RABIES

cross posted from my usual blog.

Rabies is around in the Philippines, so anyone bitten by a strange dog gets a series of shots.

Our dogs get their rabies shots, so usually we just reassured those bitten by George, the Killer Lab, but once tiny PuffPuff bit the massage therapist treating Joy, and his shots were out of date, so we had to pay for treatment.

No, I never saw a case in Africa: The protocol there was to go to an area, give all the dogs their rabies shots and paint their rumps, and then put out fresh meat and have a sniper shoot any dog without a paint jobs. After independence, alas, when bullets and snipers got expensive, some countries ended up with epidemics.

Here in the Philippines, the vets go to rural area to give the dogs the shots, and locals kill stray dogs. The local clinic will arrange for you to get the shots at a minimum cost, or you can pay 20 dollars  to buy the vaccine at the pharmacy and give the shots yourself.

In the USA, however, bat bites are a major cause of rabies. I once blew the budget of a small local township where I worked after a young girl got bitten by a bat when she opened a pantry door. Since bats don't usually attack, we had to assume it was rabid.

Nowadays, the regimine is anti globulin and three shots of the vaccine. Back then, it was 24 shots of the vaccine....by shot 12 she was getting local reactions and we started running out of places to give the shots. Ouch.

Cats also can carry rabies, as can racoons.
I remember when we had an outbreak and had to get the cats rabies shots: we took three cats in our cat carrier, and they got lose. Catfight!

Rabies is fatal. Usually you keep them comfortable with deep sedation until they die. So if you are traveling to a high risk area, or might be in contact with rabid animals, you are advised to get the shot.

But a few cases of people who had never been vaccinated beforehand have lived. LINK LINK

treatment is inducing a coma and using a breathing machine, while giving rabies globulin and anti virals. Even with this very expensive treatment, few live.

SCI AM article describes treatment.

The Milwaukee protocol via Wikipedia

Willoughby's goal was to put Giese into an induced coma to essentially protect her from her brain, with the hope she would survive long enough for her immune system to produce the antibodies to fight off the virus. Giese was given a mixture of ketamine and midazolam to suppress brain activity, and the antiviral drugs ribavirin and amantadine, while waiting for her immune system to produce antibodies to attack the virus.^[6] Giese was brought out of the coma after six days, once signs of the immune system's progress became apparent.
After infection[edit]After 31 days in the hospital, Giese was declared virus-free and removed from isolation. The extent of brain damage she had suffered was of initial concern, but while she had suffered some, the disease (and treatment) seemed to have left her cognitive abilities largely intact. She spent several weeks undergoing rehabilitation therapy and was discharged on January 1, 2005.^[9] By early 2005, she was able to walk on her own, had returned to school, and started driver's education, indicating a successful recovery.^[10]

only 5 patients out of 36 survived using this protocol.

and there is a suggestion that the drug ketamine has anti rabies virus properties.

Ketamine is used to induce anesthesia, and works without depressing respiration or blood pressure. Alas, often adults who got it also got terrible nightmares, so now it is used in the USA only to put one to sleep (e.g. in Caesarian sections, where you dont want a baby half asleep from mom's anesthesia and you can't or don't have time to do a spinal). They also use it for kids for things like minor fracture setting, because unlike adults, kids don't get nightmares.

In Africa, we used it when we couldn't do a spinal anesthesia or local anesthetic block: because we didn't have a trained anesthetist. We put it in an IV, and gave it until the patient stopped moving, then slowed it down to start surgery. When the patient started moving again, we increased the rate a bit. Only one problem: Once we needed something, so the guy watching the drip (who was our floor scrubber) went out to get it, and the patient started hypoventillating and turning blue. No nurse either, so I had to break scrub and stop the drip. Luckily his breathing came right back, so I didn't have to intubate him.

Since it is used for animal anesthesia, some has been diverted to get high as a "club drug".

