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A vaccination tool every parent could use

Regular readers know that I lived in Chicago for three years in the late 1990s. Indeed, Chicago is probably my favorite city in the world, and my years there count as three of the happiest years of my life. I lived in a cool neighborhood near DePaul in Lincoln Park; never again in my life am I ever likely to live in a place with such a fine mixture of residential houses, businesses, restaurants, bars, and parks. Moreover, I still have family there, which, combined with my knowledge of the city, leads me to continue to feel a connection to the city. It’s that connection that guarantees that I remain interested in the goings-on in Chicago and is also part of the reason why the yearly descent of anti-vaccine quacks on the Chicago metro area for the Autism One quackfest annoys the crap out of me.

It’s also why I’m concerned to learn that there are a number of schools with vaccination rates that are low enough that they could serve as the incubators for outbreaks of infectious disease, as this story in Sunday’s Chicago Tribune by Trine Tsouderos, Deborah L. Shelton and Joseph Germuska, entitled Low vaccination rates in some schools raise outbreak risks reports:

Clusters of children without their required vaccinations in about 200 Illinois schools are raising the chances of school-based outbreaks of serious preventable diseases such as measles and whooping cough, a Tribune analysis of state data has found.

The Tribune found that the number of public and private schools with immunization rates below 90 percent — a protection level the state recommends in order to prevent epidemics — has grown dramatically in recent years for each vaccine.

For example, in 2003, 31 schools fell below 90 percent for measles vaccinations. Last year, 124 did. The number of schools below 90 percent for polio rose from 27 to 122 during the same period.

Some of these schools serve low-income students who arrive at school without proof that they are up-to-date on their immunizations, the Tribune found. Others are private schools serving middle-class and wealthy families who sometimes seek religious exemptions from vaccination requirements.

The story provides a detailed, interactive map that allows parents to look up the vaccination rates at their children’s schools. It reminds me of the same sort of data presented in an earlier article that looked at vaccination rates in California schools and provided a map listing vaccination rates in schools in southern California, but the Tribune map is more user-friendly.

One aspect of public healht that anti-vaccine activists frequently distort is high overall vaccination uptake rates. For example, the article points out that the overall vaccination rate in Illinois is still around 98%. Sounds great, right? Well, yes, it is quite good. The problem is that the number of schools with vaccination rates below 90%–and even those below 60%–have rapidly increased in number since 2003. These clusters of unvaccinated children eat away at herd immunity and provide a nidus for infection to take hold and spread among the population. Since no vaccine is 100% effective, these pockets of unvaccinated children can be a danger even to the vaccinated. Even worse, children who can’t be vaccinated, either because they are too young or have a medical condition that doesn’t permit them to be vaccinated, depend upon herd immunity to protect them. When that herd immunity wanes, they are at risk:

But scientists and public health officials say clusters of unvaccinated people across the country are weakening the herd immunity made possible through vaccines and resurrecting preventable childhood diseases that can be deadly.

“Whenever the community risk goes up, everyone tends to get affected, including people who are vaccinated,” said Saad Omer, an Emory University scientist who researches unvaccinated clusters. “Even the best vaccines are not perfect.”

Clusters of unvaccinated people are, Omer said, like patches of dry grass that, with a single match, can start a wildfire that will burn not only dry material, but sometimes wet as well. The match could be a student who returns from a trip abroad with measles or a train commuter with whooping cough.

That’s actually not a bad metaphor. How many times have I seen anti-vaccine advocates asking pro-vaccine parents why they should be worried if their children are vaccinated? They’re protected, right? Well, yes, but not all of them. The measles vaccine in the MMR, for instance, is around 90% effective. That’s pretty darned good as medical interventions go, but that means that around 10% of children vaccinated against measles will fail to develop adequate immunity to prevent infection.

There appear to be two types of clusters of unvaccinated children. One kind is due to poverty and a highly mobile population, where children show up at achool unvaccinated or without records of having been vaccinated. These children don’t have good access to medical care, and as a result many never receive recommended vaccinations. Many also don’t speak English very well, if at all, and many have parents who can’t read.

The next category have no such socioeconomic problems. These are schools where there are large numbers of parents seeking religious exemptions:

Clusters of unvaccinated students with religious exemptions are more common in private schools, the Tribune found, and such exemptions are rising. For example, religious exemptions for the measles shot grew from about 3,400 in 2000 to about 9,500 last year.

