Respectful Insolence

As hard as it is to believe, I’ve been blogging nearly nine years. Indeed, my nine-year anniversary is coming up in just over a week. It’s been almost a decade! Early on during near-decade that I’ve been laying down bits of Insolence, Respectful, and Not-So-Respectful, I developed an interest in the antivaccine movement. Antivaccinationism, “antivax,” or whatever you want to call it, represents a particularly insidious and dangerous form of quackery because it doesn’t just endanger the children whose parents don’t vaccinate them. It also endangers children who are vaccinated, because vaccines are not 100% effective. The best vaccines have effectiveness rates in the 90%-plus range, but that still leaves somewhere up to 10% of children unprotected. Worse, because herd immunity requires in general approximately 90% of the population and above to be vaccinated against a vaccine-preventable disease to put the damper on outbreaks, it doesn’t take much of a degradation of vaccination rates to put a population in danger of outbreaks. That’s why, even though overall vaccine uptake is high in the US, we still see outbreaks, because there are areas with pockets of nonvaccinators and antivaccinationists who drive vaccine uptake down to dangerous levels. We’ve seen this in California and elsewhere. Other countries have observed even more dramatic examples, the most well-known being the way that fear of the MMR vaccine stoked by Andrew Wakefield’s bad science and the fear mongering of the British press led MMR uptake to plummet. The result? Measles came roaring back in the UK and Europe, from having been considered under control in the 1990s to being endemic again by 2008.

As much as I get chastised by concern trolls for saying this, to antivaccinationists it really is all about the vaccines. Always, always, always, always. They blame vaccines for autism, other neurodevelopmental conditions, and a wide variety of chronic diseases, without evidence that there is even a correlation. They even falsely blame sudden infant death syndrome (SIDS) on vaccines, even though there is no evidence of an association and, indeed, existing evidence suggests that vaccines likely have a protective effect against SIDS more than anything else. No matter what happens, no matter what the evidence says, antivaccinationists will always find a way to blame bad things on vaccines, even going so far as to claim at times that shaken baby syndrome is a misdiagnosis for vaccine injury.

One thing, however, that is often forgotten, is that antivaccinationists also do their utmost to downplay the beneficial effects of vaccines. One such tactic is for antivaccinationists to claim that the pertussis vaccine doesn’t work because we are seeing resurgences of pertussis even in the face of high vaccine uptake. For example, another common trope is what I like to refer to as the “vaccines didn’t save us” or the “vaccines don’t work” gambit, in which it is pointed out that the introduction of vaccines don’t correlate tightly with drops in mortality from various diseases. Julian Whitaker even used this gambit when he debated Steve Novella. The fundamental flaw in this trope neglects the contribution of better medical care to the survival of more victims of disease, which decreased mortality. If you look at graphs of disease incidence you will see a profound and powerful effect of the introduction of vaccines on specific vaccine-preventable diseases. In other words, vaccines work.

Over the Thanksgiving long weekend here in the US, there appeared a study that simply emphasizes once again that vaccines work. More importantly, it estimates how well they work. I’ve frequently said that vaccines are the medical intervention that have saved more lives than any other, and this study by investigators at the University of Pittsburgh’s graduate school of public health, published on Thanksgiving Day in the New England Journal of Medicine (NEJM) and showing up on the news the day before provides yet more evidence to support my assertion. In one way, it’s a shame that it was published over a long holiday weekend here in the US, where it was unlikely to garner as much attention as it normally might have at another time. On the other hand, it was Thanksgiving, and if there is anything we should be thankful for it’s that so few children die of vaccine-preventable diseases anymore. This study simply underlines this.

What the authors did was a massive undertaking that involved going back over case reports from before and after times when specific vaccines became commercially available. Boiled down to its essence, the study examined these reports and came up with estimates for cases of a disease prevented based on the drop in cases after the vaccine for that disease came into widespread use, and they did it all the way back to 1888. From the Methods section of the paper:

In an effort to overcome these limitations, we digitized all weekly surveillance reports of nationally notifiable diseases for U.S. cities and states published between 1888 and 2011. This data set, which we have made publicly available (www.tycho.pitt.edu), consists of 87,950,807 reported individual cases, each localized in space and time. We used these data to derive a quantitative history of disease reduction in the United States over the past century, focusing particularly on the effect of vaccination programs.

We obtained all tables containing weekly surveillance data on nationally notifiable diseases that were published between 1888 and 2011 in the Morbidity and Mortality Weekly Report and its precursor journals from various online and hard-copy sources.21-24 We digitized all data available in tabular format that listed etiologically defined cases or deaths according to week for locations in the United States. Reported counts (weekly tallies) of cases or deaths and the reporting locations, periods, and diseases were extracted from these data and standardized. Then we selected eight vaccine-preventable contagious diseases for more detailed analysis and computed weekly incidence rates, deriving a quantitative history of each disease.

