Measles: Europe sees record number of cases and 37 deaths so far this year
BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3596 (Published 20 August 2018) Cite this as: BMJ 2018;362:k3596All rapid responses
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I have new data on the autism epidemic from US Social Security data on autism.
SSI Figures Nationwide
Year Under 5 to 64 Increase
2006 84,217
2007 97,455 13,238
2008 112,414 14,959
2009 130,772 18,358
2010 151,260 20,488
2011 173,946 22,686
2012 199,445 25,499
2013 223,523 24,078
2014 246,415 22,892
2015 275,740 29,325
2016 301,783 26,043
2017 327,442 25,659
Also old data from the US Department of Education.
Ages 6-21 Nationwide
School Year Students Increase
1994 22,780
1995 28,813 6,033
1996 34,082 5,269
1997 42,487 8,405
1998 53,561 11,074
1999 65,391 11,830
2000 78,717 13,326
2001 97,847 19,130
2002 118,603 20,756
2003 140,920 22,317
2004 166,302 25,382
2005 193,481 27,179
2006 224,415 30,934
2007 258,095 33,680
2008 294,302 36,207
2009 335,199 40,897
2010 369,664 34,465
2011 406,957 37,293
2012 443,562 36,605
2013 478,684 35,122
2014 513,171 34,487
2015 549,851 36,680
Ray Gallup
Competing interests: No competing interests
I am not surprised by the cynicism expressed by Dr Anand regarding public reporting and presentation of measles cases in Europe and the UK. The contempt has now spread to ordinary members of the public, particularly our young persons in the UK, most of whom will at some point, have had their schooling adversely affected by autistic fellow pupils and those with ADHD, a condition now recognised as part of the ‘spectrum’. Thinly spread ‘special needs’ resources has resulted in many of these pupils being educated in mainstream classes without any extra support, putting pressure on both teachers and pupils. Inevitably, the education of some pupils has suffered as a result.
With measles cases, Public Health England apparently has two opposing agendas. The UK public health agencies are all keen to retain the WHO measles elimination status granted in 2017. (1) At the same time they are determined to increase measles vaccination rates.
Quote:-
“The World Health Organization Regional Office for Europe [3] has confirmed that the UK has maintained its measles and rubella elimination status in 2017. This is a huge achievement and a testament to all the hard work by our health professionals in the NHS to ensure that all children and adults are fully protected with two doses of the MMR vaccine.”
In order to ‘ensure’ older children and adults are ‘fully protected with two doses of the MMR vaccine”, PHE has apparently resorted to scare tactics. Mysteriously, this same agency has published two separate sets of measles surveillance numbers for the first quarter of 2018. (2 & 3)
January –March 2018 (2):-
Notified 1202 :Tested 748 (62.2%): Positive 91(12.2%)
January –March 2018 (3):-
Notified 1201: Tested 750 (62%): IgM Pos 175: PCR pos 72
Other pos 3: Tested Locally 15: Total 265.
According to the PHE accompanying blurb (3):
Quote:-
“Recent infection is confirmed by measuring the presence of IgM antibodies or detecting viral RNA (by PCR) in these samples.
Samples that have been confirmed positive for measles or rubella are further sequenced and entered on the WHO global Measles Nucleotide Surveillance (MeaNS) or the Rubella Nucleotide Surveillance (RubeNS) system respectively which are hosted at the National Reference Laboratory. Genotyping and further characterisation of measles and rubella is used to support investigation of transmission pathways and sources of infection.”
This suggests samples are first tested for the presence of IgM antibodies. Oral fluid samples testing positive for measles, are then further tested for measles RNA strain for the reasons above. If that is the case then those 72 measles positive cases sent for RNA strain typing appear to have been counted twice in the final total, grossly inflating the number of cases. (3) The similarities in the numbers notified and tested in the two tables suggests the same data sets were used in both tables.
