Happy Mother's Day!
Religious Freedom Under Attack by Church Leaders

Autism, Vaccination and Immigrants - Yet another Clear Correlation An Update

MinnesotaBy Edward Yazbak MD

A recent measles outbreak has recently been reported in Minnesota.

According to the MN State Department of Health, there have been 51 confirmed measles cases (48 children and 3 adults) as of May 10, 2017.

Forty seven cases were unvaccinated, one case had 1 dose of MMR vaccine and two cases had 2 doses of MMR. The vaccination status of one case was unknown.

There was no mention of hospitalization or death.

Forty six cases were Somali Minnesotan.

The previous measles outbreak was in 2011 when 26 cases were reported.

Wolff and Madlon-Kay discussed that 2011 measles outbreak in their publication titled “Childhood vaccine beliefs reported by Somali and non-Somali parents”.

They reported that: “Somali parents were more likely than non-Somali parents to have refused the MMR vaccine for their child (odds ratio, 4.6; 95% confidence interval, 1.2-18.0). Most of them refused vaccines because they had heard of adverse effects associated with the vaccine or personally knew someone who suffered an adverse effect. Somali parents were significantly more likely to believe that autism is caused by vaccines (35% vs. 8% of non-Somali parents). Somalis were also more likely to be uncomfortable with administering multiple vaccines at one visit (odds ratio, 4.0; 95% confidence interval, 1.4-11.9) and more likely to believe that children receive too many vaccines.”

The authors concluded that: “Statistically significant differences in perceptions and use of vaccines were reported by Somali and non-Somali participants. Somali parents are more likely to believe that the MMR vaccine causes autism and more likely to refuse the MMR vaccine than non-Somali parents. These beliefs have contributed to an immunization gap between Somali and non-Somali children.” https://www.ncbi.nlm.nih.gov/pubmed/25002000

The complete publication is available at http://www.jabfm.org/content/27/4/458.long

*****

On January 21, 2011, I published my original review: Autism, Vaccination and Immigrants - Yet another Clear Correlation” It was later translated to Russian.

Here it is, as previously published.

*****

Autism and Autistic Spectrum Disorders (ASD) seem more common among young Somalis in Minnesota and among immigrant communities in several western countries.

At least as late as 2003, Ethiopian-born immigrants to Israel had no recorded cases of autism.                                 

[That is correct: Not a single one!]

                                                                  *****

The medical literature contains several reports of a higher prevalence of autism among immigrant communities worldwide.

The earliest report I could find was published on March 6, 1976 in the Australian Medical Journal. According to Haper and Williams, relatively more New South Wales children who had at least one foreign-born parent whose native language was not English, carried a diagnosis of infantile autism. The authors attributed the behavioral changes to environmental stresses, adjustment difficulties and a confusing language environment leading to de-compensation of an already vulnerable child.[i]

Autism was a purely psychiatric disorder at the time. Just nine years earlier, Bruno Bettleheim had published his widely read The Empty Fortress: Infantile Autism and the Birth of the Self, where he promoted his sad and offensive "refrigerator mother" theory of autism.

Gillberg and Gillberg reported in 1996 that of 55 thirteen-year-old children with autism they investigated, 15 (27%) were born to parents, “at least one of whom had migrated to Sweden”. In several cases, the affected child was the first born in Sweden after the mother’s arrival to the country.[ii]

In 2006, Maimburg and Vaeth [iii] reported results of a “population-based, matched case-control study of infantile autism” in Denmark and stated that the risk of infantile autism was increased with foreign citizenship.

Across the Atlantic in 2007, Canadian physicians were reporting similar findings from Montreal to Vancouver and some complained that there was “little research to understand why.”[iv] 

At the time, I talked to a few informed parents in Montreal and reviewed with them the local situation.

I was told that for years, the “mother tongue” of students in Montreal schools was French 42%, Non-English 36% and English 22% and that most if not all non-English-speaking immigrant children attended “French” schools.

The parents also claimed that the city’s French schools enrolled a significant number of children with Pervasive Developments Disorders and provided me with school year 2001-2002 data from a “Special Needs School” in a Montreal French School Board. Of the 185 students aged 4 to 13 in that French school, 56 (30.3%) carried a diagnosis of Pervasive Developmental Disorder (PDD).

The demographic data are illustrated in the following table. 
 

