The Disneyland measles outbreak continues apace, and a woman refuses quarantine

disneyvaccine

Brief Orac follow up note, January 21, 2015: Antivaccine pediatrician “Dr. Bob” Sears responds to his patients’ parents’ concerns about the Disneyland measles outbreak. Hilarity ensues.

Last week, the self-proclaimed “happiest place on earth” wasn’t so happy.

You’ve probably figured out that what I’m referring to is the latest measles outbreak. Some of you have been talking about it in the comments, and I keep seeing news about it. Finally, I couldn’t resist applying a bit of not-so-Respectful Insolence to the whole situation. I realize that some of you might have seen this at a certain loved and hated blog that has become quite popular, there’s plenty here to go around, particularly given the involvement of a very old “friend” of the blog, someone who goes way back to 2005. Yes, nearly ten years, dating back to May 2005. (Holy, hell, has it really been that long?) And, yes, there are updates.

Not surprisingly, this outbreak happened in the Los Angeles region, Orange County to be precise. Surprisingly (or perhaps not so much), it happened at Disneyland. I say “not surprisingly” because it’s been well-publicized over the last few years that there are pockets of low vaccine uptake and high personal belief exemptions in California, complete with measles and pertussis outbreaks. This is thanks to pockets of affluent, entitled parents full of the Dunning-Kruger effect who think that they can learn as much about vaccines and autism via Google University as pediatricians and researchers who have devoted their entire professional careers to studying them. Of course, these parents are also facilitated by pediatricians who cater to their fears, the most famous of whom is Dr. Bob Sears, whose The Vaccine Book is a very popular, reasonable-sounding (to parents not aware of the antivaccine tropes within) bit of antivax lite, but there is also our old buddy Dr. Jay Gordon and a host of others.

So what happened at Disneyland? On January 7, the California Department of Public Health confirmed seven measles cases:

California Department of Public Health (CDPH) has been notified of seven confirmed cases of measles in patients from five different locations within California it was reported today by Dr. Ron Chapman, CDPH director and state health officer. Two Utah resident cases have also been confirmed and three additional California residents are also suspected to have measles and are under investigation. All confirmed and suspect cases reported visiting Disneyland or Disney California Adventure Park in Orange County, California sometime between December 15 and December 20, 2014.

Based on information from current cases, it is likely that a person infectious with measles was at one of the theme parks on these dates. People can be infectious with measles for nine days. Measles typically begins with fever, cough, runny nose and red eyes and within a few days a red rash appears, usually first on the face and then spreads downward to the rest of the body. Measles is a highly infectious, airborne disease.

By week’s end, health officials were reporting a dozen cases and expecting more to appear. Of the total cases thus far, six of the original seven cases were in unvaccinated children. Late Thursday the health department reported:

Orange County health officials confirmed late Thursday that a total of five more people contracted the disease, bringing the countywide total to six cases.

As of the other day, the number of cases had increased to 26 known cases (and probably rising). Measles is one of the most contagious diseases in the world, and it spreads easily among humans. So it is not surprising that, contributing to this outbreak, which now encompasses multiple states, was one woman traveling:

A wave of measles cases traced to Disneyland threatens to spread farther. An unvaccinated California resident infected in the outbreak traveled by plane between Orange County and Seattle-Tacoma International Airport during the holidays, health officials said.

The number of measles cases stemming from the outbreak has risen to 26 and now involves Washington state, Utah and Colorado.

The airline passenger, a woman in her 20s, fell ill after visiting Disneyland in December and became contagious on Dec. 28. She flew from Orange County to Seattle on Dec. 29, stayed with family in Washington’s Snohomish County and returned to Orange County on Jan. 3. She wasn’t diagnosed until Jan. 8 in California, health officials in Washington state said.

The passenger flew to Seattle on Alaska Airlines Flight 505 on Dec. 29, a Washington health official said. She returned to Orange County on Jan. 3 on Virgin America Flight 1780.

Meanwhile:

A South Pasadena woman’s younger sister came down with the measles. Now, federal health officials want her locked down under quarantine, but she is resisting.

Ylsa Tellez is a 26-year-old grad student whose younger sister, 24-year-old Maura Tellez, was one of the confirmed cases of measles caught recently at Disneyland. So far, there have been 26 confirmed cases of measles, but Ylsa is not one of them.

And:

“(They were) saying I need to get vaccinated and I need to be quarantined, otherwise I’m going to go to jail or something, or I’m going to get a misdemeanor,” said Ylsa.

