US county bars unvaccinated children from public spaces amid measles emergencyBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1481 (Published 28 March 2019) Cite this as: BMJ 2019;364:l1481
All rapid responses
UNLIMITED TOLERANCE OF VACCINES?
In my May 8 response to Joel Harrison I should have responded specifically to his discussion of our immune system and its seemingly unlimited capacity to respond to vaccines. (Harrison, BMJ rr 5/7/19) This idea was most famously proposed by Paul Offit. (Pediatrics 2002;109:124. Pediatrics 2003;111:653) Offit’s articles are interesting, and they continue to be quoted in defense of our dense immunization schedule, but they are theoretical and do not prove that the benefits of the schedule outweigh the risks. Only trials of the type proposed by Fine (Trop Med Internat Health 2007;12:1), Aaby (BMJ 2012;344:e3769) and Shann (rapid responses to Higgins, BMJ 2016;355:i5170) could do that. Here are some examples of how vaccines challenge our immune systems and produce dangerous or unpleasant reactions:
1. There is at least one fatality caused by multiple vaccinations. This was the healthy young woman who died from an autoimmune disease 33 days after receipt of smallpox, anthrax, typhoid, hepatitis B and MMR vaccines. (US Department of Defense, “Panels find vaccines may relate to reservist’s illness, death” News release, November 19, 2003. CIDRAP News, November 19, 2003)
2. Kawasaki disease first appeared in the 1960s and its frequency has marched upward right along with the expansion of the immunization schedule. (Uehara, “Epidemiology of Kawasaki disease” J Epidemiol 2012;22:79) This mysterious immune disorder has been associated with several vaccines in trials and case reports, including hepatitis B, rotavirus, yellow fever, pneumococcal conjugate, influenza, and group B meningococcal vaccines. No randomized trials have tested the possibility of vaccines’ causal role.
3. Acute febrile reactions, including seizures, are well-known responses to vaccinations. These are not trivial, and there is a dose-response relationship: the more vaccines given at one time, the greater the risk.
4. In spite of official pronouncements, vaccines have never been exonerated as potential causes of SIDS. Whole cell pertussis vaccine/wP is a highly reactive vaccine and was a major suspect in the 1970s and 1980s. SIDS declined in the US as use of wP declined, and there was a similar association in Japan. Vaccines in use today are just as reactive, so it is worth noting the persistence of SIDS with an age peak when they are administered. Inflammatory cytokines are important components in the SIDS cascade; some of the same cytokines are evoked by vaccinations. (Goldwater 2017. Ausiello, Infect Immun 1997;65:2168. Talaat, Influenza Other Resp Viruses 2018;12:202.) The statistics associating vaccinations and SIDS are conflicting and, once again, we have no unbiased trials to answer the question of causality.
According to Offit’s theory we should be able to tolerate any number of vaccines at any age, but the foregoing examples suggest otherwise.
A case can be made for trials comparing the current immunization schedule beginning at birth to 6 weeks with schedules that begin later—4, 5 or 6 months of age. Different assortments of vaccines could also be compared. Vaccine authorities have said such trials would be unethical, but they don’t have the data to support the assertion, and people like Fine, Aaby and Shann would disagree.
ALLAN S. CUNNINGHAM 9 May 2019
Competing interests: No competing interests
“…………..the pharmaceutical companies would have to produce separate vaccines for these few, losing millions of dollars in the process”. (Joel Harrison RR 8th May 2019)
I would be interested in Joel Harrison’s supporting evidence for this statement
Who can say what the financial situation would be for the pharmaceutical companies if they returned to marketing single vaccines? It doesn’t follow that the revenue generated in marketing monovalent vaccines would be confined to merely the “few” with a natural immunity to one or other of the component viruses in the MMR. For years, many parents have been requesting the return of single vaccines for their children.
Back when the UK switched from single vaccines to the trivalent MMR, the pharmaceutical companies were making a lot more money off the cumulative cost of three single vaccines than that anticipated with the introduction of the trivalent MMR vaccine.
The Minutes (23rd January 1987) of the Working Party set up to introduce the MMR vaccine into the UK immunisation programme included the fact that the likely cost of the SmithKline & French MMR vaccine (Pluserix) was to be " not more than £3" (1)
The relevant BNF for the same timeframe has the cost of the monovalent Measles vaccines as, Attenuvax, £1.32, Mevilin-L £ 1.42 and Rimevax at £1.31 with monovalent Mumps vaccine at £4 per dose and monovalent Rubella vaccine at £1.90.
