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How stigmatized are undervaccinated children and their parents?

Antivaxers often complain that they are judged harshly. It turns out that they are probably correct. But is this a bad thing? More importantly, what about the children, who didn’t choose not to be vaccinated?

I’ve discussed several times over the last several years my impression that the media have become in general less tolerant of antivaccine views. At least, the media seem less willing to indulge in “tell both sides” false equivalence. Back when I started blogging, I routinely used to bemoan how news stories about vaccines or autism would almost inevitably include obligatory quotes from antivaxer like J.B. Handley, Jenny McCarthy, and sometimes even Andrew Wakefield. More recently, over the last five years or so, such tropes seem a lot less common. I don’t have any solid evidence to back up my impression, but I’m not alone in it. I’d like to think it was because of evidence, but generally I’ve attributed much of this change to the the downfall of one of the most famous antivaxer of all (at least before the rise of Donald Trump, and even then most people didn’t know that he has antivaccine views), Andrew Wakefield. When Wakefield lost his medical license and the was revealed to be a fraud, it provided a handy shorthand way to dismiss antivaccine views. Again, that wasn’t my preferred way to have won people over, but stories tend to be more effective than evidence.

It’s against that backdrop that I came across a story about a study examining how the mothers of unvaccinated children are viewed by other people. From the story in the Vancouver Sun:

Mothers of unvaccinated children are judged harshly by other people and their children are more likely to be shunned by other families, according to a study from the University of B.C.

And it really matters why the child is unvaccinated.

Those moms who outright refuse to vaccinate their kids are viewed most negatively, said co-author Nicholas Fitz, now a research associate at Duke University in Durham, N.C.

“On measures of social distance — like would you let your child befriend an unvaccinated child or work on a school project together — across the board unvaccinated children suffered from stigma,” he said. “People felt the most anger and the least sympathy for the refusal group and viewed the mothers as a danger to the community.”

But, because of the perceived health hazard, the child is most likely to be shunned.

“They don’t want the family to move into the neighbourhood … and they don’t want their children to play with (unvaccinated) children,” he said.

The authors Carpiano et al discuss how parents in the US are frequently judgmental of each other in the introduction to their study and then point out that vaccination status has become another area where judgmental attitudes can come into play:

In addition to these cultural expectations, media coverage of undervaccination has heavily focused on “anti-vaxxer” parents (mostly mothers), who refuse vaccinations for their children. This small, but vocal proportion of parents of the total undervaccinated population—more likely to be white and higher SES and thus with greater capacity to undertake healthy practices—are (a) known for rejecting certain evidence-based medical recommendations, (b) engaging in emotionally-, time-, and (often) financially-absorbing “intensive mothering” practices centered extensively on managing a child’s development; as well as (c) often identifying with essentialist notions of mothers as the best caregivers for their children (Reich, 2016 ; Hays, 1998). Popular media has even characterized anti-vaxxers as dangerous (e.g., Sriram, 2015). This attention paid to anti-vaxxers has contributed to misconceptions and even stereotypes about other vaccine-hesitant parents who refuse or delay vaccinations for their children (e.g., Haelle, 2015).

Of course, antivaxers are dangerous, but I always try to distinguish between vaccine-hesitant parents who have fallen under the sway of antivaccine views and the hard core antivaxers themselves, who spread the message. The former can be reached; the latter are virtually unreachable with rare exceptions.

In the study by Carpiano et al itself, the authors consider three issues:

  • Is undervaccination stigmatizing for the parent and the child?
  • Do stigmatizing attitudes depend on the reason for undervaccination?
  • What are the policy consequences of undervaccination attitudes?

Guided by these issues, the authors sought to investigate three questions:

  1. To what extent does the causal reason for a child’s undervaccination status predict people’s: a. Evaluations of child undervaccination (in terms of attribution theory-based emotional reactions and/or mother judgment-based differentness, credibility, and dangerousness) and b.Stigmatizing behavioral orientations (i.e. social distance and discrimination) towards undervaccinated children and their parents?
  2. Do people’s evaluations of child undervaccination explain differences in stigmatizing orientations observed across different undervaccination reasons?
  3. Do these undervaccination evaluations and stigmatizing orientations predict support for specific child vaccination policies?

Carpiano et al examined these questions by designing a survey-embedded vignette experiment that was administered in 2015 using Amazon’s Mechanical Turk (MTurk), an online crowdsourcing Internet marketplace that allows individuals and businesses (referred to as Requesters) to coordinate the use of human intelligence. It’s a tool that’s been increasingly used to recruit subjects for social science experiments like this one. Carpiano et al designed a survey-embedded vignette experiment with checks for whether or not the participants paid attention to the instructions and had understood the survey items. Overall, the sample surveyed included 1,469 participants representing at least 46 US states and Washington, DC. The four vignettes were about a mother who either has:

  1. Concerns about vaccinations and has decided to refuse vaccinations for her child (“refusal”).
  2. Concerns about vaccinations and has decided to delay some of her child’s vaccinations (“delay”)
  3. No concerns about vaccinations but whose job and family demands have made it difficult to schedule medical appointment so her child has only received some vaccinations (“time constraint”)
  4. No concerns about vaccinations and has decided that her child always receives recommended vaccinations (“up-to-date;” the control condition).

The mother in each vignette was randomized to be:

  • either white (and named “Molly”) or Hispanic (and named “Maria”)
  • either high or low socioeconomic status (in terms of education and job).

The authors note:

We selected Hispanic (versus White) because, in addition to Hispanic being a minority demographic group in the US, at the time we developed the study (i.e. following the Disneyland measles outbreak), politicians and pundits had publicly raised concern about illegal immigrants (often portrayed as being Hispanic) being unvaccinated and thus posing a risk for spreading disease (e.g., see Kessler, 2015). Hence, randomizing the mother’s demographics enabled us to determine if they influenced respondents’ reactions to the undervaccination condition at hand. As further context, US White and Hispanic children ages 19–35 months had similar 2014 national coverage rates for most vaccines and dosages (Hill et al., 2015).

