This illustrates why your vaccine choice matters to the rest of us

[CatherinaJTV]

one family's vaccine refusal killed one, another child, infected by the same unvaccinated pre-teen is still dying (since 2005):

justthevax.blogspot.com/2011/10/so-predictable-so-sad-natalie-dies-of.html

Well, if you could read Turkish, I could direct you to Turkish Ministry of Health's report on SSPE where nationwide incidence rate is stated as 2.5/1,000,000.

Again, that is 10 times the rate of mortality from C-Sections.

If you are half as "scientific" as you pretend in your blog, you would know that incidence is only meaningful when in context of a country's at-risk population - i.e. 76 is not very high in a country with 75 million people, half of whom are under the age of 30.

OP how many of the Turkish cases also contracted measles as infants?

I'm finding all this very concerning WRT how mass vaccination affects age distribution.

Cote, I'm not disputing that the number of cases is not terribly high in relation to the actual population BTW. I'm just interested in distribution.

Btw re "there are other hospitals that deal with SSPE in Turkey"

You clearly don't know where Harran is, or what this "Harran University" is about, or you would not make such a hilarious comment with a straight face

Fyi, Harran is one of the most rural and least educated areas in Turkey, and that is against some competition. That Harran University was created less than 20 years ago basically for political posturing, and the state has to force doctors to "serve" in that part of the country.

So, I am well aware that there are other hospitals in Turkey that deal with SSPE, would you believe. Like, real hospitals that are properly staffed and have adequate diagnostic equipment, for example.

So, the relatively high number of SSPE cases could be due to the high number of under 30ies? Nevertheless, they do get significantly more than, for example, Germany.

Beachcomber - re distribution

You can safely assume that vaccine prevalence rates are among Turkey's lowest in that region, if not the lowest. I doubt if mass vaccination is a concern here.

Catherina - As someone as "scientific" as yourself would surely know, there are a number of variables here, any and all of which may explain why Turkey has more cases of SSPE than Germany:

• vaccine prevalence (assume lower in Turkey and much lower around Harran)
• size of at-risk population (much larger in Turkey due to much younger population than Germany. Median age in Turkey is 28 vs 44 in Germany - 4th oldest population in the world!)
• access to health services (very good in Germany, weak in Turkey, and laughable in South-East Turkey where Harran is)

I'm sure at someone who writes a scientific blog about such matters can come up with more.

Thanks Cote for that information.

OP it would be a good idea for you to stop mixing up factors, figures, etc for different countries and different populations in such an irresponsible way IMO!

next you'll claim that vaccination prevents SSPE...

What exactly is that supposed to mean?

Which vaccine are you talking about and in which population?

Your figures are all over the place. Your German examples are very very concerning.

Beachcomber - I am actually not quite sure about what Cote and I disagree.

The incidence (so new cases per year) in Germany is about 0.08 per million (i.e. about 7 cases in 90 million population - the high number is SSPE/measles cases).
Cote says, the incidence of SSPE in Turkey is 2.5 per million (from a Turkish source that I have not read) - that is 30 times higher than in Germany (we don't know about SSPE/measles cases in Turkey, but Cote says, many of the cases come from poor unvaccinated families).

I called SSPE incidence in Turkey "very high", it is 30 times higher than in Germany, IMO that counts as "very high". Cote says that is because so many are unvaccinated in rural Turkey, but that doesn't really contradict me (because I keep saying vaccines prevent SSPE).

Overall, SSPE goes down both in Turkey and in Germany as vaccination rates increase and measles cases go down.

Of course sspe rates go down with fewer measles cases in a population. As cote said it's the numbers contracting sspe in which population size which is important. Which is why I was bleating on about numbers earlier (the proportion of sspe cases may have increased in infants in heavily vaccinated populations but surely actual numbers haven't???)

And why (for me) it's so interesting that one measles case supposedly led to 2 sspe cases. Ok it's possible but all things being equal surely incredibly unlikely? Unless there was something about that particular strain that increased sspe risk?

Exactly. I don't understand why we started off talking about an extraordinary case in Germany, but now we seem to be discussing figures for Turkey and the US.

As you say saintly, we need actual numbers for infants in Germany to see if this goes any way to explaining what appears to be a very high proportion of measles cases developing SSPE in a rich western country.

I can only imagine that there will be an investigation into the virus that has caused these two cases as Germany must be very worried about this surely?

A high proportion of measles cases developing SSPE in a highly vaccinated population needs explaining. Of course one explanation may be that there are very few cases of measles in Germany but a high proportion of them are in infants. This would still be worrying though in terms of what is says about maternal immunity and dependence on the vaccine programme.

