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You can’t hide in the herd

Can you hide in the herd?  Well, I suppose the title has given away the punch line.

Herd immunity is a fascinating effect, and one of the mainstays of a public vaccination effort.  The idea is that if enough people in the community are immune to a particular disease, then those who are susceptible will rarely come into contact with a person who is contagious, and the disease will be unable (or find it difficult) to spread.  This results in a greatly reduced risk of infection for the entire population regardless of their individual immunity.

This has lead to the belief that because of the protection of the herd’s immunity, individuals now have the option to avoid even the minimal cost and risk of vaccination while having the same reduced risk of infection as if they had vaccinated.

Let’s set aside the fact that that there are people who have no choice but to rely upon herd immunity as their sole line of protection against these infections.  Forget that there is a threshold below which herd immunity collapses, and that our current vaccination rates tend to be right on the cusp of that threshold.  Pay no attention to the fact that the personal decision to not vaccinate deprives others of their sole protection from these infections.  Finally, ignore the ethics and self-defeating nature of benefiting from the sacrifice of others while simultaneously eroding the efficacy of the herd immunity being exploited.  On a small enough scale, doesn’t the tactic of hiding in the herd provide the same protection as getting vaccinated without incurring the minimal risk of vaccination?

Not so much.

Countless reports of outbreaks around the world consistently describe a disproportionate number of infections during vaccine-preventable outbreaks occurring in the unvaccinated.  For instance, in Indiana in 2005 an outbreak of measles infecting 34 people was traced to a 17-year-old unvaccinated girl who had contracted measles in Romania.  In that outbreak 94% of the infected were unvaccinated.

This scenario was repeated during a measles outbreak in California in 2008 where 12 children were infected.  The index case, an unvaccinated boy who had traveled to Europe, infected both of his siblings, five schoolmates, and four children from his pediatrician’s office.  None of the children were vaccinated, though three of the four infected in the office were too young to have been vaccinated.  Zero vaccinated children contracted measles.

Reports such as these highlight how quickly these diseases can spread, how easily the unvaccinated are infected, and the limited effectiveness of voluntary isolation.  They also demonstrate the effectiveness of herd immunity in containing the infection, and rather strongly suggest that, even with intact herd immunity, the vaccinated and unvaccinated are not at equal risk of infection.

How much greater is the risk, though?  10%?  50%?  Perhaps fully twice as likely to be infected?  The magnitude matters to parents (and physicians) who are weighing the risks of vaccines and their corresponding diseases.

A group from Kaiser Permanente of Colorado has attempted to help put a number on that increased risk.  Within the last year they have provided two matched case-control studies that quantify the magnitude of the risk children incur because of vaccine refusal.

Their first study found that the act of refusing to vaccinate against pertussis (whooping cough) placed children at a 23 times greater risk of contracting pertussis.  That’s a 23 fold-increased risk of a disease that, in children under 12 months of age from 2000-2004 in the US caused 62.8% to require hospitalization, 55.8% to have apnea, pneumonia in 12.7%, and death in 0.8%.

Their second study, published just this month and following the same format as the first, focused instead on the risk of varicella (chickenpox) infection after vaccine refusal.  Here they identified an 8.6-fold increased risk of infection with a disease that as recently as 1995 (when the vaccine was released), tallied 3,000,000 infections, 10,000 hospitalizations, 4,000 cases of pneumonia, 600 cases of encephalitis and 100 deaths per year.

These findings further reinforce the fact that even in a community with intact herd immunity, the choice to remain unvaccinated places children at a markedly higher risk than their vaccinated counterparts.  The delusion that hiding children within the herd provides them with protection even remotely equal to vaccination must be abandoned.

It bears to be stated again, frankly and clearly.  The choice to refuse a vaccine, to “hide in the herd,” is an active decision to accept a markedly higher risk of infection, its complications, the associated medical costs and lost wages, the responsibility of spreading the disease to others should an infection occur, and to choose to undermine the very herd immunity on which we all depend.

Parents want to be fully informed about the medical decisions they make for their children, and rightfully so.  To that end, we do everyone a disservice by allowing the public discussion to be dominated by the risks of vaccines to the exclusion of other equally important topics, including the risks of not vaccinating.  Studies such as these are a needed and welcome addition to the literature, and should provide a valuable insight for people wanting to make a properly informed decision.

Posted in: Science and Medicine, Vaccines

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84 thoughts on “You can’t hide in the herd

  1. ZenMonkey says:

    Thank you for this excellent article. As someone who is forced to hide in the herd (due to complications with chronic illnesses), I’ve been annoyed in past months with perfectly healthy — that is, immunizable — people claiming “herd immunity” as a reason not to get vaccinated. My feeling is they read the term and glommed on to it because it comes off better than the truth, which is either “I’m too lazy” or “Needles scare me.”

    (Please note I’m not accusing people who were unable or unwilling to locate the H1N1 vaccine in its shortage of being lazy. Here in L.A., for a while it was a hell of a thing to try to get vaccinated for that, even if you were a member of a group recommended to get it.)

  2. RMSE says:

    Good article on important topic.

    Anyway, to convince most of the concerned-and-hesitant people to vaccinate one has to directly disprove their fears. Still much to be done here.

    Take aluminium salts. Dr Offit makes many efforts to debunk claims about their toxicity. However the evidence he presents is often perceived weak. Let’s take a look at his paper from Pediatrics (co-authored, December 2003). His discussion is only based on data for oral exposure – there is no word on aluminium levels in the blood after injection. Fast forward to January 2009, and another paper in Pediatrics co-authored by dr Offit presents the same argument extrapolating numbers for oral ingestion of aluminium in milk to intramuscular injection. At the same time one may look into any source on toxicology to verify how toxic pure aluminium is and that only about 2% of aluminium ingested orally is absorbed. In absence of data on blood aluminium levels after intramuscular injections (I could not find any, so likely many people will not either) prudent folks assume that it all goes into a vein at once, and that all salts are dissolved at once. And they say: ‘ok, so we have to multiply Offit’s numbers by a factor of 50 then’. This leads to results largely exceeding safety limits. Then they imagine how much of it goes through the not-fully-developped blood-brain barrier of a neonate before not-fully-efficient-in-removing-probably-anything kidneys of a neonate eliminate it from the blood. No surprise they believe in conspiracy theories.

    Hence my question: is there any publicly available reliable study on blood aluminium levels after vaccination with aluminium salts as adjuvants ?

    Best regards

  3. Dawn says:

    Very interesting post. One request (since I am very mathmatically challenged): Can you give the percentages for the numbers in the 2nd study similarly to the first study? I can’t relate the risks well (although I do understand that unvaccinated persons have a higher risk of infection). Or, for both studies, give numbers and percentages? (I can’t access the actual linked studies as they appear to be blocked by our firewall…)

  4. rork says:

    Dawn may not be a mathematician, but the point is dead on.
    The relative risks are not enough for a person to compare the risks and benefits. Give the absolute risks.

    Is that or is that not axiomatic in good science writing?

    I am pro-vaccine. We’ve had some “nice” increases in pertussis in my little neck of the woods this year. Have folks litigated in these cases anywhere?

  5. Ian says:

    Maybe if we started calling it “body herpes” instead of a cute name like “chicken pox” people would take it more seriously.

    And whooping cough does sound like something out of the Oregon Trail game. It could also use a rebranding to make it more hip and modern.

  6. windriven says:

    The anti-vax rabble has done a magnificent job exploiting the old maxim that if one repeats a lie often enough it becomes the truth. Couple that with inertia (yeah, yeah, I’ll get vaccinated next week…) and it is no wonder that US vaccination rates are declining to the point of herd immunity collapse.

    One must also fault the news media. Coverage of vaccination efforts is inevitably ‘balanced’ with the febrile nightmares of this or that anti-vax organization leaving the viewer (does anybody still read newspapers?) with the net misapprehension that the risks and the benefits are similar. Given that misapprehension the prudent course is to postpone vaccination until one can determine if there is a large outbreak of the creeping fung among those who do get vaccinated.

    It really is important for the rational community to get organized and engage the anti-vaxers more fully in the venues that shape public opinion.

  7. Basiorana says:

    Doesn’t measles require 90-95% of the population to be vaccinated to have any sort of herd immunity, and for pertussis it’s 94%? How is herd immunity even a factor here? Surely we don’t have 95% of our population getting the MMR and DTaP, considering both those who can’t get them and those who are too young.

    Besides, herd immunity doesn’t apply to tetanus. I always thought herd immunity was an awful argument for not vaccinating, since no one in modern times spends all of their lives in areas with 95% compliance with vaccination policy.

  8. Fifi says:

    Great post, thanks! I particularly like that you point out that trying to take advantage of herd immunity when one can get vaccinated is actively taking away from others who don’t have an option to be vaccinated.

    I think there’s a clear distinction to be made between vaccinating against childhood diseases and a flu vaccine. Not that I’m trying to dissuade anyone from getting flu vaccines if they want them, or if they live with someone who is immune compromised or they work in an environment where it’s necessary, just that they’re not really necessary for the general population as immunizing against childhood diseases and there’s two different discussions to be had. The coolest thing about vaccinating against things such as polio and other childhood diseases is that universal (or near universal) vaccination can effectively wipe out a disease.

