Deadly Serious Ignorance – and proud of it too

Being a vocal proponent of vaccines in general, the pandemic influenza vaccine as well, I sometimes run afoul of those who have swallowed the lies and propaganda spread by the anti-vaccine lobby.


This weekend found me embroiled in a particularly personal forum dust-up on this issue.  It is not unusual for me to be involved in “internet dust-ups”, but it is unusual for me to become so personally outraged. As I said in one of the conversations – up front and plainly:

“I have *extreme* difficulty keeping my *contempt* for the anti-vaccine gang from showing. I have *extreme* difficulty in remaining patient in the face of self-inflicted ignorance. I have *extreme* difficulty in quietly accepting the willful endangerment of dependents, be they our children or our elderly, or those otherwise vulnerable populations-segments-cohorts.”

We are supposed to understand and respect a parent’s “right” to refuse to have their children vaccinated, and since only about 40% of parents are willing to have their children receive the pandemic influenza vaccine, their position and opinion is the loudest one heard.  Never mind that the opinion and decision is stupid, ill-informed, ignorant, and potentially reckless.

The anti-vaccine crowd has done such a thorough job with their disinformation rhetoric that roughly 60% of parents believe the vaccine is the danger their children face, not the novel influenza virus H1N1-2009 [Swine Flu].


Most people believe that the pandemic influenza vaccine is an “experimental” vaccine.

It is not.

The pandemic vaccine is the exact same vaccine we have been producing for influenza for over forty years – more than 4 decades.  The only thing different about the pandemic strain vaccine and the seasonal influenza vaccine is the swapping of the two genes that code for influenza’s outer proteins, the NA and HA.

Those genes are swapped out with a certain cyclical regularity as our seasonal influenza changes [drifting or shifting] and the HA and NA used is no longer a “good match” to the circulating strain.

No one indulged in histrionics when the seasonal vaccine received the genes pertinent to the latest dominate strains of seasonal influenza, the Brisbane strains, yet for the pandemic version we are “rushing untested vaccine”, interpreted as “unsafe”, and “making our kids guinea pigs”.

The pandemic vaccine is manufactured in exactly the same way, using the same outdated, inefficient, and expensive process we have used to manufacture our seasonal vaccine for those more than 4 DECADES. It is grown in chicken eggs.  It may be outdated, inefficient, and expensive, but at least we have a decades long track record for safety and efficacy to look to.

Most people believe the vaccine is adjuvanted.  The US pandemic influenza vaccine is not.

There really isn’t much to explain.  It’s a “Yes – No” kinda thing.  It is not, so that would be “no”.

Many parents believe the hysteria about Thimerasol causing autism irrespective of having no science to back up that belief.  Regardless, the children’s vaccine does not contain Thimerasol, nor does the inhaled version: FluMist.  Thimerasol free.  How much plainer does that need to be made?  It is either in the vaccine or it is not.  In the case of the injectable children’s vaccine and FluMist: It is not.

I could go on with the more “wing nut” beliefs circulating among people, but I will spare the reader – and myself.

But back to my weekend dust-up:

A mother on the flu forum I participate on posed the question of whether or not she should get her asthmatic son vaccinated with the pandemic and/or seasonal influenza vaccine.  A child with asthma.  I found the question being posed by someone who was a member of Flublogia itself to be as painful as it was shocking.  Flublogia is the umbrella name for the social media sites [forums & establish/credible blogs] devoted either entirely, or in large part, the issue of novel influenza viruses and pandemics from same.  One would think that those who occupy Flublogia would be a bit more well informed of very simple FACTS. Alas, they are not.

One would also expect medical professionals to be more informed than the average ill-informed citizen. Alas, they are not.  Two trained nurses chimed into the conversation about the vaccine for H1N1-2009 being “experimental” and “untested” and of “unknown safety and efficacy”.  Further, because I am not a trained medical professional I couldn’t possibly know WTF I’m talking about [paraphrased].  ’Tis a fact, I am NOT a trained medical professional.  But I am also not ignorant, and they, at least on this issue, clearly are, their professional training aside.

Nurses and doctors are victims of the very same lies and misinformation as the general public. Thankfully, not quite to the extent as the average [non-medical professional], but still, shockingly frequent.

