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Suspicion of vaccines among those who should know better

I realize I repeat this a lot, but it bears repeating a lot. Vaccines are, without a doubt, one of the greatest advances in health care devised by the human mind. Arguably, vaccination campaigns have saved more lives and prevented more suffering and death than pretty much any other medical preventative intervention ever invented. I realize that I tick off antivaccinationists when I say that, but I don’t care. Actually, I do care. I kind of like ticking off antivaccinationists using science. You didn’t think I’ve been blogging for seven years purely out of a sense of duty to humanity, science, medicine, and ethics, did you? Maybe 90% duty, but I have to have a little fun as well.

Because vaccines have been so successful, for the most part health care professionals tend to view them in much the same way as most people view clean water and pure food; i.e., as unabashedly good and healthy things. And, except in rare instances, they are. Unfortunately, as we in medicine have demontrated since the time of Semmelweiss, we aren’t always the best at doing what’s best for our patients, such as washing our hands before seeing patients, but that’s not so much out of opposition to handwashing or a belief that handwashing doesn’t do any good. Rather, it’s usually more due to pure laziness or carelessness. Unfortunately, all too often, the same cannot be said of health care professionals when it comes to basic vaccinations that protect both us and our patients, in particular the influenza vaccine. A friend of mine, Mark Crislip has a word for such health care workers (and, make no mistake, this group includes doctors, nurses, and many others): Dumb ass. (Or, for those of you who don’t have access to Medscape: Dumb ass.)

Yes, I realize that it’s considered exceedingly gauche these days to be so judgmental, so much so that even Orac can’t help but cringe just a little bit at Mark’s judgment. At the same time, I know he’s right. Also remember: Mark is not calling patients who refuse recommended vaccinations for themselves or their children dumbasses. He’s calling health care professionals who refuse recommended vaccinations by that moniker. The reason should be obvious. First, health care professionals should know better. They really should. They have no excuse not to know better. Yet there is a cadre of doctors, nurses, and others who resist doing the right thing. Second, health care professionals have a duty to their patients to protect them from harm whenever possible, and, like handwashing between patients, certain vaccinations in certain specialties are part and parcel of protecting patients. This is particularly true where I work: A cancer center. There are a lot of immunosuppressed chemotherapy patients around who could easily die if they caught influenza.

Mark’s admonitions were in my mind as I came across this post on Gaia Health (a website run by a homeopath) entitled Nurses Don’t Trust Vaccines, So Study Researchers Show Them No Respect. The title, as is common with antivaccinationists, is overwrought. In fact, when I read the study by Baron-Epel et al entitled What lies behind the low rates of vaccinations among nurses who treat infants?, I didn’t think the authors were disrespectful at all. (In fact, all they noted was that many of the nurses who took part in facilitated focus groups as part of the study expressed antivaccine views, and that is undeniable. The quotes are there, as you’ll see.) In the meantime, homeopath Heidi Stevenson is very irate at this study:

The researchers had no interest in considering whether the role played by nurses as the primary contacts with patients might give them a valuable perspective on the issue. Instead, their only interest was in figuring out how to counter the nurses’ views. In other words, the presumption was that nurses are less intelligent and less capable of making rational decisions than they are.

Heidi says that as though it were a bad thing!

I keed, I keed, of course, but only a little. The implication was not that nurses are less intelligent; the implication of the study was that health care professionals can fall prey to misconceptions about vaccines that clearly derive from the antivaccine movement. That, too, is undeniable. (Look at Dr. Bob Sears if you don’t believe me. Of course, Dr. Bob strikes me as not the sharpest knife in the drawer; so maybe he’s a bad example.) In any case, the impetus for this study was a pertussis outbreak in an Israeli hospital in 2010:

In the summer of 2010 pertussis was diagnosed among 20 nurses and physicians in obstetric and neonatal departments in a large hospital in Haifa, Israel. The Ministry of Health (MOH) recommended immunizing the HCWs in these departments, and in two nearby hospitals. In addition, nurses working with infants in the Mother and Child Healthcare Centers (MCHCs) in this district were also asked to immunize themselves. After three months only two percent of the MCHC nurses did so.

The aim of this study was to identify the barriers and reasons why these nurses did not vaccinate themselves against pertussis despite the fact that the pertussis vaccine is the vaccine these nurses administer to infants every day. These barriers may not be specific towards the pertussis vaccine and may help understand non-compliance towards other vaccines.

A pertussis outbreak among 20 nurses and physicians? In obstetric and neonatal departments? This is a no-brainer! Health care professionals taking care of infants in that hospital needed to be vaccinated to protect themselves and their patients. Not to do so would be an epic failure at both goals. Yet, epic fail is what there was at those hospitals. only two percent of the nurses did.

To try to understand the reasons for noncompliance, focus groups were interviewed, and a qualitative analysis carried out on the nurses’ responses. This qualitative analysis revealed several key themes used by the nurses as their justification for not wanting to receive the Tdap vaccine, even though they administer pertussis vaccine to infants. Here are the main themes, with brief explanations, random Orac snark, and, for some of them, sample quotes from the nurses:

