One more measles update – quarantine not being observed by some

The new update from the regional health people on the measles outbreak has a few interesting tidbits in it:

  • We now have 18 confirmed cases
  • Ages of those affected range from 4 years to 23 years
  • There are cases in Lethbridge, Fort Macleod, Picture Butte, and Coaldale.
  • So far, all cases are in unvaccinated individuals.

Several families are under quarantine, but some are not observing the quarantine recommendations.

So, stupid is as stupid does, I suppose.

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Measles vaccination rates in Southern Alberta by region

Here’s a graphic from Alberta Health on vaccination rates in southern Alberta for measles by town and region.

Note that anything <80% creates conditions for a sustained epidemic. The AHS goal is 98% coverage, which is about what is needed for herd immunity to keep any cases from developing.

Note too that metro Lethbridge (due north of Spring Coulee, in the approx centre of the map) is in the 80-90% range, and yet that is where the outbreak began and is persisting for the moment. So 80-90% doesn’t cut it.

Measles Coverage 2013

And, a second slide gives some of the complications that attend the illness.

They don’t mention SSPE, which can afflict the brains of measles patients even decades later.

Measles Complications

Is Popeye More Likely to Respond to Vaccination?

(or, Why blaming nutrition is not your anti-vax get-out-of-jail-free card)

In Southern Alberta, we are currently in the midst of a measles outbreak.

Some have asked me recently about the claim that better nutrition would lead to better vaccine response.

The purpose of this claim seems to be an attempt to disprove concerns about herd immunity.

Background

No vaccine is 100% effective. Those who do not respond to the vaccine, and patients that are too young to be vaccinated, depend upon herd immunity for protection—measles (or other infectious diseases) can’t get established in a population unless there is a certain percentage of vulnerable people.

So, when those who through bad science or their own philosophy reject vaccination, they increase the risks to everyone. If you don’t want to get a tetanus vaccine, fine—the only person you’ll kill or cripple is yourself.

One dose of measles vaccine is typically 95% effective. A second booster can get that to 98-99%. But, it ain’t 100%. Bluntly, if you forgo things like measles vaccines, you put me and my kids at risk. You also put kids with leukemia, and patients with HIV, and newborns too young to be vaccinated, and a variety of others at risk too.

(89% of patients in the USA in 2011 who got measles had not been vaccinated. But, 11% who got it had been. Thanks a lot.)

Blame the victims

Now, this seems like a pretty crumby thing to do—and it is. So, some are now claiming that they aren’t really putting your kids at risk, because vaccines work better if you have better nutrition. The subtext is clear—if you get the measles vaccine and you don’t respond to it, it’s your own darn fault for eating such a lousy diet, or not taking some vitamin supplement, or whatever. (If they go a step further and try to sell you the supplement, run away.)

We are supposed, then, to blame the lousy diet of people who do get vaccinated, and not the irrational and scientifically unsupportable decision of the vast majority of those who choose not to vaccinate.

This might be a compelling argument—if it were true. But it isn’t.

The First World and the Third World

It’s always a bit dubious when people start bemoaning poor nutritional status in North America. If anything, we eat too many calories and the like; we do not typically have a problem with macro- or micro-nutrient status (with some subgroups being exceptions, which I shan’t go into here).

But, for the sake of argument, let’s follow the claim, and see where it leads.

If poor nutrition was a significant factor in vaccine non-responders, that would be an important thing to know. Why? Well, for starters, when we give vaccines in the Third World, those people are at much higher risk of malnutrition, poor vitamin status, and all the rest than anyone in the First World would ever be in their worst nightmares. So, if nutrition is a factor in measles vaccine response, we ought to be able to detect that in the Third World especially. We’d like to know, because maybe it would be better to give them some vitamins or better nutrition, and then vaccinate them later. (A similar analysis could be and has been conducted for a variety of vaccines; I will focus on measles because it is the one in the news right now.)