  9. wales says:

    Basiorana asks “Doesn’t measles require 90-95% of the population to be vaccinated to have any sort of herd immunity?” From 1967 to 1985 US measles vaccination coverage rates never exceeded 67%, yet measles incidence decreased from 204,136 in 1966 to 2,822 in 1985. Obviously vaccination rates of far less than 90% for measles had a considerable impact on incidence rates.

    Regarding pertussis, from 1962 to 1985 childhood pertussis vaccination coverage rates never exceeded 78% (dropping well below that in many years) yet pertussis incidence dropped from 17,749 in 1962 to 3,589 in 1985. According to the Pink Book, childhood pertussis vaccination coverage rates have been around 95% since 1994. Pertussis is endemic among the adult population due to waning vaccine induced immunity and less than 5% of adults receiving boosters. The vaccine is only 85% effective at best. Even with 100% of children vaccinated, pertussis won’t go away until more adults get vaccinated. At best, with 100% of the entire population vaccinated, 15% are still vulnerable due to less than perfect vaccine efficacy rates.

    Source: CDC Pink Book appendix G for disease incidence and vaccination coverage rates. http://www.cdc.gov/vaccines/Pubs/pinkbook/pink-appendx.htm

  10. provaxmom says:

    Fifi–I wholeheartedly disagree with your point about the flu vaccine. Especially in the context of today’s post and herd immunity. This quote of yours “just that they’re not really necessary for the general population as immunizing against childhood diseases and there’s two different discussions to be had” is just like everything I hear from the anti-vaxers.

    To me and my special needs son, the three immuno-compromised students in my class, my neighbor going through chemo………flu is equally if not more necessary than other vax. While I would probably fare very well if I got the flu, not everyone will. And I’m a humanist, I believe we’re all in this together. I owe it to my son, my students and my neighbor to try to not expose them to the flu.

  11. Scott says:

    Fifi does have an accurate point, in that there are several illnesses we can hope to eradicate but flu is not one of them. But neither is tetanus, for example. So the distinction between flu vs. childhood is quite incorrect.

    But while it’s true that there’s extra return for vaccination for some diseases that could be so eradicated, that only makes them even better. The death toll from flu is more than high enough to make it a very important vaccine that more people should get.

  12. rork says:

    A recent story about chicken pox in my local public school.
    3 unvaxed sibs get it and are thought to have transmitted it to several vaxed kids (based on timing and proximity).
    Response expected: outrage at non-vaxed kids exposing complying people, with “where do you get your bleeping ethics?”
    Response observed: outrage that vax didn’t work (perfectly), with “see, why bother to get it? There’s no point anyway.”

    Perhaps the “it burns” idiom fits here, but it wasn’t just the dumbest people I am sorry to report – more missionary work is clearly needed.

    Back to the main subject, a weakness of the article:
    Presuming any non-zero risk of vax, there is a cutoff for % vaxed, that if exceeded, makes vax riskier than no-vax (for most bugs at least). That is a theorem of decision theory. We have to live with the fact that some of the only-me people know this, even if they don’t voice the “yeah, let’s just ride the herd (of sheeple)” argument (since that’s counterproductive for a rebel, both mathematically, and as propaganda). So I keep playing the ethics cards – your behavior is expected (probabilistic sense) to contribute to the harm and death of others.

  13. leonet says:

    @RMSE who asked [. . .] Hence my question: is there any publicly available reliable study on blood aluminium levels after vaccination with aluminium salts as adjuvants ? [. . .]

    There have in animal models (Vaccine. 1997 Aug-Sep;15(12-13):1314-8.), but I’d like to point out some problems with your post:

    1) The fact that scientists haven’t chased down and disproved every one of the hypothetical mechanisms by which vaccine and/or adjuvants could cause injury is not evidence of a conspiracy. The aluminum injury hypothesis hasn’t been systematically pursued because there are limited resources and a conspicuous absence of clinically noticeable adverse effects from aluminum at the levels used in vaccines for over 100 years.

    2) You don’t have grounds to assume, a priori, that all of the aluminum injected in an intra-muscular vaccine goes directly into the blood. Your assumption of a 50-fold greater dose from a vaccine is highly implausible in view of basic anatomy and physiology.

    3) There has been a government-backed movement to reduce aluminum levels in infant formula because there have been demonstrated adverse effects from high levels of consumption (>55ug/Kg) on a daily basis. If anything, this show the scientific community responding prudently to a small but demonstrable valid risk factor.

  14. wales says:

    Rork is correct about decision theory. One problem with rork’s strategy to “play the ethics card” is that many parents believe their fiduciary duty to their children outweighs their obligation to society. Therefore if it is perceived that risk of vax outweighs risk of non-vax to their own children, the fiduciary duty of acting in the best interest of their children will win. Call it selfish “only-me”, or call it fiduciary duty (as it is known in the legal and financial professions), the label chosen is a matter of perspective.

  15. Scott says:

    That’s precisely why mandatory vaccination is so important. It breaks the prisoners’ dilemma and prevents freeloading.

  16. wales says:

    Depends on how far you’re willing to go to enforce “mandatory”.

  17. Fifi says:

    provaxmom – “While I would probably fare very well if I got the flu, not everyone will. And I’m a humanist, I believe we’re all in this together. I owe it to my son, my students and my neighbor to try to not expose them to the flu.”

    We’ll have to agree to disagree here since there are other ways to prevent exposing vulnerable people to the flu other than getting vaccinated (which may not protect anyway). I’m a humanist too so we can both play that moral card, we just disagree over flu vaccines. If I was looking after someone who was immune deficient – such as my friends who had AIDS who I nursed at one time – or in a position where I’d be in contact with a lot of people, particularly vulnerable people, I’d be getting vaccinated. However, I work at home and I’m not entirely convinced regarding flu vaccines (and I’ve discussed this with a number of doctors who aren’t convinced themselves and am not anti OR pro vaccine simply as an ideological stance).

    The reality is that flu vaccines don’t always protect against the flu since it’s always a bit of a crap shoot as to which way the viruses will mutate. Certainly as a teacher you have a responsibility not to infect your students – a flu vaccine may prevent you getting the flu, or you could end up getting the flu anyway because it wasn’t the one that you’ve been vaccinated for. In the latter case, I’d hope you’d stay home (or somewhere else away from anyone vulnerable) or take precautions so as not to infect others. Even if you do get the seasonal flu vaccine, you may need to consider other strategies to keep anyone immune compromised safe. Too many people go to work when they’re sick or assume that the flu vaccine means they can’t get the flu. Anyway, clearly we differ in how we approach this since I’m not uncritically accepting of any vaccine and it seems that this is a bit of a mission for you if your name here is any indication. I respect your choice and support immunization against childhood diseases – I do think it’s unethical and unreasonable to propose that flu vaccines should be mandatory for the general population. Particularly in light of some of the political and corporate/commercial shenanigans that go on that aren’t motivated by science or public health concerns but by profit in the case of certain vaccines.

  18. windriven says:

    @wales

    1. I didn’t even know that adults COULD get a pertussis booster
    I’ll certainly look into getting one. Thank you.

    2. Can you tell me a good SBM source for information on actual risks of vaccination? I would like to verbally smack the #%*@ out of interlocutors who brush off the necessity of vaccination on the basis of ‘risk’. I’m not at all interested in perceived risk, only in actual risk. i.e. if 1,000,000 people are vaccinated against halitosis disgutus, there is a statistical likelihood that 3 will cough up their spleens and die.

    @Fifi

    There are well understood mechanisms to avoid contracting HPV other than vaccination. Nonetheless, my three daughters are vaccinated. Stuff happens and it only has to happen once.

    As a humanist you may wish to consider that yes, there are ways for the immunocompromised to avoid influenza but generally at the cost of further circumscribing their already altered lives.

  19. Zoe237 says:

    The best source of information about the risks of vaccination is the CDC, ime.

    I don’t know, I could hide in the herd from polio pretty well, considering there hasn’t been a wild case around here in 30 years. Or diptheria. There might be a slightly increased absolute risk, but it isn’t much. That’s why I was wondering if, while certain diseases are eradicated from certain parts of the globe, but not others, if the absolute risk of vaccines (while very very small) aren’t larger than the chance of catching and dying/serious morbidity from the disease. Given that the herd is vaccinated and you are not.

    I”m interested in the rise of pertussis as well. It doesn’t seem to be as related to drop offs in vaccination rates, but I could be wrong. I don’t think adults can be vaccinated either- the vaccine for adults is DT. (which, yep, bad me, I haven’t gotten in 15 years). I wonder why adults don’t have the P component, at least to protect smaller kids. Are there different strains of pertussis? Or is the vaccine not as effective, or are higher percentages necessary to ward it off?

    Unbiased information would be great. The CDC is pretty good at this, but you have to read a lot to find raw numbers (as a layperson who cares about her kids). (Oh, and I also heard on NPR that the CDC recommended that parents who have kids sick from the flu not pick up or go near their babies… yuck). From talking to others from all sides of the fence, parents feel attacked by some vaccine advocates. These advocates really ought to concentrate their ire on people who spread misinformation (Handley et al) rather than parents who don’t know who to believe and are scared of autism.

  20. RMSE says:

    @leonet

    Many thanks for the reference. Judging from the abstract this paper is what I desired. I shall try to access it.