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'original
Headsup AnneAlthouse

zika update

cdc report

the risk to the general population is low, about 1percent: for high risk women who have positive lab tests and went to get screening the risk was higher:29 percent. But because Ultrasound screening is not sensitive to milder cases, the percentage is probably underestimated.

ncreasing epidemiologic, clinical, laboratory, and pathologic evidence supports a link between Zika virus infection during pregnancy and adverse pregnancy and birth outcomes, including pregnancy loss, microcephaly, and brain and eye abnormalities (12–16). A critical knowledge gap for health care providers counseling women is the level of risk for adverse pregnancy and birth outcomes associated with Zika virus infection. That risk is currently unknown, but two recent studies might be informative. A retrospective analysis of the 2013–2014 Zika virus outbreak in French Polynesia identified eight fetuses and infants with microcephaly; using mathematical modeling, it was estimated that microcephaly affected approximately 1% of fetuses or infants born to women infected with Zika virus during the first trimester of pregnancy (17). In a recent study from Brazil, among 42 women with laboratory-confirmed Zika virus infection at any time during pregnancy who underwent prenatal ultrasonographic studies, 12 (29%) had abnormal findings; these included microcephaly, intracranial calcifications, other brain abnormalities, abnormal cerebral artery flow, intrauterine growth restriction, and fetal death (16). Further studies are underway to better estimate this risk but it is important to recognize that microcephaly caused by viral destruction of brain tissue is likely to be part of a spectrum of neurological damage; the percentages in both studies may substantially underestimate the proportion of infants affected.

CDC estimates how to make all the women in Puerto Rico stop having babies because hey they are at risk.

 after all a lot of their pregnancies are "unintended" i.e. unplanned (in a culture where laissez faire is the approach to babies).

Approximately 715,000 women aged 15–44 years reside in Puerto Rico, and there were approximately 34,000 births in 2014 (3). A 2008 hospital-based survey of postpartum women in Puerto Rico indicated that 65.5% of pregnancies were unintended in Puerto Rico, compared with 51% in a probability sample of the general U.S. population (the 50 U.S. states and the District of Columbia), according to the 2008 National Survey of Family Growth (4,9). In 2014, among women aged 15–19 years, the birth rate was almost twice as high (40/1,000) in Puerto Rico as in the U.S. overall (24/1,000) (3).

they go into a lot of detail and then do note that their estimates are based on old and sometimes biased (cherry picked population) data. But hey, Zika will probably make more women want to contracept.

Am I the only one who thinks the zika hysteria is being manipulated to scare women? Population control people are taking advantage of the problem to push their agenda.

No I am not being hard hearted: where is the hysteria about cytomegalovirus in Puerto Rico causing birth defects?

Transmission of CMV infection may occur throughout life, chiefly via contact with infected secretions.^[16] In the developed world, CMV is the most common congenital viral infection. An overall rate of congenital CMV transmission of approximately 1% (ranging from 0.25–2%, depending on the population studied) has been estimated in newborn infants in the developed world in most reviews. This translates to about 80,000 congenital CMV infections per year in the United States and Europe.

Where is the hysteria about cocaine damage to fetuses? Or Fetal Alcohol syndrome?

CDC report on FAS:

Gender neutral bathrooms? The Pee on the toilet seat problem

To gender neutral bathrooms, I say depends

To letting men into a woman's bathroom, I say bah humbug.

If there is a single room, often it is used by either sex.

But "bathrooms" mean many stalls.

a single room bathroom can and often is "unisex". No problem. Often these unisex bathrooms have a urinal on the wall, a place to wash your hands, and a nice solid lock on the door.

But for larger bathrooms, privacy is different.

Women have periods, for example, and often are embarrassed about it.

A decent woman's bathroom should have a couch for those with their periods to lay down on, and have larger disposal wastebaskets inside the stalls for pads etc. They also have vending machines for these things.

There are mirrors over the wash basins, to check out one's hair and makeup.

But since fixing one's makeup tends to slow down those who just want to wash their hands, a high quality women's bathroom often have a separate area for women to sit and apply makeup, outside the area where routine hand washing is done.

