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Surprise! Relatively small decreases in vaccine uptake can lead to big increases in vaccine-preventable disease!

Whenever vaccine uptake falls to a level below that needed to maintain herd immunity, the risk of outbreaks of vaccine-preventable diseases climbs. It doesn’t take that dramatic of a decline. Here’s a study that shows how a small decrease in vaccine uptake can lead to a large increase in disease.

One of the most common tropes used by antivaxers is to attack herd immunity as not being real. Herd immunity, or as its sometimes called, community immunity, is a name for a phenomenon in which in a population with high levels of immunity to a disease members susceptible to the disease are protected. Basically, because the vast majority of members of the population are immune to a disease, that disease can’t gain a foothold in the population and lead to an outbreak or an epidemic. Basically, transmission from person to person is interrupted because any susceptible person who becomes infected is surrounded almost completely by people who are immune. Thus, although individuals or small groups of individuals can become infected, in a population where a sufficient percentage of is immune the immune population serves as a “firebreak” on outbreaks, preventing them from spreading too far, protecting both those who are vaccinated and those who are not.

In this day and age, herd immunity is almost always achieved not through natural infection, but rather through vaccination. It’s why public health officials emphasize high levels of vaccine uptake. How effective herd immunity is depends upon how infectious the agent being vaccinated against is, how effective the vaccine is, and what percentage of the population is protected by it. For instance, for a disease like measles, which is among the most contagious of vaccine-preventable diseases for which the vaccine is greater than 90% effective, the percentage of the population that needs to be vaccinated to achieve herd immunity typically from 90-95%.

So why would herd immunity be such a threat to antivaccine beliefs? The reason is simple. It’s another major benefit of vaccines. More importantly, the existence of herd immunity undercuts another favorite antivaccine talking point, which is that, by choosing not to vaccinate their children, antivaxers are not endangering any one and that vaccinated children have nothing to fear from their unvaccinated children, because they are protected. Of course, obviously one problem with that argument is that many vaccines are not 100% effective, which is another reason why why herd immunity is so important.

Sadly, we see evidence of this effectiveness when vaccine coverage falls. Antivaxers will frequently point out that vaccine coverage in a state is at a very high level, and that’s frequently true. However, it is pockets of low vaccine uptake, where vaccination rates fall below that needed for herd immunity in communities where antivaxers are concentrated. But what would happen if vaccine uptake declined nationwide? Well, a recently published study out of Stanford University asked that question. Basically, it was a study modeling what would happen under various scenarios if vaccine uptake. The reason is obvious:

The routine vaccination of children is declining in Texas and other areas of the United States where they allow for personal belief and other nonmedical exemptions to childhood vaccination requirements. In these areas, there is growing vaccine hesitancy—defined as a delay or refusal to accept vaccination based on personal beliefs despite availability— that could accelerate gaps in vaccine coverage across the United States. The determinants of the parental decisionmaking process on whether to vaccinate their child are complex and context specific, but are often influenced by misinformation, false claims regarding vaccine safety, and a low perceived risk of infectious diseases among other factors. While the sources driving vaccine hesitancy (eg, the “antivaxxer” movement, celebrity endorsement, and online content) have historically been outside of science and government, there have recently been calls for a special government commission on vaccine safety, despite overwhelming scientific consensus on the safety and effectiveness of vaccinations. If the panel were to draft policies that relax childhood vaccinations requirements, the already declining trends in vaccination coverage in US children may decline further. The aim of this study was to estimate the potential public health and economic consequences of declining childhood vaccination, a result of a growing vaccine hesitancy movement, using the case example of measles, mumps, and rubella (MMR) vaccination and measles virus.

I’ve written before about declining vaccination uptake in Texas. It goes counter to the inaccurate stereotype of antivaccine beliefs and vaccine hesitancy as being primarily the province of hippy-dippy, granola-crunching lefties in that antivaccine sentiment is driven by a potent mix of pseudoscience and far right libertarian anti-government regulation sentiment. Basically, antivaxers have figured out how to weaponize their views by coupling them to right wing rhetoric about “freedom.” Not surprisingly, Dr. Peter Hotez, a pediatrician and public health researcher at Baylor and founding dean and chief of the Baylor College of Medicine National School of Tropical Medicine in the Department of pediatrics, is co-author on this study.

So what did the investigators do? Basically, they used publicly available data from the US Centers for Disease Control and Prevention to simulate county-level MMR vaccination coverage in children 2-11 years in the US. They applied a stochastic mathematical model, which was adapted to infectious disease transmission. Using the model, they estimated a distribution for outbreak size related to vaccine coverage. The predicted effects of declines in nonmedical exemptions were modeled and validated it against an independent data set from England and Wales.

So what did the model show? Not unexpectedly, with increasing nonmedical exemptions comes increasing numbers of measles cases:

The authors also found:

We found that a 5% decline in MMR vaccine coverage in US children would result in a 3-fold increase innational measles cases in this age group, for a total of 150 cases and an additional $2.1 million in economic costs to the public sector (Figure).With declining vaccination coverage, the size of outbreaks increased. Increased MMR vaccine coverage in children, through elimination of children with nonmedical exemptions or other mechanisms, increased national MMR coverage to95%prevalence (state variation, 91%-98%).We predicted that this strategy would reduce annual cases of measles by 20% (from 48 to 38 cases) and was an effective strategy to mitigate annual measles cases and costs.

