Student guest post: Challenges and Progresses in HIV Vaccine Research

It’s time for this year’s second installment of student guest posts for my class on infectious causes of chronic disease. Third one this round is by Jack Walsh. 

The Human Immunodeficiency Virus (HIV) infection is one of the most significant global health challenges of this 21st century. Since the isolation of the virus in 1983, it has infected 70 million people among whom 35 million have died of Acquired Immunodeficiency Syndrome (AIDS).1 Although important progresses have been made in slowing down the pandemic and reducing the morbidity and mortality related to HIV/AIDS with the highly active antiretroviral therapy (HAART) drugs, there are still difficulties in stopping the dissemination of the infection. It is estimated that for every person gaining access to HART, there are two new others infected by the virus.2 An effective and safe vaccine is therefore needed to prevent HIV from spreading, but the development of the vaccine has been proven to be an enormous scientific challenge.

HIV presents particularities that make it very difficult for researchers to find a vaccine. It is a lentivirus from the Retroviridae family, slowly progressive using an enzyme (called reverse transcriptase) for the transformation of its genome or genetic material (RNA in this case) into a new one (proviral DNA) integrated in that of the human host using another enzyme known as integrase. One of the most fascinating characteristics of the virus is its genetic variability in both an infected individual and geographically. In a same person, new mutations can be introduced in almost every new copy, creating up to millions of new particles every day. One antibody could then neutralize one virion, but not another.3 Additionally, super-infection in an individual already HIV infected results in new recombinants increasing further viral genetic diversity. The virus also presents two different types, HIV-1 worldwide and HIV-2 confined to West Africa. HIV-1 is further subdivided into subtypes or clades differently distributed on the globe and further diversified within each clade. Moreover, by integrating proviral DNA in the genome of memory cells of the immune system (CD4+ T cells) the HIV can escape the immune surveillance. To complicate the development of an effective vaccine, the virus envelope is able to hide receptor site to antibody that could potentially inhibit its effect (neutralizing antibodies). This explained the inefficiency of antibodies generated by vaccines targeting the glycoprotein 120 (gp120) located on the surface of virus developed in early vaccine trials.4

However, despite these challenges, encouraging progresses in the development of an effective HIV vaccine have been made. The first HIV vaccine trial was opened at the National Institutes of Health (NIH) Clinical Center in 1987, including 138 healthy volunteers. Other large scale trials included participants from North America and The Netherlands (1998), then Africa and Asia (1999).5 Three main approaches have been used in the development of an HIV vaccine: 1) the induction of neutralizing antibodies against HIV using the virus envelope proteins (gp120 or 140), 2) the use of viral vectors to stimulate responses form killer cells (CD8 T-cells or T cell that would recognize antigens on virus surface of the virus-infected cell, binds to it, and kill it), and 3) the optimization of cellular immunity (activation of killer cells) and humoral immunity (production of antibody) with prime-boosts (administration of one type of vaccine, such as a live-vector vaccine, followed by or together with a second type of vaccine, usually a recombinant).6 Also, to cope with the genetic variability of the virus, multiple strategies are explored, such as mixing envelope immunogens from several HIV subtypes or clades. Unfortunately, most of the tested vaccine models did not significantly reduce HIV infection in participants, except an envelope-based subunits’ vaccine tested in Thailand which showed significant decline by about 30% in HIV infection in 2009.7 Though modest, the results clearly show that HIV/AIDS is a vaccine preventable disease. More recently in 2012, a Spanish study showed promising results in the development of a therapeutic HIV vaccine effective in reducing the viral load by 90% after 12 weeks of therapy, awkwardly the vaccine lost effectiveness within a year.8 Just a few days ago, the Duke Human Vaccine Institute team published an important study, in which it has been able for the first time to map the co-evolutions of antibodies and virus in an infected individual, whose immune system launched a broad attack against the pathogen, using new technologies. They also identified the viral surface glycoprotein, which initiated the neutralizing antibody development.9

Despite two decades of disappointing results on HIV vaccine research, we now have started to see encouraging advances. For the first time a candidate vaccine was successful in significantly reducing the HIV infection. Furthermore, an important progress has been made very recently in identifying neutralizing antibodies initialization and mapping. The study provides crucial insights for the development of a vaccine that could mimic the actual antibody development and elicit non-strain specific antibodies. Progress towards finding an effective vaccine is slow, but we can optimistically say that the future is promising.

