I Speak of Dreams

Claim: "40 Children in Chad Paralyzed by Vaccines" Is Probably False

eta, 1/24/2013 results of independent investigation: 

Meningitis Vaccine in Chad: Not the cause of anything except immunity to Meningitis A

 

Yesterday's post on events surrounding a meningitis immunization clinic in a remote part of Chad -- I have updates.

From the Meningitis Vaccine Project Download MVPstatement_10Jan2013_EN

Statement: MenAfriVac vaccination campaign in Gouro, Chad

Ferney-Voltaire, 10 January 2013—The Meningitis Vaccine Project learned of the story published in the Chadian weekly La Voix regarding the MenAfriVac vaccine that was introduced in Gouro in December 2012. On behalf of our global partners, we wish to emphasize that we take every MenAfriVac-related report very seriously.

An investigation team is on the ground in Chad to explore what caused these statements. All available data point to the high safety and effectiveness of the vaccine. We believe that the investigation in Chad will shed light on the exact circumstances that caused the publication of the article in La Voix. We will make that information public as the scientific reports become available.

Via e-mail, I contacted the US embassy in Chad. Les McBride (USAID Program Manager – Chad at the U.S. Embassy, N’Djaména) replied

Q: I would really like to have more facts on the matter to publicize. Can you help me? Specifically, has any more information been made public about the cause of the childrens' illnesses?
A: We are not aware of any additional information that has been made public. There is a CDC doctor based in Chad with whom we have occasional contact and he has kindly provided us with some details through e-mail communication. A CDC team from Brazzaville has also arrived and is in the process of investigating this accident.
Q:How many children were affected?
A: 34 (source: weekly Health Ministry epidemiologic meeting attended by CDC).
Q: How many were hospitalized?
A: No reliable information available; we only have anecdotal reports from laypeople.
Q:Are any still hospitalized?
A: Idem.

So. Christina England's claim that "40 children were paralyzed by the MenAfriVac" cannot be verified, and is most likely false. Sarah "The Healthy Home Economist"'s claim that "government of Chad desperately trying to silence the frantic parents of the paralyzed children by paying them hush money" has no evidentiary base, and is most likely false

Is It True that a Meningitis Vaccine Paralyzed Many Children in Chad?

(eta = edited to add)

eta: results of independent investigation: 

Meningitis Vaccine in Chad: Not the cause of anything except immunity to Meningitis A

 

 If you believe anything that Christina England writes, it is.  (Protip: if you get a positive review from John Scudamore, you have evoked Skopie's Law, squared.) Otherwise, you are deeply sceptical.  

Some background:

There is a relatively new meningitis vaccine, MenAfriVac®,  that was developed specifically for use in Africa's meningitis belt. According to Vaccine News Daily in December, 2012, "The World Health Organization announced earlier this month that a resident of Africa’s meningitis belt would receive the 100 millionth MenAfriVac meningitis vaccine."

The current situation in Chad is dire, as a March 2012 press release from Medicins Sans Frontiers reveals  

Chad Facing Malnutrition and Meningitis Emergencies

NEW YORK/N’DJAMENA, MARCH 28, 2012—Severe acute malnutrition in parts of Chad has reached emergency levels, requiring immediate life-saving interventions, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today....

Meanwhile, a meningococcal meningitis outbreak has struck the country....In response, MSF will launch, in collaboration with the Ministry of Health, mass meningitis vaccination campaigns...The campaign will utilize the new MenAfriVac vaccine, which confers longer immunity from meningitis for a wider section of a population than previous vaccines.

A MSF blog post on a previous vaccination campaign in Chad writes:

Meningitis is a serious bacterial infection that strikes during the dry season, when people’s nasal mucus becomes too dry to act as an effective barrier against bacteria. This natural protection does not usually return until the middle of May, or sometimes as late as June, with the arrival of the rainy season. If it goes untreated, the illness is fatal in 50 percent of cases, while 30 percent of survivors suffer serious neurological effects or are left without their hearing.

