Mild reaction again....now what?

southernbubby

Sun, Nov 10 2019, 9:56 am

southernbubby wrote:

I thought that you had an article about SSPE occuring in children who got the MMR after the measles.

Found the answer to the question:

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November 05, 1982 / 31(43);585-8
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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail.

Subacute Sclerosing Panencephalitis Surveillance -- United States
Subacute sclerosing panencephalitis (SSPE) is a slow-virus infection of the central nervous system associated with prior measles infection. Onset generally occurs in late childhood or adolescence and is usually characterized by the insidious onset of mental deterioration and myoclonia. Although spontaneous improvement or stabilization can occur, the vast majority of patients proceed over a period of months to years to generalized convulsions, dementia, coma, and death.

To collect demographic and clinical information on SSPE cases, a national SSPE registry was initiated in 1969 at the University of Tennesee. Since October 1980, responsibility for the registry has resided with the Medical College of Georgia.* The registry is supported by the Office of Biologics, Food and Drug Administration, and maintained in collaboration with CDC. *Inquiries and suspected case reports can be directed to Dr. Paul R. Dyken, Professor and Chief, Section of Pediatric Neurology, Medical College of Georgia, 1459 Laney-Walker Boulevard, Augusta GA 30912.

A case of SSPE is defined by CDC as an illness with a compatible clinical course plus one of the following items of supporting laboratory evidence: 1) measles antibody detected in the cerebrospinal fluid (CSF), 2) a characteristic pattern on electroencephalography, or 3) typical histologic findings in brain biopsy material or tissue obtained on postmortem examination.

As of July 1982, 634 individuals suspected of having SSPE, with onset from 1956-1981, had been reported to the registry; of these, 368 were U.S. citizens who met the case definition of SSPE and had onset of symptoms between 1969 and 1981 (Figure 1). Fifty-five percent (202) of the 368 confirmed cases had a history of only measles infection; 14% (51) had a history of only measles vaccination; and 17% (63) had a history of both, with the natural illness most frequently preceeding the vaccination. The remaining 14% (52) gave no positive history of having natural measles infection or measles vaccination.

The reported incidence rate among U.S. citizens under 20 years of age has been estimated for selected years (by year of onset of SSPE). The rate for 1970 is estimated at 0.61 per million population, decreasing to 0.35 in 1975 and 0.06 in 1980.

A crude estimate can be made of the risk of SSPE following natural measles infection by determining the year in which a given person who developed SSPE contracted measles and the number of measles cases that occurred in that year.** Similarly, the risk, if any, associated with measles vaccine can be estimated by determining the year of vaccination of patients with SSPE and the net number of doses of live-virus measles vaccine distributed during that year. The estimated risk of SSPE following natural measles infection averaged 8.5 cases per million measles cases occurring in 1960-1974.*** The estimated rate of SSPE following measles vaccination averaged 0.7 reported SSPE cases per million doses of live-virus measles vaccine distributed from 1963 (the year of vaccine licensure) through 1974. **Assuming a 10% reporting efficiency, estimated case numbers were determined by multiplying reported cases for those years by 10. ***The average interval between onset of measles and onset of SSPE is approximately 7 years. Thus, SSPE risk estimates for persons who developed measles beyond 1974 are less likely to be accurate. Reported by P Dyken, MD, R DuRant, P Shmunes, Medical College of Georgia, Augusta, GA; Surveillance, Investigations, and Research Br, Immunization Div, Center for Prevention Svcs, CDC.

Editorial Note
Editorial Note: Reported SSPE cases with onset since 1973 have declined substantially paralleling the substantial decline in reported measles cases after 1964-1966 (Figure 1). The lag period between the decline in reported measles cases and the decline in reported SSPE cases is similar to the mean latent period of 7 years noted previously between natural measles infection and subsequent onset of SSPE (1). Recently reported cases have a mean latent period of approximately 10 years, indicating that many of these cases may reflect sequelae due to measles incidence from the 1960s and early 1970s.