The cumulative cost is over £7 for the three monovalent vaccines with a comparison £3.80 (plus VAT) for the trivalent MMR.
A paper by CRAIG C. WHITE, MD, JEFFREY P. KOPLAN, MD, MPH, AND WALTER A. ORENSTEIN, MD, Benefits, Risks and Costs of Immunization for Measles, Mumps and Rubella, AJPH July 1985, Vol. 75, No. 7, records the saving in using the combined MMR vaccine as opposed to monovalent vaccines, to be $60 million.
“Using the same methodology, but assuming single antigen vaccine, the benefit-cost ratios for measles, rubella, and mumps were 11.9:1, 7.7:1, and 6.7:1, respectively The savings realized due to the use of combined versus single antigen vaccine total nearly $60 million.”
That saving of $60million in using MMR as opposed to the monovalent vaccines was a loss of $60million dollars to the pharmaceutical industry and suggests that rather than lose money from the manufacturing of monovalent vaccines, they actually generated more revenue from them. Who can say with certainty that a return to manufacturing single vaccines would result in a loss to the pharmaceutical industry?
Competing interests: No competing interests
Joel Harrison writes with authority and some precision about measles and vaccinations, but I believe he is wrong to dismiss legitimate concerns about vaccine safety on the part of JK Anand, John Stone, Elizabeth Hart and others. (Harrison, BMJ rapid responses 5/7/19, 4/13/19, 3/31/19)
Does he know that a substantial proportion of cases of paralytic polio has been attributable to injections of vaccines or antibiotics? (Hill, BMJ 1 July 1950. Strebel, NEJM 1995;332:500. Kohler, Int J Epidem 2002;32:272) Will he acknowledge the possibility that this might also be true of acute flaccid myelitis/AFM, the devastating polio-like disease now afflicting children? (Cunningham, BMJ rapid responses 1 January 2015 to 11 April 2019) Does he believe that our knowledge of adverse vaccine effects is complete? Does he believe that every vaccine on the US immunization schedule is vital to the health of every American child? Would he agree that, in addition to humanitarian motives, there are also non-humanitarian motives driving our immunization programs?
Has Dr. Harrison read Paul Fine and Peter Smith’s editorial about “Non-specific vaccine effects”? (Tropical Medicine and International Health 2007;12:1) Among other things they say this: “As an increasing number of new vaccines is introduced into all populations, the possibility of changing the basic vaccine schedule provides a window of opportunity for making controlled changes that could be designed not only to evaluate the immunologic effects of different schedules, but also to evaluate possible longer-term beneficial or adverse non-specific effects.” They suggest that we need to study the overall benefits and risks of our immunization schedules. Similar suggestions have been made by Aaby (BMJ 2012;344:e3769) and Shann (rapid responses to Higgins, BMJ 2016;355:i5170).
I think children should get the measles vaccine, but prevailing uncertainties about vaccines should prompt some humility among advocates.
ALLAN S. CUNNINGHAM 8 May 2019
Competing interests: No competing interests
Response to Dr Anand
Dr Anand writes: “I am all for Measles vaccination where the person has NOT had laboratory confirmed measles NOR clinically diagnosed measles with KOPLIK SPOTS. . . Where the patient or guardian gives a history suggestive of rubella or rubeola or of mumps, a vaccine is not given without prior test for naturally acquired antibodies.”
1. Given that until recently naturally occurring cases of measles, mumps, and rubella had all but disappeared in the US, this would involve only a few hundred cases;
2. However, if someone has immunity from the natural disease, then an attenuated (severely weakened) vaccine would have NO effect, thus giving the MMR would be absolutely NO problem.
3. Despite any necessity, to ensure those who had natural immunity from one of the three were protected against the other two, the pharmaceutical companies would have to produce separate vaccines for these few, losing millions of dollars in the process. Never going to happen !
4. So, all his requirement would do is add costs and delays to kids getting vaccinated, especially given that even if they had had one of the three, they still need to be protected against the others.