 

References

[1] World Health Organization (WHO), Global Health Observatory (GHO). HIV/AIDS, Global situation and trends. 2012. http://www.who.int/gho/hiv/en/

2 Letvin, Norman L. “Progress and obstacles in the development of an AIDS vaccine.” Nature Reviews Immunology 6.12 (2006): 930-939.

3Letvin NL. Progress Toward an HIV Vaccine. Annu. Rev. Med. 2005. 56:213–23

4Marc GP, OsmanovSK, Kieny MP. “A review of vaccine research and development: the human immunodeficiency virus (HIV).” Vaccine 24.19 (2006): 4062-4081.

5 National Institute of Allergy and Infectious Diseases (NIAID). History of HIV Vaccine Research. 2012. http://www.niaid.nih.gov/topics/hivaids/research/vaccines/Pages/history.aspx

6 Ross, Anna Laura, et al. “Progress towards development of an HIV vaccine: report of the AIDS Vaccine 2009 Conference.” The Lancet infectious diseases 10.5 (2010): 305-316.

7 Rerks-Ngarm, Supachai, et al. “Vaccination with ALVAC and AIDSVAX to prevent HIV-1 infection in Thailand.” New England Journal of Medicine 361.23 (2009): 2209-2220.

8 García, Felipe, et al. “A Dendritic Cell–Based Vaccine Elicits T Cell Responses Associated with Control of HIV-1 Replication.” Science translational medicine 5.166 (2013): 166ra2-166ra2.

9 Liao HX et al. Co-evolution of a broadly neutralizing HIV-1 antibody and founder virus. Nature 2013. Epub April 3, 2013

Student guest post: The Fallacious Fad of Foregoing Vaccinations

It’s time for this year’s second installment of student guest posts for my class on infectious causes of chronic disease. First one this year is by Dana Lowry.

Humans have a long history of illness and death from infectious diseases. It wasn’t until the 1790s that we had a solution. Edward Jenner recognized that milkmaids never contracted smallpox but suffered from a more mild disease, cowpox. Jenner took pus from a cowpox lesion on a milkmaid’s hand and placed it in an incision he made in an eight year-old boy’s arm. He then exposed the boy to smallpox; the boy didn’t contract the disease, proving he was immune. Jenner experimented on several other children, including his own 11-month old son, and his theory of passing on immunity proved to be successful. The Latin term for cow is vacca, which is where Jenner coined the term “vaccine”. Jenner’s discovery eventually led to the eradication of smallpox from the U.S. in 1949 and from the world in 1979. For over a century, vaccines were limited to preventing smallpox but as we know today, vaccines prevent a large number of diseases.

Although many developing countries still suffer from the burden of preventable infectious diseases, the U.S. has greatly increased the life expectancy and quality of life through the use of vaccines. In the 1940s, the U.S. recommended vaccines for diphtheria, pertussis and tetanus; polio was added in the 1950s. In the 1970s, measles, mumps and rubella (MMR) were added to list. Today in the U.S., immunizations are recommended for 17 vaccine-preventable diseases during one’s lifetime and more are available for individuals traveling outside of the U.S. Many of these vaccinations are combined so they can prevent multiple diseases from one series of immunizations. The increase in life expectancy in the 20th century is largely attributable to vaccines. For each birth cohort vaccinated, 33,000 lives are saved, 14 million cases of disease are prevented, healthcare costs are reduced by $9.9 billion and $33.4 billion is saved in indirect costs. The Bill Gates Foundation believes that vaccines are one of the most cost-effective investments in global health, saving about 2.5 million lives each year. One child dies every 20 seconds from vaccine-preventable diseases while tens of thousands of other children suffer from severe illnesses and permanently disabling diseases.

Despite the facts, less and less parents are choosing to vaccinate their children today because of fears that vaccines are unsafe. Much of the controversy started with Dr. Andrew Wakefield, a former British surgeon and medical researcher. Wakefield published a paper in 1998 linking the MMR vaccine to autism and bowel disease. Wakefield’s entire study was found to be fraudulent and the infamous paper was retracted in 2010. But, what got more attention than a retracted science paper was Jenny McCarthy sharing her personal life story of how her son got autism from a vaccine on the Oprah Show. Unfortunately, more moms keep up-to-date with Oprah and popular news rather than science and still do not know the truth behind Wakefield’s falsified study; therefore, the autism myth continues.