We estimated the number of cases that have been prevented since the introduction of vaccines for seven of the eight diseases. (Since there were no data from the era before the introduction of the smallpox vaccine in 1800, we could not quantify the number of smallpox cases that were prevented by the vaccine.) We estimated the numbers of cases of polio, measles, rubella, mumps, hepatitis A, diphtheria, and pertussis that were prevented by vaccines by subtracting the reported number of weekly cases after the introduction of vaccines from a simulated counterfactual number of cases that would have occurred in the absence of vaccination, assuming that there were no other changes that would have affected incidence rates. We used the year of vaccine licensure as the cutoff year to separate the prevaccine period from the vaccination period. Counterfactual numbers were estimated by multiplying the median weekly incidence rate from prevaccine years with population estimates for vaccination years.

Yes, you read that right: nearly 88 million reported individual cases. The New York Times news report on the study points out that this massive digitization of data was performed by Digital Divide Data, described as “a social enterprise that provides jobs and technology training to young people in Cambodia, Laos and Kenya.” However, getting the data digitized and organized into spreadsheets was only the first step. Massive databases and spreadsheets are not particularly useful if they aren’t in a form that can be queried to answer research questions. The data thus had to be standardized and sorted in order to allow for that. Once that was done, the investigators were able to conclude since 1924:

Assuming that the difference between incidence rates before and after vaccine licensure for these diseases was attributable solely to vaccination programs, we estimated that a total of 103.1 million cases of these contagious diseases have been prevented since 1924 on the basis of median weekly prevaccine incidence rates. Estimates based on the 10th and 90th percentile of weekly prevaccine incidence rates were 72.3 million and 147.8 million cases, respectively. Of those hypothetical cases, approximately 26 million were prevented in the past decade. Sensitivity analyses that used different methods for imputing missing data and for simulating counterfactual cases resulted in estimates ranging from about 75 million to 106 million prevented cases. The number of cases that were prevented per disease depended on the incidence rate before vaccination and the duration of the vaccination program.

If you delve into the paper, you’ll find a really cool interactive graphic about disease elimination in the US, specifically hepatitis A, measles, mumps, pertussis, polio, rubella, and smallpox. As you move your cursor to different points of the graph, different facts and statistics pop up. You can look at state level data. If you click on different lines indicating when a specific vaccine was first licensed, all the other lines representing the other diseases disappear, and you see the data only for that disease. For instance, if you look at when the measles vaccine was first licensed in 1963, you’ll see a brief blip upward in measles incidence well within the range of random variation followed by a drop to almost zero by 1968, a mere five years after the vaccine was licensed. The pertussis vaccine took a bit longer; after it was licensed in 1948 it took around 8 years before the disease incidence hit bottom. Particularly cool is a set of graphs in Figure 2 that show snapshots of disease elimination in the US for different diseases and the entire country divided up into ten different areas. It’s particularly striking and an effective way of demonstrating the effect of vaccines on infectious disease:

VaccinesWork

The investigators were very conservative about their assumptions, as well. The authors point out in the discussion that their estimate of number of cases of diseases prevented is probably an underestimate. The reasons include an inability to include all vaccine-preventable diseases and to correct for underreporting of cases. They note that the underreporting rate was higher in the era before specific vaccines came into use and that they don’t always have the detailed historical demographic data, such as birth rates and age-specific disease incidence rates, that would enable them to make such adjustments. Unfortunately, such data are only available for a small number of locations and for limited periods of time.

One weakness of the study is that the authors could not examine death rates in nearly as much detail as they could study incidence. They could only estimate the effect of various vaccines on death rates. Hence, they did not report death rates in the NEJM article because, according to the NYT article, death certificate data became sufficiently reliable and consistent only in the 1960s. They could, however, make a reasonable estimate of three or four million deaths prevented based on the known mortality rates of the diseases studied in the database.

The real accomplishment of this project is not so much the first publication, but rather the open-source Project Tycho™ database, named after Danish scientist Tycho Brahe (1546—1601), who was known for his detailed astronomical and planetary observations. The reason for choosing Tycho Brahe becomes obvious if you know that Tycho could not use all of his data during his lifetime. However, his assistant Johannes Kepler (1571-1630) used his data to derive the laws of planetary motion. As the authors put it:

Similarly, this project aims to advance the availability of large scale public health data to the worldwide community to accelerate advancements in scientific discovery and technological progress.

And:

The database contains three levels of data. Level 1 data were the basis of the NEJM article, and “include different types of counts that have been standardized into a common format for a specific analysis published recently in the NEJM.” Level 2 data are defined thusly:

Level 2 data only includes counts that have been reported in a common format, e.g. diseases reported for a one week period and without disease subcategories. These data can be used immediately for analysis, includes a wide range of diseases and locations but this level does not include data that have not been standardized yet.

While Level 3 data are defined:

Level 3 data include all the different types of counts ever reported. Although this is the most complete data, the large number of different counts requires extensive standardization and various judgment calls before they can be used for analysis.