Dr Anand writes: “The immunising doctor arranges to follow up and record all adverse reactions which he then notifies to the appropriate authority responsible for maintaining a register, analysing adverse reactions, collating the data from all the population so immunised.
From the CDC Vaccine Safety Website: “Healthcare providers are required by law to report: “Any adverse event listed by the vaccine manufacturer as a contraindication to further doses of the vaccine. Any adverse event listed in the VAERS Table of Reportable Events Following Vaccination that occurs within the specified time period that occurs within the specified time period after vaccination.
Healthcare providers are encouraged to report:
Any adverse event that occurs after the administration of a vaccine licensed in the United States, whether or not it is clear that a vaccine caused the adverse event
Vaccine administration errors.”
Dr Anand raises requirements that have already been met ! ! !
Dr Anand writes: “Parent or guardian gives full, free, INFORMED consent. No pushing, prodding, bullying.”
He seems to have missed what I wrote in a previous comment, so I repeat it here: “We usually live in dense urban environments. People have rights; but also responsibilities. Do we consign the above children [those who have medical conditions so they can’t be vaccinated, are too young, or for some reason their immune systems did not respond to a vaccine] to staying at home, not going to school, not going to parks, not going shopping with their parents? Not allowing visitors to their homes? Whether we have a vulnerable child or not, I think of the phrase: “There but for the Grace of God go I.” Individuals live in communities !”
Despite what antivaccinationists believe, vaccines are quite safe, though not 100%; but the chances of a serious adverse event are minuscule. On the other hand, as more and more parents refuse to vaccinate their children, they put not only their children at risk; but others as well. So, society has a right by law to protect them and the law does exactly that.
Dr Anand writes: “I did wonder why you found it necessary to bring in the epithet “anti-vaxxer” if you were not implying that I AM AN ANTI-VAXXER. . . if you search the Rapid Responses in the BMJ and also the indexes of the Lancet and the BMJ, Dr Harrison, you will find how enthusiastic I have been for proper vaccination for various diseases going back a professional life-time.”
As I wrote in my previous RR to Dr Anand: “Typical antivaxxer’s unending questions.”
As I’ve clearly explained above, his requirement to determine if a child had a natural infection from one of the MMR is mistaken, his requirement of doctors to report adverse events shows he hasn’t done his homework, and, since we live in communities, rights have to be balanced with responsibilities, and the law clearly protects those vulnerable who can’t be vaccinated or the vaccine didn’t take. It is typical of antivaccinationists to claim they are pro-vaccine, just so many caveats that are either mistaken or illogical that the end result would be a severe reduction in vaccinations. Thus, Dr Anand is an antivaccinationist ! ! !
CDC Information for Healthcare Providers. What to Report. Available at: https://www.cdc.gov/vaccinesafety/hcproviders/reportingadverseevents.html
CDC VAERS Table of Reportable Events Following Vaccination. Available at: https://vaers.hhs.gov/docs/VAERS_Table_of_Reportable_Events_Following_Va...
Reiss D (2015 Oct 5). Parental and Children’s Rights - Vaccination Mandates. Skeptical Raptor. Available at: https://www.cnn.com/2019/03/30/opinions/vaccinations-new-york-ban-reiss/...
Reiss D (2015 Oct 6). Vaccines and Religious Exemptions - Recent Legal Decision. Skeptical Raptor. Available at: http://www.skepticalraptor.com/skepticalraptorblog.php/vaccines-and-reli...
Reiss D (2019 Mar 30). New York county's move on vaccinations was bold, necessary and perfectly legal. CNN. Available at: https://www.cnn.com/2019/03/30/opinions/vaccinations-new-york-ban-reiss/...
Competing interests: No competing interests
Dear all interested in immunisation against a particular disease - by full, free, informed consent of the person at risk of that particular disease.
1. It is stated that the “hesitants" are mostly well-educated.
Might I suggest that cultural anthropologists be kept out of it? Margaret Mead is sometimes invoked. But it is forgotten that she did not write about Samoa by reading about Samoans, nor did she pay flying visits only.
Could it be that the well-educated parents take umbrage at being bullied? Being told that they are enemies of society?
2. A curious fact. I have it from an unimpeachable source that in Germany, there is licensed, a monovalent MEASLES Vaccine. But it is not available. Why, I wonder.
It may be costly. But might I suggest that the vaccine may be made available to those who are willing to pay?