If you go way back to 1980, this question was looked at for smallpox and measles. The conclusion:

 Malnutrition did not affect the children’s ability to develop adequate immune response to measles o[r] smallpox vaccine, and there were no major complications during the 8-week period of follow-up. Since measles is a very severe disease, which in malnourished children can carry a case fatality rate as high as 50%, malnutrition should be a prime indication for measles immunization, and certainly not a contraindication.[1]

No effect—and many of these kids were severely malnourished.

Is 1980 too long ago? Well, here’s one from August of 2013.

It looks at kids who are both malnourished and have potentially disastrous risk factor: kids with HIV+ mothers. This is a randomized, placebo-controlled trial that gave some kids vitamin supplementation prior to measles vaccination.

The stage of the mother’s HIV affected how well the kids’ immune system responded—more advanced HIV made it more likely for the children to respond. But, what about the “nutrition” that we’re assured is so important?

There were no effects of infant multivitamin supplementation on measles seroconversion proportions, IgG concentrations, or IgG avidity. [2]

Translation: Seroconversion means developing protective antibodies; IgG concentration is how much antibody; IgG avidity is how well the antibody binds to measles.

Long story short—giving the kids vitamins made no difference at all to the vaccine responses, and they’re from Tanzania.

Are we really expected to believe that a kid in North America—no matter how lousy his or her diet—is in worse nutritional shape than a child born to an HIV+ mother in Tanzania?[3] Well, anti-vaccination activists have asked us to accept bigger whoppers than that, so I guess we shouldn’t be surprised.

An ironic risk—would supplements be risky?

Ironically, the public health worry about malnutrition and supplementation has been whether supplementation might worsen the measles vaccine response rate. It would be great to give all the kids you saw in your third world vaccination clinic Vitamin A—this has been shown to be cost effective, and they need it. It’s hard to get them into the clinics; they have to travel a long ways sometimes, and wait a long time. How great would it be to do both at once, if you can? But, what if doing one makes the other less effective? This actually might have happened when some six month old kids were vaccinated. (They were vaccinated early—but, this is a scary prospect, if true.)

Well, this has been looked at—happily, there is no concern so far.

Overall, the seroconversion rates did not differ between vitamin A (89.5%) and placebo (87.6%) groups. There were no significant differences in the geometric mean titers in the two groups (ratio of geometric means, 1.19; 95% confidence interval, 0.97–1.46). Among malnourished infants, the geometric mean titer was significantly greater in the vitamin A group compared to the placebo group (ratio of geometric means, 1.57; 95% confidence interval, 1.18–2.0), but seroconversion rates did not differ. There were no differences in seroconversion rates and geometric mean titers in the two study groups among the well-nourished children. These results indicate that 30 mg vitamin A does not reduce the immune response to the coadministered vaccine and, therefore, can be continued to be given safely in public health programs (emphasis added).[4]

Note that antibody levels were slightly lower in malnourished kids—but, there was no statistical difference between malnourished or well-nourished children in whether they’d have measles immunity or not.

But, it’s ironic that the thing that worried real vaccine scientists is the exact opposite of what the North American anti-vax nutrition pushers claim—the worry was that supplementation in people who were truly malnourished might actually decrease the vaccine’s effectiveness. It certainly didn’t increase it.

Big Picture

Am I, perhaps, merely cherry-picking studies? Am I just finding a few that support my position, while ignoring the others?

A fair question. Fortunately, someone recently did an extensive analysis of all vaccines and all the data on nutrition status and response to those vaccines. (This was done for the Bill and Melinda Gates Foundation, which was founded by the Microsoft billionaire and his wife. They do really good work, and it is intensely data-driven.)

