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May 02 2012

Measles is on the road to recovery

Well done anti-vaxxers – another triumph for public health. There are more than 200 confirmed cases of measles in the outbreak on Merseyside.

There are 210 confirmed cases, 39 of which needed hospital treatment. Ninety two cases are under investigation.

About 50% of the cases are in children under five years old.

The outbreak, which is concentrated on Liverpool where there are 125 confirmed cases, is the largest since the MMR vaccine was introduced.

Strange, isn’t it. There’s an effective vaccine for measles. You’d think it would be going away, not coming back.

Dr Roberto Vivancos, a Health Protection Agency consultant, said: “It’s obvious from these statistics that people who are not fully vaccinated are not just at risk themselves, but they pose an infection risk to others, such as defenceless babies and toddlers who are too young to be vaccinated.

“Measles is a very infectious illness that spreads rapidly amongst children and adults who are not protected by MMR vaccine.

“It is also a serious illness that can lead to serious complications. On rare occasions, people die from measles.

“It should not be treated lightly, but it is an avoidable illness and we strongly advise parents to ensure that their children are vaccinated.”

Fascist! It’s every parent’s right to refuse to get children vaccinated. Our ancestors died to protect our right to refuse to get children vaccinated; the right to be infected and to spread infection to others is sacred and cannot be abrogated.

33 comments

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  1. 1
    Matt Penfold

    I cannot understand why local authorities cannot be given the power to ban children who have not been vaccinated from attending state funded schools. Even limiting the use of the power to when there is an actual outbreak could alleviate a lot of suffering.

  2. 2
    sundoga

    Better idea: legally require vaccination. People do NOT have the right to abuse their children – and that’s what refusing to vaccinate is.

  3. 3
    Ophelia Benson

    In some places they do, don’t they? Or is that just a US thing? I think some schools make enrollment conditional on up to date vaccinations.

    On the other hand in the US most states allow “religious” exemptions – which is simply…horrendous.

  4. 4
    Matt Penfold

    In some places they do, don’t they? Or is that just a US thing? I think some schools make enrollment conditional on up to date vaccinations.

    I recall reading that in the US it can be made mandatory, but there are no such powers in the UK. Until Wakefield it had not be necessary, of course, and I suspect since then successive Governments have not had the courage.

    Our local secondary school had an outbreak of measles a couple of months ago. Thankfully no one has suffered any lasting damage from having got the disease (or nothing has been reported at least) and the authorities did a good job. There were staff on hand to vaccinate the children and staff, and a very strong recommendation, that the parents of those children who had not been vaccinated and who did not want them to be, should keep their kids away from school until the outbreak had ended.

    On the other hand in the US most states allow “religious” exemptions – which is simply…horrendous.

    Absolutely.

  5. 5
    Markita Lynda—threadrupt

    One of your inoculations — smallpox or diptheria — was made mandatory when there was an epidemic and voluntary inoculation wasn’t enough. And that led to a permanent decline of the disease.

  6. 6
    Markita Lynda—threadrupt

    Without a law requiring them, you can raise the percentage vaccinated dramatically by requiring parents to get a letter from their doctor excusing their child on medical reasons if they are not vaccinated in time for school attendance. Since parents have to take the child to the doctor anyway, and the doctor doesn’t usually find any medical reason, the kids get the shot.

  7. 7
    SnowyBiscuit

    Ophelia Benson:
    In some places they do, don’t they? Or is that just a US thing? I think some schools make enrollment conditional on up to date vaccinations.

    Yes, schools do require up-to-date vaccinations. BUT, the anti-vaxxers have been known to simply lie on the vaccination records (my nephew’s mother did this). Also, too many localities have an out for people with “religious or ethical objections” to vaccines.

    My grandmother had polio as a girl (circa 1920) and lived with a club foot and hip problems for the rest of her life (all 93 years of it). She endured multiple treatments, surgeries, and terrible arthritis. My mother’s older brother died of complications from measles. So of course the anti-vaxers make me utterly, completely, nearly incoherently angry.

    No one should have the right to make anyone re-live the days when a couple of the kids in your class in grade school would die.

  8. 8
    SnowyBiscuit

    Edit — make that clarified to “schools in the US”.

  9. 9
    Matt Penfold

    No one should have the right to make anyone re-live the days when a couple of the kids in your class in grade school would die.

    Thankfully I never had that happen, at least not because of a preventable disease. When I was in primary school I did have a friend who’s brother had been left profoundly deaf by measles and that was bad enough to make me aware measles is not something to be taken lightly.

  10. 10
    Ophelia Benson

    My older sister had polio as a girl. She had a paralyzed lower leg for the rest of her life, which became a painful sideways twist of the ankle in middle age.

    The vaccination came along in time for me. I can only imagine my mother’s feelings.