The authors then asked questions about how the parents in the vignettes were viewed, stigmatizing behavioral orientations, and policy support. Results of evaluation measures for the vignette parents are shown in this figure:

Basically, undervaccination reflected negatively on the mohter. Anger and blame at the mother were highest for mothers refusing vaccines, less so for mothers who were time-constrained. These time-constrained parents also evoked much more sympathy than the other groups, which makes intuitive sense.

Here are the results on stigmatization:

What these results suggest is that both unvaccinated children and their parents are socially stigmatized, but that the child is stigmatized more than the parents, as the differences in the scores between fully vaccinated children and the undervaccinated were much greater than the differences in stigmatization between the parents. The authors themselves note in the discussion:

Third, participants reported even stronger social distancing attitudes towards the undervaccinated child than the mother. This suggests that children bear the bigger burden in undervaccination—in addition to not being protected from one or more vaccine-preventable diseases, they may be the recipients of courtesy stigma via the stigma of their parent’s decision/inaction (Phelan et al., 1998). We further discuss this idea below in relation to advancing stigma research.

It also turns out that those who read different vignettes also ended up with different attitudes towards what should be done to encourage vaccination. Those who read the refusal vignettes tended to be more supportive of punitive measures, such as banning unvaccinated children from school, but the differences were not large. For instance, those who read the vaccine refusal vignetted were only 24% more likely to support banning undervaccinated children from school. In addition, those who read the delay condition were only 15% more likely to support more education and services and 16% more likely to support reporting school vaccinated rates, while those reading the time constraint condition were 30% less likely to support a fine or a tax on parents of undervaccinated children.

So basically, the results of this study show that negative portrayals of antivaxers appears to be having an effect. However the message is being received, via the media, the Internet, or other sources, the parents of undervaccinated children are viewed negatively, and the reason matters. Outright refusers are viewed the most negatively, and time-constrained parents the least. The latter group even provokes a fair measure of sympathy. This does not bother me. What does bother me is that the children are stigmatized more than the parents. It bothers me because it is not the children’s fault that they were born to parents who won’t protect them from infectious disease, whatever the reason for their refusal or delay of vaccines.

The authors, to their credit, tackle the issue head on. They note that social stigmatization can work in changing behavior, noting the most obvious example, smoking. They then point the similarities and differences between smoking and vaccine policies:

Our investigation also informs stigma research more generally. First, it highlights the interplay of evaluations and consequences for the parent and child. Stigma research has considered how family members of stigmatized persons can also be stigmatized as recipients of courtesy stigma (Phelan et al., 1998). Child undervaccination extends the courtesy stigma concept, as the focus of the stigma is both the parent and the child—for mutual and distinct reasons. A child’s (under)vaccination status is a consequence of the parent’s actions, regardless of whether those actions are by choice or constraint. This status is beyond a child’s control, yet the child bears the burden of any negative consequences from parental (in)action. Thus, the child risks being doubly stigmatized as both the identified child of a vaccine-hesitant parent and a perceived health risk.

Second, our focus on stigma of undervaccinated children and their parents provides important angles to scholarship on the ethics of using stigma (or more broadly, denormalization) as a policy tool for modifying behaviors (see debates between Bayer, 2008a ; Bayer, 2008b and Burris, 2008; and Bell et al., 2010 ; Bayer, 2010). Given that vaccinations are necessary for ensuring the health of a community (including people who cannot be vaccinated), they juxtapose individual and public rights (as well as the role of government). This situation is similar to anti-smoking policies and second-hand smoke, but is more complex in that it entails the parent (as the decision maker) and child (as a beneficiary and health risk). This additional dimension is essential in ongoing debates about stigma and policies that aim to address adult and child health conditions and behaviors (e.g., eating unhealthy foods, obesity).

Of course, hard core antivaccine parents feed on any perception of stigmatization. How often have you read posts by such parents ranting about how they feel judged when interacting with health care providers, the press, and others? They revel in painting themselves as the persecuted minority, sometimes going to ridiculous extremes, such as donning a yellow badge with a syringe on it patterned after the Yellow Star of David that the Nazis required Jews to wear, thus likening their “plight” to that of the Jews during the Holocaust. Indeed, antivaxers are quite enamored of Holocaust analogies, either with vaccines causing a Holocaust or laws requiring children to be vaccinated before they can attend school being likened to Nazi-ism. Even mildly vaccine-hesitant parents can be turned off by excessive judgment.

Basically, stigmatization is highly problematic because it is the children who suffer far more than the parents, even as they are unnecessarily left vulnerable to infectious diseases. Also, we basically know that stigmatization only makes the beliefs of committed antivaxers stronger and increases their will to resist. However, this group of antivaxers is, as I pointed out at the beginning, different from the mere vaccine-averse. Their numbers are smaller, even though they are much louder and more responsible for spreading antivaccine beliefs. The question is whether stigmatization has an effect on vaccine-hesitant parents and whether it makes them more likely to vaccinate or less likely—and at what cost, given that it is the children who suffer far more than the parents. While it’s encouraging that parents of undervaccinated children are not viewed favorably because it indicates that pro-vaccination views predominate and that the reason for not vaccinating matters, we have to ask: How can we as a society maximize the social pressure to vaccinated without harming the very children that suffer from not being vaccinated? The answers to those question await further research.

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]

474 replies on “How stigmatized are undervaccinated children and their parents?”

/stigmatization is highly problematic because it is the children who suffer far more than the parents

I have not read the Sun article or the original one but it strikes me that the “stigmatization” of the children may not be so much stigmatization as simple self-defence.