3. The WHO knows full well that in India it quite happily supports MEASLES - RUBELLA vaccination.
Yet , in Europe, it has to be MMR.
Some, maybe many of us, rebel against the elite. (Possibly in the BREXIT debates pre-referendum, many voters rebelled against the perceived unaccountability of the Commissioners, and, as I found in my dealings with them the uselessness of the MEPs.)
Competing interests: Attempting to discover facts, truths, half-truths, from the utterances of well-meaning experts
Single measles, mumps and rubella vaccines aren’t available in the UK through the NHS and aren’t recommended by the NHS (1) but some private clinics offer monovalent measles vaccine. (2) (3) (4) Merck ceased producing monovalent measles vaccine some years back but there are other brands available.
Since 2001, the situation, as stated by Yvette Cooper MP to the House of Commons, has been that…………….
“None of the single measles and mumps vaccines licensed in the United Kingdom is manufactured for, or marketed in the UK, and the licence holders advise that the products they manufacture outside the UK for other countries do not fully comply with their UK licences. None of the single measles and mumps vaccines imported into the UK are licensed for use in the UK, or in full compliance with an extant UK product licence. Consequently, as unlicensed vaccines, they may only be imported and supplied to fulfil special needs, in response to the prescription of a doctor, and for use by his/her individual patients on his/her direct personal responsibility.” (5)
The MHRA publishes quarterly reports on the importation of unlicensed medicines into the UK which includes single vaccines.(6) The Human Medicines Regulations 2012 (SI 2012/1916) allows for the importation of and supply of unlicensed medicinal products for individual named patients. Between the third quarter or 2007 for example, and the third quarter of 2008 there were 1085 measles vaccine notifications, 769 for monovalent rubella and 1126 for mumps. In June 2004 as a result of legal advice the MHRA had to accept multiple notifications for the same product in one day where they had previously only been accepting one, with a resultant increase in the number of unlicensed monovalent vaccine imports.(7)
(5) Hansard 20 th March 2001: column :134W
(7) Summary Report for Importation of Unlicensed Medicines 01 Jul 2008 – 30 Sep 2008
Competing interests: No competing interests
Dear Dr Harrison,
May I hasten to express my gratitude for bothering to respond to me. Although I did wonder why you found it necessary to bring in the epithet “anti-vaxxer” if you were not implying that I AM AN ANTI-VAXXER.
Just to clarify:
1. I am all for Measles vaccination where the person has NOT had laboratory confirmed measles NOR clinically diagnosed measles with KOPLIK SPOTS.
2. I am, in fact, for vaccination against ALL infectious diseases - provided:
a. Parent or guardian gives full, free, INFORMED consent. No pushing, prodding, bullying.
b. The immunising doctor arranges to follow up and record all adverse reactions which he then notifies to the appropriate authority responsible for maintaining a register, analysing adverse reactions, collating the data from all the population so immunised.
c. Where the patient or guardian gives a history suggestive of rubella or rubeola or of mumps, a vaccine is not given without prior test for naturally acquired antibodies.
I may have forgotten to make other points.
If you search the Rapid Responses in the BMJ and also the indexes of the Lancet and the BMJ, Dr Harrison, you will find how enthusiastic I have been for proper vaccination for various diseases going back a professional life-time.
And if what described, above are, in your eyes, the attributes of an anti-vaxxer, then, dear Dr Harrison, you are very welcome to label me so.
Competing interests: No competing interests
It is unusual for a correspondent to make so many assertions about another as Joel Harrison has done here about myself [1,2], and a lot of it seems rather speculative and regrettable.
What we do need to address is the issue of multiple vaccines and the use made of Paul Offit's calculation about the number of antigens in vaccine schedule products compared to putative infant capacity  by Offit himself and others. In fact this calculation may be irrelevant to the safety of products or at best only one of many elements involved. In my evidence to the Health and Social Care Committee  I was clear that I was concerned about how this claim was deployed for public consumption. Indeed, this always seems to have been the purpose given that the paper in which it appeared was entitled 'Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System?'  and I gave examples.