  11. 11
    eric

    In the U.S., the Food and Drug Administration (FDA) regulates and licenses all vaccines to ensure safety and effectiveness. No federal vaccination laws exist, but all 50 states require certain vaccinations for children entering public schools. Depending on the state, children must be vaccinated against some or all of the following diseases: mumps, measles, rubella, diphtheria, pertussis, tetanus, and polio.

    That from the CDC web site: http://www.cdc.gov/vaccines/vac-gen/laws/state-reqs.htm. They even have a small applet letting you search vaccination requirements by state, grade, and disease.

    I’m okay with religious exemptions, with two caveats. One: epidimiologists determine the amount allowed. I.e., if they determine that the % of unvaccinated kids is becoming too high in an area to prevent an epidemic, vaccination then becomes mandatory in that area. Two: kids without vaccinations should be identified in some way. The idea that my (hypothetical) infant would be exposed to measles because you didn’t get your kid vaccinated and I didn’t know that is horrifying. In this instance, the people around you need to be informed of your risky health choice, because it affects their health too.

  12. 12
    Gregory in Seattle

    Washington State is in the midst of a pertussis (whooping cough) epidemic thanks to the anti-vaxxers: see here. So far this year, more than a thousand cases have been reported to the state health department, which is TEN TIMES as many as there were in the first four months of 2011.

  13. 13
    Ophelia Benson

    Good god! I didn’t know that about Washington state. A thousand…

    And pertussis is really horrible.

    eric, why on earth are you ok with religious exemptions? I think that’s a terrible idea.

  14. 14
    Raging Bee

    Why the fuck do we have religious exemptions for a PUBLIC HEALTH procedure? Whatever happened to equal protection of the laws and no favoritism toward this or that religion?

    Allowing a religious exemption for a life-saving preventive measure is no better than allowing a religious exemption for our rape or murder laws.

  15. 15
    raven

    Measles can be fatal. 2 or 3 out of 1,000 children who get it will just die. Many more will suffer permanent damage.

    The whooping cough epidemic in Washington is quite large, considering it is a preventable disease. The reported cases are around 1000. It’s estimated that there are 10 times that many unreported cases for something like 10,000 actual cases.

    Pertussis is occasionally fatal in infants.

    A great job again by the anti-vaxxers.

  16. 16
    raven

    My older sister had polio as a girl. She had a paralyzed lower leg

    When I was a kid growing up, a lot of older adults limped in various ways. We all knew what that meant. Polio.

    In my generation the vaccine existed and you don’t see that. If it wasn’t for various dysfunctional third world situations, polio would be like smallpox, extinct.

  17. 17
    iknklast

    I don’t think religious exemptions should be allowed for parents; their children do not belong to them, and do they really have the right to impose their own religious doctrine? No, not if there is a risk to the child’s health or well being.

    If a parent doesn’t wish to get themselves to the doctor, fine, that’s their choice. But religious exemptions should apply only to the choice of the individual being exempted, and that should only occur if they are old enough to make a fully informed decision.

    Children should be vaccinated. No exceptions, unless there is a really good medical reason for not doing it – and being born to delusional parents isn’t really a good medical reason, now, is it?

  18. 18
    A. Noyd

    Ah, yes, Washington’s pertussis outbreak. I’ve a naughty inclination to go around to all of Seattle’s eighty billion acupuncture clinics and pin up signs saying, “Hey, all you alternative medicine-loving fuckwads, thanks for the pertussis outbreak. Now, go get a needle stick that will actually make a difference: the Tdap booster.”

  19. 19
    SnowyBiscuit

    raven:
    When I was a kid growing up, a lot of older adults limped in various ways. We all knew what that meant. Polio.

    In my generation the vaccine existed and you don’t see that. If it wasn’t for various dysfunctional third world situations, polio would be like smallpox, extinct.

    Exactly, and that’s why the anti-vaxxers are so utterly cavalier about the repercussions of not vaccinating their children.

    The thing that will quickly change the mind of a lot of the anti-vaccine crowd is when their children begin to be killed or seriously damaged by a vaccine-preventable disease. Those parents are so wrapped up in themselves and their rights, that it will take personal losses to make them get it.

  20. 20
    Ophelia Benson

    Ok I see a place for a really good documentary movie here, full of old footage of kids in braces, wheelchairs, iron lungs. Then George Clooney or someone saying IS THIS WHAT YOU WANT YOU FUCKING FOOLS????

  21. 21
    Didaktylos

    My mother (she’s 80 in December this year) caught measeles aged 12 – and it severely damaged her hearing. She is now almost completely deaf.

  22. 22
    kagekiri

    Ugh, I hate anti-vaxxer and anti-medical-science BS I have to deal with because of my fundie parents. They’re not quite at “faith-healer” levels, but they have a distinct disdain for medical science, partly rooted in Christianity, and partly rooted in believing in Eastern medicine.

