Syracuse University mumps outbreak – bad anti-vaccine math

Syracuse University mumps outbreak

Partially because I’m an alumnus, and partially because I watch new reports about infectious disease outbreaks all over the world, I’ve been following the recent Syracuse University mumps outbreak. As of 13 November 2017, Syracuse University (SU) Health Services has reported 41 confirmed cases and 78 probable cases of the mumps on the SU campus.

One of the age-old tropes of the anti-vaccine statistics world is that kids who have been vaccinated against the mumps (or measles or any disease) are more likely to get mumps (or any disease) than those who are not vaccinated. I squashed this myth before, but you know what happens – the anti-vaccine zombie tropes tend to reappear over and over and over and over again.

Now, the anti-vaccine statistics deniers have jumped into the Syracuse University mumps outbreak with their alternative facts, or should I say alternative math. So, once more unto the breach, dear friends, once more. We will take down this trope. Continue reading “Syracuse University mumps outbreak – bad anti-vaccine math”

Measles infections prevent heart disease – an anti-vaccine trope

measles infections prevent heart disease

Here we go again, another anti-vaccine trope based on one paper without adequate scientific criticism of said paper. What is this trope? Mumps and measles infections prevent heart disease and stroke. Let me jump right to the conclusion – wrong.

Although I’ve seen this story before, like most zombie tropes in the anti-vaccine world, this one has come back from the dead. In the pseudoscientific website, Health Impact Newsthe author writes:

By my calculations, natural infection with the measles and mumps will prevent millions of heart attacks and strokes. Why is this information not all over the TV and internet? I will tell you why. Because mainstream media is in bed with Big Pharma who pay their bills. The politicians are slaves to their corporate masters. Our children should be exposed to every virus and bacteria for which a vaccine exists.

The author’s shrill claim is based on a 2015 article published in the lower impact factor journalAtherosclerosis. The authors concluded that “measles and mumps, especially in case of both infections, were associated with lower risks of mortality from atherosclerotic CVD (cardiovascular disease).”

Now, it’s time to turn a critical and skeptical eye towards that article.

 

Mumps and measles infections prevent heart disease – the paper

The study evaluated lifestyle questionnaires from 43,689 men and 60,147 women who were aged 40-79 years at the baseline period of 1988-1990. Individuals of that age probably were not vaccinated against measles or mumps, since that vaccine wasn’t available for children until the late 1960s, when the individuals in the study would have been 20-50 years old. The questionnaire included history of measles and mumps, and were followed until 2009.

The authors then determined hazard ratios (HR, see Note 1) for mortality from cardiovascular disease (CVD) between groups with history of measles and/or mumps infection versus those who did not have those infections. Here are some of the results of the analysis:

  • Men with history of measles had an HR for all CVD deaths of 0.92.
  • Men with history of both measles and mumps had an HR for CVD deaths of 0.80.
  • Women with both infections had an HR for all CVD deaths of 0.85.

The researchers also looked at comparisons between infected and non-infected groups for various types of CVD, but these data probably are the most important.

The study also attempted to show that there was no difference in infected and non-infected groups for a series of confounding variables. They include:

  • Age
  • Body mass index
  • Hypertension
  • Diabetes
  • Previous history of CVD
  • Smoker
  • Exercise level
  • Education
  • Stress level

Taken at face value, the research does seem to support the contention that we shouldn’t get the MMR vaccine to protect ourselves against measles and mumps, because catching those diseases may protect us against cardiovascular disease when we get older. But really, does it really gives us evidence to quit vaccinating? Let’s take look.

