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Current Measles Epidemic - previously vaccinated individuals.(72 Posts)
I don't think they've done the number crunching for this particular outbreak.
But in previous ones, HPA have published figures which say that about 7% of cases occurred in people who had received at least one dose of a vaccine which contained the measles component. It didn't specify beyond that (MMR or single, or one dose or two).
Vaccination status of those catching measles in Wales.
My figures regarding vaccination come from this:
Which someone I know attended.
It appears about 90% were unvaccinated.
Dr Mary Ramsey ( www.meningitis.org/book-of-experience/mary-ramsay-29770) was speaking and she "stated unequivocally that this is a case of failure to vaccinate, and not vaccine failure."
If you are interested in recent figures for measles across Europe:
Measles in vaccinated/unvaccinated:
There were, in total, 12,132 cases of measles.
Regarding the vaccination status of those catching measles, where it was known (which is was in 90% of the cases):
In 2006 94% were either unvaccinated (77%) or incompletely vaccinated (17%).
In 2007 97% were either unvaccinated (87%) or incompletely vaccinated (10%).
So fully vaccinated individuals accounted for 6% of cases in 2006, and 3% of cases in 2007.
Some data regarding the outbreak in Wales:
Does anyone know how many lab confirmed cases there were?
No. Nor is it known if all cases were sent to labs, or whether it was only "not sure" cases (which were't included in the figures unless confirmed).
So they aren't really great figures are they...
Magadalen, I think your figures on vaccination status refer to reported cases rather than lab confirmed? The breakdown is like this so far
Jan 50 reported, 12 confirmed
Feb 5 reported, 8 confirmed
March 288 reported, 22 confirmed
April 519 reported 216 confirmed
May (these figures from much earlier this month) 34 reported, 22 confirmed
So there's no doubt there was quite a lot of measles, just not as many as have been reported.
Does confirmed = lab confirmed?
Of those reported but not confirmed, are we saying that they were not measles?
If confirmed only by a doctor, don't they count as measles cases anyway? Sorry, being a bit thick here.
That's not thick is it? Yes, lab confirmed. If sent to a lab and not confirmed by a lab then not measles. But if not sent to a lab and only clinically diagnosed then may still be measles. I've seen the figures on what's been sent to the lab and it's high but I can't find them again or to be honest I should be bothered because it's Friday night. On the question about whether it's measles if diagnosed by a doctor I don't know. I know they underdiagnose in vaccinated people, maybe the overdiagnose, in an outbreak, in unvaccinated people.
Goodness, this is confusing. Are all suspected cases meant to be lab confirmed? Will we ever know the true number? Were the powers that be just trying to frighten every parent into having their unvaccinated child jabbed?
Tabitha to that my answers would be
1. I don't know
2. I doubt it
3. I would put a vanload of money on it
but that's not hugely scientific!
Yes, they were using the opportunity to ram home a message to immunise.
This is a done by devolved authorities (one bit that always struck me as slightly crackers, owing to how infectious diseases spread). And the English protocols are well known, the Scottish ones are available in detail on line. And the Welsh ones aren't. And as no-one has paid any attention to Welsh infectious disease stats before, this lack has led to conspiracy theorists jumping in.
I cannot find their "who to test" protocol. It is likely to include early suspected cases (start of outbreak, new cluster location) plus a random selection from reported cases.
Then what we don't know: did they send all probable cases or all possible cases? Probable cases are those in an outbreak area showing all symptoms of measles. Possible cases are those in such an area showing only one or two symptoms. It would only be worrying if the 'probable case' diagnosis accuracy was very off.
I haven't seen for sure whether the stats on number of cases include possible cases, or only confirmed and probable. And without that, it's not yet possible to form a view on accuracy of the figures as published.
(And from that, accuracy of media as reporting)
There was no concern in the media about over-stating the problem. I believe the numbers reported by the media were as high as they possibly could be - every possible and probable case. And I'm sure it was more than "using the opportunity" - this outbreak had been rumbling along for a while, along with one in the North East, and suddenly all the big media outlets decide it's a big story? That's a coincidence.
Isn't there also an issue with the stats whereby GPs will use vaccination status as a diagnostic tool? Ie, a child with measles-type symptoms will be assumed to have something else if they've had the MMR (like a 'wild measles type virus' as one of my friends was told ) but if they haven't, it will be diagnosed as measles. Yet maybe both children had measles, maybe neither did - who knows without labwork?
So I don't really trust the statistics to give a realistic picture of a) number of cases or b) spread of cases among vacc-ed/un-vacced children.
