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The Mayor of Algonac responds to a hepatitis A outbreak by promoting antivaccine pseudoscience

Southeast Michigan is currently in the midst of a hepatitis A outbreak that started in August 2016. In Algonac, a small town in the Thumb region, the mayor decided to help a restaurant whose business suffered when one of its new staff members under training caught hepatitis A. Unfortunately, the form that help took was to host an antivaccine propaganda meeting.

Algonac Flaming Grill
A staff member of this restaurant caught hepatitis A in the ongoing outbreak in Michigan. The Mayor of Algonac, Eileen Tesch, decided to help by hosting an antivaccine event there. This is the kind of help that isn’t needed.

One of the things I like to do from time to time to set this blog apart (and also because it interests me) is to discuss happenings and news relevant to the major topics of this blog that are occurring in my neck of the woods. It’s the reason why, for instance, I’ve discussed the Flint water crisis on more than one occasion. It’s the reason why I’ve written about attempts by naturopaths to get their quackery licensed in my state.

Unfortunately, I’ve also has to write about outbreaks of vaccine-preventable diseases in Michigan, grassroots efforts to increase vaccine uptake and the attempts of the Michigan Department of Health and Human Services (MDHHS) to combat them, the reaction of antivaccine activists to the efforts of MDHHS, and some seriously bone-headed bills the Republicans in the Michigan legislature have tried to pass. Despite these outbreaks, we in Michigan have had to endure invasions of antivaxers trying to persuade our scientifically clueless legislature to make it easier for parents to refuse vaccines for their children, thus facilitating outbreaks of vaccine-preventable diseases, with Del Bigtree himself giving speeches about vaccines as though he were Patrick Henry speaking about throwing off the yoke of King George.

One of the lesser known vaccine-related stories going on in our state at the moment is a hepatitis A outbreak:

Hepatitis A has continued to spread in southeast Michigan with 319 confirmed cases between Aug. 1, 2016 and Sept. 15 — resulting in 14 deaths, state health officials announced Thursday.

The cases in Detroit and Wayne, Oakland, Macomb, Monroe and St. Clair counties represent a 16-fold increase over the same period in 2014-15.

Eighty-one cases were diagnosed last month alone, compared with six reported to the Michigan Department of Health and Human Services in August 2016.

“The southeast Michigan hepatitis A outbreak remains a top priority for public health officials from both the investigation and prevention standpoints,” Dr. Eden Wells, chief medical executive for MDHHS, said in a press release Thursday.

“Hepatitis A is a vaccine-preventable disease and in addition to our investigation of current and new cases, our focus is strongly aimed at increasing vaccination in adults, where hepatitis A vaccination is commonly low.”

Hepatitis A is a vaccine-preventable disease, and the vaccine against hepatitis A is included in the CDC’s recommended vaccine schedule. However, most adults are not vaccinated against it because the vaccine was not approved for use in the US until 1995. The disease is spread through contaminated food and water, but can also be spread through person-to-person contact, such as illicit drug use, sexual activity, and other close contact. Worse, people infected with hepatitis A are infectious for two weeks before symptoms appear.

You might wonder at this point why I’m writing about our hepatitis A outbreak. The reason is that antivaxers never miss a chance to use an outbreak to try to further their message. This time around, I’m referring to Eileen Tesch, the Mayor of Algonac, a town on the Canadian border in the thumb region of Michigan. Here’s what she’s up to:

Algonac’s mayor is helping to facilitate a hepatitis A vaccine discussion at the restaurant where a worker was found to be infected with the illness last month.

St. Clair County health officials investigated the case in mid-October after a recent hire at the Algonac Flaming Grill went home sick. Several other hepatitis A cases have been identified in the county, and the county itself is one of several in the region affected by an outbreak.

Mayor Eileen Tesch said she was concerned that people who were at the restaurant over an eight-day period were encouraged to get vaccinated against the disease.

Uh-oh.