There is often a several-year lag period between onset of SSPE and registry notification (median = 3 years). Reporting is probably not complete, in part because diagnosing the illness requires a high index of suspicion. However, surveillance efforts have increased during the past 2 years from the immediately preceeding years (e.g. by continually soliciting reports from pediatric neurologists). Therefore, the apparent decrease in case reports since 1973 is probably an accurate trend, but the apparent annual case report level since approximately 1980 must also be viewed with consideration of these factors. Because of the lag time between natural measles illness and SSPE onset and the current lag time between onset and reporting, the impact on SSPE incidence of the dramatic decline in measles incidence as a result of the measles elimination effort will not be seen for nearly another decade.

Four lines of evidence indicate that measles vaccine protects against SSPE: 1) the decrease in reported SSPE cases in recent years as measles incidence has declined; 2) two case-control studies performed in the United States which indicated that measles vaccine, by protecting against measles, reduces the chance of developing SSPE (2,3); 3) a cohort analysis of children born from 1953 to 1973 indicating that, for cohorts born since 1966, one of the first years of widespread use of measles vaccine, the incidence rate of SSPE occurring at all ages has progressively decreased (4); 4) estimates of the ratios of SSPE cases to measles cases and of SSPE cases to measles vaccinees suggest that if there is any risk of SSPE following measles vaccination, it is less than or equal to one-twelfth the risk of SSPE following measles infection. Although some cases of SSPE have developed among children who had no history of natural measles infection but who received measles vaccine, these patients may have had unrecognized measles illness (e.g., during the first year of life). Studies performed before measles vaccine licensure indicated that 15%-30% of persons without a history of measles illness had evidence of measles antibody (5). A better picture of the etiologic role of live-measles vaccine in SSPE occurrence will only be seen several years after interruption of measles transmission in this country. Based on current imperfect estimates, however, the risk, if any, of SSPE from vaccination seems extremely low.

SSPE is only one of a number of degenerative neurologic diseases. In such illnesses, testing for measles antibody in the CSF will allow the diagnosis of SSPE when applicable. In order to obtain as complete reporting as possible, health-care providers and public health personnel are encouraged to report all suspected cases to the registry.

References
Modlin JF, Halsey NA, Eddins DL, et al. Epidemiology of subacute sclerosing panencephalitis. J Pediatr 1979;94:231-6.

Detels R, Brody JA, McNew J, Edgar AH. Further epidemiological studies of subacute sclerosing panencephalitis. Lancet 1973;2:11-4.

Halsey NA, Modlin JF, Jabbour JT, Dubey L, Eddins DL, Ludwig DD. Risk factors in subacute sclerosing panencephalitis: a case-control study. Am J Epidemiol 1980;111:415-24.

Halsey NA, Modlin JF, Jabbour JT. Subacute sclerosing panencephalitis (SSPE): an epidemiologic review. In: Stevens JG, Todaro GJ, Fox CF, eds. Persistent viruses. (ICN-UCLA symposia on molecular and cellular biology, Vol XI, 1978). New York: Academic Press, 1978: 101-14.

Krugman SA, Giles JP, Jacobs AM, Friedman H. Studies with live attenuated measles-virus vaccine. Comparative clinical, antigenic, and prophylactic effects after inoculation with and without gamma-globulin. Am J Dis Child 1962;103:353-63.

Disclaimer All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.
Page converted: 08/05/98

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amother

Green

Sun, Nov 10 2019, 10:14 am

southernbubby wrote:

Found the answer to the question:
Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail.

Subacute Sclerosing Panencephalitis Surveillance -- United States
Subacute sclerosing panencephalitis (SSPE) is a slow-virus infection of the central nervous system associated with prior measles infection. Onset generally occurs in late childhood or adolescence and is usually characterized by the insidious onset of mental deterioration and myoclonia. Although spontaneous improvement or stabilization can occur, the vast majority of patients proceed over a period of months to years to generalized convulsions, dementia, coma, and death.