I'm not disputing that lower number of measles cases = lower number of people who develop SSPE. I do not see that as an argument for the MMR vaccine however. I see it as an argument for measles vaccine.

I always think it is potentially concerning when a vaccine program alters the natural age distribution for a disease however.

Beachcomber - I mentioned Turkey, because jimjams (I think) asked whether the Germans did not investigate their SSPE cases, and they do, partly in collaboration with the Turkish experts, who have more experience, since they have many more cases than Germany.

Bellini et al have said they have no indication that the D3 strain carried any higher SSPE risk, several strains circulated in 1999 in Germany, from the geographical distribution, Micha and Natalie most likely had a D7 strain (but you cannot say unless you sequence material post-mortem).

The little data I can find suggests that there are no strain differences when it comes to SSPE (www.ncbi.nlm.nih.gov/pubmed/12161818).

So very strange that 2 developed SSPE

I do hope that actual numbers of cases of measles in infants has decreased - dramatically I woukd hope - but I have never managed to find the figures. Only proportions. If anyone has the figures please share.

The changing age distribution is potentially more of a problem for hib and mumps especially mumps which is nearly always mild in young children (third of cases asymptomatic) but more likely to lead to complications in adults.

The actual numbers of mumps cases in the 17+ age group has increased I believe since records were kept (which was with mmr introduction). This was put down to mr being given for a period rather than mmr but I'm not sure waning immunity was ever completely ruled out.

Catherina - i wasnt actually bickering about figures at all.

My point, which seems to have whizzed over your head, was that you are shamelessly alarmist (2.5/1,000,000 is a very low incidence rate, about a tenth of CS's mortality rate, yet it is "very high", according to you), and you seem to be copying and pasting from sources you feel support you without properly understanding their implications (good luck with the Harran University SSPE "experts" Germany is collaborating because they are oh so experienced in this field )

" it is 30 times higher than in Germany, IMO that counts as "very high""

No. That counts as relatively high. If you were from Papua New Guinea, it would be relatively low.

Small difference perhaps, but an important one. Especially if you pretend to write a "scientific" blog about this stuff.

about a tenth of CS's mortality rate

for women who have a section. The incidence of SSPE is not 2.5 per million measles cases, it is 2.5 per million population.

And yes, the incidence in PNG is even higher in epidemic years - but that is even further away from Europe...

I would like to suggest, with scientific rigour that matches Catherina's that the mothers of those babies caused the contraction of their disease for not having breastfed them well into their second year. Not knowingly of course, and it is still very sad!

Starlight - there are no measles antibodies in breastmilk after a couple of weeks post partum. Maternal immunity is transplacental and decays with a half life of 3 to 4 weeks.

Catherina, there are antibodies to everything the mother herself carries antibodies to, which incidentally are stronger if the mother had measles than a vaccine. I'm assuming here that you know nothing about breastfeeding.

Further, much of the make up of breastmilk is unknown so not only is your claim unfounded, it is further unproven.

Starlight - I would claim some practical knowledge about breastfeeding, having breastfed mine for the world average :o I am a big fan/advocate of breastfeeding for a number of reasons.

I know very well that breastmilk/exclusive breastfeeding reduces the risk of severe rotavirus, hib, invasive pneumococcal infection, polio and cholera.

It does not protect against measles (or varicella, as I know from my own experience) though:

www.ncbi.nlm.nih.gov/pubmed/15601649

Maternal immunity against measles is passed through the placenta before birth. Then it decays quickly with a half life of 3 to 4 weeks.

Beachcomber, I linked to a German text - the citation for my numbers is

Arenz S, Liebl B, Wildner M. Erhöhtes Risiko für SSPE nach Maserninfektion im ersten Lebensjahr. Kinderärztliche Praxis 2006;77:29-31

And infants have always caught measles in the first year, the absolute number of infants with measles has dropped, due to the success of the MCVs.

Please can you give me the absolute number of measles in infants I have been looking for years (talks to self).

Why are you being so alarmist? We're all aware on here that measles can in very rare cases cause sspe (am still staggered at two cases from one infection occurring by chance though - would really want to examine that carefully). We're aware of the other complications of measles - as I said my own mother was very ill with measles and is deaf in one ear because of it. These factors were considered before vaccination choices were made.

mhh, not sure about alarmist - I am so involved in this, because the whole thing happened in a small town in which a friend of mine lives with her twins (who were small at the time) and because I "talked" (by internet) with Micha's mum and uncle.

I had a look for absolute number - I know I have seen them, but the English publications (in Eurosurveillance) of German outbreaks always give the age-specific incidence, sigh. Will dig some more after work...