Curiouser and curiouser. The number of measles cases testing IgM positive in Table 1 for the second quarter of 2018 appears as 239 cases. This is also presented as the TOTAL number of cases in the same table, suggesting for the second 2018 quarter, IgM positive measles cases also sent for RNA testing were not counted twice in Table 1. (1)
April –June 2018.
Notified 1763: Tested 1161: IgM Pos 239: PCR pos 120
Other pos 48: Tested Locally 14: Total 239.
Conversely, the PHE blurb below Table 1 states the total number of positive measles cases to be 421, the sum of all the measles cases testing positive. (239 IgM + 120 PCR+ 48 other positives+ 14 tested locally)
This total, with regional breakdown numbers is repeated in Table 2. (1)
I am not disputing the veracity of the actual laboratory test results, but the way in which they have been presented seems confusing and misleading, not only to ordinary members of the public like myself, but to medical professionals and politicians too. Perhaps a representative of PHE would like to explain?
1. Laboratory-confirmed cases of measles, mumps and rubella (England): April to June 2018 Health Protection Report Volume 12
https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
2. Measles cases confirmed by oral fluid IgM antibody tests and/or PCR in each quarter compared to the number of notified cases. January to March 2018
https://www.gov.uk/government/publications/measles-confirmed-cases/measl...
3. Laboratory confirmed cases of measles, mumps and rubella, England: January to March 2018 Health Protection Report Volume 12 Number 19 Advanced Access report 1 June 2018
https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
Competing interests: No competing interests
SURVEILLANCE RRPORT Monthly measles and rubella monitoring report, August 2018, ECDC
According to these tables (on page 3 of the document) Figure 2, Measles notification rate per million population by country - Measles. United Kingdom, 2018
Jan Feb Mar April May June
58 82 150 207 174 89 TOTAL FOR THE FIRST SIX MONTHS equals 263
However, for the period July 2017 to June 2018, the total notifications were 945.
And for the same period of twelve months, the total laboratory positive cases were 945
This implies that in our large country, our public health service managed to achieve 100% laboratory examinations of our 945 notified cases, and also that 100% of the clinical diagnoses were confirmed by the laboratory services.
I apologise to the NHS for ever having doubted its abilities.
Competing interests: No competing interests
I am grateful as ever to Wendy Stephen - not writing at any length beacause I am in hospital. It says in the document she cited that there were 265 confirmed cases in England in the first quarter of this year, whereas in the one I cited it said that it was only 91, and this was updated as late as 10 July [1]. Indeed, it is not completely clear whether this is a figure for England alone as I have previously assumed or possibly for the whole of the U.K. But it looks as if between 10 July and 24 August they found 174 confirmed cases from before April (nearly two-thirds) that they did not know about.
[1] https://www.gov.uk/government/publications/measles-confirmed-cases/measl...
Competing interests: No competing interests
The Public Health England laboratory confirmed figure for measles since the start of 2018 in England is 686. (Published 24th August 2018) (1)
For the first quarter of 2018 (Jan - March) Wales had 14 cases, Scotland had one and Northern Ireland reported no new cases.
For the second quarter (April – June) Wales had 7 cases, Scotland had one and Northern Ireland had none, bringing the total number of laboratory confirmed cases in the UK between January and June 2018, to 709.
(1) https://www.gov.uk/government/publications/measles-mumps-and-rubella-lab...
Competing interests: No competing interests
I was very puzzled by the WHO Europe Surveillance Data cited by Zosia Kmietowicz , and re-posted by David Oliver, stating "so far this year there have been 760 confirmed cases of Measles in the UK".
Bearing in mind, the only cases of measles are LABORATORY CONFIRMED cases. I was assuming the above quoted measles cases were taken from 2018 official UK measles surveillance data, and the UK cases were compiled from England, Wales, Scotland and Northern Ireland. I am also assuming the figures cover the period from January to circa July 2018.
