Read excerpts from a Facebook conversation about PIC’s press release on December 20, 2017, MMR Vaccine Causes Seizures in 5,700 U.S. Children Annually, between Dorit Rubinstein Reiss and Physicians for Informed Consent.

Dorit Rubinstein Reiss This press release is misleading in many ways. First, it uses a 2004 Danish studies and ignores later studies that found that the risk of febrile seizures from MMR is extremely low. It certainly provides no data that shows febrile seizures from MMR in 5,700 children in the U.S., and does not show its methodology, which was not peer-reviewed in any way, in the press release or a link to it. Second, it provides no good data on the risk of febrile seizures from measles. It’s initial claim in BMJ on that topic was based on assumptions about reporting, and there’s no data for it. Nor is there biological plausibility: febrile seizures are caused by fever, and fever from MMR is less common than fever from measles: high fever is a routine part of measles. Saying that the vaccine that causes less fever causes more febrile seizures than the disease is suspect, and in this case, done with no real data. Finally, the claim that febrile seizures lead to epilepsy in 5% is strange, and is certainly not what experts say. For example:…/Febrile-Seizures-Fact-Sheet… “Multiple or prolonged seizures are a risk factor for epilepsy but most children who experience febrile seizures do not go on to develop the reoccurring seizures that are characteristic of epilepsy. Some children, including those with cerebral palsy, delayed development, or other neurological abnormalities as well as those with a family history of epilepsy are at increased risk of developing epilepsy whether or not they have febrile seizures. Febrile seizures may be more common in these children but do not contribute much to the overall risk of developing epilepsy. 12/21/2017

Children who experience a brief, full body febrile seizure are slightly more likely to develop epilepsy than the general population. Children who have a febrile seizure that lasts longer than 10 minutes; a focal seizure (a seizure that starts on one side of the brain); or seizures that reoccur within 24 hours, have a moderately increased risk (about 10 percent) of developing epilepsy as compared to children who do not have febrile seizures.”

Dorit Rubinstein Reiss Note that even if the information wasn’t highly problematic, given the risks of measles – pneumonia, death, SSPE – it’s still not a hard decision.

Physicians for Informed Consent There has been no study done since 2004 that includes a control group of 98,000 unvaccinated kids. The Danish study is in a league of its own in its statistical power. If you believe you’ve found a study with confidence intervals as narrow as the Danish study, please let us know.

The Danish study shows MMR causes seizure in 1.56 kids per 1000. There are 3.64 million kids vaccinated with a first dose of MMR every year in the US. (1.56/1000) x 3.64 million = 5,700. The data cannot be clearer.

The Measles Disease Information Statement (DIS) shows that seizures occurred in about 1 in 3,000 measles cases using the CDC measles surveillance of measles seizures in the 1980s and 1990s.

Before the measles vaccine, annually, there were 4 million measles cases of which 440,000 were reported for a reporting rate of 11%. Please review the Measles DIS for references.

Fever alone does not cause seizures, so to use the incidence of fever alone to make a statement about the incidence of seizures is not sound science. In addition, according to CDC, 1 in 6 (17%) of those vaccinated with MMR have a fever. There are more than enough fevers caused by the vaccine to result in seizure in 1.52 per 1000 kids.

Saying that we have any idea of how many measles cases resulted in fever when only 11% of measles cases are reported is suspect. There are more fevers caused by the vaccine (17%) than there are reported cases of measles (11%).

Vestergaard “evaluated the association between febrile seizures and epilepsy in
a population-based cohort of 1.54 million persons born in Denmark (1978–2002), including 49,857 persons with febrile seizures and 16,481 persons with epilepsy.” Vestergaard found that the “cumulative incidence of epilepsy after febrile seizures was 6.9 percent 23 years after the first febrile seizures” and “among persons with no history of febrile seizures, the cumulative incidence of epilepsy was 1.8 percent at the age of 25 years, that is, the mean age of persons followed up for 23 years after the first febrile seizures.”

The experts are correct when they say “most children who experience febrile seizures do not go on to develop the reoccurring seizures that are characteristic of epilepsy.” Since 95% of febrile seizures do not lead to epilepsy, it is true that most febrile seizures do not lead to epilepsy. This does not contradict the fact that 5% of them do.

The risk of death from measles is 1 in 10,000 cases, most of which are low in vitamin A.

What is problematic is that not a single statistic was provided in this entire rebuttal to contradict the statistics that measure the incidence of MMR-related seizures.

