If you decided to postpone baby jabs...

[thehouseofmirth]

how long did you delay them for and what was the rationale for your decision?

S'okay Ruty. I've read your views on this before so I know that you give a lot of careful thought to it.

I take issue with your view though but not on a personal level, on a scientific level.

Until an effort is made to investigate suspected, biologically plausible and proven manifestations of vaccine damage, we are in a situation where it is impossible to know if the benefit of mass vaccination outweighs the risk on a population level.

Until we develop screening processes for vaccine damage susceptibility it is impossible to calculate risk/benefit ratio on an individual level.

The fact is that the concerning rise in autoimmune disease, autism, allergies, asthma, MS, diabetes, bowel disease and so on happened in the same time period as we increased the vaccine schedule load. There is a lot of quality research that solidly links these conditions to vaccine damage. There is a lot of research to link SIDS to vaccine damage. The same can be said for demyelination conditions, seizures and inflammatory diseases like juvenile rheumatoid arthritis.

Until we address these and other health concerns with comprehensive impartial research we are in no position to judge the value of vaccines.

Additionally there is much information pointing towards improvements in sanitation and nutrition as having a much greater effect on public health than any vaccine. If vaccines save so many lives why to see similar declines in mortality figures for diseases for which there was no widespread vaccination such as scurvy, typhoid and scarlet fever?

Again, we need that much called for study comparing vaccinated and unvaccinated populations that the government is so reluctant to carry out. In the meantime it would be nice if they could start to keep a proper record of vaccine damage and examine the thousands of children damaged by MMR. Oh and bring back single vaccines. (And better regulate the pharmaceutical industry, improve screening procedures for contamination, sort out the business of hot lots, change the safety testing regulations, stop the testing of experimental vaccines on third world populations, etc, etc.)

I agree with much of what you say BC. I didn't quite understand those graphs though. When that guy says 'By 2007 the chance of anyone in England and Wales dying of measles if no one were vaccinated was less than 1 in 55 million (see graph)' I don't understand how he could have come to that conclusion when most children have been vaccinated.

I do agree with what he says about mumps though, and how vaccination may be just pushing up the age that young men get it, making it a more dangerous disease.

my aunt died of polio before my mother was born, and I do find it hard to believe that sanitation alone would stop polio, particularly as we still release quite a lot of untreated sewage into our seas.

Unfortunately poliomyelitis is one of the diseases where improved sanitation has a worse effect. In the US, when running water and sewer cleanups were instigated around the 1920s, there was a huge increase in cases of polio. What happened is that the better hygiene practices interfered with the circulation of poliovirus all right, but pushed up the average age of infection so that children tended to catch poliovirus later and outside the protective cover of maternal antibody. Without this, they were more likely to develop poliomyelitis as a result of the infection and did so in larger numbers.

Regarding the claim that measles mortality was falling, and the implication that somehow we just needed to wait around until 2007 for it all to go away; people should look at that graph critically and see the flaws in drawing that conclusion. Yes, mortality of many things - of infectious and non-infectious cause - has fallen throughout the 20th century, probably because of better healthcare and medical support. However you cannot just extrapolate from the downward trend until it crosses the axis of '1 child per 55 million' without at least stopping to think about why it may be erroneous to do so. After all, at the top end of the graph, the extrapolation does not fit the data, so why should we make a complete guess that it would at the bottom end? There are plenty of reasons for thinking that it wouldn't, not least of all of which is that there will always be a number of people who die from measles because (a) The disease is not recognised early enough to allow effective supportive treatment or (b) Effective support could not be given because the disease is so severe. The full article highlighted a difference between the number of deaths in rural areas being higher than urban, and that families on lower incomes had ten times greater death rate than higher incomes. This points towards access to healthcare and nutrition being factors influencing death rate, and since these certainly have not completely gone away, I suggest that it is nonsense to predict there being an absence of measles deaths by 2007 if everything had been allowed to continue 'naturally'.

However what none of this data shows is the effects on morbidity (illness). I hope that most people would acknowledge that recovery from severe measles is not necessarily complete, and that those children who were saved from dying but left with brain damage might have shown a rising trend. After all, the average number of measles cases on the US statistics graph did not change at all between 1912 and 1968, and severely affected children who did not die must be accounted for somewhere.

