mumps infection would have behaved differently to other childhood infections then the number of cases would have been in decline anyway. Also absence of certain diseases after vaccination may not indicate health. Suppression of acute disease can lead to chronic conditions, so a rise may be observed elsewhere in other more chronic and long-lasting conditions. Additionally, measles, whooping cough, scarlet fever, diphtheria showed very similar trends in decline of cases and severity, from the mid-1800s to the present day, so if mumps had been notifiable then it is likely that mumps would have behaved in the same manner, regardless of vaccination. The Role of Medicine by Thomas McKeown is a useful source for looking at the morbidity and mortality of infectious diseases. In response to Dr Lewis, I would also urge him to look at further graphs that cover much greater periods of time for the various diseases. The outbreak in 1970s of whooping cough is often used as a fine example of the need to vaccinate. However there is a great amount of literature that highlights many aspects not included in the health department literature. For example, according to Professor Gordon Stewart during the 1978 epidemic of whooping cough the UK mortality rate was the lowest ever, and that a high proportion of cases were observed among fully-vaccinated children. I also understand that this epidemic was world-wide and not restricted to the UK. Countries with high uptake of whooping cough vaccine also experienced high number of cases, and indeed Sweden, with a reasonably high uptake withdrew this vaccination as a result of this epidemic. There is a great deal of very interesting information further to my brief comments, and I would only encourage Dr Lewis to research further. I agree with Dr Lewis that parental choice should be permitted, but this unfortunately is not the case at present. GPs are under pressure to meet targets and many parents come under enormous pressure when either being selective or declining all vaccines for their children. A doctor on BBC radio last week stated that these target schemes were 'a good way to motivate GPs' to vaccinate. Why would GPs need any motivation, especially in the form of financial incentives, if all GPs are totally confident that vaccinations offer some benefit. Also, over the years, many parents contacting The Informed Parent have indicated to me that they were concerned by the limited knowledge on vaccination their practitioner appeared to have, and were unable to discuss the subject in any proper depth. This should not be the case. As for Dr Lewis's questions - 'How long does MMR immunity last ?' 'How often will it need to be repeated ? ' 'Might it be better to encourage wild mumps in childhood ? ' I have been asking similar questions, especially as 'immunity' is still not understood. The WHO acknowledge that some individuals with high levels of antibody may still contract the disease, and equally an individual with no detectable antibodies may not develop the disease. In other words there is no precise relationship and therefore antibody levels do not equate immunity. When MMR was first introduced the public was told that one jab would be lifelong protection, and then a few years later a booster jab was introduced. And how can the protection be established even if further boosters are added, if antibodies are not an indication? More should be investigated into the benefits of childhood infections, particularly the long-term benefits. I am aware of a study which indicates that women who have a history of mumps infection in childhood are less likely to contract ovarian cancer in adulthood (Epidemiological studies of malignancies of the ovaries. West R O, 1966, Cancer, July 1001-1007) This is indeed interesting and I wonder if there are any studies looking at men developing prostrate cancers and their history of mumps, maybe there will be a relationship there? Competing interests: None declared
Re: Re: unusually, an interesting question is posed 21 May 2005
John P. Heptonstall, Director of The Morley Acupuncture Clinic and Complementary Therapy Centre. Practitioner of TCM -acu LS27 8EG Send response to journal: Re: Re: Re: unusually, an interesting question is posed	Graeme Johnson might feel that "although mumps may have become less common before the vaccine was introduced, the graphs on pages 129-131 of the 1996 Green Book are impressive" but even more impressive is the comment by Galbraith et al in 1984 (1) when mumps really was an item... "A study of routine data on mumps in England and Wales suggests that its epidemiological features are changing from those of an epidemic disease in young adults and older children to a more endemic disease in younger children. Infection now occurs at an earlier age, at which complications are less frequent and symptomless infection may be more common. The incidence of clinical disease may be falling. The high proportion of registered deaths in the middle aged and elderly may be an artifact due to misclassification of causes of death and to misdiagnosis. These changes lessen the need for routine immunisation" - one might almost say the vaccine was introduced in the nick of time, as far as the purveyors were concerned, before the public got wind of its relative obsolescence. Mumps can cause viral meningitis - a less threatening form of meningitis than that for which cases have increased exponentially since the introduction of mumps and Hib (another cause of viral menigitis) vaccines; a likely reason is that 'chasing away viral' allows bacterial - the much more dangerous form of meningitis - to 'take its place'. Regards John H. References 1. www.ncbi.nlm.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dpot=Abstr.. Competing interests: None declared
Re: Re: Re: unusually, an interesting question is posed 21 May 2005
John P. Heptonstall, Director of The Morley Acupuncture Clinic and Complementary Therapy Centre. Practitioner of TCM -acu LS27 8EG Send response to journal: Re: Re: Re: Re: unusually, an interesting question is posed	I sympathise with some of the points made by Dr Lewis, but am not impressed by his reference to "conspiracy theorists" on either side. How easy it seems to be in the eBMJ to makes claims of "conspiracy" theorist nowadays without having to qualify, through evidenced fact, the claim. I wonder if Dr Lewis has any stats for the national rate of bacterial meningitis pre mumps vaccine introduction, and the rather exponential rise in that form of meningitis since? According to my medical contacts who were actively employed during the 70s and 80s they remember very little bacterial meningitis so where has it arisen during the 90s - one of the most well known outbreaks having been caused by the Urabe vaccine strain of mumps in the early 90s, and another during the MR campaign 1994. Regards John H. Competing interests: None declared
Re: Re: Re: unusually, an interesting question is posed 21 May 2005
Bronwyn Hancock, Co-ordinator, Vaccination Information Service Turramurra NSW Australia Send response to journal: Re: Re: Re: Re: unusually, an interesting question is posed	Dr Lewis, You highly deserve credit compared to so many other GPs for your willingness to be openly critical of the stance on vaccines taken by the DH, your honesty to admit that so many vaccinated teenagers are getting mumps unlike their unvaccinated parents and your courage to dare to suggest 'Might it be better to encourage wild mumps in childhood?' with which I agree wholeheartedly. In fact, childhood diseases are beneficial for children (when not incorrectly managed, that is), priming and maturing the immune system. In the case of mumps it was published in the journal Cancer (1966) that it lowers the risk of ovarian cancer. However I am going to dare to try to take you to an even more radical position. I note that you recognise the decline in diseases before the introduction of vaccines, but still accept the teaching that vaccination made a considerable contribution "as an added value.. Whooping Cough resurgence, and subsequent suppression is a good case in point." It is very understandable that you would accept this, because the DH provides plenty of graphs such as are in the Green Book referred to above which portray an actual acceleration in the decline in the number of *reported* cases of a disease after the introduction of the vaccine. However when you look into the subject a little more deeply there are many facts that all tend to undermine the significance of this apparent “evidence”. These include the following: 1) There was no corresponding acceleration in the decline in death rates, 2) The diagnostic guidelines given to doctors were supplemented with “No history of vaccination” when the vaccines were introduced. Even without these written guidelines, doctors are taught that vaccines are effective. The result is that upon seeing an illness in a child who has been vaccinated “against” it, doctors have been observed to conclude that the disease must be a different disease, so the case of the disease is not reported. For example whooping cough gets called “croup” when it occurs in vaccinated children, and diphtheria gets called such names as “epiglotitis”, or, as in this case, described in “Raising a Vaccine Free Child”, by Wendy Lydall (2005, pg 68), ‘Her aunt had nursed diphtheria cases in Britain in the 1950s, and she said that her niece had the typical symptoms of diphtheria. The girl was flown by helicopter to a bigger hospital in Auckland, where they took a swab from her throat and confirmed diphtheria. When they learned that the girl was fully immunised, one of the doctors said to the mother, "Then it can’t be diphtheria." They changed the diagnosis to bacterial tracheitis.’ So the teaching of doctors that vaccination will reduce number of cases *reported* of a disease is a self-fulfilling prophecy, regardless of how many cases there are in reality. 3) With some diseases, even the diagnostic criteria were changed (coincidentally?) when the vaccine was introduced (or not long after). Polio is a classic example of this. The vaccine firstly was introduced after a significant decline of polio in the early '50s (UK peaks were in '47 and '50, vaccine introduced in '56; US peaks in '48 and '52, introduced '55; Australia peak in '53, introduced '56). The vaccine was then actually found to cause more paralysis(1,2), so, soon after its introduction, the diagnostic criteria were made much stricter. The criteria now required paralysis to occur, which is rare, and the paralysis to last over 60 days, which is rarer still. They also required the virus to be detectable in the faeces 48 hours apart. (The guidelines also now had added to them: "No history of immunisation".) As the recorded cases of "polio" continued to decline, there was a significant increase in cases of "cerebral palsy" (a broad term which covers it well), "aseptic (viral) meningitis", "Guillain-Barré syndrome"(3,4), "lower motor neuron disease", "infective polyneuritis", "symmetrical paralysis" and other names. Usually no diagnosis is ever given – when paralysis occurs the doctor tells the parent that it will not last, and since there is no longer any interference, such as calipers or iron lungs (which were found to be counterproductive), this prognosis is usually correct. 4) Doctors, who base their diagnosis on symptoms, can be misled by the distortion of the symptoms due to derailment of the immune system by vaccination (due largely to the procedure bypassing the primary defences in the skin and mucous membranes). Results can include, for example, vaccinated children not getting the proper rash when they get measles. Consequently doctors are less likely to correctly identify the virus or bacteria that is present in such individuals. 5) It is well documented that doctors grossly under-report cases. Under-reporting has been found to be up to 24,000 times (5), and applies far more to vaccinated c/f unvaccinated individuals (6). Given this massive under-reporting, figures are very vulnerable to pressure on GPs from health departments to report every case they see during particular periods, which of course are the periods in which vaccination coverage is down (Health Department says something along the lines of: “We need to monitor cases carefully, because we fear that the low vaccination compliance will lead to an outbreak.”), e.g. in the UK after the publicity in the 1970s about the DPT vaccine causing brain damage and recently the MMR causing autism. 