  • Lack of trust in the health authorities. Much of this was related to the H1N1 pandemic the year before, which, because the pandemic wasn’t as serious as had been feared, led to the nurses thinking that health authorities overreacted.
  • Treatment of nurses by the employer. Nurses were unhappy at what they perceived as being badgered to be vaccinated. Sample quote: “They should treat us like human beings.” “…we were threatened, we got multiple emails asking who got vaccinated and if not why not…”
  • The right for autonomy. This is the typical resistance we see to being told what to do. It’s the same sort of attitude that underlies resistance to the individual mandate in the Patient Protection and Affordable Care Act. Some of the reactions were quite clear in this respect: “One nurse in the hospital got pertussis, and infected someone- or not- don’t know. So then ‘wham’ all the nurses have to get immunized, so no one got immunized and they are right!…what are we?- in Soviet Russia?…on principle I am not getting vaccinated this year.” Because, I suppose, requiring this nurse to do the responsible thing for herself and her patients is just like the authoritarian regime that was the Soviet Union, and being stubborn is the same thing as being principled. In this, these nurses sound like physician members of the AAPS, who seem to think that physicians should be allowed to do anything they please, damn science and science-based guidelines. “Health freedom” infects nursing.
  • Mistrust of health information. Sample quote: “…you can’t brain wash us, they expect us to forget what they said three months ago or a year ago and start again, part of what we did was not so good, now we do something else. …you can do that at work but not in my private life, I can’t…”
  • The split between professional role and personal life. This one is rather disappointing. Nurses are professionals, just like physicians. There are responsibilities that come with being a professional and that also intrude into one’s personal life. That’s part of what it is to be a professional.
  • Fear of side effects. The authors observe, “The nurses reported on their experiences of side effects of vaccines. They felt that the risk of contracting the diseases and the severity were not worth the risk of being injected with a vaccine that was not in use long enough to know what the side effects were. This was directed towards both influenza and pertussis vaccines, and they felt the authorities were using them as guinea pigs.” Never mind that the pertussis vaccine has an excellent safety record.
  • Risk perception. Many of the nurses didn’t think they were at risk for pertussis, even though there had just been an outbreak. Sample quote: “I think that at my age I should be immune to pertussis, I am sure I was exposed during my life, I am not ten years old, and not twenty, and also, how many nurses had pertussis and infected others?”

Perhaps the most disturbing aspect of this entire study was this:

Interestingly enough, the fact that they themselves can infect the infants that they come in contact with came up only once in all the discussions, and was not discussed in depth. This issue seems not to bother them and they do not see the ethical problems related to the possibility of their being infectors. There is a need to increase the nurses’ awareness of the unethical aspect of not being immunized and increase the perception of themselves as transmitters of diseases.

Sadly, I’ve seen such attitudes among physicians as well. Part of it, I think, is a sense of entitlement in which health care professionals convince themselves that they are, in essence, invulnerable and would never endanger their patients. The bottom line from this study, unfortunately, is this:

The nurses expressed antivaccinationist ideas and these may be preventing them from being immunized as recommended. Emotions and attitudes such as fear of the vaccines, mistrust in the health authorities, a demand for autonomy, low risk perception, perceiving themselves as private persons and not only nurses, in addition to not perceiving themselves role models, lower the compliance with vaccine guidelines for HCWs. These attitudes and emotions may influence their actions toward other vaccines in the future. Stemming from this study an ethical problem is raised: to what extent should the health authorities give autonomy regarding vaccination to HCWs working with vulnerable populations? Additional research and interventions to increase trust between nurses and the authorities and knowledge regarding vaccines is needed.

I’ll say. And, if Dr. Jay Gordon and Dr. Bob Sears are any indication, physicians shouldn’t be too smug. We’re just as prone to antivaccinationist nonsense as these nurses apparently were.

Yes, this was a small study. Yes, it was not in any way comprehensive. However, it does raise some disturbing issues. If nurses in a pediatric unit, whose jobs it is to administer vaccines, can be so easily swayed by antivaccine views to the point that, even after an outbreak of pertussis they refuse to be vaccinated, how, then, do we combat antivaccine views. Science isn’t enough; these nurses had access to the science and rejected it because of mistrust of health authorities and an unprofessional lack of concern over whether they themselves could be vectors to infect the infants they take are of. These are exactly the nurses who should most readily understand the importance of vaccination, just as pediatricians like Dr. Bob Sears and Dr. Jay Gordon are exactly the medical specialty that should understand that the vast preponderance of existing scientific and clinical evidence does not support the belief that vaccines cause autism. Yet, there they are, promoting (in the case of Dr. Gordon) or insinuating (in the case of Dr. Sears) that vaccines do cause autism. Indeed, that brings me to one part of this study where our homeopath might have a little point: Why weren’t physicians studied or interviewed?

Be that as it may, clearly, we have a problem in our own professions. As Mark Crislip would put it, we in the health care profession have far too many dumb asses in among our ranks.

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]

120 replies on “Suspicion of vaccines among those who should know better”

The “communist” and “health fascism” memes are rather common these days. Australia’s most prominent antivaxxer was interviewed on a certain radio station late last year. Eventually the interviewer said:

“What are these people, like governments, doctors, the skeptics, what are these people when it’s controlling, and the haters that are out there. What’s the difference, probably even much better off under a communist system.”

Meryl Dorey: “That’s right. There isn’t any difference. And [vaccine supporters are] a hate group. They definitely are. They act like a hate group, they’re abusive, they’re bullies. So, yeah, I agree with you 100% with what you’re saying and it’s anti-democratic. You know, in a democracy we do have this right to choose, we do have the right to speak, so anyone who says we’re not is not democratic, and I think we all want to live in a democracy.”

When the autonomy to sabotage oneself and ones community apparently represents unassailable democratic rights, and evidence is the weapon of “hate groups” we have a problem Houston.

There seems to be a common double-standard in the risk assessment. For the intervention only the risks are considered, while for doing nothing only the benefits are considered:

“If I get vaccinated, theres a 1/10000 chance I’ll have side-effects. If I do nothing, there’s a 3/4 chance I’ll stay healthy anyway. Conclusion…?”

What many people (and that includes parents of small children, and apparently nurses and doctors as well) fail to see is that when contemplating vaccination they stand in front of two gates, both with risks and benefits: Both gates have consequences for your health and you are responsible in both cases. The evidence pretty conclusively shows that one of the gates offers significantly better overall outcomes, and it happens to be the one with the vaccines.

Unfortunately, people are irrational and biased when it comes to weighing off a small immediate risk and a big benefit versus an unknown risk and no benefit. Our conservative minds compel us to just rather not do it.

In short: “Doing nothing” is just as much a medical decision, an intervention, as going through with vaccination is. Not choosing is also a choice.