The increase reflects growing unease among some parents — mostly affluent, according to some surveys — about the safety of vaccinations, even though vaccines rarely cause serious complications and the notion that they can cause autism has been scientifically discredited.

That’s what I love about Trine Tsouderos. She doesn’t mince words. It’s quite true that the myth that vaccines cause autism has been scientifically discredited again and again and again and again. Unfortunately, it doesn’t die. It’s like a zombie in a monster flick; just when you think it’s finally been killed for good, a hand reaches out of the dirt of the grave to grab the ankle of children and infect them with measles. It’s all due to what Dr. E. M. Fine appropriate calls a “brutal, ugly logic”:

Strong herd immunity can protect infants and other vulnerable members of society from dangerous diseases, but achieving it requires people to think alike, and they don’t.

“Individuals, if they look at the world selfishly, will say: ‘I don’t want a needle to be stuck into my kid, but I want everyone else to be vaccinated,'” said Dr. Paul E.M. Fine, a community immunity expert and professor of communicable disease epidemiology at the London School of Hygiene and Tropical Medicine. “There is a brutal, ugly logic there.”

Which basically describes anti-vaccine groups like the NVIC and Generation Rescue perfectly.

In the end, the Chicago Tribune has done its readers and the citizens of the State of Illinois a great service by producing this interactive map. The anti-vaccine movement demands “informed consent” and to be given more information. In this case, I agree, although I doubt this is the kind of information that they want us to have. However, if I were a parent, I would certainly want to know the vaccination rate at any school where I was going to send my child. This is exactly the sort of information that should be available for every city, every county, and every state.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

293 replies on “A vaccination tool every parent could use”

A nice rebuttal of the anti-vaxers’ favourite position. I have to admit, relying on herd immunity when you’re personally undermining it and encouraging others to do so requires a special kind of stupid.

Here in France, DPT is still mandatory, while MMR, HPV and HepB are merely “recommended” (but still subsidised by the health service). Tuberculosis isn’t even recommended any more for most children: needless to say, the disease is on the rise again, especially among the poor and immigrants.

I am seeing that 98% statistic quoted a lot. Generally followed by complete denial of the problem of the unvaxxed pockets.

Despite having been vaxxed as a child (because my parents remembered polio, measles, et al), I still got mumps and then German measles. So I was worried that I hadn’t become immune. For my upcoming Euro trip I had to pay $60 for a specialist visit to the travel clinic, and get MMR again. (I have been unable to detect any subsequent spectrum characteristics. Well, beyond what I already had.)

These people cost me time and money. And I have a nephew with leukemia that can’t afford to have anyone in the family bring this around.

The willfully ignorant enrage me.

Great information – thankfully it looks like the parents in my neighborhood have some sense.

That is a great tool and I wish we had something like that for my area. In talking to my son’s pediatrician, there is a noticeable amount of vaccine rejection in our area. It’s very frustrating, and considering my mom is undergoing chemotherapy at the moment, a little scary.

I loved that tool – I live in the area and spent a good hour perusing the pockets. The schools my kids go to have good rates, but even the absolute numbers are scary. There are 10 exempted kids in a school of 470. The rate sounds fine, but I find it mind boggling to even think about the fact that there are 10 among kids and families that I probably know who don’t get vaccinated. I also pinged one of the worse schools out in the far west suburbs (around Naperville). This was a place with something like 50% non-compliance and a $10,000 yearly tuition to boot.

Like clockwork. As soon as there is a video of a child who died of pertussis (Australian 5 week old boy) or a child who has permanent spastic quadriplegia as a result of contracting pertussis in early infancy, Thingy comes posting; cruel ignorant troll.

Trine Tsouderos is an extraordinary reporter who reports regularly on the impact of the anti-vax movement and the tearing down of our public health system.

VISs (Vaccine Information Sheets) for all Recommended Childhood Vaccines are available in 40 languages and should be provided to parents before the child receives any immunizations. Occasionally an immigrant parent is illiterate in their own native language. It takes time, but it is time well spent, to read the contents of a foreign language VIS to these parents. During my experience in public health, I found high compliance with immigrant groups. I believe that immigrant parents were grateful for an effective public health system because of their earlier experiences in foreign countries where the infant death rate from vaccine-preventable diseases was their reality.