Basically, minor declines in MMR vaccine coverage (in this case, from 93% to 88%) can result in major increases in the number of measles cases. Indeed, the authors note that their model, if anything, probably underestimates how much the number of measles cases can increase if MMR vaccine uptake falls significantly:

This modeling analysis likely predicts a conservative estimate for a rise in measles cases associated with declining immunization status because of foundational model assumptions and since we limited our analysis to US children (age 2-11 years). The model is designed to simulate outbreaks in highly immunized population and nonendemic settings. However, large reductions in MMR vaccine coverage could allow for measles to become endemic again, which is not accounted for in this model, and would likely result in thousands of annual measles cases. Owing to constraints on data for immunization status in the adult population and social mixing structures, we limited our analysis to children ages 2-11 years who contribute approximately 30% of the annual measles cases. However, the number of cases of measles would be much larger when accounting for other age groups, such as infants, adolescents, and adults. This increased number would be, in part, driven by infants younger than 12 months who are not yet eligible to receive measles vaccines, as illustrated in the sensitivity analysis modeling an expanded age group (0-11 years). Finally, the upper limit of the prediction interval in the base case analysis demonstrated substantial nonlinearity, suggesting the possibility for large outbreaks due to random chance with small reductions in vaccine coverage.

This is an important point. As is the case now, even with high overall vaccine uptake over a wide geographic area (e.g., the state of California or Texas) there can exist pockets of low vaccine uptake where outbreaks can and do occur. It is not unreasonable to predict that if the overall vaccine uptake for the whole country declines from 93% to 88% there will either be more areas with vaccine uptake low enough to compromise herd immunity or that existing areas of low uptake will have lower uptake still, to the point where it’s way below the level necessary for herd immunity. Then, of course, as the authors point out, the model doesn’t even account for all the vulnerable children, such as those too young to be vaccinated, as was pointed out:

“Outbreaks happen in communities, so we need to zoom in further than just national or statewide statistics when it comes to vaccination rates,” said Maimuna Majumder, a researcher at the Massachusetts Institute of Technology in Cambridge who wasn’t involved in the study.

For example, one recent study in California found county-level measles vaccination rates as low as 70 percent even though the statewide average was 90 percent, Majumder said by email.

Whenever a study or public health official has expressed concern about low vaccine uptake in California, as in during the debate in 2015 over SB 277, the bill that passed into law and eliminated non-medical exemptions to school vaccine mandates in California, antivaxers have keyed in on that one statistic, that statewide vaccine uptake was high. While high average uptake is a good thing, if there are pockets where the uptake is well below herd immunity levels, outbreaks of vaccine-preventable disease become more likely. Fortunately, SB 277 appears to have been working well thus far. In just one year, there are fewer counties with exemption rates high enough to be concerning, and exemption rates overall have plummeted. No wonder antivaxers hate it.

Obviously, this is a modeling study, and a model is only as good as the assumptions used to construction and the data used to generate it. However, the results of this study are in line with what we already know. Decreasing vaccine uptake leads to more outbreaks of vaccine-preventable diseases, more cases, and more suffering among children. (Just look at the Somali immigrant community in Minnesota, where American antivaxers have convinced the Somali community that the MMR vaccine causes autism, resulting in a huge plunge in MMR uptake and the expected concomitant measles outbreak.) Antivaxers will try to deny that, but the evidence is overwhelming that vaccines work and that when antivaccine sentiments take hold children are endangered. If we’re not careful, we could be sliding back towards a time when measles was endemic, as the UK did after Andrew Wakefield published (and publicized) fraudulent science that incorrectly concluded that vaccination with MMR was a risk factor for autism. The UK is only now recovering to the point that it was before Wakefield. If we’re not careful, we’ll be next.

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]

188 replies on “Surprise! Relatively small decreases in vaccine uptake can lead to big increases in vaccine-preventable disease!”

It isn’t rocket science – diseases just need access to hosts. Even a small drop can increase the “chinks in the armor” which allow diseases to be exposed to the vulnerable and enhance transmission…..

I saw a report on that same study on Ars Technica last night. I was wondering how long it would be before Orac blogged about it 😉

You listening, Jay? This is what your “alternate” vaccine schedule is risking. A three fold increase in measles cases with an approximate cost per case of $20,000 that could add millions in additional public health costs to Santa Monica (your taxes will have to go up to cover it).

And that’s not even considering the human costs. Hmph.

The cost numbers also match other studies that looked at costs of outbreaks.

More evidence, if we needed any, that anti-vaccine activism costs us in suffering and costs.

I am skeptical Texas legislators would be affected enough by this, but who knows? The fact that Dr. Hotez is local might help.

Well, the Republican Party claims to be the party of fiscal responsibility.

Allowing the state to bear the burden of the paranoia of a few is not fiscally responsible. And I don’t care what the libertarians say, this is not a personal liberty issue. No one has a right to infect other people.

Oh, Vinu. For a moment I was worried that the BMJ was posting nonsense. But then I checked and saw you were just hawking another of your silly “studies”.

A friend suggested anti vaxers also anti Trump, possibly based on a legislature in Texas supporting anti vax. He and I both retired physicians have suggested it should be a legal requirement for parents to see that their kids are vaccinated.
Certainly should be anti Clinton which is purported to desire national Neal rules,but not a political,party item but a group who don’t trust any medical science and are still seduced by Wakefield, Kennedy, and actors.
In history of U.S. Many splinter medical Groups and confidence men who follow the preacher and like to drink the Gatorade or cool aid..
Would that this discussion could,help those change belief.

@ Vinu (#3),

Thanks for sharing!

I’ve got absolutely no respectful insolence for your work, only curiosity and admiration.

Can someone please explain to me why, if this study is accurate, we don’t have massive measles outbreaks amongst adults who long ago lost any immunity from their MMR vaccination? There are likely millions of adults in the US who are no longer immune to measles, not having had the MMR in well over 20 years, so you would think that for any small measles outbreak amongst kids, like the one in Disneyland, you’d also see many cases amongst adults over the age of 50 whose last MMR shot was likely over 30 years ago?

Wow, he has certainly taken the idea of self-reference to a whole new level….