Dorit Rubinstein Reiss The rate of death in the last outbreak in the U.S. and in the current outbreaks in Europe is substantially higher than 1:10,000, closer to the 1:1000. There’s no good basis for the 1:10,000 claim, to my knowledge.
It is true I did not link to the most recent studies, the one you have ignored. Here is one.
Note that it points out that the risk is higher with mmrv and still small.
Note also that the Danish study you draw on described the risk as small, too.

Dorit Rubinstein Reiss A. The MMR VIS that the law requires providers to give parents mentions the risk of febrile seizures and gives the correct numbers. It’s not hidden.
B. I collect a paycheck from a law school, where I’m a tenured professor. I voluntarily correct inaccurate claims about vaccines online to protect children. I hope my work helps protect all your children. They are welcome.

Physicians for Informed Consent The CDC’s VIS does not provide the confidence interval around its MMR-seizure ratio, therefore, although it’s not incorrect, it is also incomplete. Vestergaard’s MMR-seizure ratio has a narrow confidence interval, 1.56 seizures per 1000 vaccinated kids (CI 1.44-1.68). The CDC’s number has a wide confidence interval which it is not disclosing, a confidence interval whose range includes Vestergaard’s results. We provided an example of this situation in the MacDonald study you referenced earlier.

Dorit Rubinstein Reiss To the comments above: opening any textbook on infectious diseases – or looking at the CDC pink book – would teach you that high fever is part of a typical case of measles. It’s the pattern of the disease. Here is a helpful article by infectious diseases experts on the risk of measles.…/189/Supplement_1/S4/823958

Physicians for Informed Consent Words like “often” and “typical” need to quantified and none of the sources you’ve cited provide a number. 1 in 6 doses of MMR result in fever, which can fit the definition of “often” and “typical.” Can you provide a reference that measures the % of reported cases of measles that result in high-fever?

Dorit Rubinstein Reiss And yes, we have data on MMR and seizures. It is more current than the study you used and does not support your numbers. Finally, the Vestergaard study emphatically does not support a view that febrile seizures cause epilepsy in anyone.  Among other things, they pointed out that febrile seizures could mark existing susceptibility to epilepsy. They did mention that prolonged febrile seizure could cause epilepsy, but without data on MMR and prolonged seizures, that doesn’t help you, and they themselves could not, and said that clearly, separate that out. To go from that study to “MMR causes high rates of febrile seizure and that causes epilepsy” is unwarranted.

Physicians for Informed Consent If you are referring to the MacDonald study, this statement is incorrect. As we posted earlier, MacDonald’s abstract reports the MMR risk of seizures 7-10 days after vaccination–a period of 4 days. However, Vestergaard measured it 1-14 days after vaccination, a period 3.5 times longer than MacDonald’s. MacDonald also detected a significant MMR risk 0-42 days after vaccination. The result is shown in table 2: an RR of 1.48 (CI 1.22–1.79) for the entire 42 day period. Since, according to table 1, the baseline risk in the 42 day pre-vaccine control period was about 15 per 10,000, the study did not rule out the possibility that MMR increases the risk of seizure by 79% of 15 per 10,000, or about 12 per 10,000. That value is close to Vestergaard’s result, so MacDonald is not contradicting Vestergaard.

Physicians for Informed Consent We don’t understand how you can make this assertion when Vestergaard states, “The cumulative incidence of epilepsy after febrile seizures was 6.9 percent 23 years after the first febrile seizures” and “among persons with no history of febrile seizures, the cumulative incidence of epilepsy was 1.8 percent at the age of 25 years, that is, the mean age of persons followed up for 23 years after the first febrile seizures.” How do you explain the extra 5% of incidence of epilepsy in the seizure group?

Dorit Rubinstein Reiss And again, there has been no evidence provided that 5,700 children in the U.S. have a febrile seizure post MMR. None. Wanting it to be so is not data.

Physicians for Informed Consent As we posted earlier, the Danish study shows MMR causes seizure in 1.56 kids per 1000. There are 3.64 million kids vaccinated with MMR every year in the US. (1.56/1000) times 3.64 million = 5,700. You can try to question the evidence, but you can’t say it isn’t there.

Dorit Rubinstein Reiss I can’t stop anti-vaccine activists from attributing non-existent conflicts of interest to me, but the claim that I am paid to post is simply false.

Physicians for Informed Consent We ask that everyone in this discussion focus on the science and refrain from character defamation.

