What to Fear in 2015

From Parade Magazine,  What to Fear in 2015:

An excerpt:

Here are a few of the things you should and should not fear in 2015:

  • Flu not Ebola
  • Domestic violence not serial killers, pedophiles
  • Heart disease not Mercury in fish
  • Not getting enough dietary fiber not gluten
  • The re-appearance of measles, whooping cough, and other preventable diseases not vaccine side effects
  • Texting while driving not air travel
  • Malware on your cell phone not bulk password theft
  • Gun violence among young people not school shootings/mass murders
  • Sitting too much not heart attacks during exercise

Another link on the measles epidemic from NY Times: Vaccine Critics Defensive. Another editorial remarked on how Ebola which is much less contagious than the measles alarmed so many people in this country; it stated that if a terrorist, rather than parents refusing vaccinations, had unleashed a highly contagious virus on our communities, many would be calling for military retaliation. Unfortunately, it takes a measles epidemic to provide a passionate argument for immunizations. Related blog post1400 Different Immunization Schedules -What Could Go Wrong …

From NBC News Measles Vaccine FAQ

Exceptions for Valproate-Associated Liver Failure

Recent guidelines (AASLD/NASPGHAN 2014 Guidelines for Evaluation of Pediatric …) have included valproate-associated acute liver failure (VPA-ALF) as an absolute contraindication to liver transplantation.  The reason is that most of these VPA-ALF patients have Alpers-Huttenlocher syndrome (AS) and have done poorly after transplantation due to progressive neurological decline.

AS in turn has been recognized as secondary to mutations in DNA polymerase subunit gamma (POLG1).  This gene product’s role is to maintain the integrity of mitochondrial DNA (mtDNA).

New data (Liver Transplantation 2014; 20: 1402-14, editorial 1287-89) suggests that there are exceptions for some cases of VPA-ALF.  In this report, 4 VPA-ALF patients with POLG1 mutations underwent successful liver transplantation.  Three are alive at followup 4-19 years later and one died suddenly 2 years after transplantation.

Key findings:

  • These cases had mutations in POLG1 associated with later onset and milder disease.
  • In the three long-term survivors, VPA was introduced at 14, 20 , and 21 years of life.

Take-home points:

  • For children less than 10 years of age, “VPA-ALF should remain an absolute contraindication to LT because neurological progression is almost inevitable.”  Supportive treatment, including N-acetylcysteine and carnitine should continue.
  • There is a “strong case for screening for POLG1 mutations before VPA use…even a single mutation should be seen as a contraindication to VPA.”

Related blog posts:

Also, I added a link on yesterday’s post regarding measles to a story on NPR which explores the most recent increase in cases and provides background information.  For example: “Before a vaccine was developed in the 1960s, measles caused more than 2 million deaths per year.”  And worldwide, even now, “nearly 400 kids die from measles each day. In 2013, more than 70 percent of measles deaths were confined to six countries: the Democratic Republic of Congo (DRC), Ethiopia, India, Indonesia, Nigeria and Pakistan.”

Measles Epidemic 1991 -Compelling Narrative

I saw two personal heroes yesterday –Donald Schaffner and Paul Offit.  This happened at the 13th annual Donald Schaffner conference.

Dr. Schaffner is a former surgeon at Children’s Healthcare of Atlanta .  In recent years, he has battled a number of medical problems.  During my early years as an attending, he and I worked together to help a number of children.  His patience, caring, and dedication to providing the best care were unrivaled.

I had never met Dr. Offit in person and this was the first time that I heard him speak.  However, he has been an outspoken advocate for vaccines and has written extensively on this subject; in addition, he has cast a critical eye on some alternative medicine practices.  I have quoted him numerous times on this blog (see links below). His topic for this conference: “The Philadelphia Measles Epidemic of 1991: Lesson from the Past or Prologue to the Future.”

This was an amazing narrative of the measles epidemic combining the epidemiology, with journalism, law, politics, and the history of refusing vaccines.  I did not take any notes, though I did take two pictures.  The lecture was effective because it was presented like any good story with lots of details, facts, and passion.  The lies and mistakes were discussed as well.

Legal Foundation for Compulsory Vaccination during Measles Epidemic

Legal Foundation for Compulsory Vaccination during Measles Epidemic

High case fatality among those who claimed religious exemptions to vaccine

High case fatality among those who claimed religious exemptions to vaccine

Key points:

  • Religious vaccine exemption was claimed initially by Christian Scientists. This has been expanded by other groups claiming personal beliefs.
  • Vaccine successes have made people forget how dangerous diseases like measles can be; unfortunately, resurgence of these diseases may be necessary to convince people that vaccination is worthwhile

One more link -yesterday on NPR: Measles Still Kills

Related blog posts: