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Help me make sense of MMR - hype or theory

941 replies

felicity10 · 17/02/2011 20:53

OK, so I've been through a few pages of previous posts, I must be missing something because I can't make sense of it!

DD is 1 and I've had a letter about the vacs from the GP. I've heard about the MMR in the news few years ago and about the link to autism, but I just would really value your views.

Single vacs with no mumps or the MMR? Confused Can anyone point me in the direction of key MMR issues?

I just don't want to get to the gp's and then feel like I am getting bullied into having the mmr - it is normally very no nonsense nurses who barely speak english, so will be unlikely to give me a clear answer as to any risks.

I am amazed that we have this lack of clarity in the UK.

Many thanks in advance!

OP posts:
ArthurPewty · 10/03/2011 11:02

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ArthurPewty · 10/03/2011 11:05

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StataLove · 11/03/2011 21:30

Wow! I came back to see what had happened and didn't realise that the thread had descended into comedy.

[wipes away tears of laughter]

'Bathing in a pool of mild childhood illness' And which illnesses would they be exactly? Measles with a one in 5,000 case fatality in the UK? Pertussis where you struggle for breath and has even worse case fatality? Or maybe diptheria which can easily be imported from abroad? What a lovely bath to expose your children to in an erroneous belief that their immune systems are somehow better by not being vaccinated! Yes, they probably do have slightly better immunity now (all immunity wanes over time - it's the lack of natural boosters though that's the main reason for less immunity in vaccinated populations but our children are being exposed to the same diseases and my children are getting boosters of some diseases thanks to yours suffering the disease) - but they've also had the disease and its potentially life threatening complications.

You see, some of you have said about how you agonised over not vaxing and that you're not really anti-vax but then when you say crap like that, you realise that it's all a show because you wish your children had bathed in childhood illnesses like measles, whooping cough, diptheria and polio Hmm

By the way, if you have more than one child, often secondary cases in the same household have a worse case of the infectious disease as they have often had more sustained exposure to the pathogen than their sibling leading to a worse case of the disease. I'm sure that will lead to great family dynamics.

Herd immunity is a 'myth'! Grin That's the funniest thing I've heard in ages. And from a neurologist who may have had one lesson in epidemiology in med school 40 years ago. Like it or not, herd immunity is nuts and bolts epi and it's an empirically observed mathematical model.

OK, fudamentals of epi again (we learnt earlier that a study encompasses many types of investigation and also why a screening programme can't work - if you're going to talk about epi, let's get things right).

I can't believe that RPO the lovely gooseberry actually had this idea that an individual is somehow conferred magical 'herd immunity' powers and it stops their immune system being overpowered. And then the lightbulb moment when she realised that it's all about exposure. Well, DUH!!! Of course it is! It's all about the probability of exposure. Did you just figure that one out? Or did your mis well informed friends fill you in?

How do you think smallpox was eradicated? Was 100% of the population immunised? Was 100% of the population naturally immune? No and no. We reached a high enough percentage of vaccination to prevent any sustained transmission. As there was no animal reservoir, the disease was eradicated globally. How could that be if we didn't vaccinate 100%? Herd immunity of course!!

The threshold for herd immunity which means that virus transmission cannot be sustained in the community varies by disease. It is higher for measles than many other diseases as measles is very contagious. What you need to do is ensure that the basic reproductive rate (the number of secondary cases generated from a single infective case introduced into a susceptible population) is below 1. In other words, one infected person can infect on average less than one other person (natually, measles R is about 7 or 8). Infection persists if R => 1 and there is a steady influx (births) of susceptibles (whenever maternal antibodies are no longer protective). By immunising, you are reducing the number of susceptibles in the population. When you have a low enough number, R is below 1 and the transmission cannot be sustained.

That's why natural immunity can't result in herd immunity (that was one of the funniest things I've ever heard - like the virus cares!) unless no-one has any more children (and no migration) following an epidemic. Sure, people are now immune (and possibly with better immunity than the vaccine but they've had and even died or permanently damaged from a nasty disease) but as new susceptibles enter, R will go up. And anyway, if you had full herd immunity with no children being born, natural immunity would also wane over time in the absence of exposure to the virus. Eventually, when R exceeds 1, you'll get an epidemic. That's one of the reasons why epidemics occur cyclically. What part of this is troubling you exactly?