Men often wonder what takes women so long when they go to the rest room: This is why. Also, a lot of gossip goes on while you are applying mascara etc.

Modern PC Bathrooms often have a "baby" area to change a diaper (but the couch doubles for this in a traditional bathroom, as does the flat area at the end of the washbasin area in days).

But here is the problem no one wants to discuss: we have to sit down.

Now, the dirty little secret is that women don't like to sit on a place where someone else has sat. Often they don't sit on the seat, which is often wet after flusing or worse, from the previous person. Yes, there is toilet paper and seat covers, but not in most bathrooms, and often these things clog up the bowl or quickly fill the trash hamper.

But most restrooms don't have these things, so it means partly undressing and doing your thing while trying not to sit on the seat which is "dirty" (even when it looks clean, women think it is "dirty").

And so often women simply don't go at all.

We docs see a lot of problems with these women who tend toward UTI's getting cystitis because they are traveling and don't drink water because they hate using a strange (read "dirty") bathroom.

This also complicates the life of those taking diuretics, aka "water pills". Many of my patients would skip the diuretic when they shopped, and end up in the emergency room with lungs full of fluid that night.

Another thing annoys me about this PC bullying: if you let transvestites use the bathroom, who would know? A good transvestite is not a threat. He/she usually looks and acts like a woman (often with exaggerated femininity, but a woman). So many women would simply not notice he was a she. He/she might even ask if anyone is bothered if he/she uses the place, and those who I know are very clean.

So what if a person is "transgender" and in "transition".

Again, why should one notice?

The fact that it is noticed, and women are noticing, is the problem. It means that they are not women. Meaning they have a mental problem and are now trying to force their mental problem on us.

And now that the latest fad is "transgender", it's become an epidemic some gay activists have decided their "rights" overrule our rights.

 So why do the the other 99.4 percent of us have to bow down, leave behind our modesty and give into the tyranny of political correctness?

maybe because the rights of these few misbeguided folks are not the ultimate aim. The ultimate aim is to make the entire country "gender neutral". Hence the government has an interest in pushing Catholic sisters to provide contraception and abortifactive medicines, because hey, a pregnant lady is nature's way of saying men and women are different.

That is why the next step if the claim is that we shouldn't have separate bathrooms at all.

Right now, the most prominent advocates for gender neutral bathrooms seem to be transgender individuals and allies. But efforts to integrate toilets have been carried out by different groups over time, and could also benefit diverse constituencies, particularly when we're talking about fully enclosed unisex toilet facilities. Such restrooms would be useful for parents of opposite-sex young children, adult caregivers of opposite-sex older parents, Muslims who perform ritual ablutions, transgender individuals, women who routinely face longer public restroom wait times, men whom "potty parity" laws have left with longer wait times, and anyone who's ever been inconvenienced because their assigned bathroom was undergoing cleaning with no alternative available. 

Most of what he cites would not be made better by unisex bathrooms.

Right now, a simple request at the door would allow a man to help his wife into the handicapped stall if she is wheelchair bound. Similarly, a simple request will allow a man to ask a passing woman to check on his spouse with Alzheimer's who got lost.

But what about women worrying about boys in the men's room? Why should we worry? Well, again the reason is left out: Perverts. If my son is abused in a man's bathroom or sees open sex there, maybe what should be done is to arrest the perverts. Do things get better by letting the perverts do their thing in our restrooms?

The "potty paradigm" referred to also can be gotten around with a request: We women once just opened the empty men's room door and stood guard so we could use it when our group was running behind.

As for Muslims doing ritual ablution: You mean Muslim ladies would feel comfortable washing their feet in front of a man? I have no problem with letting Muslims use the handicapped area to do ablutions (most handicapped toilet stalls have sinks inside the stalls).

In short, for a fake reason (not to hurt the feelings of a protected group) the rest of us are supposed to lose our modesty over exposing our bodily functions to a strange person of the opposite sex.

finally, the real problem no one wants to talk about:

Men's rooms have urinals. Women's do no.

