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Geneva, Switzerland (GenevaLunch) - [Update, 6 April: please note important link added, 5 April Poling family letter to the New York Times, below] Schools in Vaud are receiving letters this week from the cantonal health department
about the worsening measles epidemic. Parents may receive letters about
school rules covering children who are not vaccinated, as well as
information about bringing vaccinations up to date.

If you would like a PDF copy of this article to share please contact the editor. This article may not be reproduced in part or in whole in any format without written permission from the editor.

Measles fact sheet from GenevaLunch: click on image to enlarge for easy reading.

Five weeks ago Swiss public officials, with WHO backing, sent an alert to Euro 2008 teams and fans coming to Switzerland for the football matches in June that they should be vaccinated against  measles.

Some 2,000 measles cases have been reported in Switzerland since the
end of 2006, with 600 of these since January 2008 alone: in October
2006 there were no cases, by August 2007 doctors had registered 170 new
cases in a month and while March 2008 figures are not yet available by
19 March 158 new cases had been reported for the month, with no let-up
in sight. By comparison, Britain in 2007 had some 1,000 cases for a far
larger overall population.

Professor Claire-Anne Siegrist is head of the vaccinology centre and research laboratory at the HUG
(Geneva University Hospital). She has been watching the relentless
spread of the Swiss measles epidemic. GenevaLunch editor Ellen Wallace
spoke to her about measles, vaccinations – and some parents’ fears that
vaccines can cause autism. Wallace is the mother of a 15-year-old
daughter who is autistic (featured on GenevaLunch this week for
World Autism Day), and as a parent she has been following the
vaccines/autism debate since it surfaced 10 years ago. Discussions have
grown heated, mainly in the US and the UK, over whether vaccines play a
role in provoking autism.

Three events are converging in the news, and the combination plus
the complexity of the debates has resulted in raising parents’ fears:
the current Swiss measles epidemic, a recent court award to parents of
an autistic child in the US and the medical board investigation into
possible professional misconduct in Britain in late March of Dr Andrew
Wakefield, one of the first researchers to say there was a link between
autism and vaccines (reports: BBC, Daily Telegraph).

The Swiss measles epidemic goes to America

A handful of measles cases appear in Switzerland nearly every year,
but in late 2006 the number suddenly began to rise. As the school year
drew to a close public health authorities heaved a sigh of relief,
thinking the holidays would break the chain of contagion. That didn’t
happen and although there was a brief drop at the end of 2007 the
number of cases rose sharply in January 2008 (InfoVac graph).

Photo: a child covered in the measles rash, courtesy of US Centers for Disease Control and Prevention

Meanwhile, a seven-year-old boy from California who came to
Switzerland on vacation went home to the US 13 January, fell sick and
developed a rash 25 January. He had not been vaccinated. That one carrier quickly spread the measles
and by 21 February there were 11 cases of Swiss strain measles in San
Diego, four of them picked up by very young children in the doctor’s
office the day the boy visited there. One of these babies then flew to
Hawaii. Public health officials, alerted to the boys’ case, tracked the
children and then people on the plane, several of whom were vaccinated
right away. Epidemiologists today can accurately trace back and
identify strains of the disease.

The Swiss measles case was given heavy media coverage in the US
because many states have mandatory childhood vaccinations. California
does not: it has PBEs, or personal belief exemptions that allow
children to attend school if they are not vaccinated, which is also the
case in Switzerland. The quick spread of the disease in San Diego
sparked renewed debate over the right to refuse vaccinations, often
from fear of side effects or that they will provoke dormant potential
health problems. At the heart of the debate is the question of which is
the greater risk, measles or other problems, including autism.

Claire-Anne Siegrist is a pediatrician and researcher in the field of vaccines, one of Switzerland’s most respected authorities, and she is firm on the point that the risk with measles is far higher. A top regional health authority who is also a pediatrician says of her, "I personally might take a slightly less strong stand and say I’m open to a possible
relationship, for example following a stressful event, like a major
illness, but she is very, very knowledgeable and a good scientist."