Furthermore, parents argue “herd immunity”. If your children are effectively vaccinated then why would I have to worry about mine? First, many vaccine-preventable diseases still exist in other countries and can easily be brought into our country; second, some individuals do not build immunity to the disease even after vaccination. The more and more parents that opt out of vaccinations, the less protection their children have from the rest of the “herd”. Additionally, parents argue that their children should contract diseases “naturally” through the environment to build immunity. Parents don’t fully understand the severity of these diseases because many have been virtually eradicated through the successful use of vaccines. Though some crippling effects of polio still linger, it is rare to come across someone wearing braces or using a wheelchair as a result of a polio infection in the U.S. Many vaccine-preventable diseases can cause death during the initial acute illness and if the individual survives, he or she may be left with chronic effects that last a lifetime. Polio can lead to temporary or permanent paralysis, deformities in the hips, ankles and feet; measles, mumps and varicella can all lead to brain damage and mumps is known to cause deafness; hepatitis B can cause permanent liver damage and even liver cancer. The list of damaging effects goes on and on.

In some areas throughout the U.S., as many as 1 in 20 kindergarteners have not been vaccinated. As the antivaccination fad grows in American so do the infectious disease rates. Measles was said to be eliminated from the U.S. in 2000 but an average of about 60 cases of measles occurs each year, typically from traveling. However, in 2011, there were 17 measles outbreaks in U.S. communities and the number of cases jumped to 222. In 2012, the U.S. had one of the largest pertussis outbreaks in nearly 50 years. Nationwide, over 85,000 vaccine-preventable diseases occur each year. I am not arguing that vaccines have no potential side effects and have never caused adverse effects or even death in children. However, I do think vaccines have done considerably more good than harm. So I urge parents, before deciding to withhold your children from vaccinations, look into the facts and make a decision based on science – not popular news. Although outbreaks of disease have been conquered in the past, many vaccine-preventable diseases remain throughout the world and the U.S. is not immune to future outbreaks.

 

Temple Grandin is wrong on vaccines and autism

Temple Grandin is undoubtedly one of the most famous women with autism of our time. Trained in animal science, Dr. Grandin is a widely read author and noted speaker on autism. April is National Autism Awareness Month, and Dr. Grandin has a new book out, “The Autistic Brain.” Together, this must have seemed like a good time for the New York Times to interview her. Unfortunately, the interview is superficial and not very illuminating, and what Dr. Grandin does say is disappointing. Her take on vaccines and autism, which apparently is elaborated upon in her new book:

Q: In your new book, “The Autistic Brain,” you seriously entertain possible links between vaccines and autism in children, links that scientists have vehemently dismissed.

A: Well, there’s only one vaccine that could possibly be a problem, and that’s the measles-mumps-rubella vaccine. Now that they’ve changed the vaccine, it has fewer antigens, and that would make it a lot safer. But with the old version of the vaccine, I have not yet come across a study that looked at regressives — when a child had some speech but lost it.

Q: There has been a highly emotional battle between mothers of autistic children and the scientists who dispute their theories.

A: I have talked to maybe five or six of those mothers, and that’s the reason I don’t pooh-pooh it. Those mothers have all described the same things. They all have the vaccine, and then they talk about fevers and the weird wailing that started in just a few days. When I brought this up to an expert and asked, “Have you ever studied the regressive group separately?” I got silence.

This is the problem when scientists speak about areas where they’re not experts. I got a lot of flak for my post to my dad addressing vaccines, with people accusing me of being condescending and underestimating his intelligence, but this shows it’s not an intelligence thing at all. (Plus, my dad is plenty intelligent–otherwise why would I bother to write that for him at all?) Grandin is obviously intelligent. She’s also highly educated. She has a PhD in another field. But she’s not an expert in vaccines, as her comments show, and that’s the problem with scientists who speak outside of their area of expertise. Even the very educated amongst us can’t know everything, and it becomes problematic when we use our reputation as scientists to promote something that we don’t have the background knowledge to really understand.

So, Grandin. First, she’s simply wrong about MMR formulation. Perhaps she’s thinking of the DTP vaccine, which now includes an aceulluar pertussis component (“DTaP” or “TDaP”) and therefore has reduced the amount of antigens in the vaccine (not that “excess” antigens are a problem for our immune system, which deals with literally millions of antigens on a daily basis, but that’s another story).

She’s also wrong about studies on regressives. As a scientist, why doesn’t she do her own literature search, rather than “asking experts” and supposedly getting silence? Because she could find several such studies, like this study in the journal Pediatrics or this one in PLoS ONE, if she simply searched.