So let’s get this straight. Public health officials are doing what science and medicine dictate that they do in the middle of an outbreak: Work to get at-risk people vaccinated against the disease that is at the heart of the outbreak, in this case hepatitis A. This is not rocket science, as they say. If there is an outbreak of a disease like hepatitis A, then part of the strategy to control that outbreak is to vaccinate as many at-risk people as possible. That is what St. Clair County and Michigan public health officials are doing. That is what, apparently, Ms. Tesch is so “concerned” about this routine public health effort that she has decided to take action. She arranged a meeting at the Algonac Flaming Grill to promote her antivaccine viewpoint:

“People lined up for hours to receive the free hepatitis A vaccine,” she wrote in an emailed invitation. “More importantly, I’m concerned people were not adequately informed of the serious risks associated with (the) vaccine, how and where they were manufactured, how effective it is, and your rights if you should suffer a vaccine injury.”

“People lined up for hours to receive the free hepatitis A vaccine”? Gee, Ms. Tesch writes that as though it were a bad thing. I note that nearly 700 people were vaccinated as part of this campaign, and the restaurant management was fully supportive:

And:

And:

So the management of the Algonac Flaming Grill is clearly doing the right thing, cooperating with county health officials and getting their employees vaccinated. At this point, I can’t help but note that statewide there have, thus far, been 495 cases of hepatitis A, with 416 hospitalizations (84%), and 19 deaths (3.8%). that’s right, nearly 4% of the people who have contracted hepatitis A have died, and well over four out of five of them required hospitalization. This is serious business and a real public health problem.

In any case, the meeting occurred last night; thus far I haven’t been able to find any news accounts about it. What I could find was this:

Tesch said the event — slated from 6 to 8 p.m. on Thursday — at the Flaming Grill restaurant is meant to share information and to help draw customers back to the restaurant.

Although Tesch said the event isn’t necessarily meant to appear “anti-vaccine,” one of the people she has invited to speak is Amiee Nelson, a nurse with Michigan for Vaccine Choice, a group that lobbies against vaccinations. According to its website, the organization promotes information, including about rights and waivers, for making vaccination-related decisions.

The other expected speaker is chiropractor Eric Marshall.

Tesch said that although she is mayor, she was organizing the event as a concerned resident. She did, however, mention the event during Tuesday’s City Council meeting.

Lovely.

I took a look at Tesch’s Facebook page, and there I found abundant evidence that she has imbibed deeply of antivaccine pseudoscience, her claims that she is “not antivaccine” notwithstanding. For instance:

And:

Let’s just put it this way. Anyone who takes Robert F. Kennedy, Jr.’s crank views on vaccines the least bit seriously is arguably antivaccine. Don’t believe me? I could literally list dozens of examples, but a couple will do. These include RFK, Jr.’s meeting with Donald Trump, RFK, Jr.’s attacks on the CDC, and his penchant for referring to the “vaccine Holocaust.”

If you don’t believe me, then check this out:

Although Tesch said the event isn’t necessarily meant to appear “anti-vaccine,” one of the people she has invited to speak is Amiee Nelson, a nurse with Michigan for Vaccine Choice, a group that lobbies against vaccinations. According to its website, the organization promotes information, including about rights and waivers, for making vaccination-related decisions.

The other expected speaker is chiropractor Eric Marshall.

I’ve written about Michigan for Vaccine Choice, most recently when a local news station quoted Joel Dorfman, a representative from this antivaccine group, with what I referred to as a “blink and you’ll miss it” caption identifying him. I also noted that MVC was the group that hosted Del Bigtree in last year’s trip to try to influence Michigan legislators. Let’s just put it this way. MVC is antivaccine as antivaccine can be. If you want to get an idea, juist peruse MVC’s website. It’s chock full of antivaccine tropes, including what I like to call the “toxin gambit” (here), a PDF full of long-discredited antivaccine articles and studies by long discredited antivaxers (like Russell Blaylock), and a reading list featuring antivaccine propaganda by antivaccine activists that I’ve written about on multiple occasions, such as Dr. Robert Sears, Barbara Loe Fisher, Dan Olmstead, Mark Blaxill, Suzanne Humphries, and Louise Kuo Habakus.

As an aside, I can’t help but chuckle at MVC’s reaction to the above description of the organization:

No, I’d say Jackie Smith got it quite right. MVC is antivaccine, providing misinformation about vaccines and lobbying to make it easier for parents not to vaccinate. As for the chiropractor Eric Marshall, his website includes antivaccine chestnuts like:

The current US vaccine schedule requires 45 vaccines at 6 months of age; 64 at 18 months and at least 74 at 4-6 years!! There is no proof that a child’s immature immune system can handle this chemical assault.