It's true that the determination of R is more complicated. For example, it depends on how well the population mixes and the contact rate. So R is lower among the elderly and higher among school children who mix with one another more. So you need higher rates of immunisation among children to lower R and prevent a disease becoming endemic (when a disease is endemic it is being transmitted but not epidemic and means that R is about 1 - that's the case for measles in London).

The threshold is also not a magic one. If you go under the threshold for edemicity, you may still be able to prevent epidemics as you can keep R at around 1. The more susceptibles you have in a population, the greater R and the greater the likelihood of secondary transmission. It's very simple really. It's not an all or nothing situation. Less suscpetibles means less transmission and less severe epidemics. But there is a threshold to prevent sustained transmission whcih varies by disease and population parameters. Where's the myth exactly?

The only part you could possibly argue with is to say that a lower proportion of the population are vaccine immune than otherwise said. Possibly. But that could equally be an argument for a booster rather than arguing against the whole concept of herd immunity. At least make sense for gods sake, surely you could pay find a sympathetic epidemiologist rather than turning to a neurologist for epidemiological explanations when he clearly doesn't have a clue!

Thanks guys for cheering me up!

StataLove · 11/03/2011 21:38

Not sure why you're upset about the libel stuff btw. Beach said it was a shitty thing to do to post libel on an anonymous website so I knew she'd be upset by all the libel that had been spread all over this thread - or are you only upset by 'libel' that you don't agree with?

Bruffin - thanks for reporting the posts. To be honest though, I'm thinking it might have been better for them to have stayed. I think the level of vitriol reflects a lot and I've also realised I'm in quite good company. After all, the editor of the BMJ is a bitch, the editor of the Lancet is a liar and I'm a c**t so I feel quite honoured to be placed among such an illustrious crowd. Do you see the pattern?!

Serisouly though, I may have been more sensitive in my posts if I hadn't been provoked, particularly by two posters - one of whom even name changed in order to be rude and obnoxious. I do regret that a bit but you can't shoot your parents and then cry that you're an orphan so it doesn't bother me that much!

ArthurPewty · 11/03/2011 21:42

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StataLove · 11/03/2011 21:48

I've also been thinking a bit and I've developed a theory.

I think that television watching causes autism.

  1. Television watching has increased the same time autism has increased! Why? Surely you can SEE the relationship and no-one has provided any other explanation (oh, other than changed diagnosis, increasing parental age but hey there's a lot we don't know so I'll ignore it)

  2. Parents have reported television watching started prior to the development of autism. Nearly all children have watched at least some television prior to developing autism. In fact, I do not know of one child who has not one watched ANY tv at all prior to the diagnosis of autism.

  3. There is solid evidence that television watching at a young age affects the developing brain. Therefore television watching can cause autism.

  4. There is a clear financial interest from advertisers on television to get our children watching television from a very young age. The younger they are, the more embedded their products become. Therefore, they will cover up any attempt to prove that television watching causes autism.

  5. No one has ever every shown that television watching DOES NOT cause autism. Not for sure, not 100%. Sure, there have been some very large studies showing no effect but they are all flawed and biased and ghostwritten by the large TV companies. I want to see a study that shows that television watching is 100% safe.

And that is how your argument sounds to me regarding vaccines and autism.

silverfrog · 11/03/2011 22:05

that would be funny, Stata, if i hadn't read it before.

maybe you could try to be original in your insults next time?

StataLove · 11/03/2011 22:13

I wouldn't be surprised if you had seen it before silver. That kind of example generally (in various guises and not necessarily with vaccines) will form a part of any decent health related basic research methods course when making the point correlation does not equal causation.

It's a very common error as humans are hardwired to make those kind of connections. Unfortunately the world is more complex than that.

ArthurPewty · 11/03/2011 22:14

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StataLove · 11/03/2011 22:21

Ugh. Outed. I should have been more cunning.

ArthurPewty · 11/03/2011 23:26

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StataLove · 12/03/2011 00:10

I'm far more interested in hearing why an empirically observed model like herd immunity is a myth (clue: because it's not). How do you think infectious diseases spread? What are the parameters that you suggest? How do you get herd immunity without vaccines if you constantly have susceptible people joining the population through birth (once maternal antibodies wear off so we don't let that red herring distract us)?

gooseberrybushes · 12/03/2011 05:06

Box of frogs.

gooseberrybushes · 12/03/2011 05:16

Actually -- perhaps a little more.

I would be very happy to respond to most or all of your points if they weren't so childishly voiced and if it wasn't so very obvious that you are not reading, understanding, or even interested in the responses.