John Stone provided a link to the confirmed measles cases in England, (1) The table, updated to 10th July 2018, states:-
Notified cases 1202
Sent for testing 748
Confirmed cases 91 (12.2%)
Scotland has so far identified ONE confirmed measles case up to May 2018. (2) So that makes 92 cases.
Finding accurate measles surveillance figures for Wales proved impossible. This meant relying on the information provided by Wales Online with the scary headline(3):-
“Dozens of cases of measles reported in Wales so far in 2018 with major rise in numbers” (23rd June)
Quote:-
“From the start of the year up to June 17 a total of 155 suspected cases of measles were reported in Wales to Public Health England (PHE), which collects reports for England and Wales.
Cases across England and Wales have now exceeded 1,500 in 2018.”
These cases were all suspected measles cases, but the presentation implied these cases were actual cases. Public Health England, a taxpayer funded UK Government Agency, appears to be the source of most of these scaremongering press releases, virtually all of which blame the temporary dip in MMR vaccination rates, during the early 2000s, for thousands of unvaccinated ‘teenagers’.
The word ‘unvaccinated’ these days includes those young persons who had one MMR vaccination, instead of the two recommended doses. The 2013 Welsh measles outbreak was reported by the BBC to have more than 1000 measles cases. (4) The Inquiry into the outbreak (5) was told there were more than 1200 notified measles cases in Wales. Again the implication was these were actual cases, rather than suspected ones, when the reality was around 300 laboratory confirmed cases to August 2013. (6) Again the ‘teenagers’ were targeted for extra MMR vaccine doses.
I could find no information at all on Northern Ireland, but assuming the 12.2% of measles tested samples proving positive, in England, (1) was a similar percentage in Wales, then we can assume around 19 actual Welsh measles cases. That makes a grand total of around 111 confirmed measles cases for the three UK countries which provided figures.
I strongly suspect Public Health England as the original source for Zosia Kmietowicz ‘s stated 760 so called ‘confirmed’ UK measles cases during the first half of 2018. This figure is very similar to the numbers stated to be sent to the laboratory for testing in England, (748), up to July 10th.(above) (1)
Note – persons across the Atlantic Ocean and the North Sea, often confuse England with the United Kingdom.
The following PHE press release (7) states:-
“Between 1 January 2018 and 6 July 2018 there has been 757 laboratory confirmed measles cases in England”
This is completely at odds with the official surveillance data, (1), unless the WHO has quoted the numbers of cases being sent to the laboratories for testing, as confirmed cases.
Again the ‘teenagers’ are blamed, but there is also an admittance most of the cases are linked to travel and migration.
Quote:-
“The increase in measles circulation is mainly associated with travel to and from Europe where there are large ongoing measles outbreaks.
Young people and adults aged 15 and over who missed out on MMR vaccine when they were younger and some under-vaccinated communities have been particularly affected.”
The only persons who have shown some commendable common sense in all this are the targeted ‘teenagers’ and young adults, most of whom will have received at least one measles vaccination. (Monovalent measles vaccinations are not included in the quoted statistics.) Young persons have proven resistant to vaccinations with more and more MMR doses, and good luck to them, particularly since in the UK, parental vaccine choices are disregarded with older children. The pressure on these youngsters to be lined up and vaccinated is enormous, particularly since most vaccines are now delivered in schools. Taxpayer funded Government agencies should NOT be sending misleading data to the WHO or putting out public press statements which seem to be little more than scaremongering.
Former British Prime Minister Benjamin Disraeli was credited with this piece of wisdom:-
"There are three kinds of lies: lies, damned lies, and statistics." Too True!!
1. https://www.gov.uk/government/publications/measles-confirmed-cases/measl...
2. https://www.hps.scot.nhs.uk/immvax/measlesdata.aspx
3. https://www.walesonline.co.uk/news/health/dozens-cases-measles-reported-...