6) The apparent impact of vaccines on the number of reported cases varies often quite significantly from one country to another. For example a greater decline in reported number of cases with increased vaccine use has been reported in communist countries such as Hungary, East Germany and Poland than in other countries (Gangarosa et al, The Lancet, Jan 1998). There is no reason that the vaccine would be more effective on children living under a communist regime than a non-communist regime, so clearly government figures of cases are unreliable in reflecting the true trend, because they can be influenced by politics. Indeed Hungary recently admitted (as also reported in the Lancet) that all statistics during the communist era were falsified; including mortality figures. The fact that there are also inconsistencies between “democratic” countries tells us that political influences are affecting the figures in these countries too. Confirming this we have found that WHO figures differ suspiciously from figures published in peer-reviewed medical journals and other sources, e.g. in respect to the infant mortality trend in Japan after the minimum vaccination age was raised and lowered . 7) In outbreaks of diseases, figures often indicate that the percentage of cases vaccinated are as high, sometimes even higher than the vaccine uptake levels in the community, e.g. • 87% of cases of whooping cough in South Australia from 1990 to 1996 were fully vaccinated (according to questionnaires to parents) (7), • In an epidemic of whooping cough in Sweden in 1978, the percentage of cases fully vaccinated was found to be least as high as the population compliance rate of 84%, so the government discontinued whooping cough vaccination (8). In fact epidemics of measles, mumps, whooping cough, etc, “even” occur in populations which are at least 98% (some 100%) vaccinated (9,10), and even where the compliance is less, there have been many outbreaks where only the vaccinated caught the diseases. Examples include Illinois 1984 (100% cases vaccinated) (11), Hobbs, New Mexico 1985 (12), Corpus Christi 1985 (school outbreaks of measles - 100% cases were vaccinated - the 1% who were unvaccinated did not contract it) (13), Cincinatti 1993 (100% cases vaccinated), North Idaho 1997 (100% cases vaccinated). More examples are cited in “Vaccination – A Parent’s Dilemma” by Greg Beattie (1997, available from The Informed Parent). So the so-called “herd immunity” principle (the claim that with 95% coverage, outbreaks will be prevented) clearly does not hold, and is only devised as an excuse when outbreaks still occur in populations where compliance level is less than 95%, and as a method of getting the public to pressure the non-conformers to fall in line. 8) Sometimes the vaccination programs are begun/ended at peak/trough times of the natural 3-4 year disease cycles (possibly deliberately on some occasions), with the inevitable wane/wax phase of the cycle being falsely attributed to vaccination/lack of vaccination, and 9) These disease cycles, caused by the number of susceptibles gradually increasing over time, and decreasing again when outbreaks occur, have not increased in length with the use of vaccines. It may be interesting to note that until recently when a vaccine was first introduced usually only one dose was expected to be enough to do the job. However because it failed, another dose was added to the schedule. It still failed, so another was added. So we are now in Australia up to the sixth dose of the whooping cough vaccine for current adolescents, and the fully vaccinated still get whooping cough. In fact one area in Australia in June 2000 (the Hunter Valley) was proudly boasting that it had the highest vaccination coverage in the state, second highest in the country. No sooner had this boast been published than there was a big nationwide news story that there was a big outbreak of whooping cough in the Hunter Valley. A couple of years later there was another story - diabetes epidemic in the Hunter Valley. (Why aren't we surprised? we thought.) If one studies individual articles in medical journals, there are many different unscientific methods researchers use to conclude effectiveness, other than those already covered above. The medical literature is highly contaminated with such unscientific conclusions. According to the British Medical Journal (“The Poverty of Medical Evidence”, May 10, 1991), “only 1% of articles in medical journals are scientifically sound.” I have a big list of those methods, but I think what I have included above is enough for one Rapid Response. We are still, after many decades, waiting for a randomised, double- blind placebo-controlled trial establishing that vaccines are effective, but the pharmaceutical industry, the main provider of research funds (in fact it has now more blatantly taken over the research), will not do it, and amazingly justifies this by saying that to do it they would have to deny the vaccine to the control group, which is supposedly unfair to those people. Thus we are just given a circular argument. I hope this helps to put the subject in a new light. The reason, by the way, that those adolescents are getting mumps is not that they were protected when younger by vaccination and the vaccine has now worn off. The fact is that they were never protected (except when they were infants, by transplacentally transmitted immunity). On the contrary, the derailing effect of vaccination causes a problem that even after subsequently developing the disease naturally the vaccinated person often *still* is not immune - i.e. rather than immunise, vaccines can prevent immunity from developing. (Vaccine-induced antibodies and immunity are totally different things.) Anyway the explanation and evidence for the fact that vaccines actually increase susceptibility needs too much text for this Rapid Response. References: 1. Vaccination. The Hidden Facts. Ian Sinclair. Sydney. 1992 pg 23. 2. Nathanson, N., Langmuir, AD, 1963a. The Cutter Incident. Poliomyelitis following formaldehyde-inactivated poliovirus vaccination in the United States in the spring of 1955. I. Background.Am J Hyg:78:16-28 3. Vaccination? A Review of Risks and Alternatives. Isaac Golden. Daylesford Vic. 1994 (5th Edition). pg32 4. Current Pediatric Diagnosis and Treatment 7th Edition 1992. University of Colorado School of Medicine 5. Br J Clin Pharm 1997 Feb;43(2):177-81 6. Pediatrics 1998;102:909-912 7. Greg Beattie Vaccination – A Parent’s Dilemma (1997, The Oracle Press, Qld). 8. JD Cherry et al,1988, Report of the task force on pertussis and pertussis immunisation. Pediatrics (Suppl): 939-984 9. Bull WHO 1993 10. Herceg, Passaris and Mead. An outbreak of measles in a highly immunised population: immunisation status and vaccine efficacy. Australian Journal of Public Health 1994 Vol. 18 no. 3. 11. MMWR: June 1984 12. MMWR: Feb 1 1985 13. NEJM: March 26, 1987 p771 Competing interests: None declared
Mumps dissent 23 May 2005
Mark Struthers, General Practitioner Bedfordshire mark.struthers@which.net Send response to journal: Re: Mumps dissent	I would like to comment on just one aspect of Magda Taylor’s excellent response to Messrs Midgley, Johnston and Lewis. (21 May 2005) She mentioned the target system for the remuneration of GPs conducting childhood immunisation. Targets for vaccination and cervical cytology were introduced in 1991 as part of Mrs Thatcher’s health service reforms. They have been highly successful at raising the level of immunisation uptake. Kenneth Clarke, the then Health Secretary (and now possible Tory Party leadership hopeful) was very perceptive about what motivated doctors. The financial penalty for not reaching the higher target level is considerable. The advice a person gets about whether to have a smear or to have their children immunised has little to do with confidence in the cervical screening or child immunisation programs. It’s all about practice income and maximising it – pure and simple. The introduction of the new ‘five-in-one vaccine and the generally lower uptake of MMR will bring new financial anguish to GPs as practices struggle to reach the 90% uptake target. Just one or two conscientious objectors amongst parents will result in a loss of £5,700 in target income for the average practice (Pulse 30 April 2005, front page) It is no wonder that some GPs are tempted to remove these dissenters from their lists. Recognising the danger, the GP negotiators are now forlornly fighting the Department of Health for ‘informed dissent’ for childhood immunisation, to soften the blow of these target remuneration changes. However, the bottom-line to all this is this: the GP is not a source of impartial advice on the safety or otherwise of vaccination. The parent who wants to be reliably informed should beware and look elsewhere. Competing interests: a GP principal for 15 long years, now salaried and somewhat less conflicted by financial interest in vaccine uptake.
Re: Competing interest 23 May 2005
Jennifer M BEST, reader in virology King's College London, SE1 7EH Send response to journal: Re: Re: Competing interest	John Stone states that our Division within Guy's, King's and St Thomas's School of Medicine has received grants from GlaxoSmithKline and Aventis. This is not relevant to our Clinical Review as there are many research workers in this Division. None of the authors of our review have research grants from these companies. EMM has received small travel grants, as already declared. Competing interests: None declared
False Government Mumps Scare Stories 24 May 2005
Clifford G. Miller, Lawyer, graduate physicist, former university examining lecturer in law BR3 3LA Send response to journal: Re: False Government Mumps Scare Stories	Dear Sir, FALSE GOVERNMENT MUMPS SCARE STORIES The information at the end of this response is from a UK Health Protection Agency leaflet on the alleged risks of mumps. The leaflet is sent repeatedly to parents (one example, by letter 4 times in six months) by some UK general medical practitioners with a letter offering the MMR booster vaccination and asking for written confirmation if the booster is not wanted for their child. This seems to be done so the GPs can hit their vaccination targets and get the money offered by the British government as an inducement for doing so. Its effect is to pressurise and frighten parents into vaccinating their children when there is no need. Some practices strike off their patient roster parents who refuse vaccination for their children (an illegal practice). The HPA figures are grossly misleading. Whilst sent to warn of the risks of mumps, they make no distinction between the risks for a child (minimal, as mumps is a relatively benign illness in children) and the risks for adults (higher). Despite the fact that the higher adult risk figures are provided, the worst statistic is profound deafness in one ear occurring in 1 in 15,000 people. The true figure for children is likely to be much lower but that will not prevent the HPA from sending information like this out to be used as a scare tool. Similarly, the risk of death from encephalitis is so low it equates to one person dying every ten years or so and it is so rare the adult figures provided have a 50% error margin. The risk is between 1 in 400,000 to 1 in 600,000 cases. What is more, it is not simply a matter of chance. People do not die simply as a lottery but because they are already ill, have some pre-existing disposition or a weakness in their immune system, so not the normally healthy person. This also shows that the HPA information is misleading. It further shows some GPs have no qualms about sending out misleading information and putting their patients unnecessarily at risk. It further ensures HPA information cannot be relied on by the public as accurate or impartial medical information. Additionally, to put the 1 in 15,000 figure for profound deafness in adults in context 3,750 in every 15,000 people in Great Britain have some hearing difficulty (375,000 percent higher). for 750 of them, it exceeds 25 decibels. That is a hearing loss that interferes with speech acquisition in a child or effective conversation in an adult the proportion with a 25 decibel hearing loss is 75,000 percent higher than profound deafness in one ear caused by mumps Accordingly, in the deafness stakes, mumps is so low down the scale as to be irrelevant. To put it further into context, six times more people each year are struck by lightning in the UK (a pretty rare event) as died in the major measles outbreaks in 1988, the year it was decided to introduce MMR. And despite being such a rare event, that is roughly thirty-six times more than will achieve profound deafness as a result of natural mumps. Further, these figures overstate the position by a further factor of at least three times because lightning strikes every year, but mumps and measles come and go. There were approaching 80,000 measles cases in 1988 and 47,000 in 1987 and there will be less between major outbreaks as natural herd immunity is gained and then wanes. To put this further into context, there are 1500 asthma deaths each year rising at 1% per annum - 10,000 percent more than measles deaths in 1988 vaccines are implicated in allergies like asthma and immune diseases 1 in 1000 infants die from SIDS SIDS was rare prior to 1950 vaccines are implicated in SIDS deaths over 12 times more children are killed on our roads each year . 