All of these data are broken down into diseases, states, and cities, as well as time periods. Level 1 data include eight diseases, 50 states and 122 cities from 1916-2009; Level 2, 47 diseases, 50 states, 1,287 cities from 1888-2013; and Level 3, 56 diseases, 72 disease subcategories, 3,000 cities, etc. from 1888-2013. Any investigator can establish an account to look at Level 1 and Level 2 data, although the University of Pittsburgh won’t give out Level 3 data to anyone, because the database contains “substantial number of counts for which the disease name, time period, or location has not yet been identified from contextual information.” To get an idea of the power of this database, it’s useful to take a look at a couple of short videos:

And:

As you can see, this is a fantastic resource that is likely only to get better with time as raw data are curated, organized, and put into a form that can be mined for correlations. Epidemiologists, vaccinologists, and infectious disease researchers will be able to use this resource to ask questions and look at historical comparisons in a way that they haven’t been able to do before because of the difficulty in reconstructing old disease patterns. No wonder the Bill and Melinda Gates Foundation funded this work!

There is one concern I have about the project, although it does not in any way outweigh the potential usefulness of this database. That concern derives from what I know of bad science generated by antivaccinationists. I can easily see antivaccine “scientists” mining this database in ways to look for correlations to support their agenda, particularly if they get their hands on the raw data, which, according to the authors, needs a lot of cleaning:

These data have not been filtered or standardized and cannot be used for analysis. These data include a large variety of data counts and often varying types of information. In this level, multiple types of data counts are often available for one location, disease, and week. In some cases, different counts provide conflicting information on a location and disease. The use of data from this level requires extensive knowledge of the historical U.S. disease surveillance system and data digitization and quality control procedures. We continue to standardize data and will include newly standardized data in the level 2 data section of this website at regular intervals. These level 3 data are provided for those that are interested in contributing to the data standardization process.

Can you imagine what Jake Crosby might do with such a data set? Or Mark and David Geier? Just take what they’ve tried to do with the VAERS database and the Vaccine Safety Datalink and put it on steroids. I rather expect that various antivaccine “scientists” have already registered accounts for Project Tycho™ and are furiously mining ever smaller slices of data trying to see if they can “prove” that vaccines don’t work or linking their work with other databases to try to correlate vaccine uptake with autism.

Still, any database can be abused, as can any scientific tool. Given how antivaccine activists abuse science itself, any new tool that legitimate scientists can use to advance scientific knowledge has the potential to be abused by cranks. If the database is truly open source, then its creators are obligated to provide access to everyone who requests it. The benefits of such a resource far outweigh the risk that Jake Crosby, Mark Geier, Gary Goldman, or other epidemiologist wannabes might use it to produce nonsense. Besides, the correlations between the introduction of various vaccines and plunges in the incidence of the diseases being vaccinated against are so robust that I doubt the antivaccinationists can do any real serious harm, other than producing studies to use to preach to the choir with. Meanwhile, real scientists will be using the database to do real science and ask important questions about infectious disease and how it can be prevented with vaccines.

Comments

  1. #1 cakesphere
    December 4, 2013

    With the deluge of crap that antivaccinationists put out regularly, it is always gratifying to see a study that kicks the chair out from under them.

    As I lie here in bed with an awful cold, I am grateful for the fact that it is nothing worse, thanks to modern medicine :)

  2. #2 Denice Walter
    December 4, 2013

    The latest aria in the “Vaccines Didn’t Save Us” repetoire is:
    Dissolving Illusions: Disease, Vaccines and The Forgotten History” by Suzanne Humphries and Roman Bystrianyk.
    ( see Amazon)

    From excerpts and discussion I’ve heard, it seems that large cities were overflowing and afloat in poo 100 years ago which led to epidemics – the amount and distribution of said poo is examined in great detail: poo in Lnndon, poo in Paris, poo in NY-

    -btw- felicitations, Orac!

  3. #3 Sarah A
    December 4, 2013

    The side-by-side comparison shown in this figure, showing drops in incidence at different time points for each disease, and always after the introduction of a vaccine, ought to be enough to convince any rational person that vaccination, not improved hygiene and/or nutrition, is responsible. Of course, if antivaxers were rational they wouldn’t be, well, antivaxers. No study (not even the vax vs unvax study they keep whining for) is ever going to convince committed antivaxers, but hopefully studies like this one will get through to concerned parents who are trying to decide whether or not to vaccinate their kids.

  4. #4 palindrom
    December 4, 2013

    Denice @1 — You mean, they already had flush toilets back in the 1950s when the polio vaccine came in?

    Well, I’ll be.

  5. #5 Denice Walter
    December 4, 2013

    @ palindrom:
    Oh I know!
    At any rate, the book has its own eponymous website WITH GRAPHS!

  6. #6 AnObservingParty
    December 4, 2013

    “But this doesn’t address the most recent, important epidemic!!” I can already see the comments stating this. Except they’ll be all-caps, with gross misspellings and grammar that looks like a drunk-text.

  7. #7 Sarah A
    December 4, 2013

    From excerpts and discussion I’ve heard, it seems that large cities were overflowing and afloat in poo 100 years ago which led to epidemics

    Do they even attempt to explain what all this poo had to do with airborne diseases like measles and pertussis, or is that a silly question? This is a shining example of the strong elitist element I’ve noticed in a lot of antivax rhetoric: my child doesn’t need vaccines because only dirty poor people get sick.