 

The critique

  1. This is a one-off primary study that has not been confirmed by any other researchers. This places it at the lower end of the hierarchy of scientific research.
  2. The authors did not propose a biologically plausible explanation. If one is to propose a correlation between two events, especially when the temporal difference is over 50-70 years, one must also propose a plausible reason why you might assume there is correlation. Is there a plausible reason for anyone to believe that a mumps or measles infection will protect someone from cardiovascular disease? I have a scientific bias towards plausibility, otherwise we can propose inane scientific hypotheses that waste the time of everyone involved.
  3. There is simply little evidence that measles or mumps is correlated with CVD –  a review of PubMed for any articles that might establish a relationship between mumps and/or measles with CVD provided me with two articles. The first is the one we are discussing herein. The second, also published in Atherosclerosis, seems to indicate that mumps and measles is related to higher rates of CVD. This is why cherry picking is bad – you seek out articles that support your pre-conceived conclusion rather than let all of the evidence lead you to a conclusion.
  4. The use of questionnaires for epidemiological studies is frowned upon by many researchers. The reasons for this are many, but they include a reliance upon the memory of the participant for events that may be 50 or 60 years in the past. For a highly infectious disease like measles, it’s hard to believe that 50% of the participants in this survey caught neither mumps or measles as a child. It’s more likely that they actually had caught the disease but forgotten about it. A properly designed study would have measured measles and mumps antibodies then determined the HR. Or used actual medical records (like a lot of vaccine studies use for case control studies of vaccine effectiveness and safety).
  5. The hazard ratios were tiny. Yes, it appears that mumps and measles infections prevent heart disease – the data seem to show a 8-20% reduction in CVD risk. But is that clinically significant? If being vaccinated against measles and mumps showed a 200-300% increase in the risk of CVD, I would be impressed and troubled by the results. But such a tiny reduction in the risk could be explained by anything. A missing confounder. Other infectious diseases. Nutritional levels. In fact, I can go on and on. Furthermore, is an 8% reduction in risk of CVD, if it is valid, worth the risk of death or disabling conditions from contracting measles or mumps? Although the question is rhetorical, it’s actually necessary to come to a conclusion based on the results provided.
  6. Speaking of vaccines, why wasn’t vaccine status asked (although the same memory issues that would plague this questionnaire would still bother me here)? Even though most of the participants probably would have missed the vaccine, some may have gotten it.
  7. The results also showed a 5-20% increase in risk of CVD for women who had either mumps or measles. That result alone throws into question the whole study, because the results are all over the place.

Can one use this article to claim that mumps and measles infections prevent heart disease and stroke? Not really. The best I can say, and I’m doing this with a lot of trepidation, is that this study provides us with observational data, not a confirmation or refutation of a hypothesis about mumps and measles infections. It certainly does not give us any reason whatsoever to change public health priorities in vaccinating against mumps and measles despite the anti-vaccine tropes.

 

Notes

  1. A hazard ratio describes a ratio of hazard rates between two events. In the case of this study, if the rate of cardiovascular disease mortality for the mumps infected group is 1.0 and it’s 2.0 for the non-infected group, then the hazard ratio is 0.5. That is the mumps infected group is only 50% as likely to have died of cardiovascular disease as the non-infected group.

 

Citations:

Vaccines prevented 200 million cases of disease in the USA from 1963 to 2015

vaccines prevented

Lest we forget, vaccines are one of the greatest medical inventions of all time. Without them, we would see cemeteries filled with children who would have died before they were even five years old.  In fact, the best evidence we have tells us that vaccines prevented 200 million cases of diseases in the USA alone in the five decades since 1963.

A recent study, published in AIMS Public Health, estimates that around 200 million cases of polio, mumps, rubella, measles, adenovirus, hepatitis A and rabies have been prevented in the U.S. from 1963 through 2015 as a result of widespread vaccination. The study, authored by Leonard Hayflick and S. Jay Olshansky, two leading experts on public health and infectious diseases, also discloses that about 450,000 deaths have been avoided in the U.S during this period, although other studies put that estimate of lives saved at a much higher number.

Dr. Hayflick discovered the human cell strain, WI-38, in 1962 which was critical to the safe manufacturing of vaccines, which became widespread in 1963. According to the article, the vaccines produced from the WI-38 cell line prevented almost 4.5 billion occurrences of the diseases, and stopped them from returning to infect us. Dr. Hayflick developed the foundation that allowed the world to have relative safe and very effective tools to prevent infectious diseases.

