Darla Shine's misinformation about measles – FactCheck.org


For nearly 18 hours on Twitter, Darla Shine, wife of Bill Shine, deputy chief of staff of President Donald Trump, made a series of false and misleading statements about measles and vaccines.

  • Shine said to "bring back" childhood diseases because they "keep you healthy and fight cancer". Infantile diseases, of course, make people sick – not healthy – and can be deadly; they do not protect against cancer either. Although survivors gain immunity, the same effect can be achieved with much greater safety with vaccines.
  • She cited reports on a clinical trial at Mayo Clinic to support her claim that measles can "fight cancer". But the researchers did not give his patients measles to kill the cancer cells; they gave them a weakened version of the measles virus similar to the vaccine.
  • Shine suggested that her children would not be immune for life because they had received the MMR vaccine instead of being infected, as she did. In some cases, the infection results in stronger or longer protection than that provided by the vaccines, but experts say that additional protection does not outweigh the risks of not being vaccinated.
  • Shine warned pregnant women not to receive vaccines because of a lack of safety testing and approval from the Food and Drug Administration. It is true that the FDA has not allowed vaccines to be used during pregnancy, but there is a lot of evidence to support the use of multiple vaccines. And the Centers for Disease Control and Prevention recommend that women be vaccinated with each pregnancy.
  • She falsely stated that "many" child victims of the ongoing measles outbreak in Washington State had been vaccinated, and called on the media to "confirm that 75% of those infected by measles in New York were completely vaccinated. " both epidemics were not vaccinated.
  • Shine retweeted unreliable web site articles that falsely claimed that there is evidence that the measles vaccine is responsible for the spread of the disease. No documented case of measles passes from person to person because of vaccination.

We do not generally analyze statements by spouses of political figures. But Shine's claims, if taken seriously, could be dangerous for public health. Here, we discuss the many falsehoods and explain how she misinterpreted some otherwise interesting research on cancer at an early stage.

Childhood diseases do not keep you healthy

The tweet of February 13th that kicked off Shine's comments on measles and vaccines has made fun of the ongoing epidemics and has demonstrated a lack of understanding of the purpose and impact of the disease. effectiveness of vaccines. To date in 2019, there have been six measles outbreaks, including three in New York and one in Texas, in Illinois and in the state of Washington.

Shine suggested that contracting the measles virus was not so bad, and even went so far as to say that bringing back childhood diseases could be an improvement, since they "keep you in good health and fight against cancer.

These two ideas, however, are false. It is true that if you survive a childhood illness, you will develop an immunity that will protect you later. But acquiring immunity with a natural infection is dangerous. And bringing back childhood diseases "again" will not fight cancer.

We will discuss cancer demand later, but first, let's look at some epidemiological history.

In the decade prior to the launch of the first measles vaccine in the United States in 1963, the measles virus 3 to 4 million Americans every year, mostly children. Between 1956 and 1960, more than half a million cases were reported annually to the CDC, and an average 48,000 people were hospitalized and 450 people died.

These figures mean that thousands of baby boomers born between 1946 and 1964 died of measles, although the younger generation may have received the vaccine.

Thousands more have suffered complications, including pneumonia; encephalitis, or swelling of the brain, which can lead to permanent brain damage; and ear infections, which can lead to hearing loss – not to mention the pain and suffering of a normal and uncomplicated case of measles, which comprises fever, cough, runny nose, red eyes and a characteristic rash.

With vaccination, measles cases reported in the United States have declined by more than 99 percent. According to an estimate by researchers from the CDC and the World Health Organization, the measles vaccine saved more than 20 million lives worldwide this century alone.

Rate of a rare but fatal complication of measles called subacute sclerosing panencephalitis, or SSPE, also fall as vaccination became the norm. In this state, children develop fatal neurological symptoms six to eight years after contracting the measles virus.

In 2000, the United States stated that the disease was "eliminated", meaning that the measles virus had not been transmitted continuously to others for a year or more in a given geographical area. This status remains today.

The disease remains a concern, as measles is still common in other parts of the world and can be imported. Outbreaks d & # 39; habit This happens when an unvaccinated person catches the disease abroad and brings it back to the United States for transmission to other immune system. Measles is very contagiousand 90% of people who are not immune will become ill if they are exposed to a sick person who coughs and sneezes.

The current measles vaccine, given as a two-dose combination measles, mumps and rubella vaccine, or MMR, is highly effective. One dose of measles vaccine protects 93% of the population against measles, and is effective for 97 percent people who receive two doses.

The vaccine, which consists of a weakened live virus, or subdued, is also sure. The most common adverse reaction is a fever, which affects 5 to 15% of people. About 5% of people develop a mild rash. More serious reactions include allergic reactions, but they are extremely rare, about one in a million doses.

Contrary to what Shine suggests, it is much safer to get immunity against the vaccine than against the natural infection. Even with the best medical care, 1 to 2 in every 1,000 patients will receive dieand a quarter of patients are hospitalized.