(You might want to see this MSF photoessay on a rural meningitis vaccine campaign)

On January 6 2012,  the rarely-truthful anti-vaccine activist Christina England published a story at the blog VaxTruthFrankLies.  The story goes that in the village of Gouro in the department of Borkou Ennedi Tibesti, a meningitis immunization clinic was held in December  2012 using the MenAfriVac.  About 500 children were vaccinated. Later 40 or more fell ill with alarming symptoms highly unusual after vaccination.

http://vactruth.com/2013/01/06/paralyzed-after-meningitis-vaccine/

At this blog, a person claiming to be a vaccine expert is telling a different story http://makaila.over-blog.com/article-le-drame-post-vaccinal-de-gouro-explique-par-un-expert-national-independant-du-tchad-113898660.html (translation by Google with hand edits)

Last week Chad sites relayed news of illnesses following a vaccination clinic in the area of Guoro (department of Borkou Ennedi Tibesti (BET). This prompted the Minister Ngaourang Nahor and his team to go to the site of the incident, through city of Faya. They are currently exploring this situation.

Following the clinic, 30 children were evacuated to Faya for presenting with headache, insomnia, convulsions, hallucinations, fever, etc ... After administration of vaccine against meningitis A meningo due to Neisseria meningitidis serogroup A. [It was reported in La Voix that the vaccine used was MenAfriVac.]  

These symptoms are known in the medical literature, and are known to experienced vaccinators. For example, in a vaccination campaign against meningitis reported by the London newspaper the Observer in 2000, 13,600 cases of adverse reactions were observed in vaccinees. (eta: a factual discussion of the 2000 meningitis C vaccine scare can be found here.  Another news story here. The adverse reactions were for the most part, quite mild) There were even cases of meningitis caused by these vaccines in subjects free of any contact with this disease. (eta: since the vaccine used in the UK in the 1999-2000 campaign was a conjugate vaccine, made by linking a tiny fragment from the bacteria's sugar coat to a protein,  it is impossible to acquire the disease from a conjugate vaccine.)

Moreover in Chad, vaccinators and supervisors ignore the stated precautions and administrative procedure for this particular vaccine. This vaccine cannot be mixed with other vaccines, either by combining two different vaccines in a same syringe or administering two two vaccines in a same site. (eta: While it is true that MenAfriVac should not be combined, the degree to which this precaution is violated in Chad is not known, nor is it clear that any administrative improprieties occued in Gouro.) 

The illnesses in Gouro (dept. BET) may be explained by breaking the cold chain for this vaccine. (eta: breaking the cold chain would render the vaccine ineffective and would be unlikely to cause illness). Indeed, many supervisors and vaccinators sent to BET do not care about the state of vaccines. They use the cold-chain thermoses and fridges for their own refreshments and set the vaccines at room tempertaure or worse. A supervisor from N'Djamena sent to a vaccination campaign in Fada dared to put his soft drinks in the thermos and put the vaccine in the trunk of the cab of the car where it is more than 110 degrees F when the vaccines should be between 40 to 47 degrees F ... Imagine the consequences of such stupidity on precious vaccines.

Officials of the vaccination program in Chad are negligent or irresponsible toward all campaigns in remote areas such as Kanem, BET or eastern Chad. Either they do not reach their targets or they are neither the means nor the desire to go properly vaccinate these remote populations. These officials lack a professional conscience.

In the Kanem region, many vaccinators are camping in the bush, where they and fill out their records at leisure, burying the vaccines and returning to the capital with 110% figures-- all invented, and without a single child being vaccinated.

About vaccination in BET-- in general, in the scattered towns and villages, the rough roads, the very short time limits, supervisors and vaccinators pretend to be vaccinated and share diems and other emoluments relating to the campaign in which billions are invested each year.