Ylsa says she refuses to be a prisoner in her own home despite the possible quarantine order. Ylsa’s mother is also defending her daughter.

“It’s not nice when my daughter is threatened like this because she’s not even sick,” said Myrna Tellez.

No, but she’s been exposed. The reason to quarantine someone who has been exposed is because that person can be infectious before symptoms appear. That’s why quarantine is recommended for the incubation period, until health officials can be sure that Tellez doesn’t actually have the measles and is no longer contagious. One comment I saw about this issue (several comments, actually) questioned why we quarantine someone like Tellez but not Ebola patients. When I see a question like this, I want to respond: How is this thing not like the other? Measles is incredibly contagious through respiratory contact. In contrast, Ebola is not. It requires close personal contact with infected bodily fluids. Quarantine can stop the spread of a disease like measles; for Ebola it’s a lot more dicy.

In fact, I had never really thought of it before, but a theme park is an excellent incubator for an outbreak of a disease as highly infectious as the measles, particularly a theme park like Disneyland. While many theme parks tend to attract mainly from their region, theme parks like Disneyland, Disneyworld, Universal Studios Orlando, and the like, attract visitors not just from their region but from all over the world. That includes countries where there are ongoing measles outbreaks and high percentages of unvaccinated children. Add to that a location in a state where there are populations of children with low MMR uptake who visit Disneyland too, and the recipe for an outbreak is there. Over the Christmas holidays, it finally happened.

I’ve mentioned antivaccine and antivaccine-sympathetic physicians in southern California before. It’s not surprising that the most prominent are running like the wind from news of the Disneyland outbreaks.

For example, given that he’s the foremost seemingly “reasonable” promoter of antivaccine pseudoscience, it’s not surprising that Dr. Bob Sears is once again feeling the heat, as well he should. You might recall that, in response to previous outbreaks in southern California, Dr. Bob let loose with a rather despicable couple of posts to his Facebook page, in which he expressed vexation with parents who, rightly concerned about the measles outbreak, were apparently deluging his office with calls of concern and asking if they should get their children vaccinated. His first response to them was basically a highly unprofessional rant entitled “Measles Epidemic…Not!” and boiled down to, in essence, “get the vaccine if you’re worried, but there’s no real reason to worry,” a complete abdication of his professional responsibility as a pediatrician. He also downplayed the significance of the measles outbreak in a fashion completely unbecoming a pediatrician (or physician of any kind). Basically, Dr. Bob’s message was: Don’t worry, be happy, and, if you’re worrying and not happy, get the vaccine. Just don’t bother me about it anymore. Oh, and you nasty pro-science vaccine supporters (whom he described as “mandatory vaccine militants”) out there are big meanies for pointing out that I’m irresponsible and antivaccine.

So great was the heat Sears felt, even from his own “vaccine-averse patients,” that he felt obligated to post a follow-up. And so he did in a Facebook post entitled “Orange County Measles Epidemic . . . Not (yet, anyway)!” This time, the message, also highly unprofessional, boiled down to, “Don’t worry, be happy, and if you’re worrying and not happy get the vaccine. Just don’t bother me about it anymore.” Oh, and “I’m giving informed consent.” The problem, as we’ve documented many times here, is that Dr. Bob and his fellow antivaccine activists don’t give informed consent. They provide “misinformed consent” that vastly inflates the risks of vaccines, attributes nonexistent risks to them (such as autism; more on that later), and minimizes the benefits of vaccines.

This time around, Dr. Bob appears to have learned a lesson from his previous crybaby outbursts. He’s managed to keep a tighter rein on his petulance. Last Thursday, he wrote a post entitled “Measles Makes a Stop at Disneyland“. His tone is much more measured, but underneath lies the same old attitude, in particular his downplaying the seriousness of the measles. Indeed, after acknowledging that the measles can be “miserable,” well, here’s how Dr. Bob put it:

The bad news – although I make light of people’s tendency to panic unnecessarily, measles is no laughing matter for those who are exposed to one of these nine cases. Although most cases pass harmlessly in the long run, it is a miserable week. Severe complications are very rare, thankfully. But moderate complications, like pneumonia, can occur. It can also be more severe for infants and for pregnant moms and for immunocompromised people. Our hearts go out to any of these high-risk people who are exposed. But most complications are manageable. So, it is a worry for exposed people, I know. But for the public at large, we should just go about life as usual. For anyone exposed to those nine, you are being managed by your doctor and the health department.

As with all previous measles outbreaks, there’s no reason to panic. Here is some info to know:

If vaccinated with one dose of MMR, you have a 95% chance of being immune. If two doses of MMR, 99% chance. But this isn’t perfect. As you will read in the link, one of the cases was fully vaccinated.

Make light of people’s tendency to panic? A more accurate way of saying it would be that Dr. Bob heaped scorn on people’s concerns, not just once but twice. Still, at least he acknowledges the potential complications, but even then he can’t resist downplaying their seriousness. Pneumonia a “moderate complication”? No, it’s a serious complication that very frequently requires hospitalization. I suppose it’s a minor victory, though, that he acknowledges that the MMR is highly effective, particularly when multiple doses have been received, but one still can’t help but note that Dr. Bob had to harp on the fact based on information available at the time that one of the cases was fully vaccinated.

Meanwhile, I had an exchange with our old buddy Dr. Jay Gordon on Twitter, based on this Tweet:

Of course, the CDC recommends that children receive their first dose of the MMR vaccine between age 12 and 18 months. So what’s this with Dr. Jay’s obfuscating? People on Twitter wanted to know:

Dr. Jay responded:

To which I responded:

Dr. Jay responded:

Which wasn’t an answer. Finally, after more pestering, he said:

And:

So, as has beenobserved before, Dr. Jay won’t give the MMR (or, it would seem, any vaccine) unless the parent badgers him to do it. Basically, like Dr. Bob, he washes his hands of the decision (and therefore responsibility) to vaccinate, justifying it by saying he’s just letting the parents choose. The problem is that he’s “letting them choose” based on misinformed consent, in which his copious statements expressing “concern” about vaccines, invoking the “toxins” gambit, and likening vaccine manufacturers to tobacco companies, as he states unequivocally that vaccine cause autism.

Not coincidentally, after Dr. Jay was cornered on Twitter, he had a couple of new posts on his blog to justify his “concern” for vaccinating children under three. First, he referenced the conspiracy-laden “#CDCWhistleblower” manufactured scandal and referred to the original paper by DeStefano et al. to justify his concern about vaccinating children under three. As I explained in three lengthy posts, neither that study, Brian Hooker’s now-retracted paper, nor William Thompson’s conscience tortured over fairy dust, show that the MMR vaccine causes autism when given before age 3. Dr. Jay clearly misunderstands the science.

Dr. Jay’s second post is entitled “The MMR is not controversial because of Wakefield“, a title that almost destroyed my keyboard, as I was foolishly taking a sip of my Sunday morning coffee when I first read it. Key gems:

The vaccine is best given later because it can cause large side effects in a small percentage of kids when given at 12-15 months. Parents’ testimony, the above CDC publication and much more supports this conclusion.

Dr. Jay provides no evidence to support this and no citations, but this is of a piece with what Dr. Jay contributed to the response to the earlier measles outbreaks in southern California. His letter to his patients basically echoed Dr. Bob, saying, “If you would like the MMR vaccine, feel free to get it.”

He then concludes:

When we coerce parents into vaccinating their children younger than they feel comfortable doing, we diminish their confidence in their doctors and compromise our ability to continue the dialogue about vaccines and all aspects of their children’s care. If one really cares about herd immunity–and I do–respecting parents’ decisions is crucial.

Of course, a huge part of “respecting parents’ decisions” is to give the parents accurate scientific and medical information, rather than antivaccine fear mongering. If parents’ pediatricians say or imply that vaccinating (or vaccinating before a certain age) is dangerous when it’s not, the parents will likely believe it, particularly if they are predisposed to believe bad things about vaccines. Dr. Jay, whether knowingly or unknowingly, presents a slanted case to his patients’ parents, thus making it highly unlikely that they will agree to the MMR before age 3. Of course, if Dr. Jay doesn’t even offer it before age 3 and has to be pummeled by pro-vaccine parents into giving the vaccine earlier, then very few of his patients will get it before age 3. Parents who have to badger their child’s pediatrician to vaccinate will pretty quickly realize that this is not the pediatrician for them and find another who vaccinates according to the CDC schedule. Dr. Jay’s patients are thus self-selected to be vaccine-averse, and he caters to that. After all, he is well known as Evan’s pediatrician (Jenny McCarthy’s son) and has even written the foreword of one of her books.

Unfortunately, the problem of pediatricians who are either antivaccine, antivaccine-sympathetic, or have come to cater to vaccine-averse parents is a huge problem in California. There are, not surprisingly, pediatricians who aren’t as famous as Dr. Bob Sears or Dr. Jay Gordon contributing to this problem. They are misleading parents and catering to the scientifically-unfounded fears of others.

