In a post-modern world, the spirit of the Berean’s to investigate to see if something were true (Acts 17:11), is easily trumped by emotional antidote. However, as a YWAMer who has worked in Global Health and Primary Health Care for over 25 years and also as a father of young children, can I ask you to please don’t delay in getting caught up on your children’s and your immunizations…if not for yourselves, then for the protection of your friends and the children around you.
Playable Covid-19 Epidemiology Simulator Give it a try! Try your hand at this! For 25 years every student that came through my Community Health course or Applied Epidemiology seminar got a free app called EpiInfo, to both simulate epidemics and to help tease out the causes and variables. Our field practicums used it in N. Iraq, Yemen, Cambodia and Bolivia. In class, we usually started with simulating food poisoning at church picnics and would end up with a full cholera epidemic, but the linked animations are a pretty good summary and hands-on Epi simulator for what is affecting our current pandemic. For those interested play around with the intermittent lock-downs. Also, if really interested, listen to the “This Week in Virology” podcast discuss a just published simulation of how schools could rotate face-to-face attendance and online learning to maximize protection from spreading the virus between school to home.
Ebola vaccine success:
Race is now on to protect those at risk
A vaccine can now protect against Ebola (Image: Cellou BinaniI/AFP/Getty Images)A vaccine for Ebola produced in just one year instead of the usual decade provides 100-per-cent protection against the disease. Preparations are already under way to make it available to healthcare workers and families wherever the virus remains at large.
“This is a very good day,” says Seth Berkley, chief executive of the GAVI Alliance, the global organisation that has earmarked $390 million to extend availability of the VSV-ZEBOV vaccine beyond Guinea, the country where it has been successfully tested on more than 7500 people.
“All affected countries should immediately start and multiply ring vaccinations to break chains of transmission and vaccinate all frontline workers to protect them,” says Bertrand Draguez, medical director of relief organisation Médecins Sans Frontières.
The rapid availability of a vaccine would be a huge boost for citizens of those three countries and for all the health workers still operating in them to deal with new cases.
Emergency authorisation
Berkley says that the GAVI Alliance has already earmarked “considerable” funds that could make this roll out possible, and that discussions are under way with the governments of affected countries, the funders of the clinical trials, the manufacturer of the vaccine and the World Health Organization to decide how to move forward as fast as possible.
Although the trial isn’t yet over, the WHO could theoretically issue an Emergency Use Authorisation before it ends. This would enable the vaccine to be legally deployed where needed.
“When there’s a WHO recommendation, we will be willing to purchase and stockpile the vaccine until we get regulatory authorisation from individual governments,” Berkley says.
The trial is still in progress, but evidence that the vaccine works arose by studying how well the vaccine protected health workers and family members associated with new cases of Ebola. They wanted to see how well this strategy of “ring vaccination” – immunising those people in closest contact with any new cases – protected those exposed.
Rather than vaccinating only half the participants, and risking the lives of others by giving them a dummy vaccine, the researchers gave half the participants the vaccine immediately after they had contact with a newly diagnosed case, while the other half received it three weeks later.
After three months, the result was resounding. No instant recipients were infected, but 16 of those receiving the vaccine three weeks later were. “This is an extremely promising development,” said Margaret Chan, director-general of the WHO. The results at three months were so impressive that all subsequent participants have since been receiving the vaccine immediately.
Hard to store
Developed initially by the Public Health Agency of Canada, the vaccine is a live but harmless virus called vesicular stomatitis virus, which normally infects animals, engineered to contain a key fragment from the Ebola virus. The immune systems of recipients make antibodies that prime for defence against the real virus.
The race is now on to provide it wherever possible, pending negotiations between all the parties involved. “We can say that Guinea is now taken care of, but what happens in Sierra Leone and Liberia, and other countries where there are outbreaks such as Mali and Uganda,” says Berkley. “We need some type of procedure to say it’s OK to use it in these other settings.”
Berkley said that the vaccine is not perfect. It must be stored at -80 °C, which is not easy to guarantee in tropical countries. It also may not protect against all strains of Ebola. Nor is it yet established how long immunity lasts.
But other trials of vaccines against ebola are under way, says Margaret Harris of the WHO. In Liberia, the VSV-ZEBOV vaccine is being trialled head-to-head against a rival vaccine produced by Glaxo-Smith Kline, and a vaccine developed by the US Centers for Disease Control and Prevention in Atlanta, Georgia, is being tested in Sierra Leone.
Harris said that cases are still coming to light, but they are waning in number. “We’ve had a very encouraging week, and for the first time we’ve seen a column of zeros where there are usually new cases.”
Only the female Anopheles mosquito caries malaria and only they put their tale up when they bite you. If the tail’s not up, it’s not a malaria mosquito.