Would a  unisex toilet have urinals, forcing men to urinate in front of women, or would they just force all the men to wait in line like women usually do, to use the stall for this.

Now the dirty little secret that all married women know is that men sometimes don't lift the toilet seat, and/or forget to put it down again.

so it's not a "civil rights" issue: the issue is pee on the toilet seat, and that a lot of women will avoid using the rest room at all because they are too embarrassed to do so.

Substandard medicines for TB

China is taking over the US pharmacology industry, so gets a bad reputation.

But the problem in quality control isn't limited to China:

The Manila Bulletin reports a medicine used for TB has been recalled by the FDA:

The FDA warned “that a specific batch of Rifampicin + Isoniazid + Pyrazinamide + Ethambutol HCl 150 mg/ 75 mg/ 400 mg/ 275 mg Film-Coated Tablet (Onecure) is being recalled due to the non-conformance to the specifications of assay and dissolution of the Rifampicin component as reported by the FDA Common Services Laboratory (CSL)-Alabang Testing & Quality Assurance Laboratory.” 

 Onecure is manufactured by Novartis (Bangladesh) Ltd. in Tongi, Bangladesh, imported in the Philippines by Sandoz Philippines Corporation and distributed by The Generics Pharmacy Inc.

so even though it has the name of big drug companies on the lable, the drug is substandard.

of course, they were caught.

How many "generics" or counterfeit medicines (i.e. manufactured to look like they were made by "big pharm" but are shoddy imitations) are around?

Small pox

Small pox is a live vaccine, meaning it will die if not stored correctly.

So how did they keep vaccines "viable" in the days before refrigeration?

Preventig smallpox by variolation (giving people a small dose of smallpox from a known case) goes back to antiquity, and was practiced in China and in Africa and some Muslim lands in the Middle East, but was introduced into England from the Ottoman empire partly thanks to Lady Montague (and into America by preacher Cotton Mather).

 Dr. Emmanuel Timoni of Constantinople promoted the practice that variolation began its spread through Western Europe. After coming across the practice in Constantinople, Timoni wrote a letter describing the method in detail which was later published in thePhilosophical Transactions in early 1714.^[5]:77 His account would become the first medical account of variolation to appear in Europe. Although the article did not gain widespread notoriety, it caught the attention of two important figures in the variolation movement, Bostonian preacher Cotton Mather and wife of the British Ambassador to theOttoman Empire, Lady Mary Wortley Montagu.

there were various regimens on how to do this: A chapter in the book The Hemmings Family describes the regimen and how Jefferson paid to have his slaves in Paris get variolated.

There were many smaller epidemics in the Americas,  but a lot of rural people were vulnerable, and this included those joining armies during the revolutionary war.

For example, black slaves who joined the British loyalists on the promise of freedom had a terribly high mortality rate when they got accidentally exposed.

In contrast, Washington, who had almost died of small pox as a youth and knew about variolation, recognized the threat and tried to protect his solders, first by quarantine and then by imposing variolation to any recruit who never had the disease (i.e. most of the recruits).

More HERE.

Weighing the risks, on February 5th of 1777, Washington finally committed to the unpopular policy of mass inoculation by writing to inform Congress of his plan. Throughout February, Washington, with no precedent for the operation he was about to undertake, covertly communicated to his commanding officers orders to oversee mass inoculations of their troops in the model of Morristown and Philadelphia (Dr. Shippen's Hospital). At least eleven hospitals had been constructed by the year's end.
Variola raged throughout the war, devastating the Native American population and slaves who had chosen to fight for the British in exchange for freedom. Yet the isolated infections that sprung up among Continental regulars during the southern campaign failed to incapacitate a single regiment. With few surgeons, fewer medical supplies, and no experience, Washington conducted the first mass inoculation of an army at the height of a war that immeasurably transformed the international system. Defeating the British was impressive, but simultaneously taking on Variola was a risky stroke of genius.