BTW Beachcomber; re the rubella figures previously discussed... I too am a bit confused, but by the difference in data between the table copied from the 'WAVES' website and the original Danish reference you linked to on PubMed (Bitsch et al). I think whoever made that table has misinterpreted the original study, which indeed seems to be that they found a 50% (7 of 14) fetal infection rate in women having rubella in the first trimester. In the 'WAVES' table it says there were 14 infections in the first trimester and 7 of those had severe defects; which obviously is not the same thing. Unfortunately the journals access I have does not go back as far as 1987 for the DMB, so I cannot look for explanations.

I sense we are likely to disagree on which figures are most relevant to the UK, but just to be clear; the basis on which advice is given to parents who are unlucky to be in the worst situation is based on the Miller study. That is; the risk changes throughout pregnancy and when infection occurs in the first 11 weeks of pregnancy there is a 90% fetal infection rate and 90% likelihood of those infected being severely affected (overall risk of severe affect due to rubella is approximately 80%). After 11 weeks the overall risk is substantially reduced and between 16 and 20 weeks the risk is one syndrome of deafness in a small number. Pre-natal diagnosis may be useful in these cases to establish fetal infection. After 20 weeks, maternal rubella infection is not expected to have any consequences for the pregnancy.

Ruty, sorry to hear what happened to your aunt.

I think when Clifford Miller talks about 1 in 55 million he his following the trend of the graph plus comparing measles to other infectious diseases such as typhoid and scarlet fever. He argues that there is no reason to think that measles would not have followed a similar trend in terms of virulence. I wonder what the chances of dying of scarlet fever are today for a healthy child in which the disease is not mismanaged.

In these times when the government is literally trying to put the fear of death into us over the dangers of measles I'm always curious as to why no mention is ever made of the success of treating measles with high doses of vitamin A. The WHO knows this and uses vit A in developing countries so why aren't we using it routinely in the UK if we are so concerned about measles rates?

It is strange how there seems to be so little discussion over what makes some children more at risk to developing complications from infectious disease and the measures which can be used to prevent this happening.

For rubella figures I agree the risk is high in the first trimester of pregnancy. This is why I think it is vital that young female children are exposed to rubella when it is natural for them to do so. It is one of the (many) reasons why I would refuse MMR for my DDs. If I had DSs I would refuse this vaccine because they don't need it and toddlers should not carry the responsibility for adult women. It is ridiculous to think that we can stop circulation of this disease by the use of a live virus vaccine which does not have a 100% efficacy rate, which does not give lifelong immunity and which is not given to 100% of the population. And, has anybody asked themselves if it is a good idea to interfere with viral ecosystems to the extent of trying to eradicate a virus anyway? Are we just crossing our fingers that there were not be any consequences of this in terms of virus mutation, serotype replacement, affects on human health due to no longer benefiting from the benefits of infection and so on?

Polio is very very interesting. There are a lot of unanswered questions about this virus. I read a lot about it when I decided not to vaccinate my second child against it. It was one of the diseases that I was the most afraid of. I was under the impression that the risk of permanent paralysis was very high for anyone who contracted polio. The official figures are actually as follows; 90% of people will have a subclinical case, 5 to 10% will result is aseptic meningitis, less than 1% will develop paralysis and the majority of those cases will not be permanent. The next thing I wanted to know was what put a person at risk for developing complications and how come the polio epidemics of the 20s, 40s and 50s didn't seem to fit in with these figures. What had happened to make polio go from being a relatively benign enteroovirus to a virus that paralysed and killed so many and which people became so afraid of?

Well there is a lot of controversy surrounding all this, I've got to go out just now but will come back later.

i think Musukebba is correct when she talks about improved sanitation triggering the polio epidemics of the 20's and onwards. children who would have previously been exposed as babies were exposed as older children and many more were seriously affected by the virus.

I am very interested in the possibility of treating measles with Vitamin A - does this happen in places were measles is still quite rife? Africa for example? I would love to know more about it. I was hospitalised with measles aged 11. I have no idea if i was vaccinated against measles or not, my mother gave me all my other vaccinations so I don't know if it was a blip or whether my vaccine immunity failed.

Hi ruty...

Treatment of measles with high-doses of vitamin A is definitely recommended in countries like Africa, where the mortality from measles is much higher than in the Northern hemisphere countries like US and UK. There are good studies which led to its endorsement by the WHO - as Beachcomber says - and the World Bank, as routine practice in developing countries.