    If anyone else knows any more sources on this subject and can reference them then I would also be deeply grateful.

    And by the way:

    ” 1) The fact that scientists haven’t chased down and disproved every one of the hypothetical mechanisms by which vaccine and/or adjuvants could cause injury is not evidence of a conspiracy. ”

    Agreed. It is not an evidence of conspiracy. My point was that if argument apparently does not add up then people tend to be oversuspicious and more likely to believe in anything stupid including conspiracy theories. On the other hand I appreciate dr Offit’s argument about formaldehyde. Comparing its smallish quantity in vaccine and large quantity in human body is convincing. Maybe such an argument could be valid for aluminium too ?

    “The aluminum injury hypothesis hasn’t been systematically pursued because there are limited resources and a conspicuous absence of clinically noticeable adverse effects from aluminum at the levels used in vaccines for over 100 years.”

    True. With emphasis on ‘noticeable’.

    “You don’t have grounds to assume, a priori, that all of the aluminum injected in an intra-muscular vaccine goes directly into the blood. Your assumption of a 50-fold greater dose from a vaccine is highly implausible in view of basic anatomy and physiology”

    Agreed. Moreover, it is also not plausible to me that all the aluminium hydroxide/phosphate will be dissolved at once (correct me if I’m wrong: as a salt it should not cross blood-brain barrier so easily). However, when not knowing “how much” one tends to evaluate by assuming pessimistic extreme of 1/0.02=50. Not so uncommon approach (even for scientists) and many would intuitively perceive it as safer than a wild guess (possibly largely overestimating the risk with all the consequences).

    “3) There has been a government-backed movement to reduce aluminum levels in infant formula because there have been demonstrated adverse effects from high levels of consumption (>55ug/Kg) on a daily basis. If anything, this show the scientific community responding prudently to a small but demonstrable valid risk factor.”

    If 2% Al from this daily oral dose goes into blood this gives 0.02*55mcg=1.1mcg/Kg. For a 4Kg neonate this is 4*1.1=4.4mcg daily. GSK’s Infanrix Hexa vaccine contains over 800 mcg of pure Al. Hence daily dissolution and transmission into blood of only 1% of these 800 mcg exceeds 4.4mcg by a large margin (and is enough Al ‘supply’ for many days). Is it safe to assume that less than 1% of vaccine’s Al goes into blood daily ?

    Is 5% or 10% for a neonate with miniscule muscle mass not plausible ?

  21. weing says:

    “The reality is that flu vaccines don’t always protect against the flu since it’s always a bit of a crap shoot as to which way the viruses will mutate. ”

    Welcome to reality. Do you wear seat belts? Have airbags in your car? They won’t prevent a car crash and they won’t always protect you in the event of one. Would you rather be in a crash without a seat belt and airbags?

  22. weing says:

    Oh. I get it. The flu vaccine will miraculously start working once the vaccine manufacturers stop making a profit on it. Just like medications start being effective once they become generic? You can’t be serious.

  23. Fifi says:

    windriven – “As a humanist you may wish to consider that yes, there are ways for the immunocompromised to avoid influenza but generally at the cost of further circumscribing their already altered lives.”

    I wasn’t suggesting that those with comprised immunity further circumscribe their lives, I was suggesting that people with the flu or any other infectious disease do the sensible thing and stay home so they’re not running around spreading germs. Those are two entirely different things and I was putting the responsibility on the person infected to circumscribe their activities. For some idiotic reason people seem to think that going to work or sending their kids to school when they’re sick is noble (and certainly bosses reinforce this idea even though it’s stupid since it just means more of the workforce is likely to get ill).

    There is no way at this point in time to actually eradicate the flu through vaccination. It’s quite a different issue than vaccines for childhood diseases such as polio, chicken pox and so on. The reality of flu vaccines is that they’re a crap shoot. The flu virus mutates very quickly so an educated guess is made about how it will evolve then a vaccine is created. Sometimes we’re right, some seasons we’re wrong. So, even if everyone gets a flu vaccine it doesn’t mean that people won’t still get the flu (or that particular season’s vaccine will be effective). So the reality is that people who are immune compromised will still need to take precautions no matter how many people get a flu shot. In the case of H1N1 in Quebec, that flu had already spread through the population by the time the vaccine was available to most people. Certainly people in high risk groups – who were obviously prioritized – got the vaccine and if I lived with someone who was immune compromised I certainly would have been on the priority list and gotten it. By the time it was available to the general public, the flu season was pretty much over. There was a lot of unwarranted hysteria around H1N1 (not to mention some very shady government decisions made in Canada that were clearly to benefit Pfizer and not in the public interest).

    It’s a fantasy to believe that the world will be safe for people with compromised immunity if only everyone would get a flu vaccine. The reality of living with a compromised immune system is that one has to be careful in public, and that the people one lives with and is intimate with need to be extra cautious. Have you ever cared for anyone with a compromised immune system?

    As to your daughters getting the HPV vaccine, that’s a decision for your family or daughters to make. Just as it’s a decision for other families and individuals to make for themselves. If you have sons, did you get them vaccinated as well? (This would protect both them and any women they have sex with.) The HPV vaccine reduces certain risks for cervical cancer but it’s not a magic bullet and doesn’t remove all risk. I hope you’re making sure your daughters are aware they need to get regular PAP smears as well and are still at risk for cervical cancer (if a reduced risk). On the up side, it’s a good way to bring up sexual health to girls and start discussion and to make them aware of the potential consequences of having unprotected sex.

  24. Fifi says:

    weing – Two issues here – corporate profit and public hysteria.

    1. Public hysteria. The hysteria around H1N1 was entirely out of proportion to reality. The percentage of people who got very sick and/or died from H1N1 vis a vis the percentage of people who normally get very sick and/or die from non-H1N1 flu was actually less. Since younger people got hit by H1N1 instead of the elderly, people freaked out more. (Many elderly people actually had some immunity to H1N1 from the last time that strain was around.)

    2. No, I don’t think that the effectiveness of vaccines is linked to corporate profit. However, there were clearly some very shady dealings here in Canada. Ironically, considering your snide tone, the issue in Canada was that making Pfizer the sole manufacturer actually meant there were inadequate supplies and immunization of the general public didn’t happen until after H1N1 had spread through the general population. Considering that a Pfizer executive – who still works for Pfizer – was appointed to a public health funding body, there are good reasons to be suspicious of the current Canadian government’s relationship with Pfizer. (Incidentally, health researchers in Canada and scientists weren’t thrilled with this, just like they weren’t thrilled by having a chiropractor appointed Minister of Science and Technology.)

    Anyway – my point was that vaccinating against polio and other childhood diseases, which could be eradicated by universal vaccination programs, is entirely a different thing than seasonal flu vaccines. I curious, how many adults have had booster shots and know which vaccines they need booster shots for as adults? It’s important not to get caught up in ideological pro-vaccine and anti-vaccine ideologies that mean that one is no longer actually considering each vaccine on the evidence. It seems that this is what a lot of people tend to do.

  25. Fifi says:

    weing – It’s pretty entertaining that you’re so hung up on continually defending corporate profit and seem upset enough by generic drugs to need to bring them up in this thread in such a snide way. To answer your silly assertion that’s very wide of the mark…the benefit of generic pharmaceuticals – apart from their lower cost – is that they’ve been used for longer so there’s a much better knowledge about side effects and effectiveness. In some cases, such as some anti-depressants, they’re actually more effective than newer drugs (if less fashionable to prescribe). Of course, in some cases they’re not and a newer drug really does have more benefits. There’s also the not small consideration that new pharmaceuticals (by that I mean still under patent) do sometimes get rolled out and promoted using pseudoscience (I include hiding negative results in that category and gaming studies). It’s not until they’re widely prescribed that problems show up. With generic drugs, any of those issues are already known (as well as interactions with other drugs and so on). Really it’s about prescribing what’s most effective, not what the salesman is pushing this week.

  26. windriven says:

    @Fifi

    “I wasn’t suggesting that those with comprised immunity further circumscribe their lives, I was suggesting that people with the flu or any other infectious disease do the sensible thing and stay home so they’re not running around spreading germs.”

    Unfortunately the incubation period for influenza can vary from 1 to as many as 5 days during which the infected people are shedding virus.

    A quick Pubmed search yields plenty of results that substantiate this. So an infected individual may unwittingly infect one or many other individuals depending on, among other factors, their social interactions and the immune status of those with whom they come in contact.

    Herd immunity isn’t just for diseases that can, thankfully, be eradicated.

  27. windriven says:

    @Fifi

    At the risk of setting you off on another anti-capitalism frenzy, I wonder if you might have visited Yugoslavia (as it was then known), China or Poland during the years when the economy eschewed capitalism. I ask because I did. And I’ve been back to all but what is now Serbia in the years since.

    Capitalism is not a perfect economic system. I would be willing to bet a substantial sum that I could present a far more compelling case that capitalism in the classic sense has outlived its usefulness than could you. Your arguments amount to little more than fear, envy, fury and hatred in one measure or another and do nothing to address the underlying issues.

