Monday, September 19, 2011

Polio in China

As of 13 September 2011, nine cases of polio have been reported in the Xinjiang region.  There has been one death.  All of the cases had wild-type polio 1 (WPV-1) which originated from Pakistan.  Xinjiang shares a border with Pakistan where polio is endemic, along with other neighbouring countries, India, Afghanistan and Tajikistan that are also polio-endemic.

Four children between the ages of four months and 2 years were infected in July, data for the other five are unknown but appear to be all infants, including the one fatality.  This is the first outbreak of polio in China since 1999, when an importation from India was identified.  The last indigenous case was in 1994.  An intense surveillance and vaccination programme has been launched in the region in hopes that the spread can be contained.  However, given that paralytic polio occurs in ~1% of polio cases and of that, 5-10% result in death and there were at least four cases of paralysis and one death, it is more than likely that hundreds, if not thousands of cases have gone undetected.

This outbreak demonstrates the vulnerability of populations who are not adequately vaccinated and the relative ease at which an infectious disease can cause an outbreak even in a country previously certified as polio-free.

Tuesday, September 13, 2011

Lessons From the MMR Scare

That was the title of Fiona Godlee's webcast from the National Institutes of Health, Fogarty International Center, Tuesday, 6 September 2011.  Dr. Godlee is the editor-in-chief of the British Medical Journal (BMJ) and published the three part series by Brian Deer exposing the fraudulent research of Dr. Andrew Wakefield.  Her talk can be viewed in its entirety here.

She reviewed the key points of Mr. Deer's protracted investigation of Dr. Wakefield's MMR research and the painstaking measures the BMJ took to review and validate Mr. Deer's reports.  She raised concerns of fraud in science and what medical/scientific journals could do to prevent such an occurrence from happening again.  She also discusses the role of the media and their contribution to the legitimising of Dr. Wakefield's, now retracted, Lancet report.  Dr. Godlee also makes an intriguing proposition for improving public health communications by entreating investigative journalists to work with epidemiologists.  We have already seen the success of solid science reporting by the likes of Brian Deer and Seth Mnookin so it is a feasible proposition.

Dr. Godlee provides an honest and thorough analysis of fraud in science/medicine and public health communications deficits along with some criterion to prevent fraudulent scientific reporting.  All in all, an informative talk and interesting points made during the question and answer session.  Jake Crosby from the Age of Autism made an embarrassing showing by introducing himself as "Jacob Crosby from the George Washington School of Public Health and Health Services", not disclosing himself as a student and implying he represented the school as faculty or staff.  Not to mention, I doubt the George Washington School of Public Health and Health Services sent Mr. Crosby as their representative, but rather, he attended as Age of Autism's lackey.  Mr. Crosby also missed the point of a "question and answer" session and launched into a churlish diatribe of fraud allegations against Brian Deer which can be viewed at the 54:04 mark on the webcast.

Saturday, September 3, 2011

Death isn't everything, part 3: measles in Minnesota

This is Mahi Abdalla on his mother's lap (photo Jim Gehrz, His family took him from Minnesota to Kenya where he contracted measles. He had been unvaccinated, because he was only 9 months old when he left the country. He spent three weeks in the hospital, two of those on a ventilator, due to measles pneumonia.

The US has seen over 175 measles cases this year; in the 1989-1991 epidemic, the death rate was just over 1 in 400 reported cases (123 acute deaths, at least 11 due to SSPE). Mahi was "lucky" with this severe but not fatal course of measles - it is only a question of time when the US will see their first acute measles fatality since measles were thought eradicated from the Americas. SSPE as a late consequence of measles usually in the first couple of years of life is still looming over the heads of the babies and toddlers who contracted measles this year. Sad...