Dammit.

I had planned on posting something else tomorrow that, because it had been posted elsewhere, would be minimal work. The reason, of course, is because it's the 4th of July weekend and today is a federal holiday. Unfortunately, sometimes things happen that I cannot ignore, even though all sorts of other bloggers are writing about the same thing, because, well, it's something that goes to the very core of what this blog stands for. As you know, one of the most frequently addressed topics (certainly in the top three, if not number one) is the antivaccine movement, its pseudoscience, and the threat it represents to public health through decreased vaccine uptake that leads to outbreaks of vaccine-preventable diseases. This danger was illustrated in a big way earlier this year when there was a large outbreak of the measles centered at Disneyland and attributed largely to the unvaccinated. Indeed, the Disneyland measles outbreak was arguably a pivotal event by itself because it's impossible to imagine that SB 277 woud have even been introduced into the California legislature for consideration, much less passed by both chambers and signed into law by the governor. SB 277 is now the law of the land and has eliminated non-medical exemptions to school vaccine mandates in California. That's right. California joined Mississippi and West Virginia as the only states that do not permit either religious or personal belief exemptions.

Unfortunately, I learned yesterday afternoon that something else had happened that drives home the fact that measles, contrary to what antivaccine apologists try to claim, is dangerous and can be deadly. Yesterday, a tragedy occurred. The Washington State Department of Health announced that a woman had died of unsuspected measles:

OLYMPIA - The death of a Clallam County woman this spring was due to an undetected measles infection that was discovered at autopsy. The woman was most likely exposed to measles at a local medical facility during a recent outbreak in Clallam County. She was there at the same time as a person who later developed a rash and was contagious for measles. The woman had several other health conditions and was on medications that contributed to a suppressed immune system. She didn’t have some of the common symptoms of measles such as a rash, so the infection wasn’t discovered until after her death. The cause of death was pneumonia due to measles.

This is a horrible tragedy that I've been fearing for a long time, and it's finally happened. The measles has claimed its first victim in the latest series of outbreaks. Indeed, this was the first measles death recorded in the US in 12 years.

I know what antivaccinationists are going to say. They'll say that they're sorry, that this is horrible. Then they'll make excuses, adding that this woman was immunosuppressed and that's why she died. They'll claim that measles is a benign disease to almost everyone else. Of course, that's only partially true. The mortality rate from measles in otherwise healthy individuals is quite low (approximately 1 to 2 per 1,000), but it's not zero. Complications like pneumonia are by no means uncommon. Less common, but still to be feared, are complications such as encephalitis (again, approximately 1 in 1,000) or, even worse, the uniformly deadly complication of subacute sclerosing panencephalitis (SSPE). This is a rare but fatal disease of the central nervous system that results from a measles virus infection acquired earlier in life, usually developing 7 to 10 years after a person has measles, even though the person seems to have fully recovered from the illness. Elsewhere in the world, measles is far deadlier. It's also incredibly infectious, caused by one of the most easily transmissible viruses known to medical science.

But how could this woman have gotten so sick and died before it was realized that she had the measles? After all, the measles is nothing if not very recognizable, thanks to a characteristic rash caused by the disease. Here's why:

It's not surprising that the woman had no obvious measles symptoms; people with compromised immune systems often don't develop a rash when infected with the virus, said Paul Offit, chief of infectious disease at Children's Hospital of Philadelphia. The woman's death was a preventable, but predictable, consequence of falling vaccination rates, said Peter Hotez, president of the Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development in Houston.

As noted over at io9, rashless measles is rare, but far from unheard of. An overreview of measles warns:

Among immunocompromised persons, diffuse progressive pneumonitis caused by the measles virus is the most common cause of death [97–104]. These patients may first have typical measles with pneumonia, or they may have a nonspecific illness without rash followed by pneumonitis without a rash. In general, signs of pneumonitis develop in the 2 weeks after the first onset of symptoms [90, 96, 105]. Other patients have had reappearance of rash and pneumonitis after long intervals following “classical” measles [97, 106].

In other words, if you're immunocompromised, you might not know you have the measles until you develop severe viral pneumonitis due to the measles virus. Make no mistake, in immunocompromised patients with the measles, pneumonitis is the most common cause of death.

This woman's death was not tied to the Disneyland measles outbreak, but Clallam County had a small outbreak of measles earlier this year, which is not surprising given that Washington has been a hotbed of low vaccine uptake and antivaccine activity, to the point that the legislature moved to make it more difficult to obtain nonmedical exemptions. Clallam County has not been immune to parents declining to protect their children from vaccine-preventable diseases by claiming personal belief exemptions. Indeed, it ranked 30th out of 39 counties in Washington for in its rate of complete immunizations, with a compliance rate of 48%, meaning that over 50% of its schoolchildren are either undervaccinated or unvaccinated. In Clallam County, as few as 56% of schoolchildren in Port Townsend schools, while 89% of children in Port Angeles schools are completely up to date on their vaccines.