  8. #8 Lawrence
    December 4, 2013

    @Sarah – correct….look at the way that Bill & Melinda Gates are vilified by the anti-vax movement for pushing for vaccines in the 3rd World (and of course, they totally miss the other areas of the Gates’ Grants, which include improved sanitation technologies, etc).

  9. #9 AnObservingParty
    December 4, 2013

    @ Lawrence @ Sarah A

    Exactly and exactly. Worrying about non-existent vaccine safety concerns is very much a G-8 World Problem (I don’t say “first world” anymore because that’s a Cold War remnant and the Cold War is over). Especially since you see sites like Vac Truth posting things like, “if increased sanitation reduces disease, why don’t we work on that instead of sending vaccines to these countries?” Ummm….because most of what we vaccinate for 1) is airborne or droplet transmission, 2) polio in 1950s US? 3) Gates is doing that. But it’s multi-pronged, and that won’t fix the vaccine thing. These people don’t have a basic understanding of pathogen transmission.

  10. #10 Jeff1971
    December 4, 2013

    And then, of course, didn’t these diseases rip through indigenous people all round the world, killing millions? Ya know, those folk eating the nuts and berries, gluten free diets, no dental amalgam, no big pharma. Just good healthy, dead, natives.

  11. #11 JustNuts
    December 4, 2013

    @Denise: I’ve seen the “public sanitation (toilets & sewers) saved us” statement so many times in anti-vax blogs that I keep this vaccine preventable diseases transmission mode list handy for response:

    * Adenovirus – Respiratory
    Anthrax – Respiratory
    Diptheria – Respiratory
    Tetanous – Injury/penetrating wounds
    Pertussis – Respiratory
    Hepatitis A – Fecal/Oral
    Hepatitis B – Bloodborne & body fluids
    Haemophilus influenzae type b – Respiratory
    Human Papilloma Virus – Sexual transmission
    Influenza – Respiratory
    Japanese Encephalitis – Mosquito (vector)
    Measles – Respiratory
    Mumps – Respiratory
    Rubella – Respiratory
    Meningococcus Pnuemonia – Respiratory
    Pneumococcus – Respiratory
    Polio – Fecal/Oral
    Rabies – contact with infected animal (vector)
    Rotavirus – Respiratory
    Shingles – Residual from prior Varicella infection
    Smallpox – Respiratory
    Typhoid Fever – Fecal/Oral
    Varicella – Respiratory
    Yellow Fever – Mosquito (vector)
    (* Discontinued)

    Only Hep A, polio and typhoid have a fecal/oral transmission mode!

  12. #12 AnObservingParty
    December 4, 2013

    Adenovirus is listed as Contact, even though it’s a respiratory virus, in the CDC Transmission Based precautions. So *maybe* handwashing would help. Maybe. And Hep A still spreads quite readily in countries with toilets, because people don’t wash their hands and then make food. Or raw oysters, I like raw oysters.

  13. #13 Jacob
    New Orleans
    December 4, 2013

    @ Denice

    Well, Suzanne Humphries has a nice entry in the encyclopedia of American Loons.

    http://americanloons.blogspot.com/2013/11/783-suzanne-humphries.html

    I wish that we could make requests for this. I noticed on several Orac posts, you have called out Kelly Brogan MD, a Sayer Ji lover at greenmedinfo.com. How has she escaped the notice of the American Loons folks? Or Orac for that matter?

  14. #15 JustNuts
    December 4, 2013

    OOPS – Cholera needs to be added to that list, it’s fecal/oral too.

  15. #16 Lawrence
    December 4, 2013

    @Jeff – and of course, in many developing countries, there is very little access to basic medical care & no access to advanced medical care that we take for granted (no ERs, etc) – so preventing diseases in the first place is really the only way to reduce mortality rates…..something that the anti-vax folks seem to conveniently forget.

    The 1.5mil people that still die every year of the measles doesn’t seem to be a bother….

  16. #17 Sarah A
    December 4, 2013

    @JustNuts and AOP

    Yes, I noticed that in the figure in the post Hep A is still going strong right up to until the vaccine was licensed in the mid-1990s. And ironically, polio didn’t become an epidemic disease until after improvements in sewage treatment, and it was actually more common among children of higher socioeconomic status. It’s thought that sewage treatment and better hygiene resulted in children being exposed to the virus at a later age, increasing the chances of severe disease.

  17. #18 AnObservingParty
    December 4, 2013

    Exactly @ Sarah A. Kids weren’t playing in “ditch liquor” anymore as toddlers. But those are all rational, evidence-based conclusions. They have no place in antivax rhetoric.

  18. #19 Deepsix
    December 4, 2013

    Anti-vax folks always make me think of this: http://www.theonion.com/articles/my-baby-dont-want-no-medicine,10757/

  19. #20 palindrom
    December 4, 2013

    Deepsix — Ah, good old Amber Richardson, the “author” of this absolute classic :

    http://www.theonion.com/articles/i-hope-my-baby-doesnt-come-out-all-fuckedup-and-sh,10917/

    Next to Herbert Kornfeld and Smoove B, Amber’s one of my favorite Onion “commentators”.