In my state we, at one time, had very strict vaccination regulations for entry into day care and kindergarten. Unfortunately, those regulations have changed with the resulting outbreaks of vaccine-preventable diseases. Time to re-visit those regulations once again, as we have seen the results of philosophical and religious exemptions.

@1 anarchic teapot “relying on herd immunity when you’re personally undermining it and encouraging others to do so requires a special kind of stupid.”

Actually I think it’s not stupid, it’s “a special kind of ethics” especially after reading the ranting they do on the net. I used to think they were misinformed and scared. Now I think they are no better than drunk drivers, actually they’re worse. At least the driver is drunk.

I couldn’t believe that map the other day when I read it. I thought this only happened in California and Utah, and a few of those weird charter schools where kids set their own curriculum. I was shocked to see it going on here.

lilady:

Occasionally an immigrant parent is illiterate in their own native language.

One good example of this in my area is the large Hmong community. A new wave of immigrants recently came in, and it’s gotta be massive culture shock, coming from a squalid refugee camp in Laos or Thailand to St Paul/Minneapolis — in January, naturally, just to add to the fun. Fortunately, there’s a large community of them here already to help them settle in, but one challenge is that until recently, no one was literate in Hmong because it had no written form. A written form was developed, however, using the Roman alphabet, and you can see multilingual signs all over the local hospitals with English, Spanish, Hmong, Russian, and sometimes a few other languages. (Chinese, Arabic, etc.) But the new Hmong have to learn how to read their own language. Fortunately, most of the medical providers around here are sensitive to that now, and have translators on staff, but there’s only so far that can go. Explaining the value of immunization requires translating not just words but *concepts* which are unfamiliar.

That’s a pretty cool tool. I’d love to see it expanded to cover the entire nation.

It’s shameful that two elementary schools near the U. of Chicago fall short. Fortunately, the one run by the U of C (Lab School) meets the standard.

I know why Thingy doesn’t like the metaphor, it doesn’t include the notion that it doesn’t matter if you throw out a soggy cigaret butt in the swamp or play with a flame thrower in an Arizona forest, any flame is an assured forest fire.

Actually I think it’s not stupid, it’s “a special kind of ethics” especially after reading the ranting they do on the net. I used to think they were misinformed and scared. Now I think they are no better than drunk drivers, actually they’re worse. At least the driver is drunk.

I’m reminded of a line from, I think, The Great Gatsby, where one of the characters is lightly scolded for driving recklessly. Her response: “It takes two to have an accident.”

The problem with that logic: There is always, always an overabundance of other people thinking the same thing.

Am I the only one to see a connection to the fact that the substantial majority of people consider themselves to be above average drivers?

That “takes two to have an accident” doesn’t even work for accidents: one careless, drunk, or sleepy driver can drive straight into a tree. (Even a careful, sober, awake driver can have their tires fail, or a tree branch hit their car: but being careful, sober, and awake when you drive helps a lot.)

The really special “ethics” isn’t even the ones who are undermining herd immunity, which is just destructive: someone who actually thought that way would be encouraging everyone else to get immunized and immunize their kids, quietly claim a religious exemption for themselves, and not talk much about it, because if they talk about it people might follow their lead.

It’s either A) rank hypocrisy or B) “special ethics” combined with failure to realize that other people exist, are capable of thought and decision making, and might do the same neglect using the same rationale, producing a larger, emergent form of neglect (specifically, breaking down herd immunity).

Sadly, I suspect ~90% of the anti-vaxxers I’ve met fall into category B.

NJ has also seen a drop in vaccination rates ( Star Ledger, 8/22/10) making it 42nd in the nation. Like Chicago, NE NJ includes pockets of affluence, poverty, and immigration- often in the same town ( Cliffside Park- probably 15,000 people per square mile; while many workers from Central America reside here, so does a US Senator- and other affluent folk).

We also have anti-vaccine activists- LKH, Assembly Member Charlotte Vandervalk- and charter schools springing up like mushrooms. If you look at the CA data Liz has so graciously provided- you’ll catch a glimpse of one aspect of the charter school phenomenon- in Sebastopol in Sonoma- anti-vaxxers flock to these innovative, barely administered schools to escape the soul-killing machine of mass state-education. And they’re cheaper than Steiner. NJ’s governor is big on charter schools.