Her biggest problem, though, isn’t just failure to represent the scientific literature or to understand the MMR vaccine. It’s her over-reliance on anecdote. Simply by the numbers, this correlation between regression and MMR vaccination (or any vaccination) is completely expected. There are currently about 75 million children in the United States. It’s estimated that anywhere from about 1 in 90 to 1 in 50 kids have some kind of autism spectrum diagnosis. Using the higher numbers for the sake of argument and easier math, that’s about 1.5 million kids, and most are diagnosed between the ages of 1 and 5. The first dose of the MMR vaccine is at ~12-15 months of age–when many parents of children with autism are starting to realize that their kids perhaps aren’t communicating like their peers or showing other characteristics of autism, and may think about getting them evaluated. That’s a window of about 1500 days, in which the majority of those 1.5 million kids receive their diagnosis–so averaging a thousand kids a day. Some of those kids will have just gotten shots, and some will have the reactions Grandin mentions–fevers, crying–by chance alone. Some will also wear mismatched socks that day. Some will eat Cheerios for breakfast. But because these aren’t in the news, moms don’t remember the socks, Cheerios, or a thousand other things that their kid did that day that are just as relevant to developing autism as the vaccines they received.

Correlation does not equal causation, and in this case, many, many studies have *disproven* such a link. Talking to “five or six mothers” does not trump years of scientific data looking at many thousands of kids diagnosed with autism, and it’s unfortunate both that Grandin has promoted this type of thinking, and that the New York Times interviewer considered that newsworthy enough to ask Grandin, out of everything else in her book.

An open letter to my dad on the occasion of his recent anti-vax Facebook postings

Pa and I 3Dear Pa,

I know you care deeply about many issues, especially social justice. You’re tired of wars, you’re ashamed of the attempts to destroy social programs in this country, you hate seeing the unions that helped you as a worker provide for our family get dismantled by wealthy CEOs whose only goal is to make themselves and their cronies more wealthy. These are noble things to believe in, and values that you’ve instilled in your children.

But you probably don’t often consider how you select and digest (and frequently, share on Facebook) the stories that you’ll accept as true. This is called cognitive bias–sorry, that’s a terrible article for a layman, but I’d be happy to discuss next time I’m home. Anyway, the bottom line is that the beliefs you already hold prime you to accept certain types of information, and reject others–and it’s something everyone should be aware of when reading anything on the Internet, especially. You don’t investigate how the authors of articles and videos you read and view came to their conclusions, or what data they may have overlooked (I’m being generous here–in most of the things you post, it’s not a matter of “overlooking” contradictory evidence on the case of the authors, it’s flat-out denial that it even exists). And you’re not an expert on health issues like fluoride or vaccines, so I don’t expect you to go back to the journal articles and try to figure out if these people you’re listening to are telling the truth. That’s what I do, but it took years of training to get me to this point, as you probably remember.

You repeatedly caution, “follow the money.” Often this is the case, and no one disagrees that many times people or companies do some nasty shit in the name of profit. However, you have to look at this on a case-by-case basis. Let’s look at vaccines, for instance. Sure, pharmaceutical companies make money off of vaccines. However, this money is a fraction of what they make for drugs that treat chronic conditions or “lifestyle” medicines, like cholesterol meds and Viagra. Indeed, many pharmaceutical companies have gotten out of the vaccine game altogether because it’s not particularly profitable, and because of lawsuits directed against them (which, in most cases, aren’t based in science but on fear and misunderstanding of cause and effect). This leaves us with fewer and fewer options when we need new vaccines quickly, like for the H1N1 pandemic in 2009.

So, we’re agreed that vaccines are potential money-makers for pharmaceutical companies (though, comparatively, not a lot). Let’s look now at those who started the most recent iteration of vaccine panic, including Andrew Wakefield. Wakefield is the British doctor whose study first drew an association between the measles/mumps/rubella (“MMR”) vaccine and autism. Except, first of all, it really didn’t if you look at the original article. And, you might note that article has a big “RETRACTED” notice at the top. This means that the journal took away its support of the paper–it shows that it never should have been published. That’s because, for that study and several others, Wakefield lied about data, unethically recruited test subjects, and/or just outright made shit up. Why might he do this? Well, a British lawyer had paid him to find evidence of this connection between MMR and autism, so that the lawyer could sue on behalf of the parents. Oh, and did I mention that Wakefield stood to make money for a replacement for the MMR vaccine as well? Follow the money indeed–though in this case, it didn’t lead to the pharmaceutical companies. Wakefield was tried in England and stripped of his medical license, but has since moved to the United States and still spreads misinformation about vaccines.