@MB – because in most people, the MMR does confer lifelong immunity.

The fact that we don’t have large outbreaks shows the efficacy of the MMR.

MJD, did you read the two comments on Vinu’s “paper” that blows his I’ll conceived “theories” out of the water and into the stratosphere? It might moderate your admiration.

Hint – if vaccines cause diabetes, why aren’t we all diabetic? Another hint – anedoctal evidence. Yet another hint – no evidence that egg embryo cells contaminate vaccines. (Writing as one whose brekkies is two eggs on toast!)

Mr. Big @10: That’s an excellent question!
The answer is that immune memory is not the same for all diseases. In general humans make very long lasting immunity to yellow fever, smallpox and measles. In general humans make crap, very short term immune memory to pertussis (whooping cough), both the disease and the vaccine. It’s annoying.

The reason that the common “childhood” diseases were called that in the days before vaccines is that they were most often seen in children because if you got it as a child (and survived) you were very unlikely to get it as an adult.

That’s how the idea of variolation came to be. Before any vaccines there was a process by which a person was deliberately exposed to a mild form of smallpox. They would get the disease, but generally a milder, more survivable form, and then would be protected against it in the future.

It doesn’t work for everyone and every disease, but for the population at large, it does work. That’s why we’re here in the first place.

Thanks for asking!

Right now on Facebook a mom is debating me on the gardisil vaccine and is making crazy claims and getting likes for each crazy claim. I am so disappointed in humanity now. No facts, just emotional plea… then one mother said she only has one child (I only have one child) and will not take the risk… I remind her about Polio. The Disney debacle. She won’t stop!!

My child is fully immunized. I recently had the shingles vaccine and while I had a reaction I would do it again! I was counting the days until insurance would pick it up. I have seen too many people suffer with Shingles. I may still get it, but I know it will be a whole lot easier having had the vaccine than not. I have no idea why these moms are so scared of vaccines. One mom claimed she had over twenty years in the pharmaceutical industry. I wanted to ask, in what position so badly but, I can’t. My child is still connected to these weirdos.

Yeah, vinu what you’ve linked to is no kind of a research study, but a letter to the editor of the BMJ that you managed to get published on their website.

One of the comments on Research Gate to your “analysis” is too delicious not to share:

“I am not suggesting you need to run such experiments for a technical report, but I would seriously suggest that you take time to understand the biology of both vaccinations and type 1 diabetes.”

Helen, it must be very demoralizing, but these people are doing bad research in the extreme wackadoodle corners of the internet. There are many articles (and comments) that demolish their concerns at Science Based Medicine and here. Recommend they look here. Then try to turn it off. But stand firm. Hang in there.

@ Panacea #2

Assuming we take Dr. Jay at his word, I doubt it’s clear from the model what the risks would be if vaccination rates in X percentage of the population were only Y percentage, but only for children below the age at which Dr. Jay “advocates” for kids to get their shots – if the vax uptake was then appropriately high for kids age 3 and older…

We can’t easily gauge the effect of pediatricians vaccinating on a delayed schedule as we can’t just assume their patients would otherwise receive their shots on the recommended schedule. Parents with minor qualms about the MMR might vax on schedule if no doctor is available to recommend and provide the delayed service. However, parents with more qualms about the MMR might not vax at all unless some trusted physician avers “it’s definitely safe if you wait a bit.” If the later outnumber the former, the lax-vaxer pediatrician is actually aiding public health rather than harming it, at least in the short term. That might well be the case in localities prone to becoming anti-vax clusters.

For example, looking at the situation in the Twin Cities, I’d rather have Somali families immunizing their kids late than not at all. Since their freak-out is based on their unfamiliarity with ASD, and shock at having receiving several ASD diagnoses within their community, it would follow that this could be greatly relieved if the shots were delayed until after the age where ASD typically presents – hard to blame the vaccines then.

This does not mean that I’m willing to let Dr. Bob entirely off the hook for the Disneyland outbreak, or even give Dr. Jay a free pass unless/until he can verify that he doesn’t enable non-vaxers and actually succeeds in getting otherwise reluctant parents to go along with immunizing on the delayed schedule. I’m just urging caution in judging any pediatrician who actually adheres to the practices Dr. Jay claims.( It seems pretty clear that Dr. Bob is an anti-vax enabler extraordinaire, handing out bogus medical exemptions and the like….)

Bovine serum albumin (BSA) contaminated vaccines and membranous nephropathy (MN):

In response to:

“Have you considered bovine serum albumin (BSA) contaminated vaccines as the source of both BSA and BSA antibodies in these patients?”

Dr. Du writes:

“That is a very interesting question I never thought about. Immunization of some types of mouse strains (e.g. BALB/c) with cBSA can induce MN-like kidney disease. …”

https://www.researchgate.net/publication/51182667_Early-Childhood_Membranous_Nephropathy_Due_to_Cationic_Bovine_Serum_Albumin?feedback/

Dr. Pinheiro, an endocrinologist, commenting on my MMR/diabetes article:

“It´s very very interesting! The Increasing in type 1 diabetes in children last years must have an ambiental etiology and an etilogy could be antibodies against chicken GAD65 which cross-react with human GAD65.”

https://www.researchgate.net/publication/317127703_Comparative_Pathogenesis_of_Autoimmune_Diabetes_in_Humans_NOD_Mice_and_Canines_Has_a_Valuable_Animal_Model_of_Type_1_Diabetes_Been_Overlooked?feedback/

Increased MMR vaccine coverage in children, through elimination of children with nonmedical exemptions[…]

I wonder if we are soon gonna see antivaxxers posting about the study, with this little excerpt interpreted as a call for a genocide of unvaxxed.

Helen, share where and we can come to back you up.

