NZ - Pertussis : MOH changes the diagnosis criteria - 31 May, 2012

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NZ -

Pertussis : MOH changes the diagnosis criteria - 31 May,

2012

's Desk

Pertussis : MOH changes the diagnosis criteria - 31 May, 2012

- Tuesday, June 19, 2012

On 31 May, 2012, the New Zealand Ministry of Health made the astonishing

decision to

change the diagnostic criteria for whooping cough.

These were the old criteria for a confirmed or probable case:

" Confirmed: A clinically compatible illness that is laboratory

confirmed by isolation of B. pertussis from a pernasal swab, or

epidemiologically linked to a confirmed case.

Probable: Cough lasting longer than two weeks and one or more of the

following ... " :

After 31 May 2012, the Ministry of Health added new criteria in red:

" Confirmed: A clinically compatible illness that is laboratory

confirmed by isolation of B. pertussis or detection of B. pertussis

nucleic acid, preferably from a nasopharyngeal swab, or is

epidemiologically linked to a confirmed case.

Probable: A clinically compatible illness with a high B. pertussis IgA

test or a significant increase in antibody levels between paired sera at

the same laboratory... "

The routine use of this new PCR test in New Zealand to detect DNA

(nucleic acid) from whooping cough bacteria, is presumably, - primarily -

to justify jumping in really quick with the antibiotic Azithromycin.

The introduction of two antibody tests one month apart, (which supposedly

proves that an active infection has occured) are presumably, to

" confirm " that the case was whooping cough, not something else

which can mimic whooping cough. But there could be other

" consequences " of these two tests which might be

" intended " consequences.

The " old " diagnostic method was the culture method, where the

bacteria from a swab is smeared onto a culture medium in a

" plate " , and put away for a few days to grow. Then

bacteria are looked for under a microscope. But while the older test is

much cheaper to do, it is labour intensive, requires the bacteria to

still be alive before being put onto culture medium, and the results take

a few days. The test can also be wrecked, if samples aren't taken

properly, stored properly etc.

The newer Polymerase Chain Reaction test is

a fast geeky genetic test, which looks for bits of bacterial

DNA. Unlike the culture test, the PCR test doesn't require LIVE

bacteria to be present, and is easy to do in comparison with the culture

test, but is more expensive.

However, the newer PCR test has quite a few problems.

The first is, that the test can create a false positive diagnosis of

" pertussis " in people with supposedly classic whooping cough

symptoms, when those symptoms are not caused by the whooping cough

bacteria at all.

The second is that PCR testing is easily contaminated.

Here is an example of how, over several months during 2006

in Dartmouth University USA false positive whooping cough PCR

tests, completely misled infectious disease experts. I've

highlighted and emphasized the coloured extract below:

" For two weeks starting in mid-April last year, she coughed,

seemingly nonstop, followed by another week when she coughed

sporadically, annoying, she said, everyone who worked with her.

Before long, Dr. Kirkland, an infectious disease specialist at

Dartmouth, had a chilling thought: Could she be seeing the start of a

whooping cough epidemic? By late April, other health care workers at the

hospital were coughing, and severe, intractable coughing is a whooping

cough hallmark. And if it was whooping cough, the epidemic had to be

contained immediately because the disease could be deadly to babies in

the hospital and could lead to pneumonia in the frail and vulnerable

adult patients there.

It was the start of a bizarre episode at the medical center: the story of

the epidemic that wasn't.

For months, nearly everyone involved thought the medical center had had a

huge whooping cough outbreak, with extensive ramifications. Nearly 1,000

health care workers at the hospital in Lebanon, N.H., were given a

preliminary test and furloughed from work until their results were in;

142 people, including Dr. Herndon, were told they appeared to have the

disease; and thousands were given antibiotics and a vaccine for

protection. Hospital beds were taken out of commission, including some in

intensive care.

Then, about eight months later, health care workers were dumbfounded to

receive an e-mail message from the hospital administration informing them

that the whole thing was a false alarm.

Not a single case of whooping cough was confirmed with the definitive

test, growing the bacterium, Bordetella pertussis, in the laboratory.

Instead, it appears the health care workers probably were afflicted with

ordinary respiratory diseases like the common cold.

....At Dartmouth the decision was to use a test, P.C.R., for polymerase

chain reaction...

....Many of the new molecular tests are quick but technically demanding,

and each laboratory may do them in its own way. These tests, called

''home brews,'' are not commercially available, and there are no good

estimates of their error rates. But their very sensitivity makes false

positives likely, and when hundreds or thousands of people are tested, as

occurred at Dartmouth, false positives can make it seem like there is an

epidemic.