    Capitalism has brought vast improvement to most of the lives it has touched – though often not in the early years, and certainly not in equal measure to capital and to labor. It has bestowed upon us products and technologies that even kings could only dream of just a century ago. But it has done this at the cost of unsustainable consumption of resources and has systematically valued only the production and distribution portion of the economic cycle, totally ignoring the the end-of-life cycle. This has been exacerbated by a shift to entirely disposable products since the Second World War. In short, the capitalist system as currently implemented is a bit of a Ponzi scheme because, while the assets keep rolling in and getting distributed, huge offsetting liabilities are being ignored and pushed off into some undefined future (that we are rapidly closing on).

    All that said, to eschew vaccination for, say influenza, because you despise the companies that profit from its manufacture is shortsighted and it does, in fact, impact those around you. Apple and Microsoft earn quite handsome profits. Do you avoid computers because those companies profited wildly from capitalism?

    Fight against those things that you believe to be evil. But get vaccinated so that you can help others join you in the fight.

  28. BillyJoe says:

    Regarding the flu vaccine.

    The medical authorities and WHO do not seem to have reacted hysterically to the swine flu epidemic in my opinion. The media, on the other hand, play both sides of the fence, exaggerating the risk in the early stages and then minimising it in the later stages when the epidemic turned out to be not as bad as originally thought. The initial information coming out of Mexico was disturbing to say the least with an extraordinarily high case fatality rate. The WHO and various medical authorities reacted appropriately to this information, but perhaps they were a little slow to scale down the response once it was clear that the threat was significantly less severe and perhaps no worse than the seasonal flu.

    On the other hand, the manufacture of the vaccine was well progressed by that stage and it seemed silly to waste it. In the circumstances, it seems only prudent to continue the rollout and urge the vulnerable members of the public to get vaccinated. Australia in fact had enough vaccines for everyone, which was overkill because you’re never going to get full 100% take up. In the event less than 1 in 5 got the vaccine partially because our flu season was coming to an end just as the vaccine became available (It will help for next Winter however), and partly because of a now cynical media coverage.

    I would rather see them over-react a little than under-react and risk the consequences of a severe flu epidemic without any vaccine. In any case, they will learn from this experience as they have done in the past.

    BJ

  29. Fifi says:

    windriven – I see my response to weing, who apparently has a longstanding love affair with Big Pharma/Corporatism that overshadows any affection for SBM, has triggered your own need to espouse your love of Corporatism dressed up as Libertarianism. Have at it if you must. It’s pretty entertaining that you claim to be a Libertarian but seem to be espousing mandatory flu vaccines and trying to tell me what I should do with my body…hmmm, not so Libertarian really are you? I do get vaccinated when I consider it warranted, which is something I discuss with my parents (both doctors, my mom gave me all my childhood vaccines) and my own GP if the risks and benefits aren’t clear to me from available info.

    My not getting vaccinated against H1N1 had absolutely nothing to do with corporate profits on my side, that’s a pretty shoddy strawman you’re constructing. The corporate issue was that it meant there was no vaccine available to me until last month. At this point it’s hardly worth it since the virus has come and gone where I live. Because there was only maker in Canada, it prevented sufficient vaccine being made in time for it to actually be very useful for the general population. Being a a humanist, I didn’t try to hustle some vaccine for myself before people in high risk groups got vaccinated. Selfish me!!! I’ll wait for next year’s round and then decide upon the evidence available at that time. Oh, and the regular seasonal flu shot has only recently become available here because of worries about interactions if both were given at the same time. I suggest you focus on making your own decisions rather than trying to force me to do what you think I should do based on your non-professional opinion and lack of actual information (and political ideology).

  30. windriven says:

    @Fifi

    “and trying to tell me what I should do with my body”

    You are a piece of work Fifi. You are welcome to comb through every post I’ve made on every blog that has ever appeared on this site (or any other) and you will not find a single instance where I have advocated forcing anyone – much less you – to do anything with the possible exception of forcing parents to give life-saving medical therapy to their dying children – and I’m not at all sure I’ve even given voice to that. Trying to persuade you with logic – a concept that is clearly foreign to you – is rather different than forcing.

    You have instead demonstrated that you live in a cartoon world of white knights and evil dragons; your apparent lack of understanding of simple economic and scientific concepts is breathtaking.

    Get vaccinated or don’t; on a personal level I couldn’t care less. But don’t claim that science supports your personal irresponsibility. It does not.

    I don’t know weing. But s/he certainly has said nothing in anything I have ever read here to deserve your vituperative assaults. Instead of ad hominem attacks why don’t you cobble together a concise argument supported by meaningful thought that might actually bring light to the conversation and perhaps even convince someone?

  31. TD says:

    @Zoe237

    “I don’t know, I could hide in the herd from polio pretty well, considering there hasn’t been a wild case around here in 30 years. Or diptheria. There might be a slightly increased absolute risk, but it isn’t much. That’s why I was wondering if, while certain diseases are eradicated from certain parts of the globe, but not others, if the absolute risk of vaccines (while very very small) aren’t larger than the chance of catching and dying/serious morbidity from the disease. Given that the herd is vaccinated and you are not.”

    I don’t think that’d be a good idea unless the disease has been eradicated fully, like smallpox.
    You never know where you’re going to go in future or who’s going to be coming to your area.

    In the Netherlands there’s a group of strict Calvinist who’re opposed to vaccination because they think God decides whether we get ill or not. While not everyone in that group avoids vaccination, enough people do to create a close-knit community with a low herd immunity.
    This groups remains highly susceptible to epidemics of vaccine-preventable diseases so while Europe has been declared free of polio, it’d take just one infected person to cause a decent epidemic in this community, which has indeed happened in 1971, 1978, and most recently in 1992/93.
    While this is about a largely-unvaccinated group and not an individual, the point is that the polio-free bubble is not particularly secure until the disease is eradicated worldwide.

  32. desiree says:

    “3) There has been a government-backed movement to reduce aluminum levels in infant formula because there have been demonstrated adverse effects from high levels of consumption (>55ug/Kg) on a daily basis.”

    are your units right here, and can you link to the demonstrated adverse effects? all i can find is this: http://pediatrics.aappublications.org/cgi/reprint/97/3/413.pdf which states that levels as high as 0.5 mg/Kg/day appear to be safe. but this is from 1996.

  33. rtcontracting says:

    @Fifi:

    Your “there-were-clearly-some-very-shady-dealings-here-in-Canada” theory seems to be based on some shady facts.

    Pfizer didn’t supply any H1N1 vaccine in Canada. GlaxoSmithKline supplied the Arepanrix H1N1 vaccine.

    You can be suspicious of the Canadian government’s relationship with Pfizer all you want, but it didn’t impact GSK getting the H1N1 contract.

    Also, you say that having one manufacturer limited supplies and meant that the vaccine couldn’t be delivered until after the virus was widely spread in the public. Countries like the US that had multiple vaccine suppliers also had limited supplies and also released their vaccines at roughly the same time as Canada.

  34. windriven says:

    @rtcontracting

    Say it isn’t so! Fifi? Factually wrong? Who would have imagined?

  35. woofighter says:

    @Zoe 237
    “I”m interested in the rise of pertussis as well. It doesn’t seem to be as related to drop offs in vaccination rates, but I could be wrong. I don’t think adults can be vaccinated either- the vaccine for adults is DT. (which, yep, bad me, I haven’t gotten in 15 years). I wonder why adults don’t have the P component, at least to protect smaller kids.”

    There IS an adult vaccine for pertussis –

    “Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years, or after an exposure to tetanus under some circumstances. Tdap is similar to Td but also containing protection against pertussis. A single dose of Tdap is recommended for adolescents 11 or 12 years of age, or in place of one Td booster in older adolescents and adults age 19 through 64.”

    (http://www.cdc.gov/vaccines/vpd-vac/pertussis/default.htm)

  36. BillyJoe says:

    Do we consider ethics here?

    There is no better ethical guide than Kant’s Categorical Imperative: “Act only according to that maxim whereby you can at the same time will that it should become a universal law”. In other words: “Act like you would want others to act”.

    That would pretty well rule out the option of hiding in the herd wouldn’t it? Imagine if everyone did that? Is that the result you are after? If not, then that should not be an option for you.

  37. weing says:

    “I don’t think that’d be a good idea unless the disease has been eradicated fully, like smallpox.”

    I used to think so too until I read reports of smallpox being found in corpses that have thawed out due to global warming.

  38. Zoe237 says:

    “While this is about a largely-unvaccinated group and not an individual, the point is that the polio-free bubble is not particularly secure until the disease is eradicated worldwide.”

    No, and I agree with BillyJoe about the ethics. However, if I refuse the polio vaccine, and the rest of *my* herd is vaccinated, then the risk to me (in the U.S.) is very close to zero, unless I travel. It’s being dishonest to claim (not that anybody has here) that there is a serious individual risk from polio in the U.S., given high vaccine rates. This is directly due to herd immunity.

    “A single dose of Tdap is recommended for adolescents 11 or 12 years of age, or in place of one Td booster in older adolescents and adults age 19 through 64.”

    Good to know, woofighter. I wonder why P vaccination of adults is not widespread.

    I do consider the flu shot to be different, since as far as I can tell, it’s not targeted for eradication. Not that I agree with Fifi, or her tactics. It also would be pretty much impossible to mandate a vaccine that has to be given *every* year to 300 million people.