5000 people die each year in hospital from MRSA and other hospital caught infections and a further 2500 survive (it is claimed in recent media reports that these figures are understated by the DoH by a factor of six) These figures reveal the purpose of mass childhood vaccination programmes. These are not to protect the child from harm but the UK National Health Service from the cost of treating mumps cases. These figures are insufficient to justify a mass vaccination campaign for mumps amongst children. Mumps, like rubella, is testimony to cost being the predominant factor for vaccination. The justification for mass mumps and rubella vaccination of children is paper thin. In children mumps and rubella are mostly benign childhood diseases. The risk from rubella is to the developing foetus. To deal with this, we used to vaccinate pre-pubescent girls who tested negative to rubella antibodies. Further, contrary to legal and ethical obligations, when the HPA information is sent out, no information on adverse effects is provided. Even if figures were provided on adverse vaccine reactions and even if they were not subject to exaggeration, there are no proper figures that can be provided that are reliable because no proper figures are collected on short and long term adverse vaccine reactions . This enables the pro-child harm lobby to promote vaccines unencumbered by the true scale of harm they cause. Add into this mix the habit of government to exaggerate figures when it suits and downplay similarly, parents are wise to hold back from vaccinations for mumps and avoid the risks of adverse reactions. These are real risks as the Honda/Rutter et al paper on Japanese incidence of autism demonstrates when corrected. There was a 150-200% increase in vaccinations in Japan in 1993 simultaneously with the substantial rise in autism reported by Honda/Rutter from then on. Notably, the vaccinations were particularly for measles and rubella. Well nourished western economy children with clean drinking water rarely die from measles. Those that do are likely immunocompromised. RISKS OF LISTENING TO THE CHILD HARM LOBBY: To the question 'How many people in the UK each year die or suffer long term adverse effects of vaccines' the answer is 'Don't know. Who's counting'. Most adverse vaccine reactions are neither recognised or diagnosed. Fewer are reported. There is no also long term monitoring of vaccine safety. It could indicate if modern medicine causes increases in well known conditions (cancer, diabetes) or has created new ones (MS, ME, life threatening food allergies, food intolerances etc.). Then the risk to the adult population of contracting childhood diseases needs to be taken into account. This exists because vaccination does not confer lifelong immunity, it does not confer absolute immunity but might reduce morbidity and reduces the beneficial effect to adults of naturally boosting immunity by exposure to the wild viruses. And be wary of medical professionals who say new illnesses have solely genetic causes. Genetic change in a single generation in multiple individuals (eg. food allergies) is impossible. UK Department of Health Information Inherently Unreliable The UK DoH has potential legal liability for costs and damages for death or injury but also wants to achieve the short-term 'savings' of vaccination programmes so will have a tendency not to release voluntarily full information on vaccination risks. _______________________________________________________________________ TEXT OF HPA MUMPS LEAFLET Mumps Mumps is an acute viral illness spread by saliva or droplets from the saliva of an infected person. Symptoms begin with a headache and fever for a day or two and then swelling of the parotid glands which may be unilateral (one side) or bilateral (both sides). The parotid glands produce saliva, and are located in front of the ear, At least 30% of cases in children have no symptoms. The incubation period is 14-21 days and mumps can be spread from several days before the parotid swelling to several days after it appears. Although rarely fatal, complications of mumps can include: Meningitis in up to 15% of cases, though usually without further complications. Orchitis (inflammation of the testes - usually unilateral) in up to 20% of post-pubertal males. Sterility seldom occurs. Oophoritis (inflammation of the ovaries) in 5 percent of post-pubertal females. Sterility seldom occurs. Profound deafness occuring in one ear 1:15,000 cases. Encephalitis between 1:4000 and 1:6000 cases, case fatality rate for mumps encephalitis is 1.4%. Pancreatitis, neuritis, arthritis, mastitis, nephritis, thyroiditis and pericarditis may also occur. Although no evidence of foetal abnormalities, mumps in the first trimester of pregnancy may increase the rate of spontaneous miscarriage. Treatment There is no specific treatment for mumps. Treatment is based on alleviating symptoms. Prevention Mumps vaccine is one of the components of MMR vaccine. The introduction of MMR vaccine in 1988 effectively halted the three yearly cycles of mumps epidemics. There is no single antigen mumps vaccine licensed in the UK, and single mumps vaccine has never been used as part of the national immunisation schedule. Since 1998 MMR has been given to children between 12-15 months and since 1996 it is also given at 4 years of age. There is no upper age limit and where required, two doses can be given, separated by a three monthly interval. _____________________________________________________________ Email for Clifford Miller: bmj050521-insert_at_here-cliffordmiller.com Competing interests: None declared
Re: Re: Re: Re: unusually, an interesting question is posed 24 May 2005
Peter Flegg, Consultant Physician Blackpool, UK FY3 8NR Send response to journal: Re: Re: Re: Re: Re: unusually, an interesting question is posed	John Heptonstall suggests that the reduction in cases of mumps meningitis following MMR vaccination has somehow cleared the way for cases of “much more dangerous” bacterial meningitis to occur. I have heard this claim before, and it is quite untrue. Heptonstall says that bacterial meningitis rates have increased “exponentially” since MMR was introduced. However, National Surveillance statistics (1,2) clearly show the opposite. Cases of bacterial meningitis peaked in the late 1980s and have been in decline since. (Interestingly, this decline actually begins in 1988 coincident with the introduction of MMR, and predates the introduction of Hib vaccine by 4 years). (1) Commun Dis Rep CDR Wkly. 1997 Aug 1;7(31):275, 278. Bacteremia and bacterial meningitis in England and Wales: 1982 to 1996. (2) Davison KL, Ramsay ME. The epidemiology of acute meningitis in children in England and Wales Archives of Disease in Childhood 2003; 88:662-664 http://adc.bmjjournals.com/cgi/content/full/88/8/662 Competing interests: None declared
Re: Re: Competing interest 24 May 2005
John Stone, none London N22 Send response to journal: Re: Re: Re: Competing interest	I am grateful to Jennifer Best for her elucidation. I would simply point out that the information in the official source only lists this money as payments to the department, and also that given the lines of patronage any paper that did not support the interests of the manufacturer could easily affect long term funding of the department and university. Competing interests: Parent of an autistic child
The Cost of a Rubella Outbreak Would be More than Just Financial 25 May 2005
Tony Floyd, Medical Student Newcastle University Send response to journal: Re: The Cost of a Rubella Outbreak Would be More than Just Financial	Clifford Miller has written: > "Mumps, like rubella, is testimony to cost being the predominant factor for vaccination..." Cost effectiveness may well be one factor. In the United States there was a major epidemic of rubella every 6 to 9 years prior to the introduction of vaccination. In 1964 there was approximately 12.5 million cases of rubella, as many as 11,000 fetal deaths, and approximately 20,000 cases of congenital rubella (1). Congenital rubella syndrome results in mental retardation, deafness, heart defects and cataracts. According to the text book below (2), this would have resulted in approximately: 13,500 deaf babies 3,000 babies with heart defects 3,500 with behavior disorders and mental retardation 3,500 with cataracts and other eye deformities This applying to the 1964 outbreak only. A cost to more than just the government bean counters, I would suggest. *** References: (1) Orenstein WA, Bart KJ, Hinman AR, Preblud SR, Greaves WL, Doster SW, Stetler HC, Sirotkin B. The opportunity and obligation to eliminate rubella from the United States. JAMA. 1984 Apr 20;251(15):1988-94. PubMed (2) Cooper, LZ, Preblud, SR, Alford, CA. Rubella, In: Remington JS, Klein JO eds. Infectious diseases of the fetus and newborn, 4th edition. Philadelphia: WB Saunders;1995. p. 268. Competing interests: None declared
H.influenzae Clarification 25 May 2005
SM Pearce, Biomedical Scientist NHS Send response to journal: Re: H.influenzae Clarification	Dear Sir, I should like to correct John P. Heptonstall who refers to Haemophilus influenzae as a virus, whereas it is a bacterium. H. influenzae is the organism the Hib vaccine protects against. Regards S.Pearce Competing interests: Understands the Post Hoc ego Propter Hoc Fallacy
Re: Mumps and Rubella 25 May 2005
Jennifer M Best, reader in virology King's College London, SE1 7EH, Ravindra K. Gupta, Eithne MacMahon Send response to journal: Re: Re: Mumps and Rubella	The purpose of our review was not to generate concern and fear about mumps, but to inform doctors and other health professionals about mumps, its complications, prevention and diagnosis. This was considered necessary, because mumps had become a rare disease in the UK since the introduction of MMR vaccination in 1988. Although it is true to say that mumps is usually a mild disease in children, about 15 % of cases develop meningitis and between 1:400 and 1:6000 encephalitis. 1.4% of those with encephalitis are fatal. In addition, one in 15,000 cases develop permanent deafness in one ear. Prior to 1988 there were about 1200 hospital admissions each year in England and Wales for mumps meningitis and encephalitis1. Affected children are usually perfectly healthy before acquiring mumps. Several mumps vaccines were developed in the 1950s and 1960s. Some of these were never used routinely. The attenuated strain of mumps virus called Jeryl Lynn is used in MMR vaccines in the UK. It is very rare for this vaccine to cause meningitis (less than 1 case in 1 million children vaccinated). Another attenuated strain of mumps virus, Urabe, is more likely to cause meningitis. This was not recognised in prelicensure vaccine trails, but only when large numbers of children were vaccinated. The UK discontinued use of the Urabe strain in September 1992. Mumps was made notifiable in 1988 in order to monitor the success of the vaccination programme. Notified cases can be tested in order to confirm or refute the diagnosis of mumps, as the clinical diagnosis of mumps is not always straightforward. Following the introduction of rubella vaccination in 1970, the possibility of a change in the age of infection for rubella was addressed, because rubella is a more serious problem if acquired in early pregnancy. Every effort is therefore made to identify susceptible women of child- bearing age by means of rubella antibody screening. Susceptible women are then offered vaccination. The aim of mumps vaccination is to prevent mumps complications and hospital admissions. Two doses of vaccine are recommended in order to induce a long-lived immune response. Currently students are being offered MMR vaccine and a good uptake of the vaccine should stop the spread of mumps. Children who have not received two doses of MMR should also be vaccinated. Competing interests: EMM has received travel grants as declared on the original review.