Which makes me despair: during the H1N1 crisis- which hit students hard ( including my relative, living at her U.: she was ill for weeks)- we experienced school closings in the metro area, especially NYC. I can imagine measles spreading in one of these towns or densely populated sections of the city. I hope that when vaccination rates finally turn around, the increase will not have been triggered by that proverbial “best teacher”- dire experience- for fools keep no other.

It’s generally accepted now that closing schools during the recent H1N1 “pandemic” (a label which the WHO essentially made meaningless in order to apply it to what turned out to be a milder than usual flu season) was a mistake. The kids didn’t stay home, they went to the mall, so this did nothing to control transmission. Most of the costs of the phony pandemic resulted from over-reaction — loss of restaurant business, tourism, closing of schools and businesses, etc.

That said, once the vaccine became available it was obviously a good idea for people to get it.

@ Calli Arcale: VIS(s) are now available in the Hmong language. My personal belief about the VIS(s) is that they might be more effective if women in the latter stages of pregnancy were provided a folder with all the VIS(s) beforehand. Even if they cannot read them, encourage them to sit down with a member of their closely-knit community who can interpret them for the parents. It might also help with English-speaking expectant parents as well…as a counterbalance to the garbage spread on the internet.

The VFC (Vaccines for Children) Program is operational in all areas of the United States. It provides (tax-dollar- paid-for) “free” vaccines to all children on Medicaid, children whose parents have no medical insurance or who have medical plans that don’t cover childhood immunizations. Neighborhood public health clinics and some private practitioners are VFC “providers” and the Program covers children from birth through their eighteenth year.

There should be a lot of linkage between local health departments and local immigrant groups (churches, social clubs, etc.) It really “works” to get reliable “leaders” on board, so that immigrants have access to vaccines and primary health care.

Note that even Uncle Bob Sears recommends that his followers not advertise their non-vaxxing activities and blend into the herd, knowing full well that they need others to step up to keep their risks small enough to justify not vaccinating.

@Liz–I used that data to do a spreadsheet for the Bay Area counties (am writing about it) I can send it to you, if you like. The rates of PBEs in private and charter schools are absolutely shameful

We are very lucky to have Trine Tsouderos. She is the rarest of science journalists.

Whenever Trine writes an article, Anne Daschel writes comments discouraging people from using the vaccine court to get compensation for vaccine injuries – I wonder how much the pharma companies pay her for that service…

“It is generally accepted now that closing schools during the recent H1N1 “pandemic” (a label which the WHO essentially made meaningless in order to apply it to what turned out to be a milder than usual flu season) was a mistake”. (Citations, please)

While you are looking up citations, you might also check the meaning of “pandemic”.

Also check out this article on the internet:

Researchers find lessons in first NYC H1N1 deaths (May 3, 2010)

See Cervantes that’s why decisions about pandemics are made by trained public health officials, instead of the dilittantes who are clueless about disease transmission.

@ Fellow: and Anne has her very own, brand new blog called AnneDachel ( see AoA)
Lord, so much nonsense , so little time! What’s a girl to do!

Lilady — I know VISes are available in Hmong, I was just raising the Hmong as an example of a group of immigrants who in many cases won’t be helped by native-language materials, because most of the newcomers are illiterate even in their own language. Most of them learn to read once they get over here, but it’s harder for the older ones. Hospitals and clinics are, as I said, largely aware of this and keep a Hmong interpreter on staff, but it’s a challenge because translating the words isn’t enough — the translator has to almost be a medical educator because the *concepts* are so novel. (It’s hard to get a decent education when you’ve lived most of your life either on the run or in a squalid rainforest refugee camp run by a government which resents your very existence.)

That’s not to say it isn’t worth trying. It’s always worth trying, and we’ve got enough Hmong here now that community support is really starting to gel, and they’re becoming integrated with the larger community. They do not generally shun vaccination, once they know what it’s for, and they tend to be eager to accept modern medicine.

Orac

“but I want everyone else to be vaccinated”

Which basically describes anti-vaccine groups like the NVIC and Generation Rescue perfectly.

So they’re “anti-vaccine” but they want everyone to get vaccinated. Makes sense.