Prior to the development of WI-38, anti-virus vaccines were grown in monkey cells, which had some issues that made many question their safety, although most of the concern appeared to be overblown. However, once the WI-38 was available, it became easier to develop and produce vaccines for many viruses.

Drs. Hayflick and Olshansky wanted to see what effect that seminal event had on public health. And the numbers were incredible. Continue reading “Vaccines prevented 200 million cases of disease in the USA from 1963 to 2015”

Mumps outbreaks in 2016 – highest number in over a decade

mumps outbreaks

Over the past few years, there have been outbreaks of diseases we all assumed had been eradicated – chicken pox, measles, and, more recently, mumps. According to a report from the Centers for Disease Control and Prevention (CDC), there were over 4,000 mumps cases in the USA in 2016. Mumps outbreaks may be the new normal thanks to clusters of unvaccinated kids.

The mumps vaccination program started in 1967 – before that there were about 186,000 cases reported each year (and that number might be low because of underreporting). Once mumps vaccinations were commonplace, the incidence of the disease fell by over 99%. For those who think that better sanitation or whatever caused decreases in diseases, I think that 1967 is fairly recent, and it’s clear that the vaccine itself started the precipitous drop in mumps outbreaks. Since the start of the vaccine era, annual mumps cases in the USA hovered below 1,000 during most years. But over the last 10 years, there has been a noticeable uptick in annual cases, with a high of over 6,000 cases in 2006.

Let’s examine the mumps outbreaks and see what may be the cause. Spoiler alert – expect Andrew Wakefield’s name to appear.

Continue reading “Mumps outbreaks in 2016 – highest number in over a decade”

Arizona measles outbreak – blame anti-vaccine employees

Arizona measles outbreak

Here we go again. Department of Health Services officials in Arizona  have reported that 22 confirmed measles cases in the state associated with a Federal immigration detention facility. This Arizona measles outbreak has one source – Federal employees of that facility who refused to get vaccinated against measles.

We all know why people don’t vaccinate their children with the MMR vaccine against measles, mumps and rubella – the zombie myth that vaccines cause autism, which has been so utterly debunked that it gives new meaning to the word, debunked.

Let’s take a look at the root of the Arizona measles outbreak. I’m sure there are lessons to be had there.

Continue reading “Arizona measles outbreak – blame anti-vaccine employees”

Andrew Wakefield – dishonest attempt at self-justification

Andrew Wakefield

The movie Vaxxed is an anti-vaccine polemic that claims, despite all of the high quality contradictory evidence, that there is a link between the MMR vaccine, for mumps, measles and rubella, and autism. Furthermore, it claims that the US government is engaging in a conspiracy to hide said link. Reviews of the film have appropriately emphasized the checkered past of its director, Andrew Wakefield, a discredited ex-scientist with a history of misrepresentations. Many of the reviews point out that Wakefield is not a credible source for information on vaccines.

In a recent video posted on the Vaxxed website, Andrew Wakefield took those claims head on, mounting a passionate defense of his reputation. If anything, however, this video further shows that Wakefield is not a good source of information.

The video’s claims range from unsupported (and implausible) to blatantly false. Unfortunately for Wakefield, Brian Deer meticulously documented each step in the events, making it relatively easy to identify the problems in these claims. Unfortunately for the rest of us, Wakefield’s adherents are unlikely to check his claims, and others may also accept his word without fact-checking. It’s therefore worth going through the claims.

To hear Wakefield, he was the victim of a conspiracy mounted because he dared raise safety concerns about vaccines. But as with his book, Callous Disregard (pdf), Wakefield’s claims are ill founded. In short, there are good reasons he lost his license and his reputation as a serious scientist.

A brief review of the history of this story – in 1998, Wakefield and co-authors published a paper suggesting that the measles component of the measles-mumps-rubella (MMR) vaccine caused changes in some children’s guts, and that those changes were associated with autism.

In 2007, after extensive investigation by Brian Deer published at The Sunday Times, Britain’s General Medical Council (GMC) opened an investigation of their own to answer the question: Did Wakefield engage in serious professional misconduct?  In May 2010, the GMC found that yes, he did, and removed Wakefield from the British medical register (pdf).