An un-vaccinated person, adult or child, is a time bomb. I would not want a child of mine associating with such a person. Heck, I would not want to associate with such a person.

As a poor analogy, I live in an area where rabies was endemic and still occurs despite heroic efforts by the provincial and federal governments. I would not even think of petting a dog that I knew had not had their rabies vaccination.

I am sorry for the children who are stigmatized (shunned?) but it is morfe a case of child abuse by the parents than a problem with other people.

jrkrideau said exactly what I wanted to say. The isolating of unvaccinated children is to protect other children.

I share Orac’s concerns about unvaccinated children bearing the burden of their parent’s foolish decisions. Children can be very cruel to one another, and young children in particular cannot understand the reasoning of adult decisions. Teens need to be able to form stable peer groups.

This is the kind of issue that can have a negative impact on social development.

I have no idea what the answer to this problem is, but dismissing it as “them’s the breaks, vaccination is too important” is not it.

Exactly. It’s way more complicated than simplistic dismissals and the apparent lack of empathy for the children of antivaxers and the vaccine hesitant. How far should people go in stigmatizing children who had no part in the decision not to be vaccinated? How do we protect our children without adding to the harm unvaccinated children are already suffering?

I don’t think it’s as simple as those children being isolated for defense. I do hear people talk about them in ugly terms. That is a problem. Vaccine-deprived children are victims. I think social anger about non vaccinating is needed to get policy changes, but we need to consider the cost.

This is important work, and I hope they continue and look at the other questions Orac mentioned – how does stigmatizing affect vaccines hesitant parents.

Yes. I’ve occasionally seen provaxers describe unvaccinated children in the same sort of ugly terms that nativists use to describe immigrants, as “dirty,” spreading filth and disease, etc. I must confess myself to having occasionally drifted in that direction in the past, but I’m trying to watch myself to stop from doing it in the future. These children are victims; they didn’t choose not to be vaccinated. We should not forget that. It might be necessary to isolate them by keeping them out of school and daycare to protect others, but if it’s done abusively and punitively it will harm them.

Another excellent reason not to stigmatize the children of antivaxers. We don’t want to emulate antivax behavior.

I’ve been accused many times of making fun of children who are “vaccine damaged.” When I ask for evidence of my actions, I get only evidence of me berating anti-vaccine parents. Children are, as you and others have stated, innocent in this whole discussion. Even if the kiddos are at protests with their parents, holding signs and whatnot, they don’t know any better. Adults, on the other hand, should know better… For them I have no patience.

I actually divide such parents into two groups. There are the real antivaxers. For whatever reason they’ve come to believe that vaccines are dangerous, and nothing will change their minds. These sorts of parents are relatively few in number and are the “leaders” of the antivaccine movement. They write the blogs, form the organizations, make the videos and movies, show up on TV and other media, and support the bogus science claiming to find that vaccines cause autism. With them I have no patience and tend view our job as trying to inoculate parents whom they can influence from their malign views, because changing the minds of such parents is incredibly difficult and rarely successful.

Then there are the vaccine-averse. They tend to be the ones who have heard scary things about vaccines (often from the former group) and are taking what they view as a cautious, reasonable path. These parents range from being almost part of the first group to being just mildly scared when their children are vaccinated. As I’ve said many times, if you don’t have the scientific background to recognize antivaccine misinformation, that misinformation can sound very convincing and it is not unreasonable to take precautions. These are the parents who are reachable, and for them we must have patience for the good of their children.

I think a missing vignette is where the child is not fully vaccinated because of a reason recognized by national health authorities as a good reason not to get certain vaccinations (e.g., had a life threatening reaction to the first DTaP so does not get the second). How would the children and parents be treated then?

jrkrideau (#1) writes,

An un-vaccinated person, adult or child, is a time bomb.

MJD writes,

A “time bomb” is defined as a process or procedure causing a problem that will eventually become dangerous if not addressed.

A vaccination could be a “time bomb” by definition in that it’s a process or procedure that may become dangerous (i.e., contraindications) if not addressed.

@ Orac,

Are parents who fail to immunize their children simply over- reacting to the vaccination “time-bomb effect”?

If this is the case, social pressure to vaccinate may increase their will to resist.

In my opinion, if medical science fails to eliminate vaccine contraindications there will always be a small number of parents that break the social contract of herd immunity.

In a worst case scenario, increased social-pressure to vaccinate may turn into bullying and that is a sickening thought.

@MJD-There are legitimate contraindications to vaccination-for example, immunocompromised patients often cannot receive live virus vaccines. These patients, who, for legitimate medical reasons, cannot be vaccinated, rely on herd immunity and are (along with infants who have not yet been vaccinated) the ones who are endangered the most by ignorant parents who refuse to vaccinate their children.

Also, MJD, this post is discussing children who are unvaccinated not because they have a legitimate reason why they cannot be vaccinated, rather, it is discussing children who could be vaccinated, but are not because their parents are misinformed. There is a huge difference.

I don’t think that children with a legitimate medical reason why they can’t be vaccinated would face stigma, much less “bullying”, because they are unvaccinated.

For one thing, in many cases, a serious illness (e,.g., acute leukemia), that those in their schools/communities would be aware of, would be the reason why they couldn’t be vaccinated.

Since vaccination is a medical procedure and therefore private personal information, it seems to me that any stigma experienced by the child would only be because the parent chose to share their child’s vaccination status with others. That’s on them unless/until our society starts demanding unvaccinated individuals be publicly identified whether with yellow stars or pick triangles or some other easily visible means. I don’t think that is likely to happen.

It’s quite a conundrum. On the one hand I agree that children of antivaxers are victims and don’t deserve social isolation. On the other hand I’ve already vaccinated my child, mostly to protect him but also with the vulnerable (such as unvaccinated children) in mind. Should I go even further and encourage interaction between my child and an unvaccinated child? That feels too risky to me.

