Measles outbreaks at festivals can’t be blamed wholly on anti-vaxxers | Jules Montague

Your main concerns when you attend a festival might include any of the following: how will I identify my tent at 5am? Is glamping worth it? Will Este from Haim do bassface?

But one thing you should not have to worry about is: will I get measles?

Public Health England has confirmed a significant number of infections linked to music festivals and other large public events. There have been reports of 38 suspected measles cases at events in June and July alone. Glastonbury had 16 cases, with seven cases reported from the NASS festival near Bristol; six at the Triplicity festival in north Devon; three at Tewkesbury medieval festival; two at Nozstock: the Hidden Valley in Herefordshire; two at Noisily in Leicester; one at the Secret Garden Party near Huntingdon; and one at Yeovil Show.

In all, 234 cases have been confirmed between January and June, compared with 54 for the same period last year.

Why is this happening now? One possibility is that the Wakefield generation has come of age. The fraudulent study by Andrew Wakefield that incorrectly linked the MMR vaccine and autism was published 18 years ago. Although later discredited (with Wakefield being struck off the medical register), the rate of vaccination against measles plummeted after the study’s appearance in The Lancet. There were 56 cases of measles the year before its publication in England and Wales; by 2008 there were 1,370.

Many parents of the Wakefield era chose not to vaccinate their children and were understandably swayed by breathless media coverage, inconsistent messages from health providers, and apparent validation of Wakefield’s findings by the scientific community; it took The Lancet 12 years to retract the publication. If you were the parent of a toddler in those years, what would you have done?

Now, those unvaccinated children have grown up. They go to festivals. The virus is so contagious that if one person has it, 90% of those in close contact will also become infected if they are not immune themselves. And so Public Health England has urged teenagers and adults to check with their GP if they have been vaccinated and to receive two doses of the MMR vaccine if required.

The Wakefield-era children also grew up to account for most of the 1,219 measles cases in the Swansea measles epidemic in 2012, in which one person died. Although some recovered quickly from fever, conjunctivitis and a rash, others suffered more significant complications. According to the US Centers for Disease Control and Prevention, one or two out of every 1,000 children who become infected with measles will die from respiratory and neurologic sequelae including blindness, seizures and encephalitis. Since 2006, there have been three deaths from measles in England and Wales.

This historical legacy is compounded by anti-vax sentiment that has become more visible in recent years, albeit not necessarily more widespread. The consequences of this movement travel beyond forums and Facebook posts. It is easy to imagine it to be as infectious as the virus itself, but I think there is a more nuanced subtext, too.

Measles arrived at Disneyland, California with one case in December 2014. Within four months, there were 145 confirmed cases in seven states and three countries, all linked to Disneyland. The authors of an analysis in JAMA Pediatrics journal said the outbreak was directly associated with substandard vaccination compliance: “The ongoing measles outbreak linked to the Disneyland Resort in Anaheim, California, shines a glaring spotlight on our nation’s growing anti-vaccination movement and the prevalence of vaccination-hesitant parents.”

Vaccination is more than a personal choice; the inaction of others can affect even vaccinated children and adults

Vaccination is more than a personal choice; the inaction of others can affect even vaccinated children and adults. Community vaccination helps to halt the spread of the virus and thus protects the wider population. The sum is greater than its parts. But here’s what is crucial. Each outbreak is different, there are nuances to each one, and not all can be attributed simplistically to a groundswell of anti-vax sentiment. Swansea is definitely not California.

For example, early 2014 cases were linked to unvaccinated travellers returning home who had acquired the virus abroad (an outbreak in the Philippines was an important factor) and then infected others in communities with lower vaccination rates. Despite the concerns expressed in pockets of unvaccinated residents, there is no nationwide loss of confidence in vaccines. Sometimes it’s a case of missed doctors’ appointments or single vaccines refused rather than staunch dissent. And vaccine refusal does not correlate with a lack of knowledge. Moral outrage is too easy.

Julie Leask, an associate professor at Sydney University’s school of public health, provides level-headed discussion on this topic: “To be committed to the science of immunisation ideally comes with a commitment to the science of immunisation behaviour. Media often present this problem as refusal to vaccinate. But the evidence is clear and it’s more complex: under-vaccination is broadly about a lack of acceptance and a lack of opportunity to vaccinate fully or on time. It’s not just the haves, but the have-nots who don’t fully vaccinate.