What about other anti-vaccine players? Jenny McCarthy has made millions selling books about how she “cured” her son Evan of his autism. Joseph Mercola makes millions selling dietary supplements (untested and largely unregulated, by the way), and lives in a two million dollar mansion. I know you’ve criticized creationists; well, these people are the creationists of the medical field. They distort, they cherry-pick their evidence, and they cause the public to lose confidence in credentialed scientists because of their writings. Credentialed scientists like myself, who carry out the vast majority of this research but certainly don’t live in million-dollar homes.

And you’re helping the Mercolas of the world–every time you post something like your “Italian court rules MMR vaccine causes autism” picture. Guess what “evidence” that court used? Andrew Wakefield’s discredited study. In science, this is an error even a first-year PhD student would be embarrassed to make. Not surprisingly, the decision is being appealed. But in the meantime, every parent who (wrongly and unscientifically) believes that vaccines caused their child’s autism is being buoyed by this court, whose decision is being trumpeted by people like Mercola and Mike Adams at Natural News (another supplement-pusher like Mercola, with no medical expertise or training). Every time someone buys into their anti-vaccine line and chooses to buy their supplements instead of vaccinating their child, it puts other children in danger. And you’re helping them.

Know the results of this vaccine backlash? Research dollars are diverted away from real causes of autism and other conditions. And kids are dying. Just in the U.S., there have been more than 1000 vaccine-preventable deaths in the last 6 years, and over 100,000 vaccine-preventable illnesses. Freaking whooping cough has made a huge comeback in the U.S. A big reason for the resurgence of these diseases is because anti-vaccine myths and scares spread so easily between acquaintances–in person, and on social media; scares that you’re now perpetuating with your own posts. Sure, it’s a free country and you have every right to share these pictures and memes, but have you thought about the possible harm it might do to others when you click “share”?

I know how crazy it drives you when Republican politicians (and friends and relatives) post pictures and stories that are flat-out wrong, about the deficit, the economy, “Obamacare,” and more. It makes you nuts how uncritically they quote Fox News. They don’t examine their own biases; they don’t stop and think why they accept that Obama is the anti-Christ and that everything associated with him is evil, even if the facts clearly contradict their belief. Sure, they may know a lot, but it’s all from the same sources and it reinforces their pre-existing belief that Obama is Satan. Here’s the kicker: you’re doing the same thing. Yes, I know you’ve watched a lot of YouTube videos on vaccines, and fluoride, and other health issues, but the ones you watch–and accept–are the ones that already appeal to the beliefs you’ve accepted. This isn’t how science works, or how evidence is fairly weighed. I know this can get messy, because again, you’re not one of those trained scientists and you don’t know how to navigate the literature and determine which studies are well-conducted and which ones are crap. So sometimes, you have to accept that there are people out there who have taken the time to do this in an unbiased fashion, and decide to trust them (y’know, people like your daughter, perhaps? Or thousands of other scientists and journalists who have studied these fields for many, many years?), and look skeptically upon people like Mercola et. al. (Follow the money!)

I will be sending along some books I hope you’ll read with an open mind: The Panic Virus by Seth Mnookin, and Deadly Choices by Paul Offit. Both come into this from different backgrounds–Mnookin is a journalist and new parent who was investigating vaccines, while Offit is a research scientist like myself who has worked in vaccines and infectious diseases his whole life. Both come to the same conclusions: vaccines are safe, and critical for public health. And before you google Offit and find that he holds a vaccine patent, ask yourself–if I were to work on a vaccine at some point in my career, would you dismiss my authority and expertise for that reason? Or would you be willing to look at the science behind it before making a judgement?

Next discussion: the Illuminati. Baby steps.

Love,

Tara

 

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Is history repeating itself?

This is the fifteenth of 16 student posts, guest-authored by Cassie Klostermann. 

One of the major accomplishments that public health professionals pride themselves in is the reduction of people getting sick or dying from preventable infectious diseases. Unfortunately, these debilitating, historic diseases that health professionals had once thought they had under control are starting to rear their ugly heads once again in the United States (U.S.). One of these diseases that I am referring to is measles. Measles is a highly contagious virus (from the genus Morbillivirus) spread through the air when an infected person coughs or sneezes making measles extremely easy to get by being around someone who is sick with this disease. According to the Centers for Disease Control and Prevention (CDC), if someone has the measles virus they could potentially infect 9 out of 10 people they come in contact with who are not immune (i.e. not vaccinated) to the disease.