  39. manixter says:

    Has anyone mentioned that parents who tend not to vaccinate their children tend to cluster? If one wants to rely on herd immunity, using the national vaccination rates would be overestimating your child’s protection (you’re not the ONLY one on your block that bought a copy of Dr. Sears’ book…)

    Thank god my pediatrician kindly but firmly shows the door to parents who choose not to vaccinate… and treats their kids as contagious until they find another pediatrician.

  40. windriven says:

    @weing

    A rather small quibble. The reports I have seen are about the fear of smallpox infected corpses thawing due to global warming, not that they are currently thawing.

  41. Zoe237 says:

    “Thank god my pediatrician kindly but firmly shows the door to parents who choose not to vaccinate… and treats their kids as contagious until they find another pediatrician.”

    The last time I read (granted maybe 3 years ago), the AAP explicitly recommends against this. It leaves children without pediatricians (if another who will take unvaxed kids can’t be found). And it’s hardly a kid’s fault that their parents aren’t informed. I know one family at my school who doesn’t go to the doctor at all for exactly this reason. If measles rates skyrocket in the next few years, making unvaxed kids a significant risk in the waiting room as rates lower due to misinformation, I’m sure the AAP will reevaluate. Maybe quarantines and forced vaccination will become necessary.

  42. weing says:

    @windriven,

    You’re right. Still it’s a possibility in the future. The vaccine stores may still come in handy. Personally, I’ve been vaccinated twice for it already.

  43. Fifi says:

    rt – “Pfizer didn’t supply any H1N1 vaccine in Canada. GlaxoSmithKline supplied the Arepanrix H1N1 vaccine.”

    You’re quite right, I stand corrected and have no issue saying so. Seriously, unlike some people here this isn’t about promoting a economic or political ideology for me, it’s about protecting public and academic science from being decimated in the same way it was by the NeoCons and Corporatists in the US. (Though I guess being pro-SBM and public science and anti-pseudoscience could be seen as a political or social position – however it seems quite in line with an SBM blog to me!) The fact that I got the vaccine manufacturer wrong doesn’t negate the current Canadian government’s attempts to sell out Canadian health research and science to corporate interests by appointing a chiropractor to be the Minister of Science & Technology and putting a still active Pfizer executive on the board of a body that funds public health research. No one who works in academic science or medical research in Canada thinks this is a good thing. Nor does it change the fact that in Quebec the regular flu vaccine was only offered to the general public this month and the H1N1 vaccine wasn’t available to the general public until after the virus had actually spread through the population.

    Anyway. My main point was there is a difference between vaccinating against childhood diseases that can be eradicated and the flu which cannot (at this point in time). Due to the nature of the flu virus, which mutates very rapidly, the evidence around efficacy of the flu vaccine isn’t even really as open and shut as people seem to believe (and some seasons the vaccine misses the most virulent and dominant evolutions of the virus – this is VERY different than the vaccines for childhood diseases which we know are effective from experience, even if we have come to understand that some wear off with time and adult boosters can be necessary). You don’t vaccinate your child against polio simply to protect others, it’s also to protect your child from the virus. It really is comparing apples and oranges.

    People seem to get so caught up in absolutes and ideological stances around vaccination that they’re no longer actually dealing with science or evaluating the risk/benefit of each vaccine on it’s own merits but are instead applying a blanket black and white ideological stance to ALL vaccines. I’m neither an anti-vaxer nor a pro-vaxer – those are ideological positions and not evidence-based ones. I evaluate each vaccine on its own merits. It’s a pity that so many people seem to be purely ideologically driven on this topic. It gets in the way of having a rational discussion.

    Joseph Albletz, I apologize for (unintentionally) derailing the comments following your very good post about childhood vaccination, parental decisions and herd immunity. I didn’t expect such a reactionary and ideological response to merely pointing out that childhood diseases can potentially be eradicated by universal vaccination (a very good thing) but that the flu can’t, isn’t even always effective against the flu around in a particular season, and is an adult choice. You only focused on childhood diseases and parents vaccinating children, my apologies for (unthinkingly) muddying the waters. Childhood vaccines have been around a long time, we’re pretty clear on what the risks/benefits are and the consequences of not vaccinating. This is much less true of flu vaccines. My point was that all vaccines need to be considered on their own merits, which is how everyone I know who works in medicine or science approaches this issue, so I wasn’t expecting that saying so would unleash such a fanatical response.

    I hope that people here engage in the most basic form of preventing spreading the flu virus and don’t assume that being vaccinated actually protects them from all flu viruses. Regular handwashing (including cleaning under your nails), never coughing or sneezing into your hand or into the air and staying out of public places as much as possible when infected are still necessary whether one gets a flu vaccine or not and can actually be very effective in preventing the spread of the virus (the sneezing and coughing are the viruses way of spreading itself). And there’s the very obvious precautions to be taken if one is caring for or around someone who has a compromised immune system (something I have done myself).

  44. TD says:

    I’m starting to think it may be time to inquire about adult pertussis vaccination. My last one was over 15 years ago.
    I’m also glad there are still smallpox vaccine stores after being informed of the possibly contagious ice people. Eep!

    @Zoe237

    “No, and I agree with BillyJoe about the ethics. However, if I refuse the polio vaccine, and the rest of *my* herd is vaccinated, then the risk to me (in the U.S.) is very close to zero, unless I travel. It’s being dishonest to claim (not that anybody has here) that there is a serious individual risk from polio in the U.S., given high vaccine rates. This is directly due to herd immunity.”

    While in the Calvinist group in my example is quite easily identified, manixter’s point is a good one. They’re not the only group not too keen on vaccinations. Unless it’s a frequent topic of discussion, finding out the vaccination status of the people one spends time with can be quite tricky, not to mention the travel-habits of other people. Having said all that, the CDC doesn’t list any serious ones except the possibility of an allergic reaction (http://www.cdc.gov/vaccines/vac-gen/side-effects.htm#polio) so even if the risks of not vaccinating are small, I’d expect them to be larger than the risk of vaccinating unless you’re allergic to any of the ingredients even if you live in a minimal-risk area.

    The point you mentioned about unvaccinated children and paediatricians is an interesting one I’ve been thinking about as well. As I intend to be a GP one day and would like to practice in an area at the tail-end of the Dutch bible belt, I will probably have to think of a way to take care of those people (and other people of a somewhat contagious nature) while not putting others at risk.

    So far I’ve not come any further than pre-visit screenings and having another area for them, but I have no clue how feasible this would be.

  45. Zoe237 says:

    “I’d expect them to be larger than the risk of vaccinating unless you’re allergic to any of the ingredients even if you live in a minimal-risk area.”

    I’m perfectly willing to admit I’m thinking of this in the wrong way- I’m not a doctor and neither are my parents. Give me a number. My risk as a non-vaccinating person contracting polio in the U.S. is… what? One in a million? More? How many people have lived in the U.S. since 1979 and haven’t gotten polio? When/if it does come to the U.S. by way of an unsuspecting traveler, what are the chances it’ll be me infected, in rural Michigan? (Of course, I’m vaccinated against polio, just curious).

    There seems to be two reactions to my above questions, when I’ve asked them to people in the past. The responses are 1. Low individual risk. Getting the vaccine is for herd immunity and because you give a crap about the rest of humanity. And 2. If you don’t get the polio vaccine, the individual risk is high that you could die. Maybe the truth is somewhere in between, I don’t know.

    Smallpox is a good example of risk/benefit analysis. There was some talk and recommendations for vaccinating military members for smallpox, but the risks were pretty big for this vaccine, and the benefits small. I totally agree though that polio is one of the least reactive vaccines out there.

    “Unless it’s a frequent topic of discussion, finding out the vaccination status of the people one spends time with can be quite tricky, ”

    I’d say it’s the number one topic among new parents that I hang out with, ahead of strollers and carseats and birth and breastfeeding. (And unfortunately sbm is losing). But, no, I certainly don’t know everybody we run into vaccination status.

  46. Unfortunately I know a lot of mothers who don’t vaccinate. In my opinion, they have trouble sorting out credible vs. unsupported misinformation–and not just about vaccines. Another factor is that anti-vaccination is a marker of status for a certain type of insular and self-validating peer group. Status can be a powerful motivator. Really, it’s a lot like any other social/fashion trend, but more deadly.

    I find the argument that risks of a particular disease are negligable to be incredibly self-involved. Maybe for a healthy older child, but what about newborns like the baby in Australia who died of vaccine-preventable pertussis? When vaccine deniers say “It’s only one child…” What if it’s my newborn? Or theirs? Or if a death got traced back to their unvaccinated child? I just don’t think they can wrap their minds around the potential impact on other people.

    OT (sorry): We recently took one of the Little Anthropologists to Children’s Hospital in Denver (minor structural disorder, excellent prognosis). Amazing facility. I think more people work there than live in our town. We had an incredibly positive experience.

    Seeing truly heartbreakingly ill children puts the ridiculous handwaving over the miniscule risks of vaccines into perspective.