Re: Re: Mumps and Rubella 26 May 2005
John Stone, none London N22 Send response to journal: Re: Re: Re: Mumps and Rubella	Best et al offer an extravagant range for the incidence of encephalitis in cases of mumps of between 1:400 and 1:6000. These figures also contrast with the Health Protection Agency which offers a higher incidence figure of 1:4000. But where do all these figures come from? Would you not expect one figure for the UK rather than an interesting selection? Is it too much to ask that they reveal their sources if they are going to make such claims? For the record the CDC Pink Book states: "Encephalitis is rare (less than 2 per 100,000 mumps cases)." p.136 [1] The 1:400 figure is more than 100 times greater than that for the US! What is going on? {1] http://www.cdc.gov/nip/publications/pink/mumps.pdf Competing interests: Autistic son
Re: False Government Mumps Scare Stories - Reprise 26 May 2005
Clifford G Miller, Lawyer, graduate physicist, former university examining lecturer in law BR3 3LA Send response to journal: Re: Re: False Government Mumps Scare Stories - Reprise	Dear Sir, FALSE GOVERNMENT MUMPS SCARE STORIES As exemplified by the St Mary's trick on freshmen regarding the flavour of the urine of a diabetic, observational skills are perhaps considered more important in medicine than debating ones. If it is permissible, may I suggest to Tony Floyd, Medical Student, Newcastle University, considering sharpening them also. Regarding his posting about rubella [1] he appears to have failed to take account of the statements in my posting [2] that:- "The risk from rubella is to the developing foetus. To deal with this, we used to vaccinate pre-pubescent girls who tested negative to rubella antibodies." email Clifford Miller at bmj050524"insert an 'at' sign"cliffordmiller.com ___________________________ [1] The Cost of a Rubella Outbreak Would be More than Just Financial 25 May 2005 [2] False Government Mumps Scare Stories 24 May 2005 Competing interests: None declared
False Government Mumps Scare Stories - (Reply to Jennifer Best) 26 May 2005
Clifford G. Miller, Lawyer, graduate physicist, former university examining lecturer in law BR3 3LA Send response to journal: Re: False Government Mumps Scare Stories - (Reply to Jennifer Best)	Dear Sir, FALSE GOVERNMENT MUMPS SCARE STORIES - (Reply to Jennifer Best) The sort of paper [1] that has provoked this and other exchanges is precisely what Government jumps on to run false mumps scare stories in the press. I am obliged to Jennifer Best for her response [2] which assists to make some of the main points I set out earlier [3]. Ms Best says she has no intention to scare. However, her response omits matter that will give a misleading impression of risk and could result in scares. The omitted matter is contained in the HPA leaflet I quoted verbatim in my earlier response [3]. The HPA state (and Ms Best does not) that:- mumps is rarely fatal cases resulting in meningitis have no other complications Ms Best also fails to observe that the HPA figures are global for adults and not just for children, yet the HPA aims them at parents in the context of vaccinating children. Further, as Ms Best confirms was the practice with rubella, we do not have to vaccinate everyone. We could leave it to people to decide as they reach adulthood if they have not developed natural immunity by contracting the disease naturally in the wild. Accordingly, we could leave nature to take its course. Those who want natural immunity can have it and those who do not or have not achieved it by adulthood can choose vaccination. Ms Best also refers to 1200 hospital admissions each year which shows two things:- her figures cannot be right if the HPA's own leaflet [3] confirms mumps goes in three yearly cycles so it is impossible to have 1200 admissions annually the concern is with hospital admissions (a cost indicator) rather than outcomes (a health indicator for the individual), which makes the point that the purpose is not individual health but NHS wealth Ms Best also makes no comment on the fact that adverse vaccine reactions are not being diagnosed or recorded so we have no proper idea of the acute and chronic short and long term harm caused by vaccines. Hence, my use of the terminology 'Child Harm lobby'. The practice of prophylactic mass vaccination for the vast majority who are at no risk from the disease has to be questioned in the absence of data on risk of vaccination. Unlike my prior response [3] Ms Best makes no effort either to put what she says into a risk context others can understand, nor does she comment on the fact that the risks are nowhere as bad as a one-sided set of statistics with no balance or context might lead others to believe exists. She further does not comment on the relative risk contexts my prior response provides. [1] Mumps and the UK epidemic 2005 BMJ 2005;330:1132-1135 (14 May) [2] Re: Mumps and Rubella 25 May 2005 [3] False Government Mumps Scare Stories 24 May 2005 ___________________________________ email Clifford Miller at cgmiller"insert an 'at' sign here"cliffordmiller.com Competing interests: None declared
Re: Re: Re: Re: Re: unusually, an interesting question is posed 31 May 2005
John P. Heptonstall, Director of the Morley Acupuncture Clinic Leeds LS27 8EG Send response to journal: Re: Re: Re: Re: Re: Re: unusually, an interesting question is posed	Unlike Peter Flegg I do not think the emergence and development of newer versions of bacterial meningitis, and meningococcal diseases in general, including the serious upsurge in septicaemia without meningitis that is apparent throughout the periods of introduction of various vaccines from the measles vaccine of the late 70s through the MMR in 1988, Hib in 1992, MR in 1994 and MMR2 in 1996, has nothing to do with the vaccinations. I think it is very probable and if so the DoH and others who adopt the “party line”, that variations in the presentation and spread of meningococcal diseases are unaffected by vaccines other than advantageously through a reduction in the microbes and their effects, ignore evidence that disputes their stance. It is not surprising as they are ultimately responsible for any significant dangers and damages caused by vaccines. Contrary to Peter Flegg’s assertion that CDR and PHLS figures (his references illustrate their data) evidence a reduction in bacterial meningitis in the UK coincident with MMR introduction in 1988 and 4 years before introduction of Hib vaccine in 1992, I suggest Flegg is misrepresenting those reports and figures. 1. The CDR graph “bacterial isolates from CSF to the PHLS in England & Wales 1982- 2001” certainly show peaks around 1987/8 and 1990 for N. Meningitidis (most common bacterial isolate) then a decline between 1992 and 1994 – but the decline includes all isolates, not just N. Meningitidis, it includes Hib and S. Pneumoniae and others. Is Flegg seriously suggesting that the MMR vaccine initiated a decline in all those bacterial isolates? 2. Is the vaccine success argument merely a smokescreen for an easily predicted rise and fall of the bacterial disorders that are seen to have returned to 1982 levels by about 1996, conveniently during - and probably despite - vaccine introduction, after displaying a sine wave of activity with peak at 1997/8 during that period? 3. That sine wave, shown clearly with the CDR graph, has several significant blips during the middle period coincident with the introduction of MMR, Hib and MR. The graph supplied through Flegg’s second reference Davison and Ramsay 2003 extends the period to 2001 and from that one can see a further climb in bacterial isolates after 1996 (MMR2 introduction) despite the reduction in such isolates as lumbar punctures went out of fashion and therefore collection of CSF. 4. Throughout the 1980s as Flegg states, meningococcal diseases were on the increase – coincident with the introduction of the single measles antigen vaccines in the late 70s. The peak of the sine wave appears to be 1987/8, just as the MMR1 was introduced, then there was a downturn between 1988 and 1989 when measles vaccination was reduced in favour of MMR1; within two years of the introduction of MMR1 we see another upsurge in 1990 of bacterial isolates, then a significant downturn from 1990 to1991, and less so from 1991 to 1992. It was during this period 1990-92 that problems with Urabe mumps vaccine strain emerged and in 1992 the MMR1 with Urabe was withdrawn in the UK after an outbreak of meningitis caused by the vaccine. The downturn might be due to reduction in use of MMR1 due to Urabe. 5. Hib was introduced in 1992, and Flegg and the PHLS/DoH credit the subsequent downturn in cases of H. influenza bacterial infections to Hib vaccine – but, as already stated, there was similar downturn in all bacterial isolates during that period; surely Flegg and the PHLS/DoH do not expect us to believe that Hib vaccine caused downturns in all isolates, or that Hib vaccine was selective of Hib infections and it was coincidence that all other isolates also significantly declined? 6. MR was given to 8 million UK children in 1994 to “protect against a statistical risk of an impending measles epidemic” – it was also in 1994 that the shelf life of those vaccines meted out to 8 million kids was said to have almost ended since they were withdrawn in 1992 (2 years is said to be the typical shelf life of that vaccine) and mumps vaccine was excluded due to meningitis link. Within 4 weeks of mass vaccination numerous children around the UK developed meningitis (within days of each other, and in some cases within hours of each other despite distance) and several died. 7. From the graphs it is clear that there are significant upward blips in 1995 (coincident with MR mass vaccination) and again in 1997 (after MMR2 was introduced in 1996 to pre-schoolers). The CDR graph showing 1982 to 1996 sine wave does not show the subsequent upward trend obvious on the Davison graph between 1996 and 2001. I would suggest the graphs could also evidence: - That something, possibly measles vaccine since around 1979, caused a significant increase in the bacterial isolates seen at the PHLS during 1982-1988 and withdrawal of that vaccine coincided with what would have been a downward trend thereafter to pre-1982 levels. However, in 1988 MMR1 was introduced and this caused an immediate rise in bacterial isolates to 1990 that would have continued had the vaccine not been affected by Urabe meningitis scares and eventually withdrawal in 1992. Isolate figures dropped between 1990 and 1992. From 1992 we see a significant downward trend as MMR1 vaccine uptake diminished due to lack of public confidence; that scepticism was effectively countered throughout 1994 by propaganda from the UK DoH of a threat of “deadly measles epidemic beding imminent” which convinced 8 million UK children to be MR jabbed, many defying parental advice, as they succumbed to the propaganda that they might die if they are not vaccinated. The MR led to an outbreak of meningitis and subsequent increase in isolates seen a 1995, which then fell off to 1996, then returned to an upward trend after 1996 due to the 1996 introduction of MMR2. CSF isolate procedures actually declined from the mid 1990s as lumbar puncture fell out of use yet the bacterial meningitis isolates significantly increased beyond that period. Also meningococcal septicaemia without meningitis has shown a significant upward trend during the period of vaccine introduction, without decline, coincident with autism increases during the same period. Have there been any studies into possible links between septicaemias and ASDs? Riordan FA et al 1995 (1) state that the proportion of cases with septicaemia alone increased from 7% in 1977-1985 to 36% in 1990-93 and mortality is highest (compared to other MCDs) in such conditions. Statements in Davison and Ramsay that rebut Flegg’s position that ”bacterial meningitis cases peaked in the late 1980s and have been in decline since…coincident with introduction of MMR in 1988” are:- “The number of cases and deaths from meningococcal disease (both meningitis and septicaemia) started to rise in 1995, because of an increase in serogroup C infections, particularly C2a strains”. “In 1996…This came against a background change in clinical practice away from performing lumbar punctures, which meant CSF isolates of N. Meningitidis started to decline. The trend in CSF isolates was in contrast to increases in the overall number of confirmed cases”. And from the CDR report page 278 “The numbers of cases of meningococcal meningitis and septicaemia notified to the ONS increase markedly in 1995 and 1996; the PHLS Meningococcal Reference Unit also reported a marked increase in cases in 1995 compared with 1994, and the number of cases in 1996 (provisional total) was similar to the number in 1995”. Is it not commercially prudent to be able to predict rise and fall of disease in order to introduce a “saviour” product (vaccine) at the appropriate time? During the 1860/70s in England and Wales there were about 6000 deaths per million of under-15 year old children with scarlet fever, diphtheria, whooping cough or measles; by the 1940s this rate had declined by 90% without vaccination. The first diphtheria vaccine was introduced in the 1940s, the first whooping cough vaccine in the early 1950s, then measles vaccine in late 1960s (US) and 70s (UK), no scarlet fever vaccine was ever introduced (yet in naturally declined). Deaths from whooping cough in under 15s declined by 98.5% by 1953 (before vaccination was introduced) from more than 1500 per annum in 1868. In the mid 1800s the rate of deaths from measles was about 1100 per million yet by the mid 1960s it was virtually nil without vaccination. Perhaps Peter Flegg would like to comment further? Regards John H. 1. “The changing presentations of meningococcal disease”, Riordan FA et al, Eur J Pediatr. 1995 June; 154(6): 472-4 Competing interests: None declared