This review was published in 2009, and full text is available.[5] Here’s some measles-related highlights (emphasis added in all cases):

  • “Our analysis indicates that malnutrition has surprisingly little or no effect on vaccine responses.”
  • Protein-energy malnutrition “studies did not show any association between malnutrition and the immune response to M[easles] Vaccine.”
  • A few studies did show that children with kwashiorkor (severe, starvation-level protein lack in the diet—there are very disturbing pictures here if you want to see how bad we’re talking) had lower responses to measles vaccine. But, some of these studies only waited two weeks to see if there was a response—in other studies of kwashiorkor, malnourished children delayed their response to the vaccine, but by three weeks had, like the well-nourished, a good response.
  • Young children (6 months) given Vitamin A [VA or Vitamin A supplementation=VAS] have lower response rates, but only if they have high levels of antibodies from their mothers. “Moreover, a clinical trial in Bangladesh assessed the effect of VA supplements on M[easles] V[accine] response when administered near to vaccination or not. VAS administered within 4 wk before or 2 wk after measles vaccination was not associated with altered vaccine failure rate compared with administration of VA outside these time limits.” In sum, “although mean antibody titers tended to be higher in participants who received VA, seronconversion rates were universally high and did not significantly differ between supplemented and unsupplemented participants.”
  • Data on iron deficiency is poor, but “children with iron deficiency anemia seem to have intact antibody responses to vaccination. Although iron deficiency is known to affect T lymphocytes, the antibody response is preserved, even when it requires help from T h[elper] cells.” Likewise for Vitamin D, “there is no evidence that vitamin D has any effect on vaccine response,” though the data is very sparse.
  • Zinc supplementation may affect cholera vaccine response, but not “BCG, diphtheria and tetanus toxoids, rabies, influenza, and pneumococcal vaccines.” Measles has not been looked at at all.
  • “We found occasional evidence of marginal effects of micronutrients, but the evidence base is very limited and frequently contradictory.” It is hard to see how these type of effects, which can barely be discerned (if they exist at all) in Third World populations could make much of a difference in North America.

Summing up the data

The authors frequently return to the fact that there isn’t a ton of data on this topic—which should tell us that if they don’t know, then the confident assertions of those in North America who claim that “studies show” that nutrition is a big factor in First World vaccine failures are talking out of their hat. Thus, far, we can barely find any evidence in the Third World in horrendous circumstances:

Surprisingly, we found little convincing evidence to indicate that current nutritional status or coadministration of nutrient supplements has clinically important effects on vaccine efficacy.

To claim that the non-responders have only their poor diet to blame if they get measles—instead of what is essentially a superstitious or pseudoscientific decision of non-vaccinators to forgo vaccination—just isn’t supported by the facts.

So, why do some people not respond to vaccines?

This is an active area of research. There’s a very interesting bit of data out of Israel that compared desert Bedouin Arab responses to measles vaccine versus Israeli Jewish children.[6]

This is interesting for two reasons:

  1. From a nutrition standpoints, the Bedouins are at a disadvantage—they have much larger families (9 children on average), live in crowded, relatively unsanitary conditions, have many more infections, and almost certainly have a lower standard of living and access to much less robust food supplies.
  2. Genetically, the two populations are different.

Intriguingly, the Bedouin had a 99% conversion rate, while the Jewish group had only a 79% response—astonishingly low. This was not a one-time fluke either—a previous study of Jewish children had likewise 24% not respond to the vaccine, despite having evidence they were vaccinated.

This sort of thing isn’t confined to the Middle East. Studies have observed:

  • First Nations people responding better than Caucasian Canadians;
  • East Indians responding better than Africans;
  • Twin studies show that identical twins have a higher rate of vaccine failure if one twin fails.

You see where this is headed—vaccine response depends, at least in part, upon genetic factors. The mechanisms for this are just beginning to be explored, but they have to do with mutations to the receptors. Some mutations improve your response, and others decrease it.

So, a large part of whether you respond is simply a genetic luck of the draw. We can’t eat our way out of it.

Bottom line

So, if you’re not going to vaccinate yourself or your kids, please—at least be honest about the facts. You’re putting them at risk. But, you’re also putting the rest of us at risk too.

It isn’t because we wouldn’t eat our spinach.