Let’s just put it this way. Anyone who refers to the vaccine schedule as a “chemical assault” can safely be assumed to be antivaccine. I’ll leave out the other tropes about how infectious diseases are good for children, rants about pharma conspiracies, and the like. You get the idea. In case you don’t, here’s Mayor Tesch again:

Tesch said she was originally going to host the discussion at her home but wanted to support the restaurant. She said she had heard some blowback about the event, though most residents shared complaints in Facebook comments, which she hasn’t seen.

“I’m not taking a public stance on anything,” she said. “… I am freedom of choice. Once you have the information, you decide what you want to do. Free country. Personally, I don’t get vaccines. I don’t have any children. I don’t get any flu shots, I don’t take any medication. We’re a very pro-drug society. My husband, he’s a veterinarian. Every commercial (on TV) is about a drug. My husband says he does everything not to put the animals on drugs. One maybe.”

“No one’s taking a position, no one’s going to be getting into arguments,” Tesch added. “It’s just a discussion.”

In the invite email, which is also signed by her husband, Jim, Tesch alleged the health department only focused on one option — a tactic that with “negative” press she said also injected “unsubstantiated fear in the community.”

This is, of course, nonsense. The county health department utilized education, environmental inspections and cleanups, immune globulin, and vaccines. As is usually the case in public health, the intervention to stop the outbreak has been multidisciplinary and multimodality.

It’s not all bad here, though. For example, the local newspaper, The Times Herald, published an editorial lambasting Tesch for promoting antivaccination quackery, using exactly those words. Even better, the 6th Circuit Court of Appeals just slapped down an antivaxer suing over the MDHHS rule requiring parents seeking a waiver for school vaccine mandates to go to the local county health office:

The Sixth Circuit upheld the dismissal Tuesday of a Michigan mom’s lawsuit alleging county health officials unconstitutionally attempted to keep her from obtaining a religious vaccination waiver for her children, finding the inconveniences she experienced did not amount to coercion against her exercising her religion.

A three-judge panel rejected Tara Nikolao’s contention that the state and Wayne County violated her First Amendment religious rights by forcing her to answer questions at the health department, and that nurses subsequently failed to properly describe her objection to vaccinations. The panel said Nikolao’s lawsuit lacked the requisite claim that she was forced to perform an act her religion prohibits.

The Sixth Circuit upheld the dismissal Tuesday of a Michigan mom’s lawsuit alleging county health officials unconstitutionally attempted to keep her from obtaining a religious vaccination waiver for her children, finding the inconveniences she experienced did not amount to coercion against her exercising her religion.

A three-judge panel rejected Tara Nikolao’s contention that the state and Wayne County violated her First Amendment religious rights by forcing her to answer questions at the health department, and that nurses subsequently failed to properly describe her objection to vaccinations. The panel said Nikolao’s lawsuit lacked the requisite claim that she was forced to perform an act her religion prohibits.

“While Nikolao has presented facts suggesting that she was exposed to religious information with which she did not agree, she has given no indication that the information coerced her into doing or not doing anything,” U.S. Circuit Judge Richard Fred Suhrheinrich wrote in the panel’s 12-page opinion. “Nikolao went to the [Wayne County Department of Health] to receive a vaccination exemption and left with one.”

Nikolao’s suit is a doozy. Apparently she was upset that the waiver she obtained didn’t specify her exact objection, which was that the body is considered a temple and she cannot use vaccines containing “‘moral problems,’ such as those created from aborted fetal cells.”

Parts of California and Arizona are arguably the epicenters of the antivaccine movement in the US, but we have them here in Michigan, too, and they are just as deluded and just as dangerous. This is particularly true when they are in political positions of power, such as mayor. Fortunately, Algonac is a small town of only around 4,000 people. Unfortunately, we have others with antivaccine proclivities.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

81 replies on “The Mayor of Algonac responds to a hepatitis A outbreak by promoting antivaccine pseudoscience”

Huh. I hadn’t heard about a Hep A outbreak. I’ll give my family a warning since they are mostly Oakland and Macomb areas, some a bit more west than that. As far as I am aware, they are UTD with most vaccines but probably haven’t had the Hep A – at least the older adults.