  20. #21 Shay
    December 4, 2013

    I kind of liked playing in ditches as a kid. Children today miss so much.

    JustNuts, thank you for that list, I’m adding it to my files.

  21. #22 ebohlman
    http://turnipsandpotatoes.wordpress.com
    December 4, 2013

    Lawrence: IIRC, measles deaths are now down to a tenth of that, about 150K/yr, with most of the decline having occurred in the last 15 years. Essentially all of the decline occurred in places where the only thing that changed during that period was the institution of an aggressive vaccination program.

  22. #23 lilady
    December 4, 2013

    I would need a 1:1 personal tutorial to be able to work the TYCHO program (I’m so computer skills deficient).

    @ JustNuts: Nice breakdown on the routes of transmission of V-P-Ds. One of my favorite comments, when replying to a troll on a science blog, who pulls that hygiene/indoor toilets gambit is to query the troll:

    - Which vaccine-preventable-disease is spread through the fecal-oral route?

    -Which vaccine-preventable-disease is spread through sexual contact/exposure to infected blood?

    -Which vaccine-preventable-disease is spread via the airborne/respiratory droplets/respiratory secretions exposure route?

    You guys had indoor flush toilets when you were growing up?

  23. #24 Chris
    December 4, 2013

    JustNuts, you need to add typhus, fleas are the vector.

    I was vaccinated for as an infant, along with typhoid and yellow fever, since I was born in the Panama Canal Zone.

    Also there is tuberculosis.

  24. #25 Gray Falcon
    December 4, 2013

    Then you have the truly bizarre: Those who claim that smallpox and polio are still around. The level of conspiratorial paranoia and outright gullibility required to believe that boggles the mind.

  25. #26 Dangerous Bacon
    December 4, 2013

    But flea-borne epidemics are excellent for stimulating the immune system!

    I read that in “Tom”s Terrific Typhus”, now available on Amazon and a great gift for the moms and dads on your Xmas list.

  26. #27 Renate
    December 4, 2013

    @ Dangerous Bacon
    “Tom’s Terrific Typhus”?
    Would that be written by the same author as
    “Melissa’s Marvelous Measles”?
    And I don’t think that was Roald Dahl.

  27. #28 lilady
    December 4, 2013

    BCG Vaccine for TB is not on the CDC Childhood Recommended Vaccine Schedule, nor is Typhoid Vaccine (S. Typhi) on that schedule:

    http://www.cdc.gov/VACCINES/vpd-vac/typhoid/default.htm

  28. #29 AnObservingParty
    December 4, 2013

    It still is in a lot of European countries, lilady. I am curious to see if the US schedule will ever change if MDR-TB becomes more of a concern in the US.

    “Tom’s Terrific Typhus?” OMG.

    Someone should write, “Sarah’s Super Smallpox.”

    Page 1: She died.

  29. #30 Denice Walter
    December 4, 2013

    For your enlightenment and entertainment-

    Humphries appears @ Null’s Show ( see PRN/ GN Show/ 11/08/13- at 41 minutes in)
    supposedly, earlier crapisodes lead up to her appearance wherein public poo, rotten food, poisoned water, dead bodies ( animals and human) in the streets and river and children working in coalmines are indeed the causation of illness.

    So I imagine that writers like Shaw, Wilde, Wharton and James created an entirely false picture of late Victorian candy@ss London and NY: they left out the crap sullying those splendid drawing rooms.

  30. #31 Chris,
    December 4, 2013

    lilady, JustNuts list included Japanese encephalitis and typhoid, so I assumed he was covering all international vaccines.

    The interesting thing is that some of those diseases were better controlled by sanitation and vector control than the vaccines. Malaria and yellow fever often happened in the USA until the early twentieth century.

  31. #32 lilady
    December 4, 2013

    AnObservingParty: It’s not the MDR-TB I’m worried about; it’s the XDR-TB which is a concern. The United States invested hundreds of millions of dollars to set up TB Control programs (early 1990s), when the full force of the combined HIV/TB active TB infections showed up, to institute DOT (Directly Observed Therapy) with the hiring of thousands of field workers actually observing TB cases taking their medication. That public health initiative was a good investment.

    http://jama.jamanetwork.com/article.aspx?articleid=182876

  32. #33 Budget Player Cadet
    December 4, 2013

    Anyone know who funded this study? I don’t particularly care, but my facebook is full of morons…

  33. #34 AnObservingParty
    December 4, 2013

    @ lilady,

    Umbrella, we don’t differentiate at my facility between MDR and X simply because we have yet to have an X. But yes, it is scarier. Shoot, susceptible TB causes a panic, and it’s very treatable. Even if that were to become endemic again….I’d get a BCG.

  34. #35 AnObservingParty
    December 4, 2013

    OT: Anybody watching the false equivalency on Katie today for HPV? I forgot to set my DVR….

  35. #36 Orac
    December 4, 2013

    Anyone know who funded this study?

    The Bill and Melinda Gates Foundation funded Project Tycho.

  36. #37 Lawrence
    December 4, 2013

    Oh no Orac….you know what that means…..