To collect demographic and clinical information on SSPE cases, a national SSPE registry was initiated in 1969 at the University of Tennesee. Since October 1980, responsibility for the registry has resided with the Medical College of Georgia.* The registry is supported by the Office of Biologics, Food and Drug Administration, and maintained in collaboration with CDC. *Inquiries and suspected case reports can be directed to Dr. Paul R. Dyken, Professor and Chief, Section of Pediatric Neurology, Medical College of Georgia, 1459 Laney-Walker Boulevard, Augusta GA 30912.

A case of SSPE is defined by CDC as an illness with a compatible clinical course plus one of the following items of supporting laboratory evidence: 1) measles antibody detected in the cerebrospinal fluid (CSF), 2) a characteristic pattern on electroencephalography, or 3) typical histologic findings in brain biopsy material or tissue obtained on postmortem examination.

As of July 1982, 634 individuals suspected of having SSPE, with onset from 1956-1981, had been reported to the registry; of these, 368 were U.S. citizens who met the case definition of SSPE and had onset of symptoms between 1969 and 1981 (Figure 1). Fifty-five percent (202) of the 368 confirmed cases had a history of only measles infection; 14% (51) had a history of only measles vaccination; and 17% (63) had a history of both, with the natural illness most frequently preceeding the vaccination. The remaining 14% (52) gave no positive history of having natural measles infection or measles vaccination.

The reported incidence rate among U.S. citizens under 20 years of age has been estimated for selected years (by year of onset of SSPE). The rate for 1970 is estimated at 0.61 per million population, decreasing to 0.35 in 1975 and 0.06 in 1980.

A crude estimate can be made of the risk of SSPE following natural measles infection by determining the year in which a given person who developed SSPE contracted measles and the number of measles cases that occurred in that year.** Similarly, the risk, if any, associated with measles vaccine can be estimated by determining the year of vaccination of patients with SSPE and the net number of doses of live-virus measles vaccine distributed during that year. The estimated risk of SSPE following natural measles infection averaged 8.5 cases per million measles cases occurring in 1960-1974.*** The estimated rate of SSPE following measles vaccination averaged 0.7 reported SSPE cases per million doses of live-virus measles vaccine distributed from 1963 (the year of vaccine licensure) through 1974. **Assuming a 10% reporting efficiency, estimated case numbers were determined by multiplying reported cases for those years by 10. ***The average interval between onset of measles and onset of SSPE is approximately 7 years. Thus, SSPE risk estimates for persons who developed measles beyond 1974 are less likely to be accurate. Reported by P Dyken, MD, R DuRant, P Shmunes, Medical College of Georgia, Augusta, GA; Surveillance, Investigations, and Research Br, Immunization Div, Center for Prevention Svcs, CDC.

Editorial Note
Editorial Note: Reported SSPE cases with onset since 1973 have declined substantially paralleling the substantial decline in reported measles cases after 1964-1966 (Figure 1). The lag period between the decline in reported measles cases and the decline in reported SSPE cases is similar to the mean latent period of 7 years noted previously between natural measles infection and subsequent onset of SSPE (1). Recently reported cases have a mean latent period of approximately 10 years, indicating that many of these cases may reflect sequelae due to measles incidence from the 1960s and early 1970s.

There is often a several-year lag period between onset of SSPE and registry notification (median = 3 years). Reporting is probably not complete, in part because diagnosing the illness requires a high index of suspicion. However, surveillance efforts have increased during the past 2 years from the immediately preceeding years (e.g. by continually soliciting reports from pediatric neurologists). Therefore, the apparent decrease in case reports since 1973 is probably an accurate trend, but the apparent annual case report level since approximately 1980 must also be viewed with consideration of these factors. Because of the lag time between natural measles illness and SSPE onset and the current lag time between onset and reporting, the impact on SSPE incidence of the dramatic decline in measles incidence as a result of the measles elimination effort will not be seen for nearly another decade.