The measles vaccine, on the other hand, has rarely been associated to deaths in healthy persons, and it has not been demonstrated that the vaccine caused these deaths. As the World Health Organization Explain on its website, "so few deaths can reasonably be attributed to vaccines that it is difficult to assess the risk statistically."

Finally, a recent study suggests that measles immunization has additional benefits beyond simply avoiding measles infection. A 2015 study published in the newspaper Science found that measles immunization was associated with lower mortality from other childhood diseases. Researchers believe that this is because measles infection can impede a person's immune system for two to three years, increasing people's vulnerability to other illnesses during that time. This is yet another proof that it is the vaccination against childhood diseases – and not the infection – that keeps you healthy.

Measles and cancer

After Shine, childhood diseases "fight cancer," she says, tweeting stories describing preliminary research from the Mayo Clinic.

The Mayo Clinic has published a case report in 2014, a patient with multiple myeloma who went into remission after receiving an experimental treatment using a measles-derived virus. But Shine is wrong to conclude that research advocates that more people be infected with measles.

As mentioned in both articles, the researchers did not infect the naturally-occurring measles virus to fight cancer. They used a modified virus, weakened and similar to the measles vaccine virus. In other words, they did not inject measles into patients; they gave them a large dose of vaccine.

The idea was that the virus infects cancer cells and fuses them, then breaks down and dies, which is the modus operandi of the measles virus. But it was important that the virus is not its normal and powerful being.

Angela DispenzieriThe Mayo Clinic researcher, who is responsible for this trial, told us that scientists would never consider infecting cancer patients with actual measles.

"It could be deadly, because it's such a bad virus," she said during a phone interview.

In addition to being safer, the vaccine version of the measles virus may be particularly useful for this type of oncovirotherapy because it tends to use particular receiver penetrate more common cells on some cancer cells than on healthy cells. This way, it can help limit the deadly power to the tumor.

The research was born from observations that some patients with leukemia and lymphoma improved after going down with measles. But Dispenzieri stressed that these conclusions were anecdotes. They have been helpful in thinking about this new approach to the fight against cancer, she said, but they do not prove, even for people with this type of cancer, that measles infection beneficial effect rather than harmful.

Dispenzieri also warned that although the therapy seems to have worked for one patient, the researchers have still not seen a similar response in others. The work is still in its infancy, she says, and is not approved by the FDA.

Duration of immunity

Shine also suggested that her naturally acquired immunity was more durable than her children's immunity because they received vaccines.

The immunity that a person develops after contracting an illness is sometimes greater than the immunity gained by vaccination.

After all, the body is exposed to a lot larger dose microbe, over a longer period, so it is not surprising that this translates into stronger or more durable immunity. But that's also why the person gets sick. The idea that it would be useful to give up the vaccine to get these slight improvements is a persistent myth of the vaccine.

As we have already pointed out, immunity against measles carries a much higher risk of dying or developing a serious complication than getting vaccinated.

It also puts others at risk. Vaccinating as many people as possible protects people who have not been vaccinated, as well as all those who can not be vaccinated, such as infants and people with compromised immune systems. This is known as herd immunity.

Vaccines reproduce the natural infection experience using much lower doses or inactive portions of viruses and bacteria, so that there is always protection, without the danger or hassle of getting sick .

In particular, there is several pathogens for which vaccines provide better protection than natural infection, including pneumococcal bacteria, tetanus and human papillomavirus or HPV. With tetanus, for example, it takes so little toxin to get sick that it is not enough to trigger the create protective antibodies. A person needs the vaccine to develop immunity.

Vaccine safety during pregnancy

Shine's third tweet about the vaccine wrongly concluded that pregnant women should not be vaccinated.

Shine's statement was made in response to a tweet from a naturopathic doctor, who shared an article from Children's Health Defense, an organization opposed to vaccination.

The article and the tweet emphasize that the FDA has not approved vaccines for use in pregnant women, which is true.

But Linda Eckert, an obstetrician-gynecologist and maternal vaccination specialist at the University of Washington, told us that it was actually an issue of agency technicality – which does not change the fact that several vaccines have been well tested in pregnant women and have demonstrated benefits for the infant and the mother.

"We have a lot of data on the safety of vaccination during pregnancy," Eckert said during a phone interview.

According to Dr. Eckert, one of the problems is that pregnant women have been excluded from all clinical trials for 30 years, making it impossible to carry out the traditional studies required for FDA approval.

And the fact that the FDA has not licensed a vaccine for pregnant women does not mean that the FDA does not want women to use them. FDA scientists explain in a article published in the newspaper Vaccine that although pre-registration studies have not yet been performed, it "does not prevent the use of these vaccines during pregnancy" and that "this use does not prevent the use of these vaccines during pregnancy" is not considered "non-compliant", adding that the recommendations of various groups "are not inconsistent with FDA labeling."

According to the CDC, pregnant women should have vaccines against seasonal influenza and whooping cough, or whooping cough, at each pregnancy.

The influenza vaccine is important because the flu can make pregnant women very sick.

"The flu hits you harder when you're pregnant," said Eckert, "and it's also harder for the pregnancy."