There's been a great deal of clarity and cogent argument. LIke I said, it's almost impossible to see how anyone can continue to ridicule and belittle in the way that you do, if you've read and understood what's been said. Even if you still disagree, this hysterical laughter is little short of bizarre.

I'm very confident in my decision, and in the evidence that's brought me to this pass. I really don't need validation from someone with quite limited understanding of the issues.

Smile
bubbleymummy · 12/03/2011 11:19

Stata, just to clarify - are you saying that natural immunity can not lead to herd immunity? You did say:
'That's why natural immunity can't result in herd immunity (that was one of the funniest things I've ever heard'
So I just want to confirm that's what you actually meant.

StataLove · 12/03/2011 11:40

If you have a closed population with no new susceptibles joining then natural immunity could certainly lead to herd immunity. But that would mean that no-one is having children or in-migrating without immunity. That's part of the reason why infectious disease are often epidemic - the susceptible population grows and grows until the disease can be freely transmitted - and you get an epidemic. People then gain immunity (or die) ie are removed from the susceptible population and the epidemic dies out but remains endemic - and then the whole cycle is repeated.

All the herd immunity model says is that if you decrease the susceptible population through vaccination, you can reduce the transmission through the population. If you reach a certain threshold level, which is different for each disease and population, transmission is not sustained in the population.

You could argue that immunity (vaccine and naturally acquired) does wane over time, especially in the absence of boosters. Fair enough. Why does that make herd immunity a myth? It worked for smallpox, didn't it?

Beachcomber · 12/03/2011 12:07

Well I'm afraid I lost all interest in anything Stata has got to say when she accused Dr Wakefield of being personally responsible for children dying. (But not Professor Walker-Smith or Dr Murch I note. Hmm). This to me shows that there is no point in trying to engage in sensible discussion about real life facts and realities.

I also cannot muster any interest for the ridiculously over-simplistic reduction of Disease Bad = Vaccines Good.

Real life ain't as simple as that.

As for the silly nonsense about television and the comment that followed "And that is how your argument sounds to me regarding vaccines and autism."

Yes well stata - that might be because you have admitted yourself that you have not looked at the science which shows MMR/autism link to be biologicaly possible - nor or you able to understand it you said.

You can make up nonsense like this all you like, but you are just playing around at having a debate without engaging in the sold facts and realities that are important medical and health realities for a lot of people.

Yet again you are implying that the thousands of parents who have witnessed their children reacting badly to MMR (children with remarkably similar medical histories and family background remember) are stupid and delusional.

You think you know more about their children than they and the people who examine and treat those children do. (Using science that you have not read and do not understand.)

Here have a Biscuit for your misplaced arrogance.

Your presence is useful on this thread as you perfectly exemplify the smoke and mirror dishonesty that has been an integral part of all this from the moment Dr Wakefield said the word 'vaccine'.

If you knew anything about the science you would be able to see that this is not about science or medicine at all any more (probably never has been). It is a purely political issue. Shame on all those involved.

Beachcomber · 12/03/2011 12:10

engaging in the solid facts

ArthurPewty · 12/03/2011 12:13

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gooseberrybushes · 12/03/2011 12:32

Yes me too, no interest at all. I'm faintly intrigued that S thinks that rpo gooseberry is some kind of reality reveal, as if no one else noticed. But apart from that no, not really.

But I am interested in tl:dr. What is that?

StataLove · 12/03/2011 12:33

So, no answer to a very simple question! Please demonstrate how herd immunity is a myth. Because you made it up and don't have a clue what you're talking about with regards to herd immunity.

(as they all go off to google the anti-vax websites to find something)

How very unsurprising.

ArthurPewty · 12/03/2011 12:42

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ArthurPewty · 12/03/2011 12:43

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StataLove · 12/03/2011 12:54

No, that's right. You should definitely keep talking among yourselves and ignore the pesky truth that actually what you're saying is complete mumbo-jumbo.

Like herd immunity being a myth which is completely untrue as I clearly demonstrated in the my post which was too long for you. Generally these kind of things do require some investment of time to understand them, but who needs to do things like that? We're all experts!

gooseberrybushes · 12/03/2011 12:55

I got a long way down actually. Sticker please. But I decided pretty early ("wiping tears of laughter") that it wouldn't be worth a response.

Look girls at all the hard work you did, and all those great links, and the research, and the logical argument, and the evidence of shall we say ahem poor oversight, and everything. Wasted. Honestly. Some people are never grateful.