Four lines of evidence indicate that measles vaccine protects against SSPE: 1) the decrease in reported SSPE cases in recent years as measles incidence has declined; 2) two case-control studies performed in the United States which indicated that measles vaccine, by protecting against measles, reduces the chance of developing SSPE (2,3); 3) a cohort analysis of children born from 1953 to 1973 indicating that, for cohorts born since 1966, one of the first years of widespread use of measles vaccine, the incidence rate of SSPE occurring at all ages has progressively decreased (4); 4) estimates of the ratios of SSPE cases to measles cases and of SSPE cases to measles vaccinees suggest that if there is any risk of SSPE following measles vaccination, it is less than or equal to one-twelfth the risk of SSPE following measles infection. Although some cases of SSPE have developed among children who had no history of natural measles infection but who received measles vaccine, these patients may have had unrecognized measles illness (e.g., during the first year of life). Studies performed before measles vaccine licensure indicated that 15%-30% of persons without a history of measles illness had evidence of measles antibody (5). A better picture of the etiologic role of live-measles vaccine in SSPE occurrence will only be seen several years after interruption of measles transmission in this country. Based on current imperfect estimates, however, the risk, if any, of SSPE from vaccination seems extremely low.

SSPE is only one of a number of degenerative neurologic diseases. In such illnesses, testing for measles antibody in the CSF will allow the diagnosis of SSPE when applicable. In order to obtain as complete reporting as possible, health-care providers and public health personnel are encouraged to report all suspected cases to the registry.

References
Modlin JF, Halsey NA, Eddins DL, et al. Epidemiology of subacute sclerosing panencephalitis. J Pediatr 1979;94:231-6.

Detels R, Brody JA, McNew J, Edgar AH. Further epidemiological studies of subacute sclerosing panencephalitis. Lancet 1973;2:11-4.

Halsey NA, Modlin JF, Jabbour JT, Dubey L, Eddins DL, Ludwig DD. Risk factors in subacute sclerosing panencephalitis: a case-control study. Am J Epidemiol 1980;111:415-24.

Halsey NA, Modlin JF, Jabbour JT. Subacute sclerosing panencephalitis (SSPE): an epidemiologic review. In: Stevens JG, Todaro GJ, Fox CF, eds. Persistent viruses. (ICN-UCLA symposia on molecular and cellular biology, Vol XI, 1978). New York: Academic Press, 1978: 101-14.

Krugman SA, Giles JP, Jacobs AM, Friedman H. Studies with live attenuated measles-virus vaccine. Comparative clinical, antigenic, and prophylactic effects after inoculation with and without gamma-globulin. Am J Dis Child 1962;103:353-63.

Disclaimer All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.
Page converted: 08/05/98

HOME | ABOUT MMWR | MMWR SEARCH | DOWNLOADS | RSS | CONTACT
POLICY | DISCLAIMER | ACCESSIBILITY

Safer, Healthier People

Morbidity and Mortality Weekly Report
Centers for Disease Control and Prevention
1600 Clifton Rd, MailStop E-90, Atlanta, GA 30333, U.S.A

USA.GovDHHS
Department of Health
and Human Services

This page last reviewed 5/2/01

Pretty sure the vaccine in question is NOT the live attenuated MMR but rather an earlier version known to have adverse side effects and no longer in use. (But can't look it up right now, will try later.)

rachel6543

Sun, Nov 10 2019, 10:18 am

Have you actually talked about your concerns with your pediatrician? I would start there. And if your child has such bad eczema, I would see if I could find a (pediatric) doctor who specializes specifically in that. As to a medical exemption, have you actually asked your pediatrician yet? Lots of people are saying it’s impossible. But it sounds like to me you have very real, valid concerns. I would start with talking with the doctor and if needed get 2nd or 3rd opinions.

southernbubby

Sun, Nov 10 2019, 10:28 am

amother [ Green ] wrote:

Great point!
But notice the way that this statistic was twisted into fact by what appears to be an anti-vax poster. And because of statistics and quotes (such as Bill Gates) taken out of context, anti-vaxers fail to make what should be valid points regarding vaccine safety.