False Government Rubella Scare Stories - Only 20,000 Percent Overstated 1 June 2005
Clifford G. Miller, Lawyer, graduate physicist, former university examining lecturer in law BR3 3LA Send response to journal: Re: False Government Rubella Scare Stories - Only 20,000 Percent Overstated	Dear Sir, FALSE GOVERNMENT RUBELLA SCARE STORIES - ONLY A 20,000 PERCENT 'OVERSTATEMENT' Tony Floyd, Medical Student, Newcastle University cited truly shocking rubella figures [1] ....... .... shocking because they are impossible. Mr Floyd says: "In the United States .... [i]n 1964 there was [sic] approximately 12.5 million cases of rubella, as many as 11,000 fetal deaths, and approximately 20,000 cases of congenital rubella." The authority cited was a 1984 article [2] by, among others, Walter Orenstein, a Director of the US National Immunisation Programme. His job was to promote vaccination. On those figures Mr Floyd extrapolated further figures which are so out of line with what is known that the wheels of this bandwagon start to fall off. Why impossible ..... ? Because the true figure was nearer 20,000 percent lower. The incidence in 1964 would have resulted in less than 200 congenital rubella syndrome ('CRS') cases for the whole of the USA and not 20,000. The 1964 recorded rubella incidence for Maryland, USA, was, for example, 1:1000 population [3], [4]. The sub-group of CRS cases was typically 1:1000 of total rubella cases [5]. The largest annual total of nationally reported cases of rubella in the United States was in 1969, when 57,681 cases were reported (58 cases per 100,000 population). [5] At around 12,000 percent fewer cases than the figures Mr Floyd cites, well within the order of magnitude of error government is comfortable working with, but not an error the public would tolerate (if only the media would spill the beans). The figures Mr Floyd cites are also impossible for the very reason that if the 1964 figures were as he claims, then the disease concerned would seem to have been something new, that overcame the naturally acquired immunity of 1 in 16 Americans to rubella infection [5]. That immunity was acquired when epidemics of rubella occurred every 6-9 years, and in annual rubella outbreaks. If it did that to naturally acquired immunity in 1964, it would today do even greater damage to the weaker 'immunity' conferred by vaccines (and those of you who think existing vaccinations will protect against a pandemic of 'flu or anything else should think again - sometimes faith is not worth dying for). A web search produces numerous webpages repeating the figures Mr Floyd cites, referring to 1964 as a 'pandemic' and attributing the Orenstein paper as their source. It is strange therefore that other more recent texts appear not to refer to these figures, making passing reference and no more, such as 'epidemics of rubella occurred every 6-9 years, with the last major U.S. epidemic occurring in 1964-1965.' and without mentioning 'pandemic'. [5] If the figures had been as outrageously large as Mr Floyd claims, and reliable, then they would be a major issue for any work of reference on the topic, but that seems not to be the case. Further, where also are all the 1960's papers telling us all about this remarkable pandemic and commenting on what kind of rubella or rubella-like disease this might be? Where are all the US paediatricians who might have been starting out in practice then or who were still in medical school who might have remembered such an auspicious 'pandemic'. Then how is it that we start to hear about these horror stories in a paper published 20 years later and just in the middle of the big push for the MMR vaccine in the USA and only 4 years before its introduction into the UK? Why did Mr Orenstein not comment on the 1940 rubella epidemic which was three times that of 1964, when Maryland saw 10,000 cases of rubella - three times greater than in 1964 and a pattern, if repeated throughout the US would still have seen 8000 percent fewer cases than those claimed by Mr Floyd in 1964? [3] It is becoming increasingly clear to me from seeing the kinds of exaggerations that have been taking place that drug companies in the post WWII era of the 1950's and 60's could only have been looking closely at the rapidly falling disease incidences in the western world. In doing this they could not have failed to realise three things. This was a lucrative business opportunity to introduce mass national vaccination programmes. They could only win. Two hundred years of disease statistics showed disease incidence had been dropping dramatically, continuing with low levels post 1940. It would be like playing football downhill with a gale on your back against a one legged team. They must have realised their vaccines would be heralded as the saviours of the world from disease. They also must have realised that if someone did not do something pretty damn quickly, the opportunity would be gone, as the morbidity and mortality levels continued to fall to very low levels through the rest of the 20th century. What troubles me also greatly is that DT vaccines first appeared in the 1920's, just in time for Kanner to 'discover' autism and which he described as something not seen before (and so anyone claiming it had been around in 1800, there appears to be some difficulty with that proposition). What further troubles me is the association between DT/DTP and autism from the earliest times of its introduction into the USA in the 1940's. This also then means that if vaccines, and not just MMR vaccines, have been implicated in autism (and many other ailments besides), the claim that autism appears coincidentally around the time when MMR is administered is self-confounding. With the authorities failing to admit the vaccine/autism connection for other vaccines, the claim rings hollow. Further, we see an acceleration of autism when vaccination is accelerated and expanded. Finally, the case study forming the basis for modern vaccination is smallpox vaccine. However, the claim that smallpox vaccine eradicated smallpox rings hollow when the history is considered. Despite compulsory vaccination through the Vaccination Acts of 1840, 1841 and 1853 and the Acts of 1861, 1867 and 1871 making parents liable to repeated fines, the smallpox vaccine still had not eradicated smallpox in 150 years since Jenner's demonstration of cowpox vaccination. [6] The last large epidemic of smallpox (but not the last epidemic) was in London in 1901- 02. [6] Legislation to make immunisation compulsory was widely unpopular (the vaccine was lethal) and all legislation enforcing compulsion was finally withdrawn in 1948. [6] What is particularly troubling about the smallpox story is that smallpox continued to be imported into the UK from overseas up to the 1970s. How is it that a population without herd immunity suddenly seems not to be dropping like flies to this 'dangerous' disease? What is more, by the mid 1970s, it was clear that the risk of death from the complications of smallpox vaccination outweighed the predicted number of deaths that would follow importations. [6] Consider in parallel cholera, which seems to have vanished with the advent of clean water. Smallpox vaccine is no success story. It illustrates instead the success of medicine and drug company interests over commonsense and our political masters. email Clifford Miller bmj0505431"insert an 'at' sign"cliffordmiller.com ________________________________________________________________________ [1] The Cost of a Rubella Outbreak Would be More than Just Financial 25 May 2005 [2] Orenstein WA, Bart KJ, Hinman AR, Preblud SR, Greaves WL, Doster SW, Stetler HC, Sirotkin B. The opportunity and obligation to eliminate rubella from the United States. JAMA. 1984 Apr 20;251(15):1988-94. PubMed [3] Maryland Department of Health, 3,583 cases of rubella during 1964. http://edcp.org/html/rubella.html accessed 30 May 2005 [4] Population 3.9 million in 1970, increasing by 1/2 million every 10 years - provides estimated population 3.5 + million in 1964 http://www.mdp.state.md.us/msdc/popproj/TOTPOP_PROJ04.pdf [5] Epidemiology & The Prevention of Vaccine Preventable Disease 5th Edn, Jan 1999, p178-9, W Atkinson MD MPH, S Humiston MD MPH, C Wolfe, R Nelson [6] Immunisation against Infectious Disease 1996 - The 'Green Book'. Competing interests: None declared
Re: Re: Re: Re: Re: Re: unusually, an interesting question is posed 1 June 2005
Peter Flegg, Consultant Physician Blackpool, UK FY3 8NR Send response to journal: Re: Re: Re: Re: Re: Re: Re: unusually, an interesting question is posed	John Heptonstall accuses me of misinterpreting CDR and PHLS reports. However, there is no room for misinterpretation. Heptonstall claimed in both of his two responses on 21 May that bacterial meningitis increased "exponentially" following the introduction of MMR in 1988. The reports, as I have indicated, do not show this. They indicate a decrease in bacterial meningitis CSF isolates from 1988 onwards. I attach the relevant Figure, so other readers can decide whether, as Heptonstall claims, cases have increased exponentially since 1988. Figure 2. Reports of bacterial isolates from the cerebrospinal fluid to the Public Health Laboratory Service in England and Wales, 1982–2001. (1) However, isolates are only part of the story, and as Heptonstall indicates, in the 1990s other diagnostic methods came into use such as PCR for one of the bacterial causes of meningitis, meningococcal infection, enabling cases to be diagnosed more definitively. From 1995 to 1999, meningococcal disease notifications (using a combination of diagnostic methods) did increase, but by 2003 the numbers had declined back to the levels seen in the early 1990s (2). However one analyses the figures, one cannot dispute the fact that bacterial meningitis cases have not increased since 1988, but if anything have declined overall. We can debate the reasons for evolving epidemiological patterns until the cows come home, but Heptonstall cannot massage the data to fit his own misconception that MMR vaccination has somehow led to an "exponential" rise in bacterial meningitis. (1) K L Davison and M E Ramsay. The epidemiology of acute meningitis in children in England and Wales. Archives of Disease in Childhood 2003;88:662-664. Public Health Laboratory Service Communicable Disease Surveillance Centre, London, UK. (2) http://www.hpa.org.uk/infections/topics_az/meningo/data_menuk1.htm Competing interests: None declared
Re: Re: Re: Re: Re: Re: Re: unusually, an interesting question is posed 2 June 2005