AAAAAH!

A pertussis outbreak in HCPs in OB and neonatal units?
:headdesk::headdesk::headdesk:

Then the nurses REFUSED to vaccinate themselves?

I know in the pediatric hospital I worked in the result would be nurses looking for employment elsewhere.

Oh, poor babies were getting “badgered” and “threatened” by getting emails reminding them to get their vaccines. Of course reminders were needed.

And they should know, “autonomy” is about the ability to make decisions, NOT by the decisions you make.

Nurses were unhappy at what they perceived as being badgered to be vaccinated. Sample quote: “They should treat us like human beings.” “…we were threatened, we got multiple emails asking who got vaccinated and if not why not…”

What makes these nurses think they are so special? Do we not have expectations of professionals performing their duties and punitive action if they do not? I think there is a considerable amount of arrogant ignorance on the part of anti-vaccine nurses. My opinion is established from not just this survey but my online experiences. They have fallen into the trap of “being educated” makes them believe that they are equipped to make such decisions autonomously.

Perhaps we should remove the word “Professional” from their title “Health Care Professional” and replace it with something more appropriate?

Come to think of it, why not replace the “Health Care” bit as well, since it clearly does not apply.

Perhaps the initials “DA” after their names would be eminently more suitable?

MCHC nurses are a mixed bunch. Most of ones I took my children to were science-based -namely, they weren’t scared of their job of giving vaccines and they didn’t attempt to sabotage breastfeeding. But the nurses at one of the MCHCs my patients go to…let’s just say I have to restrain myself from going over and strangling them almost on a weekly basis. Not anti-vax as much as vax-wary. Baby arrives at her long-overdue appointment with a bit of a runny nose? Nurses send her to me to “examine her to see if she can get her vaxes today”. Hellooooo ladies, you have GUIDELINES from the Israeli Health Ministry when vaxes are contraindicated. I know for a fact a sniffle with no fever isn’t one of them. And sending the baby to wait in a germy doctor’s waiting room full of really sick kids? Yeah, great idea. :/ .

Also? I would give my eyeteeth for a Tdap booster. AFAIK they only give it to the second-graders under the auspices of the MCHCs. I envy those nurses who were (I assume) offered it.

Anj, the MCHCs (Tipot Halav,as we call them) are community clinics run mainly by nurses that are responsible for most of the well-baby care up until age 3, and in some cases deal with prenatal care as well. A Tipat Halav nurse is a job coveted by many young nurses with families because of the easy work and convenient hours. I agree, give it to other nurses.

Correction: the nurses refusing the vaccine were in the Mothers And Children Centers.

Which makes it only marginally less shocking.

(Personally, I couldn’t believe that the HCWs in the OB and Neonate units weren’t mandated to be current on their vaccines. For anyone who notes there were “only 20” cases, that’s “confirmed cases”.)

Is there a financial liability present for a hospital if its nursing staff in baby ward refuses to be vaccinated and then passes along pertussis to any of the patients?

“I think that at my age I should be immune to pertussis, I am sure I was exposed during my life, I am not ten years old, and not twenty, and also, how many nurses had pertussis and infected others?”

Apparently this nurse isn’t aware that immunity from pertussis infection can wane in as little as 4 years. Wow. How irresponsible can these nurses (and physicians like them) be?

If it were up to me, and this is just me (so don’t go interpreting it as the opinion of any of my now 5 employers), if you refuse to vaccinate for any reason other than a medical or physiological impairment, you don’t get a license to practice medicine, nursing, etc. Period.

I have no tolerance for people wanting to play games with something so important. Don’t want to vaccinate? Go flip burgers. You should know better.

At one of the hospitals I work at, if you don’t get the Tdap and can’t show evidence that you’re up to date on your Tdap, you can’t get admitting privileges, the same as if you don’t get your yearly TB test, in which case they suspend your admitting privileges until you do get your TB test.

I have no problem with this policy.

My 19 year old son and I were at the county hospital clinic. He was very sick, running a fever, sore throat, swollen glands. The intake nurse was taking his vitals. I mentioned that we had both had our flu shots. She volunteered that she didn’t believe in flu shots. She told some anecdote about her daughters getting flu and how she took care of them and never caught it herself.

When I got home I emailed the public health department and got the response that, no, health care workers are not required by law to be vaccinated in Iowa. How can that be? The ignorant woman I talked to at the clinic was around the sickest of the sick all day, every working day. She could be a marvelous vector for flu, pertussis, measles, anything. Vaccinations for health care workers should be mandatory unless they can’t have them for valid medical reasons.

As Mark Crislip would put it, we in the health care profession have far too many dumb asses in among our ranks.

It always starts from the top. How stupid can you be?

[…]the same as if you don’t get your yearly TB test, […]

And what exactly do you mean by a “yearly TB test” for someone (i.e. an employee, staff) who have previously had a positive PPD? Listen the disingenuous Orac is trying say something.

Sounds like a marketing opportnuity: Do you trust your medical center to keep your children safe? At hospital X, all of our care providers are fully vaccinated to make sure we don’t pass along the diseases we are supposed to be preventing.

Orac @13

While I agree with your general sentiments, I’m not sure that annual TB tests are supported by a solid evidence base. The tests for TB are far from perfect, and unless you belong to a high risk group, the chance of contracting TB is small.

Perhaps an infectious disease specialist could correct me if I’m wrong.

@Dr. Bollocks

Too many factors to discuss this without making a comment into a blog post. Basically, if you serve a high-risk population, or belong to that population yourself, then annual skin test with follow-up chest x-ray or gamma-interferon are recommended and bring the “far from perfect” closer to “perfect”, within reason.

Remember that screening tests have better positive predictive values when the population being tested has a higher prevalence of what you’re looking for. So you weed-out the low-risk folks and include the high-risk folks.

Healthcare providers almost automatically go into the “high-risk” category because their jobs will have them interact with people who may have TB at a higher rate than people in the general community or other professions. This even includes lab techs (like me) who handle infectious material.