I took this with my son’s camera at the YWAM Clinic in Kangulumira Uganda. You can see the distinctive double dotted ring form of P. falciparum malaria (lower middle), and two schizonts (upper left)
Fifteen Years After Autism Panic, a Plague of Measles Erupts Legions spurned a long-proven vaccine, putting a generation at risk By JEANNE WHALEN and BETSY MCKAY
Aleshia Jenkins receives a measles vaccine this year.
PORT TALBOT, Wales—When the telltale rash appeared behind Aleshia Jenkins’s ears, her grandmother knew exactly what caused it: a decision she’d made 15 years earlier.
Ms. Jenkins was an infant in 1998, when this region of southwest Wales was a hotbed of resistance to a vaccine for measles, mumps and rubella. Many here refused the vaccine for their children after a British doctor, Andrew Wakefield, suggested it might cause autism and a local newspaper heavily covered the fears. Resistance continued even after the autism link was disproved.
The bill has now come due.
A measles outbreak infected 1,219 people in southwest Wales between November 2012 and early July, compared with 105 cases in all of Wales in 2011.
One of the infected was Ms. Jenkins, whose grandmother, her guardian, hadn’t vaccinated her as a young child. “I was afraid of the autism,” says the grandmother, Margaret Mugford, 63 years old. “It was in all the papers and on TV.”
The outbreak presents a cautionary tale about the limits of disease control. Wales is a modern society with access to modern medical care and scientific thought. Yet legions spurned a long-proven vaccine, putting a generation at risk even after scientists debunked Dr. Wakefield’s autism research.
The outbreak matters to the rest of the world because measles can quickly cross oceans, setting back progress elsewhere in stopping it. By 2000, the U.S. had effectively eliminated new home-grown cases of measles, though small outbreaks persist as travelers bring the virus into the country. New York City health officials this spring traced a Brooklyn outbreak to someone they believe was infected in London.
Measles outbreaks are a “canary in the coal mine,” says James Goodson, the lead measles expert at the U.S. Centers for Disease Control and Prevention. People who refuse one vaccine may be spurning others, setting communities up for outbreaks of other dangerous diseases that are slower to propagate, he says, such as diphtheria and whooping cough.
“Despite the fact that it’s one of the greatest health measures ever invented by man or woman, there seems to still be a small residue of humanity that objects to the very idea of immunization,” says Dai Lloyd, a doctor in Wales who treated many of the recent measles cases. “If you go around the cemetery you can see the historical evidence of childhood slaughter from pre-immunization days.”
Measles is a respiratory condition causing fever, cough and rash. Most people who catch it recover fully. But measles can lead to deafness and pneumonia, and, in about one in 1,000 cases, death. It is one of the most contagious diseases, spread by coughing and sneezing.
It is also among the most preventable, with an effective inoculation since the 1960s that is now commonly given with mumps and rubella vaccines in a combined “MMR” vaccine. The U.K., as did the U.S., categorized measles as “eliminated” over a decade ago, meaning it was no longer circulating from within its borders.
Dr. Andrew Wakefield in the 1990s suggested an autism link to the vaccine.
Child deaths from measles world-wide fell 71% to 158,000 in 2011 from 2000, says the Measles & Rubella Initiative, a partnership of global-health groups.
Most measles occurs in developing countries. But it is resurging in some of the very countries that have led global campaigns against it. France was close to eliminating it in 2007 before an outbreak infected more than 20,000 people between 2008 and 2011. Philosophical opposition to vaccines helped cause the outbreak, says the European Centre for Disease Prevention and Control.
The 117 U.S. cases reported so far this year are up from 54 in all of 2012 and could put the U.S. on track to match the 220 logged in 2011, the highest since 1996. England reported 1,168 cases in 2013 through May, up 64% from the year-earlier period and the highest recorded level since 1994.
“It’s very galling we had measles eliminated and now we’ve got it again” in the U.K., says Paul Cosford, medical director of Public Health England, the government public-health agency.
The autism scare behind the Wales outbreak tracks to the era of Dr. Wakefield, then a researcher at London’s Royal Free Hospital, whose suggestion of a vaccine-autism link began to get press in 1997.
A paper Dr. Wakefield published in 1998 in the Lancet, a medical journal, described 12 “previously normal” children who developed gastrointestinal problems and developmental disorders including autism. His paper concluded that “in most cases, onset of symptoms was after measles, mumps, and rubella immunization. Further investigations are needed to examine this syndrome and its possible relation to this vaccine.”
Medical experts immediately warned parents that they considered the research incomplete and speculative, and said there was no evidence of a link. Among other studies debunking his research, a 2004 review of epidemiological studies by the U.S. Institute of Medicine found no evidence MMR caused autism.
The Lancet retracted Dr. Wakefield’s paper in 2010 after the U.K.’s General Medical Council concluded that his work was “irresponsible and dishonest.” The council that year stripped him of his medical license, saying in a report that he had engaged in “serious professional misconduct.”
