Dr. Ellen Burgess called for mandating vaccinations for school children in a video interview and news article posted on Global News on October 31, 2016. Her ostensible reason was information in a new study. Vaccine Choice Canada responds with the following letter.
November10, 2016 by mail & email
To Dr. Ellen D. Burgess
Professor, Department of Medicine
Foothills Medical Centre. Calgary, Alberta
Re: Oct. 31, 2016 Global News Okanagan story with video Interview:
Dear Dr. Burgess,
We are writing to you regarding the October 31, 2016 Global News story and the live interview you gave about a new study that purports a risk rate of 1 in 600 children for SSPE, a devastating and fatal complication of measles.
The study you reference, Subacute Sclerosing Panencephalitis: The Devastating Measles Complication Is More Common Than We Think, was presented as an oral abstract on Friday October 28 at an annual medical conference–IDWeek–held in New Orleans, Louisiana from Oct. 26-30.
To our knowledge the full paper has not been published, but the Abstract specifically states that the 1:600 incidence of SSPE in children under 1 year of age is based on data from the 1988–1991 measles epidemic in California. This risk assessment means 1 case of SSPE per 600 reported measles cases in infants in that region during that time period. See Appendix 1 for detailed quotes/data and Appendix 2 for references with hyperlinks on this and all of the following points. (Hyperlinks are undelined on all pages of this letter.)
Your Global News interview raises some questions to which we request your response:
- Does it concern you that only 8 of the 17 SSPE cases in this study were living in the US when they contracted measles?
On reading the published abstract (Results section), we note it states that only 8 of the 17 cases had measles when they were living in the United States. This means it is unlikely that 11 of SSPE cases actually relate to the SSPE risk estimates for California given in the study, Risk estimates are based on the number of cases of measles occurring in a location and the number of SSPE cases occurring after exposure to those measles cases. See Appendix 1.1 for details on the Abstract and especially see Appendix 1.3.1 for good practice when associating SSPE cases with risk estimates for a given location. [Appendix 1.1]
- Why is this being reported as current risk when it is not?
It is SSPE risk for children less than 1 year of age (age specifics not mentioned by you or the reporter) from an epidemic that occurred over 25 years ago with a 9-fold increase in volume of measles cases and a very particular demographic for those cases. According to the 2015 edition of the CDC Pink Book: “In addition to the increased number of cases, a change occurred in their age distribution. Prior to the resurgence, school-aged children had accounted for the largest proportion of reported cases. During the resurgence, 45% of all reported cases were in children younger than 5 years of age. In 1990, 48% of patients were in this age group, the first time that the proportion of cases in children younger than 5 years of age exceeded the proportion of cases in 5–19-year-olds (35%).” [Appendix 1.2.1] Further, children infected with measles under the age of 1 year carry a risk of 16 times greater incidence of SSPE than those infected at age 5 years or later (2013 Sardana et al). So this demographic change resulted in a much higher rate of SSPE during the epidemic then seen before or since. That is why this cannot be considered a current risk assessment.
- Do you expect the demographics during the epidemic discussed above and the vaccine failures discussed below would ever occur again in either the USA of Canada? If so, please explain how this might happen.
The CDC further explains it was the waning vaccine efficacy in young mothers who had received only one dose of MMR vaccine in their childhood that resulted in so many infants contracting measles coupled with the low vaccination coverage of low-income, inner city, pre-school children that resulted in the large numbers of under-five year old children getting and spreading measles. [Appendix 1.2.1] In 2004, Orenstein et al stated: “Two major causes of this epidemic were vaccine failure among a small percentage of school-aged children who had received 1 dose of measles vaccine and low measles vaccine coverage among preschool-aged children.” The primary and secondary vaccine failure resulting in this epidemic is why the change was made to a two-dose regime of MMR vaccine and why vaccination campaigns for pre-school children were instigated. As a result of these changes, today we see a completely different demographic for measles cases than occurred in the 1989-1991 epidemic with a concomitant lower risk of SSPE cases today. In fact, a 2016 CDC MMWR report says: “SSPE is a rare, long-term complication of measles. Widespread use of measles vaccines has been associated with the near disappearance of SSPE in the United States.”