It’s because we are unwise enough to have 60% vaccine coverage, in a disease that needs at least 80% to prevent epidemic spread.

Learn more

For information about measles , go here.

If you think you or someone may have measles, do not go to the ER. Do not go to the doctor’s clinic. Do not go out in public.

If you live in Alberta, call this number, and do what they tell you: 1-866-408-5465.

Third world skepticism


[1] AE Ifekwunigwe, N Grasset, R Glass, S Foster, “Immune responses to measles and smallpox vaccinations in malnourished children,” Am J Clin Nutr 33/3 (March 1980) :621–4.

[2] Christopher R. Sudfeld, “Effect of Multivitamin Supplementation on Measles Vaccine Response among HIV-Exposed Uninfected Tanzanian Infants,” Clin Vaccine Immunol 20/8 (August 2013): 1123-1132.

[3] Recall that having HIV+ mother doesn’t just expose the child to risk of infection—such women are less likely to be well, are less able to work, will probably make less money in a country not known for high-riding lifestyles, and are less able to provide food for the baby, etc. You’re at risk in this situation.

[4] Rajiv Bahl et al., Vitamin A Administered with Measles Vaccine to Nine-Month-Old Infants Does Not Reduce Vaccine Immunogenicity,” The Journal of Nutrition 129/8 (August 1999): 1569–1573.

[5] Mathilde Savy et al., “Landscape Analysis of Interactions between Nutrition and Vaccine Responses in Children,” The Journal of Nutrition 139/11 (November 2009): 21545–22185.

[6] Bracha Rager-Zisman, et al.¸Differential Immune Responses to Primary Measles-Mumps-Rubella Vaccination in Israeli Children,” Clin Diagn Lab Immunol 11/5 (September 2004): 913–918.

Vaccines and aluminum safety

Aluminum safety and vaccines

Some asked me about the risk of aluminum in vaccines, so I thought that would be a worthwhile question to address.

In addition to the substance against which a patient is being immunized, some vaccines contain adjuvants. An adjuvant is an additional substance that is used to boost the effectiveness of the vaccine. This has several benefits:

  • the immunity may be longer-lasting, reducing or eliminating the need for more vaccine doses
  • the immunity may be more effective, meaning that a greater proportion of those vaccinated will respond
  • the vaccine can get away with using less of the bacteria/virus against which you are being vaccinated

One adjuvant that used to be used was thimerosol, which is now only found in the annual influenza vaccine. It was removed as a precautionary measure, even though there is no evidence it causes harm, and a number of studies which failed to find any evidence of harm.

The vast majority of North American vaccines use aluminum salts (and aside from influenza, these are the only adjuvants used in Canada).

Aluminum salts

The three salts used are:

  • Aluminum hydroxide
  • Aluminum phosphate
  • Potassium aluminum sulfate

These have been used for seventy years in vaccines (since 1926), so they have a long track record of safety.

The World Health Organization and European standards bodies recommend (and Health Canada agrees) that no dose of vaccine contain more that 1.25 mg per dose of human vaccine).

Let’s put that dose in context. Aluminum is a very common substance in our environment. Even human breast milk, for example, contain 0.040 mg/L; commercial formulas have 0.225 mg/L. So, in about 31 litres (8 gallons of breast milk) you get as much aluminum as one vaccine dose (or 5.5 L of formula).

Doing the math

Let’s be conservative, and assume a breast-fed baby eats 6 times a day (every 4 hours, which as any new mom will tell you, is a relatively reasonable assumption). That means they’ll drink an average of 125 mL (5 oz) of breast milk every feeding, or 6 x 125 mL = 750 mL per 24 hours. Thus, with even fairly conservative assumptions, every 40 days or so, an exclusively breast-fed baby will eat as much aluminum as in one vaccine dose.

If, on the other hand, the baby is formula fed, at the same volume and rate, then the child ingests that much aluminum every 8 days or so.

