H5N1

Polio and vaccination: A memoir of what we’ve forgotten

The Tyee has published my article Polio and Vaccination: A Memoir of What We’ve Forgotten. Excerpt:

We’re seeing reports of a “polio-like” disease turning up in Canada and especially in the U.S. Acute flaccid paralysis is leaving kids partially or completely paralyzed, and parents are understandably scared. The U.S. reportedly has 60 cases so far this year, and Canada has perhaps 30.  

AFP and its subtype, acute flaccid myelitis, are even becoming a political issue: the right-wing American Association of Physicians and Surgeons warns about the “public health threat from uncontrolled immigration” and suggesting that the “caravan” of asylum seekers might be bringing AFP with them. 

As literally a one-in-a-million disease, AFP is a faint echo of poliomyelitis itself. But it comes at a time when we’ve forgotten how deadly childhood diseases can be, and many have even begun to question the vaccines that saved both them and their parents from death or lifelong impairment.  

Seventy years ago this month, I was seven years old, running a fever, and unable to touch my chin to my chest. Every parent in 1948 knew those were likely symptoms of polio, and that same afternoon I was in a downtown hospital for tests. They showed I was indeed one of over 20,000 polio cases in the U.S. that year.  

My memories of the next two weeks are fragmentary but vivid. I’m carried on the shoulder of a tall black man to undergo a spinal tap — not a funny phony band, but my first experience of real pain. I’m in a ward with other kids, each of us in a crib — a crib! — learning to use bedpans and suffering the further indignity of having our temperatures taken rectally. Drop a comic book through the crib slats to the floor, and it’s gone forever.

Every day we lie on our stomachs in our cribs while “hot packs” — steaming-hot blankets — are piled on us. This is state-of-the-art therapy for polio patients.  

Toward the end of my hitch, I’m taken from my crib in a wheelchair, plunked into a bathtub and sloshed with green disinfectant soap. Then I’m taught how to walk again. After two weeks in a crib, it’s not easy.  

Finally back home, I begin to understand that I am really lucky. Other kids have died, or been trapped for life in iron lungs that keep them breathing. When I’m back in school, I see a girl with a brace on one leg from her own case of polio. She’s not the last.

Young adults are the new vaccine skeptics

Via his blog on CBC Radio, Dr. Brian Goldman writes: Young adults are the new vaccine skeptics. Excerpt:

The influenza season is just beginning and that means many Canadians are rolling up their sleeves to get their flu shot. But there's a growing chorus of doubt about the benefit and safety of vaccines — and some of it comes from a surprising new source.   

The latest skeptics are young people. That's the main conclusion of a 2018 report entitled The State of Vaccine Confidence in the EU: 2018. It's put out by the Vaccine Confidence Project, a website created by the London School of Hygiene and Tropical Medicine to (among other things) "monitor public confidence in immunisation programmes."  

The 2018 report measured vaccine confidence among 28 EU nations. Between 2015 and 2018, confidence in vaccines decreased in Poland, Czech Republic, Finland and Sweden. 

Overall, young people surveyed were less confident and more skeptical of both seasonal flu shots and MMR (measles, mumps and rubella) vaccines than older people. Those aged 18 to 24 were 28 per cent less likely than those aged 65 and older to agree that vaccine are safe. Those aged 25 to 34 were 39 per cent less likely than seniors to believe in the safety of vaccines.  

Researchers think younger people are less confident in the safety of vaccines for several reasons. One factor, paradoxically, has to do with the level of education. Compared to older citizens, younger people tend to be better educated.  

Skepticism about safety and efficacy of vaccines 

The survey found that those with the greatest education were less likely to agree that vaccines are important for children, that the MMR vaccine is important for children, that vaccines are safe and that vaccines are effective.  

This is speculative, but it's possible that younger people are less confident in vaccines because they favour social media over mainstream media sources of information. Social media tends to be more skeptical about the safety and efficacy of vaccines. 

