More disease and death among the unvaccinated

Beginning on Friday after my post expressing amazement at something as rare as a 70° F temperature in January (at least around my neck of the woods), namely an actual provaccine article in the Huffington Post, a number of you began sending me links to a story that I find most disturbing, a mini-tsunami that continued all weekend. In fact, it’s so disturbing that I kept procrastinating all weekend until I wasn’t even sure I was going to write about it at all. But the comments kept coming, and I realized once again that, once one gains a reputation as a go-to blogger about a certain topic, there’s actually a bit of an obligation involved. As hard as I still find to believe it, more people than I would have dreamt possible actually care what I think about certain issues. (Yes, it’s pretty amazing, but there you go.)

Before I get into this story, you’ll notice one thing that I haven’t seen thus far (at least not as of late Sunday night, when I wrote this). I haven’t seen, for example, anyone on the antivaccine blog Age of Autism acknowledging this story. I haven’t seen one word there or on any of the other antivaccine sites that I monitor. Nothing from David Kirby on HuffPo. Nothing from Barbara Loe Fisher. No Dr. Jay “I’m not an antivaccinationist I just sound like one” Gordon showing up to say how exaggerated the story is. Nope. I’ve seen none of this.

Perhaps it’s because this story, which appeared in the New York Times on Friday afternoon and was entitled Minn. Illnesses Worry CDC Officials:

ATLANTA (AP) — Five Minnesota children have grown sick — and one of them died — from a germ that can cause meningitis, causing U.S. health officials to warn of the importance of a common childhood vaccine.

The Hib vaccine, which is given to babies, has succeeded in reducing U.S. cases of the bacterial illness to about only 20 a year in children younger than 5. But a cluster of five cases occurred in central Minnesota last year in young children. One child, who was 7 months old, died of meningitis in November.

No other states have reported such an increase. But Minnesota’s disease surveillance is unusually good, so problems in other states could be developing, said Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention.

And what was the likely cause of this cluster of H. influenzae type B cases in Minnesota. If you’ve been reading this blog, I think you know the answer to that one:

Three of the five children — including the dead child — had not received any vaccine, due to a decision by their parents. But a shortage of Hib vaccine may also have contributed, CDC officials said.

That’s right. Three of them were completely unvaccinated. Because I wanted to know more, I decided to look at the CDC’s MMWR report that describes the incident:

During 2008 in Minnesota, five children aged 5 months to 3 years were reported with invasive Hib disease; one died (Table). The patients resided in five different counties in Minnesota and had no known relationship to each other. Three patients had received no vaccinations because of parent or guardian deferral or refusal. One child was aged 5 months and had received 2 doses of Hib PRP-TT vaccine in accordance with the primary series schedule. Another child had received 2 doses of Hib PRP-OMP vaccine, but no booster dose, per CDC recommendations during the shortage. Subsequent to Hib infection, this child was diagnosed with hypogammaglobulinemia. None of the five were enrolled in group child care. The five cases in 2008 were the most reported for 1 year from Minnesota since 1992, when 10 cases were reported (Figure 1).

I can guess what antivaccinationists would say about this. They’d pooh-pooh it, saying it was just five children, that it was a single cluster that may not mean anything. Sure, that’s possible. But it’s damned peculiar, don’t you think, that every single one of these children were either completely unvaccinated against Hib , not completely vaccinated, or possibly immunosuppressed.

What worries me (and the CDC) is that this might be the proverbial “canary in the coalmine.” As was pointed out in both reports, Minnesota has an unusually good disease surveillance and tracking system. Ironically, enough, it isn’t just children whose parents refused to vaccinate their children who died, but a shortage of Hib vaccine may have contributed to the problem. Either way, there’s a clear reason why the antivaccine contingent hasn’t commented on this. Whether it was a shortage of vaccines or parents refusing vaccines that resulted in this cluster of Hib cases, the Minnesota experience over the last year is yet one more piece of evidence that vaccines prevent infectious disease and death. When viewed in the context of other evidence that the introduction of the plain polysaccharide vaccine in 1985 and the conjugate vaccine in 1988 resulted in a rapid and profound decrease in the incidence of Hib infection, 85% in Minnesota by 1993. Observation, history, and science show that incidence and death from infectious disease is inversely correlated to vaccination levels. When vaccination levels fall, be it from antivaccine sentiment or from parents refusing to vaccinate their children, infectious diseases formerly protected against inevitably return.

What’s particularly disturbing about this incident is that it suggests how easily herd immunity can be compromised for Hib. If it were up to full protective levels, then even the children whose parents were foolish enough not to vaccinate them would have been protected. Take a look at this figure from the MMWR:

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Notice that only 50% of the children have had all three doses.

Another factor to be considered is this from the MMWR:

The cases occurred during a Hib vaccine recall and continuing nationwide shortage that began in December 2007. The recall of certain lots of the two Hib-containing vaccines manufactured by Merck & Co., Inc. (West Point, Pennsylvania) and cessation of production of both vaccines left only one manufacturer of Hib vaccine in the United States (Sanofi Pasteur, Swiftwater, Pennsylvania) (2,3).

In other words, there were only two manufacturers of the Hib vaccine in the U.S., and all it took was a recall to get one of them to stop making the vaccine. Why is it that there are so few manufacturers of this and other vaccines? Could it possibly be because of the legal liability issues stoked by the antivaccine movement? Unfortunately, these days manufacturing common vaccines is a relatively low profit, high liability business activity. If I were CEO of a large pharmaceutical company, my fiduciary duty would make me wonder whether I should stop manufacturing vaccines too.

I hope this incident is just a blip, a one-year anomaly that will get better once Hib vaccine availability is back to where it was. I really do. The problem is, I fear that it’s not. With increasing numbers of parents refusing to vaccinate, thanks to the lies of Jenny McCarthy and the antivaccine movement, I worry that all it now takes is a vaccine shortage to reveal the chinks in herd immunity.

I also worry that, thanks to antivaccinationists, that clusters and outbreaks of vaccine-preventable disease will be an increasing problem.

ADDENDUM: The Bad Astronomer noted this story.