John P. Heptonstall, Director of the Morley Acupuncture Clinic Leeds LS27 8EG Send response to journal: Re: Re: Re: Re: Re: Re: Re: Re: unusually, an interesting question is posed	I can see Peter Flegg’s appreciation of the graphs he presents but how can he reconcile the following statement, found in (1) and quoted below, plus those I have already provided made by experts of the PHLS about increases in meningitis and meningococcal diseases being continuous from around 1994/5 through 1999, with his assertions? His reference graphs are of bacterial isolates in CSF and these were effectively discredited post 1994/5 by the very experts he cites in his references who said the number of CSF isolates fell dramatically from around 1995, not because meningococcal diseases were declining but because CSF isolates were no longer being collected. Peter Flegg has not provided graphs on PCR records, or other means he suggests replaced CSF isolates to identify rates of MCDs for analysis. The statement I refer to is found in (1) “The Meningitis Research Foundation (MRF) says the UK is now (1999) suffering the highest number of meningitis cases in 50 years. A spokeswoman said that, in the past cases tended to be more isolated but there have been a growing number of cluster outbreaks in recent years. PHLS notification figures of the disease over the first few weeks of 1999 bore this out”. Peter Fleggs graphs show meningitis to have dropped to its ”lowest level since 1982” by about 1993/4 but it then “increased significantly from 1994 to 1995/6” according to the PHLS; it then “reached its highest level for 50 years in early 1999” according to the MRF. Is not an “exponential increase in the 1990s, since MMR was introduced” what must have occurred when the rate of meningitis in the UK suddenly rose, within about 5 years, from “in 1993/4 being the lowest since 1982" to "in 1998/9 being the highest in 50 years”? One wonders whether the graphs Peter Flegg provides are of any real value after 1994/5; or are they propaganda? After all, the focus should not be meningitis but meningococcal diseases (MD) in general, which show a variety of symptoms yet are in majority N. Meningitidis infections according to the PHLS - whether appearing as meningitis, meningitis with septicaemia or as septicaemia without meningitis; and the variety represents in combination a dramatic exponential rise in MCDs between 1994 and 1999 with potentially ‘explosive’ (in terms of probable vaccine causation) spikes just after mass MR vaccination, just after MMR2 introduction, and not forgetting a dramatic hike between 1988 and 1990 in meningitis as shown on Peter Flegg’s graph immediately after MMR was introduced in 1988. Graphs often belie what happens around the country in pockets. For example in December 1994 during the mass MR vaccination campaign a number of children died at various locations around the UK of a meningitis outbreak, others fortunately survived; in January 1999 “a severe outbreak of meningitis in South Wales took a prominent position in the headlines” and 3 children died (1). A study in Gwent (2) reported in 2003 that social deprivation and MCD collude at small area level; the incidence of MCD increased from 8.1% per 100,000 (in areas of the least deprived 1/5) to 19.8% per 100,000 (in areas of the most deprived 1/5) with strongest associations for the under 5 age group, serogroup B disease, and with overcrowding. Correcting social inequalities, improving nutrition and sanitation, removing deprivation, despite vaccination ought to assist greatly. Regards John H. 1. http://news.bbd.co.uk/1/hi/health/293501.stm 2. MD and social deprivation: a small area geographical study in Gwent, UK”, Fone DL et al, Epidemiol Infect 2003 Feb; 130(1):53-8 Competing interests: None declared
Re: False Government Rubella Scare Stories - Only 20,000 Percent Overstated 3 June 2005
Louis Z Cooper, Professor Emeritus of Pediatrics, Columbia University 80 Central Park West, New York, NY 10023, USA Send response to journal: Re: Re: False Government Rubella Scare Stories - Only 20,000 Percent Overstated	I do not know where Clifford Miller looked since he missed a wealth of literature about the 1964-65 rubella epidemic. His conclusion is totally incorrect. I write from painful, personal experience. With my team at the Rubella Project, then at the New York University Medical Center-Bellevue Hospital I took care of and published on more than 400 children with congentital rubella syndrome. We had some contact with double that number. These are not statistics, but real children and their families seen by one single program. To make matters even more disturbing, approximately 75% of the pregnant women reported to the New York City Department of Health as having rubella did not come to term because of therapeutic or spontaneous abortion. As to the overall impact of rubella during that single peak period, in the United States, reasonable extrapolations support the estimate that approximately 1% of pregnancies were adversely affected. With 4 million births, that represents approximately 40,000 unfortunate outcomes. Because of almost universal administration of rubella vaccine to children, mostly as MMR, on March 21, 2005 at the CDC National Immunization Conference, Dr. Julie Gerberding, the CDC Director was pleased to announce the elimination of endigenous rubella and congenital rubella syndrome in the United States. I hope this personal experience helps to set the record straight. Competing interests: None declared
Re: Re: Re: Re: Re: Re: Re: Re: unusually, an interesting question is posed 3 June 2005
Peter Flegg, Consultant Physician Blackpool, UK FY3 8NR Send response to journal: Re: Re: Re: Re: Re: Re: Re: Re: Re: unusually, an interesting question is posed	John Heptonstall must not confuse meningococcal disease with all- cause bacterial meningitis. This is an error he borrows from the 1999 BBC News item quote of the Meningitis Research Foundation spokeswoman saying "the UK is now suffering the highest number of meningitis cases in 50 years." This statement refers only to meningococcal meningitis (which comprises only a portion of all bacterial meningitis), as becomes evident later in the article. As I admitted, there was a rise in total notifications of meningococcal meningitis in the late 1990s. This was entirely due to a rise in group C meningococcal disease, and this rise has now been reversed following introduction of meningococcal group C vaccination. I did give a reference (1) which gives exact numbers of ALL laboratory reports (isolates and PCR, blood and CSF) for the whole of the UK. This shows meningococcal isolates increasing from 1994 to 1999 and then declining again immediately after vaccine introduction. Finally, Heptonstall still refers to a "dramatic hike between 1988 and 1990 in meningitis as shown on Peter Flegg’s graph immediately after MMR was introduced in 1988." The graph referred to clearly shows a decline after the 1988 peak. I make no assumptions or conclusions as to why this may be, but I remain bemused by Heptonstall's persistence in trying to link events (even non-existent ones) to the introduction of MMR. (1) http://www.hpa.org.uk/infections/topics_az/meningo/data_menuk1.htm Competing interests: None declared
False Government Rubella Scare Stories - Reply to Professor Louis Z Cooper 6 June 2005
Clifford G. Miller, Lawyer, graduate physicist, former university examining lecturer in law BR3 3LA Send response to journal: Re: False Government Rubella Scare Stories - Reply to Professor Louis Z Cooper	Dear Sir, FALSE GOVERNMENT RUBELLA SCARE STORIES I am grateful to Louis Z Cooper, Professor Emeritus of Pediatrics, Columbia University, New York for his personal account of 1964, albeit anecdotal. [1] Regrettably it shows official 'estimated' figures are less well grounded in fact than prudence might dictate - illustrating my point. The Orenstein 'estimated' 20,000 congenital rubella syndrome ('CRS') figure [2] is suddenly an 'estimated' 40,000 - doubled at a stroke. In contrast, the figures I cited [3] were documented official figures from real reported cases. I cite more here to assist waverers. A brief literature survey shows varying figures cited with abandon: 12 million, 12.5 million, and from 10,000 to 30,000 miscarriages, stillbirths and CRS. Even if right, and they are not, just as hard cases make bad law, worldwide policy should not be based on uncommon once-in-25-to-50 year epidemics and never on inaccurate wildly varying data. Further, and obviously an oversight, Professor Cooper's interests were not disclosed. His involvement since 1964 in all aspects of rubella vaccination, including research, commercial, official and political assists in putting his perspective in context. [4] Reported US rubella cases prior to vaccination were less than 50,000 per annum. [3], [5] Average US CRS incidence was less than 50 per annum. [3] One study averaged 80 Japanese CRS cases per annum between 1965 - 1985 [6]. Another notes 39 Japanese CRS babies in 2,000,000 cases in 1975-1977 when notification was operating. [7] Contrast the US CDC's official autism spectrum disorders ('ASD') incidence of 24,000 ASD children per annum, with a 500,000 prevalence aged 0 to 21. [8] We cannot justify mass vaccination on this basis, particularly where the vaccines are not properly tested or subject to short and long term safety monitoring. No one knows the full extent of all problems vaccines cause because no one is looking or counting - less than 50 CRS cases per annum against 24,000 autism spectrum disorder? All when disease incidence has been falling dramatically irrespective of vaccination. It seems rubella overestimation might be misdiagnosis. According to Kibrick: "... illness with features resembling those of rubella may sometimes be due to other causes. Thus, rubella-like illness may be incorrectly diagnosed as rubella ....." [9] A paper from one of Professor Cooper's own New York Rubella Project colleagues, John Sever, states:- Evidence that erroneous diagnoses are common in this disease is provided by results of a study on 464 pregnant women wherein attempts were made to correlate the patient’s history of rubella with presence or absence of antibody. No correlation was observed. This suggests that “the occurrence of rubella as reported by patients cannot be taken as a reliable index of previous exposure” . [10] As for birth defects, with a low average incidence of CRS, rubella cannot be the culprit (and the following is 2005 published - when indigenous US rubella is claimed eradicated):- "Birth defects affect about one in every 33 babies born in the United States each year. They are the leading cause of infant deaths, accounting for more than 20% of all infant deaths. Babies born with birth defects have a greater chance of illness and long term disability than babies without birth defects." [11] Compounding these inaccuracies, 1964 house to house survey data collection methods were questionable, with limited sample sizes (0.00022 fraction of the US population). As for the varying figures for miscarriage (10,000 to 12,000), two fifths of pregnancies miscarry. 4,000,000 live US births means 1.6 million annual miscarriages in the US, so where the assorted 10,000 to 12,000 figures comes from is anyone's guess (and it seems that is precisely what they are). Even on the basis of Professor Cooper's own paper there could be no more than 4000 US CRS cases. This assumes his 'Rubella Project' was limited to the cited area of 20 million [12] (and the population of New York State in 1963 was less than 17.5 million [13]). Professor Cooper also cites anecdotally 400 women reported to the New York City Department of Health during 1964-5; 300 having terminations. As 92% of rubella cases deliver normal healthy children, adjusting for normal miscarriages, had these run full term they provide a potential figure of CRS births for this cohort of 24. [14] email Clifford Miller: bmj050604{insert an 'at' sign here}cliffordmiller.com _________________________________________________________________ [1] Re: False Government Rubella Scare Stories - Only 20,000 Percent Overstated 3 June 2005 [2] Orenstein WA, Bart KJ, Hinman AR, Preblud SR, Greaves WL, Doster SW, Stetler HC, Sirotkin B. The opportunity and obligation to eliminate rubella from the United States. JAMA. 1984 Apr 20;251(15):1988-94. [3] False Government Rubella Scare Stories - Only 20,000 Percent Overstated 1 June 2005 [4] New Study Shows No Link Between MMR Vaccine and Autism NNii Press Release November 07, 2002 Board of Trustees of The Albert B. Sabin Vaccine Institute [5] In the early 1960s, there were 40,000 and 45,000 cases of rubella per year (Horstmann, 1986; Parkman, Meyer, & Hilleman, 1997, 2000; Cooper, 1966) [6] Rubella and Congenital Rubella Syndrome in Japan: Epidemiological Problems Jpn.J.Infect.Dis.,56,81-87,2003 [7] Epidemiology of rubella and congenital rubella infection in Japan. Kono R, Hirayama M, Sugishita C, Miyamura K. Rev Infect Dis. 1985 Mar-Apr;7 Suppl 1:S56-63. [8] About Autism Autism Information Center, National Center on Birth Defects and Developmental Disabilities - accessed 4 June 2005 [9] 'Rubella And Rubelliform Rash' BACTERIOLOGICAL REVIEWS p. 452-457 December, 1964 [10] 26. SEVER, J. L., G. 811. SCHIFF, AND R. J. HUEBNER. 1964. Frequency of rubella antibody among pregnant women and other human and animal populations. Obstet. Gynecol. 23:153-159. [11] Birth Defects US Centers for Disease Control and Prevention - accessed 4th June 2005 [12] THE BURDEN OF CONGENITAL RUBELLA SYNDROME Vaccines. Preventing Disease and Protecting Health, 1 January 2003, vol. 1, no. 1, pp. 53-60(8) [13] COMPONENTS OF POPULATION CHANGE [14] DANISH MEDICAL BULLETIN MARCH 1987 - WAVES Vol. 11 No. 4 p. 21 Competing interests: None declared
Re: Re: Re: Re: Re: Re: Re: Re: Re: unusually, an interesting question is posed 16 June 2005