Put another way, under US guidelines (and I expect Canadian ones are almost the same) within the first 6 months of life, a child would get a total of 4 mg of aluminum from vaccines. They would have absorbed 10 mg from breast milk, 40 mg from formula, or 120 mg from soy formula.

What happens to the aluminum?

Now, maybe there’s a difference between injecting aluminum and eating it? As it turns out, not that much.

Less than 1% of the aluminum consumed by mouth enters the bloodstream—it is quickly bound to a protein called transferrin (also involved in iron metabolism) and excreted through the kidneys.

Almost all the aluminum injected by vaccines will enter the bloodstream. But, there again it binds to transferrin, and is removed by the kidneys. How fast? Regardless of oral or injection route:

  • 50% gone within 24 hours
  • 75% gone within 2 weeks
  • Almost 100% gone within 3 years.

By adulthood, we have accumulated 50-100 mg of aluminum in the body. That gives you some idea of how rapidly you’re excreting it—40 mg of infant formula in the first 6 months is almost equivalent to the total aluminum that remains in the body by adulthood. Clearly, the vast majority is not sticking around.

We don’t have to rely on theory to prove this. All unvaccinated babies have 5 nanograms of aluminum per mL of blood all the time. If you vaccinate a baby, the concentration of blood aluminum doesn’t change enough for us to detect it. We’re talking about such tiny, undetectable increases that it would be incredible for it to cause a problem.

Are you saying aluminum can never be harmful?

No, of course not. With everything, “the dose makes the poison.” Even water is poisonous and potentially fatal at high enough doses.

Premature babies in NICUs can have aluminum troubles if their kidneys don’t work (remember, aluminum is excreted by the kidneys—no kidneys, and all that aluminum sticks around).

The second group is (you guessed it) adults with renal failure. If they take antacids, these can cause problems, since a daily dose of antacids contains about 1,000x the dose of aluminum in a vaccine. And even here it takes months or years of high-dose aluminum administration to cause problems.

Premature infants or patients with kidney failure have blood levels of aluminum at least 100x greater than healthy babies. And, remember, healthy babies’ blood level of aluminum doesn’t even budge when we vaccinate.

And, like anything, the immune reaction we’re trying to generation with aluminum can cause local soreness or redness, or rarely an allergic-type reaction. But, those are usually minor issues.

Further studies

So, harm from this miniscule amount of aluminum (which is in our food and drinking water anyway, at higher levels) is extraordinarily unlikely.

Furthermore, we’ve used the stuff for seven decades, without a huge outbreak of problems from aluminum toxicity, which effects are well known from patients with renal failure.

But, we have even more cause for confidence. In 2004, an aluminum containing vaccine and adverse reactions was reviewed. This included 3 randomized trials, 4 semi-randomized studies, a cohort (retrospective) study, and 27 other studies.

[Note that this study was done in the UK, where the American/Canadian element aluminum is called aluminium, but it’s the exact same thing, just in the Queen’s English.]

Two main groups were compared:

  • Children vaccinated with aluminum hydroxide adjuvants vs. no adjuvants
  • Children vaccinated with various aluminum adjuvants vs. no adjuvants

Aluminum adjuvants caused more local pain or swelling—but, this is to be expected, because the whole reason we include adjuvants is to create a more robust immune response from the body. There was no difference in the rate of more serious adverse reactions:

The frequencies of local reactions of all types, collapse or convulsions, and persistent crying or screaming did not differ between the two cohorts of the trials. In older children, there was no association between exposure to aluminium-containing vaccines and onset of (local) induration, swelling, or a raised temperature, but there was an association with local pain lasting up to 14 days (2·05 [1·25–3·38]).

And, most importantly,

We found no evidence that aluminium salts in vaccines cause any serious or long-lasting adverse events.

Critics of vaccines will sometimes appeal to studies on mice or local reactions about the problems associated with aluminum injection. However, why rely on mice studies when we have decades of human evidence and experience that strongly suggest safety in the real human world?

(There’s an old joke in medical research that we can cure every cancer in mice—it’s shifting the treatment to humans that’s the trick.)