Dr. Wakefield says he questioned MMR’s safety but strongly urged parents to continue with a measles-only vaccine. “MMR doesn’t protect against measles,” he says. “Measles vaccine protects against measles.” He says he stands by his work despite contrary conclusions by other scientists. He didn’t respond to subsequent requests for comment on his license revocation.
His report helped spark backlash against MMR, especially in English-speaking countries, say health officials in the U.S., U.K., Australia and other countries. An estimated 2.1% of U.S. children who received other routine vaccines weren’t immunized with MMR in 2000, up from 0.77% in 1995, according to a 2008 study published in Pediatrics that concluded the change was “associated with” Dr. Wakefield’s study.
Dr. Wakefield says he rejects the idea that his research helped cause measles outbreaks, because he told parents to keep vaccinating with measles-only vaccine.
U.S. critics, including some who questioned vaccines in general, continued to campaign against the vaccine. Among them, former Playboy model and actress Jenny McCarthy, who has been named a co-host of ABC’s “The View,” became a leader of the anti-vaccine movement in the U.S. several years ago when in televised interviews she linked her son’s autism to vaccinations. A publicist for Ms. McCarthy, who wrote the forward to a 2010 book by Dr. Wakefield, didn’t respond to requests for comment.
Dr. Wakefield’s work especially reverberated in the U.K. MMR vaccination rates among 2-year-olds in England fell to 80% in the 2004 fiscal year from about 92% in 1997.
But nowhere did the toxic mix of dubious science, sensational headlines and parental fear take a bigger toll than in southwest Wales. As Dr. Wakefield’s concerns gathered steam in Britain’s national media in 1997, a Port Talbot mother, Jackie Eckton, phoned the South Wales Evening Post to ask whether other parents had experienced problems with MMR.
In one 1997 article, Ms. Eckton told the Post the vaccine turned her 3-year-old, Daniel, who had been diagnosed with autism, into a “distant and silent recluse.” She told the paper she wanted to form “some sort of action group so people can help each other fight this thing and what it does.”
The Post instructed parents wanting to join her campaign to phone its news desk.
Within days, parents of 20 other children formed a group led by Ms. Eckton, and demanded Jump to the full WSJ article
Olivia, my eldest daughter, cuaght measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the way to recovery, I was sitting on her bed showing her how to fashion little animals out of colored pip-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.
‘Are you feeling all right?’ I asked her.
‘I feel all sleepy,’ she said.
In an hour, she was unconscious. In twelve hours she was dead.
The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her. That was twenty-four years ago in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her.
On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunized against measles. I was unable to to that for Olivia in 1962 because in those days a reliable measles vaccine had not been discovered. Today a good and safe vaccine is available to every family and all you have to do is ask your doctor to administer it.
Many do not accepted that measles can be a dangerous illness. Believe me, it is. In my opinion parents who now refuse to have their children immunized are putting the lives of those children at risk. In America, where measles immunization is compulsory, measles like smallpox, has been virtually wiped out.
Here in Britain, because so many parents refuse, either out of obstinacy or ignorance or fear, to allow their children to be immunized, we still have a hundred thousand cases of measles every year. Out of those, more than 10,000 will suffer side effects of one kind or another. At least 10,000 will develop ear or chest infections. About 20 will die.
LET THAT SINK IN.
Every year around 20 children will die in Britain from measles.
So what about the risks that your children run from being immunized?
The are almost non-existent. Listen to this. In a district of around 300,000 people, there will be only one child every 250 years who will develop serious side effects from measles immunizations! That is about a million to one chance. I should think there would be more chance of your child choking to death on a chocolate bar than of becoming seriously ill from a measles immunization.
So what on earth are you worrying about? It really is almost a crime to allow your child to go unimmunized.
The ideal time to have it done is at 13 months, but it is never too late. All school-children who have not yet had a measles immunization should beg their parents to arrange for them to have one as soon as possible.
Incidentally, I dedicated two of my books to Olivia, the first was James and the Giant Peach. That was when she was still alive. The second was The BFG, dedicated to her memory after she had died from measles. You will se her name at the beginning of each of these books. And I know how happy she would be if only she could know that here death had helped to save a good deal of illness and death among other children.”
Roald Dahl, 1986
Dahl, in his garden writing shed in 1986,
writes about the death of his eldest daughter
Weighing children, the best way to evaluate child health is to monitor growth. Smokey Mountain, Manila
Yeah! We’ve obtained an invitation for our students to work alongside the ongoing immunization and well-baby programs that YWAM-Balut runs on Smokey Mountain. (Their project leaders took the PHC school in Kona a couple years ago and the work here was launched after their field assignment.) Our students not only will gain a better understanding of how organized Well-Child program and clinic runs, but will gain valuable experience and confidence practicing their immunization, growth monitoring and other clinical skills.
