Articles

Pockets of Vaccine Noncompliance in California

The LA Times recently published their analysis of data provided them by the state of California and found that there are pockets of high rates of exemption from vaccines among kindergarteners. In the US public schools require that all children receive the recommended vaccines. However, states can allow exemptions for the religious beliefs of the parents.

Over the years anti-vaccine activists have been successful in many states in expanding the rules for exemption. In California, for example, parents may seek excemption if they have “philosophical” objections to vaccines – which means there really isn’t any criteria beyond the parent’s wishes. The anti-vaccine movement has been active not only in pushing for the weakening of vaccine requirements but also in teaching parents how to use the laws to evade vaccination for their children.

The LA Times found that, while state wide the exemption rate was only 2%, exemptions were largely clustered in certain schools. They report:

In all, more than 10,000 kindergartners started school last fall with vaccine exemptions, up from about 8,300 the previous school year. In 1997, when enrollment was higher, the number of exempted kindergartners was 4,318.

and

At Ocean Charter School in Del Rey, near Marina del Rey, 40% of kindergartners entering school last fall and 58% entering the previous year were exempted from vaccines, the highest rates in the Los Angeles Unified School District.

Herd Immunity

These numbers are concerning because they threaten herd immunity – when about 90% of the population is vaccinated then there are not enough vulnerable hosts to spread an infection efficiently, so outbreaks are uncommon. When vaccination rates drop significantly below 90% then herd immunity is lost and infectious diseases can spread, resulting in outbreaks.

This is not mere theory – it happens. In the UK fears that the MMR vaccine was linked to autism (even after the original research by Andrew Wakefield was exposed as wrong, subject to undisclosed conflicts of interest, and maybe even fraudulent, and later evidence confidently showed no link between MMR and autism), led to a precipitous drop in the rates of MMR compliance. The UK does not mandate vaccine for entry into public schools, so they lacked the buffer (for what it’s worth) that exists in the US. As a result there was, and continues to be, a resurgence of previously controlled diseases, like measles.

The later scare that the mercury-based preservative thimerosal could be linked to autism has had a similar effect, and such fears rapidly spread to the US.  This link too has been shown to be false, and in any case thimerosal was removed from the childhood vaccine schedule by 2002, but the this has not stopped the anti-vaccine movement from spreading unwarranted fear.

The result was not as quick or dramatic as in the UK, probably because of the public school vaccine mandates, but still pockets of low vaccination rates are already leading to measles and mumps outbreaks on this side of the pond.

The loss of herd immunity affects more than just the children whose parents decided not to vaccinate them. No vaccine is 100% effective, and some children have medical contraindications to vaccinations. These children would also be at risk from those who chose not to vaccinate. Also, the public at large pays the price as previously eradicated diseases make their way back into the population.

Skeptical of Mainstream Beliefs

The LA Times reports that the schools with high rates of vaccine exemptions tend to cluster within affluent schools. They report:

At Ocean Charter School in Del Rey, near Marina del Rey, 40% of kindergartners entering school last fall and 58% entering the previous year were exempted from vaccines, the highest rates in the Los Angeles Unified School District.

Administrators at the school said the numbers did not surprise them. The nontraditional curriculum, they said, draws well-educated parents who tend to be skeptical of mainstream beliefs.

“They question traditional knowledge and feel empowered to make their own decisions for their families, not deferring to traditional wisdom,” said Assistant Director Kristy Mack-Fett.

There is a great deal of overlap between such attitudes toward vaccines and those of some alternative medicine proponents.  Such attitudes do not reflect true skepticism, which is based upon a respect for logic and evidence. Rather it appears to be a countercultural philosophy – the rejection of ideas not because they lack value but because they represent the mainstream.

This is a knee-jerk “tradition = bad, conventional wisdom = worse” reflex which does not serve these parents or their children well. It is also, I should point out, a logical fallacy – a type of ad hominem reasoning that claims that conventional wisdom is wrong simply because it’s conventional.

Mack-Fett also gives the “empowerment” argument, popular among the promoters of so-called alternative medicine. This is a populist fallacy that counsels the rejection of expert consensus regarding the complexities of science and evidence and tells parents to rely instead on their own knowledge. Of course, this is often being counseled by those who are simultaneously giving gross misinformation.

To be clear, I think that adults should have the right to make health decisions for themselves, and they have a limited right to make decisions for their children (until it conflicts with the state’s duty to protect children from abuse and neglect). Freedom is not the issue. The issue is whether or not it is good practice to pay appropriate consideration to the careful and transparent recommendations from experts or instead to rely upon dubious sources or the vagaries of information on the internet.

Affluent parents, and really most parents today, have been lulled into a false sense of security by the successes of the past. Parents today have never known polio or measles outbreaks, so they downplay their significance. The LA Times again:

“As a parent, I’d rather deal with my kid dealing with measles or mumps and sit with them in a hospital . . . than taking your chances on a shot and having irreversible effects,” said Kim Hart, a mother of two in San Clemente.

I have news for Ms Hart – death is irreversible. Measles can sometimes lead to death. It can also cause other serious and irreversible consequences. What Hart and many parents like her demonstrate is profoundly misplaced fear based upon systematic misinformation. The evidence is clear and overwhelming – the risks from vaccines, while non-zero, is statistically tiny, while the risks from the diseases they prevent is significant and well documented.

Conclusion

As others have already pointed out, what this means is that California is the likely location of future outbreaks of measles and other vaccine-preventable diseases.  We are likely to face at least several years of outbreaks from the damage to the vaccine program that the anti-vaccine movement has already done. If they continue to make inroads into the public consciousness they are likely to do far more damage.

The antivaccine activists deserve unmitigated blame for the death and disease that results from their campaign of fear and misinformation. It is frustrating that as the scientific evidence mounts to show that vaccines are not linked to autism, the antivaccine crowd becomes more and more vociferous. Loudness does not count in science, but it can have an effect in the public arena.