Siegrist believes that the debate has cultural overtones, noting
that in France and Switzerland there is little support for the notion
that there might be a vaccine and autism link. She compares it to the
skepticism and lack of interest in English-speaking countries over a
long-raging French debate about hepatitis shots and multiple sclerosis.
"The parallel I want to make is the time issue." Hepatitis shots were
targeted in France when nurses given the shots were diagnosed with MS
during similar post-vaccination timeframes. Children are now often
diagnosed with autism shortly after the time when MMR (measles, mumps,
rubella) vaccinations are given.

There is concern in the medical field in Europe and in the US that
no matter what beliefs people have about vaccines, there is a
widespread, incorrect belief that measles is not a particularly
dangerous childhood disease. For a start, it affects all ages, but
before vaccinations became common 45 years ago many people caught or
were exposed to it in childhood. Secondly, it is far more dangerous
than, for example, chicken pox. While up to one in 10 patients with
measles may need to be hospitalized, that figure is one in 1,000 for
chicken pox.

"The measles is not just a little flu," Claire-Anne Siegrist emphasizes. "It can
provoke a very high and very long fever that is exhausting. It might
last a week but it can leave a child wiped out for days." In 15% of the
cases in Switzerland, there have been complications. These can range
from pneumonia to severe ear infections and encephalitis. Nearly 8
percent of the measles patients have been hospitalized. In Geneva, four
of the 10 cases reported in one month involved hospitalization.

And measles can cause death. "Every day I fear that we’ll hear a
child has died – it could happen," says Siegrist. Statistically, the
mortality rate is 1 per thousand in developed countries and up to 25% in
countries where malnutrition and poor access to health care is a
problem.

The epidemic has touched Swiss cantons to very different degrees.
"There is a direct relationship between the number of vaccinations in
cantons and the number of cases we are seeing. In Geneva, we’ve had 48.
In Vaud, with a higher vaccination rate, we’ve had 11. Valais, two,"
says Siegrist, one of seven experts at InfoVac, a Swiss-based
vaccination database service. "But Lucerne, with a low rate of
coverage, has had 480 cases."

Geneva, she says, may have a higher rate in part because of the
city’s large foreign population, with people coming from countries that
may have started vaccination programmes or recall (second shots)
programmes relatively late.

An article published by wire service AP and widely picked up by its
member newspapers about Swiss measles and the Euro 2008 football games
noted that it is surprising that Switzerland has a relatively low
coverage for vaccinations. Siegrist agrees about the rate, saying that
Africa, with 85% coverage, is nearly equal to Switzerland. This should
not, however, surprise.

"Only rich countries propose the MMR – it’s too expensive for others, but all countries offer measles vaccinations." The international Measles Initiative,
with several major organizations involved, has made a big push for
measles shots, raising coverage in many countries. In countries where
the triple MMR shots are given, parents concerned that this is too much
for young bodies have avoided vaccinations altogether.

Most Swiss measles patients have been 5- to 15-years-old, but
one-third are over age 20, mainly parents who were never vaccinated and
who have been infected by their children. A surprising 57 people are
over age 40. "Today, it’s possible to have avoided it as a child, so
for a lot of people it’s harder to tell if if they were ever exposed."

When in doubt, she counsels, get vaccinated. And children who have had only one shot should be given a second.

Siegrist’s firm words on vaccinations are likely to be ignored by a
group whose most extreme members believe vaccinations are directly
responsible for the large increase in the autistic population, either
because of mercury or thimerosal, used in the vaccines (see the US Federal Drug Administration page on this and a different point of view from Natural News).
In the United States, the national Centers for Disease Control (CDC)
figures released in February, the most comprehensive to date, show that
the rate of autism is 6.7 per 1,000, up from earlier figures of 4 or 5
per 1,000.  Autism organization figures point to an increase
that is more rapid, with higher numbers. In either case the increase is
too great to be attributed only to better and earlier diagnosis,
although this is generally agreed to account for some of it. Siegrist,
in her forties, says that she when she began working as a pediatrician
there was little recognition of autism and few cases from which doctors
could learn, and this has changed.