  47. squirrelelite says:

    Fifi,

    First, I commend you for accepting correction graciously. It’s an important difference between an informed discussion and an argument.
    Second, thanks for devoting so much effort to participating in the comments on this and many other blog postings.
    Third, a little friendly advice. I think you might get a little more appreciative and less argumentative or dismissive response if you work a little on making your comments a bit shorter and to the point. Shotgunning lots of “main points” into one comment makes it harder to tell what the point is and how to respond.
    Now, I will offer my answers to a few of your points. As I do so, keep in mind that the thrust of the main blog was that herd immunity is not perfect and to work at all, it depends on a variable but large portion of the population getting immunized. When people choose to take advantage of herd immunity as an excuse not to get an immunization, they erode the herd protection they are relying on.
    I think BillyJoe explained it pretty well at 2:15 when he gave his version of Kant:
    “Act like you would want others to act”.
    1. I know “the current Canadian government’s … appointing a chiropractor to be the Minister of Science & Technology” has been commented on elsewhere on this Blog. (I.E., ridiculed!) I don’t remember about the “still active Pfizer executive” but that may have been discussed also. That’s not so black and white. If Pfizer is applying for funding from this body, then it is a clear conflict of interest. However, if Pfizer is privately funding their own research, having someone on the board who knows what it takes to actually do health research and get useful results may be a good thing. I don’t know enough about the specifics to go further.
    2. I am surprised that “the regular flu vaccine was only offered to the general public this month (I presume that means Jan 2010?)” I got my seasonal flu shot here in the U.S. a couple months ago. “The H1N1 vaccine wasn’t available to the general public until after the virus had actually spread through the population.” Sorry, the crystal ball was a little cloudy last year. Since this was a novel strain that just appeared in 2009 and required a new vaccine to be developed and tested for it and since it appeared way out of season and very quickly spread into a global pandemic, this is only to be expected.
    3. Yes, “there is a difference between vaccinating against … diseases that can be eradicated” and those which cannot. In the case of diseases which have low mutation rates and no non-human residual sources, there is some hope for ultimate success. For diseases like “the flu virus, which mutates very rapidly”, we are stuck with maintaining eternal vigilance. However, when you state that “the evidence around efficacy of the flu vaccine isn’t even really as open and shut as people seem to believe”, I am not sure what you are looking for. If you really insist that a vaccine has to be 100% effective in order to be useful, then you are slipping into the utopian or nirvana fallacy. Medicines, including vaccines, don’t have to be 100% effective. They just have to be significantly better than the alternative. I have a seizure disorder and will probably take a medicine to mitigate it for the rest of my life. It is not 100% effective, although the current medicine seems to be better than the previous one. Fortunately, though, the results are good enough that any problems are extremely rare and I consider taking the medicine to be much better than the alternative.
    4. “You don’t vaccinate your child against polio simply to protect others, it’s also to protect your child from the virus. It really is comparing apples and oranges.” Actually, all vaccines against viruses are to protect the person receiving them from the virus. Likewise for vaccines against bacteria. Herd immunity is a secondary but much appreciated benefit.
    5. “People seem to get so caught up in absolutes and ideological stances around vaccination that they’re no longer actually dealing with science or evaluating the risk/benefit of each vaccine on it’s (sic) own merits but are instead applying a blanket black and white ideological stance to ALL vaccines.” I’m not quite sure where you are going with this one, but I will try to respond. Actually, there is a lengthy, detailed and careful procedure to evaluate “the risk/benefit of each vaccine” before it gets approved for general use. One of the big questions that are considered is whether the vaccine should be given to everyone and when or if not, then to whom should it be targeted. Another issue is whether there are some people who definitely should not receive the vaccine (such as people who are allergic to eggs.) I’m sure Dr. Paul Offit or any of the regular contributors to this blog could explain the details to you better than I can. I think our real difference on this issue is the degree of confidence we have in whether this process gives us answers that are scientifically, medically, fiscally, and reasonably justified. I have a high degree of confidence in this process. I suspect you do not. If you think that each person needs to individually evaluate each vaccine before accepting it for themselves (or their child), then perhaps you can explain what you think is a reasonable and science-based process for making that decision. This may be a bit of a strawman, but I did say “if”.

    So much for brevity. I guess I don’t have much wit tonight.

  48. squirrelelite says:

    Zoe237 and woofighter,

    I don’t know what the standard is where you live, but the last two times I have needed a tetanus shot (including last month when I tried to separate two of our dogs), I have been offered and gladly accepted the DTP shot (diptheria, tetanus and pertussis).

  49. Uncle Glenny says:

    zoe237,

    A better example of a vaccine given conditionally is yellow fever, as mentioned in passing in this article on HepB vaccination. It is not normally given in this country; I received it before travelling to Italy (albeit in 1971 – I don’t know under what conditions it’s given now).

  50. Uncle Glenny says:

    How US-centric of me: I’m in the US, btw.

  51. TD says:

    Zoe237, it seems I’m rather out of touch on current parenting. Either that or the antivax movement is still the fringe thing it’s always been around here.

    As for numbers and your individual risk, I have no idea what the exact numbers would be or even if it’d be possible to calculate risk. I remember learning about prediction models, but it’s not something I’ve ever dealt with in anything approaching a professional manner and I have no idea if there’s one specifically for polio.

    I expect your individual risk would depend on whether the factors helping to keep the U.S. polio-free for all those years are still in play today.
    As far as I can tell, the main danger is an imported case coming in contact with (people from) a largely unvaccinated group so it’d depend on just how many people are opting out on vaccination, how they congregate and what how/if you come in contact with them, the travel habits of the people in your area, and the travel habits/origins of people travelling to your area. A proper model would probably also feature the efficacy of the vaccinations and percentage of non-responders to estimate how many people are unprotected.
    If any of those things have changed recently (how recent is this more public awareness of the vaccine misinformation?), your individual risk may be higher than you would have estimated by only looking at the long polio-free period.
    Though probably still quite low.

  52. Esattezza says:

    This is somewhat off topic, but…
    I was feeling a bit masochistic this morning and went on the Generation Rescue site. Has anyone else noticed that, now that mercury is in very few vaccines and can be avoided completely by parents if they request, the “mother warriors” have moved on to raising questions about aluminum?

    http://www.generationrescue.org/autism/15-thimerosal-vaccines.htm

  53. squirrelelite says:

    Esattezza,

    Yes, that has been noted. It is called moving the goalposts.

  54. Esattezza says:

    squirrelelite,

    I know what it’s called :P I just hadn’t seen the claim before and was wondering where I might find a good critical review of the issue.

  55. Esattezza says:

    oh, and on the issue of what to call it, i prefer intellectual dishonesty ;)

  56. Esattezza says:

    Annnddd… now i see that it’s been mentioned in these very same comments. Sorry for being a pain in the arse and not paying attention guys.

  57. squirrelelite says:

    It’s OK. Welcome to the blog.

  58. RMSE says:

    @ Essatezza

    The fact that GR poses a question is not a proof that this is always a totally-stupid-nonsense question. If it were, then at least a few dozen of serious papers in respected journals would be nonsense too :)))

    Like this one:

    Inter-subject variability in the metabolism of
    aluminium following intravenous injection as citrate
    R.J. Talbot, D. Newton, N.D. Priest, J.G. Austin and J.P. Day
    Human & Experimental Toxicology (1995), 14, 595-599

    And like the one leonet quoted.

    Beware of “the boy that cried wolf” syndrome
    or maybe “the boy that cried toxicity” ?

  59. provaxmom says:

    Fifi-yes, you and I will have to agree to disagree, because at this point I can’t even tell if you’re for or against vax. Your initial post seems like you are for vaxing, then you parrot every anti-vax argument I’ve ever heard.

    The only reason vaccines exist isn’t just to eradicate disease–it’s to protect individuals in the moment.

    And your repeated “crap shoot” argument literally makes me lol. Yes, researchers throw all of the H#N# possibilities into a hat, then they pick a few, and that is how they formulate which vaccine to produce. Much time, energy, money, science and math is used determine which strains should be made. And after the season, they look at flu-death rates and which deaths could have been prevented–ie, how many people died from the strains for which there was a vaccine. Even on what is known as a ‘bad match’ year, the rate of preventable deaths is usually 60-70%, and we haven’t had a bad match year since 2003. A good match year is 90% or better–that means 90% of the flu deaths involved a strain of the flu for which there is a vaccine.

    So if all of that is a crap shoot to you…….good luck. You’re going to need it.

    Also, I would bet that Canadians, yourself included, probably fear illness much less than I do. You know you are going to have health care coverage, I do not. Two of the four members of my nuclear family have pre-existing conditions and my 3-year-old has already chewed up 15-20%of his lifetime maximum. I realize that is getting a bit off-topic, but suffice it to say that in our household, we will do anything reasonable to avoid getting sick. And imo, a flu shot is more than reasonable.

  60. gaiainc says:

    Until recently, the thought was that the primary DTaP series was sufficient to protect against pertussis into adulthood. Now the thought is that the primary series is not enough to last through adulthood (perhaps because adults are not exposed as often to pertussis due to vaccination and this is MY speculation), so adults need a booster. So one can try to hide in the herd, but I’d consider that a last resort.

    Yellow fever– some countries require proof of vaccination in order to enter, like to Tanzania or Kenya. That was probably the worse vaccine I’ve ever had since it left me feeling grumpy and achy for a few days and with a red, itchy, somewhat tender streak for about 2 weeks. Glad that I will not have to get that one again.

  61. Enkidu says:

    rork stated: Response observed: outrage that vax didn’t work (perfectly), with “see, why bother to get it? There’s no point anyway.”