Just texted my mom. She and my dad have MD appointments next week and will ask him if they should get the vaccine. No one in my family is afraid of vaccines but they DO have the sense to be afraid of hepatitis!

I tried to get the Hep A vaccine before I went to South Korea on vacation a few years ago. I couldn’t get it. My doctor didn’t have it, couldn’t get it in time, and trying to get it from the public health department was a joke; the person I needed to talk to was only in the office two days a week for two hours, and never answered the phone.

It was very frustrating.

Granted, that happened in North Carolina. I hope you have better luck in Michigan.

I work with a lot of human blood so I thought it would be a good idea to get the Hep A series. Here’s the conversation with my doctor:
Me (making chit chat): Oh yes, sometimes I have to work with a liter of blood a week!
Doc: Wow, that’s a lot!

30 seconds later:
Me: I’d like to get the Hep A vaccination.
Doc: Well you only need that if you work in food service or with human blood …
Me: I work with human blood.
Doc: Ok, then let’s get you signed up!

Minor brain fart aside, I didn’t have any trouble getting the series.

I followed that FaceBook link and the trolls are all over the restaurant. They’re claiming the employee got Hep A from spoiled food, alleging coverups and such.

So far no one has called it a conspiracy to get people vaccinated.

Yeah, there’s one woman named Theresa Hogert Daugherty who’s particularly vile, ranting about how there are drug addicts working at the restaurant. The boyfriend of one of them showed up to defend her, saying she’s been clean for a long time now, and this woman just keeps ranting. Despicable. I do agree, though, that it is odd that antivaxers haven’t descended.

I would note the full quote from the link –

Mortality:
Overall mortality rate is estimated to be <0.015%. However, in hospitalized patients with icteric hepatitis, the mortality rate is reported to be 0.23% in those 49 years old.

What’s the going pay for cherry pickers these days?

I think i see the problem. Try this –

Mortality: Overall mortality rate is estimated to be {less than}0.015%. However, in hospitalized patients with icteric hepatitis, the mortality rate is reported to be 0.23% in those {less than} 29 years old, 0.3-0.6% in those 30-49 years old, and 1.8-2.1% in those {greater than} 49 years old.

I forgot the sign <, which would mean that this is an underestimation. Concerning the hospitalized patients with icteric hepatitis, this would mean that almost all of them are misdiagnosed. Medicine is no more what it used to be, but when you see a patient with jaundice, if you don't diagnose hepatitis, you should turn to preventive medicine or blogging.

Orac comments,

I’m beginning to wonder if I should get the vaccine.

MJD says,

Absolutely get the vaccine.

At your age, brain developmental-milestones have been completed with optimal results.

Isn’t it wonderful that you have an immune system that is resistant to vaccine-induced atypicality?

Also, a very good post!

It’s clear that Mayor Eileen Tesch is exercising her political position to promote her personal beliefs and vaccine agenda.

This is what makes America great, freedom-of-speech on the “vaccine issue” has no boundaries.

I noticed that the image Orac used at the beginning of this post promotes the product from “Sinovac”.

Q. Is this a subliminal message or just bad advertising.

In my opinion, a tradename like “Cureovac” would be more helpful to promote a positive first-impression.

Wait, so MJD was too dumb or just etymologically ignorant to even play the “all vaccines are made in China and nobody knows what’s in them” card? (Only Merck and GSK have U.S.-licensed hep A vaccines.)

A counterpart to “Michigan for Vaccine Choice” is “Ohio Advocates For Medical Freedom”, an anti-vaccine group whose leadership ranks include an RN and some other allied health care types. They’re pushing Ohio House Bill 193 to make it illegal for hospitals and other health care facilities to mandate flu shots for their employees (the “medical freedom” of health care workers apparently trumps the right of patients not to be sickened by health care workers with influenza).

The “Sinovac” product that Orac promotes in the topic image is a vaccine manufacturer from Beijing, China.

http://www.sinovac.com/?optionid=776&auto_id=646

In the contraindication section it states,

“People who suffer acute diseases, serious chronic disease, acute paroxysm of any chronic disease, fever.”

Q. Fever is a contraindication for this vaccine, doesn’t that encompass the entire global population.

@Orac and Minions,

How can there be “trust’ in the vaccine industry when a universal mechanism “i.e., fever” is a vaccine contraindication?