I mentioned that we had both had our flu shots. She volunteered that she didn’t believe in flu shots.

Yah, I had a similar experience the year before last. In this case it was after an appointment and the nurse came in and asked whether I was going to want a flu shot. To “not right now,” she responded with a portentous-sounding “I don’t blame you.”

I didn’t bother explaining that it was because it was 4:30 p.m., phlebotomy–which I had to visit–appeared to be packed to the gills, and my previous experiences with extracting a vaccine from the clinic seemed to invariably involve sitting around in an unattended hallway for half an hour.

Something about vaccines calls up a primitive emotional response- as if they suddenly transport moderns back into the era of tabu actions and numinous presences- all told, this is not a good thing. Why should nurses and doctors be immune?

Nearly every day I come across essays at various fonts of woo that riff upon this theme: vaccines are interference with Nature and therefore have dire consequences. These people can certainly churn out DumbA$sery on a grand scale.

-btw- @ AoA, a fellow describes ‘Autism Barbie’, her army of therapist-dolls and vaccine advocate dolls ( pharma shills et al) including Orac’s “friend” *et Cie*. Unfortunately, no photos.

The tests for TB are far from perfect, and unless you belong to a high risk group, the chance of contracting TB is small.

The Mantoux Test is a highly specific and sensitive test, Monovacc, less so. The chance of contracting TB may be small but hospitals have vulnerable patient populations which need to be protected and staff who come into contact with people who may be positive for TB. Also, with multiple and complete drug-resistant strains emerging and mobility of people from all over the world, TB is a very important pathogen to monitor.

Regarding personal liberties and Vaccinations: You have a right to choose what goes in your bodies–unless you drop a urine positive for THC or meth or cocaine, or show up for work drunk, in which case you can be fired or required to undergo diversion. Even the most intimate personal liberties can be infringed upon–you have a right to sleep with anyone you want–How could your employer mandate who you can sleep with?–unless it’s a patient, or in some cases, a co-worker, in which case you can and will be fired. So employers can and do and should place limits on personal liberties as a condition of employment, and requiring nurses who take care of vulnerable infants to get a pertussis is a definite, but needed, infringement on their personal liberties.

I realize that I tick off antivaccinationists when I say that, but I don’t care.

When I read that, a certain quote came into my mind.
“A gentleman is one who never unintentionally hurts another’s feelings”
Sometimes feelings should be hurt.

So, yeah, this is totally stupid. So what’s the solution. Or rather, what are the solutions. I think it should go without saying that no vax = no job. But what else? My husband is a PT and has to have titers drawn periodically to see if he needs boosters. Is this not standard practice? It seems that might mean something to Miss “I think that at my age I should be immune to pertussis.” Approach of the centers? Treat them like children. Have a vaccine fair! I’m just rattling things off here. These are completely irrational people, so things that would work for you and me aren’t going to work for them. Time to get creative!

I would caution you all to not bash all nurses. That being said, I cannot fathom how any nurse…or doctor, would refuse to be vaccinated to protect the vulnerable people they care for.

In 2009, the NYS Health Commissioner issued a directive that all health care workers be vaccinated against the H1N1 influenza virus. Some HCWs protested, a judge issued a temporary order against the mandate and the order was rescinded by the then Governor…due to a shortage in vaccine stock. I had recently retired as a public health nurse, so I sought the vaccine from my private doctor. I only received the seasonal flu vaccine in October, 2009 and was notified in January that the separate H1N1 vaccine was available and I received that vaccine.

When I worked as a public health nurse, I was provided with the seasonal flu vaccine by my employer…in fact my department set up the flu vaccine immunization program for staff. We devoted 2-3 afternoons in a conference room for staff in the Health Department and distributed a supply of vaccine for staff in our satellite clinics. Our immunization rate with seasonal flu vaccines amongst doctors and nurses approached 100 %, each year.

I was required to have a chest x-ray prior to employment and to have blood tests for all vaccine-preventable diseases to prove immunity. When the varicella vaccine was licensed in 1995, I was tested for immunity as well and would have received it, if my titer didn’t prove that I was immune. When I worked as a tuberculosis case manager and saw patients in the clinic with active TB infection, I was Mantoux tested every 6 months.

If you want to have the respect of the community at large…and respect for yourself…as a health care professional…then you do not refuse any immunization, based on some silly ignorant stance of “autonomy”.

@ lilady:

Believe it or not, woo-meisters took credit for the order against the mandate, saying that those in power *really* were responding to the *vox populi* or suchlike: the ‘shortage’ was manufactured.

IIRC, Null, anti-vaxxers and a few nurses held a protest at the capitol building ( filmed and archived for posterity). *Le grand idiot* often cites that as an example of how alt med is gradually influencing policy. Just like the removal of Thimerisol. (Hah!)

About nurses and others: anyone is subject to woo. You can find psychologists who think that SSRIs cause depression. Education does not provide immunity to BS 100% of the time. If only.

“So then ‘wham’ all the nurses have to get immunized, so no one got immunized and they are right!…what are we?- in Soviet Russia?…on principle I am not getting vaccinated this year.”

“On principle,” maybe this nurse should consider a career outside the healthcare field. His/her “right” to be a self-righteous dumbass is not more important than a newborn’s right to have a decent shot at continuing to live.

When you read this section of Orac’s post, after your blood pressure returned to normal, did anyone feel tempted to make a Yakov Smirnoff joke?

@Ren, #12:

“I have no tolerance for people wanting to play games with something so important. Don’t want to vaccinate? Go flip burgers. You should know better.”

I wouldn’t recommend they enter the food service industry, either. I don’t want any whooping cough on my 14-month-old’s chicken nuggets anymore than I want it in his pediatrician’s office.