“A typical measles outbreak will reveal this. There will be children whose parents refused vaccination; children whose parents were unwittingly not up to date for lack of access; affordability or awareness; adults and travellers who didn’t get a needed booster; and babies who are too young to be vaccinated.”

So although “festival measles” seems to largely fit with the coming of age of the Wakefield generation and more particularly a broader anti-vax narrative, it is too simplistic to conclude that this is applicable to all. But it does provide an opportune moment to discuss issues around vaccination, to strengthen public health infrastructure to deliver effective programmes, and to ensure there is never even the possibility of a Wakefield generation occurring again.

Related: Measles warning to young people at festivals after series of outbreaks

Measles outbreaks at festivals can’t be blamed wholly on anti-vaxxers | Jules Montague

Proof for NHS statins guidance "wholly inadequate", says specialist

He has now stopped taking them and mentioned: “I am not going back on statins unless I have the evidence”.

Great will publish its final suggestions on statins following month, after a public consultation. Its draft guidance suggests cutting the “risk threshold” for statins in half — meaning that the vast bulk of men aged in excess of 50 and most girls above the age of 60 are most likely to be recommended to consider the medication to guard towards strokes and heart condition.

Experts said the adjustments would indicate that the amount of individuals recommended to get cholesterol-lowering medication was very likely to rise from 7 million to twelve million, leaving a single in 4 grownups on the medicine.

Last week the tips was criticised by a group of nine major medical doctors and academics who said the medication could do much more harm than great.

In a letter they accused Good of an “overdependence” on research funded by the pharmaceutical business, which are kept “hidden” due to business confidentiality agreements.

The group cited research, independent of the drug sector, displaying that statins have been connected with a 48 per cent boost in the threat of diabetes in middle-aged females.

Other likely side effects could incorporate depression, fatigue and erectile dysfunction, they warned.

Prof Mark Baker, director of NICE’s centre for clinical practice, admitted the expert panel which drew up the advice had partly relied on summaries of data from the Clinical Trial Support Unit at Oxford University, which is run by Sir Rory.

Prof Baker said the total data could not be launched to Nice or independent researchers simply because the trials have been “commercially funded” and the details was owned by drugs companies.

The unit receives tens of hundreds of thousands of pounds in funding from this kind of companies, though Sir Rory has insisted its outcomes “bear no relation to our funders.”

On Saturday Sir Rory explained the group which criticised the guidance need to be “ashamed of themselves”. Such considerations in excess of statins could “cause really massive numbers of pointless deaths from heart attacks and strokes”, he advised the Guardian.

Even so Prof McPherson, who chairs the Uk Health Forum, said he supported the points raised in the letter. He known as on Sir Rory, a fellow epidemiologist, to let the data on statins trials to be scrutinised by “independent reviewers”.

Prof McPherson told The Telegraph: “It is outrageous that Great is producing these pronouncements with no seeing the information and with out the data becoming witnessed by independent reviewers.”

He added: “My interpretation of the proof base currently being utilized is that it is wholly inadequate to make this kind of a prescription.

“As far as I can inform the trials had been not correctly accomplished in the sense that there was not systematic, routine periodic double blind evaluation of high quality of existence in between therapy of handle in all these trials, which you need.

“Also, in so far as there was, none of these information are offered for public scrutiny.

“I feel Great creating these slightly draconian guidelines on the basis of such an inadequate proof basis is foolhardly.”

He added: “I have just stopped taking statins and I am significantly more agile than I was when I was on them. I want to know why, what is the proof for it. I am not going back on statins except if I have the evidence.

“You envision all this creaking an aching is a matter of aging, and it may not be.”

On Saturday Sir Rory intervened in a row more than two current academic papers in the British Health-related Journal which questioned the widespread use of statins.

The authors have both withdrawn statements right after some figures they cited had been discovered to be incorrect, and the posts are getting reviewed by the journal. Sir Rory mentioned a third party, such as the Standard Medical Council or Division of Wellness, should carry out its personal evaluation of the articles.

Proof for NHS statins guidance "wholly inadequate", says specialist