The Gouro incident should prompt our country's authorities to have the awareness and responsibility to sanitize the vile nest at the vaccination program, which is infested with swarming moths, cockroaches and vultures who get rich on the graves of our compatriots, decimated by infectious diseases that an immunization program carried out with contientous rigor would prevent.

Dr. M.A.M
Expert tropical diseases
Researcher in mass vaccinology 
Chad, N'Djamena

Original story (click to embiggen)

Original of Dr. M.A.M's comments (at http://makaila.over-blog.com/article-le-drame-post-vaccinal-de-gouro-explique-par-un-expert-national-independant-du-tchad-113898660.html

image 1 -- click to embiggen

image 2 -- click to embiggen

A medical professional discussing the clippings above made the following observations:

The key is "Selon les parents" (according to the parents) and there has been no genuine medical info forthcoming.

The symptoms are more like those of some sort of poisoning than any meningitis I can think of. Organophosphate insecticide contamination of something the children (ages 7 through 18) ate on their trip to the clinic?

"*many* of the children reacted within 24 hours of receiving the vaccine. He said that at first the children vomited and complained of headaches, before falling to the floor with uncontrollable convulsions while bent over with saliva coming from their mouths."

For one, even if you get injected in the arm with a virulent meningitis bacteria ... it takes longer than 24 hours for you to incubate it and show symptoms. And headaches, vomiting and convulsing with excessive salivation aren't typical of meningitis.

[Relative to Dr. M.A.M's speculations about the effect of breaking the cold chain] Breaking the cold chain ruins the vaccine and makes it ineffective because the organism dies, it doesn't become more virulent.

At any rate, MenAfriVac can be held at temperatures of up to 40 C (104 d F) for up to 4 days without refrigeration. So what's the bottom line? MenAfriVac is saving thousands of lives; more that 100 million people have been vaccinated with it; and something possibly went awry in one Chadian vaccination drive. It's not even clear that the children were paralyzed or remained paralyzed. Validation from actual physicians required. I've contacted both PATH and Medicins Sans Frontieres for more details.

Close analyses of the, "50, 60, no, 101 reasons not to vaccinate" meme crawling around

The first list was called "40 reasons not to vaccinate" and was penned by one Jagannath Chatterjee ("Fighting Vaccines Since 1985").  It is not a surprise that he has his own page on Whale.to.  (If you don't instantly recognize Whale.to, consult Scopies' Law)

Autismum addressed the falsehoods and distortions on her blog:

• 40 Reasons-Part 1
• 40 Reasons-Part 2
• 40 Reasons-Part 3

 Julian Frost, an adult autistic living in South Africa, had an extremely strong negative reaction to Mr. Chatterjee's falsehoods: 

• Rant Alert – Mr Jagannath Chatterjee is a lying prick

Between November 28, 2012 and December 7, 2012, someone named Sarah published a series of four blog posts called "101 Reasons Not to Vaccinate" on a blog by New Zealand anti-vaccination organization.  I haven't been able to ascertain Sarah's full name, nor her expertise in vaccines.  The New Zealand "Immunisation Awareness Society" is headed by one Hilary Butler.

An Australian with the nom de blogue Addryanne Adamsyn has a blog opposing the (so called) Australian Vaccination Network  (AVN).  Addryanne took the time to analyze each of the 101 reasons falsehoods, distortions, excuses, and downright fabrications:

• 101 Reasons not to vaccinate?  Reasons or Excuses?  Part 1 
• 101 Reasons not to vaccinate?  Reasons or Excuses?  Part 2
• 101 Reasons not to vaccinate?  Reasons or Excuses?  Part 3
• 101 Reasons not to vaccinate?  Reasons or Excuses?  Part 4

Thanks to KD Shives for Going Against the Herd: The Importance of Mass Immunity to Society

Thimerosal-Derived Ethylmercury Is a Mitochondrial Toxin in Human Astrocytes: Possible Role of Fenton Chemistry in the Oxidation and Breakage of mtDNA

 Sharpe, MA, Livingston AD, and Baskin DS,  Thimerosal-Derived Ethylmercury Is a Mitochondrial Toxin in Human Astrocytes: Possible Role of Fenton Chemistry in the Oxidation and Breakage of mtDNA  J Toxicol. 2012; 2012: 373678. doi:  10.1155/2012/373678

This paper has been touted recently by anti-vaccination folk as "evidence" that thimerosal is causal in autism, most recently by David Kirby at the Huffington Post

I haven't found formal analysis of this paper yet, but it was the subject of an online discussion.