@ Denice Walter: The organizer for that protest in Albany was Kevin McCashion…a local *political organizer* from Troy New York. He fancies himself as a political pundit representing the far-to-the-right political movements that includes *health freedom* and *small gubmint* constituencies. He is *eminently qualified* to speak about immunology and public health…Not.

For your viewing pleasure, here is a website with some of the videos about the H1N1 vaccine program:

http://www.veengle.com/s/flu%20shot%20mandate.html

A pediatric nurse who refuses vaccination against a disease that is deadliest to infants on *principle* is a nurse who puts her pride ahead of her patients. And a nurse who thinks proving a point about autonomy is more important than the welfare of his or her most vulnerable patients during a pertussis outbreak is not someone who should be in healthcare.

And a nurse who thinks proving a point about autonomy is more important than the welfare of his or her most vulnerable patients during a pertussis outbreak is not someone who should be in healthcare.

The lunacy of this is that the decisions that these people make are NOT “autonomous,” in that they are not just making decisions about themselves. They are making decisions that have large impact on others, including those who are especially vulnerable to the risks posed by those decisions.

That’s about as autonomous as driving down the wrong side of the road. Damn it, no one is going to tell me what side of the road to drive on! It’s my car, I control it.

I found the article a few days ago and was absolutely shocked that health workers in the midst of an outbreak refused to be responsible. It made me curious what kind of workers’ rights must exist in Israel. In a lot of states here in the US most are qualified as “at will” employees in “right to work” states. In these states neither the employee nor the employer are required to provide notice or reason as to why they are terminating the working relationship. I would expect to be terminated as a health professional if I did like they did.

Mr Woo is an LPN (yes, I know ~shakes head~) and complies with requirements to be sure he does nothing to endanger his patient. Patient safety and quality of care are the number one priority of both him and his employer. He reserves the woo for his own self-practice, and hasn’t refused any vaccines that I know of, and he believes in Hulda Clark’s zapper.

If it were up to me, and this is just me (so don’t go interpreting it as the opinion of any of my now 5 employers), if you refuse to vaccinate for any reason other than a medical or physiological impairment, you don’t get a license to practice medicine, nursing, etc. Period.

Completely agree. My only connection to health care is as a patient, and all my life I have assumed that people working in hospitals are required to be up to date on their vaccines. It shocked me when I learned that this is not necessarily the case. If you don’t want to assume certain risks that come with a job (whether they are realistically high or the mind has greatly exaggerated them), then don’t do that job. At the very least, anyone who refuses for non-legitimate medical reasons should have something on their person to indicate it, like a tag saying, “I haven’t had a flu shot” or “I’m more likely to infect you with preventable diseases” or something.

A pediatric nurse who refuses vaccination against a disease that is deadliest to infants on *principle* is a nurse who puts her pride ahead of her patients. And a nurse who thinks proving a point about autonomy is more important than the welfare of his or her most vulnerable patients during a pertussis outbreak is not someone who should be in healthcare.

Absolutely agree.

Marry Me, Mindy:

I agree with the sentiment, but I’m not sure that’s a good argument. Yes, a person who drives on the wrong side of the road deliberately is exercising autonomy. It’s stupid, it’s insane, and it jeopardizes others, but if it’s a conscious decision on their part, it’s exercising autonomy. Murderers exercise their own autonomy. What you mean is that they are expressing their own autonomy at the expense of someone else’s autonomy. Which is, in many ways, what happens all the time when we live together in a civilization. Our choices affect others, which means we should have some sort of responsibility to others — and means we get to bear the consequences for our autonomy when it pisses off or injures someone else.

I think nurses who want to be truly autonomous should go ahead and do so. If they really really really want to be autonomous, there are many wilderness areas where they can go live by themselves as hunter-gatherer hermits. I suspect they will not enjoy this very much, and will soon be wanting their social contract back.

Hi Mrs. Woo…We missed your posts here on RI…welcome back.

Here’s a copy of the letter signed by the NYSNA (New York State Nurses Association) and various private and public union officials about the mandatory H1N1 flu vaccine for HCWs.

When this happened, I sent a letter to the NYSNA and to the head of the public employees union who signed this letter, telling them that they do not represent my opinions about mandatory seasonal flu vaccine, mandatory H1N1 flu vaccine and other mandatory vaccines for HCWs who have face-to-face contact with the public or with patients.

http://www.nysna.org/images/pdfs/practice/nycosh_daines_ltr.pdf

Notice how the letter mentions extraneous issues associated with flu transmission within a health care facility and the effectiveness of seasonal flu vaccine…in years gone by, when there wasn’t a *good match* with the influenza strains contained within the vaccine and the circulating influenza strains within the community.

I felt ashamed that my professional association chose to take that stand against the H1N1 flu vaccine in 2009.

In a lot of states here in the US most are qualified as “at will” employees in “right to work” states. In these states neither the employee nor the employer are required to provide notice or reason as to why they are terminating the working relationship. I would expect to be terminated as a health professional if I did like they did.

And the head of personnel at such a hospital would be stoopid not to terminate such a person’s employment. That scenario has “wrongful death lawsuit” written all over it: unvaccinated nurse catches virus from one patient, nurse transmits it to second patient, second patient dies. If I were an ambulance chasing lawyer, representing the relatives of the second patient would sound like an easy payday to me, because it would be straightforward to prove that the hospital did not take all reasonable precautions to prevent the death of the deceased.

“Because, I suppose, requiring this nurse to do the responsible thing for herself and her patients is just like the authoritarian regime that was the Soviet Union.”

You make that sound like a bad thing, considering that the average life expectancy in “free” Russia dropped quite rapidly after the dissolution of the Soviet Union in 1991.

They probably think they just had croup. A common argument of the anti-vax folks is that we have just been renaming vaccine-preventable diseases once we come out with a vaccine.

So pertussis because croup. Even smallpox and polio never really went away, they were just renamed.

@Vincent Iannelli: you know, it’s just so sad that you can say that because I imagine you’ve heard them say it in your practice – and I’ve heard it too. As if there isn’t a HUGE difference between croup and pertussis. I know you know the difference, as do I. But they will convince themselves there IS no difference. As well as smallpox is really chicken pox, and polio is – uh – whatever.

