Re: Measles epidemic feared..BMJ Response from Hilary

[Guest guest]

There is discussion at the BMJ going on.

http://www.bmj.com/cgi/eletters/337/oct01_3/a1856

Doubt they will publish my response to Flegg, but here it is,

though I've altered one sentence to correct a grammar mistake:

Dear Sir,

Flegg says that there would have to be an average of 750 MMR

deaths a year, to tip the balance in favour of not vaccinating with

MMR.

During the rationing of the second world war, in 1943, measles death

rate in UK was 773 (1), and it never approached that rate again.

In the fifteen years before the measles vaccine was licensed in the

UK death rates never went above 200; in the ten years before the

vaccine was introduced, the death rate never went above 150. After

1953, deaths rates were never of the order of 1 per 2,000.

The measles vaccine was licenced 24 years later in 1967, and did not

reach significant levels of uptake for quite some years after that.

In fact in 1980, there were 139,487 cases of measles with 26 deaths.

Even that isn't 1 per 2,000 cases. And presumably those deaths also

included late-onset deaths as well.

Therefore, Flegg's basis for 750 deaths per year would indicate

that this analysis came from Kuhn's Sabre Toothed Tiger

syllabus.

The reality of the years between 1952 to 1970, and afterwards, prove

that Dr Flegg's mathematical equations are about as relevant as

saying that the measles death rate in Africa, is comparable to the

Measles death rate in UK.

Flegg accuses some here of having a Nirvana complex. It's hard

to go beyond " Pinocchio's nose " , when attempting to ascribe the

relevance of Flegg's statistical prowess to the UK conditions

of today.

In reply to Flegg's expansion of my question to him: no, it did

not occur to me that Flegg would decide to include the third

world when the BMJ was discussing a topic based in UK.

But since Flegg wishes to compare apples with army jeeps, let's

discuss his concept of that as well. Flegg states that, " in 1999

there were estimated to be 873 thousand deaths from measles, reducing

to 530 thousand in 2003. "

Last year, WHO (2) stated that use of the measles vaccine in Africa

had slashed the death rate from measles by 91% since 2000. This 91%

is an artifact figure, because before 2000, measles in Africa

was " estimated " , while after 2000, notifications were only accepted

after being laboratory proven. In 2000, WHO implemented a system of

laboratories (3) specifically to diagnose measles, and provide the

laboratory confirmed cases which are now the basis of WHO data.

Look at pages 2, and 14. On page 14, 14,185 cases were reported in

2006, but after blood testing, 9,764 were " discarded " . That's an

immediate 69% drop in cases, because they are no longer relying on

doctor's eyes.

On page 2, of 14,185 cases, 3,257 were accepted, leaving a balance of

10,928 discarded measles cases which equals 77% which were NOT

measles after being blood tested, but which would have been accepted

on the pre- 2000 measles notification system. Comparing data from

laboratory-confirmed blood tests after 2000, with pre-2000 guessing,

and then claiming a 91% decline, is not a valid scientific

comparison.

Which raises an obvious issue. Flegg says that clinicians

caring for measles cases " would have had no doubt. Acute measles is

a relatively easy clinical and laboratory diagnosis. " Did (and can)

UK doctors do any better than those who guessed measles in Africa

before 2000, or even New Zealand for that matter? That depends on who

you listen to.

An old UK newspaper article, unfortunately undated, received on 17th

April 1997, reads: London (Europe Today). – " 97.5% of the times that

British doctors diagnose measles they are wrong " , says a publication

of the Public Health Laboratory service. The mistake being made by

National health GP's was found when the services tested the saliva of

more than 12,000 children who had been diagnosed as having measles.

Buttery, an adviser on transmissible diseases at the Cambridge

and Huntingdon Health Department, said that the majority of

doctors " say they can recognize measles a mile off, but we now know

that this illness occurs only in 2.5% of the cases. " Buttery says

that doctors classify as measles, many other viruses that also cause

spots. He found eight different viruses during the survey in East

Anglia. One of them, parvovirus, gives symptoms similar to German

measles. The reason for the high rate of error puzzled

Buttery. " Doctors are neither vague nor careless, " he said. The

solution is to defer the diagnosis until more detailed information

can be got. There are 5,000 to 6,000 cases of measles registered each

year in the United Kingdom, but these findings now call most of them

into doubt. "

A later report by the same laboratory (4) showed that the most common

viruses causing " morbilliform rash " in the UK are " parvovirus B19;

group A streptococcus; human herpesvirus type 6; enterovirus;

adenovirus, and group C streptococcus. "

An editorial in an Australian medical journal (5) pointed out that:

• In Sydney, in 1990-1995 only 49% of 58 notified cases were

serologically confirmed.

• In , in 1997-1998 only 8% of 248 notified cases were

serologically confirmed, and for the whole of Australia in 1997 –

1998, only 45% were serologically confirmed.

• In 1994 in UK and Finland, only 1% of notified cases were

serologically confirmed.

So now, doctors check for BOTH IgM (immediate antibody) IgG (evidence

of past infection). If there is both IgM and IgG an enzyme

immunoassay or a reverse transcriptase polymerase chain reaction is

required to type the virus to figure out whether it's wild, vaccine,

or whatever (6). In my files is an MMR information sheet to parents

which states that neither rubella nor measles can be correctly

diagnosed without a blood test. (In UK they use a saliva test.)

Therefore, according to medical literature, and information provided

to parents, I would dispute Flegg's assertion about the ability of

all doctors to easily or accurately diagnose measles or rubella,

without the assistance of technology. For the same reason, I also

dispute the validity of comparing any historical data from 1850 with

any data after laboratory data conformation was required.