amother

Yellow

Sun, Nov 10 2019, 2:35 pm

rachel6543 wrote:

I have discussed my concerns about vaccinating a child with very bad eczema. He also has some brain abnormalities that put him at increased risk for seizure disorders. My Dr. told me, "even if you begged me I wouldnt vaccinate him, but I can lose my license over this".
he went ahead and named me 2 dr. who this happened to. Unless you dont have a clear contraindication to vaccines, there is no way to get ME

#BestBubby

Sun, Nov 10 2019, 4:00 pm

amother [ Yellow ] wrote:

Disgraceful that doctors must choose between risking a child's life or losing their license! Most doctors would risk the child's life. The doctor can't be sued and will just deny any harm as "coincidence".

amother

Honeydew

Sun, Nov 10 2019, 4:06 pm

amother [ Yellow ] wrote:

Weird I know a few with called concerns and they got exemptions. That’s this year September and there kids are in school. My own child was vaccinated late due to eczema.

amother

Orchid

Sun, Nov 10 2019, 4:11 pm

amother [ Honeydew ] wrote:

Weird I know a few with called concerns and they got exemptions. That’s this year September and there kids are in school. My own child was vaccinated late due to eczema.

The doctor may have written it, but once the DOH audits the school, they will reject it and child will no longer be able to attend

nchr

Sun, Nov 10 2019, 4:22 pm

amother [ Yellow ] wrote:

Unless your doctor is lying and saying your children received vaccines which they did not, I don't see why recommending you delay vaccines for a particular child would make him lose his license. That sounds very odd...

amother

Jade

Sun, Nov 10 2019, 6:20 pm

nchr wrote:

People whom this law has not affected, such as you, are very naive about the current state of affairs.

She's telling you what her doctor said. You think she's lying or her doctor is lying?

I can tell you the same thing happened to me and my DS also in regards to eczema. The doctor told me she's only given 2 ME's in her whole career. The doctor needs to fill in a very specific form with loads of information and proof and her own personal details, such as her cell phone number. They harass you. That's why she only gives ME's for contraindications given by the CDC.

This poster isn't the first one to post on here about the impossibility of getting an exemption for a child with prior vaccine reactions. Talk to people in the trenches and hear their experiences instead of accusing them (or their doctors) of lying.

[For the sake of clarification, in order to delay vaccines, a ME is needed. One cannot merely delay. Doc needs to fill in a form for a ME which is for a specified time period in order to delay.]

nchr

Sun, Nov 10 2019, 7:00 pm

amother [ Jade ] wrote:

People whom this law has not affected, such as you, are very naive about the current state of affairs.

She's telling you what her doctor said. You think she's lying or her doctor is lying?

I can tell you the same thing happened to me and my DS also in regards to eczema. The doctor told me she's only given 2 ME's in her whole career. The doctor needs to fill in a very specific form with loads of information and proof and her own personal details, such as her cell phone number. They harass you. That's why she only gives ME's for contraindications given by the CDC.

This poster isn't the first one to post on here about getting an exemption for a child with prior vaccine reactions. Talk to people in the trenches and hear their experiences instead of accusing them (or their doctors) of lying.

[For the sake of clarification, in order to delay vaccines, a ME is needed. One cannot merely delay. Doc needs to fill in a form for a ME which is for a specified time period in order to delay.]

I was not referring to a Medicql Exemption or OPs chuld. I was stating that a doctor is not going to lose his license over the example the poster described. Stating kids received vaccines they did not or fabricating reactions for a ME could result in losing a license, but not what the poster described.

amother

Jade

Sun, Nov 10 2019, 7:23 pm

nchr wrote:

But they're afraid that they will. Otherwise, why aren't they writing more ME's for children they are saying should not be further vaccinated? What have they got to lose?

amother

Wheat

Mon, Nov 11 2019, 5:28 am

amother [ Jade ] wrote:

But they're afraid that they will. Otherwise, why aren't they writing more ME's for children they are saying should not be further vaccinated? What have they got to lose?