So Washington's controversial decision was one reason why the USA became an independent state: But ironically smallpox is also one reason why Canada never became part of this independent nation: The rebel forces sent to conquer Canada were essentially wiped out by smallpox.

in the days when small pox was rampant, finding a case to use for variolation was not a problem, especially since the dried sores from recovering cases could still spread the disease.

Enter Jenner, whose observation that dairy maids had beautiful complexions, and linked that observation to the fact they often contracted cowpox from milking, began the modern era of vaccines. Cowpox (which eventually evolved into the vaccinia virus) was essentially an "attenuated" vaccine, where giving a mild case of the disease gave you immunity, albeit sometimes only temporary immunity. Measles vaccine is another version of the attenuated virus being used.

Since the virus is live, it has to be kept in a controlled environment (i.e. refrigeration or freezing).

So how did they do that in the good old days before refrigeration? Vaccination would give you a small pustule for a short time only: In the days when it took weeks to travel across oceans or between cities, it would not persist long enough in a person to use by the time you arrived.

Key word: A person.

From Listverse:

(via a headsup from Presurfer)

Francisco Balmis’s Smallpox Mission.

Photo credit: Ecelan

The solution involved passing it arm to arm between orphans. Twenty-two orphan boys between eight and 10 were brought along and given the vaccine successively.
It reached Colombia, Ecuador, Peru, Venezuela, Cuba, and Mexico. Based on its success, Charles IV ordered the campaign to continue in the Philippines

this article includes a section on the Spanish and later the American attempts to vaccinate people in the Philippines. One major problem was that often the vaccination was not "successful": either the vaccine was of poor quality (i.e. not enough live virus, often from poor storage) or the vaccination was not done properly and no infection resulted.

another problem was that people didn't cooperate and get the vaccine, resulting in essentially the militarization or big brother government enforcing it on the unwilling.

Immunization produces "herd immunity", so that epidemics don't spread: Lower the herd immunity, and the unvaccinated are at risk. (the vulnerable include those who refused the vaccine by choice or where the vaccine didn't work: i.e. bad vaccine, or sometimes health problems so your body didn't produce antibodies).

One result was a lot of small pox cases continued so a lot of anti vaccine folk back then insisted the vaccine was evil: like today, the anti vaccine crowd was lead by celebrities, e.g. George Bernard Shaw.

the problem was complicated because now the disease was reported in government statistics, whereas in past days often cases died without being reported or were misdiagnosed: e.g. cases of chickenpox, impetigo. Also, mild cases of small pox where the vaccination was out of date  or "didn't take", but the person naively didn't get a booster vaccination, are reported.

Typical screed about manipulation by public health authorities such as this one ignores the simple fact: We don't see small pox nowadays, so if the vaccine programs didn't work, where are the cases now?

We had the small pox "headsup" after 9-11, where worries about bioterrorism included an attack with smallpox.

The problem was that if we saw a case, there were only two physicians in our small town who might recognize it. No, I was not one of them: even though I had worked in rural Africa, the disease had been eliminated from our area. But my husband saw it in Sulu (Philippines) in the early 1950's (the Moros didn't like vaccination) and one elderly psychiatrist saw it in the 1940's....the last US outbreak was in the late 1940's. Like other outbreaks, that last one was stopped by giving everyone in the area vaccinations (50 thousand people).

That is why a real problem is quality control. (again I refer to the Chinese story of a previous post of not storing vaccines correctly: The authorities know from experience that giving bad vaccines is worse than no vaccines: this could allow epidemics to arise while lowering the public trust that vaccines work, leading to fewer getting the vaccines, which could result in a death spiral to huge epidemics.)

Finally: The elimination of smallpox from the modern world is one of the unsung successes of the United Nations.

but even before the disease was eliminated, they stopped giving it to people in the USA because the "side effect profile" was high.

link2

The traditional vaccination had problems: Including spreading the pustule into open scratches in kids with ecsema, and in people with weak immune systems actually giving them a severe infection that could kill you. This includes spreading to caretakers with cancers, on chemo, or who had HIV: not just those who were vaccinated, but sometimes in those who accidentally touched the lesion.