However, since Flegg is presumably calculating his risk benefit

analysis on potentially invalid data, I have no choice but to do the

same. If the UK historical data for measles deaths is inaccurate

because it too contains more " viruses " than just measles, that makes

Flegg's calculations in the first paragraph, even more

extravagant.

In countries like UK the decades of pre-vaccine death decline is

obviously due to factors unconnected with the use of any vaccine. For

the same reason, the WHO media release claiming that the measles

vaccine has reduced the measles death rates in Africa by 91% between

2000 – 2007, defies logic, analysis and reason for anyone who knows

the facts. I note that Flegg has stopped short of repeating

that spectacular assertion. Perhaps it's because even he can see the

ludicrousness of such a claim.

If that is the case, the Flegg fails to mention that

comparative data in the UK, uses the same " mistake " . Total numbers

without any laboratory confirmation before 1994, cannot be validly

compared with laboratory-confirmed cases only. To do so is not

legitimate " science " .

Flegg states that, " during the last 10 years the case fatality

for acute measles in the UK has been in the order of 1 in 2000 " .

In UK, from 1998 to 2007 (as of 24th November), there were 28,364

cases of measles.

Out of the 12 deaths from 1998 - 2007, one is known not to be

measles, one is provisional, 2 were immunodeficient children within

the age where vaccines are administered, and the other 8 were older

deaths resulting from infections contracted prior to 1967. From the

years of 1998 – 2007, the risk of any unimmunized child dying from

ACUTE measles was as follows:

immunodeficient children = one per 14,182 cases of measles; healthy

normal children = 0 out of 28,364.

Any suggestion that in 2008, the risk of any child dying of acute

measles is 1 in 2,000 is another fictional statistical manipulation,

in the same vein as: " in order for the risk/benefit equation to be

tipped in favour of leaving children unvaccinated against MMR, there

would need to have been more than 7500 deaths from MMR in the last 10

years. "

Flegg says, " The only reason more children do not die of

measles in the UK is that herd immunity is still sufficiently high to

protect those who cannot or have not been fully immunised. "

That is not entirely correct in my opinion.

A site called Measles Initiative says that(7), " Measles is a leading

killer of children in many developing countries for several reasons.

Children are already compromised with poor living conditions, they

are infected at very young ages when their immune systems are not

strong, malnutrition is rampant in many homes, and many families do

not have access to medical care to treat measles and its

complications. Measles, itself, does not kill children. Instead,

complications from measles attack the child's already weak immune

system. Measles attacks the body, inside and out. It is similar to

HIV in the sense that when it knocks down the immune system, the

child becomes susceptible to the myriad of diseases that fester in

poor living conditions. "

Do children in the United Kingdom have the same living conditions as

children in Africa?

Flegg also says, " I have no doubt that another vulnerable group

(infants too young to be vaccinated) will see deaths within its ranks

before too long. "

Before the measles vaccine was used, it was exceedingly rare for any

infant younger than 18 months to acquire measles because of the

strong maternally transferred immunity and, if a mother breastfed,

through the many immunological components within breast milk.

Those women in UK who now have naturally acquired measles in the last

decade, will transfer solid immunity to their babies, and their

babies will be unlikely to experience measles before 18 months. On

the other hand, those vaccinated mothers who have not had natural

measles, will not transfer that sort of immunity to their babies, and

their babies might be at risk. That being the case, to blame

unvaccinated children for a relatively new problem created by the use

of a vaccine in the first place, is more fact juggling.

A better initiative to reduce all risks to any child from any cause

whatsoever, would be to employ a certain young British chef to help

start nationwide " Vitamin D, Victory gardens, exercise and cooking

course " initiatives for parents and the unemployed, as well as

someone else to teach " breastfeeding, home nursing and nutrition

during infection " . More than any vaccine, parents who provide their

children with correct nutrition, enough vitamin D, sleep, exercise,

and decent home nursing, can vastly decrease the annual expenditure

of NHS with regard to a long list of conditions, (including potential

complications and deaths from any infections).

These are conditions African parents would give their eye teeth for.

If they were able to achieve even half of what the UK achieved after

World War II, even without a measles vaccine, African children would

have far less to fear from measles infections.

.

(1)

http://www.hpa.org.uk/webw/HPAweb & HPAwebStandard/HPAweb_C/119573383581

4?p=1191942172799

(2) Measles deaths in Africa plunge by 91%

http://www.who.int/mediacentre/news/releases/2007/pr62/en/index.html

(3) Jan 2006 WHO " Afro Measles Surveillance Feedback Bulletin "

www.afro.who.int/measles/reports/surveillance_feedback_bulletin_april_

2006.pdf "

target= " _blank " >http://www.beyondconformity.co.nz/_bpost_1598/www.afro

..who.int/measles/reports/surveillance_feedback_bulletin_april_2006.pdf

(4) Ramsay, M. et al. 2002. " Causes of morbilliform rash in a highly

immunised English population. " Arch Dis Child. Sep;87(3):202-6. PMID

12193426.

(5) McIntyre, P.B. et al. 2000. " Measles in an era of Measles

Control " Med J Aust. Feb 7;172(3):103-4. PMID: 10735018. (6)

Durrheim, D. M. et al. 2007. " Remaining measles challenges in

Australia. " Med J Aust. Aug 6;187(3):181-4. Review. PMID: 17680748.

http://www.mja.com.au/public/issues/172_03_070200/mcintyre/mcintyre.ht

ml

(7) Measles Initiative - The Problem

http://www.measlesinitiative.org/problem2.asp

" ..it does not require a majority to prevail, but rather an irate,

tireless minority keen to set brush fires in people's minds.. " -