For, instance, I quoted from a publication of Offit's own hospital :
"Children have an enormous capacity to respond safely to challenges to the immune system from vaccines," says Dr. Offit. "A baby's body is bombarded with immunologic challenges - from bacteria in food to the dust they breathe. Compared to what they typically encounter and manage during the day, vaccines are literally a drop in the ocean." In fact, Dr. Offit's studies show that in theory, healthy infants could safely get up to 100,000 vaccines at once.”
I cited David Salisbury,at the time British government's vaccine and immunology spokesman, in BBC 2 Newsnight 10 August 2004  :
"The immune system of a baby has got huge spare capacity to deal with challenge. If we didn't, the human race wouldn't survive. But let's look specifically at vaccine. This has been studied carefully. A baby's immune system could actually tolerate perfectly well 1,000 vaccines".
I cited the response of the NHS 'MMR the Facts" team to an enquiry I had made :
"The CMO [Liam Donaldson] is entitled to present his statement about the immune system as a medically established fact rather than theoretical proposition. From the moment of birth a child's immune system is able to cope with the constant barrage of pathogens. As the CMO stated, this is what the..."immune system is designed cope tih (sic)..."As for example, the digestive system is "designed" to digest food and liver is "designed" to detoxify the blood. Part of the licensing process of any combination vaccine, such as MMR, has to show that the combination is safe and effective when administered to the age group for which it is intended. There is recent research from the US which supports this statement as it has specifically looked at the ability of children's immune systems, estimating that a child's immune system could cope with 10,000 vaccines any one time. Please see Offit PA et al (2002) Addressing parents' concerns: Do multiple vaccines overwhelm or weaken infant's immune system? Pediatics, 109 (1): 124-9"
As late as 2015 Elizabeth Miller of Public Health England was talking about "strong arguments against an overload hypothesis" with a citation of Offit's paper .
But the fundamental problem is that it was not I who was making naive use of this possibly irrelevant conjecture but the experts advising the public. I commented (in full) :
"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. Offit was comparing routine exposure to environmental pathogens, with cocktails of serious disease derived pathogens; it took no account, for example, of the use of adjuvants to boost the antigens and the route of
administration was nothing like routine exposure to pathogens in the environment i.e. in most cases injected when normally we have skin, the digestive system, the lungs which have evolved to protect us..."
For a long time Offit's calculation was used to reassure the public about the safety of multiple vaccines and the expanding schedule, but with so many products on the schedule and so many more in the pipeline there is surely no longer any rational way of regarding this as anything but over-medication [3,8]. This is the present United Kingdom infant vaccine schedule to 12 months:
DTaP, Polio, HiB, HepB+Rotavirus+13 Strain Pneumococcal+MenB (8 weeks)
DTaP, Polio, HiB, HepB+Rotavirus (12 weeks)
DTaP, Polio, HiB,HepB+13 Strain Preumococcal+MenB (16 weeks)
13 Strain Pneumococcal+MMR+HiB, MenC (12 Months)
It is time to stop being gung-ho, and time to start listening to people who report harm.
 Joel A Harrison, 'US county bars unvaccinated children from public spaces amid measles emergency', 7 May 2019, https://www.bmj.com/content/364/bmj.l1481/rr-13
 Joel A Harrison, 'US county bars unvaccinated children from public spaces amid measles emergency', 7 May 2019, https://www.bmj.com/content/364/bmj.l1481/rr-14
 Offit PA, Quarles J, Gerber MA, Hackett CJ, Marcuse EK, Kollman TR, et al. 'Addressing
parents’ concerns: do multiple vaccines overwhelm or weaken the infant's immune system?'
Pediatrics. 2002;109:124–9. doi: 10.1542/peds.109.1.124
 John Stone, 'What David Salisbury said and the DOH’s position on multiple vaccine safety',
BMJ Rapid Responses 20 September 2004, https://www.bmj.com/rapidresponse/2011/10/30/what-david-salisbury-said-a...
 John Stone, 'Irresponsible claims about vaccine safety? Questions for Sir Liam Donaldson and
Prof Lewis Wolpert', BMJ Rapid Responses 3 July 2004, https://www.bmj.com/rapidresponse/2011/10/30/irresponsible-claims-about-...