Many people have not enjoyed the plethora of factual information to be found sprinkled all around Flublogia and they have very little chance of over coming the anti-vaccine rhetoric so thoroughly propagated throughout every media outlet.  I may worry for them and even pity them in some ways, but I do not blame or necessarily fault them.  Hearing and reading the truth for the vast majority of people would be nearly impossible for all the noise produced by the anti-vaccine campaign.  They surely would have come across the information but it is hardly “noisy” enough to ‘break through” and register.

As is my habit, I offered my opinion on this mother’s perceived dilemma. If you don’t wish to risk your [asthmatic] child DYING get him vaccinated.  Being quite “blunt” in my exhortations I was viewed as attacking this “conscientious, loving, well-intentioned mother, just trying to do the best she can” by those who agreed with her on not “risking” having her child vaccinated [and by default, disagreed with me]. Not a single one of them expressed concern over the asthmatic child should he just happen to be so unlucky as to come down the H1N1-2009.  I guess he is an “acceptable loss” [see below] as long as everyone can smugly exercise their free will and “rights” [for their children; they don't get a say in all of this].

Congratulations were roundly extended to this thoughtful and well-meaning mother for her steadfastness in the face of my “ranting”.  I’m quite sure she, and they, feel vindicated wrapped in their shared mutually-affirming ignorance.

Meanwhile….

CDC: Seventy-Six U.S. Children Have Died From H1N1 Flu

WASHINGTON
– Federal health officials said 76 children have died from the H1N1
flu since the virus was discovered in April, which appears to be a
higher rate than pediatric deaths caused by the seasonal flu.

Anne Schuchat, the director of that National Center for Immunization and
Respiratory Diseases at the Centers for Disease Control and Prevention
said that, by comparison, 46 to 88 children died each year during the
past three influenza seasons.

Child Deaths Shoot Up

She said she expected additional pediatric deaths from the H1N1 flu.
While most of the children had underlying medical conditions, Dr.
Schuchat said 20% to 30% of them didn’t.

The H1N1 virus has hit children and young adults at higher rates
than older people, who are believed to have some sort of immunity from
exposure to viruses linked to past influenza pandemics. So far most
influenza illnesses are being caused by the novel H1N1 virus.

How do you tell a well-intentioned mother she is dead wrong?

As plainly as you can.

Then, you accept defeat and move on… and hope that she is one of the lucky ones if her son contracts H1N1-2009.  If she isn’t she will not only be dead wrong but her son might just be plain, irreversibly, dead.

In my black & white, simplistic, world view a parent has a moral obligation to protect their children from harm when and where possible — and within reason.  We cannot wrap them in bubble wrap until their 18th birthday [no matter how much we might want to].

Coincidentally, to say nothing of tragically, this story hit the wires this weekend:


Faith-healing parents charged in death of infant son

On the last day of Kent Schaible’s life, his parents and pastor intensely prayed over his 32-pound body, which, unbeknown to them, was ravaged by bacterial pneumonia.

When the 2-year-old boy finally died at 9:30 p.m. Jan. 24 inside the family’s Northeast Philadelphia home, the pastor called a funeral director to take the boy’s remains to the Philadelphia Medical Examiner’s Office.

At no time that day, nor in the week-and-a-half prior, did Herbert and Catherine Schaible seek medical treatment for their son despite his sore throat, congestion, liquid bowel movements, sleeplessness and trouble swallowing, Assistant District Attorney Joanne Pescatore said in court yesterday.

“All it would have taken is a simple visit to a doctor for antibiotics or Tylenol, maybe, to keep this child alive,” she said during the couple’s preliminary hearing.

The Schaibles were no doubt loving and well-intentioned parents… right up until their son loosed his tenuous grip on life and died.

Parents have extensive, free of interference, control of how they raise their children. Over all, and in general, that is the way it should be.  Over all, and in general, it is the most evolutionarily intelligent way for humans to raise their children given we no longer live as small bands of hunter-gatherers.  But our system means we have parents, no matter how loving and well intentioned they may be, occasionally making that stupid — and fatal — decision in the exercising of their rights to raise their children as they see fit… and make medical decisions for their children.  Irrespective of how ignorant or well informed they may be — it’s their right — usually.

A “right” is not always Right, however.  After all, in the United States one person used to have the right to own another.  A husband had the right to beat his wife — and/or children — with whatever severity he deemed “appropriate”. I believe a parent doesn’t have the moral Right to deny a minor child a vaccine that might save their life.  Yes, even though statistically most children will recover.  What about the statistically unlucky ones?  Have we no obligation to them?  Do their parents have no moral obligation?