Another factor is that some doctors themselves aren't confident about the safety and efficacy of vaccines. Where GPs were less confident, the public was less likely to feel positive about rolling up their sleeves. 

The survey found that 36 per cent of GPs surveyed in the Czech Republic and 25 per cent in Slovakia did not agree that the MMR vaccine is safe. A majority of GPs surveyed in these countries said they were not likely to recommend the seasonal influenza vaccine. Another factor is level of education.  

The 2016 survey of vaccine confidence looked at 67 countries including Canada. Overall, Canada and the U.S. had higher levels of confidence and lower levels of vaccine skepticism compared to eastern and southern European countries. However, Canada, the U.S. and Mexico had higher levels of concern about vaccine safety than countries in South America.

US: Creating health scares about immigrants

Via the website of the Association of American Physicians and Surgeons, an October 22 item: Questions for candidates on key issue # 7: Public health threats from uncontrolled migration. Excerpt and then a comment:

The American medical system is already overstressed with the problems of an aging population. How will it cope with epidemics of imported infectious diseases, some unfamiliar to American physicians, and some incurable? 

An ever-growing caravan of thousands of migrants originating in Central America is determined to force its way into the U.S., having already breached the southern border of Mexico, violently tearing down barriers and even assaulting Mexican police officers. 

What invisible travelers are accompanying them? And what infections are already here in the millions of illegals already dispersed throughout the country?  

In the past, waves of immigrants from Europe were stopped at Ellis Island, medically examined, and quarantined long enough to be sure they were not incubating a contagious disease. Procedures are less rigorous today, and of course those who enter illegally are not screened at all.  

The U.S. is currently seeing cases of a polio-like illness that paralyzes children, sometimes permanently. This year, 62 cases have been reported, and 386 cases since August 2014. Coincident with resettling about 70,000 children from Central America in 2014 there were 70 cases of polio-like paralysis and a thousand severe respiratory illnesses from the “mystery virus” enterovirus D68. 

Typhus, which is flea-borne, has been reported in Los Angeles. Severe epidemics of hepatitis A are occurring in San Diego. Mosquito-borne dengue and chikungunya are spreading in Latin America. Multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis are increasing threats, especially in poor countries.

Normally I wouldn't bother posting an item like this, but it comes from a professional organization of healthcare workers (who happen to be well over on the right of the political spectrum). 

So it seems to me unfortunate that a professional organization, whose members have been fairly rigorously in scientific method, should resort to scare tactics like these.

 

No one has said AFM and typhus cases are in the Honduran marchers; typhus in Los Angeles and hep A in San Diego appear to be focused on local poor and homeless people. Dengue and chikungunya are spread over a vast part of the tropics, and their vectors are not a serious problem in most parts of the US.

 

It's very discouraging that people with "MD" after their names are issuing such idle threats, which can only aggravate the grim political and medical situations in the US.

 

For a more accurate description of the Honduran migrants, see this article in The New Yorker.

Internet health scams: Developing a taxonomy and risk‐of‐deception assessment tool

Via Health & Social Care in the Community: Internet health scams—Developing a taxonomy and risk‐of‐deception assessment tool. The abstract:

The prevalence of health scams in Canada is increasing, facilitated by the rise of the Internet. However, little is known about the nature of this phenomenon. This study sought to methodically identify and categorise Internet‐based Health Scams (IHS) currently active in Canada, creating an initial taxonomy based on systematic Internet searches. 

A five‐step Delphi approach, comprised of a multidisciplinary panel of health professionals from the University of British Columbia, in Vancouver, Canada, was used to establish consensus. 

The resulting taxonomy is the first to characterise the nature of IHS in North America. Five core areas of activity were identified: body image products, medical products, alternative health services, healthy lifestyle products, and diagnostic testing services. 