Students in a “Special Needs School” in Montreal – 2001-2002

 

Mother-language French

Mother-language Creole (Haitian)

Mother-

language

Other”

Total

No. of Students

85

39

61

185

Students with PDD

17

18

21

56

% with PDD in Group

20

46

34

30

Table I
 

The above data very strongly suggest that in Montreal French schools, children of immigrants had a relatively higher prevalence of PDD than French-Canadian-born children.

To please the genetic crowd, I will concede that Haitian, Arab and Asian children are genetically different from French children. But it is also a fact that they have different vaccination patterns.

As an example, the Regional Program of Vaccination for the Province of Quebec [v] states that Hepatitis B vaccination is recommended and available free of charge to children whose families (or at least one parent) immigrated from regions where hepatitis B is highly endemic. The lists of hepatitis B-highly endemic countries that followed the above recommendation included 47 countries from the Sub-Sahara, 18 from Asia, 4 from the Middle-East, 24 from the Pacific Islands, 5 from the region of the Amazon in addition to Haiti and the Dominican Republic.

According to the Canada Communicable Disease Report of May 1, 2002, "the only thimerosal-containing vaccine in routine use in the infant immunization schedules of some Canadian jurisdictions is hepatitis B vaccine."[vi]

More recently, the Public Health Agency of Canada reported that “The influenza vaccine and most hepatitis B vaccines are multi-dose vaccines, which contain thimerosal as a preservative. For immunization of infants against hepatitis B, parents or guardians in some provinces and territories have the choice of a thimerosal-free vaccine.” [Updated 12/2/2010] [vii]

The Federal Canadian Immunization rules [viii] are in effect in all Canadian Provinces including the Province of Quebec. Part 3 of the Canadian Immunization Guide exclusively deals with “Immunization of Persons New to Canada”.

It includes the following statements:

New immigrants, refugees and internationally adopted children may be lacking immunizations and/or immunization records because of their living conditions before arriving in Canada or because the vaccines are not available in their country of origin.

Only written documentation of vaccination given at ages and intervals comparable with the Canadian schedule should be considered valid.

Therefore health care providers in Canada who see persons newly arrived in the country should make the assessment and updating of immunizations a priority.

*****

Section 341 of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 imposed certain vaccination requirements on all persons seeking green cards in the United States. These requirements apply to persons seeking to adjust their status to permanent residence in the U.S. as well as to those who apply for immigrant visas to enter the U.S.
Under “New Vaccination Criteria for U.S. Immigration” the CDC [ix] presently lists vaccines for the following diseases as currently required: Mumps, Measles, Rubella, Polio, Tetanus and diphtheria, Pertussis, Haemophilus influenzae type B (Hib), Hepatitis A, Hepatitis B, Rotavirus, Meningococcal disease, Varicella’ Pneumococcal disease and Seasonal influenza.

The human papillomavirus (HPV) and zoster (Shingles) vaccines were removed from the list of required vaccines for immigrant applicants in December 2009.

After carefully reviewing the Canadian and United States vaccination practices related to immigrants, the following is very evident:

Both countries take vaccination of immigrants very seriously

Immigrants and refugees will likely have a 100% compliance with US vaccine requirements and Canadian “recommendations”

Improperly administered or poorly documented vaccinations WILL be repeated as needed

The following is quite evident in most Western and developed countries:

The present generation of children is the most vaccinated ever

The present generation of young parents is also the most vaccinated ever.

This is particularly relevant to this discussion of both immigrant children and children born to immigrant parents in Canada, Israel and the United States.

**** 

In 2008, Somali parents in Minnesota were alarmed and devastated when they started noticing disproportionally high rates of Autism Spectrum Disorders (ASD) among their children when compared to their schoolmates in preschool programs.

As expected, those parents asked a simple question: “Why was this happening?

They also hoped to get an answer.

The situation attracted a lot of attention [x] nationwide. Any mention of some relationship to vaccination among immigrants was promptly squashed with the argument that many Somali children born in Minnesota also had a high prevalence of autistic disorders.

As of July 24, 2008 the Somali tragedy in Minnesota was still a mystery [xi] and the Minnesota Department of Health was still “scrambling to put together a "pre-pilot program" to assess autism in the general population.” The DOH claimed that its failure to assess the situation and come up with accurate statistics about autism among immigrant children with autism was “in part because of laws restricting access to school data.”