    Neither seem to think of pertussis or influenza as a threat to their first grand-daughter (my niece), so they put off getting the vaccines for weeks and then months despite the urging of the new parents, and made disparaging remarks about parents who are too inexperienced and that “you can’t protect your children from everything.”

    The real kicker?

    The parents of said grand-daughter are both MDs, not fear-mongerers or ignorant people prone to hypochondria. GAH.

    I had to explain that “Yes, babies actually die from this, and it’s because of stupid ignorance, and laziness is NOT A GOOD REASON TO ENDANGER SOMEONE’S LIFE.” Thrice-damned God, it pisses me off.

    Half-ignorance is really almost more annoying than full ignorance. My mother mentions something about hearing that babies need anti-bodies and get them from their mother, and thus she assumes that she can extrapolate total immunity to diseases for any nursing baby.

    But it doesn’t work that way! And the doctors know the consequences better than anyone! GAAAAARGH Dunning-Kruger effects make me want to break my head on a wall.

  23. 23
    Ophelia Benson

    Wait, what? The parents let the grandparents delay vaccinations? Why? (Prying question, but then, you brought it up…and I’m curious!)

  24. 24
    Josh Slocum

    1. While schools can make vaccines mandatory in the US 48 states allow religious exemptions. Read that again and let it sink in.

    This means: Kids can legally go to school (you know, those schools that “mandate” vaccines) in 90 percent of US states without being vaccinated.

    2. Of those 48 states, 20 states expand the exemption beyond religion to include “personal beliefs” or “philosophical objections.” Again, let that sink in.

    This means: You can believe bullshit and send your kid to school (or the grave, depending on how ambitious you are. Maybe someone else’s kid to the grave?) unvaccinated.

    Source: Johns Hopkins Bloomberg School of Public Health.

    It’s really crucial to understand that the US is NOT a leader in “requiring” vaccinations. It’s child’s play to get out of the requirement.

    My own state of Vermont, thanks largely to the hippy-dippy contingent who believes in all things Natural (they don’t seem to understand Gaia creates poisons, only a Bounty of Whole Foods), is fighting an uphill battle to get rid of our philosophical exemption.

    Brought to you by post-modernism, relativistic epistemologies and the elevation of Intuition and “I feel that blah blah blah” over facts. Additional support provided by The Consortium for the Conflation of Professed Religious Sentiment With Legitimate and Relevant Conscientious Dissent, a wholly owned subsidiary of Merka™.

  25. 25
    Liz Ditz

    Uhm, pertussis is complicated. Deliberately unvaccinated children contributed to outbreaks but weren’t the sole cause. In other words, infection rates were higher in areas of low vaccine uptake, but were also observed in areas of high vaccine uptake.

    At least in California, the outbreak was also abetted by the acellular vaccine formulation’s immunity declining sooner than than previously thought. Also, pertussis is a relatively minor disease in adulthood. Until recently, it was difficult to determine if a persistent cough in an adult was pertussis or from some other cause, but newer diagnostic tests are available.

    I’ve heard anecdotally that it wasn’t until California was well into its outbreak that adult primary care providers thought “pertussis” when presented with an adult with a persistent cough. Also anecdotally, in adults the disease may be mild enough that an infected individual may not seek medical care until many in the individual’s circle are diagnosed. (Evidently this happened in some New York office buildings in I think 2008. Not enough to be “an outbreak”.) Many adults aren’t current on their booster vaccinations, and they too are sources of infection.

    Measles, on the other hand, is pretty straight-forward. It’s highly, highly infectious, The vaccine has a pretty high protection rate after the two doses, and immunity seems to be of significant duration. The track record seems to be that unvaccinated individuals are (1)responsible for importing the disease from areas of high measles prevalence (low vaccine coverage) (Called First generation cases) and (2) much more likely to catch the disease from exposure to first generation cases.

  26. 26
    'Tis Himself

    I was eight when the Salk polio vaccine was introduced. The town offered free vaccinations to any children whose parents wanted them. With the exception of some Christian Scientists, every kid in that town was vaccinated. Our parents knew about polio.

  27. 27
    raven

    That religious exemption can be pretty flexible.

    A few years ago near me, the grade school had a whooping cough outbreak. It quickly spread to infants who weren’t yet vaccinated and some adults.

    The county healthy department went into crisis mode and told all the unvaccinated kids to go home and stay there until the outbreak was halted.

    This annoyed a lot of parents enough, especially the ones who had to go to work and had no child care, that most of them went and got their kids vaccinated.

    No one died in this cluster but there were some really sick infants.

  28. 28
    Uncle Glenny

    My maternal grandmother (b. 1908) had polio as a child. Wheelchair bound for life – she claimed she recovered from the polio but her legs were messed up by medical maltreatment. (She lived into her seventies, even surviving and recovering from a stroke, and surviving her husband by over a decade.)