Martine O'Callahan

First off, the whole study hinges on a presumption not referenced or so far tested "We postulate that this compound is preferentially taken up into the mitochondria of NHA causing damage to the respiratory chain and subsequent ROS production" There are no studies that I can find in support of this and I'm not entirely sure what they're basing it on other than they want it to be true... 

Linda Tock

We have to realize that this is an in vitro experiment. It's done in a cell line in a lab in little plastic containers like these:

http://www.nuncbrand.com/en/page.aspx?ID=229

So the first thing we have to realize; this study only looks at one specific focus; those particular cells and their reaction to thimerosal. It does not take into account the rest of the organism; the circulatory system, the liver, etc - so there is no adsorption, distribution, metabolism or excretion (often called just ADME) here - all things which occur in our bodies.

So we have to first understand that the results here may not accurately reflect what happens in a 'whole' organism. 

If we look at Figure 1 (which is actually mislabeled a/b wise in the 'window' of the study - but that's neither here nor there), we see two graphs. The top (a) graph shows the changes in mitotracker and ROS induced DCF levels as the concentration of thimerosal increases.

(ROS = Reactive Oxygen Species)

DCF = 2,7-dichlorofluorescein (I'm assuming - since they don't actually say specifically ANYWHERE in the paper what DCF is an abbreviation for).

So how much ethyl mercury was there?

At a concentration of about 2.5 uM (micro molar) we see a definitive (ie: significant) upswing in the fractional change, which is sustained through about 7.5 uM before it begins to tail off.

How much mercury is in 2.5 uM of ethyl mercury?

uM = umol/L

(2.5 umol Et-Hg/L) * (1 umol Hg/1 umol Et-Hg) * (202.59 ug Hg/1 umol Hg) = 506.48 ug Hg/L

There's 1 mole of Hg for every 1 mole of Et Hg, so there must be 1 micromole of Hg for every micromole of Et-Hg, and there's 202.59 grams of Hg per mole of Hg, therefore there must be 202.59 micrograms of Hg per micromole of Hg.

So, we have 506.48 ug of Hg in each L. 

So now what?

Well - we don't know how relative that number is. How does it compare to other studies of mercury? 

Let's compare that figure with the levels of Hg found in this study:

http://www.ncbi.nlm.nih.gov/pubmed/19560158

This study is in *preemies* - ie: low birth weight babies.

Why am I comparing the two studies? Well - the preemie study looked at the excretion of mercury from the infants - as well as the blood concentrations. 

This is relevant, because you cannot get mercury into or past the BBB without it being in the bloodstream.

So let's look at Figure 1. The highest amount of blood mercury recorded during this study was roughly 7.6 ng/mL.

How does that compare to our 506.48 ug/L from the previous study?

Well, that's rather simple. 1 ng/mL = 1 ug/L. So, the highest amount of blood mercury in the preemies in that study was 7.6 ug/L. (It's also interesting to note that the stools contained 10X the amount of mercury - on average - than the blood).

(506.48/7.6) = 66.6

emphasis added by editor The lowest amount of mercury which caused ROS generation in those astrocyte cells was over 60X the amount of mercury found in the bloodstream of infants within 48 hours of vaccination.

The *average* amount of mercury found in those infants was 3.6 (+/- 2.1) ng/mL or 3.6 ug/L. That means that emphasis added by editor the cell lines were exposed to 140 times (on average) the amount of mercury than what is found in the bloodstream of premature, low birthweight babies 48 hours after vaccination.