@CC

If your kids are vaccination, why do you consider it risky for them to associate with an unvaccinated child? It’s very unlikely that both the unvaccinated child is infectious for a VPD and your child’s vaccine won’t provide protection against that disease.

This is a common trope used by antivaxers: “If vaccines protect your child, then why would you be worried about your child playing with my unvaccinated child?”

I call it a trope because it is one. Vaccines are never 100% effective. The measles vaccine is one of the most effective vaccines there is, well over 90% effective after the full series, but even that level of effectiveness still means that a small but significant minority of children vaccinated against measles are not immune. So CC’s concerns are not irrational. It’s a real issue. Certainly I agree with CC that at least I wouldn’t encourage interaction between one’s child and the unvaccinated.

@Orac-Regarding reaching the second group–the “vaccine hesitant”, I think that a clear discussion of the dangers of the diseases might be effective. Perhaps watching a video in which the parents of a child who died of a VPD speak about their loss, or a video of a polio survivor discussing their illness, and subsequent permanent disability, would go a long way towards convincing the second group of parents to vaccinate.

I think that part of the problem is not just the misinformation regarding autism, but also that the vaccines have been so successful that some people no longer really fear the diseases that they prevent., and therefore having vaccine-hesitant parents watch a video that illustrates that the dangers of skipping vaccination is very real might be effective.

I also think a video might be more effective than just a doctor discussing the dangers of VPDs, since people could personally relate to a video more than they would a doctor discussing what they might view as “hypothetical” risks.

Like jr and Julian, I question the whole issue of “the kids bear the stigma”. This is the kind of thing that gets me POed about “social science” – a brute quantitative measure of an ill-defined and uncontrolled subjective concept (‘stigma’) as if it was some concrete, coherent and consitent property. Duh, of course you can expect parents to express “social distance” from potential sources of dangerous infectious disease. But this is not necessarily “stigma”. That is, while parents may not want their kids to befriend or be schoolmates with an unvaccinated kid – they may still view that kid with sympathy and compassion as a victim or irresponsible parenting.

There is simply no nuance or depth in survey research. In this study, the results probably have as much to do with the way the “vignettes” were written than with the set of attitudes out in the world the authors were trying to study. The way a parent responds to a hypothetical kid identified as “an unvaxed” will be different from how they respond to a real 3-dimensional non-vaxing family down the block who have been their neighbors for years (for good or ill, among other things).

Social scientists are often masters of hiding their biases and motivations, not just from others, but from their own spheres of cognition. I take these authors expressed concern for the supposedly stigmatized un-vaxed kids as a form of propaganda working to guilt-trip vax-hesitant parents into doing the right thing out of fear their kids will be socially/psychologically harmed. While likely over-stated, I guess it’s still legitimate enough a persuasion strategy…

@Beth Clarkson

Also, you ignore that children live in households and communities. My vaccinated child also has a younger brother who is too young to have received all his vaccinations. My vaccinated child and I also regularly see parents of children who are immunocompromised in addition to being in regular contact with the elderly. No one lives in a vacuum.

Focusing on the individual is part of the reason the “your kid is vaccinated so why do you care” argument is so misleading.

I take these authors expressed concern for the supposedly stigmatized un-vaxed kids as a form of propaganda working to guilt-trip vax-hesitant parents into doing the right thing out of fear their kids will be socially/psychologically harmed.

Because these parents are likely readers of Social Science & Medicine?

I also note that this study rated very little news coverage. It was really only by chance that I came across the one news report about the study that I saw. If the authors were trying to guilt trip vaccine-hesitant parents, they sure are doing a crappy job of it, given that their study got very little news coverage.

Orac, I’m not saying it not possible for a vaccinated child to contract a VPD from an unvaccinated child, I’m saying it’s extremely unlikely because it requires the confluence of two rare events – that a) your child was not immune despite the vaccine (rates vary by vaccine, but most are effective in more than 90% of recipients) AND b) the unvaccinated child is contagious for a VPD but not showing symptoms of illness. If you assume that the vaccinated child has a 10% of not having immunity (a high estimate) and the unvaccined child has a 1% chance of being infectious without displaying symptoms (again, a high estimate), then the probability of your vaccinated child might contract a VPD is only 0.1%. In other words, even with high estimates of the probabilities of those events, CC can be at least 99.9% certain that his/her child will not contract a VPD as a result.

Personally, I wouldn’t consider that a risk worth actively avoiding (I find the security of having vaccinated my child sufficient for my comfort level) but it’s up to CC whether that is worth the effort to both find out the vaccination status of potential playmates and avoid contact with those who are unvaccinated. My point was that the risk is quite low under normal circumstances and I was curious how CC evaluated it and decided it was too high for his/her comfort level.

Even accepting your numbers that would be a 0.1% risk per encounter. Kids can easily have hundreds of encounters with their friends over the course of years. Those risks add up.

@Jinny Suh #22 – I’m aware of this issues, but I don’t think those risks played into CC’s concern as stated in #17.

@Orac – exactly. What anti-vaxers fail to realize as well, is that a similar percentage of people will also not gain immunity, even if they got the disease naturally. There are plenty of individuals who suffered multiple infections of chicken pox or even measles, because their body could not develop the antibodies necessary.

In today’s world. where international travel is commonplace, any disease is merely a plane-ride away.

Orac, no, that’s not the risk per encounter. But I didn’t make that clear, so let me be more explicit. I was taking the 1% chance of a child being infectious but symptomatic as cumulative, for any particular encounter, the probability that a child was infectious would be orders of magnitude lower than 1%. Even during an outbreak, as in Minneapolis, the probability that any particular child is currently contagious without showing symptoms is considerably lower than 1%.