Or, are they just the acceptable losses in our pandemic?  What’s a few fewer children in our over populated world anyway?  And, could it be reasoned that removing the children of ignorant parents is evolutionarily advantageous to our species as a whole?  I could make the case that it is.  Unvaccinated children are risks to the larger community, and if parents aren’t willing to vaccinate for a pandemic event what else are they refusing to have their children vaccinated against?

The continent of Africa is having a resurgence of polio because parents fear the vaccine and are refusing to have their children receive one.  I don’t know about anyone else, but I’ve enjoyed living a life free of the threat of contracting polio, a threat that may one day soon suddenly appear again, as suddenly as H1N1-2009 burst onto the world unawares in April of this year.

No, I do not believe any child’s death is “an acceptable loss”.  That’s kinda the point behind my week long rant… every child deserves the best possible chance to survive to live their full compliment of naturally allotted years.  A child’s death is a horrific loss, to those who love and cherish them and to the wider community denied what contributions that child might give in the fullness of their lives.

For those who would prefer a more measured and reasoned posting on this issue, one can be found at EffectMeasure:

Why the epidemiology of swine flu matters

[Excerpt]

Posted on: October 11, 2009 2:00 PM, by revere

If you are hesitating to be vaccinated for swine flu this year, perhaps this post will help you make up your mind. If it does, I hope it pushes you to get vaccinated, but whatever persuasion we attempt here will only be from a recital of what we know of the epidemiology of this pandemic. Because it is the different epidemiology that is the main feature, not the clinical characteristics or the virulence of the virus. So far this looks pretty much like a standard influenza A virus – except for the epidemiology. Since I’m an epidemiologist, you might expect me to think this is important, and I do. Epidemiology is the public health science that studies the patterns of illness in populations. One kind of pattern we study is who is getting sick. And it is a change in this pattern that is one of the big differences between a pandemic strain and a seasonal strain. Pandemic strains have a greater tendency to infect and make sicker much younger victims. In seasonal influenza it is the over 65 age group that contributes most of the serious illness and deaths, but with pandemic strains (not just the current one), lack of immunity in the population makes those under age 65 a bigger target and they sicken and die proportionately more than in a non-pandemic season. And that’s exactly what we are seeing this year. The story that made the headlines on Friday was that 19 more pediatric deaths were added to the pediatric death toll in week 39, although not all of these children died in that week.

The dates of death for the 19 stretched between July 19 and October 3 because of the way the tally is done. Starting in the 2003 – 2004 flu season deaths from influenza in people below the age of 18 became a nationally notifiable disease, reported to CDC through state epidemiologists. Each state has its own way of ascertaining the number.
Some states are more complete and more timely than others, so notifications that come in a particular week can, and do, represent deaths that occurred over varying time periods, as in the instance of the 19 added this week. Still, it is clear that the young population is being hit particularly hard in comparison to the last three years for which we have data. 76 have died from swine flu since it made its first appearance in April, and 29 of those deaths have come since August 30, i.e., 29 in 5 weeks and those 5 weeks are extremely early in the flu season. In fact they occurred before the official administrative flu season even started (week 40).

The pattern of pediatric deaths and its difference from previous years is dramatically shown in this graph from CDC’s weekly flu report:

Pediatric Deaths by week of deaths

[snip]

Cumulative Hospitalizations Rate

You once again see the altered age pattern, this time very dramatic when comparing the youngest age group with the oldest. For those of us in the over 65 age group, the seasonal has barely begun. We are just inching our way up from typical summer levels. There’s a long way to go before we get to where we would usually be by the end of flu season. My age group looks pretty normal for this time of year. But if you look at the other panels you see that several have already exceeded, in the first week of the official flu season, the level of season risk we would have expected by the end of the season. Babies and toddlers are two thirds of the way there already (remember the scale is different for them so the same height is a higher risk than compared to the 2 to 4 year olds). The 2 to 4 year olds are already there and everyone between 5 and 49 years old has already exceeded their year end risk at a time when the season is usually just starting. The 50-44 year old group is already at seasonal average and then there’s the over 65 age group, the exception that proves the rule: this is a pandemic strain.