As long as moms and dads use their “intuition” and have Dr. Jay Gordon and Dr. Bob Sears to rely on for information about vaccine-preventable diseases, we will always have hospitalizations and deaths from these diseases.

Dr. Jay is soooo busy “tweeting” that he doesn’t have time to revise his “vaccinations” page on his website. Instead, he has Cheryl Taylor, a lactation specialist, who is not a doctor and not a nurse (she has some sort of musicology degree)…who is advising parents about vaccines:

http://drjaygordon.com/pediatricks/vaccschool.html

Hello Everyone,

I’ve been lurking for almost two years now and have learned so much from all you. Can’t thank you enough.

I have a dear friend who is completely anti-vaccine. Recently she told me that it’s the vaccinated people spreading Whooping Cough, not the unvaccinated. That sounds like total BS but I don’t know how to respond. I Googled it but all I could find was Humprhies, Mercola, etc. Can anyone point me in the right direction?

Thanks much. My background: My daughter is on the Autism Spectrum (PDD-NOS) and I’m a former fence sitter. I now firmly believe in vaccines and have abandoned the various Biomed “protocols” we doing. I still have a lot of friends who are anti-vaccine who I try to engage with. I do know a little about statistics and the scientific method but my knowledge of biology is close to zero. Plus, I’m a terrible debater. Working on both.

Advice on vaccines from someone with a musicology degree? I see a new wooscam coming: music therapy to boost kids’ immune systems. No money for Big Pharma, and no side-effects from “toxins!”

tangentgirl @42, I find the notion of debating with anti-vaccers* impossible to imagine doing with any chance of resolution. Someone who does not understand and respect scientific method will not likely understand and respect logical argument, so their arguments will be full of every sort of logical fallacy. Meaningful debate can take place only between persons who share a common language.

*A “Vax” is a minicomputer popular in the 1980s, hence, to me, an “anti-vaxxer” is someone opposed to the use of this obsolete technology. Just my hangup.

Gary (GH)

Thanks Gary. I was going to tell her that we were going to have to “agree to disagree.” Maybe the best approach is to drop little seeds and leave emotion out of it (very hard for me to do). That’s how I came around. Then again, I never believed vaccines were unnecessary; I was misinformed enough to think that vaccines could trigger Autism in a small sub-set of children.

I’ve been reading the above “report.” I need a drink.

@tangentgirl

I’ve been lurking for almost two years now and have learned so much from all you. Can’t thank you enough.

Glad I could help.

Plus, I’m a terrible debater. Working on both.

No worries. Most of the people who post here are “terrible debaters”

Most of the people who post here are “terrible debaters”

I know, Sid, but with practice and reliance on facts you’ll improve.

I work in the Australian health system, where we get our vaccinations for free. The Staff Health nurses think I’m lovely because my vaccination status is 100% compliant. Trouble is, I’m not in patient care – I look after the computers. It amazes me when the actual healthcare workers bang on about the Ebil Vaccinations.

Amongst the general community, I’m lucky enough to live in an area where the paediatric vaccination rate is over 95%. I put this down to a paediatrician who worked at our largest hospital, who was badly affected by polio in his youth. He spent a lot of his spare time going around schools and parent groups talking about vaccinations and what they prevented. And DAMN was he effective. Sadly, he died 3 years ago.

@Vincent Iannelli, QUACK

You do know the diagnostic criteria for polio was altered “once we came out with a vaccine.”? And you do know medical treatments caused polio? Especially the bulbar variety vaccine aficionados use so shamelessly to promote vaccination.

Sid:

Actually, I learned the most when people confronted/debated/debunked your beliefs.

@Bee

Advice on vaccines from someone with a musicology degree? I see a new wooscam coming: music therapy to boost kids’ immune systems.

I hear you Bee. It sounds like composer99

@ tangentgirl:

Anti-vaxxers will say anything, bending reality in order to make their point: vaccines are against Nature.

There’s a great story of a doctor whose kids are on the spectrum ( James Laidler- AutismWatch): he describes how he followed the biomed plan consisting of excruciatingly precise diets and supported these ideas, even speaking in public – until he discovered that when his kids ate the wrong choices- nothing happened: they didn’t have worse symptoms.

Woo- and anti-vax is a sub-category of woo- relies
on mis-information and outright lies to manipulate people by capitalising on their fears. These prevaricators present themselves as scientists and concerned health providers who simultaneously engender mistrust of reality-based medicine.
If you look closely at their websites ( anti-vax and alt med), you’ll that they usually have something to sell you: supplements, treatments or merely themselves.

Right now, I’m looking at a charlatan’s series of 18 articles on why vaccines are useless and dangerous that will surely go viral around the web.

Stick with us, young lady.

croup = pertussis?

Amazing. My son had croup, fortunately he no longer gets the stridor and cough when he picks up an URI. I’ve looked up the pertussis videos. That’s not croup, but I’ll never convince the anti-vaxxers of it.

BTW, here’s the report my friend sent me

This enterprise has several moving parts. As for the vitamin C, this ultimately stems from a 1936 report in translation from one Toshio Otani in Klinische Wochenschrift. It didn’t come to anything (e.g., PMID 20320700). The rest of the Humphries in this particular regard, which she failed to note in the first place, is simple babbling about Wonder Vitamin and why you should constantly ram an ounce of it through your kidneys on general principles.

The second tack is to scream that the vaccine “doesn’t prevent transmission,” which makes it even worse than the disease because it just makes people “feel better” and not realize that they have pertussis. This neglects to note that one of the symptoms, coughing your head off, is the main means of transmission, not to mention that less than optimal efficacy from the get-go isn’t none.

This then devolves into B. parapertussis and serotype replacement and the vaccine is causing a savage mutant strain and so forth.

