I thank everyone for my warm welcome to the SBM community. Although vaccine myth is of particular interest to me, I promise that my posts wont all be vaccine related. There is, unfortunately, much to discuss. In fact I had a difficult time deciding which vaccine-related issue to write about for my inaugural post. In the end I came up with more of an opinion piece, but it’s an issue worth airing. Things in anti-vaccine land may be reaching a dangerous turning point.

In the very recent past, Haemophilus influenzae type b (Hib) was what could truly be called a scourge to humanity. As recently as 1987, this particularly nasty bacterium caused invasive disease in a startling 1 of every 200 children in the U.S. under 5 years of age. Approximately two-thirds of these children developed meningitis, with a mortality rate of about 5%. Up to 30% of the survivors suffered permanent brain damage. Those children lucky enough to avoid meningitis developed pneumonia, septic arthritis, osteomyelitis, cellulitis, epiglottitis, or generalized sepsis. Fortunately I have never seen or treated a child with invasive disease due to Hib. That’s because I began my pediatric  training in 1991 when vaccination against these horrendous diseases was just beginning. What was once a common and devastating menace to children, the dreaded nightmare of every pediatrician, was quickly brought to it’s knees. By 2006, the incidence of invasive Hib disease had been cut by 99%. Within a short period of time, the very nature of pediatric medicine seemed changed forever. That’s why I was so saddened to read the Hib surveillance data from Minnesota released by the CDC in January. In 2008 five children in that state (ranging from 5 months to 3 years of age) developed invasive disease due to Hib. That is the largest recorded number since 1992, just after the vaccine was licensed. Three of those children had meningitis, one had epiglottitis, and another had pneumonia. One child, a 7 month old with meningitis, died. Of those five children, 3 had received none of the recommended doses of Hib vaccine due to parental refusal. The other 2 were too young to have completed the series, and one of these had an immunodeficiency that likely made the vaccine ineffective. At first these five cases from Minnesota seemed like an isolated fluke. Then came the news, just released by the Pennsylvania Department of Health, of seven more cases of invasive Haemophilus influenzae disease since October. All were children under 5, and all were unvaccinated or incompletely vaccinated. Three of these seven children have been confirmed to have died. And now news of a 3 year old in Maine who is recovering from Hib meningitis. There hasn’t been a confirmed case of Hib meningitis in Maine since 1989.

The most obvious and infuriating factor contributing to these small but concerning outbreaks is the increasingly prevalent phenomenon of parents refusing vaccinations for their children, or altering the vaccine schedule out of misguided concerns;  either about the dangers of “too many too soon“, or the cumulative exposure to vaccine constituants. This delay in vaccination, à la Dr. Sears, has created an increasing population of children with gaps in their vaccination coverage, and who are therefore vulnerable to vaccine-preventable disease. I may write more on Dr. Sears in a future post. For now, suffice it to say that more parents can probably quote Dr. Sears’ irresponsible and scientifically unfounded vaccine schedule than can name 3 reliable sources of vaccine information. My fear is that these terrifying outbreaks of Hib disease may be the canaries in the coal mine, signifying more trouble to come.

In addition to the increase in parental vaccine refusal, a second factor may also have played a role in this upswing of Hib disease. And this second factor has a particular irony to it. Since December of 2007, there has been a nationwide shortage of Hib vaccine. Merck, one of only two vaccine manufacturers producing Hib vaccine in the U.S. (Sanofi is the other), was forced to close it’s Hib manufacturing facility due to bacterial contamination detected at the plant on a routine FDA inspection. No actual contamination of vaccine ever occurred. However, the company recalled 12 lots of vaccine and was forced to close and retool it’s facility. While the anti-vaccine crowd has predictably spun this as an example of the dangers of our vaccine supply, it is actually a perfect example of how stringent and effective the vaccine safety system really is. The Hib vaccine shortage that resulted from this plant closure led the CDC to issue interim vaccination recommendations. It recommended that doctors continue to administer the primary series of Hib vaccines (at 2, 4, and 6 months of age), but to delay the booster dose, typically given between 12 and 15 months of age, until further notice. While Sanofi (the sole remaining producer of Hib vaccine) has purportedly had enough vaccine to meet this goal, pediatricians (this one included) have often found their supplies running low, and themselves unable to complete the primary series at the appropriate intervals. This shortage, coupled with faltering parental confidence in the safety of vaccines, has created a dangerous situation. And sometimes a strange one. On one recent day I had a mother call frantically to make sure her child would get the Hib vaccine on time, while on the next day a parent called to ask about spacing out her child’s vaccine schedule to make it safer for his immune system. Which brings me to the title of this post.