The Minnesota Department of Education on the other hand had no difficulty stating that “in the Minneapolis' early childhood and kindergarten programs, more than 12 percent of the students with autism reported speaking Somali at home. According to Minneapolis school officials, more than 17 percent of the children in the district's early childhood special education autism program are Somali speaking.”

At the time, Somali-speaking students constituted almost 6 percent of the district's total enrollment in early childhood/kindergarten special education programs.

A special education official in the Minneapolis school district was quoted as saying “I've been working to get somebody to look at this and pay attention because it feels like this is too specific [to Somalis]. It's got to be preventable.” The same official also reported that she knew of an apartment building in the city were almost every Somali family has “at least one autistic child” and added “They're given more [vaccines] then we get, and sometimes they're doubled up. Then their children are given immunizations. In Somalia, their generations have not received these immunizations, and then suddenly they're getting just a wallop of them in the moms and then in the babies. That's certainly a concern that's been expressed to me by the Somali population.”

On March 31, 2009, the MN Department of Health published “Minnesota and the Somali Community - Report of Study.” [xii] Only one statement was highlighted in “Bold” character: “This study did not attempt to identify possible causes or risk factors for ASD.”

The following paragraph was the only mention of the Somali issue in the 2-page report:
 

"Administrative prevalence of Somali children, ages 3 and 4, who participated in the MPS ECSE ASD programs was significantly higher than for children of other races or ethnic backgrounds. This is consistent with what families and others observed. Because of the study’s limitations, it is not proof that more Somali children have autism than other children; however, it does raise an important question of why Somali children are participating in this program more than other children.”
 

On January 15, 2011, the Minnesota Autism Spectrum Disorder Task Force that included two state senators and two state representatives in addition to delegates from several agencies and professional organizations issued an “Interim Report" [xiii] in which the Somali tragedy was discussed in the following sentence: “However, a Minnesota Department of Health and CDC report showed that Somali American children enrolled in Minneapolis Public Schools had an administrative prevalence of up to seven times higher.”

*****

The Israeli Paradox

For those who do not know the terribly sad story of the Jews in Ethiopia, I would like to suggest “History of Ethiopian Jews”, a remarkable review. [xiv] 

Page 2 of the review is particularly relevant to the present discussion.

It is unlikely that vaccines or medications ever reached the poor Ethiopian Jews who had been isolated for years under atrocious conditions and were waiting to be secretly evacuated to Israel, in the dark of the night. Certainly their concerned saviors could not care less whether they were vaccinated and had completed, signed and stamped “Yellow cards”.

For their part, the government and social organizations looking after the refugees during their first months in Israel had plenty to do treating their diseases, improving their health and nutrition, providing them with much needed psychological support and “relocating ” them in general. Whether or not the refugees were “up to date” vaccination-wise was certainly NOT a priority: These new citizens had in all likelihood survived all the infectious diseases that Israel had vaccines for.

*****

I recently discovered a remarkable Israeli “File Review Study” by Kamer, Zohar et al [xv] that was published in 2003 and that I somehow had missed all these years.

For accurate reporting, the authors reviewed a national Israeli registry of 1,004 Jewish children who were diagnosed with PDD. (Arab children were not included)

They also examined relevant data available from the Israeli National Bureau of Statistics and found that those Jewish children born in the years 1983–1997 and living in Israel at the time belonged to four distinct groups:
Group 1: Native Israelis of non-Ethiopian extraction: 1,198,300
Group 2: Native Israelis of Ethiopian extraction: 15,600
Group 3: Immigrants of non-Ethiopian extraction: 110,300
Group 4: Children born in Ethiopia: 11,800

Data related to the prevalence of Pervasive Developmental Disorders among those groups are summarized in Table II.

PDD Prevalence among Jewish children in Israel 1983-1997

 

Born Abroad

Israeli-born

 

Ethiopian

Other

Total

Ethiopian

Other

Total

PDD

0

59

59

13

991

1,004

Total

11,800

110,300

122,100

15,600

1,098,300

1,113,900

Rate/10,000

0

5.3

4.8

8.3

9.0

9.0

Table II 

There were significant differences in PDD prevalence between Israeli-born children and immigrant children. But unlike the situation in Canada and the United States, the estimated prevalence of PDD among first-generation Ethiopian children in Israel at the time was 0 (Zero) per 10,000 while among Israeli-born children who were not of Ethiopian origin, the estimated prevalence was 9 per 10,000. 