[snip]

The seasonal and swine flu vaccines are not intrinsically different except for the flu strains they contain. We change flu strains every couple of years routinely and these vaccines are made in the same way as we have been making them for many years. The only difference is a strain change, which is routine. This means that we have had extensive experience with the swine flu vaccine already, extending over years and hundreds of millions of delivered doses. It is not untested. Far from it.

The most rational thing to do at this moment, given what we know and don’t know, is to get vaccinated with both seasonal flu and swine flu vaccines. That’s what I’m going to do. I already got my seasonal flu shot and I’ll wait in line for my turn for the swine flu vaccine and get it as soon as I can. You not only protect yourself but you help prevent spread of flu to others.

It should be required reading for all parents who have yet to make up their minds on whether or not to allow their children to receive the pandemic vaccine.

Finally, for those who think I’ve totally slipped my last remaining tenuous grip on sanity, I will leave you with this snippet from Abbott’s Flatland: A Romance of Many Dimensions since the conversations over this past weekend so strongly brought it to mind…

How I then tried to diffuse the Theory of Three Dimensions by other means, and of the result

[snip]

And yet at times my spirit was too strong for me, and I gave vent to dangerous utterances. Already I was considered heterodox if not treasonable, and I was keenly alive to the danger of my position; nevertheless I could not at times refrain from bursting out into suspicious or half-seditious utterances, even among the highest Polygonal and Circular society. When, for example, the question arose about the treatment of those lunatics who said that they had received the power of seeing the insides of things, I would quote the saying of an ancient Circle, who declared that prophets and inspired people are always considered by the majority to be mad; and I could not help occasionally dropping such expressions as “the eye that discerns the interiors of things”, and “the all-seeing land”; once or twice I even let fall the forbidden terms “the Third and Fourth Dimensions”. At last, to complete a series of minor indiscretions, at a meeting of our Local Speculative Society held at the palace of the Prefect himself, — some extremely silly person having read an elaborate paper exhibiting the precise reasons why Providence has limited the number of Dimensions to Two, and why the attribute of omnividence is assigned to the Supreme alone — I so far forgot myself as to give an exact account of the whole of my voyage with the Sphere into Space, and to the Assembly Hall in our Metropolis, and then to Space again, and of my return home, and of everything that I had seen and heard in fact or vision. At first, indeed, I pretended that I was describing the imaginary experiences of a fictitious person; but my enthusiasm soon forced me to throw off all disguise, and finally, in a fervent peroration, I exhorted all my hearers to divest themselves of prejudice and to become believers in the Third Dimension.

Need I say that I was at once arrested and taken before the Council?

Posted in H1N1 General, Opinions on PanFlu Issues, Swine flu, Vaccines | Tagged , , , | 3 Comments

Mandatory vaccines – sorta

When I got home and fired up my laptop I was greeted by blazing red headliner letters on Drudge Report that read “Mandatory vaccination for 500,000 in NY“.  Given my interest in the pandemic issue and my general belief in the efficacy of the influenza vaccine in the face of a pandemic, even a mild one, I experienced a visceral reaction to the headline.  Crap! That’s all we need to fuel the controversy – tell people they are subject to a mandatory vaccination.

However, after reading the actual news item I take acceptation to the headline.  This is not a legal requirement, this is a requirement of continued employment – they are two different things.  New York health care workers are completely free to not get vaccinated and their employers are completely free to fire them if they do not.

Via Newsday.com

Mandatory flu vaccination splits workers

Despite a planned rally in Albany Tuesday to protest a state regulation requiring health care workers be vaccinated against influenza — both seasonal and swine flu — New York’s top public health official predicts dissenters will ultimately extinguish their anger and roll up their sleeves.

The regulation, which was approved in August, comes with a stinging addendum: Get vaccinated or get fired.

But some nurses and many other health care providers say the regulation violates their personal freedom and leaves them vulnerable to vaccine injury. And they cite deaths associated with the last federal government swine-flu vaccination program in 1976.

Refusing to be immunized against H1N1 because of the vaccine debacle in 1976 “is like saying a plane crashed 33 years ago so I’ll never fly again,” said Dr. Richard Daines, New York State health commissioner.

New York is the only state in the nation to require that health care workers be vaccinated, though other states are considering such measures. Health workers, including doctors, must be immunized by Nov. 30. Opponents say it’s simply unnecessary.