Its use is based on earlier studies which showed that children were at greater risk of severe measles if they were vitamin A deficient, but there is also evidence that it is beneficial in cases which occur in non-vitamin A deficient children. The reasons for this are that measles itself can deplete the vitamin A in circulation, and it's thought that during measles infection even well-nourished childrens' metabolism finds it difficult convert vitamin A from its storage in the liver in time to compensate for the acute depletion.

Measles of course is a profoundly immunosuppressive virus and in Africa most children die from the secondary complications like bacterial superinfection. Since vitamin A is known to be required for having good general immunity, there is a clinical and biological plausibility to back up the evidence for giving vitamin A.

Whether vitamin A can be used in the situation of the UK and US is a good debating point, Beachcomber. There are clear differences in the epidemiology of measles over here; mainly that the age range affected is above 4 years of age rather than the 0-2 years in Africa. Hence the evidence has been gathered in that 0-2y age group and might not be applicable, and in fact the children in the good studies were all hospitalised and thus the studies are biased towards those seriously ill. Also children are not anything like as malnourished here; however the counter-argument would be that measles is still just as likely to deplete vitamin A from the circulation and so supplementation may provide some benefit. I think there is one study done somewhere that I'll try and look up.

Bear in mind though that the doses of vitamin A are quite high: 200,000 IU in each of two doses and theoretically exceeds the toxic dose in anything less than an 8kg child (~25,000 IU/kg). I am not sure whether that knowing on balance that the severity of measles in the UK/US is likely to be less than in Africa, and so the risk of using high-dose vitamin A makes it less convincingly. Personally I might consider recommending it in the UK for a hospitalised child of < 2y who also had nutritional problems and a low serum vitamin A level, but would be very wary indeed of recommending it for widespread general use.

Going back to the Clifford Miller graph, I would argue that there are many reasons for not considering measles as being similar to diseases such as scarletina and typhoid. Primarily, it markedly reduces interferon gamma production for a few months and leaves the infected person immunosuppressed and much more susceptible to many bacterial infections. All that graph shows is a fall in mortality that can be explained by many social and healthcare factors identified in the same original paper, and does not provide any direct evidence that measles is losing virulence.

That is interesting Musukebba, thankyou.

I just wonder, as the UK seems, apparently to be on the brink of a measles epidemic [as reported in the press] whether it might be wise to introduce Vitamin A dosing as a standard treatment in hospitalized children. It would be very interesting to see if it improved the course of the illness. Presumably, as we are experiencing ever rising cases of measles, there have been cases recently of, if not deaths thankfully [I am aware of the boy who died a few years ago who was on steroid treatment] then of prolonged damage to children as a result of the infection? Are there any figures around to show the rates?

Looking at measles first of all, WHO estimates that treating children in developing countries with vitamin A reduces measles mortality rates by around 50%. Vitamin A also reduces the levels of measles complications such as blindness, deafness, etc and indeed can sometimes be used to reverse some of these complications if given early enough.

A study was done a while back in the US which showed over 70% of children hospitalized with measles to be vitamin A deficient. The study recommended giving children vitamin A and noted that the worse the deficiency, the worse the complications were. As Musukebba points out, measles is immune suppressive, treatment with vitamin A, (and also vitamin D and zinc) combat the suppressive effects of the measles virus and thereby lower the risk of complications from both the virus itself and from secondary infection. Neat huh?

American measles/vitamin A study

As for polio there is so much to read on this, all of it interesting and complex. One of the most interesting bits of information that I have come across though is how having a tonsillectomy affects the risk for a person to develop paralytic polio, notably bulbar polio which is the most serious type. The tonsils play a vital role in both the replication and infection process of the virus and in how humans mount an immune response to the virus. People who have had their tonsils removed develop polio complications at much higher rates than those who are intact. Tonsillectomies were all the rage from the 1920s onwards and played an important role in both increasing the number of people who developed paralytic polio and in affecting the age distribution of complications from infection.

www.whale.to/vaccine/polio_and_tonsillectomies1.html

www.whale.to/vaccine/polio_and_tonsillectomies.html

The sanitation hypothesis is interesting but doesn't fit in with the proliferation of polio complications in poorer countries with poor sanitation such as India. Also this study which examines whether the "polio model" can be applied to polio itself shows age of infection and severity of symptoms to be rather complex.

Then there is the DDT theory which examines how the use of pesticides appears to have an impact on polio epidemics.

Long but very interesting article from The Ecologist.