Not to belabor the point, not a single immigrant child of the 11,800 born in Ethiopia and living at the time in Israel carried a diagnosis of PDD. 

Native Israeli children had a higher prevalence of PDD than foreign born children. Among the children who were born in Israel, those born to non-Ethiopian parents had a higher prevalence of PDD when compared to those children who were born to Ethiopian parents. 

A genetic immunity to autism among the Ethiopians is unlikely because: 
1. Autism does occur in Ethiopia 
2. Children of Ethiopian extraction born in Israel do develop autism 

Trying to explain every aspect of the paradox is not easy. 

I do propose that Jewish Ethiopian immigrants to Israel, both infants and adults, probably received no vaccinations in Ethiopia in the rural distant areas where they lived. Their immigration journey was hasty, at night and cloaked with secrecy unlike Somali refugees who stayed in pre-immigration camps for relatively long periods of time waiting to come to the United States and certainly available for “catch-up measures.” 

The Ethiopian infants may also have been older when they started their pediatric vaccinations in Israel. 
  
Group 3 included children of non-Ethiopian origin who came to Israel in the 1990s. These children had more PDD than Ethiopians but less that “Native Israelis”. A plausible explanation could be that many if not most children from that group came from post-USSR countries, where vaccination programs were limited when compared to those of Israel.

Conclusions 

There has been a continuing barrage of attacks on Dr. Andrew Wakefield and on anyone who dares to say that a vaccine–autism connection has not as yet been properly ruled out. 

It is evident that the CDC and its supporters have not done, and will never propose to do, a vaccinated v unvaccinated study, the only way to rule out such a connection. 
A thorough discussion of the subject requires attention to the child’s and his or her mother’s vaccination profiles. 

In this review, I have shown that Autism and Autism Spectrum Disorders seem to be more prevalent among children of immigrants in some western countries. 

The fact that such disorders have not been reported among Israeli children born in Ethiopia, and in all likelihood differently vaccinated, speaks for itself. 

Similarly, the fact that children born in Israel to women of Ethiopian origin (who may have had different vaccination profiles) are relatively less likely to carry a diagnosis of PDD than children born to non-Ethiopian and Israeli mothers is also worth noting. 

This review is as close as anyone can get to an unvaccinated v vaccinated study without undertaking such a study and a Zero PDD count among Ethiopian-born children in Israel should be convincing enough that the issue is by no means settled, as some would like us to believe.

                                                                   *****

References:

i   Haper JWilliams S. Infantile autism: the incidence of national groups in a New South Wales survey. Med J Aust. 1976 Mar 6;1(10):299-301.

ii   Gillberg ICGillberg C. Autism in immigrants: a population-based study from Swedish rural and urban areas. J Intellect Disabil Res. 1996 Feb;40 ( Pt 1):24-31.

iii   Maimburg RDVaeth M. Perinatal risk factors and infantile autism. Acta Psychiatr Scand. 2006 Oct;114(4):257-64.

iv   http://www.cbc.ca/health/story/2007/06/06/autism-immigrants.html Accessed 01/14/11

v  http://www.santepub-  mtl.qc.ca/mdprevention/fiches/immunisation/paysendemiciteVHB.pdf Accessed 01/15/11

vi   http://dsp-psd.pwgsc.gc.ca/Collection/H12-21-28-9.pdf Accessed 01/19/11

vii   http://www.phac-aspc.gc.ca/im/q_a_thimerosal-eng.php Accessed 01/19/11

viii  http://www.phac-aspc.gc.ca/publicat/cig-gci/p03-11-eng.php  Accessed 01/11/11

ix   http://www.cdc.gov/immigrantrefugeehealth/laws-regs/vaccination-immigration/revised-vaccination-immigration-faq.html#whatvaccines Accessed 01/11/11

x   http://www.nytimes.com/2009/04/01/health/01autism.html Accessed 01/16/11

xi http://www.minnpost.com/stories/2008/07/24/2687/a_mysterious_connection_autism_and_minneapolis_somali_children Accessed 01/17/11

xii   http://www.health.state.mn.us/ommh/projects/autism/reportfs090331.pdf Accessed 01/17/11

xiii  http://archive.leg.state.mn.us/docs/2011/mandated/110065.pdf Accessed 01/17/11

xiv  http://www.jewishfederations.org/page.aspx?id=791&page=1 Accessed 01/17/11

xv  Kamer AZohar AHYoungmann RDiamond GWInbar DSenecky Y. A prevalence estimate of pervasive developmental disorder among Immigrants to Israel and Israeli natives. Soc Psychiatry Psychiatr Epidemiol. 2004 Feb;39(2):141-5.