The English and Scottish guidance does not include vaccination status as part of the diagnostic criteria. If anyone can find the Welsh one, then we'd know if ere is a difference there.
The media reported the published Welsh HPA figures (they're easy to find), but I've been unable to find a statement making it clear whether they include both possible and probable cases. Nor guidance to GPs on which cases to send for lab testing.
Doctors can use it as a diagnostic tool without it being "in the guidance". It's hard to trust official figures and statements simply because they're so woolly. It would be easy to tell us
1 how many reported
2 how many lab confirmed
3 how many sent for lab confirmation
4 how many lab confirmed cases vaccinated
5 how many lab confirmed cases unvaccinated
It's quite telling, I think that we don't know, and such mystery surrounds it. Perhaps the figures are a little uncomfortable for the authorities. Let's not forget a lot of people took a vaccination risk based on the sensationalisation of this outbreak. It's not just an academic question. Some children will have had vaccinations aged 6 months up, they might have had extra ones, some will have to have extra ones to the schedule after the "under-age" jabs. Every vaccination has a risk. It's a bit of a scandal that we don't know the real figures and aren't being told.
Maybe the guidance doesn't recommend using vaccination status as a way of diagnosing a disease, but nonetheless that is what happens on the ground.
There's not much you can do to stop it either. If GPs are convinced vaccination works then they are less likely to consider the possibility that a vaccinated child has <whatever illness>.
I strongly suspect there is a fair amount of overdiagnosis in unvaccinated children and underdiagnosis in vaccinated children. Which of course would paint a very different picture of the scale of an epidemic and the real risks of complications.
The protocols for handling notifiable diseases are however set out in the guidance. Yes, GPs can ignore protocols, but in general they don't.
I am hoping that a fuller breakdown of the stats for this spring's outbreaks will be published idc.
The big data sets show that around 7% of cases occur in immunised people (that's English figures, where all cases are lab confirmed). I think US and EU stats show similar.
All those numbers are being collected and will be published (most likely in Eurosurveillance in the next couple of months or three). And once they are published, they are going to be ignored by the anti-vaccine minded, because they are going to show what they always show, that 2xMMR is incredibly effective at preventing measles and that it is the collection of un- and undervaccinated in a community that allows ourbreaks and that, at the verge of measles eradication, provides the disease with CPR to make sure it can circulate just that little bit longer.
People are asking for them, why would they be ignored? They could be available now. Talking about ignoring - mass media ignoring of the lab confirmation figures, in case you didn't notice. It seems the pro-vaccine minded are ignoring that. (The idea that GPs can ignore protocols but in general they don't is very sweet.)
I thought doctors can be disciplined, and in worst cases struck off, if they ignore protocols?
And it would be amazingly irresponsible to wilfully disregard the possibility of a highly infectious notifiable disease. Yes, a measles diagnosis could be missed if it was an isolated case (because doctors mercifully don't see it that often), but during an outbreak it would definitely be considered by all but the incompetent. I do not think there are that many incompetent GPs.
It seems that figures will be published. Better done as a proper analysis, even if that takes time (is Eurosurveillance peer-reviewed?)
Why could it not be done as a proper analysis now? It could be. Yes, it would be amazingly irresponsible, it doesn't mean it doesn't happen. We still don't know about the man who died, it's still shamefully woolly. It seems he was vaccinated and therefore the possibility of measles ignored. How shamefully irresponsible is that? Pretty much. Who got struck off? Who's being disciplined? Why don't we know? It's not like the answers aren't there. They are there. We don't have them.
Let me guess: PHW may just have been ever so slightly busy with dealing with the outbreak, arranging clinics etc. I have asked PHW and they want to ascertain the actual vaccination status of the patients before they publish the data after the outbreak. We know how the numbers are likely to break down from similar outbreaks, like last year's in Merseyside:
12 of 359 confirmed cases had had 2xMMR, that is about 3.3%
We know that 2xMMR is incredibly effective and knowledge of detailed vaccination histories of the cases would not change the best course of action in an outbreak: get your MMR. If you are anti-vaccine in 2013, with all the excellent information about MMR effectiveness, then how is having precise data on yet another outbreak a couple of months earlier going to change your attitude? It won't. And all that talk about secrecy and number fudging in view of the available data from previous outbreaks in very similar settings (remind yourself about Merseyside's relative location to Wales if you want) is just totally hypocritical, IMO.
scaevola, yes, Eurosurveillance is peer reviewed and peer review takes some time (I have to do two that are overdue this weekend).
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