The timing, frequency, and intensity of fever is unpredictable and therefore adds great uncertainty whenever this vaccine is administered.

@ MJD:

People can tell if they themselves or their children have a fever – it is something that can be measured. Easily. It’s not a mystery.

One of the reasons certain people mistrust vaccines is because there has been a concerted effect to cultivate mistrust and fear.

You’re part of the problem not the solution.

“The timing, frequency, and intensity of fever is unpredictable and therefore adds great uncertainty whenever this vaccine is administered.”

If only there was this handy instrument that would measure the timing, frequency and intensity of fever. I would call it a thermometer, as in something that measures temperature.

I would call it a thermometer, as in something that measures temperature.

Well, sure, but how do you measure “acute paroxysm”?

mjd:
The real question is why anyone would listen to you when you’ve repeatedly demonstrated no respect for facts and a complete lack of understanding of any of the studies done about vaccinations.

Standing around and shouting danger exists, as you are doing, without having any supporting facts or data is not an honorable pastime. It’s pretty clear you are trying to make a scene not because of any real care for the health of people but because you have an urge to be considered important. I’m sure there are some people, as ignorant as you are, who believe you. I’m not sure how you can tolerate putting those people at risk simply because of your dishonesty.

dean,

It isn’t dishonest to be insolent towards the insolent.

After ~8 years of commenting in Orac’s living room, it should be clear that I suspect vaccines may be involved in the etiology of Autism Spectrum Disorders (ASD).

I’ve made every effort to place such teachings into the public domain including medical journals, government citizen-petitions, and other respected science-based publishers.

If successful, based on exclusionary measures, such efforts will decrease the incidence and severity of ASD globally.

Do you have what it takes to be a vaccine safety advocate, dean?

“After ~8 years of commenting in Orac’s living room, it should be clear that I suspect vaccines may be involved in the etiology of Autism Spectrum Disorders (ASD).”

It is clear. It is also clear that you have no evidence, and don’t care that you have no evidence. Dishonesty is probably too nice a term for what you push, but it is the most polite.

After ~8 years of commenting in Orac’s living room

“Steve Newell showed up one evening with a friend, a lawyer named Frank Green, whom Steve had convinced to try acid as a possible cure for his psychopathological disorders. Throughout his trip Frank blubbered about his ex-wife. She had recently divorced him, getting custody of their only child and denying Frank any visiting rights. He rolled around on the floor in front of the couch on which Sally was sitting, moaning and groaning and occasionally addressing Sally by his first wife’s name.

“Sally, he asserted, was the spitting image of this unfortunate woman. When he went to the toilet, which was frequently, it took two of us to get him past the gas heater in the hall, which he thought was ‘a passageway.’ It had been placed there to suck wife beaters down to their just rewards in the infernal regions. When he left, after Steve apologized profusely for his friend’s behavior, I thought no more of the matter. Little did I realize that this monumental creep would be the proximate cause of much suffering for me in the future.”

@ Denice Walter and Rene Najera,

It must be pleasing to think and respond in such simplicity.

Using a thermometer to determine the breadth and scope of one’s health is like determining the weather with a dangling rock at the end of a string:

When the rock sways, it’s windy:
When the rock is dry, it’s not raining;
When the rock is dripping wet, it’s raining; and
When the rock has snow on it, it’s cold.

Enough said…

When the rock sways, it’s windy:
When the rock is dry, it’s not raining;
When the rock is dripping wet, it’s raining; and
When the rock has snow on it, it’s cold

Worst Zen poem ever.

Whoever said that fever was the only indicator of health?

Just because they aren’t described here doesn’t mean that doctors don’t take other factors into consideration.

Oh why do I even try…I have more chance of getting through speaking to a dining room table

When a rock sways, it’s loose. Loose foundations crumble like your arguments.

When rock is dry it might not be raining, or it might be under cover.

When a rock is dripping wet it might be in a lack or pond

When a rock has snow on it, it might be in a hot spring.

Your dreadful poetry aside, no one has a fever all the time because such a condition is incompatible with life. Funny, though, how they always take my temperature at the doctor’s office, and just how much ones temperature tells us about a person’s overall state of health.

Well, it tells me, because I know what I’m doing.

Dear Mr. Najera,

A quick search of the USPTO using the honorable name of “Rene Najera” as an inventor presented zero (0) results.

@Orac,

Is there a characteristic, excluding judgemental, that is common in each of your minions?

San Diego County is having an awful hepatitis A outbreak right now as well:

“On March 18, the California Department of Public Health first announced an outbreak of the Hepatitis A virus. Seven months later on Oct. 13, California Governor Jerry Brown declared a state of emergency. Reported cases of Hepatitis A had more than tripled in the state, and 19 people have died.

Nearly 600 hepatitis A cases, mostly concentrated in downtown San Diego, have been reported since the beginning of the outbreak, likely caused by person-to-person transmission. This is up from an average 160 cases per year in California, said Dr. Gil Chavez, state epidemiologist at California Department of Public Health. More than 500 of the cases were reported in San Diego County.” (from https://www.pbs.org/newshour/health/understanding-californias-hepatitis-a-outbreak)

I’ve seen anti-vax scumbags play this down citing that most who have died in the San Diego outbreak were homeless, implying both that somehow homeless are less worthy of living and also non-homeless somehow will fare better against hepatitis A.

My local paper (San Francisco Chronicle) reports this morning on three people from Salt Lake City who went to a concert in San Diego in August and contracted Hep A. Hardly homeless folks.

@mjd:

Didn’t you say you were glad to see the end of the old Orac blog? Yet here you are, bouncing up like a sunbeam made of unicorns.

Or something like that.

Reply to Heidi_storage
“Wow, nearly a 4 percent mortality rate? That’s scary.”

4% of reported cases. Remember most cases will be unrecognized, undiagnosed, or unreported so the case fatality rate is far far lower than that.

Capt

I got a combination hepatitis A/B vaccine in 2005, before I went to Brazil. It’s probably a good idea to get the vaccine if you plan to travel to countries where either sanitation might be questionable or seafood is a large part of the diet (the part of Brazil I visited checks both of those boxes).

I would also say that it’s a good idea for a surgeon like Orac to get the vaccination. People in the medical profession should assume they are part of the at-risk population for any communicable disease.

mjd, you should take your Billy Joel citation to heart. If there is an afterlife, no doubt the heat that you will feel will make you wish you only had a fever.

“Using a thermometer to determine the breadth and scope of one’s health is like determining the weather with a dangling rock at the end of a string”
In twenty years of practice I never used anything but a thermometer to determine a patient’s state of health. None of that nonsense of asking questions; using my eyes, ears, nose, or hands; having the step on a scale; testing such useless markers as blood pressure and pulse oximetry. And all that fancy and of course pointless “technology” such as X-rays, ECGs, blood tests, and all the rest.
I fear you’ve bumped your head on that dangling rock a few too many times.

Old Rockin’ Dave writes,

In twenty years of practice I never used anything but a thermometer to determine a patient’s state of health.

MJD says,

Well, you’re the perfect person to come over for a bowl of stone soup.

Do prefer igneous or metamorphic?

I hope the good mayor’s veterinarian husband supports vaccines for rabies, distemper, equine encephalitis, and the rest.

I note that she doesn’t deny being anti-vaccine: she just doesn’t want to “appear antivaccine,” because she’s noticed that “I’m just asking questions” or “freedom to make your own [ignorant] choices” sells better than “I’m telling you not to protect yourself.”

@Daniel Corcos: Orac highlighted the high mortality and hospitalization rates for this outbreak, presumably because they’re noteworthy. You’re right that if Hep A usually required 80% of patients to be hospitalized and killed almost 4%, this would be a larger public health emergency, and my doctor would at least have asked about this vaccine along with whether I’d like a flu shot when I was in her office for other reasons. I hope that there’s something anomalous about this outbreak: one scary alternative is a change in the virus–either a mutation, or that a usually-rare virulent strain is becoming more common.

I hope you wouldn’t be telling Madagascar health workers, or the population in general, to relax about the plague outbreak there because Yersinia pestis isn’t usually that dangerous. That it’s unusual to have so many cases of pneumonic plague, which spreads faster and is harder to treat, is a good thing for humanity in general, but I doubt it’s much comfort for the people of Madagascar.