 Elizabeth Miller, 'Controversies and challenges of vaccination: an interview with Elizabeth Miller', BMC Med. 2015; 13: 267. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608187/
 John Stone, 'Re: How much medicine is too much? And how about vaccines?', 1 March 2019, https://www.bmj.com/content/364/bmj.l902/rr-0
Competing interests: No competing interests
Response to Dr. Anand:
Dr. Anand asks: “WHERE IN THE UK OR THE US, can a child or an adult obtain MEASLES vaccine. . . If I wanted to buy Measles vaccine . . [doctor] will only issue an MMR prescription. Why?”
Since all three, Measles, Mumps, and Rubella are diseases that historically have infected almost ALL children, each with serious risks, they are all included in the list of mandated vaccines for school entry and recommended to be given at younger ages. Giving three shots in separate needles adds to the brief pain suffered by a young child or would require multiple trips to get them. Numerous well-done studies have shown the combined vaccine to be quite safe. Merck actually offered the monovalent measles vaccines for several years after approval of the MMR; but so few chose it, that they actually lost money, so they discontinued its production. The CDC list over 40 safety studies. A search of the National Library of Medicine’s online database, PubMed, using search words “MMR vaccine AND safety” found 474 studies, not all directly relevant; but most.
In the U.S., besides at doctor’s offices, one can get MMR vaccines often for free at County Health Departments and at low prices at Walmart and Costco. Most drugs stores, Walgreen’s, etc. also offer the vaccine.
Dr. Anand asks: “Had these “measles” cases previously suffered similar looking exanthemata?”
Measles, as described in my previous Rapid Response, is a distinct disease with exanthemata only one of the signs. Having or not having a previous exanthemata does not change a finding of measles. The combination of signs and symptoms are unique if Koplik spots found, that, even without a lab, confirmation is valid. Perhaps, Dr. Anand missed this in his medical school lectures? However, if listed as a confirmed case, it means lab confirmed. According to the CDC:
“VI. Case Definition
An acute febrile rash illness with: isolation of measles virus from a clinical specimen; or detection of measles virus-specific nucleic acid from a clinical specimen using polymerase chain reaction; or IgG seroconversion or a significant rise in measles immunoglobulin G antibody using any evaluated and validated method; or a positive serologic test for measles immunoglobulin M antibody; or direct epidemiologic linkage to a case confirmed by one of the methods above “
For Rockland County:
“As of April 12, 2019, there are 184 confirmed reported cases of
measles in Rockland County.
Vaccination rates for confirmed measles cases in Rockland County as of April 12, 2019:
81.0% have had 0 MMRs
4.3% have had 1 MMR
3.3% have had 2 MMRs
11.4% unknown status”
So, the vast majority of lab confirmed cases were in non-vaccinated individuals and a few in those who had been vaccinated. However, we also know from numerous studies that those vaccinated often experience less severe symptoms.
As for the batch numbers and manufacturers, why not ask for the vaccinator’s name, specialty (pediatrician, family doctor, doctor of internal medicine, drug store pharmacist, or county health nurse, etc) and license, etc? Typical antivaxxer’s unending questions. The cases were lab confirmed and the number of vaccines received documented! ! !
In 2000 endemic measles was declared ended in the United States. Sporadic cases occurred, brought in from abroad; but due to the high level of vaccinated, resulted in few cases. With the advent of the antivaccinationists, clusters of unvaccinated, for instance, Orthodox Jews in Rockland County, have resulted in a resurgence of a potentially dangerous disease.
CDC (2014 Apr 1). Vaccine Preventable Diseases Surveillance Manual - Chapter 7 - Measles. Available at: https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html [scroll down to Case Definition]
CDC (2018 Sep 28). Measles, Mumps, and Rubella (MMR) Vaccine Safety. Available at: https://www.cdc.gov/vaccinesafety/vaccines/mmr-vaccine.html#side-effects
[Note. scroll down to “A Closer Look at the Safety” and “Related Scientific Articles]
PubMed (accessed 2019 Apr 11). MMR vaccine AND safety. Available at: https://www.ncbi.nlm.nih.gov/pubmed/?term=mmr+vaccine+and+safety
Rockland County (2019 Apr 12). 2018 - 2019 Measles Outbreak in Rockland County. Available at: http://rocklandgov.com/departments/health/measles-information/
Competing interests: No competing interests
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.
Benjamini E, Coico R, Sunshine G (2000). Immunology: A Short Course (Fourth Edition). John Wiley & Sons.
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Competing interests: No competing interests