Meanwhile, VaxTruth.org posted a highly misinformation- and fallacy-laden response to the Disneyland measles outbreak, complete with one of the most intellectually-dishonest antivaccine tropes out there, the infamous “vaccines didn’t save us” trope. It was coupled, of course, with a “What, me worry?” trope in which the writer did everything she could to downplay the seriousness of the measles. I’ll give you an example:

My friend Dawn wrote a great article called Putting Measles Into Perspective, which was published here on VaxTruth. In her article, Dawn points out that prior to the availability of the measles vaccine, which was licensed in 1963, the number of yearly measles deaths in the U.S. was approximately 450.

See? No big deal. Dawn tells us. It’s just 450 deaths of children that could be prevented with a vaccine. Actually, those deaths were prevented with the vaccine, along with 3 or 4 million cases of measles. What she also fails to mention is that, before the measles vaccine, 48,000 were hospitalized and 4,000 developed encephalitis. If you want the attitude of antivaccinationists writ large, here it is: Children dying doesn’t matter, at least not if they die of vaccine-preventable diseases. I mean, really. 43,000 people a year died in car crashes back then! A mere 450 deaths a year is nothing compared to that! She even says, “a 0.015% mortality rate among measles infected people is just not very scary.” Apparently, neither is the suffering of 4 million children, as long as it’s “natural.”

In fact, VaxTruth goes one better than invoking all sorts of fallacies to claim that measles isn’t a serious disease. Marcella Piper-Terry goes on to say that measles is actually good for you. (You remember Piper-Terry, don’t you? She’s the one who likened the act of vaccination to rape—and meant it.) Between this VaxTruth.org and the other two, there are so many lies that it might require another post to deal with. Or deconstructing the fallacies in her posts could be left as an exercise for the interested reader. (Feel free to have at it in the comments below!) To give you a taste, however:

Where else have we heard that measles infection might be a good thing? Oh! That’s right… from CNN!

Yep! You heard it right! Measles virus conquers cancer! Of course, modern cancer researchers are using a modified vaccine-strain of the measles virus, but if you listened closely to the CNN video, you might have heard about the boy from Uganda whose cancer went into spontaneous remission after he got the measles. The REAL measles.

Of couse, what Piper-Terry neglected to mention was that this took an utterly enormous dose of virus and only worked in one person out of the six in which it was tested.

Later in the article, Piper-Terry cites the hideously bad work by Theresa Deisher, the one who’s been trying to “prove” that fetal DNA in vaccines causes autism. It doesn’t. Add to that a citation from a 1959 BMJ article in which British primary care physicians discuss their experience with measles cases that year and don’t report severe cases. Of course, the numbers each saw were small; so it’s not surprising that they didn’t see any cases of encephalitis or any deaths.

But back to Disneyland. Peter Lipson pointed out, Orange County is antivaccine central in California, home to Dr. “Bob” Sears and a host of antivaccine-friendly or -sympathetic physicians who pander to antivaccine fears and even spread some of their own. Meanwhile, as I discussed a while back, there was recently a decent Japanese study that failed to find a link between the MMR vaccine and autism. Also hot off the presses in 2015, there’s a very large study published in Pediatrics examining the Vaccine Safety Datalink (VSD) for reports of adverse events due to MMRV (the MMR plus varicella vaccine combined) in 123,200 children and MMR + V (MMR plus varicella vaccine, given as separate injections) in 584,987 children. It’s a study that Skeptical Raptor turned me on to, given that I didn’t see anything in the news about this either.

The study found no statistically significant increase in the risk of the following adverse events: anaphylaxis (severe allergic rection), idiopathic thrombocytopenic purpura (an autoimmune condition attacking platelets), ataxia, arthritis, meningitis/encephalitis, acute disseminated encephalomyelitis, and Kawasaki disease. No relationship was found between the two MMR-based vaccines and increased risk of any of these conditions. Not only that, but for some outcomes, the number of events was so low that the risk was minimal and approaching zero. Autism was not an adverse event examined, but the VSD has been mined again and again looking for correlations between vaccines and adverse neurodevelopmental outcomes, and none have been found, at least not by scientists who were not explicitly antivaccine.

Sadly, the myth that the MMR causes autism, a myth “pioneered” (if you can use that word) by Andrew Wakefield, lives on. One of the areas in the US where a lot of people believe that myth (or at least believe it enough to eschew the MMR vaccine) is southern California in general, but Orange County in particular. Add to that travelers from all over the US and all over the world come to Disneyland every year, it’s actually rather amazing that there hasn’t been an outbreak there before.

And sadly it’s not just measles, either.