IHS purveyors relied on social expectations and psychological persuasion techniques to target consumers. Persuasion techniques included social engagement, claims of miraculous effects, scarcity, and the use of pseudoscientific language. These techniques exploited personality traits of sensation seeking, needing self‐control, openness to taking risks, and the preference for uniqueness. 

The data gathered from the taxonomy allowed the Delphi panel to develop and pilot a simple risk‐of‐deception tool. This tool is intended to help healthcare professionals educate the public about IHS. 

It is suggested that, where relevant, healthcare professionals include a general discussion of IHS risks and marketing techniques with clients as a part of health promotion activities.

See also this CBC News report on the study.

41,000 measles cases in Europe since the beginning of 2018

Via The Lancet: 41 000 measles cases in Europe since the beginning of 2018. Excerpt:

Despite her country having the highest number of measles deaths in Europe this year, Jovana Kostic is adamant that she will not have her 2-year-old vaccinated. She was fined 150 000 Serbian dinars (€1200) for her refusal. “I was convinced that the first round of vaccination weakened his immune system. He was never sick before that and after the first dose he had a fever for more than 7 days,” the 24-year-old from Subotica in northern Serbia told The Lancet. 

Kostic is one of a growing number of people in Serbia and across Europe who are refusing, or questioning, vaccinations against measles and other diseases. And this, say health experts, is contributing to low vaccine coverage that is driving a measles epidemic that has swept across Europe this year, claiming 37 lives—14 of which were in Serbia—with more than 41 000 cases reported in the first 6 months of the year. 

The number of cases is an 8-year high and almost twice as much as in the whole of 2017. WHO and other global health groups have called on European countries to step up efforts to halt the spread. They have also described the outbreak as “unacceptable”. 

“We have the means to avoid measles cases and deaths, and the fact that this has happened in Europe is completely unacceptable”, Nedret Emiroglu, director of Health Emergencies and Communicable Diseases, WHO Regional Office for Europe, told The Lancet. 

Measles is one of the most infectious diseases, but can be almost entirely prevented by vaccination. To eliminate the disease, vaccine coverage needs to be at 95%. But data from the European Centre for Disease Prevention and Control (ECDC) shows that only four EU/European Economic Area states met that target for 2017. 

Experts point out that some countries, such as Ukraine, which has had the highest number of reported measles cases this year, face problems with vaccine supply, whereas in others people access medical services with difficulty and cannot get the vaccines that are available. But in many countries, there is also a growing level of scepticism and even active campaigning against vaccinations. 

Heidi Larson of the London School of Hygiene & Tropical Medicine and director of the Vaccine Confidence Project, told The Lancet: “there has always been some historic distrust of vaccines and people not wanting to take them, but what we have seen recently is an acceleration of this and more polarisation on the issue”. 

“The MMR controversy from the late 1990s has not been forgotten, partly because of active support for it by groups in some parts of the continent, while there are strong anti-vaccine movements elsewhere, some of which have been picked up on by populist politicians. The vaccination issue is becoming more politically driven.” 

Some prominent politicians have indeed spoken out against vaccines. Marine Le Pen, the leader of France's far right National Rally party, publicly opposed mandatory vaccinations; founder of Italy's Five Star Movement, Beppe Grillo is a known vaccine sceptic.

Weaponized health communication: Twitter bots and Russian trolls amplify the vaccine debate

Thanks to Tony Trehy for alerting me to this story. Via AJPH: Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate. The implications are very serious. The abstract:

Objectives. 

To understand how Twitter bots and trolls (“bots”) promote online health content.  

Methods. 

We compared bots’ to average users’ rates of vaccine-relevant messages, which we collected online from July 2014 through September 2017. We estimated the likelihood that users were bots, comparing proportions of polarized and antivaccine tweets across user types. We conducted a content analysis of a Twitter hashtag associated with Russian troll activity.  

Results. 