    Exactly the mindset of most of the anti-vaxers I’ve heard. They would take the pertussis study referenced in this post and say, “89% of those infected were vaccinated, therefore the vaccine is useless.” They know nothing about statistics.

    Case in point:
    People in the link below saying stuff like, “I was fully vaccinated as a child, and was always sick. My kids aren’t vaccinated at all, and are perfectly healthy!” UGH

    http://forum.baby-gaga.com/about972586.html

  62. Zoe237 says:

    “Until recently, the thought was that the primary DTaP series was sufficient to protect against pertussis into adulthood. Now the thought is that the primary series is not enough to last through adulthood (perhaps because adults are not exposed as often to pertussis due to vaccination and this is MY speculation), so adults need a booster. So one can try to hide in the herd, but I’d consider that a last resort. ”

    Thanks, that explains a lot. I don’t think hcps even pushed P for adolescents until recently, but now that it seems to be coming back, maybe it will change.

    Yes, some of the above are reasons parents give for not vaxing. It is infuriating, and you can see the human drive towards anecdotal evidence even on this blog in multiple comments. Some parents are really frightened however of autism. They don’t know anybody with measles. They don’t even know anybody who knows anybody who had measles. They do know multiple kids with autism, however, and many parents don’t read newspapers or blogs or the CDC. They watch tv and hear rumors about vaccines causing autism, and don’t know who to believe. The “parents are stupid” crap doesn’t help either (even if it’s true). They like Oprah and dr. Oz and other celebrities because they are more relatable and also unpretentious and relatable. They use anecdotes to make their points.

    If you want to go mainstream with your message, put it on tv more.

  63. KT says:

    @Fifi –

    Your argument about the flu vaccine only makes sense if you think there is some demonstrable potential harm from getting vaccinated. Just the mere fact that the vaccine MAY not prevent you from getting the flu is no reason to avoid it. I would still get it just in case it does happen to prevent me from getting the flu. Just like certain antibiotics don’t work for X% of the population, but one still takes them as treatment to see if they do work before moving on to something else, because if they do work, they are more effective than doing something else. If the vaccine does work, it is far more effective than any other measures you may take to avoid the flu (unless you are a complete hermit, I suppose).

    Do you think there is a potential harm that outweighs the potential benefit (not getting the flu and not passing it on to others)? If not, then what is the reason not to get the vaccine, even if it is not 100% guaranteed to be effective? Not very many things have a 100% chance of being effective, and yet we do them anyway.

  64. Fifi says:

    provaxmom – “Fifi-yes, you and I will have to agree to disagree, because at this point I can’t even tell if you’re for or against vax.”

    I’m quite happy to agree to disagree, I’m glad you can do so. I’m not ideological about vaccines, I suspect that’s why you may be having difficulty because it seems to be a pretty black/white thing for you without any shades of gray. Like I said, I make decisions about individual vaccines based on the information on individual vaccines. My tendency – unless the risk/benefit evidence is huge from the outset or already established – is to be cautious and to wait and see. I respect that you choose otherwise and uncritically believe that all vaccines are good and can only be good. Having grown up around medicine, I’m more cautious (not because I’m anti-medicine, just because I’m well aware that it sometimes takes a while before we fully understand a new vaccine or medicine).

    I do understand why people get defensive and ideological about childhood vaccines. The whole “vaccines cause autism” crap is intensely annoying for a number of reasons – it’s so clearly wrong and there’s plenty of scientific evidence that shows it is, plus it’s a means to exploit the parents of autistic children and con them out of money. My main point was that childhood vaccines are in an entirely different category than the flu vaccine for adults for a wide variety of reasons. Do you believe they’re equivalent and would you unquestioningly get any vaccine?

  65. Fifi says:

    provaxmom – Life is a crap shoot. I’m always amazed by intensely fearful American culture is – there’s always something evil from the outside trying to kill Americans and American children, be it terrorists or foreigners, roving gangs of sex offenders, germs on the kitchen countertop or created by terrorists (two fears rolled up in one!), and on the list goes. Seriously, do what you need to do to deal with your fears but maybe you want to consider giving up some of them. (I’m not saying don’t get vaccinated or don’t vaccinate your kids, just let go of some of the fear that seems to drive your life and even make you resentful of Canadians…blame Canada!) It’s not psychologically healthy to be fearful all the time and it gets in the way of living. There’s not much point in being alive if one doesn’t actually live! My parents, who are doctors, let me eat dirt, climb trees and walk to school on my own. It’s not because they didn’t care, it’s because they did. Life entails risk – no matter how big the bubble we construct is, there are no guarantees that we’ll be safe (even if we live in Canada ;-)

  66. provaxmom says:

    Nice condescending post . I do not live my life in fear nor am I resentful of Canadians. In fact, I consider myself a full-fledged subscriber to Lenore Skenazy’s Free Range Kids theory ;)

    I’ll bow out now, as it appears your discussion of vaccines has degenerated into only personal attacks and making yourself feel superior and pitying me, while at the same time (again) parroting all the anti-vax arguments.

  67. TD says:

    @gaiaincon

    The RIVM, a Dutch institute similar to the CDC, cites both the lack of life-long immunity from the vaccine (and the infection) and possibly changes in the bacterium creating a minor vaccine/bacterium mismatch as a reason why pertussis rates have gone up a bit these last few years, though they do mention that if vaccinated people get pertussis it’s generally milder than it would be had they not been vaccinated.
    No talk of boosters, though. Not sure they’re even available here. Whenever I’ve seen people get tetanus shots at the ED, it was just tetanus, no DTP.

  68. BillyJoe says:

    Regarding the pertussis vaccine,

    Okay, Australia is pretty far away so this probably doesn’t interest you at all, but to me it is important because I live there, so here is what happens in Australia:

    - vaccines at 2,4 and 6 months
    - boosters at 4 years and 15 years

    The booster at 15 years was added a few years ago when youth in their 20s started getting whooping cough – a cough that lasts about 8 weeks – and passing it on to infants for whon the infection can be deadly

  69. Fifi says:

    provaxmom – “Also, I would bet that Canadians, yourself included, probably fear illness much less than I do. You know you are going to have health care coverage, I do not.”

    provaxmom – “Nice condescending post . I do not live my life in fear nor am I resentful of Canadians. In fact, I consider myself a full-fledged subscriber to Lenore Skenazy’s Free Range Kids theory”

    Um, seriously, you were the one that said you fear illness more than I do and then referred to the fact that I was Canadian as being relevant. I’ve been quite happy to agree to disagree even though you’ve been condescending for quite a bit of this conversation and simply trying to convert me (I get it, being provax is so much a part of your identity you’ve adopted it as your screen name). Apparently you’re incapable of just agreeing to disagree and leaving it at that. Good for you that you let your kids get dirty and walk to school on their own, that doesn’t change the fact that American culture is incredibly fearful in general and you yourself said that you fear illness. It’s a bit silly to get in a huff about your own assertions about yourself and when you brought up national culture in the first place!

  70. Fifi says:

    provaxmom – And it’s also pretty weak to keep trying to paint me as anti-vaccination when I’ve actually been defending childhood vaccination and other proven vaccines and pointed out early on that childhood vaccination can potentially eradicate certain diseases. Seriously, you really can’t see beyond holding an ideological position regarding vaccination can you? That’s not SBM, that’s an ideological position and you’re being no less evangelical than “anti-vaxers” (though fortunately you’ve chosen a much more constructive side of the ideological battle that anti and provaxers seem to be waging).

  71. windriven says:

    @Fifi-

    “Seriously, you really can’t see beyond holding an ideological position regarding vaccination can you?”

    This is rich coming from someone with the political depth of a self-absorbed fifteen-year-old. Your ad nauseum accusations that anyone who doesn’t agree with your puerile views is a ‘corporatist’ (whatever the hell that is) or is holding an ‘ideological position’ about this or that scientific issue is truly tiresome.

    Intellectual rigor is not a buffet table from which you can pick the morsels that you like and reject those that aren’t quite to your taste.

  72. lillym says:

    Fifi – I got what provaxmom was saying because I understand it.

    She’s not talking about fear of illness itself, but the fear of being sick and having family members that have chronic illnesses and worrying about health insurance. Worrying about what will happen if your young child maxes out their life time cap on the health insurance. Worrying if your relatives and family members with pre existing conditions will be denied health care coverage and fearing for what that might mean.

    I know what it’s like to lose someone and constantly wonder — if he had health insurance would it have happened?

    Two years ago this spring my cousin died at age 35 of a heart attack. He was dead before the ambulance reached the hospital. It was horrible, he was at some friends’ house and started to complain of a headache and pains, then he started to vomit and have convulsions. His friends called 911, but it was too late. I can’t even tell you what it feels like to get a phone call saying your younger cousin is dead.

    After the autopsy determined it was a heart attack one question kept running through my head – would he be alive if he had health insurance? After talking to one another several people realized he’d been complaining of symptoms he had that night but milder.

    He wanted insurance, but he worked for a small business as a “contractor” and thus didn’t qualify for their health insurance. He had been diagnosed with depression and couldn’t find a health insurance plan he could afford.

    I know if he had a way to pay for doctor’s appointments and tests he would have gone to the doctor.