And, it should be remembered too—everyone in public health, in vaccine research, and government health groups puts their money where their mouth is. They get vaccinated. Their children get vaccinated. It seems a real stretch to claim that these people—who often dedicate their whole lives to children’s health—are part of a conspiracy to ignore data about the safety of children. Especially when those at risk includes them and their children.

Conclusion: What choices do we have?

Let’s imagine for a moment that the critics get their way—we stop using aluminum in vaccines.

Fine. What do we do then? We have, it seems to me, three options:

  1. Vaccinate without adjuvants—this would require more frequent dosing of vaccines, would risk a loss of immunity over time (setting us up for outbreaks), or perhaps using higher concentrations of bacterial/viral material we’re trying to vaccinate against. Can we be sure that this would not create greater problems? Might not critics then start to complain about the “high doses” used, or the “increased frequency”? More vaccines more often would mean higher costs and a higher risk of outbreaks, since people would be more likely to miss their shots.
  2. Vaccinate with new adjuvants—perhaps we could develop new adjuvants (like thimerosol). But, this is unlikely to satisfy the critics for long. Even if a new adjuvant had no evidence of harm, they would still complain: and they do just that about thimerosol, even when removing it doesn’t solve the problem they claim it caused. We have decades of safety and confidence with aluminum salts, and wouldn’t have evidence that strong for decades (if ever) for another adjuvant. So, we’d be stuck in the same situation we are now, only with less evidence.
  3. Stop vaccinating altogether—this seems to be what most critics want, and what they tend to choose for their children. But, that option is a fool’s errand. We know what happens when vaccination lapses, and we know from sorrowful historical experience how devastating these diseases are.

So, which do we pick? One of the three options above?

Options #1 and #2 seem to me to put us exactly where we are now, but with less evidence, more cost, and potentially less effectiveness of our vaccine programs. Not much of a deal.

Option #3 is madness. Even vaccine critics would realize that if the majority of the population wasn’t smart enough to ignore them. It only takes a couple of polio outbreaks to see the light. (With effort, polio may soon become the second disease after smallpox to be utterly eradicated by vaccination.)

 000000 4637 PHOTO-CD-1

(Iron lungs on a polio ward, New York, 1916).

Or, do we rely for now on seven decades of experience and studies—and pretty convincing evidence from the dose data—that nothing ominous is going on?

I—and every public health group on the planet—would recommend the latter.

Fall out from Wakefield’s vaccine lies

As I described previously, an ill-founded scare about the measles-mumps-rubella vaccine (MMR) caused vaccine rates in England to plummet.

Children and adults in England are now paying the price. Due to lowered vaccine coverage, there have already been 1,200 cases of measles in England this year.  Last year, there were 2,000 cases in the entire year, so we may be on track to break that unhappy record.

This sort of thing is a good demonstration that simply having better, first-world hygiene, nutrition, and medical care can’t prevent these illnesses without vaccination. And, England is no out-of-the-way place–they are only a short jet ride away from us in North America. That’s a cheerful thought.

Even if you catch the measles and survive without getting meningitis and brain damage, that doesn’t mean that you’re out of the woods.

People who have had and recovered from measles are at life-long risk of another condition called subacute sclerosing panencephalitis. The measles virus hangs on in your brain cells, and later gives you behavioral and personality changes, seizures, spasms, difficulty walking, and coma. Think of it as a having a sort of combination of strokes, Alzheimer’s, and Parkinson’s disease. Unless caught very early, there is no treatment, and death then becomes 95% certain within about 1-3 years.

Vaccines prevent SSPE of course. If you can’t catch measles, you can’t go on to get SSPE.

So, Wakefield and those who continue to push his debunked lies have prepared England and elsewhere for another wave of disease years or decades down the line that in some ways is far worse than the initial measles.

As always, actions–or inaction–have consequences, sometimes decades down the road.

Vaccines and breastfeeding

I occasionally meet parents who have decided to delay vaccinating their newborn.