For those unclear on the concept of herd immunity, there’s a similar example concerning Chicago in the 1800’s, before they had a building code. Most landowners, in an attempt to maximize area of their buildings, while constructing them out of wood, minimizing cost. This was beneficial to the individual, but added a small risk to the community, and therefore a small risk to oneself. However, the total risk from everyone doing so added up for everyone, and in 1871, the city got a swift and terrible lesson in the tragedy of the commons: http://library.thinkquest.org/CR0215480/fire.htm. Afterwards, a building code was established to prevent such things, coming at cost to each individual, as they had to build using more expensive fireproof materials, but reducing the risks to the community as a whole.

Gray Falcon:

I plan on borrowing that graceful analogy in the future whenever I’m engaged in a herd immunity discussion. In my experience one of the most difficult topics to reasonably discuss with anti-vaxers (as regularly demostrated by Sid) is what herd immunity is, and distinguishing it from the typical anti-government/authority emotions that are manipulated by anti-vax orginizations.

Others may disagree, but in my conversations it seems that the fear-mongering of the anti-vax organizations incubates well in the government-conspiracy-theory types of the far left, and the orwellian paranoids on the far right. That’s why I love analogies like this, since I think we can say that fear of death by burning is an ideal that crosses political lines.

Most of the costs of the phony pandemic resulted from over-reaction — loss of restaurant business, tourism, closing of schools and businesses, etc.

Not at my place of business, at least. Our absenteeism skyrocketed, and for weeks afterward productivity suffered as folks got over their symptoms. Admittedly I feel strongly about this because I was one of those hit pretty hard (worst. flu. evar.) ironically just days before the vaccine went public. Also admittedly we have a number of health care workers on site who also practice in hospitals, which would expose them to carriers more than typical of the population, so we were more vulnerable.

— Steve

Question from a Brit here – does the US not have a service like Language Line?
It’s basically a teleconferencing service available to medical services (hospitals, GP practices etc), the police, and social services. The patient/client indicates their language on a wallchart. It’s written in all of the various languages with the english name of the language alongside each one. The doctor/nurse/social worker then speed dials the LL service, tells the operator which language they require, and is then connected to the first available speaker of that language. The translators usually work from home.

It’s a brilliant service because it eliminates the need to have on-site translators, especially in areas where even a small hospital may serve up to 12 different native populations. It’s especially valuable in emergency situations, because nobody has to locate a translator who may be busy with somebody else in another part of the hospital.

I’ve dealt with some truly horrific cases, where young refugees who spoke certain Afghani dialects, or Xhosa, or whatever, were able to relate what had happened to them in order to receive care. Because they were dealing with other native speakers (rather than someone who’d learned it as a second language) they were at ease, and felt free to talk. The details that were given were precise enough that the refugees were able to receive the appropriate treatment. The alternative, of mimes or drawings, would not have been as helpful. It’s especially handy in cases where the patient/client does not have sufficient literacy, in their native language, to be able to read and evaluate written material.

@elburto: there are some services like that (AT&T used to have one, I know), but hospitals and clinics try to cut costs by using employees instead. I don’t know if many places around here have Language Lines anymore.

Awww…we got a visit from Silly Sid. Don’t we all feel special?

One has to suspect that special education programs have big clusters of unvaccinated or undervaccinated kids.

Imagine being required to place your child in a special day class, where you don’t know the vaccination status of the kids around yours.

Imagine that your child, in addition to autism has epilepsy. Imagine what it’s like to have your kid in the ER multiple times with status epilepticus, a constant state of seizure. Imagine that your child has seizures when sick.

To be blunt–if you haven’t gone through it, you can’t really imagine it. But you get some of the picture from the fact that as a parent, you stay up all night wondering if your kid will suffer brain injury or death while in status.

Groups like Generation Rescue and NVIC sew this fear. Hell, JB asked his readers to “take a bow” for reducing vaccination rates.

But they take ZERO responsibility for the harm they cause.

In the case of affluent, private schools, this seems like an opportunity to hit them in the pocketbook. If these schools got a reputation for being unsafe because of low vaccination rates, the sensible parents might start to shop around for safer environments. Then, the schools would have an incentive to bring up immunization rates. I, for one, would be horrified to send my kids to a school with 60% vaccination, even though they are fully vaccinated.