    I have another friend whose husband has been out of work for over a year, they couldn’t afford COBRA (he was laid off before the subsidy kicked in), the insurance through her job would take up half her monthly pay and they wouldn’t be able to afford—well anything. So they don’t have insurance. And she got sick recently and called her doctor’s office and explained the situation hoping to get a discount on the doctor’s visit. They told her they couldn’t and it would be $250 for one visit.

    They don’t have that kind of money. She called the only clinic in the area that will see anyone, it’s a 4 month wait list for new people to get an appointment.

    Then there’s me. I have an HMO that’s really good. I can’t complain.

    But in November my side started to hurt. After multiple visits to the doctor’s office ($200 a piece if I ddin’t have insurance), blood tests, urine tests, 1 ultrasound and 2 CAT scans ($200 with insurance it would have been about $2000 without) I had to have cystoscopy with retrograde pyelogram I found out I had very bad kidney/bladder infection. So bad I’ve just finished up a 7 day course of iv antibiotics twice a day, this is done at home.

    I don’t know how many thousands of dollars all that would costs without insurance. I know the home health care service was $315/day for 7 days, which is $2205. The anesthesiologist would have been nearly $2000 out of pocket (it was on the brochure of the outpatient surgery center). I’m already up to $6400.

    If I didn’t have insurance I just would have lived with the pain because I could maybe have afforded the doctor’s visit and that’s it. Maybe the urine test (which said I didn’t have a bladder infection).

    THAT is what Americans fear. It’s not illness. It’s the fear of dying or a loved one dying because you or they can’t afford medical treatment.

    The Canadians I know don’t understand that fear because they don’t have it. They don’t have to worry about their employer raising their health insurance premiums or raising the deductible.

    Another friend of mine had to deal with an increase in the cost of insurance, her company raised it after having a bad year. It’s now $1100/month to cover her family. Her husband is self employed and they couldn’t find anything cheaper. Someone I know who works for different company was lamenting the fact her company changed insurance plans and now she’s faced with a $5000 per year deductible.

    I

  73. Fifi says:

    lillym – You’ll get no argument from me that the American for-profit medical system creates fear and suffering for quite a lot of people, and isn’t really in the public good. I have plenty of American friends and I’m a supporter of universal healthcare for a wide variety of reasons. (Having two doctors as parents meant this was something discussed at home.)

    However, it was provaxmom that brought her fear and my living in Canada into the discussion and it really has nothing to do with why I’m not that fussed about getting a flu shot. (Not that I could have gotten one until this month anyway. And, if I lived in the US I probably couldn’t afford to get a flu shot.) As I said, if she’s afraid of the flu (or complications from getting the flu) then I think doing things to both minimize her fear and her risk are obviously the right choice for her. That’s her situation and I certainly didn’t try to tell her not to get a flu shot, I’ve been arguing personal choice on that one. I’ve also been vocally supporting childhood vaccination (as well as tetanus and so on, I’m hardly anti-vaccination and it was getting a bit tiresome to be accused of being an anti-vaxer).

    Unfortunately provaxmom felt, for whatever reason, the need to make it about me living in Canada and her fear (and then got upset when I pointed out that American culture is generally more fearful of all kinds of things). For whatever reason, she seems to believe that I should be as fearful as she is.

    People die of heart attacks before ambulances arrive in Canada too, people fall through the cracks – particularly those who can’t be their own advocates or have someone be their advocate. For instance, public mental health care here is pretty overburdened and inadequate (it’s better if you have insurance or afford a therapist). I think some Americans have a rather idealized idea of medicine in Canada and the rest of the world. (Michael Moore tends to exaggerate for effect, it’s not a 1950s American utopia in Canada!) Not that I’m complaining but our system isn’t perfect and we face the same issues of an aging population, retiring doctors and staffing shortages as in the rest of the world (plus we have Americans poaching our nurses and doctors). For instance, it can be difficult to find a GP – sure there are walk in clinics but that’s not the same as having one’s own family doctor. You really do have to be quite pro-active about managing your own and your loved one’s health here too.

    So, while I appreciate your explanation it’s also quite clear that provaxmom has taken an ideological and entirely uncritical pro-vax stance about ALL vaccines and can’t simply accept that it’s not an ideological issue for me. I have never, ever, been arguing against provaxmom or anyone else getting a flu vaccine. And I’m certainly no anti-vaxer (in fact, I’ve discussed why childhood vaccination is good with many of my friends who are moms and dads and educated people about what autism is and why it’s not connected to vaccination).

  74. windriven says:

    This from Agence France Presse:

    GENEVA (AFP) – Cases of diarrhoea, measles and tetanus have been reported in Haiti, the World Health Organisation said Friday as it expressed concern about the spread of such illnesses in camps for quake survivors.

    “Several medical teams report a growing caseload of diarrhoea in the last two to three days,” said WHO spokesman Paul Garwood.

    “The are also reports of measles and tetanus, including in resettlement camps, which is worrisome due to the high concentration of people,” he told journalists.

    UN agencies and the Haitian government are aiming to launch a vaccination campaign against measles, tetanus and diphtheria next week.

    Just 58 percent of Haitian infants were immunised before the quake, Garwood said.

    Looks like almost half of Haitians are trying to hide in the herd. We’ll see how that works out for the herd.

    Vaccination is not a personal choice like whether or not to have cheese on one’s hamburger.

  75. Plonit says:

    Looks like almost half of Haitians are trying to hide in the herd. We’ll see how that works out for the herd.

    ++++++++++

    Any evidence at all to suggest that, prior to the earthquake, Haitians were declining vaccination when offered, prefering to rely on herd immunity? That’s the implication of your comment.

    Yet, in a country where most people have very limited access to primary healthcare, there are surely better explanations for low rates of vaccination than that people are ‘trying to hide in the herd’.

  76. Zoe237 says:

    “Just 58 percent of Haitian infants were immunised before the quake, Garwood said.

    Looks like almost half of Haitians are trying to hide in the herd. We’ll see how that works out for the herd.

    Vaccination is not a personal choice like whether or not to have cheese on one’s hamburger.”

    Oh goody, let’s blame the Haitians for their plight.

    Might the cause of this 58% be lack of availabillity/ economic reasons?

  77. Fifi says:

    The low vaccination rates in Haiti are due to a lack of access to all kinds of basic healthcare prior to the earthquake and intense difficulty providing disaster relief after the earthquake. But, sure, let’s blame the Haitian people for their plight and demonize an already suffering group of people, who have little or no choice or control over many basic aspects of their lives, simply to play games and be provocative on an SBM site.

  78. windriven says:

    @Plonit, Zoe, Fifi
    Don’t be obscene. No one is blaming the Haitian people for low vaccination rates. Read the comment in the context of the blog to which it is posted.

  79. Fifi says:

    windriven – “Looks like almost half of Haitians are trying to hide in the herd. We’ll see how that works out for the herd.”

    windriven – “No one is blaming the Haitian people for low vaccination rates.”

    Er, yes you did assign blame by saying “looks like almost half of Haitians are TRYING to hide in the herd”. You’ve assigned intention here. I suspect you’re just trying (see, I’m assigning intention) to be gratuitously provocative here (again).

  80. Zoe237 says:

    “Don’t be obscene. No one is blaming the Haitian people for low vaccination rates. Read the comment in the context of the blog to which it is posted.”

    I apologize for assuming then. Unfortunately, there is no personal choice for many Haitians who simply do not have access to the vaccines. This is the real danger to herd immunity.

  81. windriven says:

    @ Zoe-
    In rereading my comment it is easy to understand how it was misinterpreted. The fault is entirely mine for dashing off a poorly structured comment. My intended points were two:

    1. That given the low infant vaccination rate for diarrhea and measles, Haitians were likely to witness complete collapse of herd immunity. I meant this to be taken as an horrific object lesson about the importance of maintaining herd immunity, and;

    2. That those commenters who earlier in this blog suggested that vaccination was a personal choice were and remain quite simply wrong.

    Among the saddest ironies of point 1 is that people and organizations the world over are tripping over one another to deliver aid to Haiti now that disaster is upon them but that a relatively small investment in preceding years would have mitigated one of the problems that will plague Haitians at a time they are least able to cope with it. Sort of the opposite of the ‘boy who cried wolf’ syndrome; more out of sight, out of mind.

  82. Zoe237 says:

    “2. That those commenters who earlier in this blog suggested that vaccination was a personal choice were and remain quite simply wrong.”

    I believe that vaccinations are a personal choice, but in the case of an outbreak, I support quarantine. Or refusal for entry to public school. I would not support fines or jail time for refusal to vaccinate, at least not at the herd immunity levels we have now.

    “Among the saddest ironies of point 1 is that people and organizations the world over are tripping over one another to deliver aid to Haiti now that disaster is upon them but that a relatively small investment in preceding years would have mitigated one of the problems that will plague Haitians at a time they are least able to cope with it. Sort of the opposite of the ‘boy who cried wolf’ syndrome; more out of sight, out of mind.”

    Yep. You could say the same about New Orleans/ hurricane Katrina, or the structures in Haiti, or a billion other things. But it would cost money.

  83. Plonit says:

    @windriven

    “In rereading my comment it is easy to understand how it was misinterpreted. ”

    That’s better. It’s always a good plan to reread your own comment before accusing other people of obscenity.

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