Such parents have usually been alarmed by false claims about the risks of vaccines to children, which I have discussed earlier.

Another common worry is that children are “too small” for such vaccines. This simply isn’t true. Vaccines are timed for when a child’s immune systems will respond to them. This is why, for example, polio vaccines are given beginning at age 2 months, while measles waits for 1 year of age—a two-month-old won’t respond properly to a measles vaccine, but will to polio. (Getting such vaccines too soon wouldn’t be dangerous, but it wouldn’t generate an immune response, so there’s no point.)

Parents of unvaccinated children sometimes comfort themselves with the thought that since they are breastfeeding, this provides adequate protection. After all, there are antibodies against disease in breast milk, right?

Breastfeeding is certainly the ideal choice for the vast majority of newborns and their parents. (There are a few diseases or conditions for which you shouldn’t breast feed, and a few drugs that a mother might have to take that would be dangerous to an infant.)

It is also true that antibodies from the mother are passed in breast milk to the baby. But, parents often don’t know what kind of antibodies, and what kind of protection they provide.

And, that’s the rub, as they say.

The Children’s Hospital of Philadelphia has a Vaccine Education Center. Their statement is important:

Sometimes parents wonder whether they can forego immunizations for their baby because the baby is being breastfed; however, this is not the safest decision because antibodies in human breast milk bathe the intestinal surface but are not absorbed. Therefore, breast milk antibodies never enter the lymphatics or circulation where they would be needed to protect against diseases for which infection in the blood (circulation) is an important part of how viruses and bacteria cause disease. Examples of these types of diseases include diphtheria, tetanus, pertussis, measles, mumps, rubella, varicella (chickenpox), pneumococcus, Haemophilus influenzae type b, polio, hepatitis A and hepatitis B.

Antibodies in breast milk enter the baby’s gut. These antibodies are useful, but their only function is to prevent the baby’s gut from absorbing dangerous infections. So, breast milk antibodies are a great way to help prevent things like diarrheal illnesses. That’s no small thing—in the third world, diarrheal illness still kill millions of children every year. (Even in the US, hundreds still die every year from diarrhea.)

So, before modern sanitation and germ theory, breast milk antibodies could mean the difference between a child living and dying, and still does in the third world. (This is one reason why efforts of baby formula companies to convince third world mothers not to breast feed are so pernicious.)

But, breast milk antibodies do not enter the baby’s blood stream or lymphatic system. They stay in the gut. So, breast milk antibodies are completely powerless to fight any infection that enters a baby by any other route—for example: by the lungs, by a scratch on the skin, and so forth.

So, antibodies in breast milk might protect your baby from stomach flu—but, they won’t protect him or her from some of the worst diseases known, including:

  • tetanus (lock jaw)
  • polio
  • hepatitis A and B
  • pertussis (whooping cough)
  • measles
  • mumps
  • rubella (German measles)
  • diphtheria
  • pneumococcus (causes severe pneumonia).
  • H. influenza, type b (causes potential fatal airway compromise)

It is a sad irony that parents worry that their baby’s immune system “can’t handle” vaccinations. It can, easily.

But, their immune systems can’t handle all the above diseases very well at all—newborns are at greatest risk of death or life-long problems from these diseases in the event of an outbreak. This is because of a less well-developed immune system, and the fact that they are smaller.

A baby’s best lines of defense are:

  1. vaccination for themselves; and
  2. herd immunity from a well-vaccinated population for those diseases for which they are too young to mount a proper response.

Once again, your choices don’t just affect you—they affect my kids too. We all need that herd immunity.

Here’s hoping people will use science, and not fear, in making these decisions.

An autism epidemic?

My post on vaccines and autism got over 16,000 hits, which dwarfs anything else I’ve said about anything.

So, in the spirit of “give the people what they want,” I offer another little tidbit that is useful for thinking about these sorts of things.

