Re: Measles "epidemic" feared..BMJ Response from Hilary Butler

There is discussion at the BMJ going on.
http://www.bmj.com/cgi/eletters/337/oct01_3/a1856

Doubt they will publish my response to Peter Flegg, but here it is,
though I've altered one sentence to correct a grammar mistake:

Dear Sir,

Peter Flegg says that there would have to be an average of 750 MMR
deaths a year, to tip the balance in favour of not vaccinating with
MMR.

During the rationing of the second world war, in 1943, measles death
rate in UK was 773 (1), and it never approached that rate again.

In the fifteen years before the measles vaccine was licensed in the
UK death rates never went above 200; in the ten years before the
vaccine was introduced, the death rate never went above 150. After
1953, deaths rates were never of the order of 1 per 2,000.

The measles vaccine was licenced 24 years later in 1967, and did not
reach significant levels of uptake for quite some years after that.
In fact in 1980, there were 139,487 cases of measles with 26 deaths.
Even that isn't 1 per 2,000 cases. And presumably those deaths also
included late-onset deaths as well.

Therefore, Peter Flegg's basis for 750 deaths per year would indicate
that this analysis came from Thomas Kuhn's Sabre Toothed Tiger
syllabus.

The reality of the years between 1952 to 1970, and afterwards, prove
that Dr Flegg's mathematical equations are about as relevant as
saying that the measles death rate in Africa, is comparable to the
Measles death rate in UK.

Peter Flegg accuses some here of having a Nirvana complex. It's hard
to go beyond "Pinocchio's nose", when attempting to ascribe the
relevance of Peter Flegg's statistical prowess to the UK conditions
of today.

In reply to Peter Flegg's expansion of my question to him: no, it did
not occur to me that Peter Flegg would decide to include the third
world when the BMJ was discussing a topic based in UK.

But since Peter Flegg wishes to compare apples with army jeeps, let's
discuss his concept of that as well. Flegg states that, "in 1999
there were estimated to be 873 thousand deaths from measles, reducing
to 530 thousand in 2003."

Last year, WHO (2) stated that use of the measles vaccine in Africa
had slashed the death rate from measles by 91% since 2000. This 91%
is an artifact figure, because before 2000, measles in Africa
was "estimated", while after 2000, notifications were only accepted
after being laboratory proven. In 2000, WHO implemented a system of
laboratories (3) specifically to diagnose measles, and provide the
laboratory confirmed cases which are now the basis of WHO data.

Look at pages 2, and 14. On page 14, 14,185 cases were reported in
2006, but after blood testing, 9,764 were "discarded". That's an
immediate 69% drop in cases, because they are no longer relying on
doctor's eyes.

On page 2, of 14,185 cases, 3,257 were accepted, leaving a balance of
10,928 discarded measles cases which equals 77% which were NOT
measles after being blood tested, but which would have been accepted
on the pre- 2000 measles notification system. Comparing data from
laboratory-confirmed blood tests after 2000, with pre-2000 guessing,
and then claiming a 91% decline, is not a valid scientific
comparison.

Which raises an obvious issue. Peter Flegg says that clinicians
caring for measles cases " would have had no doubt. Acute measles is
a relatively easy clinical and laboratory diagnosis." Did (and can)
UK doctors do any better than those who guessed measles in Africa
before 2000, or even New Zealand for that matter? That depends on who
you listen to.

An old UK newspaper article, unfortunately undated, received on 17th
April 1997, reads: London (Europe Today). – "97.5% of the times that
British doctors diagnose measles they are wrong", says a publication
of the Public Health Laboratory service. The mistake being made by
National health GP's was found when the services tested the saliva of
more than 12,000 children who had been diagnosed as having measles.
Roger Buttery, an adviser on transmissible diseases at the Cambridge
and Huntingdon Health Department, said that the majority of
doctors "say they can recognize measles a mile off, but we now know
that this illness occurs only in 2.5% of the cases." Buttery says
that doctors classify as measles, many other viruses that also cause
spots. He found eight different viruses during the survey in East
Anglia. One of them, parvovirus, gives symptoms similar to German
measles. The reason for the high rate of error puzzled
Buttery. "Doctors are neither vague nor careless," he said. The
solution is to defer the diagnosis until more detailed information
can be got. There are 5,000 to 6,000 cases of measles registered each
year in the United Kingdom, but these findings now call most of them
into doubt."

A later report by the same laboratory (4) showed that the most common
viruses causing "morbilliform rash" in the UK are "parvovirus B19;
group A streptococcus; human herpesvirus type 6; enterovirus;

An editorial in an Australian medical journal (5) pointed out that:

• In Sydney, in 1990-1995 only 49% of 58 notified cases were
serologically confirmed.

• In Victoria, in 1997-1998 only 8% of 248 notified cases were
serologically confirmed, and for the whole of Australia in 1997 –
1998, only 45% were serologically confirmed.

• In 1994 in UK and Finland, only 1% of notified cases were
serologically confirmed.

So now, doctors check for BOTH IgM (immediate antibody) IgG (evidence
of past infection). If there is both IgM and IgG an enzyme
immunoassay or a reverse transcriptase polymerase chain reaction is
required to type the virus to figure out whether it's wild, vaccine,
or whatever (6). In my files is an MMR information sheet to parents
which states that neither rubella nor measles can be correctly
diagnosed without a blood test. (In UK they use a saliva test.)

Therefore, according to medical literature, and information provided
to parents, I would dispute Flegg's assertion about the ability of
all doctors to easily or accurately diagnose measles or rubella,
without the assistance of technology. For the same reason, I also
dispute the validity of comparing any historical data from 1850 with
any data after laboratory data conformation was required.