John P Heptronstall, Director of the Morley Acupuncture Clinic Leeds Ls27 8EG Send response to journal: Re: Re: Re: Re: Re: Re: Re: Re: Re: Re: unusually, an interesting question is posed	I am grateful to Peter Flegg for his persistence but can assure him I do not "confuse meningococcal disease with all - cause bacterial meningitis...an error he borrows from the 1999 BBC News item quote of the Meningitis Research Foundation spokeswoman saying the UK is now suffering the highest number of meningitis cases in 50 years." Is Flegg saying then that the "highest meningococcal disease rate for 50 years" mostly excluded meningitis? Whether the MRF is confused or not the references Peter Flegg provided (PHLS) state that there were "significant increases in meningitis", not only meningococcal disease, through 1994-6 at least, despite a coincident dramatic reduction in CSF isolates. Is not meningitis C meningitis? Did Flegg not just admit that meningitis C increased during the 1990s? Is not meninigitis B meningitis, did Flegg not ignore the fact that meningitis B also increased during the 1990s and 2000s? I see in Flegg's graph a dramatic rise in meningitis rates through the 1980s rising to a maximum just before, then another hike to just below that maximum just after (till about 1990), the 1988 introduction of MMR. So why does Flegg persist in dismissing this without explanation? Surely MMR vaccination is a suspect for that dramatic hike in meningitis between 1988 and 1990? Do the children caught up in that two year hike in meningitis not matter? How many of those children had been vaccinated and how many were free of vaccination - if Peter Flegg has that information it would provide valuable evidence as to any part MMR might have played? Does one ignore a two year rise because it was followed by a decline - if so what of scientific enquiry? One cannot ignore the fact that immediately after MR vaccine of 1994, then MMR2 vaccine of 1996, two significant hikes occurred against the apparent trend. Do these hikes not add fuel to the probability that MMR, MR and MMR2 caused the following hikes in meningitis? Once may be coincidence, twice might stimulate concern, but should thrice not then ring loud bells? I appreciate the reason Peter Flegg focusses on the meningitis aspect, but the meningococcal disease rate dramatically increased throughout the 1980s and 1990s with an emphasis on the most serious septicaemia without meningitis; does vaccination play a part in this increase, after all vaccination rates increased dramatically during the same period, as did autism. Perhaps autism investigators should concentrate a little more on the concurrent increases in meningococcal septicaemia, with and without meningitis, and autism. I remain concerned that three hikes in meningitis, just after significant introductions of measles and rubella (thrice), and mumps (twice), vaccines occurred without explanation from any authority to date. If MR, MMR1 and MMR2 were responsible for these hikes did the vaccines subsequently assist a decline or was every decline due to another cause/s? The 1800s saw a similar phenomonon with smallpox - the disease had been estimated to naturally decline by the 1870s but vaccination seems to have created hikes thereafter that prevented an expected naturally rapid decline, except in regions like Leicester which refused vaccination and subsequently experienced a dramatic decline in cases of smallpox while they raged on in other areas which had high vaccination rates. Would measles, mumps and rubella already be diseases of the past if not for vaccination? Their natural decline throughout the mid to late 20th century, prior to the introduction of vaccines, is well documented. Regards John H. Competing interests: None declared
Re: The Cost of a Rubella Outbreak Would be More than Just Financial 19 June 2005
Tony Floyd, Medical Student Newcastle University Send response to journal: Re: Re: The Cost of a Rubella Outbreak Would be More than Just Financial	In reference to my discussion of the 20 000 cases of congenital rubella syndrome in 1964 (1), Mr Miller has responded with: > “The incidence in 1964 would have resulted in less than 200 [sic] congenital rubella syndrome ('CRS') cases for the whole of the USA and not 20,000." Now Professor Louis Cooper, who authored the very book that I referenced (1), was kind enough to respond himself and advise that he himself took care of more than 400 children during that particular outbreak of CRS. Rather than retract the overly enthusiastic rounding-down from 20 000 to 200, Mr Miller derides Professor Cooper's experience as being 'anecdotal'. What else could a personal experience be? In this case Mr Miller might like to revise his estimates or explain how Professor Cooper is mistaken. Mr Miller also stated that: > “The sub-group of CRS cases was typically 1:1000 of total rubella cases" However Susan Reef MD (2) reported that: "With an average of only 212 reported cases of rubella and 5 of congenital rubella syndrome (CRS) annually for the past 5 years in the United States..." 5 in 212 would make 24:1000, not 1:1000. Also in reference to the outbreak of rubella in 1964 Miller writes: > “It is strange therefore that other more recent texts appear not to refer to these figures, making passing reference and no more, such as 'epidemics of rubella occurred every 6-9 years, with the last major U.S. epidemic occurring in 1964-1965.' and without mentioning 'pandemic'." Whether these outbreaks of disease causing deaths and birth deformities are called epidemics or pandemics, why did the last major one occur in 1964-1965? Why none since rubella vaccination was commenced in 1969? Coincidence? *** References: (1) Cooper, LZ, Preblud, SR, Alford, CA. Rubella, In: Remington JS, Klein JO eds. Infectious diseases of the fetus and newborn, 4th edition. Philadelphia: WB Saunders;1995. p. 268. (2) Reef SE, Plotkin S, Cordero JF, Katz M, Cooper L, Schwartz B, Zimmerman-Swain L, Danovaro-Holliday MC, Wharton M. Preparing for elimination of congenital Rubella syndrome (CRS): summary of a workshop on CRS elimination in the United States. Clin Infect Dis. 2000 Jul;31(1):85-95. Epub 2000 Jul 25. Competing interests: None declared
Re: Re: The Cost of a Rubella Outbreak Would be More than Just Financial 20 June 2005
John P Heptonstall, Director of the Morley Acupuncture Clinic Leeds LS27 8EG Send response to journal: Re: Re: Re: The Cost of a Rubella Outbreak Would be More than Just Financial	With reference to Tony Floyd's questions for Clifford Miller:- "Whether these outbreaks of disease causing deaths and birth deformities are called epidemics or pandemics, why did the last major one occur in 1964-1965?...Why none since rubella vaccination was commenced in 1969?" Perhaps they can be answered through an investigation of the relationship between diagnoses of roseola and rubella (1), the former having multiplied since HHV6 was identified as the cause, and the latter probably far less frequently diagnosed since physicians began to vaccinate against rubella "believing it can no longer exist in quantity"(2)... Regards John H. 1. http://adc.bmjjournals.com/cgi/content/abstract/archdischild;65/12/1297 2. http://adc.bmjjournals.com/cgi/content/full/87/3/202 Competing interests: None declared
False Government Rubella Scare Stories - Now 300,000 Congenital Rubella Cases! 20 June 2005
Clifford G. Miller, Lawyer, graduate physicist, former university examining lecturer in law BR3 3LA Send response to journal: Re: False Government Rubella Scare Stories - Now 300,000 Congenital Rubella Cases!	Dear Sir, FALSE GOVERNMENT RUBELLA SCARE STORIES - NOW 300,000 CONGENITAL RUBELLA CASES! I am grateful to Tony Floyd, Medical Student, Newcastle University for his recent comments [1]. He notes Professor Louis Z. Cooper is the appropriate commentator, as the author of a book on the subject. Tony Floyd's new figure of 300,000 congenital rubella syndrome ('CRS') cases in 1964 [2] again demonstrates how easy these government scare stories are to generate on the basis of just one journal reference. Whilst Professor Cooper's doubling of 'estimates' of 20,000 CRS cases to 40,000 [4] is perhaps not quite in accord with a scientific approach and, more importantly, not in accord with a factual one either, it is nothing compared to Tony Floyd's. Tony Floyd's stratospheric new figure is an order of magnitude higher than Professor Cooper's 40,000 figure, taking us another 1500 percent higher than the original 20,000 Orenstein 'estimate' [5]. It is not clear what point Tony Floyd wants to make, and he overlooks answering the other points previously made [6]. Further, as Professor Cooper's comments were anecdotal, it is not derision for me to point that out, particularly when responding with fact. Tony Floyd's further intervention is tinged with desperation to succeed in the argument but is fundamentally flawed. The debate concerns rubella and congenital rubella incidence prior to rubella vaccination. Yet Mr Floyd cites figures from a 2000 paper [7]. That is at a time of compulsory US mass child vaccination which he compares to 1964 when US rubella vaccination did not exist. As Tony Floyd's 300,000 CRS figure shows, this approach is akin to comparing apples with concrete. Mr Floyd also makes a further fundamental mistake. Whilst it could become so, the current debate is not about whether artificially infecting children with rubella virus to generate a form of immunity is appropriate. The debate is about whether we should apply this kind of prophylaxis to children en masse as an unnecessary medical intervention, with our eyes shut to the numbers of dead and injured. This is especially so when the consequences of not vaccinating are nothing like the exaggerated figures government is so desperate to give the public. The reason why government shuts its eyes to the dead and injured is because vaccination is not to save children's lives but to save government money, and when it comes to government money, government tends not to let small things like childrens' lives affect its calculations. Mr Floyd makes the point for me, that by administering vaccines, government thinks it saves the cost of treating 1.8 million annual measles, mumps and rubella cases. In 1960s England (and Wales), around 600,000 live births annually equated to this number of cases for the UK National Health Service to treat, even if these were just general practitioner visits and irrespective of mildness. Regrettably, none of the points Mr Floyd makes in this latest posting contributes anything of substance to this debate save than accidentally and unintentionally. To email Clifford Miller: insert an '@' sign before cliffordmiller.com in the following address: bmj050620cliffordmiller.com _______________________________________________ [1] Re: The Cost of a Rubella Outbreak Would be More than Just Financial 19 June 2005 Tony Floyd [2] This figures arises from Tony Floyd's new figure of 24:1000 rubella cases having congenital rubella syndrome outcomes [1], and his figure of 12.5 million 1964 US rubella cases [3]. [3] The Cost of a Rubella Outbreak Would be More than Just Financial 25 May 2005 Tony Floyd [4] Re: False Government Rubella Scare Stories - Only 20,000 Percent Overstated 3 June 2005 Prof Louis Z Cooper [5] Orenstein WA, Bart KJ, Hinman AR, Preblud SR, Greaves WL, Doster SW, Stetler HC, Sirotkin B. The opportunity and obligation to eliminate rubella from the United States. JAMA. 1984 Apr 20;251(15):1988-94. [6] False Government Rubella Scare Stories - Reply to Professor Louis Z Cooper 6 June 2005 Clifford Miller [7] Reef SE, Plotkin S, Cordero JF, Katz M, Cooper L, Schwartz B, Zimmerman-Swain L, Danovaro-Holliday MC, Wharton M. Preparing for elimination of congenital Rubella syndrome (CRS): summary of a workshop on CRS elimination in the United States. Clin Infect Dis. 2000 Jul;31(1):85-95. Epub 2000 Jul 25. Competing interests: None declared
Re: Re: Re: The Cost of a Rubella Outbreak Would be More than Just Financial 30 June 2005
Tony Floyd, Medical Student Newcastle University Send response to journal: Re: Re: Re: Re: The Cost of a Rubella Outbreak Would be More than Just Financial	Mr Miller has written: > “Tony Floyd's new figure of 300,000 congenital rubella syndrome ('CRS') cases in 1964" I'm sure Mr Miller has also read that CRS was widely under reported, but whether 300,000 is realistic or not I am not going to debate. He would also be quite capable of noticing that I gave the reference (1) which was published in 2000 and the quote I gave referring to 'the past 5 years.' This would, one might think, refer to the late 1990's, not 1964. So I did not give a 'new figure' for 1964. (1) Reef SE, Plotkin S, Cordero JF, Katz M, Cooper L, Schwartz B, Zimmerman-Swain L, Danovaro-Holliday MC, Wharton M. Preparing for elimination of congenital Rubella syndrome (CRS): summary of a workshop on CRS elimination in the United States. Clin Infect Dis. 2000 Jul;31(1):85-95. Epub 2000 Jul 25. Competing interests: None declared
Re: False Government Rubella Scare Stories - Now 300,000 Congenital Rubella Cases! 30 June 2005