I’m sure someone can and probably will do this better, but that’s a general sketch of how I’ve seen it try to roll. The best way to avoid spreading pertussis remains to not get it, and the vaccine remains a proper choice.

Denice,

James Laidler’s story was one of the things that led me to abandon diet restrictions. Then I found a study out of the UK that examined the urine of about 60 males on the Autism spectrum and 60 or so NT males (examiners were blinded). Only two of the Autism group were on a GF/CF diet. They found no difference in gluten/casein (proteins? opioids?) between the two groups. I was going to forward it to our DAN! doctor but never got around to it.

The same friend once asked me, “Isn’t it better to acquire natural immunity from diseases versus vaccination?” I respond, “Well, if you survive and aren’t injured by it…I guess…” Didn’t know what else to say.

AKA Sid Offit when I get filtered

@ tangentgirl

I’ve never been “debunked.” Provide an example.

@Ren, welcome back to the world of the living. May you enjoy a long stay.

@Poe2Go
You’re actually correct. Must feel strange. One person’s liberty to do drugs doesn’t outweigh another’s liberty to fire them. I’d imagine you don’t support an employer’s freedom in other areas however.

@MI

As well as smallpox is really chicken pox

They were quite often confused. But I couldn’t expect YOU to know that.

@Marry Me Mindy
You don’t have any interest in going back to Pablo?

Baglady, it seems you were paid in medical treatments while working as a nurse.

AKA Sid Offit when I get filtered

Sid, if you’re being “filtered,” it doesn’t affect your “liberty,” so deal with it.

@ tangentgirl: Here’s an article from the Immunize.org website:

http://www.immunize.org/catg.d/p2069.pdf

See section 4 about a case control study conducted by researchers at Kaiser Permanente of Colorado, where the results showed that unimmunized kids had 23 times the risk of contracting pertussis, compared to kids who were immunized against pertussis.

This same case control study abstract is available here:

http://www.ncbi.nlm.nih.gov/pubmed/19482753

@ Offal…I was paid in medical treatments? No Offal, I was paid a salary because I was educated at a top tier university, licensed as a registered nurse and experienced in epidemiology.

You should have thought about a real education Offal…not a degree in “fire science” from a fourth tier college.

I see you are posting some of your inanities again…how about some citations Offal?

@ Offal…You claimed to have won a debate about chicken pox lollipops with a college professor on a radio broadcast..

http://respectfulinsolence.com/2012/04/update_on_california_bill_ab_2109_it_mov.php

Here you tell this whopper…

“…you mean the interview in which I made mincemeat out of Dr. William Schaffner, President, National Foundation for Infectious Diseases? I heard he was actually in danger of losing his position after his poor performance debating me.”

Why did you disappear after that Offal? Remember I listened to that broadcast and you made a fool out of yourself.

You better quit whatever you’re smoking, sniffing or ingesting, Offal.

Thanks lilady.

Here’s a quote from the pdf I linked to above. This is the crux of my friend’s “argument”: (I apologize if the formatting is messed up and I left out the footnotes for brevity)

“The reason the vaccinated can spread the disease by virtue of taking them much longer to clear the bacteria, is due to an immune system that has been misprogrammed by a vaccine. Vaccinated babies, children, and adults are not able to mount the comprehensive bronchial and cellular immunity – which an unvaccinated person naturally develops in the course of the disease. The vaccine only primes the body to fight pertussis toxin and sometimes a couple of other cell antigens, in the blood, not the lung. It does this by stimulating an unnatural balance in immune cell populations. This incorrect immunity ‘learned’ from the vaccine (referred to by Dr James Cherry as ‘original antigenic sin’), is
then the same way the body then responds to a subsequent infection. If the first stimulation was to vaccine antigens, then upon the exposure to the disease, the vaccinated person will mount an inferior response, compared to a child who has
convalesced from a natural infection. It is well known that pertussis-convalesced children, who have never been vaccinated, develop important antibodies that the vaccinated do not. The vaccinationists have used this phenomenon to support the need for designing vaccines with multiple antigens. The point they miss is that it is only natural complex cellular and bronchial responses, which give the full protection. It has been shown that response to pertussis toxin and adenylate cyclase toxin is far more intense in the unvaccinated, than the vaccinated.

The naturally immune clear bacteria upon re-exposure far more rapidly than the vaccinated. There is an enormous difference between broad, long-lasting immunity from the normal disease, and limited antibody development and short-term pseudo-immunity from the vaccine.”

Speaking of the value of vaccines, this is useful.

http://www.theage.com.au/national/health/flu-vaccine-could-save-thousands-of-hospital-visits-20120501-1xxh8.html

Almost 13000 hospitalisations for flu and pneumonia, over 4000 for tetanus, measles, mumps, pertussis could have been avoided if those patients – and the people around them – had been vaccinated. Should also note from the analysis that the flu/pneumonia figures are probably understated because some people were only admitted to hospital when they were suffering complications from the transmissible disease – and that initiating infection wasn’t recorded as the reason for admission.

Off the top of my head, 17000 admissions, say minimum average 4 days in hospital, 68000 days at $1000 a day (one current estimate of costs is $1117 per day) comes out $68 million minimum. Increase the estimated number of bed days per person and pretty soon we’re talking real money.

And the cost of say 40000 vaccinations to both immunise and shield those people against transmission of infection? My WAG is that it’s not 68 million dollars.

Anyone have similar figures for large population countries? UK, USA?

There is an enormous difference between broad, long-lasting immunity from the normal disease….

The “broad” immunity, whatever that’s supposed to mean, from the “normal disease,” whatever that’s supposed to mean, isn’t notably long-lasting, so that’s out (PMID 15876927). The idea indeed seems to amount to catching pertussis at just the right age so that one will be well positioned to have the opportunity to serve as a source of infection at child-bearing age.

@ tangentgirl: I read Suzanne Humphries link that you provided and the other nonsense that is on Mercola’s website, the NVIC and other notorious anti-vaccine websites.