Posted in: Vaccines

Leave a Comment (236) ↓

236 thoughts on “Pockets of Vaccine Noncompliance in California

  1. weing says:

    The hubris of the ignorant wealthy knows no bounds. I wonder if these activists can be sued for wrongful death or disability due to having one of these preventable diseases.

  2. durvit says:

    Identification and characteristics of vaccine refusers (pdf )March 2009 (US: West Coast and Mid West groups).

    The reasons for parents to refuse to have their children vaccinated ranged from religious beliefs to, increasingly, a fear of adverse reactions to certain vaccinations. A recent study showed that the most common reason stated for refusal (190 [69%] of 277) was concern that the vaccines might cause harm.[2] Parents who refused to vaccinate their children were significantly more likely than parents of vaccinated children to report low perceived vaccine safety and efficacy, a low level of trust in the government, and low perceived susceptibility to and severity of vaccine-preventable diseases. Parents who refused specific or all vaccinations for their children were significantly less likely to report confidence in medical, public health, and government sources for vaccine information and were more likely to report confidence in alternative medicine professionals than parents of vaccinated children…

    Because of the important public health implications involved, it is important to understand characteristics of children who refused to be immunized. Our results show that refusers had not opted out of health care system but continued to participate in it. There are opportunities at regular clinic visits to provide information to refusers to influence vaccine attitudes. Our findings suggest that interventions may be implemented at clinics to improve immunization compliance and long-term follow-up with this subgroup of children. Since parents of refusers are from well educated communities, interventions should target these communities to communicate the most up-to-date research on vaccine adverse events and the consequences of vaccine preventable diseases.[31] While the parents may not permit all routine immunizations, some may be given. Progress may be made if the parents are given a wide amount of information about vaccinations including: which diseases are not affected by herd immunity, more information about the diseases, another viewpoint about vaccine side effects, and information that all vaccines routinely given to children, except some influenza vaccines, are thimerosol free.[32-36]

    It’s an interesting enough study. However, given that so many parents think that they have done their research, I don’t know how amenable they would be to more information associated with sources that they distrust or disdain.

  3. David Gorski says:

    The problem is science education. Most people have very little understanding of the scientific method and even less knowledge of the cognitive shortcomings we all share as human beings, such as confusing correlation with causation, misunderstanding regression to the mean, selective memory (confirmation bias, especially), and the need for control groups.

    Personally, as I’ve said before, I think the problem is even worse among the highly educated and affluent because they consider themselves “better” than that and can’t believe that their “personal observations” could possibly mislead them. Oh, sure, those uneducated hicks can be misled by their personal experience, but not them! They’re college-educated! Some of them even have MDs or PhDs! They can figure out anything by themselves if they put their minds to it, particularly with the help of the University of Google. Couple that with a distrust and misunderstanding of science, and you have the arrogance of ignorance writ large. After doing some reading on antivax websites, they think they know as much or more about immunology and vaccines as physicians and researchers who have spent their adult lives studying them and that they’ve come up with astounding observations that no one has ever thought of before. They cherry pick studies that they think support their viewpoint, ignoring the context and all the other studies that don’t support their view.

    It’s not just vaccines, either. It’s evolution, “alternative medicine,” 9/11 Truther conspiracies, etc.

    By comparison, scientists are the pictures of humility. Indeed, the entire reason for our constructing the edifice that is the scientific method is because we do know that, as human beings, we are very prone to fooling ourselves and letting our biases influence our results. The scientific method is designed to make that as difficult as possible. It’s a guard against self-delusion.

  4. qetzal says:

    Dr. Gorski,

    That can’t be right. I learned from pec that the scientific method is just a formalization of the way people naturally think.

    In all seriousness, you’re spot on. It’s not just that such people don’t understand scientific and critical thinking. It’s that they think they do when they clearly don’t.

    They have ‘pec syndrome.’

  5. daniel says:

    What would happen if someone were to deliberately send a child with measles to these playgrounds?

  6. Zetetic says:

    Oregon allows the same nonsense “philosophical” vaccine exemption. My neo-hippie son and daughter-in-law in Portland have not vaccinated my grandchildren and they refuse to discuss it with me – and I’m a health care professional!

  7. LovleAnjel says:

    daniel, I think deliberately sending a person with one of these diseases to a playground is…so disgusting a thought I can’t adequately describe my reaction to the suggestion. The children are not the ones making these choices, and anyone who would deliberately sicken and kill them to make a point is…a type of person I can’t name without setting off all sorts of obscenity alarms and getting myself permanently removed from the comments section.

    The outbreaks and epidemics will spread naturally, and once people get a sense of the real risk:benefit ratio of vaccination, the numbers will go back up again. You only need to hear and see a child with whooping cough once to make up your mind.

  8. Canucklehead says:

    I wonder if the parents pick and choose the vaccines they have their children inocculated with and what they base that decision on. For example if they have their child vaccinated against polio, but not measles. That would make me speculate as to where they get their information and why do they make those choices.
    I can’t imagine any parent who has seen a child suffer with any of the diseases we vaccinate for not going ahead and vaccinating their other children or even acting as an advocate for vaccination to other parents. If seems that apparant absence of these diseases has created an apathetic contempt for the severity of the disease process.

  9. Fredeliot2 says:

    Maybe California should require a 90% compliance rate for a school to be open. Another possibility would be to require parents to sign a document acknowledging that they are deliberately exposing their children to a known risk, that their fears are without merit and that can be held responsible for any adverse consequences.

  10. weing says:

    I see great opportunities for Darwin awards. Unfortunately the children are the ones that will suffer for the sins of their parents. As Pat Benatar said “Hell is for children.”

  11. wales says:

    I have seen this idea elsewhere on sbm that abstaining from vaccination or selective vaccination equates to child abuse. Do you honestly believe that state legislatures condone an illegal activity? Are the other English-speaking nations (Canada, UK, Australia, New Zealand) which do not have compulsory universal vaccination policies promoting child abuse?

    In the US all states but 2 allow religious exemptions and 20 states allow philosophical exemptions. Exercising these legal exemption rights does not equate to child abuse.

    It is doubtful that religious exemptions will ever be seriously challenged on a nationwide basis in the US. The supreme court has upheld the right of citizens to bear arms (handguns no less, talk about a threat to public health) so it is unlikely it will challenge the religious freedom upon which this country was founded.

    In the US, the National Vaccine Injury Compensation Program has paid out almost $2 Billion over 20 years to over 2,000 victims of vaccine injury. The fact is that where there are risks posed by a state mandated medical practice (such as vaccination), there will be legal opt-out procedures. Like it or not.

  12. Chris says:

    wales said “The fact is that where there are risks posed by a state mandated medical practice (such as vaccination), there will be legal opt-out procedures. Like it or not.”

    What are they compared to the risks of the diseases?

    It can’t be much since you noted only 2000 have been compensated for vaccine injury, versus the millions of vaccines administered over the past twenty years. Now if you go to Appendix G of the CDC Pink Book, you will find a list of cases and deaths of selected diseases going back at least fifty years. A quickie perusal shows that there were thousands of cases of mumps and pertussis (the latter is increasing into the tens of thousands per year), with a certain percentage resulting in death (fortunately less than 2000!).

    By the way, I just finished reading this book that should help you put the information, especially the statistics, in to proper perspective:
    http://www.amazon.com/Lies-Damned-Science-Scientific-Controversies/dp/0137155220/

  13. wales says:

    “The issue is whether or not it is good practice to pay appropriate consideration to the careful and transparent recommendations from experts or instead to rely upon dubious sources or the vagaries of information on the internet.”

    Perhaps you could help me with the vagaries of some information I have found on the internet.

    The CDC’s Pink Book states that the measles death rate in the pre-vaccine era was about 450 annually (out of 4 million disease cases annually).

    I have seen another statistic floating around, in three separate places (albeit from the same source, Dr. Paul Offit) that the pre-vaccine era measles death rate was 3,000 annually. Dr. Offit does not make any reference citations in these 3 sources: New York Times article “Fatal Exemption” January, 2007; the Children’s Hospital of Philadelphia’s Vaccine Education Center webstite and Dr. Offit’s book “Vaccines: What You Should Know”

    Can anyone tell me where he is getting this 3,000 number? A 600% difference is quite statistically significant.

  14. Chris says:

    Oops… I said

    A quickie perusal shows that there were thousands of cases of mumps and pertussis (the latter is increasing into the tens of thousands per year), with a certain percentage resulting in death (fortunately less than 2000!).

    It seems I did not go down far enough on this page:
    http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/G/cases&deaths.pdf

    It seems that for Hepatitis A the average number of deaths in around a hundrend, and for Hepatitis B it is around a thousand. Plus before the varicella vaccine, chicken pox averaged around a hundred deaths per year.

    Also, measles, mumps, rubella, pertussis, tetanus and haemophilus influenzae type b can all cause permanent injury at a rate per case higher than their death rates.

    That is much more than 2000 in a twenty year span. So I have a feeling that the vaccines are much much much safer than the diseases!

  15. Chris says:

    wales said

    Can anyone tell me where he is getting this 3,000 number? A 600% difference is quite statistically significant.

    Have you considered writing Dr. Offit?

  16. khan says:

    Are these ignorant people also refusing tetanus shots for their children (and themselves)?

  17. wales says:

    Great idea, I’ll do that. I just figured that a number at such variance with historical data being bounced around by a vaccine expert would be easy to verify in other sources and known by other infectious disease experts at sbm.

  18. wales says:

    Good question khan, about adults being up to date on their vaccinations. Since vaccine induced immunity wanes over time, right? And not just for tetanus.

    Where’s the outrage about all the unvaccinated and undervaccinated parents, grandparents and other adults who are running about undervaccinated?

  19. wales says:

    Regarding National Vaccine Injury Compensation Program mentioned above, 2,000 is only the cases awarded compensation. Just under 13,000 cases have been filed. About 7,000 have been adjudicated (2,000+ awarded compensation; 4,000+ dismissed) The remaining 5,000+ are part of the Omnibus Autism Proceedings.

    The NVICP only considers cases for certain specific types of injury, hence many cases are dismissed if they don’t fit those parameters.

    Also see the Vaccine Adverse Event Reporting System (VAERS) statistics. As a passive surveillance system, it is widely acknowledged that VAERS is subject to substantial underreporting.

  20. daniel says:

    You don’t need to die from the measles to be badly affected by them.

  21. weing says:

    waley,
    Just wait a few years and you’ll see what the death rates from measles and other preventable diseases are.

  22. wales says:

    yes, as measles reemerges due to waning immunity and increasing numbers of the population become high-risk susceptibles, (infants and adults), there will be more deaths.

    adults, better make sure you’re up to date on your vaccinations.

  23. wales says:

    daniel, the same could be said of vaccines

  24. weing says:

    waley,
    You really are stupid. Those that will be disabled and die are the ones in the unvaccinated groups. Those that have waning immunity will have a mild or subclinical form of the disease.

  25. Chris says:

    wales said

    daniel, the same could be said of vaccines

    What are the affects of vaccines? How do they compare to the several thousands of injuries from measles, mumps, rubella, haemophilus influenzae, varicella, hepatitis, pertussis, diphtheria, tetanus and polio over the past twenty years (by the way there was an outbreak of polio in Minnesota less than five years ago)?

    You do understand that there is no real evidence that vaccines have anything to do with autism. Right?

  26. wales says:

    I don’t know what peer reviewed journals you’re reading Einstein, but a 2003 Vaccine article states this about measles:

    “Antibody titres in vaccinated individuals are subject to substantial waning, which may not only result in typical measles, but also in susceptibility to a milder or subclinical form of infection.”

    Typical measles is still a threat to vaccinated individuals experiencing waning immunity. I’ll try to dig up a citation.

    BTW, there appears to be an inverse relationship between the number of insults lobbed and IQ on this site.

  27. Chris says:

    Also, from reading this: http://www.slate.com/id/2215128/ … it looks like the “treatment” young Colton Snyder got from Bradstreet was worse than any vaccine!

    Colten, now 12 years old, hated chelation, which can be painful and, on rare occasions, fatal. On Aug. 20, 2000, a nurse reported that he “went berserk” after receiving the chelating agent. On other occasions he screamed all night, vomited, and suffered constipation, back pain, headaches, night sweats, and “meltdowns.”

  28. wales says:

    Chris, I am aware of the polio cases in the Amish community in Minnesota. I am also aware that the virus the children were carrying was derived from the oral polio vaccine.

  29. wales says:

    Wow, don’t know anything about chelation, looks pretty bad. VAERS also has some horrifying statistics and symptoms of children becoming very ill from vaccination.

  30. Chris says:

    wales said

    Typical measles is still a threat to vaccinated individuals experiencing waning immunity. I’ll try to dig up a citation.

    Which is why there are boosters. The MMR was introduced in 1971, and many adults may be susceptible to measles (like a Pennsylvania man who only had one as a kid, and now he and two of his unvaccinated children have measles).

    Why is that bad? Doesn’t that indicate that herd immunity must be maintained with a highly vaccinated population to protect those whose immunity wanes?

  31. weing says:

    waley,
    Highly unlikely that a vaccinated person with waning immunity would get typical measles. A forme fruste is the most likely scenario. You obviously know nothing of medicine. I hope you don’t find that insulting and make my IQ drop. Pretty soon I could be on par with an antivaccinationist.

  32. wales says:

    Chris, yes boosters are necessary for adults now. But it is unlikely we will see the high vaccination coverage rates we see in children as there is no enforcement (such as school entry requirements).

    Back to the polio for a moment, quite an irony that unvaccinated children acquired polio from vaccinated individuals, huh?

  33. Chris says:

    wales said

    VAERS also has some horrifying statistics and symptoms of children becoming very ill from vaccination.

    One of the first things you learn in a basic statistics class is that worst way to get a statistical group is the self-selected survey. VAERS is a self-selected set of data and is not considered as a definite source of vaccine reactions. What it can do is show trends for study, but that is it. Oddly enough one of the trends it showed was that there was an increase of reports after lawyers got involved! See:
    http://pediatrics.aappublications.org/cgi/reprint/117/2/387

    So I would take the statement of “horrifying statistics” on VAERS with a large grain of salt.

    What you need to do is get real data from reliable sources. Then you need to do a real risk assessment of the vaccine reactions to the disease. This is why the USA switched from the oral polio vaccine to the IPV.

  34. wales says:

    I believe the authors of the Vaccine article were WHO scientists. Quick, you’d better inform them of your forme fruste theory before they spread more misinformation.

    I’ll get their names for you.

  35. wales says:

    Chris, are you saying that the VAERS reports submitted by physicians and nurses are inaccurate?

  36. wales says:

    Taken from the VAERS website:

    “The majority of VAERS reports are sent in by vaccine manufacturers (42%) and health care providers (30%). The remaining reports are obtained from state immunization programs (12%), vaccine recipients (or their parent/guardians, 7%) and other sources (9%). Vaccine recipients or their parents or guardians are encouraged to seek the help of their health care professional in filling out the VAERS form. “

  37. Harriet Hall says:

    The problem with VAERS is that all it shows is that someone reported that something happened after vaccination. It doesn’t show a causal relationship. For that, you have to compare a group of vaccinated to a group of unvaccinated people.

  38. weing says:

    waley,
    If they are saying what you think they are saying, then they are full of crap and I don’t care if they are WHO scientists. More likely they are saying what I am saying and you are simply misinterpreting. I have an idea. Why don’t you apply to med school, go through the curriculum and come back and discuss with us and shows us dumb docs the light?

  39. David Gorski says:

    The other problems with VAERS is that anyone can submit to it, and there is very little checking about the accuracy. Indeed, Dr. Laidler, in order to prove a point, once submitted a report that a vaccine turned him into the Incredible Hulk:

    http://neurodiversity.com/weblog/article/14/

    Another parent, not even in the U.S., submitted a report that vaccines had turned his daughter into Wonder Woman:

    http://leftbrainrightbrain.co.uk/?p=342

    It’s also hugely distorted by litigation:

    http://scienceblogs.com/insolence/2008/01/how_vaccine_litigation_distorts_the_vaer.php

    The bottom line is that VAERS can’t be used for incidence or prevalence data over time, and it certainly can’t be reliably used to determine correlation, much less causation. It’s not meant for that. It’s meant to be the “canary in the coalmine,” to be very sensitive to possible vaccine reactions but not very specific. Unfortunately, antivaxers take advantage of that and use sheer numbers of reports as “evidence” that there’s a problem. It’s meaningless, as VAERS reports fluctuate with the news and litigation, with lawyers intentionally trying to get parents to file reports and news reports about Jenny McCarthy making parents wonder and report their child’s autism to the database as a “vaccine reaction.”

    Lately, they’ve been having a field day abusing VAERS reports for the Gardasil vaccine:

    http://www.sciencebasedmedicine.org/?p=98

  40. weing says:

    BTW, Are these WHO scientists recommending we stop vaccinating?

  41. Chris says:

    I found some interesting VAERS data on the OPV here:
    http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5201a1.htm

    However, the risk of vaccine-associated paralytic poliomyelitis (VAPP) was estimated to be approximately 1 case per 2.4 million doses distributed, with the majority of VAPP cases occurring after the administration of the first dose (1 case per 750,000 first doses) (42,43). The reporting sensitivity of VAPP in VAERS was an estimated 68%–72% (44). In September 1996, to reduce the occurrence of VAPP, ACIP recommended an increase in the use of IPV through a sequential schedule of IPV followed by OPV (42). VAERS has not received any report of VAPP after OPV/IPV vaccination since 1997, suggesting a positive effect of the sequential schedule of IPV followed by OPV (Figure 9). This result is consistent with previously reported data (45). In July 1999, ACIP recommended that IPV be used exclusively in the United States to maintain disease elimination and to prevent any further cases of VAPP (46).

    I added the bolding.

    weing said

    I have an idea. Why don’t you apply to med school, go through the curriculum and come back and discuss with us and shows us dumb docs the light?

    Actually, wales could benefit from just a basic statistics course. Checking the online catalog of my local community college, it is offered at night and is a 100 level math course. It just needs basic 9th grade algebra.

    Though that may not help wales. He seems to have a set agenda and is cherry picking and highlighting the information that he thinks shows vaccines are dangerous. When shown that it does not come close to supporting his position he shifts and gets even more vague.

    A closed mind like wales’ is a fascinating and frustrating thing to come across. But my patience is exhausted, and I shall ignore him from now on.

  42. Umm, wales, I’m an adult who takes great pains to encourage other adults to get their booster shots, and I assure you all of my immunizations are up to date. Where’s the outrage about undervaccinated adults? Oh, there’s plenty. But it’s just all the more tragic when innocent children pay the price of their parents’ ignorance.

  43. wales says:

    So this statement on the VAERS website “The majority of VAERS reports are sent in by vaccine manufacturers (42%) and health care providers (30%). The remaining reports are obtained from state immunization programs (12%), vaccine recipients (or their parent/guardians, 7%) and other sources (9%).” must be inaccurate then? Really just a bunch of lawyers posing as vaccine manufacturers and physicians and public health officials? Hmmm.

  44. Chris says:

    By googling parts of the quoted paper, I found it being flouted by an antivax guy who posts here as “just the facts” (just like wales he tended to be very selective of the facts, cherry picking… so I also ignore him). Anyway here it is, cut and pasted from PubMed:
    Vaccine. 2003 Nov 7;21(31):4597-603.
    Modelling measles re-emergence as a result of waning of immunity in vaccinated populations.Mossong J, Muller CP.
    Laboratoire National de Santé, P.O. Box 1102, L-1011 Luxembourg, Luxembourg. joel.mossong@lns.etat.lu

    Here is the abstract, I am sure that the academic doctors here can get the full paper:

    An age-structured mathematical model of measles transmission in a vaccinated population is used to simulate the shift from a population whose immunity is derived from natural infection to a population whose immunity is vaccine-induced. The model incorporates waning of immunity in a population of vaccinees that eventually will become susceptible to a milder form of vaccine-modified measles with a lower transmission potential than unvaccinated classical measles. Using current estimates of duration of vaccine-derived protection, measles would not be expected to re-emerge quickly in countries with sustained high routine vaccine coverage. However, re-emergence is possible to occur several decades after introduction of high levels of vaccination. Time until re-emergence depends primarily on the contagiousness of vaccine-modified measles cases in comparison to classical measles. Interestingly, in a population with a high proportion of vaccinees, vaccine-modified measles and classical measles would occur essentially in the same age groups. Although waning of humoral immunity in vaccinees is widely observed, re-emergence of measles in highly vaccinated populations depends on parameters for which better estimates are needed.

    Hmmm… it looks like weing was correct with the milder form… also note the interesting bits I highlight with bolding.

    Also, this was a mathematical model, not an observational study. What they did was use computer tools that simulate disease transmission and put in parameters to explore the possibility of disease transmission. If you read the last paragraph of the abstract, you will see that they need better estimates for the parameters (which are the variables they plug into their computer model).

  45. gwen says:

    I was a PICU nurse for almost 20 years in California. During this time I have cared for 2 children who died from Whooping Cough despite care from a world class PICU. I have cared for children with measles pneumonia, and measles encephalopathy. I have also cared for children with chicken pox encephalopathy (one child had it twice!), One of my co-worker’s 5 year old niece died of chicken pox and one of our residents was severely disfigured and needed plastic surgery from the case of chicken pox she caught from a patient. I have stated on this board before that Hib used to be our bread and butter before a vaccination was created. The one thing these children had in common was that they were unvaccinated.
    I attended school with a girl who had paralysis from a case of polio she contracted as a child. I thought my generation would be the last with all of the side effects and deaths from these once commonplace diseases. Jenny McCarthy and Jeni Barret are taking us back to1950 and the ‘good old days’ when many children died or became deaf, blind, became physically and/or mentally handicapped from these diseases.
    I remember when nurses and residents used to sit around and compare their hepatitis B infections. It was assumed that as a nurse or resident, there was a good chance you would come down with it at some time during your career. Many died. When the vaccination was created it was immediately embraced, until the advent of HIV. A recombinant DNA version was created and I don’t know of many nurses or doctors refuse.
    I’m afraid that as doctors and nurses forget about the deaths and disabilities suffered by the generation before mine, they to will be swayed by the idiots like Jenny McCarthy and her ilk, after all, I already have problems convincing them to take a (free) yearly flu vaccination.

  46. gwen says:

    BTW all of MY vaccinations (including pertussis) are up to date, AND I get a yearly flu vaccination and make sure my family does the same.

  47. Wholly Father says:

    http://www.bayshorepediatricsblog.com/2009/01/pertussis-is-back/

    There were 3 cases of whooping cough in this small school district in Wisconsin. Also follow the link to an Hib meningitis death of an unvaccinated child in Minnesota.

  48. wales says:

    I read the 2006 Goodman & Nordin article. I fail to understand how a litigation rate of <1% distorts the VAERS statistics. Since their study only analyzed data through 2003, I conducted a quick and dirty analysis (admittedly hasty, simplistic and without the aid of SAS) of the VAERS data by searching the data from 1990 to 2008, limiting the search to the word “litigation”.

    Shown below are the number of times “litigation” appears in the TOTAL annual number of VAERS reports. There is a spike in the 2002-2004 period, but even during that peak period litigation references are well below 1%. (Even Goodman & Nordin’s peak number of 262 for 2002 is less than 1% of the total annual cases reported). Post-2003, the number of litigation cases has not increased in step with the increasing number of VAERS reports but has decreased dramatically.

    2008 37 of 30,018 reports
    2007 26 of 26,440 reports
    2006 36 of 17,440 reports
    2005 7 of 15,775 reports
    2004 96 of 15,465 reports
    2003 107 of 16,851 reports
    2002 169 of 27,164 reports
    2001 23 of 25,970 reports
    2000 5 of 23,250 reports
    1999 – 1990 Less than 5 times annually

    It’s true, anyone CAN report to VAERS, but who actually DOES report? As stated on the VAERS website and in the Goodman & Nordin report: “The majority of VAERS reports are sent in by vaccine manufacturers (42%) and health care providers (30%). The remaining reports are obtained from state immunization programs (12%), vaccine recipients (or their parent/guardians, 7%) and other sources (9%).”

    Chris, regarding the Mossong & Muller paper, yes, that’s the one I referenced. In the body of the paper the authors reveal that they omitted typical measles from their model, while at the same time stating that individuals with waning immunity are susceptible to typical or classical measles. BTW, you didn’t highlight this part of the abstract “Interestingly, in a population with a high proportion of vaccinees, vaccine-modified measles and classical measles would occur essentially in the same age groups.” Talk about cherry-picking. By all means read the paper yourself, it’s very interesting.

  49. wales says:

    Here’s a link to a recent article in the Atlanta Journal Constitution about pertussis outbreaks:

    http://www.ajc.com/health/content/metro/stories/2009/03/22/whooping_cough_vaccine.html

  50. weing says:

    waley,
    You still haven’t answered my question regarding the Mossong paper. Are they recommending that we stop vaccinating?

  51. LindaRosaRN says:

    Another affluent area — Boulder, CO — has had whooping cough problems:

    http://www.bouldercounty.org/health/hpe/iz/vaccines/pertussis/outbreak12-05.htm
    “A whooping cough outbreak began in the end of 2005 and is still going on. ” (Boulder County Public Health)

    Last I heard, Boulder has three Waldorf schools. These schools promote a culture that discourages immunization (as well as science in general).

  52. wales says:

    read it yourself “doc”

  53. wales says:

    Pertussis outbreaks among fully vaccinated children are indeed interesting.

    The Atlanta Journal Constitution article (cited above) of March 22 states “Of the 18 students in the recent Cobb cluster, 17 were properly immunized with five doses of DTaP vaccine, which protects against diphtheria, tetanus and pertussis, health officials said.”

    It further states “Despite the study’s test results, some doctors refused to believe parents when they said that their children had pertussis. “More than one said to the parent: ‘Well, your child couldn’t have had pertussis, your child’s been vaccinated,” Gabel said, adding that the department is working to educate physicians.”

    And “Dr. Walter Orenstein, a leading vaccine expert, was surprised to hear that the Cobb cluster involved young students who would have received a pertussis booster as they entered school.
    “The real issue is what the rate of vaccine failure is,” said Orenstein, a former CDC official who recently became deputy director for vaccine preventable diseases at the Gates Foundation in Seattle.

    It’s possible, Orenstein said, that the sick children were simply among the expected 15 percent of people immunized that the vaccine fails to protect.”

  54. HCN says:

    Ignore wales, he can’t even understand the stuff he is referencing!

  55. weing says:

    waley,
    I did. The question was rhetorical. Your posts have the smell of a sleazebag lawyer with an obvious agenda. Regarding pertussis, Orenstein is correct regarding what the real issue is. And you interpret this to mean we shouldn’t vaccinate? Maybe the homeopaths will come up with a much more powerful homeopathic vaccine, shaken, not stirred. No! Forget I even mentioned that.

  56. wales says:

    Wrong again, weing. Apparently your olfactory sense has been overwhelmed by a more pungent aroma.

    Now that HCN has spoken the sbm “ignore” signal has been emitted. Closed mind(s) indeed.

    The sbm dismissal repertoire is growing thin. Commentators who don’t agree 100% with compulsory universal vaccination are either 1) laughed at if they supply references to non-mainstream information 2) hectored with insulting remarks and/or accused of cherry-picking if they supply references to peer reviewed journals.

    You are all cherry-picking. Everyone has an agenda and uses applicable reference citations to support their agenda.

  57. HCN says:

    Hello, “just the facts”.

  58. wales says:

    BTW weing, you kicked off the comments on April 1 with a remark worthy of a true “sleazebag” lawyer.

  59. weing says:

    waley,
    I knew it. But BS smells the same. So, based on what you’ve posted and your understanding of the the pertussis outbreaks and the Mossong paper, you are concluding that we should vaccinate? That’s great. You have proven me wrong.

  60. wales says:

    My perspective continues to be that those who wish to vaccinate should do so and that those who do not wish to have the right not to (in most states). There are risks to vaccinating and to not vaccinating.

    Here’s one way of looking at the issue, from the Encyclopedia of Bioethics – 3rd Edition by Douglas S. Diekema in the entry entitled “Public Health Issues in Pediatrics”

    “Parents who refuse immunization on behalf of their children may have valid and important reasons for doing so. While most mandatory vaccines are effective and safe, a small possibility of adverse reactions exists.

    In fact, it has been argued that any successful immunization program will inevitably create a situation, as the disease becomes rare, where the individual parent’s choice is at odds with society’s needs.”

  61. wales says:

    With regard to “BS”, you may characterize my comments in any derogatory manner you like, but your personal opinion does not alter the fact that my comments have been factual.

  62. wales says:

    Here’s another comment with which I concur from a 2000 Editorial by Gregory A. Poland MD and Robert M. Jacobson MD of the Mayo Clinic Vaccine Research Group:

    “….our own view is that the role of the government is to inform, educate, recommend, and even provide incentives for immunization—but not to mandate without exclusion acceptance among the civilian population. Informed refusal must remain an acceptable choice in a free democracy, and the culture of informed consent, with both religious and philosophical exemption, must be maintained.”

  63. John Snyder says:

    Quoting Gorski:
    “The evidence is clear and overwhelming – the risks from vaccines, while non-zero, are statistically tiny, while the risks from the diseases they prevent are significant and well documented.”

    Moreover, the true risks of vaccines have no resemblance to the mythical, fictitious creations of the anti-vaccine lobby. And they don’t include autism.

    The future California outbreaks alluded to here, and which are sure to occur, have already started in mild form: (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5708a3.htm).

    The problem of this empowerment-at-the-cost-of-reason, so expertly outlined above, is a real phenomenon that I see daily in my pediatric practice in NYC. The pockets of under-vaccination are likely to find their origins in those communities where, ironically, parents are well-educated and resource-rich. We’re already seeing it happen: (http://www.nytimes.com/2008/05/02/health/02measles.html?scp=2&sq=measles&st=cse)

  64. Mark Crislip says:

    ….our own view is that the role of the government is to inform, educate, recommend, and even provide incentives for immunization—but not to mandate without exclusion acceptance among the civilian population. Informed refusal must remain an acceptable choice in a free democracy, and the culture of informed consent, with both religious and philosophical exemption, must be maintained.

    nor mandate seatbelts, or helmets or….
    take your pick.

    But when the shit hits the fan and they are in the hospital me and my colleagues and my hospitals take care of them, and all to often they have insufficient or no funds to cover even a fraction of their health care expenses.
    So me and mine get to pay for you and yours.

    I am waiting for one, just one, of these, for lack of better better term, libertarians types, to say doc, my choices have lead to this cancer or injury or whatever, and I can’t pay, and I am heading home to suffer of die.

    Fine. Do not get a vaccine and do not vaccinate your kids. But have courage of your convictions and stay away when illness hits. If you want freedom from vaccine it should come with the freedom to suffer the consequences.

    I know it will never happen. They are all sound and fury.

  65. Th1Th2 says:

    Vaccination is NOT a healthy choice. The biological and toxicological hazards in vaccines are not synonymous with nutrition. In fact, vaccines are antagonist to good health. Vaccines cause diseases to non-diseased individuals.

  66. Wren says:

    Th1Th2

    What on earth does vaccination have to do with nutrition?

    What diseases do vaccines cause?

  67. weing says:

    Th1,
    Where did you ever come up with that nonsense? Do you think all the diseases prevented by vaccines are a healthy choice? How will you protect against them?

  68. David Gorski says:

    Oh, goody. An actual antvaccinationist has arrived to play, spouting the same nonsense that antivaccinationists like to spew.

  69. David Gorski says:

    I know it will never happen. They are all sound and fury.

    Indeed. I think at some level they must have some vague inkling that they’re taking advantage of herd immunity and that they’d be totally screwed if vaccination rates did fall to the point where herd immunity breaks down. They also do not care much, if at all, about the rights of the children who depend on herd immunity because they have contraindications to being vaccinated or have various immunodeficiencies. They assert that their children should not be barred from public school on the basis of being unvaccinated but do not consider how their unvaccinated children put others at risk.

  70. wales says:

    The topic has been how affluent individuals (who can surely afford to pay for medical care) are exercising vaccine exemptions, but Dr. Crislip has turned to non-affluent populations and their health care decisions. Aren’t the non-affluent populations generally highly vaccinated in the US?

  71. wales says:

    What about seat belts? Why don’t school buses have seat belts? They do in Europe. Good question. And what about handguns? Surely they are a (legal) threat to public health? My point is that where there is no financial incentive to mandate certain safety policies, they will not be mandated.

  72. Diane Henry says:

    But if financial incentive was the be-all, then all these doctors would NOT push vaccines–one can make much more money when the population is suffering from infectious diseases. Why take the back door route and administer vaccines if one wants to make money?

  73. wales says:

    Vaccines are plenty lucrative. Why weaken the productivity of the working population (taking time off for illness) when vaccines are just as if not more lucrative?

    Hey guys, what’s up with the lock-up on some of my comments? I know where you’re going with this, go for it!

  74. wales says:

    BTW, I didn’t intend to implicate physicians as the money-grubbers. The vast majority of physicians are hard working and underpaid. Which I’m sure applies to the bloggers at sbm. Vaccines are most lucrative for the manufacturers, and other sundry affiliates.

  75. wales says:

    Well…..I guess comments are closed over at Gorski’s Feb 2 blog. Funny how I just missed the deadline, I was trying to respond to Chris’ comments of April 1. Are quotes from the Pediatrics journal somehow controversial or damaging?

    I get the message, skeptics are only welcome here if they agree with the status quo. A two-way dialogue would be more interesting and beneficial rather than what amounts to a monologue via different contributors. I thought that factual dialogue was the intention of this site. Shall I post my Pediatrics response here or will I get locked out again?

    Freedom of speech is indeed a rare commodity in some venues.

  76. Mark Crislip says:

    You would have to be very affulent indeed to be able to absorb the hit of a major medical illness and its aftermath, like measles encephalitis, even with insurance.

    from the conclusion of Identification and characteristics of vaccine refusers
    BMC Pediatrics 2009, 9:18 doi:10.1186/1471-2431-9-18

    Article URL http://www.biomedcentral.com/1471-2431/9/18

    “A previous study found that the consequences of not being immunized can be serious. One retrospective study investigated a cohort of 3 to 18 year old Colorado school children from 1987- 1998[1] to see if individuals and communities experienced adverse events from personal exemption to immunization. The study found that children with personal (non-medical) exemptions to vaccines were 22 times more likely to be infected with measles and 5.9 times more likely to be infected with pertussis. They also found that unvaccinated children in day care, who already have an increased susceptibility to disease, are up to 60 times more likely to acquire the disease than their vaccinated peers. It found that refusers seem to be able to transmit disease to vaccinated individuals when the two groups are mixed in a school or during an outbreak. Similarly, another study that looked comprehensively at the health consequences of religious and philosophical exemption from immunization laws[29] in a cohort of 5-19 year olds nation-wide from 1985-1992 found that refusers were 35 times more likely than vaccinated individuals to contract measles from 1985-1992 in the United States. A third study analyzed the relationship between state-level rates of nonmedical exemptions at school entry and pertussis incidence data for individuals aged 18 years or younger.[30] They found that an increased pertussis incidence was associated with an easier granting of exemptions (incidence rate ratio=1.53; 95% confidence interval, 1.10-2.14) and the availability of personal belief exemptions (incidence rate ratio=1.48; 95% confidence interval, 1.03-2.13).”

  77. cheglabratjoe says:

    Probably my single favorite thing about reading the comments here is when a woo-pusher gets worked up, enters a bunch of comments at once, triggers the spam guards, gets paranoid that they’ve been blocked, accuses the SBM bloggers of censorship, and then refuses to apologize or acknowledge their error when all their comments show up. It’s a wonderful display of their willingness to jump into “OMG CONSPIRACY!!1!” mode.

  78. wales says:

    Still waiting for my comment to show up. I will be happy to acknowledge my misunderstanding if/when they do. We all make mistakes, even skeptics.

    If you’re referring to me as a “woo-pusher”, what exactly is the “woo” I’m pushing?

  79. wales says:

    BTW, I am generally not a believer in conspiracy theories. But it is odd that I have entered multiple comments here which are all getting posted, yet the one at Gorski’s Feb 2 blog still hasn’t appeared.

    Perhaps the reference citation is being reviewed for rebuttal.

  80. cheglabratjoe says:

    Well, just in the last batch of comments, you’ve suggested that vaccines are lucrative because they make plenty of money yet don’t keep people out of work. So, would that me the military-industrial-medical complex optimizing profit and productivity? Actually, with your paranoia about your delayed comments, I guess that would be the military-industrial-medical-blogging complex. We can’t very well let any old pseudononymous commenter out the grand conspiracy, can we?

  81. wales says:

    Your assumptions about my thought processes are inaccurate. But I still don’t see the “woo” factor. Just an attempt to pigeonhole a skeptic as a paranoid and rabid antivaccinationist, justifying subsequent attack or dismissal.

  82. David Gorski says:

    BTW, I am generally not a believer in conspiracy theories. But it is odd that I have entered multiple comments here which are all getting posted, yet the one at Gorski’s Feb 2 blog still hasn’t appeared.

    That’s because I hadn’t gotten around to checking the spam filters, which were probably triggered because you were posting under a different name (“just the facts”) using the same e-mail address. Sorry, wales, but I have a day job. If I hadn’t happened to see your comment, chances are I wouldn’t have checked the spam filters until sometime tonight and you’d be crying “suppression” and insinuating that we are somehow purposely not letting you post.

    So, just for everyone’s information, in case you hadn’t figured it out yet: “just the facts” and “wales” are in fact one and the same person.

  83. wales says:

    Yes, I have resorted to a pseudonym. In recent comments to Crislip’s Aug 14, 2008 blog JTF was tarred and feathered by the coterie of usual suspects on this site and inaccurately labeled a “concern troll” (among other things).

    One of the consequences of this was that JTF was compelled to assume an alter ego in order to maintain objectivity.

  84. wales says:

    sorry for the dupe, more evidence of my “paranoia” and PC problems.

  85. weing says:

    I sniffed him out with his first post. He’s still using the same technique of self deception where he considers the benefits of vaccination on one side equal to the benefits of non-vaccination on the other. His position is the superior one, right in the middle.

  86. wales says:

    I make no claims to being superior to anyone. Vaccination is a complex issue and a difficult decision for parents. I simply believe they have the right to choose without public vilification.

  87. weing says:

    Well the two are not equivalent. One is a medical approach and the other a legal approach. If you want epidemics controlled by attorneys, fine. That will not stop the disease. The disease will ‘vilify’ the idiots.

  88. wales says:

    my “dupe” comment above refers to my pseudonym comments, still awaiting moderation.

  89. wales says:

    weing, medical and legal are just two aspects of the same issue. They would not be related if vaccines were not compulsory (as they are not in Canada, Australia, UK, New Zealand, Germany, etc.)

  90. weing says:

    You are deluding yourself by making them out to be equivalent. They are not the same as picking the color of a car. The consequences for the individual and society are different.

  91. wales says:

    thanks for removing the spam filters. my apologies for jumping to conclusions.

  92. wales says:

    weing, I didn’t say they were equivalent, but related. I understand that this is a medical site so you’re right in one sense, it’s not really the place to discuss the legal aspects. I got off on the legal tangent because of the references to sueing people for disease outbreaks and for others’ equating vaccine exemption with child abuse.

  93. TsuDhoNimh says:

    Gorski said: I think at some level they must have some vague inkling that they’re taking advantage of herd immunity and that they’d be totally screwed if vaccination rates did fall to the point where herd immunity breaks down.

    What’s his name (Sears?) of the revised schedule, actually says that. He acknowledges that his fans are free-riding on the herd, and that if too many of them do it, they’re screwed.

    But point that out to the parasites on the Motheringdotcom forums and the harpies will rend your liver and cast you out.

    As a wild idea, have people opt for EITHER alternative health care OR standard medical care in their health insurance plans, with no crossover. If you want the insurance to pay for the homeopathy and live blood analysis, it won’t pay for antibiotics and standard lab tests. (changing systems allowed once a year, at the annual sign-up).

  94. wales says:

    great idea for a fascist country. you don’t like having choices?

  95. weing says:

    I will expect you defend my choice of plastic instead of paper or a green recycling bag in the grocery store.

  96. wales says:

    in case you’re wondering about the pseudonym matter it was a not too subtle perky skeptic comment that tipped me off

  97. wales says:

    weing, it’s a free country

  98. wales says:

    I promise this is my last comment on the subject of political freedom (unless provoked of course). But how far should we go with coercion and compulsion for public health purposes? Some people believe that homosexuality should be outlawed because HIV is a public health threat.

    I don’t own a gun, drive a SUV or smoke cigarettes, but I uphold the right of others to partake of any of those activities. I am very bothered by the gun issue, but what can be done about that constitution of ours?

  99. Th1Th2 says:

    Wren,

    Because vaccines are physiological threat to good health, they induce diseases they supposedly prevent. Vaccines are not placebos, they contain the physiologic evidence of the disease. So what is there to prevent, when the non-diseased has already been injected with the disease?

Comments are closed.