F. Edward Yazbak MD, FAAP
Falmouth, Massachusetts


Comments

Feed You can follow this conversation by subscribing to the comment feed for this post.

Caroline Canttakeitanymore

The children were double-vaccinated. And they got double the rate of autism. "nuff said.

Ed Yazbak

Thank you all once more

The following link may be useful to have:

https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/e/reported-cases.pdf

"Reported Cases and Deaths from Vaccine Preventable Diseases, United States, 1950-2013"

cia parker

Kws,

There continues to be no allopathic treatment for measles or other viral illnesses (antiviral drugs are quite dangerous and are limited to use in a very short time frame, so are rarely given). There is antibiotic treatment for the relatively small number of bacterial complications, but there has never been treatment per se for any viral illness (or for pertussis once the coughing has started). The measles virus itself, like those for smallpox and pertussis, became greatly attenuated in the first decades of the twentieth century, and so the fatality rate plummeted even before the development of antibiotics for bacterial complications.

Allopathic medicine likes vaccines because they are all that it has to offer for viral diseases: prevention, not treatment. There are effective herbal, vitamin, and homeopathic remedies to treat them, but nothing will make up for poor nursing care.

kws

This is a great paper !

It's obvious the standard of medical care in 1921 was much different from 2017 is not relevant when discussing measles deaths and other serious adverse events.

Its also clear the CDC is engaged in fraud. They cook their books to serve their needs, at the highest levels. To believe anything they publish is akin to investing in a Bernie Madoff led mutual fund.

Thank you Dr. Yazbak for reaching beyond American data sources to find the truth.

cia parker

Rtp,

Measles is potentially serious and it is crucial that those who have it be well-nursed, or serious complications, even disability or death, may result. Measles patients must stay in bed from the beginning of the illness until the fever is gone, be well-hydrated, take NO fever reducers, and take the appropriate two doses of vitamin A. They should remain quiet at home for three weeks after the day the rash appears to prevent secondary infections from taking hold in these weeks before the immune system is back to normal functioning. That being said, the benefits of natural measles are so great, that parents of previously healthy, well-nourished children should not fear it, but should bear in mind the importance of the measures I mentioned.

You mistake the cause and effect sequence. There is no diphtheria in the US now, largely thanks to the use of the vaccine since the '20s. There's close to no measles in the US now because the vaccine for it has been universally given for decades, and in nearly all cases effectively prevents measles.

http://therefusers.com/refusers-newsroom/low-fatality-rate-in-european-measles-outbreak-cdc-report/#.VkVL3rnluUk

Low fatality rate in European outbreak of measles six years ago. Low, but not zero. There WERE fatalities. Rate of three deaths per 10,000 cases.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1522578/pdf/amjphnation00499-0004.pdf

Dr. Langmuir's article about measles ca. 1960, death rate of less than one in 10,000 cases in children between three and ten. As many as four per 10,000 in babies under one. So again, low fatality rate by the '50s, but not zero.

http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733835814

Official UK statistics on number of reported measles cases and fatalities for every year since 1945. Again, low, but not zero. In the '80s it was one or two deaths per 10,000 cases.

"Diphtheria once was a major cause of illness and death among children. The United States recorded 206,000 cases of diphtheria in 1921, resulting in 15,520 deaths. Starting in the 1920s, diphtheria rates dropped quickly due to the widespread use of vaccines. Between 2004 and 2015, 2 cases of diphtheria were recorded in the United States. However, the disease continues to cause illness globally. In 2014, 7,321 cases of diphtheria were reported worldwide to the World Health Organization, but many more cases likely go unreported.
The case-fatality rate for diphtheria has changed very little during the last 50 years. The overall case-fatality rate for diphtheria is 5%–10%, with higher death rates (up to 20%) among persons younger than 5 and older than 40 years of age. Before there was treatment for diphtheria, the disease was fatal in up to half of cases."

https://www.cdc.gov/diphtheria/clinicians.html

"Before the measles vaccination program started in 1963, an estimated 3 to 4 million people got measles each year in the United States. Of these, approximately 500,000 cases were reported each year to CDC; of these, 400 to 500 died, 48,000 were hospitalized, and 1,000 developed encephalitis (brain swelling) from measles. Since then, widespread use of measles vaccine has led to a greater than 99% reduction in measles cases compared with the pre-vaccine era. However, measles is still common in other countries. Unvaccinated people continue to get measles while abroad and bring the disease into the United States and spread it to others."

https://www.cdc.gov/measles/vaccination.html

Ed Yazbak

Thank you all for your comments.

