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US county bars unvaccinated children from public spaces amid measles emergency

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1481 (Published 28 March 2019) Cite this as: BMJ 2019;364:l1481

Linked opinion

Measles in America—what’s playing out in New York State is nightmarish

Re: US county bars unvaccinated children from public spaces amid measles emergency

In Stone’s previous response, he referred to his “published” submission to the UK House of Commons [actually just posted with all other submissions]. Stone wrote: “There were several obvious things wrong with Offit’s claim that 10,000 or 100,000 vaccines administered to an infant in one go might be safe. . . Last year I was attacked by the Every Child By Two website, to which Offit is an advisor and executive member, for suggesting he ever meant it literally (despite copious evidence. . .)”

Stone wasn’t “attacked by the Every Child By Two website,” but by an article I wrote for them. I neither work for ECBT, nor did they ever suggest topics. I wrote the article, submitted it to them, and they decided to post it. Would Stone consider published articles in the British Medical Journal about vaccines to be the BMJ’s work?

A little background in immunology, focusing on antibodies. The precursor to antibodies are B-cells. Each B-cell has a unique receptor formed from a random arrangement of genes. At any one time there are an estimated 10 million of these unique B-cells cruising our bodies. If a foreign antigen (a distinct section of a microbe) enters our body, a B-cell with the correct receptor will lock on to it, transform into a plasma cell which begins producing 10s of thousands of antibodies. It then becomes a race between the microbe and our immune system. If, as in most cases, we win, memory antibodies remain so that if the same microbe attacks again, it can be nipped in the bud. Vaccines simply create these memory antibodies without us having to experience the actual disease. On average children are exposed to 2,000-6,000 or more potentially dangerous microbes daily. Paul Offit explained this in both an article in the journal Pediatrics and testimony before Congress. At the very end of both he states theoretically 10,000 or 100,000 vaccines. It is obvious from the context, his explanation of how our immune system works, he is actually saying the vaccine theoretical equivalent to many antibodies, which given 10 million different antibodies, 10,000 or even 100,000 is a drop in the bucket.. Currently, the World Health Organization lists 27 approved vaccines and 19 being developed, while the Pharmaceutical Research and Manufacturers of America list almost 300 in various stages of development; but most of these would not be given to a child in the US or UK because they are for diseases not prevalent in either. In addition, just common sense says we couldn’t possibly inject a child at one time with 10,000 vaccines (even if we combined 5 into each injection). I explained this quite clearly in my article.

Apparently, Stone’s “careful reading” involves focusing on individual sentences with the inability to understand context or even common sense. Yep, Paul Offit did state 10,000 and 100,000; but anyone reading what he wrote or listening to his testimony would understand what this means from the context.

In Stone’s 2nd RR he quotes me: “‘Until recently, thanks to Stone and other antivaccinationists, measles had been declared ended in the U.S.’ I do note that while Harrison attributes to myself and others the elimination of measles in the United States.”

Given that the modern antivaccinationist movement began in the early 21st Century and endemic measles was declared over in the United States in 2000, it doesn’t make sense to attribute its end to the antivaccinationist movement. In addition, since Stone knows, from my RR and previous encounters I am a strong supporter of vaccines, why would I attribute the ending of measles in US to antivaccinationists? Yep, I goofed. Not the first time. When I write articles I send them for editing/critiquing to up to dozen colleagues; but with blog comments don’t do this. Obviously, what I meant to write was: “Until recently, endemic measles had ended in the US; but thanks to Stone and other antivaccinationists, outbreaks are re-appearing.” Mea culpa. So, two examples of how Stone focuses on one sentence, ignoring context.

Stone heads his 2nd RR with “measles is not Ebola.” In his first RR, Stone wrote that measles was not included in U.S. government’s list of quarantinable diseases. I gave Ebola as an example that just because something not on the list doesn’t mean it can’t be quarantined. In my 2nd RR I also explained that under US Constitution the States have quite a bit of independence, perhaps, something like Scotland in the UK.

