I’m in the main hall of the Telethon Institute for Child Health Research (TICHR), a large indoor venue that is part of an ongoing lecture series. Somewhere behind me in the audience is at least one other member of the Perth Skeptics (hello Grendels!).
There is a LOT of information being given tonight, and these are very slide-heavy and text-heavy discussions. Here is the best summaries I can do, but the final speaker Bruce Langoulant (talking about his daughter Ashley) is the most powerful in terms of emotive appeal. I thought this was particularly effective, considering that although like the others, he brings in personal experience – but his determination to get better information out and encouraging us to think about long-term impact of children harmed by disease is really sobering. I found myself on the verge of tears at times.
Dr Fiona Stanley introduces the panel, saying that because of the issues that are facing us in the community, and with the recent flu problems with adverse reactions – best thing to do is give info via experts, importantly to parents in acknowledging there’s been problems and not throw ‘babies out with bathwater’.
The people who will be talking to us are:
- Dr Peter Richmond – Paediatrician at PMH, Head vaccine trials groups at TICHR – prof at school of paediatrics and child health at UWA.
- Clinical Associate Professor Deborah Lehmann Infectious disease research TICHR (has worked for WHO). Has worked for 30 years and committed to reducing mortality from diseases.
- Bruce Langoulant – Chairman of the Meningitis Center (I hope I got that correct!), President of the Confederation of Meningitius Organisations Inc. and a parent of a 21 year old child disabled due to meningitus as an infant.
Brief Comments – three expert panelists. Qu. at the end. ‘Will see how it goes’. Overview by Prof Fiona Stanley of the presenters given as above.
Prof Fiona Stanley: Vaccine efficacy in the USA as assessed – data by Drs Orenstein and Bernstein given. Are assessed by comparing maximum morbidity levels before vaccine ability between 1992 and 1996 – how they show a dramatic effect on these diseases (whooping cough not as effective, will address this, these diseases are here all the time). David Issacs – The Facts, the Fears and the Future from 2000, a very good resource on infections, immunity and so on.
Whooping cough notifications over time – cases and deaths in UK from 1940 to 1973 and the mass immunisation introduced during 1950-1957 and we see how the vaccine uptake showed a dramatic fall in cases. The number of deaths 1 in 600 who get whooping cough die and 1 in 50 get brain damage – the peak had 170 thousand who caught it, and the drop after vaccination is dramatic.
Her personal experience during her postgrad training in 1970s; the pattern she showed of the dramatic influence of immunisation – 81% was the vaccine uptake. Incidences fell from 83% to 30% due vaccination – the only info people had was the images of brain-damaged children on TV, prompting people to vaccinate. ‘If we had a panel like today doing presentations more often, perhaps we’d better challenge the view that “if you don’t see the disease due to vaccination rates, then it no longer exists”‘. When in the USA they improved vaccination uptake, the level of immunity stayed at a high rate.
Theoretical time-lines of what happens with the kinds of diseases – epidemic map 2000 shown. When you get the infection, you may survive okay, yet brain-damage can happen, so vaccination is very important – incidence falls with vaccinations. People then don’t see the disease and thinks it has gone. Then what happens? Vaccination intake then falls down – when the vaccine is designed to respond to infections, makes you able to not get infected.
Dr Peter Richmond – Paediatrician at PMH, Head vaccine trials groups at TICHR – prof at school of paediatrics and child health at UWA.
‘Close the gap via immunisation’. Australia taking the world forefront in investigating and preventing disease. How we make sure they remain safe and effective, and why vaccine – and how monitored, do they overload the immune system? are many of the questions that are asked of them.
“Tale of Two Pneumonias”. Example of a child in Busselton Hospital, who within 48 hours of fever and cough, full recovery – that child happened to be him! Then, many years later, there’s the example of an 18 month child in the Gibb River road community. After two days, increasing illness, unconsciousness and shock and cardiac arrest in Derby Hospital. He talks how his experience showed that the death of the child was due to pneumococcal meningitis after pneumonia. This led him to focus on Meningitis, the bacteria that creates it.
He worked at Great Ormond St on vaccination about meningicoccal disease in SW of England – example of ‘killer brain-bug plague is featured on front of a newspaper – he learned how to implement, trial and apply them after his time there. Rather horrific pic of meningitis and how many may not survive – it most commonly affects infants, teens and young adults. Much interest as people pay attention to the deaths of teens, in comparison to infants, apparently.