Compared with average users, Russian trolls (χ2(1) = 102.0; P < .001), sophisticated bots (χ2(1) = 28.6; P < .001), and “content polluters” (χ2(1) = 7.0; P < .001) tweeted about vaccination at higher rates. Whereas content polluters posted more antivaccine content (χ2(1) = 11.18; P < .001), Russian trolls amplified both sides. Unidentifiable accounts were more polarized (χ2(1) = 12.1; P < .001) and antivaccine (χ2(1) = 35.9; P < .001). Analysis of the Russian troll hashtag showed that its messages were more political and divisive. 

Conclusions. 

Whereas bots that spread malware and unsolicited content disseminated antivaccine messages, Russian trolls promoted discord. Accounts masquerading as legitimate users create false equivalency, eroding public consensus on vaccination.  

Public Health Implications. 

Directly confronting vaccine skeptics enables bots to legitimize the vaccine debate. More research is needed to determine how best to combat bot-driven content.

Proof of children’s vaccinations? Italy will now take parents’ word for it

Via The New York Times: Proof of Children’s Vaccinations? Italy Will Now Take Parents’ Word for It. This is not going to go well. Excerpt:

Italian parents will no longer have to provide state-run schools with a doctor’s note to show that their children have been vaccinated, the country’s new populist government announced on Thursday — a move that raised alarm among experts who fear that compliance with vaccines will drop. 

The new rule, announced at a news conference by Giulia Grillo, Italy’s health minister and a prominent member of the anti-establishment Five Star Movement, requires only the assurance of parents that their children are immunized to enroll in school this September. 

The government said its aim was to simplify enrollment procedures and enable school participation for all, including children whose parents do not have their paperwork in order yet.  

“We want to spur school inclusion and simplify rules for parents,” Ms. Grillo said. 

But critics of the move say the Italian government is eroding faith in science and public norms.   

“Weakening a law that works, that Italians are respecting and is doing some good to children and to the health system is a self-destructive strategy,” said Roberto Burioni, a virologist at San Raffaele University in Milan. 

Since last year, Italian schoolchildren have been required to have 10 vaccinations. They are offered free to children, said Mr. Burioni, an online campaigner who spreads scientific information on vaccines. 

But vaccination rates in Italy and elsewhere in Europe are lower than in the United States. Last year, Germany cracked down on parents who refused to vaccinate their babies before enrolling them in kindergarten, and France introduced fines against noncompliant parents.  

Mr. Burioni noted that in Italy, a doctor-signed certificate of good health is required even for people wanting to take swimming classes. 

“And if I die while I swim, I am not hurting anyone else,” he said. “Here, we are here trusting people on something that does hurt everyone else.” 

Leading up to the elections this March, the two parties that now run Italy — the Five Star Movement and the far-right League — repeatedly expressed skepticism about the benefits of vaccines. Their program for government includes plans to revise a 2017 law that made 10 vaccines mandatory for Italian schoolchildren. 

The law was introduced to raise the country’s immunization coverage after a measles outbreak in Europe that year with more than 14,000 cases. Italy, with over 4,500 instances, was second only to Romania in the number of cases.  

The Five Star Movement says it wants the highest possible level of immunizations, but it has also long advocated overhauling the law, which it considers too restrictive. In 2015, the group proposed a law to limit vaccinations, which it considers linked to cancer, leukemia, allergies, inflammation and autism, despite scientific evidence to the contrary. 

Beppe Grillo, a comedian who was a founder of the Five Star Movement, argued in his comedy shows several years ago that vaccines should not be compulsory and that the inoculation of viruses can be dangerous. 

The League’s leader, Matteo Salvini, has also often said that 10 vaccines are “too many” and that the choice over whether to vaccinate children should be left to parents.  

“Vaccination yes, obligation no,” he said at a rally last week.