>That’s actually not a bad metaphor.

Speaking of metaphors, here’s one I’ve been meaning to post here (I did pass it along to Todd W. a while back):

During the London Blitz, “Blackouts” were instituted. Streetlights were turned off, windows were blocked, etc., all so that the German bombers would have less light to use to target the citizens of London. Note that if you didn’t follow the blackout rules in your own house, you saved yourself trouble and made yourself safer from the dangers of darkness-caused injury, but you increased the chance that your neighborhood would be hit (the bombers weren’t all that accurate) – and fires started by bombs would spread even to houses that had observed the blackout rules. Non-cooperators weren’t making a decision that only affected themselves – they were affecting everyone who lived near them.

In case it’s not clear, “blackout” regulations are analogous to vaccines, German bombs are analogous to infections, and fires are analogous to epidemics. As before, non-cooperators are risking not just their own children, but the children of their neighbors.

Orac says,”There appear to be two types of clusters of unvaccinated children.” He wishes there were two types of unvaccinated clusters. There is actually a third group, Orac, and it grows all the time (probably in pretty direct relation to the growing schedule, which likes to add new, life-threatening illnesses by the day). The third group is actually comprised of people who gave given their child a vaccine only to have had a bad reaction (yes, some even confirmed by the medical establishment. My grandmother did develop G-B after her flu shot and you can categorize me as “affluent” or “religious exemption” all you and Trine want but i haven’t given my kids all the recommended shots due to immune concerns. Oh yeah, and i’m not complaining about others who do the same. People like you and Trine willfully ignore the truth and ignore the existence of this growing third category. “If I were a parent…” you have no idea how you would behave if you were a parent. In fact you might be just as wary of the whole vaccine issue if you had the responsibility for a precious bundle.

Then, the schools would have an incentive to bring up immunization rates.

Unfortunately, the Waldorf schools (one being the worst example in the Tribune article) are ideologically committed to a policy of indifference.

Sid, are you high? How can you possibly be unaware that people can be injured by not being able to see where they’re going! And Jen, you don’t have evidence that vaccines caused problems, you have suspicions. Learn the difference.

Have you got evidence to cite for that third cluster, or just anecdotes? Because the worried well seeking religious exemptions based on unsubstantiated fear and internet conspiracy theories sounds like a description of the affluent second cluster and your supposed third cluster. I believe they are the same.

Sid – I would have thought it was too obvious to require explanation, but since it doesn’t seem to be, I’ll use smaller words: If it’s too dark to see obstacles, a person call fall. Falling can cause injuries. Those injuries would have been caused by the darkness. Simple enough?

Sid – hundreds of individuals were run over by vehicles during the blackouts during the war.

elburto — yes, there are Language Line type services available in the US as well. However, hospitals don’t always use them and NOT because of cost-cutting. It’s because it isn’t just a question of translating the words. The *concepts* need to be translated as well, and more and more hospitals and clinics are starting to understand that they need translators who have some medical training.

Now, I live in a large metropolitan area with several strong immigrant communities and relatively well-organized medical care. A rural hospital would not have this sort of luxury.

Orac, I thought you were the “vaccination tool.”

Now, if Augustine is anything but a mouthy hypocrite, he’ll rush here to chastise Sid for poisoning the well against Orac with this “ad hominem” argument. Integrity would dictate that he stand against Sid’s comment, which had no possible purpose except to slur Orac’s standing.

Anyone want to bet on him actually doing it?

@ triskelethecat: “We got a visit from Silly Sid. Don’t we all feel special? Not especially, unless I’m up for kicking around his posting…Hmm…Yes I am up for it.

@ Offal: Regarding your dumb article “No Vacation against vaccination” that you posted today on your rarely visited blog…it is replete with errors.

Offal takes on the California Department of Health and the California State Assembly that enacted new regulations requiring booster Tdap immunization for students entering grades 7-12 during the 2011-12 school year.

Quoting some “gems” directly from Offal’s blog:

“Additionally, you have many in the 7th through 12th grades who have contracted pertussis and are therefore immune.”

“Natural immunity has been shown to last at least 30 years”

(Offal as usual, provides no citations for these factoids)

Come back Offal, when you provide citations as none of us are inclined to provide you with same. And, please no smart ass comments about the youngster who is physically impaired for life, due to pertussis disease.