Parental vaccine refusal endangers lives. Here we have a situation in which an unavoidable shortage of a vital vaccine, has combined with an irrational parental mistrust of expert scientific opinion to create a critical mass of vulnerable children. The result, so far, is four dead children. But in the absence of any shortage, vaccine myth and the poor parental decision making it breeds has already had a profound impact, with the potential for more to come. In the never-ending wake of Wakefield, measles outbreaks have occurred in pockets of under-immunized children in areas of New York, San Diego, and Milwaukee.  Particularly in communities where parents know how to do their own “research” about vaccines. Many more children have suffered unnecessarily in the U.K. and elsewhere as a result of the spreading wave of panic over fictionalized vaccine dangers. In fact, as bad as this wave of vaccine parananoia is in the U.S., it’s far worse in Europe and the U.K. where vaccine mythology is rampant, and the threat of vaccine preventable epidemics is very real. This widening circle of vaccine fear across the Atlantic is a major threat to children in this country.  Imported cases of vaccine-preventable disease can now find increasing populations of under-immunized children in which to take root.

To see children fall ill and die from completely preventable diseases because of irrational fear and a belief in myth should truly make us angry. Those of us who have the knowledge and experience to speak out publicly should do so. We should seek every opportunity at our disposal to speak with a clear and unintimidated voice to say that we’ve had enough. Enough of the armchair pseudoscience. Enough of the misinformed journalists. Enough of the celebrity grandstanding. That parents in this day and age would arrange a chicken pox or a measles party so that their children could actually get these diseases rather than have them safely vaccinated makes me want to scream. The hours I spend trying to correct the massive amounts of misinformation foisted on parents who believe a seemingly endless array of conjured myth is mind-numbing. We should be calling out the phoney mavericks, charlatans, and know-nothings for who they are. Robert Kennedy, Jr., David Kirby, and J.B. Handley believe they are fighting the noblist of fights. What they are doing, of course, is endangering lives. But more broadly, their rhetoric endangers the already fragile relationship society has with an evidence-based approach to understanding the world. It is our responsibility to make it known that the controversy is over. No, that there never was a controversy in the first place. That science and reason will not allow another child to die or suffer needlessly. Really, where is the outrage?

Posted by John Snyder

John Snyder, MD, FAAP, is an Assistant Professor of Pediatrics at Tufts University School of Medicine, and a practicing pediatrician at Amherst Pediatrics in Amherst, Massachusetts. Previously, he was Medical Director of the teaching clinic at Baystate Children's Hospital, and before that he was Chief of the Section of General Pediatrics and Medical Director of Pediatric Ambulatory Care at Saint Vincent's Hospital in New York City. Since 1994, Dr Snyder has been active in pediatric resident and medical student education with a particular interest in evidence-based pediatrics. His main area of interest is medical myth and the ways in which parents utilize information in making medical decisions for their children. One area of focus has been the vaccine myth, and he lectures frequently on this subject in both academic and community settings. His other activities have included: contributor to the Gotham Skeptic blog, member of the New York City Skeptics' board of advisors, and expert for BeWell.com ("A New Social Network on Health Founded by America's Top Doctors"). Dr Snyder graduated from Mount Sinai School of Medicine, completing his residency training in pediatrics at The Mount Sinai Hospital in New York City. He is board certified in pediatrics, and is a Fellow of The American Academy of Pediatrics. Dr. Snyder has no ties to industry, and no conflicts of interest regarding any of his writings. Dr. Snyder’s posts for Science-Based Medicine are archived here.