Poland: Thousands of people in Warsaw protest against compulsory vaccinations

Thanks to David Frum for tweeting the link to this Euronews report: Thousands of people in Warsaw protest against compulsory vaccinations. The report and then a comment:

Thousands of people in Warsaw took part in a protest against compulsory vaccination for children. 

The demonstration was organised within the framework of the International Day Against Vaccinations.  

In Poland, the anti-vaccine movement grows stronger and there are more and more supporters of non-vaccinations for youngsters. Health authorities are concerned that such campaigns are having a serious negative impact on public health.  

It comes as the number of measles cases quadrupled in Europe in 2017, with 35 fatalities, according to the World Health Organization.

According to ECDC, Poland reported 49 confirmed measles cases between April 2017 and March 2018. And the Poles got off lightly, compared to Italy (3,572), Romania (1,474), and Greece (1,472). 

This is what I call health populism, and it worries me a lot.

Picard: Homeopathy leaves us deluded by diluted remedies

Via The Globe and Mail, André Picard lowers the boom: Homeopathy leaves us deluded by diluted remedies. This is part of a problem I'm coming to think of as "health populism." Excerpt:

Anke Zimmermann, a Victoria-based “naturopathic physician,” published a blog post in which she recounted treating a four-year-old boy who was acting out violently and having nightmares about werewolves by giving him homeopathic tablets made from the saliva of a rabid dog.  

The alternative-medicine practitioner boasted that the treatment was successful and the preschooler had been brought “back into a more human state from a slightly rabid dog state.”  

When the media reported on this claim and health officials reacted with outrage, Ms. Zimmermann responded by saying the saliva was so diluted that it contained no trace of rabies. 

In other words, what the boy received was nothing but a sugar pill. 

So, was the treatment dangerous, or was it fraudulent? 

Ms. Zimmermann took down her original blog post and replaced it with an attack on the media for their “salacious” coverage.  

She said the real story was: “Wonderful news: Child greatly helped by a safe, effective, homeopathic remedy costing pennies.” 

It would be easy to shrug off this case as a self-important rogue practitioner.  

But the real tragedy here is that Ms. Zimmermann is practising homeopathy – a “complementary” therapy that has way more legitimacy and popularity than it deserves.  

There has been too much focus on the fact that the remedy was made using rabid dog spit and not approved by Health Canada. It’s no worse than other homeopathic remedies made with the cankers of syphilis patients or the tuberculosis bacterium – both of which are approved by Health Canada.

Homeopathy was conceived by Samuel Hahnemann in the late 18th century. It is based on the belief that “like cures like“ and that the dilution and shaking of a substance – a process called “potentiation” – renders it not weaker but stronger.  

Homeopaths believe that the water molecules retain a “memory” of the original substance, allowing nano-doses to trigger a healing response in the body.  

This was no doubt a compelling theory in the 18th century, a time when conventional medicine consisted largely of bloodletting, leeches and enemas. 

Concepts like dilution and water memory have no basis in biology and physiology; they are not evidence-based. 

The best thing about homeopathy is that, when all is said and done, patients are essentially consuming sugar pills – deluded by dilution – which are unlikely to do any harm. The real harm comes from people forgoing legitimate treatments because they believe in magic. 

For example, nosodes – diluted bits of diseased tissue, pus, blood or other excretions from a sick person or human – are often touted as an alternative to vaccines.  

Health Canada has recently cracked down on nosodes, demanding labels read: “This product is not intended to be an alternative to vaccination.”  

But Health Canada’s rules confuse and mislead the public. 

The federal regulator has approved more than 8,500 products by granting them a homeopathic drug number (DIN-HM). This gives the public the false impression these products are legitimate.  

What a DIN-HM means is that the product is safe, not efficacious. Of course it’s safe if it consists of little more than water and sugar – oh, and “water memory.”  

A larger problem is that entire aisles of pharmacies are dedicated to homeopathic products. If you sell diluted pus alongside prescription drugs, you give the impression they are equally legitimate. That’s profitable, but is it ethical?