Jen,

Orac said there were two types of clusters, not two groups. A cluster is not the same thing as a group. A cluster is instead an abnormally high concentration. Unlike with socio-economic or religious/philosophical exemptions, medical exemptions would not be expected to cluster, unless there was a difference in the criteria for medical exemption (or some medical reason, such as access to medical care).

@lilady

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763266/?tool=pubmed

Our results support a period of natural immunity that is, on average, long-lasting (at least 30 years) but inherently variable.

And you’re saying no previously-vaccinated children in the 7-12 grades ever contracted pertussis? This report would dispute that

http://www.watchdoginstitute.org/2010/12/13/whooping-cough-epidemic-california/
Keys findings included:
For pertussis cases in which vaccination histories are known, between 44 and 83 percent were of people who had been immunized, according to data from nine California counties with high infection rates. In San Diego County, more than two thirds of the people in this group were up to date on their immunizations.

So…

The third group [is] comprised of people who gave given their child a vaccine only to have had a bad reaction

and furthermore

[the] third group … grows all the time

Hmmmm, I’m gonna hafta respond to that with the good ol’ [citation needed].

@lilady

Links got caught in the spam filter. You’ll just have to google for them

“Our results support a period of natural immunity that is, on average, long-lasting (at least 30 years) but inherently variable.”

And you’re saying no previously-vaccinated children in the 7-12 grades ever contracted pertussis? This report would dispute that

watchdoginstitute.org

Keys findings included:
For pertussis cases in which vaccination histories are known, between 44 and 83 percent were of people who had been immunized, according to data from nine California counties with high infection rates. In San Diego County, more than two thirds

Oh look! Sid can’t read:

For the current studies, epidemiologists examined the vaccine’s effectiveness in three age groups: 4-5 year olds, 6-7 year olds and 8-10 year olds. They found that while the vaccine was 95 percent effective for the first group, effectiveness dropped to 84 percent for the second group and then to 81 percent for the last group.

Are you a liar, Sid?

Source

Maybe you should learn how to cite. Do you need a special teacher?

Post caught in spam filter as well, but I basically show that Sid is lying about the numbers. What a surprise.

Do you know what the higher infection rate amongst those that are immunized (drops as low as 81%)? A possible mutation that will require another vaccination for students in a year or so. Will you be lining up to get an update? I will be, along with my family and friends.

Even if Sid’s numbers were accurate, how safe would he feel in a city where only two-thirds of the buildings were built to the fire code?

@ Stupid:

The non-morons among us can notice that with vaccination rates above 44-83%, that shows quite nicely that the vaccine WORKS. Since the vaccinated were less likely to get it than the unvaccinated.

The non-liars among us will also note that lilady didn’t say or imply anything even vaguely related to what you decided to make up and put in her mouth.

Gray Falcon:

Even if Sid’s numbers were accurate, how safe would he feel in a city where only two-thirds of the buildings were built to the fire code?

He’ll reply that he does not live in Haiti/Albania/China/etc. Which is his standard weasel reply.

Sorry, I misread Sid’s commentary, it was on the number of people infected, not the total population. Which means he’s failed Probability 101 again. Then again, he’ll probably always be known as the guy who didn’t know that darkness could be dangerous.

Which isn’t quite as moronic as being the guy who thinks that all toddlers instinctively know that it’s better to walk on the sidewalk than in the grass.

Here is another article that reviews the resurgence:

Factors contributing to pertussis resurgence
DOI 10.2217/17460913.3.3.329

The CDC schedule is a TDaP booster every 10 years.

Keys findings included:
For pertussis cases in which vaccination histories are known, between 44 and 83 percent were of people who had been immunized, according to data from nine California counties with high infection rates. In San Diego County, more than two thirds

And why would that be a key finding? Or, more precisely, why would it be a key finding for the side you want it to be? Because immunization rates are so high in the general population, of course they’re also going to be high in the sub-population of those who contract pertussis, despite the protective effect of immunizations. If someone checked the handedness of those who contracted pertussis, I’m sure they’d find that right-handed people outnumbered left-handed people by a large margin, but that would hardly be a significant finding, let alone a “key” finding.