One other factor where waning immunity in adults would have a different effect on outbreaks to lack of immunity in children is the contact factor.
Most adults have less contact, and less intimate contact, with other people in their daily routine than do children. Children spread germs very effectively. Normal adults not so much, even less in asia where it is considered a good idea to wear a mask.

Good grief – will wonders never cease? MJD (#4) has said something with which I agree wholeheartedly.

*Goes for a lie down*

@Rebecca Fisher: yes, he said something admirable, then went back down his rabbit hole when he complimented Vinu.

@Vinu: Love the cherry picked comments. And the fact that you all go round and pat each others backs on all sorts of theories and don’t so any real research.

@Craig, very true. There are certain circumstances that encourage the spread of disease. Day care, college dorms. Situations that aren’t found in adults. There’s a reason I refer to my young nieces and nephews as “The germ vectors.”

Mr Big: Actually, a lot of adults over 50 had the measles virus, not the shot. There are ways to tell whether immunity has waned, and I think people who work in health care usually have blood drawn to check whether they’re still immune. I’d suggest that should be expanded to adults who work in education and the military.

One of the major vectors of disease up until the ’40s was the military, simply because that’s what happens when you get a lot of people living together for long periods of time who have to share toilets, bunks,meals, do not get a lot of time for hygiene and are constantly under stress.

@PGP: I had the measles. I’ve had the MMR multiple times. I’m one of those lovely people who don’t develop immunity to measles (fortunately, I did develop and maintain a rubella immunity from rubella – but I don’t mind that it gets boosted with the MMR). Also didn’t seroconvert with the Hep B series. My body is weird.

I get titers drawn and the new docs are always surprised…But – but- but – your medical records say you HAD the measles?? Yup. I depend on herd immunity. Thank you to everyone who seroconverts and protects me.

@PGP
Good point on testing education staff. The military probably not so much. New recruits get a shitload of vaccines which should cover any ‘waners’.

MIDawn: Yes, I remember you mentioned that you have no immunity to measles. But most people do seroconvert. I recently had a blood test (I have anemia, and HIV screening is now mandatory, so I figured as long as I was there, might as well get tested for everything.) Next time I have a blood test, I might get my titers checked. Though my Mom and Dad both have measles immunity and I had all my shots.
But it can’t hurt to double check, especially now that the Niblet is around.

Good grief – will wonders never cease? MJD (#4) has said something with which I agree wholeheartedly.

Aside from the incoherent (“herd immunity”) and off-topic parts, I take it.

On MJD (#4)
Actually, I don’t understand what transgenders have to do with herd immunity. Being transgendered isn’t contagious.

Perhaps it’s my lack of unsterstanding of English, but the post doesn’t make much sense at all.

@Renate, it’s a reference to a news story that broke yesterday.
The Orange-haired, small handed pussy grabber has decreed that transgender individuals will no longer be allowed to serve in the U.S. military. This despite the fact that transgender people before undergoing transition, are disproportionately likely to enlist.

Re MJD’s post — leaving out the fact that it’s another obvious hijack attempt on his part, I think we all agree with it.

Perhaps it’s my lack of unsterstanding of English, but the post doesn’t make much sense at all.

Trust me, your command of English is better than MJD’s.

Helen Hollis – hang in there and keep debating the anti-vax mommies. You may not change their minds, but your comments will be out there for others to read, and a few people who are wavering about the value of vaccination may well be convinced by your words.
As for the shingle vaccine, everyone should have it. My husband had shingle three months ago; he was very ill for a week and is still suffering with nerve pain and general weakness. So, in my experience, the vaccine is well worth it.here in the UK, it’s only availble to those aged 70-80. I have some time to go before I’m eligible, but I’ll be waiting at the surgery door the day after my 70th birthday!

Helen: let me add to Mrs. Grimbles encourgement. You won’t change the minds of BSC people. But you may change the minds of people who haven’t made them up yet. I have had people tell me they would have fallen for anti vax nonsense if I hadn’t explained how the immune system works to them.

Vinu: that a couple of people might be thinking of a potential hypothesis based on a question you asked is not a ringing endorsement of your nonsense. Once these people sit down and read the literature, they’re going to figure out its nonsense. Neither of those folks have any expertise in immunology.

PGP: nursing students have to show documentation of vaccination prior to starting nursing school. If you don’t have your vaccination records, you can provide a titer as proof of immunity.

My mother lost my vaccination records at some point. Proof of immunity was not required when I first went to community college in 1983 because it was assumed if you graduated high school you were up to date. By the 90’s, vaccine uptake had dropped due to the DTP scare, and outbreaks of vaccines preventable diseases had nursing programs a bit more cautious. When I went back for my RN in 1994, I was asked for records I no longer had, and got a titer which proved my immunity (I keep that lab record and have used it multiple times since as proof of immunity).

MI Dawn: I also have not sero converted to the Hep B series, which I’ve had twice. One employer wanted me to get it a third time, and I signed the waiver after that. I don’t see the point of getting a vaccine I know won’t take. If at some point an employer DEMANDS I get the series, I’ll either have to get a letter from my doctor or do the series again . . . which of course will more likely than not fail again. But I’ll do it to keep my job.

Honestly, I don’t understand my co workers who wear a mask for six months out of the year rather than just getting the damn flu shot. So you might, I repeat might, get the icks for a couple of days. Still better than the mask.

Mrs. Gimble (# 37) writes,

I have some time to go before I’m eligible, but I’ll be waiting at the surgery door the day after my 70th birthday!

MJD says,

Hope your husband is fully recovered from the Shingles.

About getting the shot, tell them that you believe your “true” date of birth was at conception and maybe they’ll give you the shot ~ 9 months earlier. 🙂

Just trying to help!