    My mother’s brother died as a child; I don’t know why (my family wasn’t great on personal history and there hasn’t been anyone to ask for decades) but believe it to have been some now-vaccinatable disease.

    I’ve gotten the polio vaccine as a child, hep B, and whatever might come mixed with tetanus boosters as an adult. I should get a pneumonia vaccine as I’m 55, smoking history, and reduced lung capacity from scoliosis. I’ve been thinking about others (MMR? pertussis?) – even though I’m pretty much a shut-in I live with someone who works at a supermarket, ‘often at checkout.

    @Liz Ditz:

    I seem to remember a report of a small measles outbreak in the past couple years, possibly involving a summer camp, and a number of the kids supposedly had been vaccinated.

  29. 29
    Amy Clare

    Disheartening to hear of this and also the whooping cough outbreak. I wasn’t vaccinated against whooping cough as a child, so I got the disease… my parents claimed that they were warned off *by the GP* who told them I might end up with dementia.

    Turns out that there was a whooping cough vaccination scare very similar to the MMR one, in the UK in the late 70s and early 80s which caused the vaccination rate to drop to about 30%. A thorough history of it is here:

    http://briandeer.com/dtp-dpt-vaccine-1.htm

    As a result there were major outbreaks, one of which was in 1982, which was when I contracted it.

    This is an interesting blog post drawing parallels between that and the MMR scare:

    http://jdc325.wordpress.com/2011/01/07/vaccine-scares-mistakes-fraud-and-media-scaremongering/

    Both scares were due to a single flawed study, since debunked, but that the media seized on with relish.

    It’s sad to see that people have still not got the message that the MMR scare is baseless. (Also, a couple of years ago there was a mumps outbreak near where I live – I had the MMR then, as I am too old to have received it as a kid.) I guess once a scare story has been released its effects take a long, long time to dissipate. Not helped by the continued work of pigheaded anti-vaxers. :/

  30. 30
    Zyzle

    Amy: Yup, I almost missed out on my whooping cough vaccine because of this. My mum, having read about this supposed link to brain damage and was scared to have me vaccinated. Luckily for me my dad, knew a couple whose child had died due to the disease was able to talk her around.

    Luckily the scare regarding the MMR kicked off a few years after my younger sister had hers (I have a feeling when I was younger the individual vaccines were favoured over the combined).

    I also remember both grandparents telling stories similar to those above, with people desperate to get their children vaccinated against polio. Its amazing how quickly something with such a devastating effect on so many people can be forgotten.

    From earlier this year mumps is making a comeback at the University of Glasgow. I hope for 2 things here; one, that the parents of these kids are happy with themselves and two, that those suffering with the infection can avoid complications and actually be parents themselves one day.

  31. 31
    Godless Heathen

    I know that the pertussis vaccine can wear off in adults. Apparently, it’s common enough that booster tetanus/diphtheria shots now include pertussis, which is included in the childhood vaccine. I know this because when I cut myself fairly badly a few months ago, I received a tdap shot rather than just a td (or whatever it’s called) shot.

    I’m trying to find information on the MMR vaccine wearing off, but I can’t. I vaguely remember a measles outbreak among college students when I was in college 6 or 7 years ago and I thought part of the problem was that the vaccine wore off. However, I can’t confirm that.

  32. 32
    Liz Ditz

    I’m trying to find information on the MMR vaccine wearing off, but I can’t.

    The results from pubmed are complicated. This is the clearest:

    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.
    PMID: 14575773

    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.

    Translation: vaccine-derived immunity is not life-long, but we don’t know how long it is and we need to do more research.

    Annu Rev Med. 1992;43:451-63.
    The resurgence of measles in the United States, 1989-1990.
    Atkinson WL, Orenstein WA, Krugman S.
    PMID: 1580601

    Outbreaks of measles among vaccinated school-aged children continued to occur but had less impact than outbreaks among preschool-aged children. Efforts to prevent measles must be aimed at improving age-specific measles vaccination coverage among preschool-aged children, and implementation of a two-dose measles strategy among school-aged children.

    This paper was one of the factors in adding the second dose of MMR.

  33. 33
    No Light

    I’m 34, and I’ve had mumps and pertussis in the last seven years. The former caused an agonising ovarian issue, and the latter involved eight weeks of being blue, and breaking a rib.

    I’m better off than the babies who’ve died (here in the UK), but as measles is spreading rapidly I’m not feeling very positive right now. I haven’t been able to be immunised for about ten years due to a perfect storm of factors, but back then I was assured that these diseases were practically footnotes in public health history.

    Thanks Wakefield et al. I’ve incurred enough brain damage due to my condition, without adding the risk of measles encephalitis into the mix.

    When your own GP jokingly offers to write a prescription for a sterile bubble , shit starts to seem really serious.

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