So, while direct application of thimerosal might induce ROS generations in a cell culture line, the amounts of thimerosal used for the study are not representative of the typical exposure window, nor do they account for the other biological factors (ADME) which can influence the toxicity to the cell line.

 

Update: Martine and Linda have published another version of our online discussion, Overdosing Brain Cells With Stuff Is Bad

Does the flu vaccine really increase the miscarriage rate? (Hint: not just no, but hell no)

There's an article being discussed on antivaccination sites:

Goldman, GS Comparison of VAERS fetal-loss reports during three consecutive influenza seasons: Was there a synergistic fetal toxicity associated with the two-vaccine 2009/2010 season?  Published online before print September 27, 2012, doi:10.1177/0960327112455067 Hum Exp Toxicol 

Please note that the author, Gary Goldman, is neither a toxicologist nor an epidemiologist. Over at Respectful Insolence, Orac dissects this study in depth.  To summarize, he concludes.

The bottom line is that Goldman’s “study” is an absolutely atrocious bit of egregious antivaccine nonsense designed to frighten pregnant women into refusing the flu vaccine. It boggles that mind that such dreck can pass peer review and be published in an ostensibly peer-reviewed journal. That it was says a lot more about the journal than whether vaccines cause miscarriages. It also goes to show that there are journals out there that could easily go out of business and not be missed in the least—except by cranks and pseudoscientists.

Previous blog posts on Goldman's publications:

• Gorski, D MD, Science-Based Medicine, May 9 2011Vaccines and infant mortality rates: false relationship promoted by anti-vaccination movement
• Becker, C & Science Mom, Just the Vax, May 9 2011 Infant Mortality and Vaccines

How vaccine myths spread, and how amateurs using social media can be effective

In the Netherlands, there was a spate of false beliefs about the HPV vaccine that reduced vaccine uptake.  This is how the Dutch handled the problem:

Non experts ‘debunk’ vaccine myths through social media | Vaccines Today.

Rather than run radio advertisements or asking experts to do TV interviews, the Dutch authorities asked parents and teenagers to torpedo falsehoods circulating online using Facebook, Twitter, blogs and chat fora. 

“We mapped all the influencers and realised that there were basically only eight people in the Netherlands doing all the harm. We monitored messages on social media and asked mothers and girls to react to scare stories in language that our target group understands – the peer-to-peer can be very powerful,” Huibers told a workshop hosted by the ECDC at the European Health Forum in Gastein, Austria.

Christine Mosler, a prolific blogger and mother of four echoed Huibers’ advice. She said parents use social media for advice, support and company as well as for information. Mosler warned against health authorities launching awareness campaigns on social media unless they are prepared to engage.

Defining the concept of herd immunity

Back in September, Orac wrote a post, A sad, premature death cynically exploited by antivaccinationists, on the unexpected death of Jasmine Renata, an 18-year-old New Zealand resident. Her mother is now claiming that Jasmine was killed by the Gardasil vaccine. In the comments, the conversation turned to the concept of herd immunity. A New Zealand anti-vaccinationist, Ron Law, made some astonishing claims. Several commenters responded:

ChrisP:

The risk of an uninfected person becoming infected is reduced with high levels of herd immunity.

Ron Law:

One thing that puzzles me is that pre vaccine days we are told that 95% of people got infected… so if herd immunity was real then the disease would have burnt itself out, wouldn’t it?

Science Mom:

What a rookie mistake. Basic epidemiology Ron; new susceptibles enter the herd via birth and/or waned immunity. I would imagine that such an enlightened risk analyst such as yourself with so many years of “studying the medical literature” would have devoted at least a modicum of time to understanding some statistics and epidemiology. The numbers of VPD pre and post vaccine are rather self-explanatory.