Panacea–I got tired of wearing a mask so I get the flu shot. I also certainly have nasal carriage of many pediatric-office viruses which I bring into nurseries and NICUs in spite of that one rather ineffective but harmless flu vaccine. Therefore, when I do have a baby in the NICU, I will always defer to the neonatologists’ daily exams and I avoid touching that baby myself. (All my other vaccines are, of course, up to date.)

Your post #38 is really filled with cognitive dissonance. There will soon be a third MMR recommended/required for those who don’t convert after the first two. You should get that third Hep B series. I will waive the requirement for a smiley face icon here.

“In this day and age”–Orac . . . wow. I am in the midst of doing a completely hypothetical, retrospective and prospective study showing that a 5% decrease in studies like the one cited here will lead to nearly a 32% increase in fact-based decision making. I’m very disappointed to see you discussing this paper. Anyone who doesn’t already believe that herd immunity is important is a clown and will not be influenced either by Hotez, et al or by you.

No cognitive dissonance here, Jay. In spite of my working in health care, I’m actually pretty low risk since I don’t work directly in care delivery anymore. I don’t start IVs much these days, I rarely give injections. I supervise my students doing those things. Once I become an FNP, I might be at a slightly higher risk, but still less than you’d think.

And regardless of my actual risk, if the medical literature were to suggest a third series would be advisable, I’d probably get it. But it doesn’t show that, to my knowledge.

MMR on the other hand, is a disease with potentially deadly consequences. It’s a vaccine everyone should get but there are still rare people like MI Dawn who will never sero convert. If there’s evidence a third shot would reduce even those incredibly low numbers, and I didn’t sero convert after two, then I’d go for the third without complaint. But if it still didn’t work (and as MI Dawn points out, she HAD measles and still isn’t immune) well, that’s why herd immunity is so important.

I am allergic to tetanus. When I got a booster in 2003 after I got cut pulling an unresponsive patient out of a trashed motor vehicle, my entire left upper arm became very red and swollen, and the injection site blistered. In 2013, the local hospital required a pertussis booster for everyone who worked in the hospital, including nursing students and me, the instructor. We were in the midst of a local outbreak of pertussis, you see.

I couldn’t find pertussis by itself. The pediatricians only had the DTaP. The health department didn’t have it. My doctor wasn’t sure he could get it, and he said it would be expensive and probably not covered by insurance even if he could get it.

He suggested putting me on a course of prednisone and Benadryl to protect against a possible allergic reaction from another TDaP, and I agreed. Because the plan made sense, and a booster was in my best interest anyway.

I could have gotten out of it btw. All I had to do was wave the ADA and demand reasonable accommodation. I didn’t do clinic at the hospital in question, you see. I always did clinic at another hospital that wasn’t asking for a TDaP booster. My manager wanted everyone to get it in case she needed me to go to that one hospital.

Nice try, Jay, but FAIL.

And while the flu vaccine could be better, I get it every year without fail . . . because the last two times I either didn’t get it, or waited until too late, I got the full blown full flu: fever 103 F, aches, chills, the whole nine yards, and both times I got pneumonia and was sick for WEEKS.

Never. Again.

Recently on Barfblog.com there was a story concerning an anti-vaxxer group who lied to a school board about talking about organic fruits. Instead they showed an anti-vaccine video (article didn’t say which one). The AVers are stooping pretty low to get out there message. It appears they maybe in trouble legally also.

Rich –

“The Courier Mail reports that the Miami State High School was deceived by the anti-vaccination activists, which is a common tactic:

ORGANISERS of an anti-vaccination documentary screening have allegedly tricked a Gold Coast state school into showing the film after telling officials they were running a seminar on organic vegetables.

The Gold Coast Bulletin also reports the deception by the AVN and Vaxxed:

ANTI-vaxxers ‘tricked’ a Gold Coast school principal in order to spread their inaccurate documentary, says a fuming Premier Annastacia Palaszczuk.

Premier Palaszckuk today slammed the lobbyists for misrepresenting the true reason for the meeting.

“My initial advice is that there has been misrepresentation from that organisation to the school in question, where they conveyed to the principal that it was to be conveying information about organic produce.

The ABC has also reported the deceit:

A Gold Coast principal was hoodwinked into hiring out his school hall for a screening of a controversial anti-vaccination documentary, Queensland Premier Annastacia Palaszczuk says.

“My preliminary advice is that there has been some misrepresentation to the school in question,” Ms Palaszczuk said.

“They conveyed to the principal that it was to be conveying information about organic produce.”

https://reasonablehank.com/2017/07/26/queensland-public-high-school-hired-out-by-antivaxers-to-show-antivax-film/

Mikema: New recruits get a shitload of vaccines which should cover any ‘waners’.

My bad. Other people have mentioned that, but I forgot it. Although I suspect I nailed the reason for the ‘shitload’ of vaccines.

Panacea: Yup. My mom’s a nurse, and works with high-risk patients, so she had to do both.

Jay Gordon: All my other vaccines are, of course, up to date.
Sure they are, Mr. I-don’t-give-the-MMR.

@ Renate

MJD isn’t saying transgenders in general have anything to do with herd immunity. His analogy is between military service and herd immunity. Within herd immunity, we count on everyone to protect the community as a whole. We don’t harm the community by excluding people we just don’t like from participating in this protection. In his analogy, MJD is framing military service as also a form of community protection. Thus, excluding willing individuals from service because they’re transgendered is as counter-productive as it would be to prevent guardians from getting their kids vaccinated because they happen to be transgender.

So i wouldn’t say the post doesn’t make sense, but that the sense it makes is rather outre, or stretched, or idiosyncratic. It seems to involve a very uncritical view of the U.S. military, but that’s par for the course in discussing any social policy within the military, and within those brackets I wouldn’t say MJD is totally wrong in the comparison…

At one of the hospitals where I’m on staff (and where health care workers are required to get flu shots to protect patients), one of the lab employees used to wear a mask all through flu season rather than get the flu shot. I can’t imagine how people can stand doing that all day long out of fear or as a protest mechanism (there are of course exemptions for those with valid medical reasons).