Didn’t I read somewhere in the Humphries *recomendation* that she pushes 5-10 grams of Vitamin C daily for children who have pertussis? What utter nonsense. It is a bacterial infection, which if caught in its very early stages, may shorten the duration of the disease and certainly does shorten the period of infectivity…thus decreasing the risk of transmission to unimmunized infants.

There have been many studies about waning immunity after infection with the B. pertussis bacterium and after completion of the primary series of DTaP (infant vaccine).

The consensus is that immunity does wane, whether or not you have had the disease or your have completed the primary series in early childhood:

http://www.immunize.org/askexperts/experts_per.asp

The ACIP made recommendations for children, pregnant women, close household members/caregivers of a newborn to receive a boosting dose of the newly licensed Tdap vaccine. These are the recommendations for the one time “boosting” Tdap vaccine for people who have had a history of having had pertussis disease:

“If an adolescent or adult who has never received their one-time dose of Tdap is either infected with or exposed to pertussis, is vaccination with Tdap still necessary, and if so when?”

“Yes. Adolescents or adults who have a history of pertussis disease generally should receive Tdap according to the routine recommendation. This practice is recommended because the duration of protection induced by pertussis disease is unknown (waning might begin as early as 7 years after infection) and because diagnosis of pertussis can be difficult to confirm, particularly with tests other than culture for B. pertussis. Administering pertussis vaccine to people with a history of pertussis presents no theoretical risk. However, if the illness was recent (less than 5 years) and the diagnosis was certain (i.e., culture confirmed), it is reasonable to wait 3–5 years before administration of Tdap, unless tetanus and diphtheria toxoids are needed. For details, visit CDC’s published recommendations on this topic at http://www.cdc.gov/vaccines/pubs/acip-list.htm.”

Here’s another interesting article From Pediatrics…about the logistics of providing certain immunizations to parents and caregivers of infants, by the infant’s pediatrician:

http://neoreviews.aappublications.org/content/pediatrics/129/1/e247.full

This seems to be an acknowledgement of the principle of “cocooning” a newborn, that is advocated by the ACIP, by the AAP, by Family Practice doctors and by pediatric infectious diseases doctors.

Infants who are too young to receive the MMR vaccine and too young to have completed the primary DTaP vaccine series, should only be cared for by parents and other caregivers who are fully immunized against measles, mumps and rubella and who have received the Tdap boosting vaccine. Other household members should also be up-to-date on these combination vaccines, as well.

I place no value in Barry/Sid Offit’s ‘fire science’ driven drivel. Sid debates poorly here, often denigrating other poster’s credentials while having none of his own. He cares nothing for anyone outside his immediate comfort zone (aka brown skinned & foreign humans) and has a fairly high tolerance for damage to others as a result of vaccine preventable illness.

I’ve been watching the anti-vax movement lie, morph, twist and shift goalposts long enough to know that pronouncing a death knell for their views is pointless. The only thing that might move large numbers out of the cranko-sphere would be a very large, geographically widespread epidemic of disease whose vaccination they are against. Sadly, by working as hard as we do to fight them from causing such an outbreak, we preserve their science-free, bubble encapsulated delusions.

Man, not pay attention to the comments for a few days and get slimed by one of the regular trolls out of nowhere.

I’ll take that as a compliment, Schechter.

@ tangentgirl, when you said

I have a dear friend who is completely anti-vaccine. Recently she told me that it’s the vaccinated people spreading Whooping Cough, not the unvaccinated. That sounds like total BS but I don’t know how to respond.

I thought at first that your friend was simply pulling out the old mathematical blooper (which I have seen antivaxxers trot out from time to time) that because the majority of cases in outbreak X were in vaccinated people, it “proves” that vaccination raises rather than lowers the risk of getting the disease. That doesn’t seem to be your friend’s current tack, but since antivaxxers do trot that one out often enough, it’s worth showing the refutation.

I always start by positing an imaginary outbreak in which right-handed people who caught the disease outnumber left-handed people who caught the disease, and ask if this implies that right-handed people are more vulnerable to the disease, or that if we could somehow convert right-handers into left-handers, it would protect them from the disease. Most people can easily see that, if handedness has nothing to do with disease resistance, right-handers will still predominate in the population of disease cases, for the simple reason that they predominate in the general population.

Depending on the circumstances, I sometimes go further, to explain how a mathematical illusion can hide from first glance something that does drastically affect disease resistance. People often talk about the “majority” and make the shorthand assumption that the “majority” follows the primary causative factor: therefore, if unvaccinated people don’t make up the majority of cases in an outbreak, then lack of vaccination can’t really be doing anything that bad, right?

But consider this sports metaphor: if Jones strikes out at bat 9 times as often as Smith does, but Smith goes up to bat 10 times as often as Jones does, which of the two is going to have the higher number of strike-outs? That’s right; Smith has the higher number of strike-outs, even though Jones has a much higher rate of strike-outs. If, for a particular disease, the vaccinated population outnumbers the unvaccinated population by 10 to 1, the unvaccinated population could be contracting the disease at 900% of the rate of the vaccinated population and the vaccinated population would still have the numerical majority of cases. The fact that, in many outbreaks, vaccinated people make up 90 to 95% of the population and unvaccinated people still make up a majority of the disease cases shows you just how bad your chances are if you don’t vaccinate.

I know how my hospital dealt with vaccine refusers – firing them. During H1N1, everyone including the janitorial staff was required to get vaccinated. If you refused, you were fired. And rightly so.

Shame on health care providers who refuse during an OUTBREAK. My hospital sees 4-5 pertussis cases/exposures per month. The infection control department is not a fan of giving everyone on the floor azithromycin . . .

I wasn’t even allowed to enter my residency program before getting another Tdap. I also had to get antibody levels drawn for chicken pox, rubella, Hep B. (I was actually a late seroconvetor for Hep, B – it took 6 shots, but worth it bc I am always one needle stick away)

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