  37. #38 Dangerous Bacon
    December 4, 2013

    There’s a website that randomly (?) jumbles up and assorts news headlines from around the Internet into new, bizarre and often entertaining headlines.

    I mention this because they occasionally come up with one that fits right in with the daft world of antivaxery.

    A case in point is the headline “Autism linked to autism”.

    http://www.headlinesmasher.com/best

  38. #39 Eric Lund
    December 4, 2013

    Then you have the truly bizarre: Those who claim that smallpox and polio are still around.

    Polio is still around in a few countries, notably Pakistan, where the CIA used a vaccination program as cover for a DNA sampling operation to track down Osama bin Laden’s whereabouts. The result of that particular brilliant idea is that vaccination crews in much of rural Pakistan are now at risk of being shot by Islamist extremists. So we still have to vaccinate against polio, just in case some susceptible traveller visits one of those countries and becomes infected. That would be the same mechanism by which recent pertussis and measles epidemics have occurred in the West.

    Smallpox has indeed been eradicated in the wild worldwide. There was some debate a few years back about whether to destroy the last two remaining samples of the virus (one in the United States, the other in a comparable facility in Russia).

  39. #40 Krebiozen
    December 4, 2013

    Before modern medicine most people died of diarrhea (or possibly malaria), so improved hygiene did have a massive effect on people’s health. It altered mortality, especially infant mortality, from ‘appalling’ to merely ‘awful’, and made diseases transmitted by the respiratory route more obvious as fewer people died of typhoid, cholera and dysentery – they died of measles, pertussis and influenza instead. It took vaccines to reduce mortality from ‘awful’ to where we are today.

    It does seem strange that the CAM brigade, who are always going on about prevention, are often opposed to vaccination, which is an extraordinarily safe and effective way of preventing diseases.

  40. #41 Krebiozen
    December 4, 2013

    AOP,

    I am curious to see if the US schedule will ever change if MDR-TB becomes more of a concern in the US.

    I don’t think BCG is that effective at preventing TB, since we are all given BCG as children in the UK, and we have a growing problem with TB too. Presumably that’s why it isn’t used routinely in the US.

  41. #42 Michael Willems
    Canada
    December 4, 2013

    Orac – I have been following you for nine years, since you started. Keep it up. You are an inspiration. I blog too, but about photography (www.speedlighter.ca), and I do a daily post – but I have only been going for four years. Hats off to you.
    -Michael

  42. #43 Michael Willems
    Oakville, Ontario, Canada
    December 4, 2013

    Perhaps this FROM address gives us the proper picture…

  43. #44 dingo199
    December 4, 2013

    Neat. Thanks Orac.
    Anyone tell me why “Pellagra” is listed among the infectious diseases on the Tycho project?

  44. #45 dingo199
    December 4, 2013

    BCG is a pretty ineffective vaccine for preventing TB really.
    It can reduce disease burden in kids, and can reduce complication rates of things like TB meningitis, but doesn’t really do much else.

  45. #46 Tsu Dho Nimh
    December 4, 2013

    But you know they just renamed them all – the vaccines haven’t stopped anything.

    polio has been renamed acute flaccid paralysis and all the crippled kids are in FAMA camps.

  46. #47 Tsu Dho Nimh
    December 4, 2013

    @42 … “Anyone tell me why “Pellagra” is listed among the infectious diseases on the Tycho project?”

    Because it was thought to be an infectious disease for a while?

  47. #48 SteveJ
    December 4, 2013

    @dingo199
    In the early part of the 20th century, pellagra was thought to be an infectious disease. In fact there was resistance to the idea that it was malnutrition. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2589605/

  48. #49 Krebiozen
    December 4, 2013

    Don’t forget smallpox has been relabeled as monkey pox, or even chicken pox according to some loons.

  49. #50 Narad
    December 4, 2013

    The real accomplishment of this project is not so much the first publication, but rather the open-source Project Tycho™ database, named after Danish scientist Tycho Brahe (1546—1601), who was known for his detailed astronomical and planetary observations.

    As an off-topic item that maybe two regulars are likely to take the slightest note of, mention of Brahe stirs an urgency in me to note that the insistence upon extending Bayer–Flamsteed nomenclature to novae* is defensible only on the basis of the locative ablative, not Bayer’s partitive genitive.** It does not matter that they’re usually the same form. Moreover, the construction is English. The only reason that this pseudo-Latin posturing saddles the literature, IIRC, is because somebody at the the RAS was asleep at the switch.

    * Yes, I know the difference. That’s not the issue.
    ** Sorry, W——pedia. Oh, and it sure the f*ck isn’t the “possessive,” so maybe you could clean that up.

  50. #51 Rebecca
    Ithaca, New York
    December 4, 2013

    #25 – Unfortunately, polio *is* still around. There’s currently an outbreak in Syria. From NPR today:

    The World Health Organization has declared a polio emergency in Syria. After being free of the crippling disease for more than a decade, Syria recorded 10 confirmed cases of polio in October. Now the outbreak has grown to 17 confirmed cases, the WHO said last week. And the virus has spread to four cities, including a war-torn suburb near the capital of Damascus.