I am a staunch and vocal proponent of immunizations, the influenza immunization included.  I am also in absolute full agreement with this employment requirement.  Medical professionals come into physical contact with the patients they serve.  Setting aside proactively protecting one’s own health, becoming infecting and passing the infection on to others, some of whom may develop life threatening complications – and some of those might be fatal is something to be guarded against with the means we have at our disposal, in this case that is a vaccine, along with standard hospital infectious disease protocols.  When someone’s health and life are at risk extra burdens are placed on those who introduce the element of risk.

It is technically no different than the requirements I had to meet yearly to remain a certified police officer; without certification a person cannot be a law enforcement officer in the state of South Carolina.  Those requirements were to protect the public I was out protecting.  Some professions carry extra burdens for those who are in them, it’s just the way of it – accept it or move on.

Several registered nurses said they will neither contract nor transmit the flu because they’re constantly washing their hands.

The ignorance of that belief is astounding.  I can’t help but wonder if these nurses have read or heard anything about Canadian nurses and the SARS outbreak in that country.  Canada was not the only country that had nurses become infected with SARS, some of which were fatal.

SARS was not as transmissible as the influenza virus and SARS was also not infectious until after obvious symptoms presented.  With influenza a person can be infectious prior to physical symptoms, in other words, a person can infect someone else [potentially] before they even know they are infected themselves.  The exact threat or how much virus is shed prior to symptoms has not been quantified.

[snip]

“We cannot force employees to be vaccinated; however we do not have an infinite number of non-patient care positions available to reassign those who simply refuse the vaccine,” said hospital spokeswoman Lauren Sheprow.

To restate my earlier point: Accept it or move on.  If the choice is to not receive a vaccine that would be a choice freely exercised.  A choice freely exercised does not a victim make.

I applaud New York’s decision.  It protects the most people in the best manner we have at our disposal.  Sometimes, the best we can do is imperfect, but – it’s the best we can do.

Posted in During a Pandemic, H1N1 General, Healthcare During a Pandemic, Vaccines | 2 Comments

Feeling the strain in Israel

Hat tip to @Crof via Twitter.

Hospitals not prepared for swine flu epidemic, IMA warns

Sep. 27, 2009
Judy Siegel-Itzkovich , THE JERUSALEM POST

The Israel Medical Association’s Intensive Care Society demanded over the weekend that the Health Ministry allocate money to prepare the hospitals for coping with an H1N1 flu epidemic – especially for the shortage of intensive care facilities.

In an emergency meeting on the implications of the flu, the society called on the ministry to issue guidelines that would cancel nonemergency surgery if beds needed to be freed up. Today, there are only 300 intensive care beds in the public hospitals.

The intensive care specialists, headed by Prof. Charles Sprung of Hadassah University Medical Center in Jerusalem’s Ein Kerem, said that “already, we see people dying due to the shortage of intensive-care beds. In the event of a serious flu outbreak, there will be hundreds and even thousands of patients who will need such beds and won’t get them due to the lack of such facilities.”

The society said that according to official ministry predictions, about 2,200 patients will need to be attached to a respirator at any one time this winter – twice last year’s figure.

Nearly half of these patients will suffer multiple systems failure. Thus the number of kidney dialysis machines and other vital equipment must be significantly increased, as well as the number of staffers who run them, the doctors continued.

Seven of 10 patients with H1N1 flu complications need intensive care, and the amount of hospitalization days necessary is unusually long, as those who recover require more days than most other patients.

Prof. Mervyn Shapira, head of infectious diseases at the Tel Aviv Sourasky Medical Center (Ichilov Hospital), said that the anti-viral Tamiflu drug helps prevent complications mostly when given early to the patient and that there was no clear medical evidence that it saves patients at a more advanced stage of illness.

It’s hard to know if there is genuine cause for concern or whether this is someone “running the numbers” and figuring that statistically – and based on “official projections” – need will exceed the existing critical care capacity.  Without a magical crystal ball we cannot know with certainty.  But how tragic it will be if people die due to a simple lack of ability to care for them.

What I found the most surprising was in a country that lives with the major threats that Israel does, and has for a long time, that they have only 300 critical care beds in their public hospitals.  I wonder how many the private hospitals have… or how many private hospitals there are for that matter.  Perhaps there is significant capacity, and that would explain the relative [seemingly] dearth in the public system.

Fortunately, we are not expecting a serious pandemic… we are learning that even a mild one presents us with challenges we may not be able to handle very gracefully.

Posted in H1N1 General | Comments Off