The military however still gets the vaccine. That is because there is a worry about biowarfare by nut cases who might steal the few remaining small pox viruses from storage and release it.

So there is now a new vaccine used whose advantage is that it doesn't replicate in the body. PDF...

In other words, it doesn't give you a mini disease to make antibodies: It just gives you the virus that sits there and the body will make antibodies.

cross posted from my main blog.

Yellow fever outbreak

There is an outbreak of Yellow fever in Angola.

Vaccines will probably cut the spread.

from outbreak news:
they are planning to give the yellow fever vaccine to everyone in the capital (7 million plus people). And the article mentions the logistical problems.

UhOH:

A local who flew back to China after being there is being treated in a Shanghai hospital.

I guess we'll have to go back to the old days, when you carried a yellow booklet proving you had received yellow fever, small pox and cholera vaccines before they let you into some countries.

Vaccine conspiracies: Bahh. yet

I have worked in poor areas of the USA and overseas, and I tear my hair out when I see upper middle class celbrities etc. decry vaccines and have their stuff picked up by conspiracy sites, by "major" newspapers who report the controvery, and then by ignorant Mullahs (or sometimes bishops) who persuade people to avoid vaccines.

Attention: Measles kills. Whooping cough Kills. Polio cripples. Tetanus kills.

I've seen these things, and not just in the USA.

A lot of this is people needing a scapegoat for their child's autism etc. I always wonder how there are huge outcries against vaccines when much of the "epidemic" seems to be a change in the diagnostic criteria (and also that kids who 40 years ago would have been labled "retarded" and put into institutions, and parents went on to have more kids, and were assured the child was better off with "experts".

But now they are left at home for their parents to try to cope... in a society where extended families are non existant and where financially both parents are forced to work to keep in a middle class lifestyle...bearing the high cost of medical care, the loss of money from a job, and the inability to care for the other kids in the family...often parents divorce since often the stress of the child means that parents fight, blame each other subconsciously, and divorce).

So modern"bioethicists" insist it is better for the parents and the family just to kill the kids to avoid these terrible problems.

Ah, but another way to cope is to blame someone else.

I just read The Litigators, (audiobook link here) about a class action lawsuit and the legal shennaingans around it. It was probably fake (some problems but not the death pill claimed by the lawyers)...

but a subplot was about a child left brain damaged from lead in a toy. A toy manufactured in China. A toy subcontracted by an ethical firm that didn't know some corrupt manufacterer in China was cutting cost by using lead paint on a toy. In the book, the toy manufacter took responsibility and gave a huge settlement without fighting.

So was this based on reality?

2011 article in the NYDN:

Toxic lead replaced by even more toxic cadmium in children's toys, trinkets

Now that lead has been banned from children’s products, some Chinese manufacturers have been substituting the even more dangerous heavy metal cadmium, especially in costume jewelry, an Associated Press investigation reveals.

Cadmium is a known carcinogen that, like lead, can delay brain development in young children, leading to learning disabilities. Research also shows that long-term exposure can cause cancer and kidney problems.

but there were no cadmium standards in 2011 so Walmart pled they followed the letter of the law in selling such things.

In a written statement, Wal-Mart insists that it makes safety a priority. "We consistently seek to sell only those products that meet safety and regulatory standards," Wal-Mart states. "Currently there is no required cadmium standard for children's jewelry."

so is this still true in 2016?

This 2015 article from the Environmental working group webpage  notes the law hasn't been updated since 1976, and has denied consumer petitions to update standards in testing cadmium in toys and children's jewelry.

The dirty little secret is that it is not only big business avoiding regulations, but that much of the US manufacturing is now done overseas, where there is less oversite, and in places like China (and to a lesser extent India) where you can get away with it if you bribe the right people or if the regulator is a family member.