The bottom line is that there was an outbreak a few months ago in Clallam County, and, even though it wasn't linked to the Disneyland measles outbreak (health officials report that it was a different strain of the measles), it almost certainly was linked to low vaccine uptake in the county. That is why the antivaccine movement is dangerous.

Not surprisingly, the usual suspects are quick to claim that low vaccine uptake had nothing to do with why this woman died, that this death was not preventable. First up, there's Dr. Jay Gordon, our favorite "I'm not antivaccine" antivaccine pediatrician, responding to questions on Twitter:

Yep, That's Dr. Jay telling someone that this unfortunate woman's death was not preventable? Not preventable? Nonsense! MMR is very effective at preventing measles, and if MMR uptake is adequately high, herd immunity will protect people who are unfortunate enough to be immunosuppressed. Dr. Jay is basically trying to pass the buck.

Meanwhile, Dr. Bob Sears, master of the antivaccine dog whistle, is furiously trying to distance the Disneyland measles outbreak from this woman's death:

MEASLES DEATH NOT LINKED TO DISNEYLAND OUTBREAK, ACCORDING TO ABC NEWS AND WASHINGTON STATE HEALTH DEPT SPOKESMAN Here is an update from ABC News. Again, our condolences to the family.

According to the last line in the story, this case was NOT linked to the Disneyland outbreak. We don't yet know what that means. It may have been a measles strain from somewhere else? We don't know yet. Vaccine strains can also be picked up by immunocompromised people, as this woman was. But be have no facts about that whatsoever. Again, our heartfelt condolences to the family.

That's nice. You can almost hear Dr. Bob backing away and saying, "Don't blame me!." Of course, it doesn't matter that this outbreak was due to a different strain of measles virus. It really doesn't. What matters is MMR uptake, which is lower than it should be in Clallam County. The reason it's low is, at least in part, due to the fear mongering spread by Dr. Bob's and Dr. Jay's patients, some of whom are quite active in the antivaccine movement. (Remember, Dr. Jay was Jenny McCarthy's son's pediatrician back when she was transforming herself into a "warrior mother" going to war against vaccines.) It's low because irresponsible pediatricians like Dr. Jay and Dr. Bob are sympathetic to the views of antivaccine parents, to the point where they not infrequently parrot antivaccine talking points. Indeed, Dr. Jay, relying on his "30 years of clinical experience," has been known to insist that vaccines cause autism even as he admits that there's no good evidence to support that belief.

If you want despicable, though, check out this comment by someone named Jen Glover Bishop:

If pneumonia was the cause of death then measles is a non issue. Pneumonia is a complication that can occur after the common cold in an immune compromised person. Anything would have led to pneumonia in a person like that. Life is not illness proof.

This is sort of true. Even if it were totally true, there's one big difference between the common cold and the measles. We can't prevent the common cold easily. We can prevent the measles. With a vaccine. And antivaccinationists do everything to deny and minimize their contribution to outbreaks. If you really want to see how low they can go, check out this comment by Christina Wright:

honestly, i call bullshit on this story. i'm sorry if it's actually true, but its just way too vague and really sketchy that someone just so happens to die from measles as people are starting to wake up about all these bills being introduced. this is a scare tactic to whip the public back into shape. hello pharma pays $$$$$$ for marketing, thats all this is...a marketing strategy to set the tone of what's to come.

Yes, it's time for the conspiracy theories to come out. Same as it ever was. Of course, if conspiracy theories aren't enough, then there's always outright denying the importance of this story—and even that it's legitimate—as Colleen Cron Oleksinski does:

With ALL due respect, why is this making national news? People die everyday without national recognition, why is this any different? By the way, Im not buying it either.

Oleksinski was answered by a chorus of Hallelujahs:

Setting the stage. They wasted no time. This is tragic absolutely. And what did they say, she passed in the spring? Did they wait this long to have an autopsy? Bring this out now, two days after CA signs BS277 and it is from a different state...perfect to infect the whole country with PANic and misinformation. Federal bill...I can't wait.

And:

It's making the news so that the sheep will once again become paralyzed with fear...and they won't put up a fight when forced vaccinations come to their state.

And:

Getting the fear nice and deep to then roll out adult mandatory vaccines!

You get the idea. it's not our fault, and this poor woman's death is nothing more than a conspiracy by big pharma and the government to pave the way for jack booted thugs wielding syringes to force children and adults to be vaccinated. It's a fantastical, paranoid delusion, but it's what they believe, even at the expense of denying the human tragedy that's just occurred.

This is what we're up against.