Dorit Rubinstein Reiss My point about the study’s age was to point out that more recent research in the U.S. did not support the numbers cited. We do have data on rate of febrile seizures after MMR. It puts it at about 1:3,000. Most doctors have never seen it.

Physicians for Informed Consent A study should not be measured by its age, it should be measured by its statistical power. 2004 was not so long ago that a more recent study with weaker statistical power is automatically “better.” The MacDonald study you cited earlier had wide confidence intervals, as we posted earlier: an RR of 1.48 (CI 1.22–1.79) for a 42 day period post-vaccination. You have not produced a study whose CI range excludes Vestergaard’s findings.

Dorit Rubinstein Reiss Why do most parents protect their children from disease, according to the expert base schedule? Because they understand that preventing diseases is a good thing. The calculation behind the 79 dose number is a little strange, but at any rate, I’m not sure why you think preventing more diseases is a bad thing. And serious harms from vaccines are extremely rare.

Dorit Rubinstein Reiss As I mentioned, I’m not paid to post. My family does own some stock in companies. If my advocacy affected it, which is extremely unlikely, it would likely come to about $90 a year.

I donate more than that to provaccine nonprofits, the ones that work to protect us all from diseases.

As much as you would like to believe that the only reason someone would speak up for vaccines is that they’re paid, there are many people who speak up because they value protecting children from disease.

Physicians for Informed Consent We also hope that our work protects all children, and we discourage any “character assassination” as part of this important discussion. We appreciate the time you’re taking to raise these important issues, and we will do our best to encourage everyone to stay focused on the science in this discussion.

Physicians for Informed Consent We do not believe preventing diseases is a bad thing. However, vaccines are not the only way to prevent diseases, and statements like “extremely rare” need to be quantified using scientific study. A 1 in 10,000 chance of dying from measles, which is preventable with adequate levels of vitamin A, makes serious harm from measles “extremely rare” as well. The data is not as clear cut as some would have you believe. The fact we’re arguing about the results of a Danish study involving 500,000 kids, including 100,000 unvaccinated kids, is evidence of that.

Physicians for Informed Consent Many people who have questioned whether vaccines are safer than the diseases they target have also suffered from character defamation. It is not acceptable regardless of where you stand on any of these issues.

Dorit Rubinstein Reiss The 1:1000 refers to the more recent outbreaks, as I explained.

When you calculate reported deaths out of estimated cases, as you do, you’re using sets of numbers that are not based on similar things. You’re assuming all deaths were reported. That’s unsupported. You just cannot assume the deaths were all recorded as measles and not encephalitis or pneumonia.

In recent outbreaks- U.S. 1989-1991, Europe now, where surveillance efforts were intense – death rate was not 1:10000, was close to 1:1000. This, too, shows your assumption I’ll founded.

Physicians for Informed Consent It is not reasonable to assume that reporting trends of measles deaths are similar to reporting trends of the most benign cases of measles. Unlike benign measles cases, virtually all measles deaths are hospitalized before the deaths occur. Clinical measles is easy to diagnose before pneumonia or encephalitis, and hence, any resulting death gets recorded as a measles death. There is no evidence that hospitals are failing to detect measles deaths. In addition, the 4 million cases of measles in the 1960s are not an estimate, they are a fact. It would have been impossible for virtually everyone in the population in the 1960s to have been immune to measles by age 15 without at least as many people contracting measles as there were people being born.

Physicians for Informed Consent Again, the 1:1000 is measured from the 1000 cases that are serious enough to be reported to health departments. For every such case, there are 9 that are so benign that they go either unnoticed, unreported, or both. This was evident in the 1960s. There were 400 deaths out of 440,000 reported cases, about 1:1000, just like in the outbreaks you referenced. But the 440,000 reported cases were only 11% of the 4 million cases that actually occurred.

Dorit Rubinstein Reiss Measles has been hospitalizing 40% in Italy and killed 46 people in Europe in the past year and a half. That doesn’t make them stronger. And it’s unnecessary suffering.

Physicians for Informed Consent The 40% hospitalization rate in Italy is almost 3 times what it normally is in the US and the rest of Europe, which shows a deficiency in Italy that is not occurring in more developed countries. Although 46 measles deaths in Europe are tragic, so are the 5,700 seizures caused by the first dose of MMR in the US alone, and of these, 300 result in epilepsy.

Physicians for Informed Consent All suffering is unnecessary. Since the vaccine is causing its own share of suffering, it’s best to let people decide which kind of suffering they feel better equipped to confront. Why do you think it is necessary to force your strategy on everybody else?