As a CDC Explain on its website, millions of pregnant women have been vaccinated against influenza and many studies confirm the safety of the vaccine.

the pertussis vaccine is given to mothers in the third trimester to protect babies after birth. In this case, the vaccine encourages mothers to produce antibodies, which are passed on to their baby and provide protection for the next two months, while the baby can get his or her own pertussis vaccine.

The CDC Advisory Committee on Vaccines recommends that other vaccines are only given under certain conditions, for example when the mother travels abroad. Some vaccines, including live attenuated vaccines, should not be used. But this directive is not due to a known danger, but to a theoretical risk.

Poor statistics of the epidemic

In the afternoon, after suffering the backlash of Twitter users, Shine made another false claim: a "large number" of children victims of the state epidemic from Washington had been vaccinated. It was and remains inaccurate.

Almost all measles cases in current countries release in Washington are in Clark County, which borders Oregon and includes the city of Vancouver. By the time Shine tweeted, the County Public Health Department declared on its website, of the 53 confirmed cases, 47 were unvaccinated, five had no vaccine status, and one had received a single dose of MMR vaccine. Two doses are recommended for maximum protection.

As of February 27, the department reported 65 confirmed cases, including 57 in unimmunized persons, six not yet verified and two in persons who received a dose of MMR vaccine. None of these are for people who have received the two recommended doses of MMR vaccine.

A Additional the case confirmed in Washington was reported in a 50-year-old man from King County, which includes Seattle. The county health department told us that the patient said that she had been vaccinated as a child, but that she did not have verifiable proof of vaccination.

Nine hours after the tweet from Washington State, Shine applied the same line of thought to the New York epidemic, retweeting the wrong figures of someone else for Rockland County.

When Shine tweeted, the Rockland County website reported that only 4.6% of the 135 confirmed cases involved fully vaccinated persons. In contrast, 81.5% were people who had not been vaccinated. Another 3.1% involved people who had received MMR vaccine and the remaining 10.8% vaccination status was unknown. Since thenfour other measles cases were reported, but vaccination percentages remained the same.

Although vaccinated cases are rare in these two epidemics, it is not uncommon to find epidemics in which the number of vaccinated is higher, or even higher than that of unvaccinated cases. However, these examples do not prove that vaccinated individuals are at higher risk. They are expected to expect this because of the mathematical foundations.

Like the Philadelphia College of Physicians Explain on its vaccines website, as no vaccine is 100% effective, if the vaccinated group is large enough, even a low rate of vaccine failure could mean that there are more vulnerable people in the vaccinated group than in the unvaccinated group. Therefore, it is not very useful to measure the risk by considering the absolute number of sick people vaccinated or unvaccinated. Instead, the size of the vaccinated or unvaccinated population must be taken into percentage sick people in each group.

Vaccines do not spread measles

Shine also conveyed the misconception that measles vaccine spreads the disease by sharing links to two inaccurate stories posted on suspicious websites.

Both stories, which are riddled with a variety of errors, to quote many legitimate studies one who reported finding evidence of the measles vaccine strain in the body fluids of vaccinated children. Some of these children developed measles or measles-like symptoms – we'll talk about it later. These studies used a very sensitive method of detecting viral genome fragments called RT-PCR, which allowed them to differentiate the naturally occurring measles virus from vaccine strains.

Contrary to what the stories claim, none of these studies indicate that the children were contagious or part of an epidemic. This is an important distinction, says Paul Offit, director of the Vaccine Education Center and infectious disease specialist at the Children's Hospital of Philadelphia.

"The genome can be detected," he said during a phone interview. But, he added, it's not the measles virus. "He is very weak, and he is not spreading."

The release of viral particles, or so-called viral shedding, can be a problem with other live attenuated vaccines. the oral polio vaccinefor example, causes children to get rid of the virus in their faeces and other body fluids, which, if they are recovered by other non-immune individuals, can lead to an infection. Partly for this reason, the United States stopped all oral polio vaccines in 2000 and replaced them with inactivated versions that can not.

But with measles, there is not one convincing case that the vaccine has ever transmitted the virus to another person. Like a Systematic review 2016 in the newspaper Vaccine concluded: "No evidence of transmission of the measles virus to humans has been reported among the thousands of clinical specimens genotyped during outbreaks or endemic transmission and transmission. individual case studies around the world ".

A case report published in the Lancet In 1989, a British doctor described a scenario in which an 8-month-old girl developed measles symptoms after vaccination with her 4-year-old brother. But this conclusion was entirely based on timing and clinical presentation. He does not even include a lab test to confirm the measles, which was available at the time. Since then, there have been no other reports.

The researchers are so convinced that the measles vaccine is not a vector of transmission that the CDC recommended the vaccine even for people living in households with immunocompromised people.

Finally, since the case studies indicate whether measles vaccine could be the cause of measles, the answer is possible, but extremely rare.

There is a handful of isolated cases of children with measles in the medical literature after receiving the vaccine. In most cases, the symptoms may not be labeled a full-blown disease, or the children have immune deficiencies.

There are only a few cases where a healthy child has developed what appears to be full-blown measles from the vaccine strain of the virus, and even these cases can not rule out alternative causes or unique circumstances.

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