Jonas (#13) writes,

-There are legitimate contraindications to vaccination-

MJD says,

Absolutely, and at the top of the list is a severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component.

https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html

The unpredictability of allergic reactions from vaccine components and their packaging (e.g., Orac’s restriction for MJD) is a real “time bomb”.

Again, medical science has failed to eliminate such vaccine contraindications and thereafter continue to administer a defective product-by-process.

Unfortunately, children are not immune to a vaccine learning-curve that seems to have plateaued.

Q. Do vaccine safety advocates have a right to preach and practice exclusionary measures in an effort to accelerate vaccine continuous-improvement.

@Beth – funny that you consider that risk to be “minor.” Because where you compare that percentage to the percentage chance of a serious adverse reaction to a vaccine…..which works out to about 0.00013% (or 1.3 ten-thousandths of a percent), it’s obvious which is the safer course of action.

Heheh. You beat me to it. That’s where I was leading. No problem, though. It doesn’t matter if it’s I or someone else providing the message, as long as the message is provided. 🙂

Remember a few years ago, when a 17-year old girl (“Cassandra C” was forced to undergo chemotherapy for Hodgkin’s disease, against her will and against her mother’s wishes?

It amazes me that the state will intervene in that case, where the person in question was almost old enough to make her own medical decisions, and where refusing treatment affected *only* her, and did not endanger anyone else, when the state will not intervene to ensure that children are vaccinated (refusal of which not only endangers the health of the child in question, but also the health of those who are exposed to them).

Obviously it’s not a perfect comparison, considering that, without chemotherapy, Hodgkin’s disease is fatal, but I still think it’s a comparison worth making.

Sadly, I recall seeing last year that Cassandra C had suffered a relapse, and was not going to have chemotherapy to treat the relapse, so, unless she changes her mind and decides to undergo chemotherapy, it seems almost certain that she’ll die from her illness.

Ignoring that measles is perhaps the most contagious disease on the planet.

It is a testament to the effectiveness of the vaccine that there has only been 73 cases….at least 68 of them completely unvaccinated.

And you’re still wrong Beth – Orac’s math is correct, your’s is not.

Beth: “If your kids are vaccination (sic), why do you consider it risky for them to associate with an unvaccinated child?”
Beth: “I’m not saying it not possible for a vaccinated child to contract a VPD from an unvaccinated child, I’m saying it’s extremely unlikely”

There’s more to this story than vaccines not being 100% effective. Beth may wish to educate herself about risks to children who can’t be protected by vaccination due to primary or acquired immunodeficiencies. Should the parents in the following case be criticized for “shaming” parents who avoid vaccination or for “shunning” their unvaccinated kids?

http://www.motherjones.com/environment/2015/02/open-letter-parent-unvaccinated-child-measles-exposure

Personally, I have some fundamental issues with parents who intentionally not vaccinate their kids…..I don’t feel comfortable having my children exposed to that kind of thinking – it’s just ignorance.

@Lawrence – I consider the risk of adverse reactions to be well worth the benefit of vaccination for most vaccines so I agree with you on that point.

The “American Loon” ignores the studies and evidence that anaphylaxis has been shown to occur in vaccinations at a rate of less than 1 in 1 million……

What this discussion does bring home for me is the question of how am I going to work with the vaccine adverse once I begin professional practice as an FNP.

During the Spring Semester, I did my Women’s Health rotation in an affluent practice where many of the mother’s to be were heavily into woo. I always felt like I was walking a fine line with some of these ladies who instantly shut down when I discussed influenza and TDaP vaccinations with them, or where convinced Hep B was bad for their babies . . . and of course, there was the issue of the fact I was a guest there, in a student role. I met some actual anti vax folks there, not just vaccine adverse.

In a few weeks, I head to Iowa for four and a half weeks for my Peds rotation. I don’t know what I’ll find when I get there, but I have no doubt I’ll run into vaccine adverse parents, though perhaps not anyone anti-vax.

Seriously . . . I’m trolling for suggestions. How DO you approach someone who’s vaccine adverse without driving them into the arms of the antivaxxers?

@MJD (31).
Anaphylaxis from a vaccine is EXTREMELY rare, so much so that even bringing it up is kind of silly.

Not to mention that it’s pretty much irrelevant to this thread, since vaccine-averse parents don’t refuse to vaccinate their children because they are concerned about a TINY risk of anaphylaxis, they refuse to vaccinate their children because they mistakenly believe that vaccines could cause autism, or because they mistakenly believe that “natural immunity is better” (another common anti-vax trope).

And while I shouldn’t even have to say this, are you aware, MJD, that the risk of acute encephalitis from measles (13 in 1,000 measles patients, per the review article in Clinical Infectious Diseases) is vastly higher than the extremely small (maybe one in 1-2 million) chance of anaphylaxis from a vaccine?

It seems that you are either unaware of this, or, more likely, you are aware of it, but choose to wildly exaggerate the minute risk of anaphylaxis from a vaccine, while not mentioning the serious risk of encephalitis and other severe complications from measles and other VAPDs, to further your anti-vax agenda.

Sure, the vaccinating parents shouldn’t stigmatize the unvaccinated children, but there’s no reason for the vaccinated children not to do so. Child-child interactions might be more productive than parent-parent interactions.

Mom, the other kids won’t play with me because they say I haven’t had the vaccine against cooties!

@Lawrence #40: Since you asked, I will answer your question. I understand that others may disagree, but I’m not particularly interested in debating these opinions. I’d rather just agree to disagree.

I’ll assume your asking about areas where I disagree with the current CDC recommendations, not about vaccinations for diseases like smallpox and yellow fever. We didn’t deviate much from the CDC recommendations for our kids although we did insist on the killed polio vaccine back when the live vaccine was recommended.