In the initial development of vaccines – they surveillance for infectious diseases, how it occurs, what protects us, does it work in animal models and is it tolerated in animal models (e.g. rabbits). ‘We need to understand how vaccines work in people though’ – gives an example of an Australian Serogroup Distribution by age, 2002. Shows how confirmed cases – mostly young adults and teens – older kids as much more if not equal to younger kids.
So, why choose infants to vaccinate? They benefit the most. The antibodies fall around 1-6mnths of age. Around teens/adult levels, the rise again. ‘If something is around a lot, young kids get it more – where heaviest burden of infection, the younger they’ll be’. Infants respond to vaccination with protective antibodies in the first week of life. Neonates respond just as well, the immune system is primed and ready to go – ‘have one as soon as possible so you don’t get the disease and they’re going to do study on newborns with a vaccine for whooping cough’
The lady next to me just whispered ‘This talk is pitched a little too high… needs to be more broken down’. I think I’d agree with that – there’s a LOT of information being given to us, mostly about the stages in studies.
Golden staph study in progress – to see if safe and if it works. They recently completed one for meningoccoccal B vaccine trial -a nd progressing to studies in adolescents and infants. In regards to heresay, difficult to know the basis and how it arises, when there’s studies out there.
Vaccines are of important to health professionals – people may not know of the benefits, but if provide info, as PMH has, they have made vaccinations readily available for staff and they do take them up.
They keep in touch with people with vaccine study – gather as much info as possible and the safety before they use it. They did a focus-group with the teens and it reflects the altruism of society: as one person in the study said ‘When you walk out of the clinic, you feel good because you know you are helping someone‘. He talks about no safety concerns (the Lancet, 2009, 374:301-14) for the human papillomavirus tape 16,18 vaccine. Also no safety concerns with the seasonal influenza vax (CSL) trial – 14,000 adults administered to over 2008-9.
After this, they are introduced. Some disease now prevented with vaccines – chicken pox, cervical cancer, etc. There’s also Phase 4 surveillance, with detection of rarer adverse events. ‘Sometimes this is doctor reporting, or active surveillance (like a form of paralysis that was looked for during the H1N1 and was found not to occur).
Impact of the meningococcal C conjugate vaccine - pre-vax in 2002, 213 cases with 29 deaths – post vaccine in 2009 – 13 cases with 2 deaths, and 94% reduction in older adults (herd immunity) and a 93% reduction in deaths overall.
He then talks about the whooping cough/pertussis notification rates 1997-2009 and how WA had better spread and notification and how we have less of a rate of notification, and trying to promote the idea. Immunity after vaccination only lasts 5-10 years and how it can still be spread and how the very youngest can pick it up. Whooping cough vaccination prevents about 85% infection and keeps young kids out of hospital but doesn’t stop spreading – relatively there’s 25% not covered so there’ll be outbreaks but will ‘get further and further apart the more we vaccinate our population’.
He then addresses the MMR and autism claims – how he was in the UK during the Lancet Wakefield report and how he wrote a letter to the journal in response. He summarises that the laboratory techniques were discredited. ‘They didn’t seem to fit to what I knew about autism,’ and he talks how autism and Crohn’s's disease weren’t related. The lack of ethics committee in Wakefield’s research, the children’s birthday party where he paid kids for their blood and so forth. Twenty studies, large scales done later (e.g 1/2 million kids in Denmark) showed no subsequent supportive evidence – e.g., Madsen NEJM 2002, 347:1477.
2004 – other authors withdrew conclusions and how in 2010 Wakefield was convicted of misconduct by GMC. MMR does not overload the immune system – their own study shows this, in Yerkovich et al, Vacccine 2007; 25: 1764-70.
Evidence for influenza vaccine in children – in the US policy in 2003, they introduced a vaccine for under 2s in 2003 and they have about 2 million births annually with 25%-230% coverage and no safety concerns shown. Now a very large cohort of 35 million now recommended with a number of studies showing that fevers and febrile convulsions very rare.
Current Australian policy is that with chronic disease or impaired immunity with any person under 6 months recommended – in WA it’s free to all and people respond well. Does it work? For hospitalisation, there was high levels of protection against the flu, and the disease is very infectious and with estimated 35% of kids received at least 1 dose of flu vacccination in 2008.