Ron Law

Herd immunity is a theory… predicated on most people in the herd having been infected naturally…

Krebiozen

[Ron Law wrote] Herd immunity is a theory… predicated on most people in the herd having been infected naturally…

That’s not actually true. The theory was formulated to explain observations made of the natural cycle of contagious diseases and natural immunity, but is not predicated upon that. In non-vaccinated populations an epidemic occurs when each person infected infects more than one other person, causing an exponential growth in the number of infected people, and continues until there are not enough non-immune people left to continue that rate of infection. The disease then becomes endemic, where each infected person only infects (on average) one other person.

As more and more children are born, the proportion of non-immune people rises until there are enough to sustain an epidemic and sooner or later this occurs and the cycle repeats. The periodicity of an epidemic cycle is largely related to how contagious the disease is – the more contagious the disease, the higher R₀ is, the higher the herd immunity threshold and the shorter the period of the cycle.

So herd immunity is really a mathematical model that successfully explains those observations, and observations of vaccinated populations, and allows us to make accurate predictions about the effects of various public health policies. Of course in the real world and on an individual level things are more complicated, as a lot of the assumptions made are not true in every case (random distribution of immune people in the population, the number of people a contagious person comes into contact with etc.). As has been discussed here before, it doesn’t actually matter how immunity is achieved, whether naturally, by vaccinations or by a large enough proportion of the population wearing biohazard suits (not practical, obviously, but it suffices to make the point). The only important factor is that they cannot become vectors for spread of the infection; the rest of the model emerges from that.

So there you have it. Herd immunity is a mathematical model.

No, you're not entitled to your opinion

I really enjoyed this article, including the rebukes to Meryl Dorey.

No, you're not entitled to your opinion.

So what does it mean to be “entitled” to an opinion? 

If “Everyone’s entitled to their opinion” just means no-one has the right to stop people thinking and saying whatever they want, then the statement is true, but fairly trivial. No one can stop you saying that vaccines cause autism, no matter how many times that claim has been disproven. 

But if ‘entitled to an opinion’ means ‘entitled to have your views treated as serious candidates for the truth’ then it’s pretty clearly false. And this too is a distinction that tends to get blurred.

Dear Anti-Vaxxer: Yes, I do the research « SkewedDistribution

Another great post from Skewed Distribution.  The "do your research!" figure from the anti-vaxers chaps my hide.

Dear Anti-Vaxxer: Yes, I do the research « SkewedDistribution.

One of the most frequently-sighted* comments from the anti-vax crowd to those who understand the safety and benefits of vaccinations is to “do the research”. It is never really clear what they mean by this, because they say it to nurses, MDs, DOs, and others with extensive training in healthcare and public health, such as people with Master’s Degrees in Public Health and PhDs in sciences related to human health. I have addressed the arrogance of this position before in this blog post.

Highly Recommended: Your Baby's Best Shot

There's a tremendous amount of misinformation out there for new parents on the issue of vaccination: on the web, in parents' discussion groups, and even in books.   How to counter these waves of misinformation? 

Now I have a new book to give or recommend:  Your Baby's Best Shot: Why Vaccines are Safe and Save Lives,  written by Stacy Mintzer Herlihy and Allison Hagood.  You can order it from Amazon now.

Stacy Herlihy and Allison Hagood have written a lively, easy-to-read guide to the realities about vaccines.   I particularly appreciated the  chapter on the human immune system.  It is explained, and how vaccines affect the immune system is explained in non-technical language.

Many parents are concerned about the ingredients in vaccines. The book demystifies most common ingredients, and provides readers with a way of visualizing the amounts in question. The book also covers adverse reactions, and reviews how common true adverse effects are.

Next, the book turns to myths about vaccines involving autism, ADHD, allergies, asthma, sudden infant death and more. The authors carefully explain how the myths started and why they are false. Finally, the book names some of the leading figures in the anti-vaccine movement and explains how they are mistaken.

This book would make a great baby shower gift. I wish obstetricians and pediatricians would buy this in bulk to give out to their patients, either as part of prenatal care or as a helpful guide to new parents.