NaturalNews article 2013 about "organic food" from China...even if the farmers follow the law ..that irrigates using contaminated water.

we grow organic brown rice.

The bad news: brown rice concentrates some heavy metals. NYT article here.

most are small and not dangerous. Polished rice is healthier this way but has lost it's fiber and B vitamins.

Arsenic can come from ground water (especially deep wells: The use of clean deep well water in Bengladesh has cut deaths from dystentary but now they have an epidmic of arsenic).

But we are probably safe from pollution, being upstream from Manila...but what about all those newfangled mercury containing light bulbs thrown out carelessly here? or other toxins from the city dump upstream from our farm?


(note: Here we pretty well went broke following the law because we competed with rice growers who did use chemicals and pesticides when the regulator wasn't around.).

so anyway: Lack of environmental regulations not only hurt people but hurt those who try to follow the rules (how many US factories went under competing with substandard manufactured stuff from China? )

ah, but getting back to vaccine conspiracies:

Guess what: There is a major vaccine problem in China.

Via Weibo (the Chinese equivalent to twitter/facebook).

The Shandong State Food and Drug Administration is investigating the illegal distribution of vaccines, including those for hepatitis B and rabies, by nine different pharmaceutical companies. As authorities are checking where the vaccines have been sold, media are reporting they have been sold in a total of 24 different places, including municipalities and provinces all over China such as Beijing, Sichuan, Shandong, Shanxi, Hunan, Xinjiang etc.
This is original, researched content by What's on Weibo. You are free to link to this article. Please identify this website or author when you base content on this source or quote from it. Do not reproduce our content without permission – you can contact us at info@whatsonweibo.com, we’re happy to hear from you. Copyright (C) http://www.whatsonweibo.com. Read more at: http://www.whatsonweibo.com/vaccine-scandal-illegal/

a longer article on ChinaDaily:

A mother and daughter from Shandong province have allegedly sold vaccines worth 570 million yuan ($88 million) illegally since 2010 in China, posing severe health risks to users, police said on Friday.
It is believed to be the largest case of its kind in China in terms of the amount of money involved, according to media reports.
The police in Jinan, the provincial capital, confirmed an earlier report by the Paper, a Chinese news organization based in Shanghai, that the two suspects allegedly sold vaccines that were not properly refrigerated, as required by national standards, in 18 provinces and regions across the country.

and here is the kicker:

The fact that they are suspected of doing it for so long exposes flaws in the supervision system of the country’s vaccine industry, he said.

ya think?

ah, but the WHO lauds the entrance of China in to the world vaccine marketplace  (2014)at the same time that "counterfeit" and substandard drugs (mainly from China and India) are killing millions.

the article notes that it is not just manufacturing that has to be careful: You also have to store and ship the vaccines so they don't get hot and lose their ability to work.

and for those following the paper trail of donations to the CLinton foundation being used to get influence with the US Gov't, this is nor comforting:

The Clinton Health Access Initiative (CHAI) has been working with Chinese suppliers to support their applications for WHO prequalification for several vaccine candidates for the last two years, says Joshua Chu, CHAI’s Director, Vaccines Markets.The initiative also works with donors and other agencies to implement innovative market-based mechanisms, such as long-term volume guarantees, to make donor funds go further when purchasing vaccines. So far it has established volume guarantees with vaccine manufacturers in India and with other developing countries for other health products.

then there is this "Whoops":CZ magazine article that mentions the heptatis vaccine deaths.

and laments the meme: But they will be cheap! We Need Cheap!

So the conspiracy vaccine conspiracies will notice:

not just the mullahs or bishops but those in the USA:

this vaccine scandal was carelessness in storing and shipping.

But what about carelessness in manufacturing?

Or outright fraud, as in the heparin or melamine baby milk scandals, where regulation was in place and being done correctly, but the manufacturer figured out a cheaper way to make the stuff that woudn't be detected by ordinary regulatory testing.

Sigh.
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Shanghai daily reports: China is going to fix the loopholes that let these ladies in business.

Lots of other suspects involved.