Some of the most common symptoms associated with measles are fever, runny nose, and cough which are also very similar to the symptoms of many other diseases. Measles also commonly causes a rash that can cover the entire body. Those who have measles can spread the virus to another person about 4 days before and after the rash shows up. There are also a few more rare but more serious complications that can develop from having the measles virus such as pneumonia and encephalitis and it can also lead to the death of those infected.

The word measles comes from the Middle Dutch word masel meaning “blemish.” The history of measles cases goes relatively far back into history with references of the virus appearing in records as early as 700 AD. In the U.S., before the vaccine was introduced in 1963, there were about 3-4 million cases (essentially every child had had the disease by the time they were 15 years old), about 1,000 people suffered deafness or permanent brain damage (from encephalitis, for example) and around 450 people died from measles each year. By 2000, naturally occurring cases of measles in the U.S. (meaning cases that originated in the U.S. rather than another country) had been eliminated, although there are normally about 50 measles cases per year in the U.S. that come from other countries where measles is endemic (or constantly present in their population) and with increased worldwide travel people need to be more aware of their risk for contracting measles. Throughout the world, there are an estimated 20 million cases leading to about 164,000 deaths from measles each year, which is a great improvement from the 2.6 million deaths that occurred before the measles vaccine was globally used. The number of measles cases, long-term diseases, and deaths caused by measles are going down year by year and much of this progress can be attributed to efforts that provide the measles vaccine worldwide.

While the overall number of measles cases throughout the world are decreasing (mostly from decreasing cases in developing countries) the U.S. and other developed countries are seeing the opposite trend. According to the Notifiable Diseases and Mortality Tables from the Morbidity and Mortality Weekly Report, there were 223 reported cases of measles for 2011 occurring over 17 outbreaks in the U.S. (the average number of outbreaks is 4). This is an increase from previous numbers (63 cases in 2010 and 71 cases in 2009, to name a couple) and the majority of people infected, about 65%, had not been vaccinated against measles even though most of them were eligible to get the vaccine. Out of the measles cases seen in 2011, 90% were traced back to measles viruses seen in endemic countries and brought back to the U.S. where it was spread person to person in the States. Even though historically measles cases have been high in developing countries (especially Africa and Asia) extensive immunization programs have greatly decreased the amount of cases per year. Now European countries are seeing a large increase in their numbers of measles cases since 2009 because the number of vaccinated people has decreased.

The only proven way to effectively protect someone against contracting measles is to get the MMR (measles, mumps, and rubella) vaccine. If you have not been vaccinated then you are leaving yourself vulnerable to getting the diseases included in the MMR vaccine. This issue doesn’t just stop with the individual person, it spreads to everyone that individual comes into contact with. As mentioned above, measles is highly contagious and is spread through the air when an infected person coughs or sneezes so it can easily infect anyone breathing the same air you breath that is also vulnerable to the disease. When people who are vulnerable to getting the disease breathe in the contaminated air, they have a fairly high chance of getting measles and it is important to keep in mind that there are people who cannot get the MMR vaccine because they are either too young (under 12 months old), too sick (i.e. cancer patients), or the elderly who may have lost some of their immunity. For these people, they do not have a choice as to whether or not they get the vaccine, but they still deserve to have some protection from diseases prevented by vaccines. This protection comes from a concept referred to as herd immunity where there are enough people in a community or country vaccinated against a disease so that is unable to be “kept alive” because there not enough vulnerable people for it to pass through. If we are able to keep herd immunity up high enough by having enough people vaccinated against the measles, then the number of measles cases per year could drop back down to the normal 50 per year instead of 220 per year.

Travelers especially need to keep in mind that although a disease, like measles, is usually a rare occurrence in the U.S., this is not the case in many other countries in Europe, Asia, and Africa as examples. People traveling to countries where measles is endemic really should consider being vaccinated because their risk of being infected is much greater due to the higher number of people in the country infected with the disease.