I know a pediatrician personally who told me that he pretends to listen to anti vax patients because he doesnt want them to use natural doctors and pretends to hear their concerns- very few of which are real. He may make a comment like that so the parent still feels like he is on their side.

amother

Jade

Mon, Nov 11 2019, 5:33 am

amother [ Wheat ] wrote:

HUH???
You think the doc is lying that in her whole medical career she only gave 2 ME's???? She's practicing for over 20 years already! You think she's lying that the DOH harasses her and makes her put down her private phone number? You think the doctor who said "I'm not vaccinating your child anymore, but I can't give you a ME." is pretending to listen to an anti-vax parent? You think there aren't doctors who are actually concerned about the mass forced vaccination where there's no room for a more individual approach for patients?

southernbubby

Mon, Nov 11 2019, 5:39 am

amother [ Jade ] wrote:

Would it be possible to launch a class action lawsuit against the DOE and DOH? I obviously use vaccines but I believe that it should be given at the discretion of the doctor. It's unfortunate that a few bad apples capitalized on phoney exemptions and caused the people who need them to be denied an education.

nchr

Mon, Nov 11 2019, 8:18 am

amother [ Jade ] wrote:

But they're afraid that they will. Otherwise, why aren't they writing more ME's for children they are saying should not be further vaccinated? What have they got to lose?

No, they are not afraid of losing their licenses - that is hyperbole. They don't want to be (1) considered "quacky" by their peers (sorry for using that word, but their peers may); (2) busy with the follows up - they get enough of this with insurance companies. However, I do think that if a doctor genuinely believes vaccination is not appropriate for a patient, then they have a responsibility to file the ME, with their telephone number, and take the calls.

amother

Wheat

Mon, Nov 11 2019, 8:24 am

notshanarishona wrote:

Sorry , exczema is not a severe reaction.
A near fatal reaction I think any doctor would give a exzemption for but not for siblings who have a minor reaction.

https://www.aad.org/diseases/e.....cause

Vaccinations do NOT cause eczema.

Dermatologists very much encourage people who have eczema to get vaccinated.

If someone with eczema has an extreme allergic reaction to eggs, however, you should talk with your doctor about alternatives for two vaccinations.

The first vaccination that can cause problems for someone with eczema who has an extreme allergy to eggs is the measles, mumps, and rubella (MMR) vaccine. Children who have severe cardiorespiratory (heart and breathing) or gastrointestinal (GI) problems after eating eggs or just being exposed to eggs may need an alternative vaccine. This is the only situation in which an alternative to the MMR vaccine may be needed.

Even if a child has hives, the MMR vaccine can be given. You may want to watch the child for 30 minutes afterwards.

Another vaccination that has gotten some attention is the influenza vaccine. If a person with eczema has a severe allergic reaction to eggs, be sure your doctor knows this before you (or your child) receives the flu vaccine. Be sure to discuss alternate vaccinations.

The vast majority of children who have eczema should get the vaccinations recommended for their age.

Immunizations are so important for children who have eczema.

southernbubby

Mon, Nov 11 2019, 12:47 pm

amother [ Wheat ] wrote:

I'm surprised that they haven't caught on. I sometimes help with taking grandchildren to these appointments and I ask for printed information about the vaccine as well as what type of protection it provides and what type of reaction would require a trip to the ER or doctors office. I don't want them to think that they don't have to know the answers to my questions or that we are the type that doesn't even know or care about what is being injected.

amother

Jade

Mon, Nov 11 2019, 1:01 pm

southernbubby wrote:

Citizens are doing this, but good luck finding doctors to file a lawsuit against the government body which provides them with their license to practice....

southernbubby

Mon, Nov 11 2019, 1:20 pm

amother [ Jade ] wrote:

Citizens are doing this, but good luck finding doctors to file a lawsuit against the government body which provides them with their license to practice....

The DOE can be sued for denying an education.