.....Yet, epidemiologists say, one of the most troubling aspects of the

pseudo-epidemic is that all the decisions seemed so sensible at the time.

"

No doubt the New Zealand scientists also think their decision to

change the diagnostic criteria is very sensible. But... is it? If

so, for whom and why?

As

New York Times showed... when the university decided to CHECK the PCR

results with the longer laborious culture method tests, they found

that.... oops... what every single clinician THOUGHT was whooping cough

based on the symptoms and a positive PCR test.... was actually ...

something else.

Which also calls into question the ability of infectious disease

" experts " to diagnose whooping cough on clinical symptoms, in

the first place. Dartmouth University did NOT however use a pertussis IgA

antibody test to confirm the PCR test results. .

The Dartmouth experience was only one of several examples which showed

the CDC, that the PCR test for whooping cough could incorrectly

inflate case numbers with false positives.

That is why this diagnostic change in New Zealand is so

puzzling.

CDC says:

1) : " ...only patients with signs and symptoms consistent with

pertussis should be tested by PCR to confirm the diagnosis.

Which is fine, so long as that is the ONLY situation in which the PCR is

used.

CDC goes on to say: Testing asymptomatic persons should be avoided as

it increases the likelihood of obtaining falsely-positive results.

Asymptomatic close contacts of confirmed cases should not be tested

and testing of contacts should not be used for post-exposure prophylaxis

decisions.

What does the above paragraph mean?

It means that lots of people without any symptoms (asymptomatic) who will

not get any disease, will have whooping cough bacteria in their throats,

because during an outbreak over 50% of people carry it. If

they are swabbed, the over zealous doctor might then want to treat them

with antibiotics supposedly to prevent infection (post-exposure

prophylaxis) . So CDC is saying ONLY test and treat people with proven

disease.

Will the NZ doctors realise there is a good reason not to test anyone

other than a person with classical whooping cough symptoms? Might

they decide to test all contacts too, when they shouldn't?

There appears to be another omission from the New Zealand information,

which is that:

2) The PCR test is hugely susceptible to contamination.

Again, CDC says:

" Avoiding Contamination of Clinical Specimens with Pertussis

DNA

Some pertussis vaccines[1] have been found to contain PCR-detectable B.

pertussis DNA. Environmental sampling has identified B. pertussis DNA

from these vaccines in clinic environments. While the presence of this

DNA in the vaccines does not impact the safety or immunogenicity of these

vaccines, accidental transfer of the DNA from environmental surfaces to a

clinical specimen can result in specimen contamination and

falsely-positive results. If health care professionals adhere to good

practices, there is no need to switch vaccines.

However, while contamination from a DPT vaccine in a doctor's

practice or hospital should be unlikely if staff follow protocol

- the far more likely source of sample contamination would be

bacterial DNA in the practice itself, or in the

air of

the laboratory concerned. Here are two hypothetical

examples of environmental contamination in a doctor's surgery:

A suspected case is swabbed in a doctor's surgery not long after an

actual case presents. That case may have had a

nasopharygeal

swab taken which is WAY up the back of the nose which won't be

cleared out by nose blowing. They can't do a throat swab, because

when you swallow, you swallow bacteria down to the stomach and the

bacterial concentrations in the mouth are minimal. The ONLY decent

place to collect whooping cough bacteria from, is the nasopharyngeal

crypt. How " uncomfortable " the test is, is dependant on

the skill of the tester.

Just the presence of a whooping cough patient, can result in whooping

cough bacterial DNA in the air, lying inactive on surfaces in the

doctor's reception rooms, office, and the swab testing facilities.

These unseen bacterial contaminants from previous patients can be

accidentally transferred to the naso-pharangeal swab, resulting in the

suspected case (- which might not be pertussis at all -) being told that

they have whooping cough. Immediately, every contact of the

suspected case, is prescribed Azithromycin on the basis of a contaminated

false positive test result, and/or vaccinated, as in the Dartmouth

situation.

OR - a staff member handing the whooping cough swab either in the

doctor's practice or the lab, could be an asymptomatic carrier of the

whooping cough bacteria with no symptoms and anything they exhale into

the air, could contaminate any sample during that time frame. As is

so often the case with adults, whooping cough is rarely suspected or

diagnosed.

So the nasopharyngeal swab could become contaminated by whooping

cough in different ways, by DNA from air, surfaces or hands. With

the PCR test, the bacteria doesn't have to be alive or infectious to be

identified. The bacterial DNA just has to be " there " .