As with anything in medicine, vaccines can cause reactions in rare situations and I urge people to ask their healthcare provider any questions they have regarding the MMR vaccine. I also urge people to receive all of the recommended vaccines they can (unless they have had past allergic reactions to a specific vaccine) because the risk of contracting measles and dying from it is more common than having a more moderate reaction to the MMR vaccine. If you or your kids are eligible to receive the MMR vaccine, please, please get vaccinated and talk to your doctor if you have concerns about an allergic reaction. By getting vaccinated you are not only protecting yourself and your children but also those who are unable to get the vaccine to protect them from the measles. If vaccination rates do not improve, we may very well see case numbers approach historical highs present before the vaccine was used.

References

http://www.cdc.gov/measles/about/overview.html

http://www.cdc.gov/measles/about/transmission.html

http://wwwnc.cdc.gov/eid/article/12/4/et-1204_article.htm

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6104a3.htm?s_cid=mm6104a3_w

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6122md.htm?s_cid=mm6122md_w

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6115a1.htm?s_cid=mm6115a1_w

http://www.who.int/mediacentre/factsheets/fs286/en/

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6047a1.htm

http://www.niaid.nih.gov/topics/pages/communityimmunity.aspx

http://www.cdc.gov/measles/travelers.html

http://www.cdc.gov/vaccinesafety/Vaccines/MMR/MMR.html

http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Protect-Children-from-Vaccine-Preventable-Diseases-Including-Measles-.aspx

http://www.immunizationinfo.org/vaccines/measles

 

Is the HPV vaccine “weak science?” (Hint: no)

Oh, Discover. You’re such a tease. You have Ed and Carl and Razib and Phil and Sean, an (all-male, ahem) cluster of science bloggy goodness. But then you also fawn over HIV deniers Lynn Margulis and Peter Duesberg. Why can’t you just stick with the science and keep the denial out?*

But no, now they’ve let it spill into their esteemed blogs. I was interested to see a new blog pop up there, The Crux, a group blog “on big ideas in science and how these ideas are playing out in the world. The blog is written by an outstanding group of writer/bloggers and scientist/writers who will bring you the most compelling thoughts throughout the world of science, the stuff most worth knowing.” Sounds ok, let’s see what stories are up…oh, one on HPV! Right up my alley. And hey, a woman! Bonus.

*Reads story*

Ohhhhh, it’s actually one on HPV vaccine misinformation, written by the author of the fawning Duesberg article referenced above. Faaantastic.
Continue reading “Is the HPV vaccine “weak science?” (Hint: no)”

Chickenpox parties–just a Facebook friend away

I’ve written a few times about chickenpox parties. The first link refers to a magazine article describing the practice; the second, a few years later, about a Craigslist ad looking to hold such a party “at McDonald [sic] or some place with toys to play on.”

Clearly, as chickenpox cases have become more rare in recent decades due to the success of the chickenpox vaccine, moving toward social media to find infections is the way to go. It allows people to find such cases and expose their immunologically naive children to a serious virus, just as easily as googling Jenny McCarthy Body Count.” But now, it’s gone even farther, with parents on this Facebook page hooking up to not only find cases/parties, but also to ship contaminated samples through the mail:

Shipping any kind of microbial specimen is a huge pain in the rear, specifically because they have the potential to cause harm. Myself and any employees who do this shipping have to be specially trained, and we have to use a number of specialized shipping containers to mail samples, and take precautions to prevent any leakage etc. out of the packages. Yale has a nice overview of shipping specimens at the link–54 pages long. We also have to apply for permits to ship many of these organisms. Now, Varicella zoster (chickenpox) isn’t on their list as far as “select agents,” but secretions from a person thought to have or diagnosed with chickenpox would be considered a category B agent (moderate risk of harm):

Biological substances, such as diagnostic or clinical specimens from humans or animals that are known to harbor a pathogen or have a high probability of containing a pathogen.

How should you package these?

Triple packaging. Must pass a 1.8 meter or 4 foot drop test. Packages shipped by air must meet a 95 kPa or 14 psi pressure test of primary or secondary container.

You can see pages 10-11 of the pdf for more instructions. This isn’t as easy-peasy as “stick it in a Ziploc baggie.” These people are putting a dangerous substance in the mail with the possibility (remote, but there) of making people sick. What if your mail carrier had never had the chickenpox or the vaccine? What if s/he is immunocompromised in some way? These people are taking all the dangers of their “chickenpox parties” and putting them in the mail system. Thank you, Andrew Wakefield and Barbara Loe Fisher.