In general, because the risk of catching the disease can spike overnight in the case of a local outbreak, I find vaccinations worthwhile for easily communicable diseases like measles and mumps. The exceptions would be for relatively mild diseases like the flu or chicken pox (although I did vaccinate my kids for that) because the risk of serious harm from the disease is very low. In those cases, it’s not that the risk of the vaccine too high (they are very safe), but that I don’t consider the risk from the disease to be sufficient to necessarily justify the cost ($ and time) but I don’t object to them and would get them when it was convenient.

I don’t agree with the CDC that newborns need to be vaccinated for Hep B when no one in the immediate family has it. I’m not currently convinced that HPV is worth the risk for boys although the evidence for that is still coming in. Since neither of these are easily communicable diseases, I don’t think they should be required for school attendance nor are they relative to the current discussion about the risk of letting your vaccinated children play with an unvaccinated friend.

@Lawrence (#38). You’re right. And the same type of thinking that leads parents not to vaccinate can lead them to make other poor choices-for example, I bet anti-vax parents would be much more likely to buy raw milk products (which are potentially quite dangerous), or to treat potentially serious illnesses with quackery like homeopathy rather than taking their children to a real doctor.

Anti-vaxxers are usually hostile to science in general.

@Beth-You are wrong. Even previously healthy children can die from the flu. Almost all children who have died from the flu were unvaccinated. Look up the website Families Fighting Flu and read some of those families stories, and you might think differently about the necessity of the flu vax.

As for Hep B, while the risk of a child getting Hep B might be low, why not protect them? There is no way to predict what they might eventually be exposed to, and Hep B actually can be transmitted more easily than many people think. You can get it from sharing toothbrushes or razors, for example.

And the HPV vaccine is necessary for boys. Even if one were to assume that males were not at risk for HPV-associated cancers (they are), vaccinating them would still be needed to protect females. Besides, like I said, men do get HPV-associated cancers, for example, many cases of head and neck cancer are caused by HPV infection.

I had chickenpox as a child. I didn’t consider it “mild.” In fact, it’s one of the few things I remember from that early in my life because it made that much of an impression on me. I was so sick and miserable.

Plus, the varicella-zoster virus doesn’t just go away-it oftentimes later resurfaces as shingles, which is often extremely painful.

Lawrence (#41) writes,

…anaphylaxis has been shown to occur in vaccinations at a rate of less than 1 in 1 million……

MJD says,

Did you notice that the CDC used anaphylaxis as an example of a severe allergic reaction.

Another severe allergic reaction, not mentioned by the CDC, would be vaccine-induced allergies suspected in the etiology of REGRESSIVE AUTISM.

Oh….I wish I had the freedom to speak openly here at RI in the absence of Orac’s auto-moderation proclivity. 🙁

And that’s the reason why you remain in automoderation. The last time I let you out it didn’t take long at all before you were back to your old ways.

…mild diseases like the flu…

I used to think that. Then I caught a case of the flu. Not a bad cold. Not a upper respiratory illness. For darn sure not the ‘stomach flu’.

I had fever. I had chills. I ached, and I ached everywhere. And I did all that for several days straight. Come the second week, those symptoms finally went away, but it left me weak as a kitten for a few more days. I missed almost 2 weeks of work, and, frankly, wan’t much use when I went back.

I make darn sure I get a flu shot now.

There’s a lot of things that get called ‘flu’ that aren’t. But if you or yours ever come down with the real flu, I’ll bet you change your mind about the flu shot.

I used to think that. Then I caught a case of the flu. Not a bad cold. Not a upper respiratory illness. For darn sure not the ‘stomach flu’.

Yep. I got the flu 9 years ago. It was before the flu vaccine was mandatory, and for some reason I foolishly didn’t get it. I think part of the reason was because I was too busy wrapping up my old job in NJ and preparing for a new job in Michigan. In any case, it knocked me on my ass for a whole week. What so many people refer to as “the flu” isn’t really the flu but some mild viral flu-like illness. The real flu is bad. I learned that, and since then would have continued to get a flu shot every year even if it weren’t mandatory for my job.

The “American Loon” ignores the studies and evidence that anaphylaxis has been shown to occur in vaccinations at a rate of less than 1 in 1 million……

He also seems to not understand that ‘rights’ only exist in the context of a government and it’s citizens. I’m not aware of the US government, or any other government on the earth, adopting any policy that restricts anybody’s right “to preach and practice exclusionary measures in an effort to accelerate vaccine continuous-improvement”.

That’s not to say that you can’t have your ‘preaching’ restricted in a private forum, or that you won’t be laughed at for saying silly things.

Let me be specific in where the CDC fails to address the concerns of some vaccine-safety advocates.

A “severe allergic reaction” after a vaccine dose or to a vaccine component is clearly a recognized contraindication. (see comment #31).

The definition of the word “severe” is something bad or undesirable.

Therefore, a “severe allergic reaction” is effectively a bad or undesirable allergic reaction.

In children with atypical immunity, the long-term affects of a vaccine-induced allergic reaction (non-anaphylaxis) are not clearly understood.

In my opinion, the CDC gives the impression that if the vaccine doesn’t temporarily harm you or kill you (e.g., anaphylaxis) it makes you stronger.

Q. When is a vaccine-induced allergic response to beneficial proteins acceptable.

Well, I can speak directly to Chicken Pox, because I just suffered from an incredibly painful, month-long bout of Shingles at the end of last year.

I wouldn’t wish that on anyone & I am extremely happy that my kids are now vaccinated against Chicken Pox.

As for HPV, my boys will also get vaccinated – because women just don’t “get” HPV from nowhere, they get it from infected men. Plus, HPV causes a number of very nasty kinds of Cancer in men too – and the fact that we have another (HepB vaccine was the first) vaccine that prevents Cancer – we should definitely be celebrating.

Oh….I wish I had the freedom to speak openly here at RI in the absence of Orac’s auto-moderation proclivity.