Picture of the West Australian newspaper front page headline from Friday Feb 12th, 2010, on how the under-5s got vaccine for free – in 2010, the recorded febrile reactions due to the influence vaccine in young children was investigated and one in 100 had fevers. Common in young children in general, but it’s still being investigated. Reactions commenced within 12 hours of the vaccine and resolved within 24 hours – 15 out of estimated 18 thous being identified. ‘Only occurred with one manufacturer and wasn’t reported with other brands.’ They’re gathering more info from NZ vaccinations too. They didn’t see same problems with older children or adults. No similar problems in USA, where over 2 million are vaccinated.
Immunisation is one of the best things – they are studied before and after going into the population – herd immunity important – surveillance important – and ‘we need to do a better job of reinforcing and engaging the population.’ Keeping the surveillance and public informed is vital. The handbook he suggests for people is The Australian Immunisation handbook 9th edition, 2008. Written in plain English for the public and available online.
Clinical Associate Professor Deborah Lehmann – Infectious disease research
Vaccinations have saved more lives than any other single medical advance. Smallpox eradicated globally – the next is polio and there’s a global initative to do that and for tetnus, diptheria and so on. Infection is the most common reason for young children to be admitted to hospital in WA.
[About here the microphone popped out totally, and because I was in the second row, I started writing what she was saying without mic - she was then handed one pretty rapidly around the end of this next paragraph, so if there's a gap in the eventual audio, this is why]
We don’t live in an isolated community. We live in a global village, we travel a lot, people come to Australia and go overseas – exotic places have diseases and we have to prevent them when they come into Australia. Infections are not rare in Australia – the slide she puts up compares Aboriginal and non-Aboriginal, with incidences via infections being the most common and Aboriginal populations certainly showing more likelihood. Mostly due chest (pneumonia, flu, bronchial, etc). Many different bacteria carried in the noses of healthy people.
Showing slides of the iron lungs in 1952 – as a six year old herself, she got the Salk vaccine. From 1917-2000 in Australia, it didn’t disappear with improved living conditions – it was due to vaccination. How Australia was declared polio-free in 2000 and how one case in 2007 was reported – so, we must keep on going.
Measles – a major problem in many parts of the world – effort to eradicate globally. As a result of epidemic where 10 thousand in 1993-4, there was an initative and in 2009, there’s only 105 cases reported. Endemic cases has not been seen for a while. Shows a slide on the vaccine impacts on other age groups with pneumococcal disease, 2002-6 – for each of the years, a decline in the rates.
The vaccine cycle is put up on the board – will post pic of it.
Bruce Langoulant – Chairman of the Meningitis Center, President Confederation of Meningitius Organisation Inc. and parent.
‘If there’s one way of understanding the power of disease, it’s the loss, the long-term disability, the impact on parents, carers and community… It happens so quickly, last thing to do is blame people – what you should do is find solutions, because time is of the essence.’
He talks of his daughter Ashleigh, back in 1989, and how she survived and she can’t walk, talk, hear and has epilepsy and cerebral palsy and how within 30 hours it happened.
‘What gives me great hope is the HIB vaccine… as someone who has been there, I’ve been involved in the HIB program and I thought “I’ll put my skills to work as a marketing man” – as a novice, not as a doctor, it seems a simple thing that people should know: ‘”That fixes that” – and I still believe that today.’
‘What really worries me and what I react to is the photo from the [West Australian of Sarah Chivers] who chose not to vaccinate her baby son Fletcher [photo on page one which featured on 28th May, 2010]‘ – how he had a daughter with menigntius who was in hospital less than 24 hours later after the first signs, and there was no vaccine for his child back then. And how it can happen so quick. For him, that photo is a frightening reminder of how vulnerable children are and that they can do something about it. How fundraising is difficult and they still do it – to make people aware of it, how little time to do soemthing about it.
Posts a picture of an advertisement from 1999 – ‘what it looks like before it kills’, featuring a perfectly healthy baby in a pic. ‘Unless you’ve been bitten – people don’t seem to pay attention – so they published many fridge magnets, thousands across Australia.‘ [I have one of these on my fridge, for example]
Graph of the hidden impact of Pneumococcal disease in Australia. Many end up being disabled (the orange in the picture showing what happens within 48 hours and for life), due to the brain being cooked due to the disease. ‘Like shards of issues being cast into the community – the related long-term disabilities related to pneumococcal disease – carers, transport, hospital, education, etc.’