In my clinical work, people will often ask me “Why is there so much more autism these days?” And, it is this supposed increase that many anti-vaccination efforts are intended to both combat and explain.

We certainly hear more about autism. But, does this mean that there is more of it around?

One difficulty is that diagnostic criteria change—what it takes to label someone as “autistic” has not always been identical, in all places, and in all times. It is, in short, “easier” to be labeled an autistic today than it used to be.

Let’s take a more straightforward example: suppose we define hypertension (high blood pressure) as anyone with a systolic blood pressure > 150. We find a number of people in our town with high blood pressure. But, later we redefine high blood pressure to be>140–perhaps we’ve found that it remains dangerous to have pressures from 140-150 as well as over 150.

With this new definition, we diagnose everyone we caught before, plus a whole bunch of “new” people that have suddenly become sick—but only under the new definition. Nothing has changed, except the way we define the world and how we label things.

I recently read a book that summarizes this sort of thing as it relates to autism specifically:

…several recent studies suggest that the autism epidemic may be an illusion. In one investigation, researchers tracked the prevalence of autism diagnoses between 1992 and 1998 in an area of England using the same diagnostic criteria at both time points (Chakrabarti & Fombonne, 2005). Contrary to what we’d expect if there were an autism epidemic, the authors found no increase whatsoever in the prevalence of autism over time. Another study found evidence for a phenomenon termed “diagnostic substitution”: As rates of the autism diagnosis soared in the United States between 1994 and 2003, diagnoses of mental retardation and learning disabilities combined decreased at about an equal rate. This finding suggests that diagnoses of autism may be “swapping places” with other, less fashionable, diagnoses. The same trend may be unfolding in the case of diagnoses of language disorders, which have become less frequent as autism diagnoses have become more popular (Bishop, Whitehouse, Watt, & Line, 2008). All of these studies offer no support for an autism epidemic: They suggest that diagnoses of autism are skyrocketing in the absence of any genuine increase in autism’s prevalence. As a consequence, efforts to account for this epidemic by vaccines may be pointless.[1]

Both clinicians and parents may get better at choosing diagnoses, and may be influenced by other factors too. After all, it is more hopeful to label a child with “autism” (which can often be helped considerably with early and aggressive intervention) than with “mental retardation” (which may be much less amenable to improvement, depending upon the cause).

Government and schools also have an influence, since they may create certain programs or funding helps for families with autism—this gives them a real incentive to be formally diagnosed and recorded and tracked, which means they will be there when researchers go looking to determine the prevalence of autism. I certainly provide far more paperwork for people with autism now than I did ten years ago.

There’s an old medical aphorism that says, “You can’t diagnose what you don’t think of.” It’s true. And, you will also tend to diagnose more of what you think of more often.

And, we tend to think of things, or even bother looking for them, when there’s some good reason to do so.

After all, there are a couple of hundred different viruses that cause the common cold. But, I don’t have clinical tools to easily distinguish them, since I can’t do a single thing about any of them that makes a difference.

But, if there was a drug that could cure types #1-50, while doing nothing for #51-200, I’d probably look a lot harder for types#1-50. And, as a result, diagnoses would increase substantially, even though the actual prevalence and incidence of the disease doesn’t change at all.

Some of the increase in diagnosis of major depression is probably due to this sort of phenomenon: as medications that are better tolerated were developed, both doctors and patients had a reason to pay attention and to make formal diagnoses: because there was the potential of doing something.

So, we might look at the “increase” in autism diagnosis as a good thing. It could be that we’re finally recognizing a needy group that has been there all along, and we are doing so partly because we can help them. And, that recognition will lead to us being able to do even more.

And, that’s not something to panic about or try to “fix” at all. Least of all by forgoing vaccines.


[1] Scott O. Lilienfeld, Steven Jay Lynn, John Ruscio, Barry L. Beyerstein, 50 Great Myths of Popular Psychology: Shattering Widespread Misconceptions about Human Behavior (Wiley-Blackwell, 2009), 175. ISBN 9781405131124