- Why did you choose to use an SSPE risk assessment from one state in the United States, which is based on completely different data and circumstances than what happened in Canada?
The Canadian Pediatric Society undertook a study (2005 Campbell et al) to access Canadian risk of SSPE that arose from the measles resurgence that occurred in Canada in 1990–1991 with 7178 cases of measles reported. They assessed SSPE risk as follows: 1 case every 2 years in Canadian children or 2 cases of SSPE for children < 2 years of age for every 7,178 cases of measles (which translates to 1:3589). The study does not give a risk assessment for children under 5.
If you wanted to use another country’s assessment of SSPE risk, the 2013 German study (Schönberger et al) is a beautifully designed and comprehensive study. Its conclusion states: “…this study provides data on the SSPE epidemiology in Germany for the period 2003 to 2009. Our data suggest the risk of developing SSPE after acute measles infection below 5 years of age is in the range of 1:1700 to 1:3300.
- Do you believe that parents should be made aware of the low incidence rates of both measles and SSPE (or other rare measles complications for that matter) when discussing risks of complications for their various aged children?
Alberta Public Health has excellent documents on both SSPE and Measles incidence in Canada and Alberta. They are easy to understand and would give parents a much better idea of the true SSPE Risk than the California study. In over 20 years there have been no reported cases of SSPE in Alberta children (1993–2015). The Public Health Agency of Canada has an on-line database of reportable diseases current to 2014 from which measles incidence and age of infection can be accessed as well. We have included documents and data from both sources in the Appendix 1.2.2 and 1.2.3.
- Did you use the 1:600 SSPE risk to infants in the interview as though it were current risk for all children in Canada in order to justify (even if only in your own mind) mandating vaccines?
If so, we can only caution you that it is this kind of “slight of hand” with the facts that results in the public mistrust of the medical establishment’s recommendations regarding vaccines.
- When you call for mandating vaccines, do you recognize the constitutional right of every Canadian citizen to informed consent or refusal of vaccinations and other medical procedures?
We have an excellent article on our web site regarding the legal ramifications of mandating vaccinations. It begins: Health Canada States That Immunization is NOT Mandatory in Canada
“Unlike some countries, immunization is not mandatory in Canada; it cannot be made mandatory because of the Canadian Constitution. Only three provinces have legislation or regulations under their health-protection acts to require proof of immunization for school entrance. Ontario and New Brunswick require proof for diphtheria, tetanus, polio, measles, mumps, and rubella immunization. In Manitoba, only measles vaccination is covered [since Redacted]. It must be emphasized that, in these three provinces, exceptions are permitted on medical or religious grounds and reasons of conscience; legislation and regulations must not be interpreted to imply compulsory immunization.”
- Will you consider either making a correction to your Global News interview or doing another interview to clarify that the SSPE Risk you quoted in your first interview does not actually apply to Canadian children at this point in time?
Quoting the easy to understand Canadian study findings of 1 case of SSPE every 2 years in Canada would do a lot to alleviate any fear you may have generated in Canadian parents with your use of the 1:600 California risk assessment figure.
Considering the data presented here and in the Appendix, beating the fear drums of SSPE misery and death to justify mandatory vaccination of school children seems not only inappropriate, but also highly unethical.
We will be posting this letter on our web site so the public has access to our analysis of this new study, to Public Health data and to peer-reviewed articles on the risk of SSPE in children following measles infection.
Nelle Maxey, VCC Director on behalf of the Board of Directors of Vaccine Choice Canada
CC: Alberta Minister of Health Sarah Hoffman, Dr. Craig Jenne & Global News Reporter, Carolyn Kury de Castillio
Attached pdf of the letter to Dr. Burgess and the Appendix that contains further details on measles and SSPE in Canada. All references are hyperlinked to on-line locations in the pdf.