‘This is what my daughter ended up with and this is what we deal with – you are not taught about the life issues and I don’t know if many families are equipped to deal with it.’
‘…She could have been anything – but she never will. I think families in the community are better protected with vaccination. The messages are still true – make sure all the gaps are closed and grab our fridge magnets and be aware…. Ash turned 21 a few days ago and her gift to you is that investigation into the disease is fully funded by the Government.’
There are questions from the audience, but I’ll be posting this instead of detailing them all.
Someone has asked about mercury and aluminium and toxins? Dr Peter Richmond: ‘A common concern – a good thing to say is that the vaccines don’t have thimerosal or mercury. Because this was raised as an issue, those vaccines are now designed without those. All vaccines in the under five don’t have this.’
There is one parent, using her child’s example of autism, who says that the hospitals and manufacturing groups are lying to them. ‘Both of our sons are not vaccinated, we are not selfish, complacent or ignorant and have lost faith and think it’s due to good reason – we know what happened to our son.‘ Only two people applaud her.
The panel say that it is indeed a tragedy and feel sorry that the feel their treatment was different due to the vaccine – when Dr Peter Richmond talks to people, ‘we say that bad things indeed happen to children.‘ If they vaccinate 90% of population – it’s difficult to know what’s going to happen, is it co-incidental? He points out that for some cases in the UK, they found that it was due to a gene mutation which led to likelihood of fits and that people can be tested for this.
Dr Fiona Stanley says that ‘we do care very deeply about the issues raised and you don’t have to believe me – what we try to do is show evidence of risks of vaccine vs risks of the disease and we do it with huge amounts of compassion for the kind of story you tell. And we try to get the best info out possible.‘
She suggests no clapping - ‘I’m not on a side, I am here for kids’.
Information via – www.childhealthresearch.com.au
{ 10 comments… read them below or add one }
Awesome, thank you so much for this Kylie. Very sleepy right now, but I’m looking forward to reading it in the morning.
Very interesting. Sounds like it was a very informative and accessible lecture.
Thank you very much for writing it up. One thing I do kind of miss is images. You mention various pictures and graphs, yet there’s only one, which, unfortunately, I can’t quite make out. If I understand it correctly, you’re referring to images used in the lecture, so I can image you not having easy access to them. Do you happen to know if they are available somewhere else, like on the Telethon site?
Wow PB! You must have smoke coming off your keyboard by now.
Thanks for this. Well done.
Thx Kylie, wish I was there to listen too.
Great work
That would have been interesting to go to, but I can already hear the anti-vaxxers complaining: “What about balance? They should have evened it out by having untrained non-experts whose information is not based on evidence talking too. Why only show one side?”
And they’ll say it without a hint of irony.
I did get a comment about ‘But wouldn’t it be a more interesting discussion if both sides of the debate are represented?’ and a claim about ‘do it in spirit of blood sports‘ – THESE. ARE. PEOPLE we’re talking about here. ‘Blood sports’ is, to my mind, an offensive way to sum it up. This is not a game or a Roman arena. There was a Q&A at the end of the lecture, as I showed, and Dr Fiona Stanley made a statement in regards to how she saw it when she had someone talk about why they chose not to vaccinate their children.
If you want to see an example of such a ‘debate’ with ‘both sides’, then see the video of the discussion that featured the McCaffreys, as blogged on Dr Rachael Dunlop’s blog:
http://www.youtube.com/watch?v=M9asrOKCfkA
What should stay with people who want such ‘blood sport‘ is the following incident:
Toni and David McCaffery were in the audience today. I sat next to David and we chatted throughout. They both thanked myself and Richard for our support. What they did today was unimaginably tough and brave. Dana only passed away 6 weeks ago. Yet the anti-vaxers bumble along seemingly oblivious. At one stage when discussion got around to Dana’s death I heard from behind me, someone say it was only one baby. David McCaffery leaned over to me and said, “It was my baby”.
It was nice to hear from people who know what they are talking about. Plus there weren’t any hired goons loitering about the place.
But they were CUTE hired goons!
Great work Kylie – thank you for you continued efforts in providing the skeptical community with solid content.
Thanks Kylie! Wish I could have made it (at home with a sick 1yr old). I’m so glad you are getting this information out there.
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