4. Swansea measles: Epidemic tops 1,000 cases
30 April 2013
https://www.bbc.co.uk/news/uk-wales-22350001
5. Welsh Measles Outbreak Inquiry 2013
http://www.wales.nhs.uk/sitesplus/888/page/66389#unvacc
6. Welsh notifiable infections to Feb. 2014 http://www2.nphs.wales.nhs.uk:8080/CommunitySurveillanceDocs.nsf/3dc0466...$FILE/monthly%20lab%20201401_correct.pdf
7. Measles outbreaks across England PHE News Report
https://www.gov.uk/government/news/measles-outbreaks-across-england
Competing interests: No competing interests
Of course, we can go round in circles. With all due regard to David Oliver I see no hope for a rational, just or sustainable health policy in which (a) we perpetually defer to authority, (b) the vaccine lobby are always allowed to make all the running and (c) we continue to ignore catastrophic conflicts of interest . Medicine is not a hard a science, and it can only make progress by listening to the people it practices on. I do not think everything is cut and dried in astro-physics, but at least they are not practicing on our bodies.
We could scarcely have a more disturbing illustration at the moment with the manifold reports of harm from HPV vaccines and the failure to test them against placebo, not to mention the great uncertainty that they will ever impact on the target diseases [1]. The public are told the science is open and shut, but the truth is that it is always at best only messy. Being rigid and dictatorial, persecuting dissenting voices is simply a route to disaster.
[1] Jørgensen L, Gøtzsche PC, Jefferson T, 'The Cochrane HPV vaccine review was incomplete and ignored important evidence of bias', BMJ Evid Based Med. 2018 Jul 27. pii: bmjebm-2018-111012. doi: 10.1136/bmjebm-2018-111012.
Competing interests: No competing interests
Editor
The responses to this article, from correspondents with a variety of perspectives illustrates just how problematic it can be for protagonists on either side of an argument, or people like me who are only to ready to admit we have no legitimate expertise or training in this field unlike those at WHO and other national an international agencies who genuinely do, to cite studies and data to advance arguments.
I note for instance that the original column by Zosia Kmietowicz cited the WHO Europe Surveillance Data [1], saying "so far this year there have been 760 confirmed cases of Measles in the UK"
Follow the link to the document and scroll to Table 2 within it and we can see that that 760 refers to laboratory confirmed (not just suspected or reported) cases of Measles, of which 72 were classified as "imported" (in turn illustrating that transmissible diseases know no borders and why in turn, mass vaccination programmes and population immunity are an international as well as a national issue)
David Oliver
Competing interests: No competing interests
Further to letters from Jackie Fletcher, JK Anand and myself [1] I point out the Public Health England chart recording the percentage of reported measles cases tested positive for 21 quarters since the beginning of 2013 [2], with results ranging between 1.4% positive in the 4th quarter of 2014 and 29.3% for the first quarter of 2013, amounting to an overall figure (calculated by myself) of 12.9%. Only just over an 8th of notified measles cases over a five year period were real cases.
This suggests that the ramping up of pressure for political action is being based on known to be poor quality data.
[1] Rapid Responses for Zosia Kmietowicz, 'Measles: Europe sees record number of cases and 37 deaths so far this year', https://www.bmj.com/content/362/bmj.k3596/rapid-responses
[2] Public Health England, 'Eesearch and analysis Measles notifications and confirmed cases by oral fluid testing 2013 to 2018
Updated 10 July 2018', https://www.gov.uk/government/publications/measles-confirmed-cases/measl...
Competing interests: No competing interests
ASD increase 24-fold in US schools
Thank you Ray Gallup [1]. So there is a 24-fold increase in ASD in US schools over the 22 year period 1994-2015. I submit that without being complacent about measles this has much greater implications for society.
[1] Raymond Gallup, 'Re: Measles: Europe sees record number of cases and 37 deaths so far this year, 20 September 2018, https://www.bmj.com/content/362/bmj.k3596/rr-32
Competing interests: No competing interests