Jay Gordon: “Panacea–I got tired of wearing a mask so I get the flu shot.”

Good for you. Our recalcitrant lab employee finally got fed up too and decided it was better to get the shot.

“Jay Gordon: All my other vaccines are, of course, up to date.
Sure they are, Mr. I-don’t-give-the-MMR.”

PoliticalPig–I give the MMR. My vaccines are up to date.
And, don’t call me a liar or I’ll call you a

@JustaTech

I don’t think the current measles vaccine gives lifelong immunity. The CDC requires two MMR shots, so that would mean one shot does not lead to lifelong immunity. The CDC is silent in regards to the length of immunity after the second shot as far as I can tell.
As well, there are many adults who got the measles vaccine in the mid 60s, which didn’t work, but didn’t get natural measles either. Therefore they should not have any immunity to measles unless they’ve been vaccinated twice since with MMR which is unlikely. In Canada, the two doses of MMR wasn’t implemented until 1996, so anyone vaccinated prior to that in Canada is likely no longer immunized. You’d think we’d see many adults that received the ineffective measles vaccine, or were vaccinated in Canada prior to 1995 catching measles from measles outbreaks, yet we don’t, at least not like you would think given how contagious it is. Puzzling.

Panacea—My comments were unnecessarily snarky. If you work with needles, even occasional IVs and injections, Hep B is an important vaccine. I consider it more important than the MMR but that’s open to debate.

Decades ago, there was a single pertussis vaccine (whole cell) and the demand was very small so manufacture stopped. We need it back again because, like you, some people develop adverse reactions to tetanus vaccination.

I need to change my “name” to “Totally Traumatized”! Went to corner store for ice cream and there was a SUV with a big decal on the rear window “The biggest lie in history is that vaccines are safe and effective.”

I’m poleaxed! Never saw that before.

PGP #28

Back in the Good Old Days of the Spanish War and the AEF, people loved to talk about the hardiness of the good old frontier boys and their superior marksmanship – having grown up on shooting down bears and coyotes and Indians – but the Army quickly learned to quarantine such regiments in barracks until anyone who was going to die from one or another common ailment died and stopped being a burden to the organization.

#48 Mr. Big:
CDC supplied info on measles vaccine:
https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html#vaccines

“Duration of Immunity
lifelong

vaccine-induced immunity appears to be long-term and probably lifelong in most persons. “

.
.
Note it was only the 1963 killed vaccine that was ineffective and there has been live attenuated vaccine produced since 1963 (Edmonston B) followed by the live further attenuated Schwarz strain in 1965, finally settling on the live more attenuated (Moraten) Edmonston-Enders strain in 1968.
https://explorevaccines.wordpress.com/2011/04/03/name-that-strain/
and:
https://www.cdc.gov/measles/about/history.html
.
There aren’t a lot of folks wandering around who haven’t been infected with wild measles or haven’t received at least 1 dose of a live attenuated vaccine.

Robert I Bell: Back in the Good Old Days of the Spanish War and the AEF, people loved to talk about the hardiness of the good old frontier boys and their superior marksmanship – having grown up on shooting down bears and coyotes and Indians – but the Army quickly learned to quarantine such regiments in barracks until anyone who was going to die from one or another common ailment died and stopped being a burden to the organization.

One of the more interesting features of the Spanish Flu was the more robust your immune system was, the more likely you were to die. As far as the ‘robustness’ of the fighters of the Spanish War go, no one ever remembers that Theodore Roosevelt was actually fairly sickly for most of his early life.

Jay Gordon: Oh, stop it. You were a lying misogynist snake a few years back and you’re still a lying misogynist snake. You think a few glib quips will make people forget your history. Doesn’t work on me, jerk. I still remember the time you went after Lilady, and the internet never forgets.

Maybe you give the MMR now, probably not.But you only give it because you were pressured to, not because you made the decision on your own. And even now, you’re still willing to risk your patient’s lives by waiting three years. I don’t even know why you became a doctor. Helping people is the last thing on your mind. You should have been a mercenary.

Therefore, when I do have a baby in the NICU, I will always defer to the neonatologists’ daily exams and I avoid touching that baby myself. (All my other vaccines are, of course, up to date.)

1. …and the neonatologist somehow has magically different nasal carriage than you? C’mon…lame excuse. If you want to examine a baby then (a) don’t be actively sick, (b) don’t pick your nose, and (c) wash your damn hands well before doing your exam.. You do understand germ theory, don’t you?

2. Defers to neonatologist’s exam because: (a) won’t get paid by insurance anyhow for doing his own exam in NICU, and (b) probably won’t get paid by family for cash-pay billing for NICU exam, and, (c) NICU infants are almost always never old enough to examine for the purpose of telling parents they don’t have to vaccinate based on his own personal experience which trumps all science.

@Mr Big #48:

I don’t think the current measles vaccine gives lifelong immunity. The CDC requires two MMR shots, so that would mean one shot does not always lead to lifelong immunity.

FTFY. And it doesn’t matter what you think (or more correctly, want to believe). What matters is what the evidence says. And given that adults vaccinated as children don’t get measles, it works.

As well, there are many adults who got the measles vaccine in the mid 60s, which didn’t work…

There is a difference between less effective and completely ineffective. That early measles vaccines were less effective than later ones doesn’t mean they were ineffective.

You’d think we’d see many adults that received the ineffective measles vaccine, or were vaccinated in Canada prior to 1995 catching measles from measles outbreaks, yet we don’t, at least not like you would think given how contagious it is. Puzzling.