This has been discussed here many, many times before. Are you saying that you did not understand it any of those times it was discussed before? Or did you understand it but think it best to phrase things as if you didn’t understand them?

Antaeus, nothing your saying contradicts my position that many 7th to 12 graders have had pertussis and are therefore immune. As to your obsession with “key finding,” that’s from the report not me.

Mr. Offit, he doesn’t have to contradict your claim, you have to prove yours. It’s called burden of proof.

@ Offal: What site did you use (that got caught in a “spam filter”?) How about a PubMed citation?

I keyed in your sentence, “Our studies support a period of natural immunity….” into PubMed and found some very old citations of studies done in foreign countries.

“Interesting” that you refer us to Watchdoginstitute.org which an “investigative” (muckraking) site run by a California school of journalism…hardly experts in public health…with an agenda against “Big Pharma/Government Control” and the lack of impetus for “Big Pharma” to develop more effective pertussis vaccine.

Offal, being that your latest screed is directed at the California Department of Public Health and the California State Assembly for enacting new requirements for booster pertussis vaccine, why not go to the source…after all the CDPH has been dealing with the largest outbreak of pertussis and pertussis deaths in the last 57 years. Professionals at the CDPH are not journalism students, they are the experts in immunology, epidemiology and outbreak control.

Why not key in:

PertussiswebinarQandA

The site is a Q and A Session for addressing the pertussis epidemic and “Clinician’s role in preventing pertussis” (Thursday, September 2, 2010, Updated March 2, 2011)

Now scroll down…

Q. After my patients have had pertussis, how long are they immune? Do they need a Tdap booster if they have had pertussis?

A. Pertussis disease just like immunization provides temporary immunity against catching pertussis in the future. The temporary immunity from disease appears to last at least 4 years, but probably varies a great deal between individuals. (Recommendations are to boost with Tdap in early adolescence)

Offal, you do know the differences in efficacy between immunizations against bacterial diseases versus efficacy of vaccines against viral diseases, don’t you? I learned the difference in Junior High or High School General Science course…years before I ever enrolled in an Immunology 101 course.

Scott, the third cluster could pretty easily be deduced by looking up the VAERS data and also knowing that only 10% of all vaccine reactions even make it to that. grey Falcon: then I guess our family doc had suspicions too, since he advised all of us not to get flu shots.
Again, I think Both Orac and Trine are being willfully ignorant and inflammatory.

@lilady

Sweetie, I’m sorry if you don’t know how to use the interwebs, but that’s not my problem. You do know what Google is right?And I’ll take a real study (and decades of medical opinion that pertussis immunity is close to lifelong) over some random webinar chatter.

Antaeus, nothing your saying contradicts my position that many 7th to 12 graders have had pertussis and are therefore immune.

That’s very true. It’s also true that nothing I’m saying contradicts your position on the designated-hitter rule in baseball. And, of course, nothing I’m saying contradicts your position on who truly deserved to win last season’s American Idol.

But, if we could actually stick to the subject — you know, like honest people do — you were the one who brought up the fact that a majority of those who have had pertussis were immunized against it, calling it a “key finding,” and if you try to pretend that you were not trying to imply that the high percentage of immunized people among those who contracted pertussis reflected poorly on the protective effect of the immunization, I’m just going to have to call you a liar and a poor one at that.

@ # 43 Jen “In fact you might be just as wary of the whole vaccine issue if you had the responsibility for a precious bundle.” Jen has hit a new low here after viewing Autism Parent’s posting # 40 above.

Autism parent has a “precious bundle” who has seizures with the onset of febrile illnesses. The child has also had prolonged (status epilepticus) repetitive seizures. Status epilepticus is a life threatening event that can leave a “precious bundle” in a state of hypoxemia and pulmonary respiratory failure requiring resuscitation. Postictally, further neurological impairments are common.

I also had a “precious bundle” whose tenuous grand mal seizure control was compromised by fevers and childhood illnesses and lead into many episodes of status epilepticus…and he lost ground following every episode and had to be resuscitated. Postictally, he suffered through several episodes of Todd’s paralysis, as well.

How insensitive and jaded you’ve become Jen…based on some anecdotal family lore that your grandmother was diagnosed with G-B syndrome, following an influenza immunization. Stop being a troll, get some real education in the sciences and knock off the nasty, crass commentary.

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