There is a saying amongst us nerds – ‘The Internet treats ‘censorship’ like ‘damage’, and routes around it’.

If you feel that you are unfairly restricted on this blog or any other, you can, for the price of zero dollars, start your own blog, where you will have the completely unrestricted ability to go on at great lengths about any topic you wish, as well as impose any and all restrictions on readers comments you want.

While I do not, can not, and will not speak for our host, I’d go so far as to say he’d probably even allow you to mention your blog here, a time or two at least, because he’s just that kind of guy

@Beth #45: I’m sorry but you are horribly wrong on the flu. Bear in mind, much of what people think of as the flu is simply gastroenteritis. Actual influenza will knock you on your ass. I’ve had it twice . . . both in years I skipped the flu shot, or got it very late in the season (through my own neglect I will admit). Both times I got pneumonia and it took MONTHS for me to recover.

You are also wrong about Hep B. The CDC recommends it because not every other knows whether they’ve had it or not, and because while it is a blood borne disease and can be detected through a blood test, when a person has the active disease it clears so rapidly there are a lot of false negatives. The titer for the antibodies (anti-HBs) show’s you have had it or been vaccinated but doesn’t show if you have a current infection.

That’s why newborns should be vaccinated. The chance of passing this disease along is too serious for a hope for the best attitude. The newborn’s liver is immature and vulnerable.

Boys get HPV as well. Besides the head and neck cancers already mentioned, 90% of penile cancers are caused by HPV (granted it’s a rare cancer but one we could virtually eliminate by vaccinating). In addition, some of the HPV forms that cause genital warts are covered with this vaccine; boys do get genital warts, and on the penis they can cause life threatening urethral obstructions. Nasty stuff.

MJD: the CDC considers vaccine reactions. But they are so incredibly rare to be anything more than a fever and the icks for a day or two, that there is NO reason not to vaccinate on schedule. The benefits so far outweigh the risks as to make your position laughable . . . in fact it’s why we laugh at you and refer to you as the American Loon.

You’re demanding a perfect world. Such a thing does not exist.

@ Johnny (#58),

I’ve been commenting at RI for seven years.

Orac has skillfully and persistently provided a blog site that reaches a substantial global audience.

Thank you Oracmeister!

Panacea (#59) writes,

You’re demanding a perfect world. Such a thing does not exist.

MJD says,

A message to all the children learning how to make a difference:

The perfect vaccine, become a science-based thinker and make it happen.

MJD (#41) wrote: “Another severe allergic reaction, not mentioned by the CDC, would be vaccine-induced allergies suspected in the etiology of REGRESSIVE AUTISM.”
Well, you just confirmed what I already suspected: You are anti-vaccine. No, you are not a “vaccine safety advocate”, you are anti-vaccine.

There is a mountain of evidence indicating that vaccines do not and cannot cause autism. Refusing to accept that evidence makes you, to put it bluntly, delusional.

@Jonas: MJD isn’t *completely* antivax. He just has a bee in his bonnet about latex, which he believes leads to autism in certain individuals. However, in his 7 years, the story of his son’s reaction morphed and changed, so we all rather take anything he says with many grains of salt.

(He claims he’d be fine with vaccines if they didn’t have latex at the top of a vial – which I assume means he’s fine with anything in an ampule)

He’s in moderation because EVERYTHING leads to latex allergies in his comments. No one denies they exist. We do deny that latex sensitivities lead to regressive autism.

And I hope explaining things to you doesn’t put me into moderation hell – not sure how Orac flags things.

Jonas (#62) writes,

There is a mountain of evidence indicating that vaccines do not and cannot cause autism.

MJD says,

Did you mean to say autism spectrum disorders?

Said spectrum-disorder is believed to encompasses numerous dissimilar etiologies.

The subgroup most likely to be affected by vaccine insult, at the moment, is allergy-induced regressive autism.

Please provide the mountain of evidence indicating that vaccines do not and cannot cause allergy-induced regressive autism.

@ Jonas,

Do you work at the CDC?

@ Everyone,

I’m going to politely back away from commenting again in this post.

You all have a great weekend!

And I have to say, MJD’s “theory” is extremely farfetched-even by anti-vaccine standards, which is really saying something….

I wonder if MJD has heard about the studies that have come out in the last few years that show that the brain abnormalities that have been found in people with autism would have been present in utero (thus completely ruling out vaccines as a possible cause)?

My guess is that he has, but he is so convinced that his bizarre theory is accurate that he has ignored them. Anti-vaxxers do not listen to evidence.

Oh, and thanks for clarifying what the “American Loon” comment (Lawrence #41) meant.

125 words per minute – I credit my high school typing class….

i didn’t say the authors were intentionally trying to mount a guilt-tripping propaganda PR campaign. it’s more like their thoughts come through in the research publications that are their… “idiom”. You could say it’s a social science study that’s repressing it’s dreams of being a clever propaganda campaign.

Perhaps I should note I don’t necessarily consider “propaganda” a bad thing. I’m a fan of ‘agit-prop’ creative work, for example…

I see no reason not to include a frank and sensitive discussion with vax-hesitant parents about how un-vaxed children may feel stigmatized by the social isolation they will rightly feel when their peers stay away from them, not knowing whether or not they are disease vectors. To bring that home, you also present them with material on the consequences real-life unvaxed kids (often due to reasons OTHER than antivax) have suffered from VPDs. The Texas Children’s Hospital has and excellent photo-book on this, available online. (ATTN JONAS: This is what you’re talking about, just not in video. It’s good, and an equally strong video would be hard to pull off.)

I hope Beth is not the Beth Clarkson who was in pre-med when I met her.
HPV is not that much of a risk for boys? Someone needs to look up the literature on it, because I think someone hasn’t done their homework.

I had the real flu as a teen. 105 temps for a week and could barely get out of bed. Hurt to even blink my eyes. Been getting flu shots since and wish more people would.