Ten years ago she was worried about the links being made between
autism rates and vaccinations. "[Making the link] was a normal reaction
and for us, 10 years ago, it wasn’t easy to answer parents. As
researchers we have had to ask what else might have happened in that
timeframe. The huge growth in the number of autism cases has
complicated the matter." Since then, she says, public health bodies
have invested huge amounts in research, but also in better tracking
patients, to understand possible links. "We can now show that autism
cases are on the rise everywhere, even where there has been no change
in vaccinations."

US family awarded money for vaccine damage

People who have continued to argue for a link were given ammunition,
it appeared, in March, when a federal health panel recommended that the
family of nine-year-old Hannah Poling in Atlanta, Georgia, should be awarded money (the amount is not yet known) from the National Vaccine Injury Program
because of a link between her autism and vaccinations she was given.
The ruling startled many people, including her physician, who is
researching possible links between autism and mitochondrial disorders.
The court ruled that Hannah had a pre-existing mitochondrial condition
and a large number of vaccinations (nine in one day), given in one go,
aggravated the condition, leading to autism.

Hannah’s story has led to much confusion and misinformation
circulating on the Internet. It was not a court that made the decision,
but a panel, a distinction that is often poorly understood outside the
US, where the legal system for awarding damages is very different from
that of most countries. The panel did not draw a clear link between
autism and vaccines, but rather a link between one child’s rapid
decline and the vaccinations she received. As Time magazine reporter-at-large Claudia Wallis, also the mother of an autistic child,  points out in a relatively balanced article, Hannah’s
father is a biologist and neurosurgeon and her mother is a nurse and
lawyer who believe that vaccinations are important, even today. But
there is always a risk, they say. [Update, 6 April: Ed. note, a thoughtful letter to the editor from the Polings in the New York Times published 5 April 2008 clarifies many of the details and is well worth reading. The language for distinguishing court versus panel used above is not in any way designed to diminish the importance of the government concession. -EW]

Claire-Anne Siegrist says they are right, that zero risk does not
exist. She points out that with cases like this it’s important, though,
"not to confuse a legal decision which aims to help families where
there have been side
effects from a vaccination, and causality.

"The problem we face now is how to explain, scientifically, things
as complicated as links. Today I have no doubt that the MMR and autism
are not at all linked. The further we get in our genetic research the
clearer it appears that autism probably starts very early, possibly
before birth, even if the diagnosis comes much later. It might be a
combination of genetics and a virus, and so on.

"If there is a risk, it’s too small for us to measure. We can measure 1 per 1,000 but not if it’s a risk of 1 per million. So no, I cannot exclude a risk – but all
our studies show that if a risk exists, it’s less than one in a
million." The risk of not vaccinating for measles is far higher, she
says.

As for children who might be pre-disposed to other problems, Siegrist notes, "We
have a lot of evidence that there is no higher risk with vaccinations
for children weakened by other problems, such as HIV, weak immune
systems." On the other hand, some children, such as those receiving
cancer treatments, are not able to receive vaccinations and
unvaccinated children who attend school with them put these children at
risk.

There is also some confusion about fevers among young parents, she
believes. Parents worry that their children will have dangerously high
fevers post-vaccination. About 2% of children do get fevers, seven to
10 days after their shots. These are considered benign, with no
neurological effects, says Siegrist. "The fear that fevers can be bad
is very modern – a fever can’t be left untreated, but it’s part of our
defense system."

At the other end of the parental anxieties scale, a school principal
in Vaud, father of four children the youngest of whom is six, says he
has noticed a worrisome increase in the number of children who come to
school even when they are sick, possibly because in so many families
today both parents work and neither can stay home easily to watch a
sick child.

Reading the information
from the Vaud health authorities about how easily measles can spread in
a school, he reflected that society may be putting too much pressure on
parents.

Background: Canton Vaud, public health department page in French on measles