However, since Flegg is presumably calculating his risk benefit
analysis on potentially invalid data, I have no choice but to do the
same. If the UK historical data for measles deaths is inaccurate
because it too contains more "viruses" than just measles, that makes
Peter Flegg's calculations in the first paragraph, even more
extravagant.

In countries like UK the decades of pre-vaccine death decline is
obviously due to factors unconnected with the use of any vaccine. For
the same reason, the WHO media release claiming that the measles
vaccine has reduced the measles death rates in Africa by 91% between
2000 – 2007, defies logic, analysis and reason for anyone who knows
the facts. I note that Peter Flegg has stopped short of repeating
that spectacular assertion. Perhaps it's because even he can see the
ludicrousness of such a claim.

If that is the case, the Peter Flegg fails to mention that
comparative data in the UK, uses the same "mistake". Total numbers
without any laboratory confirmation before 1994, cannot be validly
compared with laboratory-confirmed cases only. To do so is not
legitimate "science".

Peter Flegg states that, "during the last 10 years the case fatality
for acute measles in the UK has been in the order of 1 in 2000".

In UK, from 1998 to 2007 (as of 24th November), there were 28,364
cases of measles.

Out of the 12 deaths from 1998 - 2007, one is known not to be
measles, one is provisional, 2 were immunodeficient children within
the age where vaccines are administered, and the other 8 were older
deaths resulting from infections contracted prior to 1967. From the
years of 1998 – 2007, the risk of any unimmunized child dying from
ACUTE measles was as follows:

immunodeficient children = one per 14,182 cases of measles; healthy
normal children = 0 out of 28,364.

Any suggestion that in 2008, the risk of any child dying of acute
measles is 1 in 2,000 is another fictional statistical manipulation,
in the same vein as: "in order for the risk/benefit equation to be
tipped in favour of leaving children unvaccinated against MMR, there
would need to have been more than 7500 deaths from MMR in the last 10
years."

Peter Flegg says, "The only reason more children do not die of
measles in the UK is that herd immunity is still sufficiently high to
protect those who cannot or have not been fully immunised."

That is not entirely correct in my opinion.

A site called Measles Initiative says that(7), "Measles is a leading
killer of children in many developing countries for several reasons.
Children are already compromised with poor living conditions, they
are infected at very young ages when their immune systems are not
strong, malnutrition is rampant in many homes, and many families do
complications. Measles, itself, does not kill children. Instead,
complications from measles attack the child's already weak immune
system. Measles attacks the body, inside and out. It is similar to
HIV in the sense that when it knocks down the immune system, the
child becomes susceptible to the myriad of diseases that fester in
poor living conditions."

Do children in the United Kingdom have the same living conditions as
children in Africa?

Peter Flegg also says, "I have no doubt that another vulnerable group
(infants too young to be vaccinated) will see deaths within its ranks
before too long."

Before the measles vaccine was used, it was exceedingly rare for any
infant younger than 18 months to acquire measles because of the
strong maternally transferred immunity and, if a mother breastfed,
through the many immunological components within breast milk.

Those women in UK who now have naturally acquired measles in the last
decade, will transfer solid immunity to their babies, and their
babies will be unlikely to experience measles before 18 months. On
the other hand, those vaccinated mothers who have not had natural
measles, will not transfer that sort of immunity to their babies, and
their babies might be at risk. That being the case, to blame
unvaccinated children for a relatively new problem created by the use
of a vaccine in the first place, is more fact juggling.

A better initiative to reduce all risks to any child from any cause
whatsoever, would be to employ a certain young British chef to help
start nationwide "Vitamin D, Victory gardens, exercise and cooking
course" initiatives for parents and the unemployed, as well as
someone else to teach "breastfeeding, home nursing and nutrition
during infection". More than any vaccine, parents who provide their
children with correct nutrition, enough vitamin D, sleep, exercise,
and decent home nursing, can vastly decrease the annual expenditure
of NHS with regard to a long list of conditions, (including potential
complications and deaths from any infections).

These are conditions African parents would give their eye teeth for.
If they were able to achieve even half of what the UK achieved after
World War II, even without a measles vaccine, African children would
have far less to fear from measles infections.

Hilary Butler.

(1)
http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/119573383581
4?p=1191942172799

(2) Measles deaths in Africa plunge by 91%
http://www.who.int/mediacentre/news/releases/2007/pr62/en/index.html

(3) Jan 2006 WHO "Afro Measles Surveillance Feedback Bulletin"
www.afro.who.int/measles/reports/surveillance_feedback_bulletin_april_
2006.pdf"
target="_blank">http://www.beyondconformity.co.nz/_bpost_1598/www.afro
.who.int/measles/reports/surveillance_feedback_bulletin_april_2006.pdf

(4) Ramsay, M. et al. 2002. "Causes of morbilliform rash in a highly
immunised English population." Arch Dis Child. Sep;87(3):202-6. PMID
12193426.

(5) McIntyre, P.B. et al. 2000. "Measles in an era of Measles
Control" Med J Aust. Feb 7;172(3):103-4. PMID: 10735018. (6)
Durrheim, D. M. et al. 2007. "Remaining measles challenges in
Australia." Med J Aust. Aug 6;187(3):181-4. Review. PMID: 17680748.
http://www.mja.com.au/public/issues/172_03_070200/mcintyre/mcintyre.ht
ml

(7) Measles Initiative - The Problem
http://www.measlesinitiative.org/problem2.asp

"..it does not require a majority to prevail, but rather an irate,
tireless minority keen to set brush fires in people's minds.." -