See comments above about less effective vs ineffective. In addition, community immunity is very good at preventing measles from jumping to immunologically naive patients.
TL:DR You are just another antivaxxer downplaying the effectiveness of vaccination as a tool to stop disease and using tactics and tropes we’ve seen and refuted literally dozens of times before.

@Rich & @shay,
Just for clarity, the ‘tricked high school’ was in Australia (not Florida) and they (of course) showed Vaxxed.

The Vaxxed morons seem to be having difficulty booking venues. (Yeah!) In some cases ticket holders don’t know the venue until 2 hours before the showing to reduce protests.

I love how anti-vaxers try to claim that the MMR isn’t effective by waving their hands & making all sorts of assumptions – yet Rubella, for instance, has been eliminated from the Western Hemisphere, and a country like Mexico has as close to ZERO measles cases as you can get (and the US, despite a population of more than 300 Million people, has no endemic transmission of measles either).

So, what’s their explanation for this? Well, to them, it couldn’t possibly be that we have a highly effective vaccine & still an extremely high rate of vaccination as well……as opposed to say, Europe, where, in some countries, vaccination can be spotty – resulting in epidemics of tens of thousands of cases.

Jay Gordon: “Decades ago, there was a single pertussis vaccine (whole cell) and the demand was very small so manufacture stopped.”

How many decades ago are we talking about? The DTP vaccine was licensed for use in 1949.
I doubt vaccination safety will be enhanced by employing a whole-cell pertussis vaccine which kids would presumably receive on a separate visit to the pediatrician ($$ from the additional office visit might look attractive to certain peds, and could be sold as lowering the Vaccine Toxin burden as compared to the combined vaccine).

@Mr Big: In case you missed it *I had the measles*. The holistic, honest-to-goodness “you’ll get lifetime immunity if you get this” measles as a child. I also got (because my grandfather was a GP and strongly believed in vaccines) every form of vaccine that came down the pike (recommended for regular patients, not things like yellow fever) while he was in practice. (He SAW all the horrible things that can happen to kids/families with VPDs so he was strongly pro-vaccine. We also had autism in our family BEFORE vaccines expanded beyond smallpox).

I don’t seroconvert. My MD thinks I *may* be OK if measles breaks out here even without a MMR, but I’d much rather not take that risk at my age. And, like Mrs Grimble, I’m counting the years till I can get the shingles vaccine, which is 60 years old here in the US

@Lawrence: and, of course, neither the US nor Mexico have areas where there are lots of poor people living in slums with lousy diets, bad water, poor food and shelter like those *OTHER* countries that have horrible measles outbreaks with deaths….oh wait….
(/sarcasm, just in case it’s missed)

#55 Julian Frost said, “There is a difference between less effective and completely ineffective. That early measles vaccines were less effective than later ones doesn’t mean they were ineffective.”
Yep… and the live attenuated vaccines weren’t even less effective. In fact the 1st one was more effective but caused more unwanted side effects (fever, rash) than the later versions… kinda’ like the whole cell pertussis vaccine vs. the acellular pertussis vaccine.
.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1227617/pdf/amjphnation00076-0075.pdf
EDMONSTON B AND A FURTHER ATTENUATED MEASLES VACCINE-A PLACEBO CONTROLLED DOUBLE BLIND COMPARISON
George Miller, M.D.; et al.
Aug. 1967
Note seroconversion rates of the various vaccines – Table 5, page 1337:
“Edmonston B – 97.6% seroconversion
Further attenuated (Schwarz) – 95.8% seroconversion”

.
No surprizes. The less attenuated Ed. B invoked a stronger immune response than did the further attenuated (further weakened) Schwarz strain – see Fig 2.
Both provided very good seroconversion rates and titers so anyone vaccinated with them that did seroconvert is probably immune for life.
.
So much for the anti-vax trope that there are huge quantities of older and elderly who are not immune to measles because of the ‘poor performance’ of the 1960s vaccines.

My sister doesn’t seroconvert for chicken pox, and three people in my immediate family have had shingles (my dad, and my maternal grandparents). Fortunately, I’m adopted, so probably not susceptible to that myself, but I really wish I could get the shingles vaccine early anyway. My sister has had chicken pox twice and has been vaccinated three times, no results.

I also know someone who is naturally immune to smallpox. She also lived through the 1950 influenza epidemic that killed two of her brothers within three weeks of each other. (She was also the only surviving child of a set of triplets, so she is an only child who should have been one of five.) And she was born during WWII in southwestern Ontario, Canada, so we’re not talking about the 19th C. here, or someone who lived in a developing country or something.

I was in the cohort that got a possibly-defective measles vaccine here in Canada, so a couple years ago I got revaccinated. I came down with bronchitis a few days later, but I don’t think it was related, although I wondered at the time.

Since children have started getting immunised routinely for HiB, I no longer get horrible sinus infections that go from nothing to catastrophic in a matter of hours and spread like wildfire to my ears, throat, and chest. That used to be an at least semi-annual thing for me, and nearly killed me when I was in graduate school in 1999, since it turned into pneumonia along with the sinus, ear, and throat infection. I can’t prove those two things are related, but I feel they are. Theoretically, HiB is supposed to be one of those things you only get once, but…

Re: “neither the US nor Mexico have areas where there are lots of poor people living in slums “. From what I read, Mexico has 97% vaccination rate for measles and similar rate for other diseases. They keep track of every child, and if a child is late, then the nurse visits the home and vaccinates the kid right there. If parents are at work, the nurse does it anyway then leaves paperwork with a babysitter. Nurses visit slums as well.

@kitty: that was my point. Mexico (and the US) have some horrible social problems in some areas. But with high levels of vaccinations, those children aren’t dying of measles like we see in other countries.