Now, to be generous, their information page has been changed since the story came out to note “ABSOLUTELY NO SENDING VIRUSES THROUGH THE MAIL. This will not be tolerated and will be deleted immediately. Local only.” However, c’mon–people still have messaging on Facebook and I doubt that’s really going to stop the determined ones. These people simply don’t care about anyone but themselves and are in denial about the fact that chickenpox can kill–the one woman who received samples didn’t even know the name of the person they were from. This is so many levels of irresponsible I don’t even know where to begin.

Finally, not surprisingly, they’re deleting any comments that run counter to their propaganda. I replied to a few comments noting that the link between chickenpox and subsequent Streptococcal infection, for example, and it was gone within 20 minutes. I also noted that both my grandmother (shingles which led to pneumonia) and an uncle I never knew (primary chickenpox followed by pneumonia when he was only a year old) died from Varicella infection. The virus isn’t a joke, and those of us who had it, like me, are at a much higher risk of developing complications via reactivation (such as shingles) than those who obtained immunity via the vaccine. I wish the vaccine had been available when I was a kid, and I am frustrated as hell that these types of “parties” still exist in the vaccine era.

[Update: at least in Tennessee, a US prosecutor is warning that these types of mailings are illegal].

Great editorial response to the Jumbotron ad

The Times Square Jumbotron ad keeps trucking, and with it frustration from the medical and public health community. The American Academy of Pediatrics sent a letter to CBS Outdoors, asking them to pull the ad, to no avail. Rahul Parikh thinks it’s time to do more:

We in medicine need more than letters and passive education for parents on a website. What we really need are some Mad Men of our own. If you want guidance, look at what the folks at the the American Legacy Foundation have done with their anti-smoking campaign, The Truth. Who can forget the TV commercial where a truck pulls up to the headquarters of a tobacco company and teenagers jump out, carrying body bags? We need powerful and unforgettable messages that remind us what’s at stake here.

Have you heard the horrifying whoop of pertussis? Seen how meningitis kills and maims kids, or the painful, paralyzing rigor of every muscle in the body of a child with tetanus? Dear AAP, collect those sights, sounds and the true stories of kids injured by vaccine-preventable diseases and the parents who cried for them when they got sick. Then have the audacity to buy space on a jumbotron, right next to NVIC’s, or in a newspaper the day after Generation Rescue takes out another of its bogus ads. Tell the stories of those parents and children — if they’re still alive today — and make it clear that choosing vaccines means choosing health for kids, families and communities.

I agree with what Parikh is saying, but it’s still sometimes tough to get over my gut reaction to that kind of emotional advertising. He’s right that it can be effective where the simple scientific facts don’t work, but like Chris Mooney notes, it also has to be “presented in a context that doesn’t trigger a defensive, emotional reaction.” For those currently eschewing vaccines for their children, that could be tricky to do, but I wonder how many are true “fence-sitters” and not emotionally committed to an anti-vaccine stance? Those are the ones we really need to work with.

[Edited to add: Steven Novella has a great post up today that reminds us why this is such an important fight: Consequences].

CBS airs anti-vaccine Jumbotron ad

Via Skepchick, CBS will be airing ads from the National Vaccine Information Center and Mercola on the CBS Jumbotron in Time’s Square (NVIC announcement here). This, while there’s a measles outbreak in Minnesota (and another one being investigated in Utah), and we’re on the heels of the worst pertussis outbreak in generations in California. Shameful.

Hello,

I recently learned that CBS will be playing ads featuring misinformation by the National Center for Vaccine information Vaccine Information Center. These ads are misleading and potentially dangerous. Vaccine-preventable illnesses have had a resurgence in the past decade, and there currently is an ongoing measles epidemic in Minnesota. Pertussis cases (and deaths) hit a record high in California in 2010. Much of this increase in disease is due to unfounded fears about vaccination, pushed by NCVI, Mercola, and even your own Sharyl Attkisson.

Recently AMC theaters did not run similar anti-vaccine ads (http://getsatisfaction.com/amc_theatres/topics/remove_the_unfounded_anti_vaccine_message_from_your_ads). Until a similar solution is reached by CBS, I will boycott CBS TV shows and sponsors, and ask others to do the same. I am an infectious disease epidemiologist and have seen the dangers that can result from vaccine misinformation. Please do not be complicit in spreading these dangerous lies to your consumers.

Thank you,

Tara C. Smith, PhD

(Some other template language can be found here).

You can also sign the petition at Change.org, email CBS (jeremy.murphy@cbs.com, info@cbsoutdoors.com) and tweet @CBSoutdoors to let them know your thoughts on this development.