    The Syrian government has pledged to immunize all Syrian children under age 5. But wartime politics is getting in the way. And the outbreak is expected to grow. “Actually, it is spreading quickly,” says Dr. Mohammed Al Saad in Gaziantep, Turkey, near the northern border of Syria. There are now more than 60 suspected cases, he says, with new ones reported each day.

    Most cases have occurred in children less than 2 years old, who were born in Syria after the war started and missed their routine vaccinations, he says.

    When I was in Israel this past summer, polio virus was found in the sewers in the southern city of Beersheba and was gradually moving north, so the Israeli government decided to revaccinate all children under a certain age. (No actual cases were discovered, fortunately. The virus was thought to have been brought to Israel by a carrier from Egypt).

  51. #52 palindrom
    December 4, 2013

    OMG, Narad, I’m a professional astronomer, but not a Latin grammar nut, so even though I’m familiar with novae I still have no idea what you’re talking about. The set of readers who understands your comment may be entirely empty.

    So let’s see — we have “Nova Cygni 1992″ which, once named as a variable star, becomes “V1974 Cygni” in the General Catalog of Variable Stars, the closeness of the numbers involved being entirely coincidental.

    Are you saying that it should be “Nova Cygnus 1992″, or something?

    We’re really getting down to brass nits now!

  52. #53 Todd W.
    http://www.harpocratesspeaks.com
    December 4, 2013

    Re: BCG

    Yeah, it’s not a particularly good vaccine. It works decently in kids in regions with high levels of endemic TB, but it wears off and isn’t very effective in adults. Boosters don’t seem to help, either. Plus there’s the added bonus of always testing positive for TB after you’ve received it!

    The U.S. has such low levels that antibiotics and quarantine have worked pretty well to keep transmission down. MDR-TB, XDR-TB and the somewhat recently discovered TDR-TB are scary. Need to find better methods of dealing with the bacteria.

  53. #54 brian
    December 4, 2013

    At a wacky anti-vaccine blog that is “edited” by a someone familiar to regulars here, a comment today included this gem:

    “As far as I could find out, the [1918-1919 pandemic Spanish influenza] hit only the vaccinated.”

    In woo land, you see, data doesn’t matter, and you can believe and spread wacky ideas like that the 500 million who were infected with influenza during that pandemic and the 50 to 100 million people who died were all victims of de ebil vaccines. (The first vaccine against influenza virus was developed in 1938.)

  54. #55 Narad
    December 4, 2013

    Are you saying that it should be “Nova Cygnus 1992″, or something?

    If construed as English, a language in which “nova” is actually a noun, yes. One doesn’t refer to “Cygni X-1,” now does one? So what is this name supposed to be built out of? Again, it ain’t the partitive genitive, which “V1974 Cygni” is. Would anyone bat an eyelash at “nova V1974 Cygni”?

    It’s a lost cause, I know. In fact, it never even made to the level where there was something to be “lost.” But let’s not pretend that it’s any better than homeopathic “Latin.” My recommendation, in cases where journals still maintain a pretense of actually having a style, is to just dump writing them out in titles, allow the abbreviation if you can’t get rid of it entirely (as here, where the older synonym is arguably superfluous and crufty), and pretend the whole thing never happened. “Nova Cyg 1992.” *Poof*.

  55. #56 Jerry Hodge
    San Diego
    December 4, 2013

    The vaccine culture war goes on. Katie Couric, during a large portion of her talkshow, provided a soapbox for antivaccinationists.
    http://www.latimes.com/business/hiltzik/la-fi-mh-katie-couric-20131204,0,4371413.story#axzz2mYndCVM3

  56. #57 The Very Reverend Battleaxe of Knowledge
    December 4, 2013

    But medieval dog-latin is the rule in science isn’t it? I think that war was lost when highly-educated physicists, many with classical educations under their belts, settled on quantum when they meant tantum.

  57. #58 Spectator
    December 4, 2013

    “Pakistan, where the CIA used a vaccination program as cover for a DNA sampling operation to track down Osama bin Laden’s whereabouts. The result of that particular brilliant idea is that vaccination crews in much of rural Pakistan are now at risk of being shot by Islamist extremists.”

    That certainly was not handled well, it could have been done as part of legitimate vaccination and never come to light. Revealing such methods so as to gloat about them is flaming stupid.

    However, the Taliban oppose all things Western and have a history or sabotaging vaccination campaigns, a history which started before the operation mentioned. Shooting, bombing or burning anyone associated with anything that to their mind is a Western influence is their standard practice.

  58. #59 palindrom
    December 4, 2013

    Narad — I insist on taking this tiresomely esoteric thread to its proper level, which is funny variable star names, such as “Y Sex”, “EZ Peg” (apparently a star with loose morals),, and the perennial British favorite, “RU Lupi”, which is obviously a question.

    OK, everyone, we’re flying this thread to Havana. Just cooperate and no one gets hurt.

  59. #60 Narad
    December 5, 2013

    I insist on taking this tiresomely esoteric thread to its proper level, which is funny variable star names

    I suppose one could get some sort of movie title from the superhumps of TU Men.