So .. " Have doctors/nurses been told about increased

false positives and varied routes of sample contamination??? "

One tutorial on PCR says: " PCR-based tests are also

extremely sensitive to contaminating DNA at the crime scene and within

the test laboratory. During PCR, contaminants may be amplified up to a

billion times their original concentration. Contamination can influence

PCR results, particularly in the absence of proper handling techniques

and proper controls for contamination. "

Put it this way… if a forensic sample was taken the

same way as as a PCR test taken in a doctor's surgery, and couriered,

opened, and treated the same manner, that PCR sample would likely be

inadmissible in court as evidence, due to the potential for

contamination, and resulting miscarriage of justice…

Given that the PCR test grossly OVER-estimates case numbers and as

this directive states: " should not be used to

diagnose outbreaks of the disease " , who benefits from adding

these two tests into the New Zealand guidelines?

Supposedly, babies and the sick. The result of the quick PCR test

will be used to justify " immediate treatment and prevention "

strategy, consisting of napalming everyone in sight with

" free " Azithromycin (supposedly to prevent spread) while at the

same time, giving the same people vaccines, and " cocooning "

family, friends, schoolmates with an extra booster of whooping cough

vaccine (plus a few other vaccines in the same syringe) all on the false

premise that it will be of benefit. Even Australia has recently abandoned

cocoooning when their research showed it was not evidence based and did

not work.

Is the new changes in diagnostic methods, scientifically and financially

acceptable, in light of false positives and contamination issues?

The inclusion of two sequential antibody tests (a month apart) could

clarify the situation. All people whose nasopharyngeal swabs are

sent for PCR testing, should have the first antibody blood test done at

the same time as the nasopharygeal swab. This first antibody test

provides the " baseline " measurement, and the second blood test

taken a month later, should show at least a four fold rise in whooping

cough antibody levels - if the person has had whooping cough.

If a PCR test result comes back positive, BUT the second antibody

test one month later showed no rise in antibodies, then the

authorities should discard the PCR result, because the lack of antibody

rise, proves that the PCR was a contaminated false positive

incorrect result.

The problem though - is that during that month between the first and

second antibody test, vaccines, and Azythromycin will be used on that

person and all their contacts like tapwater, because the PCR test result

falsely said " this person has whooping cough " .

And most patients will never know that the PCR test was false, because

they won't be told.

If MOST of the PCR tests came back positive, and MOST of

the second antibody tests also came back negative (no rise), then we

would know that EITHER the whole expensive diagnostic and treatment

protocol was a huge waste of taxpayers time and money, OR that the

antibiotics used between the two tests, prevented any rise in body

antibodies. Which of the two reasons is the best, is impossible to

assess from the limited medical literature on the topid. It it

worth the shotgun use of antibiotics, which don't help the clinical

disease, but do increas community bacterial resistance, and adverse

reactions, and gut damage from the antibiotics?

I suspect that the PCR test AND antibody tests will NOT be used

together. What ESR doesn't know, can't be justified or

confessed.

As you have seen from the medical article

in

the pertussis blogs collected together in the whooping cough

resource series, there is always significant subclinical

boosting of immunity without clinical disease. That known fact has

always been a major part of whooping cough epidemiology.

Immunity conferred by subclinical boosting from community bacterial

carriage, has never been included in the ESR data, because what is not

seen, can't become a statistic. The antibody tests, if used to

prove the existence of " suspected whooping cough " in a contact

with no significant symptoms, ... could result in an antibody

test result becoming classified as a confirmed

case, or ... a useful " statistic " .

Both the newer PCR and antibody tests could substantially increase the

ESR confirmed case numbers. That increase would NOT actually

represent a greater spread of infection levels in the community, but

would be a classic example of " when you look under every possible

stone, you will find many more slugs " . This is a more

" up market " version of what happened in

UK,

Japan and

Sweden after those three countries stopped using the whooping

cough vaccine.

Who could benefit most from an artificially created increase in

pertussis case numbers?

People who want to " create data " , to provide government

officials or media with supposed " gold standard evidence "

purportedly showing an increase in whooping cough cases.

These expensive tests with serious potential problems which render the

science highly questionable, are now being implemented by public health

zealots, ... committing and diverting millions of dollars of public

health money... for highly dubious benefits.

Is the new diagnostic criteria driven by their need to increase their

" control " over people, and advocate ....

yet more ...... whooping cough

booster vaccines for everyone .....

Would the creation of any such control, and expectation of unquestioned

compliance, be understood to fly in the face of the fact that

New Zealand now has the highest ever vaccination rate for whooping

cough, in history - with the most number of whooping cough

vaccine boosters ever?

Sheri Nakken, former R.N., MA, Hahnemannian

Homeopath

Vaccination Information & Choice Network

Vaccines -

http://vaccinationdangers.wordpress.com/ Homeopathy

http://homeopathycures.wordpress.com

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