Peter Flegg, Consultant physician Blackpool, UK FY3 8NR Send response to journal: Re: Re: False Government Rubella Scare Stories - Now 300,000 Congenital Rubella Cases!	The devastating legacy of congenital rubella syndrome (CRS) in the United States during the epidemic that occurred prior to the introduction of rubella vaccine has obviously discomfited those who would like to claim congenital rubella is of little consequence. Clifford Miller, who still seems to think there were less than 200 cases of CRS in the entire United States in 1964, is dismissive of Professor Cooper's series of 400 cases from a single centre in New York (1) which obviously comprised only part of the city's total. Professor Cooper states these 400 cases were published, but that he actually had contact with over twice that number. I would refer Miller to some of Professor Cooper's work on the subject(1). It is quite unedifying to see Miller try and reject this experience as "anecdotal" (if only all "anecdotes" were as solid) and to make issue with the non-disclosure of Professor Cooper's subsequent on the CRS and rubella vaccination after 1964 as though this implies partiality. If one wishes to leave aside estimates of cases of clinical rubella, which are obviously open to misdiagnosis and errors of under-reporting, one can look at data that no-one can misinterpret, namely clinical cases of CRS and the number of overall births. In one study of 6000 pregnant women from 11 urban hospitals in the USA, 750 women either developed clinical rubella in the first trimester or recorded exposure to an active case in 1964 (2). In total 9% of these exposed women went on to develop either clinical or serologically-confirmed rubella. There were 16 spontaneous abortions, 10 therapeutic abortions, 19 stillbirths and 17 CRS infants, 2 of whom died neonatally. These cases of early-diagnosed CRS are likely to greatly under-represent the true total of infants affected by CRS. The authors state that many infants with minor neuro- developmental/cardiac abnormalities or with deafness may not be diagnosed as suffering from CRS for many months or even years. Widespread use of gamma-globulin helped prevent many more cases of CRS in exposed women. Perhaps I can give Miller a new extrapolation to calculate: - If 17 cases of CRS (and the true number is probably more than twice that) occur for every 6000 births, how many cases of CRS might he expect from the 4 million or so births that occurred that year in the whole of the USA? (1) Cooper LZ. The history and medical consequences of rubella. Rev Infect Dis. 1985 Mar-Apr;7 Suppl 1:S2-10 (2) Sever JL, Nelson KB, Gilkeson MR. Rubella epidemic, 1964: effect on 6,000 pregnancies. Am. J. Dis. Child. 1965 Oct;110(4):395-407. Competing interests: None declared
Re: The Cost of a Rubella Outbreak Would be More than Just Financial 30 June 2005
Theo H Fenton, Consultant Paediatrician Mayday Hospital, Croydon CR7 7YE Send response to journal: Re: Re: The Cost of a Rubella Outbreak Would be More than Just Financial	Mr Heptonstall seems to allege that rubella is now often misdiagnosed as roseola. This would be odd, as the symptoms associated with these childhood exanthems are so very different. In an attempt to support his allegation, Mr Heptonstall cites two papers from Archives of Disease in Childhood (ADC). Unsurprisingly, these papers contradict his argument. I was particularly puzzled by Mr Heptonstall's use of quotation marks: ...the latter [rubella] probably far less frequently diagnosed since physicians began to vaccinate against rubella "believing it can no longer exist in quantity"(2) The reference (2) was from ADC: http://adc.bmjjournals.com/cgi/content/full/87/3/202. Strangely, nowhere in the ADC article do any of the words "believing", "longer", "exist", or "quantity" appear. A piece of propaganda often quoted by anti-vaccinationists is that whoooping cough still occurs almost as often as it used to, but it's just called croup these days. Another is that diphtheria is still common, but it's called epiglottitis. Ridiculous, of course, and it might even be funny -- except that some people might believe it. Competing interests: None declared
Rubella Scares - Demonstrating the Figures are False 11 August 2005
Clifford G. Miller, Lawyer, graduate physicist, former university examining lecturer in law BR3 3LA Send response to journal: Re: Rubella Scares - Demonstrating the Figures are False	Dear Sir, False Government Rubella Scare Stories - Demonstrating the Figures are False The USA has to date vaccinated approximately 120 million children with rubella vaccine, either monovalent or in MMR. [1] The contributions of Peter Flegg, Consultant physician, Blackpool and Tony Floyd, Medical Student, Newcastle University [2], [3] help to provide more proof this has been done on the basis of flawed and inflated figures bearing no relation to actual cases and promulgated by government and those who speak for it. We can calculate an initial ceiling beyond which we know the numbers of US congenital rubella syndrome (CRS) cases could not go. Demonstrating this initial ceiling is an order of magnitude or more higher than the real figure is also not difficult. The more accurate calculation remains one based on real figures for an entire US state in 1964, and particularly a state served by Johns Hopkins. [4] We are told [2] a paper cites 17 CRS cases from 6000 pregnancies in 11 US hospitals in 1964. If we assume the number of US hospitals were roughly similar in 1964 to 1980, the 1980 figure is 7156 US hospitals [5]. This provides the starting point of an 11,000 ceiling for US CRS cases. Approximately 1000 of these 7156 hospitals were psychiatric units. Further, of the remainder, not all US hospitals have now or had in 1964 maternity units. One might reasonably expect less than half to have had. Additionally, not all hospitals are the same size. The 1980 figures show then they ranged in size from 6 beds to over 500 beds. [5] This also shows overall substantial variations in local populations served by hospitals of substantially varying sizes. And then there would be regional variations in incidence of CRS. There were also substantially fewer hospitals with the higher numbers of beds. It would also be a reasonable assumption that the 11 hospitals cited as having 17 CRS cases were of the larger size with maternity units as it is more likely researchers would concentrate on the larger bed size hospitals with substantial maternity units. Accordingly, it can be easily seen that the numbers of CRS cases in the US would be bound to be vastly lower than 11,000 and likely by an order of magnitude or more. This is also without taking into account whether it is realistic to assume all 1963/4 US pregnancies received ante-natal care in hospital rather than with local general practice or mid-wifery practices and how many could, in 1964 afford much ante-natal care? It may have been that the 6000 cases from 11 hospitals were only those cases where hospital care was necessary. What is indisputably bizarre about the alleged 1964 rubella 'pandemic' is that for something so allegedly serious, with such allegedly serious outcomes and for so many, is that the authorities feel the need to overstate the true figures. Rubella vaccination is motivated by government desire to save money, not to protect children. There is also something seriously wrong in the world of 'professional' medicine when a student in a medical school will not agree 300,000 US CRS cases in 1964 is a figure bearing no relation to reality. [3] ________________________________ email: to email Clifford Miller substitute '@' where it says "insert an 'at' sign" in this email address: cgmiller"insert an 'at' sign"cliffordmiller.com ________________________________ [1] This figure assumes 4 million per annum birth rate since the 1969 introduction of rubella vaccine and 80% vaccination coverage over that period. [2] Re: False Government Rubella Scare Stories - Now 300,000 Congenital Rubella Cases! - 30th June 2005 - Peter Flegg [3] Re: The Cost of a Rubella Outbreak Would be More than Just Financial 30 June 2005 Tony Floyd [4] False Government Rubella Scare Stories - Only 20,000 Percent Overstated 1 June 2005 - Clifford Miller [5] ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/Health_US/hus04tables/Table109.xls Competing interests: None declared
Roseola is Confused with Rubella 11 August 2005
Clifford G. Miller, Lawyer, graduate physicist, former university examining lecturer in law BR3 3LA Send response to journal: Re: Roseola is Confused with Rubella	Dear Sir, ROSEOLA IS CONFUSED WITH RUBELLA One of your correspondents, a consultant paediatrician, admonished another correspondent in the following terms:- "Mr Heptonstall seems to allege that rubella is now often misdiagnosed as roseola. This would be odd, as the symptoms associated with these childhood exanthems are so very different." [1] However, according to what appears a classic paper on the topic, it would seem that roseola was commonly confused with rubella when rubella was prevalent:- "Of these, the disorders most commonly confused with rubella, are measles, scarlet fever, and roseola ...." [2] Accordingly, it would seem plausible that the reverse could occur now should physicians hold the belief that rubella vaccinated individuals are asymptomatic at all times. Further, it would also seem such misdiagnosis would not be 'odd'. Whilst I have had this information for some good time, I apologise to Mr Heptonstall for not bringing this to the readers' attention earlier but it appears to have become an Herculean task for those who message is iconoclastic to be published of late in the BMJ Rapid Responses. [1] Re: The Cost of a Rubella Outbreak Would be More than Just Financial 30 June 2005 Theo H Fenton, Consultant Paediatrician Mayday Hospital, Croydon CR7 7YE [2] BACTERIOLOGICAL REVIEWS - Kibrick - Vol. 28, No. 4, p. 452-457 December, 1964 Competing interests: None declared
Mumps and Hospital Contacts 30 August 2005
Monique I Andersson, Specialist Registrar Virology/Genitourinary Medicine Specialist Virology Centre, Myrtle Road, Bristol, BS2 8EL, Peter Muir, David Carrington, Phillipa Moore, Sue Hunt, Matthew Donati Send response to journal: Re: Mumps and Hospital Contacts	We would like to highlight an issue not raised by the excellent reviews by Gupta et al 1 and Savage et al 2, namely the management of hospital contacts of mumps. Mumps is usually a mild illness, but complications are significant and can be serious 3,4. Transmission may occur prior to (-5days), and after (+9days), development of symptoms or during an asymptomatic infection. In order to minimise ongoing transmission, we have introduced a protocol for managing potentially susceptible exposed healthcare workers (HCW) which includes determining their immune status by mumps IgG testing (Vidas, bioMerieux SA, France). Following exposure, seronegative HCW are excluded from clinical duties during the most likely infectious period (12-25d after), and offered MMR vaccine to protect against secondary and tertiary cases. Recent guidance5 does not recommend such testing and exclusion, partly based upon an assumption of immunity in those people born before 1980. Analysis of the age related mumps serostatus of over 1,500 patients, tested as part of this strategy at the Specialist Virology Centre (SVC), Bristol, and the Gloucestershire Hospitals NHS Foundation Trust microbiology laboratory, confirms the relatively high rate of susceptibility (around 17%) expected between age 18 to 23, but also a seronegative rate of approximately 8% amongst those aged 35 years and over. These figures assume that all antibody equivocal patients are immune. These findings are consistent with the age distribution of mumps as laboratory reported cases (SVC), and notifications to the HPA SW Regional Epidemiology Unit (table 1). Although we are unable to assess the impact of this strategy on nosocomial transmission of mumps, we believe that age alone is not a reliable indicator of mumps immunity, and consideration should be given to establishing the immune status of all new hospital staff, along with offering MMR where appropriate. This may also have benefit with respect to measles and rubella immunity. REFERENCES 1. Gupta RK, Best J, MacMahon E. Mumps and the UK epidemic. BMJ, May 2005; 330: 1132 - 1135. 2. Savage E, Ramsay R, White J, Beard S, Lawson H, Hunjan R and Brown D. Mumps outbreak across England and Wales in 2004:observational study. BMJ, May 2005; 330: 1119 - 1120. 3. Sonmez FM, Odemis E, Ahmetoglu A, Ayvaz A. Brainstem encephalitits and acute disseminated encephalomyelitis following mumps. Pediatr Neurol 2004;30:132-4 4. Caksen H, Ustunbas HB. A fatal case of acute transverse myelitis associated with mumps . J Emerg Med 2004;24:341-2 5.Mumps National Outbreak Team, Mumps FAQ www.hpa.org.uk/infections/topic_az/mumps/mumps_faq.htm#10 (accessed 10 August 2005)     All Notified Mumps Cases in Avon by Age Group in 2004 -2005 2004 2005 AGE GROUP Avon SW Avon SW 0-4 31 106 23 150 5-9 21 99 34 197 10-14 57 202 65 524 15-19 405 1408 361 2088 20-24 249 988 275 1375 25-29 30 129 54 254 30-39 26 151 47 287 40-44 9 45 16 111 45-49 8 38 14 84 50-54 4 27 3 48 55-59 5 26 3 31 60+ 3 25 5 38 Unknown 1 16 8 59 Grand Total 849 3260 908 5246 Table 1 Notifications of mumps cases for Avon and the South West region by age. Source: Health Protection Agency South West, Regional Epidemiology Unit. Data extracted from NOIDS reports on 12 August 2005. Competing interests: None declared
Re: Mumps and Hospital Contacts 1 September 2005
John P Heptonstall, Director of the Morley Acupuncture Clinic Leeds LS27 8EG Send response to journal: Re: Re: Mumps and Hospital Contacts	Sir/Madam As the NHS has for some years been recruiting overseas, and has a great many staff who are now employed in various NHS occupations drawn from many areas of the world, it would be of some value to analysts of the data provided by Monique I Andersson et al for them to identify the following:- 1. How many cases in Avon, and the SW, were of NHS workers who immigrated specifically for NHS jobs and what is their immunisation status for mumps vaccine. 2. How many cases at each age group had been immunised against mumps and how many not. The nature of immigration might confound the assumption that all cases shown, born before 1980, had wild mumps. Regards John H. Competing interests: None declared