Yersinia pestis isn’t usually dangerous nowadays because we have a cure for it, which may not have been used in Madagascar. In ancient times, it was a plague. For hepatitis A we don’t have any treatment, so we would really need to be vaccinated if the virus is that bad. But is it? If the virus has mutated to cause 4% deaths, why is there no scientific report about it?

Uh, yes there is a treatment for Hep A. immune globulin. That one has been around since doctors didn’t even know the difference in types of hepatitis! It’s so old that Burton Rouche covered it in the Annals of Medicine for the New Yorker magazine and it was re-printed in The Medical Detectives.

But why are you assuming mutation of the virus must be the cause in a change in mortality rates? Why not a change in the infected population? What if usually the people who get Hep A are young and healthy, but in this pair of outbreaks (Michigan and San Diego) the people who are getting Hep A are already sicker, or have more co-morbildities, or are getting treated much later when the disease is more severe?

Or, possibly the number of people who are infected is much higher than we have been able to count, which would bring down the mortality rate.

One of the issues with homeless areas such as skid row in Los Angeles is the lack of toilet and hand washing facilities. One homeless activist wrote a discussion about this topic a couple of years ago with the title, “Where do you go to wash your hands?” It becomes a severe problem because people defecate in the street, on the sidewalk, and in any other empty place they have access to, because they don’t have access to more traditional facilities. Los Angeles used to have porta-potties set up in the skid row area, but removed them because they were being used for illicit sex and drug use. An attempt at introducing sanitation in addition to wide scale vaccination would go a long ways towards improving the situation. It’s actually a bit surprising that we haven’t seen hep A show up in epidemic form earlier.

A Doctor I’ve seen in Santa Monica has emailed his patients suggesting they get vaccinated for Hepatitis A. It was included in his usual email urging everyone to get their flu vaccine. He will give anyone lacking health insurance their shot for $20. Not every Doctor in Santa Monica is an idiot like Jay Gordon. Of course, this Doctor treats a lot of elderly patients, and cares about them getting sick, whereas Dr. Jay doesn’t care if his unvaccinated patients kill elderly people in the community by passing on communicable diseases.

Orac, could you please upgrade the software so I can hide the braindead drivel this MJD assclown keeps posting? Even scrolling fast past it, makes my eyes bleed. Thx.

Moon writes,

Brain dead, assclown, and makes my eyes bleed.

MJD says,

Jeopardy game-show response: What are Ebola-virus symptoms?

@Moon,

Thanks for participating here at Respectful Insolence, although, your comment is better read under a third-quarter Moon.

A little off-topic, you asked Orac to “please upgrade the software” and it reminded me of the preface in my next book titled, Patents and artificial Intelligence – Thinking computers (Cambridge Scholars Publishers):

As mankind continues to perfect artificial intelligence (AI), knowing its many applications and who invented it is both enlightening and entertaining. The book Patents and Artificial Intelligence – Thinking Computers was constructed to present the growing diversity of AI and their celebrated inventors. Without a doubt, patents play an important role in the progression of AI; providing valuable information about pioneering innovations, and me-too efforts, that stimulate future improvements. Throughout this amazing journey, I discovered that many of the inventors were brilliant and their ideas profound. Although there have been many whisperings on the potential threat of AI to civilization, from this author’s simplistic and hopeful perspective, AI can be thought of as a friend in that friends let friends reboot. Most important, and with enormous gratitude, kudos to William Gates, Steve Jobs, and Stephen Wozniak for providing a helping hand to personal computers during their infancy.

@ Orac’s minions,

I’ve seen Orac’s guidelines for “guest posting” (Thanks!, Denice Walters) and am saddened that there appears to be an infinitesimal opportunity as such. If I started my own blog would y’all come over and visit?

Sure, I hate-read Jake’s blog, why not yours? I’ll never make the top of his enemies list (too much competition), but I’d really hate to loose the top slot on yours.

Johnny
The Bad One

That would depend on whether it had content more interesting than the goofiness you post here. Some blogs have been established to peddle books: The Friendly Atheist, Why Evolution is True, etc. They are successful because none of the editorial content mentions the books. You, OTOH, seem to have a need to repetitively hammer on the book’s subject, making many of your comments uninteresting.

Se Hablo Espol writes,

…making many of your comments uninteresting.