Wakefield’s claims in the Allegations video can be put into three categories:

  1. there were no serious ethical violations or fraud in relation to the article he published in the Lancet;
  2. he’d done nothing wrong otherwise, measles outbreaks are not his fault, the GMC decision was generally wrong, and Walker-Smith’s acquittal shows that; and
  3. Brian Deer’s articles are a fraud motivated by a conspiracy.

None of these claims hold water.

Continue reading “Andrew Wakefield – dishonest attempt at self-justification”

Harvard mumps outbreak – not an indictment of vaccines

Harvard mumps outbreak is attracting the anti-vaccine activists.

And here we go again. An outbreak of a vaccine preventable disease is used by the anti-vaccine crowd to indict all vaccines. Recently, the Harvard mumps outbreak has made the news after about 41 students contracted the disease. And myths arise.

Since most of those who caught the disease were vaccinated with the MMR vaccine, which protects against measles, mumps, and rubella, the anti-vaccine interwebs are jumping up and down pointing at the pro-science people and saying, “neener neener, vaccines don’t work.” Yeah, they’re that immature. And they are absolutely wrong.

Let’s take a look at the whole story, including some very simple math, which even science deniers should understand. Then we can thoroughly debunk the tropes pushed by the vaccine deniers. This should be fun.

Continue reading “Harvard mumps outbreak – not an indictment of vaccines”

Merck whistleblowers – mumps and motions – updated

merck whistleblowers

In August 2010 Stephen A. Krahling and Joan A. Wlochowski (“the relators”), former Merck virologists and often called “Merck whistleblowers,” filed suit in the name of the United States – a so-called qui tam action, where the prosecution shares any fines or penalties with the two virologists  – against Merck.

They claimed that by faking effectiveness testing, Merck misled the United States government as to the effectiveness of the mumps component of its  MMRII vaccine (a vaccine which protects individuals against mumps, measles and rubella). In 2012  a clinic and two MDs filed a class action against Merck claiming violation of the Sherman Act – monopolistic, anti-competitive behavior resulting from the fraud – and violation of various state laws. (U.S. v. Merck and Chatom v. Merck). The suits were handled together. Continue reading “Merck whistleblowers – mumps and motions – updated”

Vaccines saved lives – scientific evidence

There are many canards propagated by the vaccine deniers to support their personal beliefs (really, denialism) about the safety and effectiveness of vaccines. One of their more popular beliefs is that vaccines didn’t end many of the deadly diseases, but improved sanitation, healthcare, nutrition or magical fairies (also known as homeopathy) ended these diseases.

There is even a subgroup of these believers who think that the CDC, historians, and everyone else is lying about the epidemics that existed prior to vaccinations–let’s call this group history deniers. They reject the scientific and historical evidence that vaccines saved lives – amazing.

So, is there scientific evidence that vaccines actually ended these epidemics? Yes there is, and it’s unequivocal. Unless you want to embrace historical revisionism, and somehow all of the health care records and epidemiological information was faked, vaccines saved lives – lots of lives. Continue reading “Vaccines saved lives – scientific evidence”

Vaccines aren’t tested – myth vs. science (updated)

There are so many silly memes that have arisen from the vaccine deniers, most of which have been thoroughly debunked. Everything from the well-worn (and worn-out) “vaccines cause autism” fable, which I have quashed here, to the “these diseases aren’t dangerous”, which, of course, couldn’t be farther from the truth.

One of the more annoying of the tales pushed by the vaccine refusers is that vaccines aren’t tested thoroughly before being used on unsuspecting infants. I do not know where this started, or why it started, but like much in the anti-vaccination world, it really doesn’t matter. It just passes from one person to another across google, and individuals with no research background hold this particular belief as if it were the Truth™.

Not only are vaccines thoroughly tested for safety and efficacy before being marketed, they also are rigorously tested in various combinations with other vaccines. And I’m not Cherry Picking a few articles to support my point of view, unless by cherry-picking you mean I’m picking the best articles from the highest quality journals in medicine.
Continue reading “Vaccines aren’t tested – myth vs. science (updated)”