@Julian Frost
“FTFY. And it doesn’t matter what you think (or more correctly, want to believe). What matters is what the evidence says. And given that adults vaccinated as children don’t get measles, it works.”

Whoa, a little pedantic aren’t we? Lol…Sorry if I said “I think” instead of “the evidence presented by CDC vaccine researchers…blah, blah, blah”. What are you, a first year med student or something? Lighten up there pal.

“There is a difference between less effective and completely ineffective. That early measles vaccines were less effective than later ones doesn’t mean they were ineffective.”

Sorry, but I was quoting directly from the CDC page which states that the measles vaccine from that era “was not effective”, so you are, in a word, wrong.

“This recommendation is intended to protect those who may have received killed measles vaccine, which was available in 1963-1967 and [b]was not effective[/b].”

If you are going to play Mr Pedantic, perhaps you should check your own facts before making a fool of yourself. Or not.

“TL:DR You are just another antivaxxer downplaying the effectiveness of vaccination as a tool to stop disease and using tactics and tropes we’ve seen and refuted literally dozens of times before.”

Off your paranoid delusional meds again?

@Mr Big #65, whom I suspect is Travis:

Sorry, but I was quoting directly from the CDC page which states that the measles vaccine from that era “was not effective”, so you are, in a word, wrong.

I notice that you didn’t link to this CDC Page in any of your comments. Link, please.

Off your paranoid delusional meds again?

This, Travis, is why you keep getting caught out.

Sorry, but I was quoting directly from the CDC

O RLY? You mean this? Let’s review your comment, shall we?

I don’t think the current measles vaccine gives lifelong immunity. The CDC requires two MMR shots, so that would mean one shot does not lead to lifelong immunity. The CDC is silent in regards to the length of immunity after the second shot as far as I can tell.
As well, there are many adults who got the measles vaccine in the mid 60s, which didn’t work, but didn’t get natural measles either. Therefore they should not have any immunity to measles unless they’ve been vaccinated twice since with MMR which is unlikely. In Canada, the two doses of MMR wasn’t implemented until 1996, so anyone vaccinated prior to that in Canada is likely no longer immunized. You’d think we’d see many adults that received the ineffective measles vaccine, or were vaccinated in Canada prior to 1995 catching measles from measles outbreaks, yet we don’t, at least not like you would think given how contagious it is. Puzzling.

Where is this “quoting directly” part? This?

As well, there are many adults who got the measles vaccine in the mid 60s, which didn’t work, but didn’t get natural measles either.

“If you received a measles vaccine in the 1960s, you may not need to be revaccinated. People who have documentation of receiving LIVE measles vaccine in the 1960s do not need to be revaccinated. People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown type should be revaccinated with at least one dose of live attenuated measles vaccine. This recommendation is intended to protect those who may have received killed measles vaccine, which was available in 1963-1967 and was not effective.”

How many, Chuckles? Would a picture help?

One blessing of multiple chronic health issues: my PCP uses the ones he can to let me get shots early. Trying to remember if I was able to get the shingles vax yet. I know I did all the pneumococcal ones.

Here we go:

In March 1963 the first two measles vaccines were approved for use in the United States: a live vaccine produced by Merck (Rubeovax) and a formalin-inactivated one produced by Pfizer (Pfizer-Vax Measles–K).[7] In September 1963 the US Surgeon General Luther Terry published a statement on the status of measles vaccines.[8] The live vaccine had by this time been given to some 25 000 people in the United States. A single dose produced an effective antibody response in more than 95% of susceptible children—a response that trials had shown persisted for at least three years. Although 30% to 40% of these children showed signs of temporary high fever and a rash after vaccination, side effects could be reduced by coadministration of γ globulin. The inactivated vaccine was generally administered, in field trials, on a three-dose monthly schedule. Although this produced no side effects, antibody levels were lower than with the live vaccine, and it was not known whether they persisted beyond six months.[9] A combined schedule had also been tried. If a dose of inactivated vaccine was given a month or so before the live vaccine, reactions caused by the live vaccine were greatly reduced. The surgeon general recommended that children without a history of measles be immunized at approximately aged nine months.[10] There seemed to be no reason to begin a mass immunization program; the decision to immunize could be left to individual medical practitioners and parents.

The situation in the early 1960s was thus that live attenuated vaccines appeared to offer long-term protection against measles. Their side effects, however, were a matter of concern, and attempts to develop further attenuated, less reactogenic strains continued. (The Schwarz strain would be licensed in 1965, and Merck’s more attenuated “Moraten” strain in 1968.) Inactivated vaccine produced no side effects, but it was unclear whether it could provide protection of adequate duration. If protection was of too short duration, there was a risk of measles infection being postponed to an older age, when its effects could be more serious.

@Julian Frost
Sorry, here you go.

http://bfy.tw/D6mv

Didn’t realize you were so inept at this interwebz stuff. I should have known based on your mostly fact-free posts. My bad.

^^ Risky click of the day, Mr Big. Why the link shortener??? Without letting the site run scripts (Noscript is your friend, people), it looks like dodgy garbage…. It is *imgtfy.com* and it looks like a site to show people how to ‘Google’ like your five years old.

Mr Big, #72: Julian asked for a link to the source you used, which you claim to be CDC. You responded with a LMGTFY link for a sentence entirely different from the one you had uttered and attributed to CDC.

Are you too inept at this interwebz stuff to give a link to your source, or are you expecting Julian search through all the CDC pages to try to divine the one you used? I understand it’s easier for you that way, since when Julian finds your quote to have an entirely different meaning when placed in context, you can reply that it’s the wrong guess on his part.

That’s why citations are required when claims are made.

Thank you Tim and Se Habla Espol.
@Mr Big #72, when I asked for a Link, I meant a link to the actual Page on the CDC Website you claimed you were quoting from. Posting a link to LMGTFY is not proof.

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