MJD says,

I’m pleased that there are some comments that you find interesting.

Orac’s catch-and-release method for delivering insolence, unfortunately, left a very painful hook in my mouth.

https://respectfulinsolence.com/2011/12/02/mr-michael-dochniak-meet-prometheus/

Taking your comment to heart, though, I will endeavour to henceforth improve the quality of my comments without compromising personal integrity.

@ Moon:

Altho’ we wouldn’t want your eyes to bleed ( that would be terrible!) don’t you know that we minions are supposed to EDUCATE MJD: he’s here to provide exercise so that we polish our SB skills, like how to provide evidence, how to point out fallacies, how to deal with cluelessness, how to keep from cursing profusely whenever we see his comments.

I think that Orac wants us to become first rate BS detectors and fake news/ pseudoscience smashers.

Denice Walter writes,

…how to keep from cursing profusely whenever we see his comments.

MJD says,

Respectful insolence is in my genes, therefore, I’ll never voluntarily leave Orac’s heaven on Earth.

My awesome dad once told my immediate family, ” He’s so smart that he’s stupid”.

RI is like a second home to me!

Moon,

The wordpress software used here is already at the latest version (v4.8.3).

Alain (part-time admin for Orac).

@ Vicki Rosenzweig
99% underdiagnosis:
“A healthy man is just a sick man who doesn’t know it”
Jules Romain, Dr Knock of the Triumph of Medicine.

MJD says that MJD says: “MJD says: Well, you’re the perfect person to come over for a bowl of stone soup.
Do prefer igneous or metamorphic?”

To which I reply: Sarcasm is not just a river valley in Europe.

Hep A being a fecal oral disease can be prevented by simple hand washing. However, very few people wash their hands properly. As a food inspector I have long recommended that food establishments insure that their employees have had their hep a shots. It is much cheaper to pay for the shots than costs involved when an outbreak occurs in a food establishment. Costs for a hep a outbreak have forced many places out of business (costs could reach millions of dollars because of law suits, see Bill Marler).

This is an easy disease to prevent.

Get both hep A and B series vaccines. Hep A virus can last a long time on a surface and if fecal matter is left behind, you can imagine the rest.

Well, good news about the anti vax nuts in Ohio. I looked into the issue through the OAAPN. They tell me the measure won’t pass. It won’t even get out of committee due to opposition by hospitals in the state, who have more money and clout than the anti vax clowns.

Best part is, when I realized the OAAPN didn’t have a position statement on the importance of vaccination, I asked them to write one. They think it’s a good idea, and they’re going to do it. 😀

From this afternoon’s CIDRAP news scan: “Vaccine shortage limits hepatitis A campaign in California
A hepatitis A vaccination campaign planned in California is postponed until a national shortage of hepatitis A vaccine can be resolved. The vaccination campaign was meant to provide the second of two inoculations against the liver disease, Kaiser Health News (KHN) reported today.”

http://www.cidrap.umn.edu/news-perspective/2017/11/news-scan-nov-14-2017

@ JustaTech
“Uh, yes (sic) there is a treatment for Hep A. immune globulin (sic).”
Bullshit:
http://www.who.int/mediacentre/factsheets/fs328/en/
And how can you expect protection from antibodies if you don’t know which virus is involved?
If the outbreak occurred in a hospital, why is this information concealed?
“Or, possibly the number of people who are infected is much higher than we have been able to count”
You cannot count over 319, can you? I will help you: after it’s 320.

Who said anything about a hospital? Like, literally I don’t know where that came from.
My statement “Or, possibly the number of people who are infected is much higher than we have been able to count” has nothing to do with the ability to count higher than 319. I will re-phrase. Possibly the true number of people infected in this outbreak is higher than reported because those people have not been identified. There are many reasons why additional infected people may not have yet been identified, including being asymptomatic, not going to the doctor when sick, not being tested even if they do go to the doctor.
That was a very aggressive response. Why do you feel the need to be rude?

“Uh, yes there is a treatment for Hep A. immune globulin”.
Isn’t it rude to suggest that I post under my own name on a subject that I don’t know?
I will re-phrase too: what should I think of an article starring a vaccine and presenting a very unusual death rate of the corresponding disease?
And if you don’t find, I tell you: advertorial.

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