@ Panacea

I left a note for you about talking to the vax averse on yesterday’s thread. Where in Iowa are you headed? It’s not all the same. Take a look at the Texas Children’s Hospital VPD book I noted above. As a general rule of thumb, I’d advise keeping Orac’s description of vax hesitance above in mind:

They have heard scary things about vaccines and are taking what they view as a cautious, reasonable path.

To slightly adjust what Orac says, antivaccine misinformation can sound credible enough that reasonable parents will be concerned enough to worry, and maybe worried enough to ‘take precautions’, seeing non-vaxing as ‘better safe than sorry’. That is, the vax hesitant don’t believe vaccines cause autism, they’re just not 100% sure it doesn’t. (Of course, as Orac notes, the degree of worry and drive toward caution can vary from approachable to almost-gone-to-the dark-side.)

Still, if you gauge you’re not talking to a true anti-vax nutter, you ought to be able to identify and sympathize with the concern low-information parents may pick up from social media and local gossip. The folks spreading this may be friends they otherwise trust, so I’d try to include them in the web of sympathy, too. You can tell the parent something like, “If I hadn’t studied this, didn’t know what I know about science, and heard or read the stuff going around, I’d be worried too. But, you know word-of-mouth goes, and some pretty weird things can just get a life of their own, even though they have no basis in fact….”

I’d probably go on to offer an explanation of why vaccines have become a target of opportunity for fears and frustrations so profound that once some people latch onto the shots as a perfect too-simple scapegoat, they’re never going to let go. But whatever path you take, try to prep the emotional ground before you introduce any info on the science, and then keep that short sweet and pithy.

Yah, back in the dark ages only girls took typing class – they were the only ones likely to touch a keyboard in their careers. Us boys were all in shop class.

MJD, you keep saying, “Again, medical science has failed to eliminate such vaccine contraindications…”

I’m not a doctor, or even very good at science, but smarter people than me have said almost everything (and I’m hedging here) has a possibility of causing a bad reaction.

We can save the horrible, terrible, macro-triggering imperialism of stigmatizing the anti-vax VPD vectors by moving them to a place where they may be among like minds, those who also block vaccinations. That would be the Pashtun areas of Afghanistan and Pakistan. I believe those places also practice organic farming, use no GMOs and are free of chemtrails.

Oh, we’ll explain that there’s an alien time portal at the border and if they return to their point of origin in the USA, they will cause a time aneurysm. So, it’s go go go, no come back. Their irreplaceable indigo uniqueness will be missed

by no one.

Hi, sadmar,

Thanks for the kind words. I appreciate it. I’ll try to keep your suggestions in mind. I am very nervous about this rotation, in part because I’ll be so far from home. I couldn’t find a preceptor in my state, but since I’m licensed in Iowa I looked there and lucked out.

I’ll be in Council Bluffs, across the river from Omaha Nebraska. I have no idea what kind of a community it is. I’ve never been there before.

It really bothered me in my last rotation, dealing with so many families that were really into the alt med thing. I really want to do a good job counseling parents, but I also have to consider where the parents are so I don’t close the door so they don’t hear me at all. That’s something I’m still learning how to do.

It really is different from the regular practice of nursing. I had no idea. It’s been a humbling experience.

Orac: “The measles vaccine is one of the most effective vaccines there is, well over 90% effective after the full series, but even that level of effectiveness still means that a small but significant minority of children vaccinated against measles are not immune.”

And every child before their first birthday. Children under the age of one year old are also unprotected from mumps and chicken pox due to the fact the vaccines for those diseases are not given until after their first birthday. Not to mention that the DTaP series is not completely protective until then.

Won’t anyone think of the babies?

I say because my youngest had chicken pox when she was six months old a full year before the varicella vaccine was available (saying she was miserable would be an understatement, her older brothers also suffered). Now as a grad student, she has a much higher chance of shingles in the next three years.

I do not think well about those who think chicken pox is a “mild” disease.

Orac (from the main article): “… but I always try to distinguish between vaccine-hesitant parents who have fallen under the sway of antivaccine views and the hard core antivaxers themselves, who spread the message. The former can be reached; the latter are virtually unreachable with rare exceptions.”

From my personal experience the latter are also very annoying snooty “better parents than anyone” types. My oldest son had seizures as an infant, so only got the DT instead of the DTP. While our county was having a pertussis outbreak. It was over twenty five years ago, as a direct result of Lea Thompson’s “investigative journalism” and the efforts of Barbara Loe Fisher.

So whenever I went to a new mom/kid group I would ask about vaccine status to protect my kid. I got one woman who proclaimed that her “doctor” said that vaccines were not necessary for her children. She was really obnoxious.

I am sure her kids were perfectly wonderful little beings. If they were stigmatized it was because their mother walked and talked like a big ol’ broomstick went from her posterior all they way up to her snide mouth. No loss in socialization by avoiding that extremely unpleasant person.

# 45 Beth C

I don’t consider the risk from the disease to be sufficient to necessarily justify the cost ($ and time) but I don’t object to them and would get them when it was convenient.

Jesu, you Americans have one insane health care system. Around here you practically have to beat off nurses and doctors armed with loaded syringes whenever you step inside the clinic!

I dropped in for a flu shot last fall and ended up with two shot-up arms. Flu in one arm and Shingles in the other.

Personal cost for vaccination – wave your health card.

Well, this is partially optional since if it has expired or you forgot it, if you are a registered patient and they have your ID and health card number, they just tell you to get the (new) card and come back when you get the time.

@ 49 orac

I spent one Christmas, at about the age of 18, with the blankets pulled over my head and listening to some Nashville basketball game while I had chickenpox. Since a) I don’t live in the USA and b) don’t like or understand basketball you can imagine just how horrible I felt. You have my complete sympathy.

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