The full publication by Wolff and Madlon-Kay lists the following details under “Discussion”:

Although most Somali respondents to our survey agreed that childhood immunizations are safe and important to protect children from disease, 35% of them believe that autism is caused by the MMR vaccine.

Somali parents were 4 times more likely than non-Somali parents to report knowing a child who received the MMR vaccine and then was diagnosed with autism. These same concerns about MMR and autism also were found in focus group studies with Somali parents in Sweden and the United Kingdom. 5,6

It is known that the Somali community in Minnesota believes that their children are more affected by autism than the general public. 4

A study conducted in 2008 by the Minnesota Department of Health concluded that preschool-aged Somali children were significantly more likely than non-Somali children to participate in the Minneapolis public schools' autism spectrum disorder (ASD)–specific special education services. 8 …
http://www.jabfm.org/content/27/4/458.long

rtp

measles is of course completely harmless at any rate, but the vaccine does nothing to prevent it at any rate.

"To minimize the problem of false positive laboratory results, it is important to restrict case investigation and laboratory tests to patients most likely to have measles (i.e., those who meet the clinical case definition, especially if they have risk factors for measles, such as being unvaccinated,[...]"

www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html

And here is the UK's National Health Service: "Following assessment, if a diagnosis of measles is considered likely, it is essential to notify the local Health Protection Unit (HPU)" and subsequently: "Measles is very unlikely in people who have been fully immunized", followed by “Consider a different cause if the patient is likely to have immunity” http://cks.nice.org.uk/measles#!diagnosissub

And this is for diphtheria: "Because diphtheria has occurred only rarely in the United States in recent years, many clinicians may not include diphtheria in their differential diagnoses. Clinicians are reminded to consider the diagnosis of respiratory diphtheria in patients with membranous pharyngitis and who are not up-to-date with vaccination against diphtheria."

http://www.cdc.gov/vaccines/pubs/surv-manual/chpt01-dip.html

So as you can see, the entire so-called success of the vaccines are just a self-fulfilling prophecy.

John Stone

Grace

The Israelis are also highly embarrassed by their accurate military draft figures for the rise in autism (although perhaps not quite as steep as in some countries).

Grace Green

Thanks, Dr. Yazbak, for all these figures and your analysis. This looks very conclusive. It's surprising that the Israelis, who are at the forefront of much medical research, haven't noticed the differences in these populations, and questioned how it happened.

angusfiles

Great articles Dr Yazbak thanks.I have two Northern Hemisphere un-vaccinated kids myself and they both got measles and if you never seen the red dots which we thought were midge/gnat bites you would never have known they were meant to be ill!
You would think that if you gave Somali`s measles vaccines compared to Northern Hemisphere babies from the UK and Somalians having less vitamin A in their makeup that the damage from the vaccine could be more- it certainly seems that way.

Pharma for Prison
MMR RIP

John Stone

Dear Ed,

Thanks so much for up-dating this. While I do not have any statistics I can cite there is absolutely no doubt after more than 20 years of being involved with autism in and London that the African community is disproportionately represented in its ranks. The UK authorities would be very unlikely to make such statistics available.

Verify your Comment

Previewing your Comment

This is only a preview. Your comment has not yet been posted.

Working...
Your comment could not be posted. Error type:
Your comment has been saved. Comments are moderated and will not appear until approved by the author. Post another comment

The letters and numbers you entered did not match the image. Please try again.

As a final step before posting your comment, enter the letters and numbers you see in the image below. This prevents automated programs from posting comments.

Having trouble reading this image? View an alternate.

Working...

Post a comment

Comments are moderated, and will not appear until the author has approved them.

Your Information

(Name and email address are required. Email address will not be displayed with the comment.)