  60. #61 Narad
    December 5, 2013

    Have you seen the light curve on IM Comae?* Would that she were a white dwarf discovered by a Scotsman.

    * Think of it as like the Scrabble game from Foul Play.

  61. #62 herr doktor bimler
    December 5, 2013

    But medieval dog-latin is the rule in science isn’t it?

    Imagine my disappointment to discover that ‘tantra’ is not the plural of ‘tantrum’. Parents — you just can’t trust them.

  62. #63 AnObservingParty
    December 5, 2013

    Re: BCG

    Oh, it’s a terrible vaccine, in that it’s not nearly as effective as others…but all vaccines are risk v. benefit, and I don’t know if it’s that far-fatched to think someday the risk/benefit might be considered. If I was going to an endemic region, I’d get it.

    Todd, you can be tested, but it *may* be a false-positive for the tuberculin test. IGRA won’t be affected. http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm Most places don’t wast the money on the IGRA, and my understanding is that it’s strictly for active TB and won’t catch latent?

  63. #64 Julian Frost
    Gauteng East Rand
    December 5, 2013

    BCG is administered in South Africa. TB is endemic here. XDR-TB is starting to become a real problem. I didn’t like getting it. The nurse stamps your arm with a type of punch, then puts the BCG on your skin so it’s absorbed. It was painful and unpleasant. I still have a faint scar.

    tl;dr: we need a newer, better TB vaccine.

  64. #65 Krebiozen
    December 5, 2013

    As I recall from discussions about high-titer measles vaccines in West Africa here a while ago, BCG may have benefits other than preventing TB complications. There’s a lot of research into BCG and its various effects on resistance to a variety of other pathogens.

    BTW I still read BCG as bromocresol green, a dye used for measuring serum albumin, and have to do a double-take, every time.

  65. #66 Krebiozen
    December 5, 2013

    That came out wrong – the discussions about the measles vaccine had nothing directly to do with BCG, but someone (Blackheart?) cited the non-specific effects of BCG as evidence that measles vaccination might be bad. He thought that because one type of measles vaccine didn’t reduce mortality as much as another it was having non specific effects that were killing children.

  66. […] number of stories and twitter links about it. Orac, over at his blog, Respectful Insolence, wrote a most excellent post about the findings as well as a general discussion about the misinformation being peddled by the […]

  67. #68 dingo199
    December 5, 2013

    Yup – that was “blackheart” aka John Richard Smith, bane of Huffpo.

  68. #69 Christine (the Public Servant Christine)
    December 5, 2013

    This is one topic where a grain of truth has been taken and combined with hunches and outright lies to produce crap. As a few people have mentioned, cholera is a VPD, and many cities undertook massive public works programs in C19 to prevent the spread of cholera which could render cities uninhabitable in the summer, and decent sanitation did stop that disease spreading,
    Of course the “sanitation prevents disease” trope does not apply to all diseases, and one disease that makes it fall down in a screaming heap is measles. Measles was first documented formally in C9; and in the Middle Ages and Early Modern period in England, parishes were required to report on the deaths and causes of death each month for the parish. One of the standard causes of death, listed on every form, was measles. Yes, they were that concerned about measles deaths were required to be reported, so areas where there was an outbreak could be quarantined. And as we know the measles rates didn’t seriously drop until after vaccines.
    Smallpox is another disease that appears on the parish death lists, separate from “unknown illness.”

  69. […] A rebuke to the antivaccine movement: A hundred million cases of disease prevented and millions of l… (scienceblogs.com) […]

  70. #71 Milwaukeegirl
    December 8, 2013

    Once again I say “Thank you” to my parents and doctors for making sure I was vaccinated as a child and to later doctors who recommended flu shots even though I always have an adverse effect: my arm is sore for a day or two. Improved sanitation and vaccinations combined to transform the world into a much safer and healthier place. So, thank you, doctors and scientists who work to keep this going.

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  72. #73 mom2mj
    United States
    January 21, 2014

    What do you make of this?

    http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm376937.htm

    If the vaccinated contract pertussis and are asymptomatic AND contagious, A) don’t they present more danger because they unknowingly spread the disease? B) Won’t they be omitted from the actual numbers thus rendering experts oblivious to how prevalent the disease is and how it is being spread?

    This leads me to believe that the pertussis vaccine is beneficial for the individual but the notion that it is effective in inhibiting spread is dubious.

    I’m NOT an expert so please don’t pounce. The link is to an FDA study and is very provocative.

  73. #74 Antaeus Feldspar
    January 21, 2014

    mom2mj -

    Um, I must say that your fourth-paragraph analysis seems rather off, since you’re writing about the “vaccinated” (in contrast, presumably, to the unvaccinated) – but the FDA publication you’re basing your analysis on compares the responses to two vaccines.

    The question of the relative merits of whole-cell vaccine and acellular vaccine has been debated a long time. This is an unexpected turn in that debate. But it says nothing about the relative merits of pertussis vaccination vs. not being vaccinated against it at all. If that wasn’t what you meant to suggest, you need to be more careful in your writing.

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