Stone is right, measles is not Ebola. From a public health standpoint measles is far more dangerous. Ebola kills most of those infected; but as we saw during the last major outbreak in 2014, nine infected people returned to the US and only two died. Why? Ebola is only contagious after it becomes symptomatic, at which point the person immediately becomes prostrate, and infection can only occur by direct contact with body fluids. In Africa where an entire family ritually washes the dead bodies, many became infected. Measles is contagious 4 days prior to its becoming symptomatic, is an airborne infection, particles can hover in the air for hours. Extrapolating from prevaccine era, if a measles vaccine did not exist, someone flying in from abroad would infect many on the flight, in the terminal, connecting flights, etc, could result in several million kids suffering 7 - 10 days, up to 100,000 would be hospitalized, up to 1,000 would die and 1,000 would suffer permanent disabilities (deafness, blindness, seizure disorders, and mental retardation) and several dozen would die 7 - 10 years later from subacute sclerosing panencephalitis (a severe untreatable inflammation of the brain). Stone displays his lack of understanding of infectious diseases.

References:

Benjamini E, Coico R, Sunshine G (2000). Immunology: A Short Course (Fourth Edition). John Wiley & Sons.

Centers for Disease Control (2018 Feb 5). Measles History. Pre-vaccine Era. Available at: https://www.cdc.gov/measles/about/history.html

Cohn M, Langman RE (1990). The Protecton: The Unit of Humoral Immunity Selected by Evolution. Immunological Review; 115: 11-147.

Harrison JA (2016 Mar 18). Ignoring Context and a Lack of Common Sense: Antivaccinationists Absurdly Misusing Dr. Paul Offit’s “each infant would have the theoretical capacity to respond to about 10,000 vaccines at any one time”. Vaccinate Your Family. Available at: https://64gbq3vj11cj33l2zkxvv10k-wpengine.netdna-ssl.com/wp-content/uplo...

Harrison JA (2017 Feb 27). John Stone and the “Best of Age of Autism”: Just Plain Wrong About
Everything. Vaccinate Your Family.
https://64gbq3vj11cj33l2zkxvv10k-wpengine.netdna-ssl.com/wp-content/uplo...

Janeway CA, Travers P, Walport M, Shlomchik M (2001). Immunobiology: The Immune System in Health and Disease. Garland Publishing.

National Institute of Allergy and Infectious Diseases. Understanding the Immune System: How It Works. Available at: http://www.imgt.org/IMGTeducation/Tutorials/ImmuneSystem/UK/the_immune_s...

Offit P, Are childhood vaccines safe? https://www.youtube.com/watch?v=dQQ7izQOPdw
[Segment 27 mins to 29.20]

Sompayrac L (2016). How The Immune System Works (5th Edition). Wiley Blackwell.

Stone J (2016 Jan 5). Bexsero: More Questions for the British and Scottish Governments Over Vaccine Committee Chair. Age of Autism. Available at: https://www.ageofautism.com/2016/01/bexsero-more-questions-for-the-briti... [scroll down near end to “Posted by: John Stone | January 06, 2016 at 04:48 AM"

Sun LH (2016 Oct 28). New data shows a deadly measles complication is more common than thought. The Washington Post. Available at: https://www.washingtonpost.com/news/to-your-health/wp/2016/10/28/new-dat...

UK Parliament Health and Social Care Committee (2018 Sep). Antimicrobial resistance inquiry. Available at: https://www.parliament.uk/business/committees/committees-a-z/commons-sel... [click on “All Antimicrobial resistance inquiry publications” THEN under “Written Evidence” click on “+View all”]

Wendorf KA, Winter K, Zipprich J et al. (2017 Jul 15). Subacute Sclerosing Panencephalitis: The Devastating Measles Complication That Might Be More Common Than Previously Estimated. Clinical Infectious Diseases; 65(2): 226-32. Available at: https://www.researchgate.net/publication/315828256_Subacute_Sclerosing_P...

Wikipedia (2019). Ebola virus cases in the United States. Available at: https://en.wikipedia.org/wiki/Ebola_virus_cases_in_the_United_States

Competing interests: No competing interests

07 May 2019
Joel A. Harrison
Long-Retired Epidemiologist
None
I have NEVER worked for the FDA, NIH, CDC, any pharmaceutical company, nor ever purchased pharmaceutical stocks