In the wake of antivaccine-pandering pediatrician "Dr. Bob" Sears' attempt to paint the measles as no big deal, so much so that it totally escaped his notice that it might not be a bad idea to recommend that the unvaccinated get the MMR vaccine in the midst of an outbreak, the bad news about the Disneyland measles outbreak just keeps coming in. Hot off the presses yesterday:
There are now 67 confirmed cases of measles in an outbreak centered in California, health officials said.
The California Department of Public Health said there are now 59 cases in the state – 42 that have been directly linked to being at Disneyland Park or Disney California Adventure Park in December. Some people visited Disneyland Park or Disney California Adventure Park while infectious in January.
Measles outbreak update: 59 confirmed cases in California Measles outbreak update: 59 confirmed cases in California The 59 patients in California range in age from 7 months to 70 years. The vaccination status is known for 34 of the patients. Of those, 28 were unvaccinated, one had received partial vaccination and five were fully vaccinated.
And, there's a direct rebuke to Dr. Bob's attempt to downplay the seriousness of the measles, in which he echoed the utterly ridiculous but favored antivaccine trope that I have dubbed argumentum ad Brady Bunchium, or the appeal to an old Brady Bunch episode in which the measles was played for laughs. Basically, in the episode the Brady children all caught the measles, which was portrayed as not at all serious. Indeed, the children were shown happy to be staying home from school and playing monopoly to pass the time.
So what is the rebuke? This:
Of the cases in California, one in four sickened have had to be hospitalized.
I'd say that a disease that causes one in four of the people who get it to require hospitalization is not a "benign" disease. We don't hospitalize people lightly these days anymore, given how insurance companies, HMOs, and other entities have been trying to crack down on cost and medicine has moved to treating as many cases as possible without hospitalization. Yet one in four measles victims in this outbreak required hospitalization.
Dr. Bob remains, as ever, a petulant idiot.
Moreover, as I pointed out before, the antivaccine brigade can't even pull out the old trope in which they claim that more victims of an outbreak are vaccinated than unvaccinated, a claim that inevitably demonstrates innumeracy in that if you take into account the proportion of the population that is vaccinated and calculate the disease attack rates you'll always find that the unvaccinated have a much higher risk of contracting the disease during an outbreak than the vaccinated. Always.
Disneyland Resort employees who had contact with measles-stricken coworkers have been asked to stay home unless they can show they’ve been vaccinated or take a blood test to show they’re immune, Disney officials told the Los Angeles Times.
On Tuesday, company officials confirmed to The Times that five Disneyland Resort employees had been diagnosed with measles. Two had been vaccinated, health officials said, and the vaccination status of the other workers is still being investigated.
All resort workers who could have been in contact with those five have been asked to provide vaccination records or submit to a blood test that shows they have built immunity to the disease.
Any employees who had not been vaccinated or could not confirm their immunity status were asked to go on paid leave until their status could be confirmed, Disney officials said.
This makes a lot of sense. I'm glad that Disneyland is doing the right thing for its employees and patrons in this case. Tell them to stay home on paid leave until enough time has passed to see if they are infected or not, or have them show proof of vaccination or evidence that they are immune.
At this point, I think it's worth citing quotes that you, my readers, provided me with regarding what doctors really thought of measles. First, thanks to Todd, here is J. Mayer, MD addressing the 34th Annual Meeting of the State Society (California) in 1904 [emphasis added]:
It is hard to combat the old notion that measles is something akin to a common cold with a rash, and that there is nothing to be done but keep the patient warm. It is also difficult, as you know, to have people accept a new medical idea, which is not to be wondered at. The truth is that we, ourselves, too often encourage indifference by some such remark as “It is only measles.”
Gentlemen, experience has taught me that every case of measles should be looked upon by a physician as involving not only the question of the future usefulness and well-being of the subject, but even that of his life.
Dr. Mayer then quoted The Twentieth Century Practice of Medicine:
Measles is a dangerous disease-one of the most dangerous with which a child under five years of age can be attacked. It is especially apt to be fatal to teething children. It tends to kill by producing inflammation of the lungs. It prepares the way for consumption. It tends to maim by producing inflammations of the ears and eyes. Measles has carried off more than four times as many persons as enteric fever. It is therefore a great mistake to look upon measles as a trifling disease. Every child ill with measles ought at once to be put to bed and kept warm, for the mildest cases may be made serious by a chill. Measles is for this reason most dangerous in winter and spring. The older a child is, the less likely it is to catch measles, and if it does, the less likely it is to die. If every child could be protected from measles until It had passed its fifth year the mortality from this disease would be enormously decreased. It is therefore a great mistake – because as a rule children sooner or later have measles – to say, “The sooner the better,” and to take no measures to protect them, or even deliberately to expose them to infection.
So the sorts of arguments being made by antivaccinationists, Dr. Bob Sears, and, yes, Dr. Jay Gordon are very old arguments indeed. They are the same sort of "don't worry, be happy" fallacies that have been around at least a century. Earlier than that, nearly 170 years ago, a very famous American writer had his own experience with the measles, an experience that he described in an essay entitled The Turning Point of My Life:
When I was twelve and a half years old, my father died. It was in the spring. The summer came, and brought with it an epidemic of measles. For a time a child died almost every day. The village was paralyzed with fright, distress, despair. Children that were not smitten with the disease were imprisoned in their homes to save them from the infection. In the homes there were no cheerful faces, there was no music, there was no singing but of solemn hymns, no voice but of prayer, no romping was allowed, no noise, no laughter, the family moved spectrally about on tiptoe, in a ghostly hush. I was a prisoner. My soul was steeped in this awful dreariness--and in fear. At some time or other every day and every night a sudden shiver shook me to the marrow, and I said to myself, "There, I've got it! and I shall die." Life on these miserable terms was not worth living, and at last I made up my mind to get the disease and have it over, one way or the other. I escaped from the house and went to the house of a neighbor where a playmate of mine was very ill with the malady. When the chance offered I crept into his room and got into bed with him. I was discovered by his mother and sent back into captivity. But I had the disease; they could not take that from me. I came near to dying. The whole village was interested, and anxious, and sent for news of me every day; and not only once a day, but several times. Everybody believed I would die; but on the fourteenth day a change came for the worse and they were disappointed.
So, far from always having been viewed as a benign childhood disease that most children get and recover from without incident, which is the view that Dr. Bob and his fellow antivaccine minions would have you believe, the measles was actually feared as a scourge in the 1800s and even into the 1900s physicians recognized that it could cause serious complications. Even today, with all the modern medical care and supposed fantastic nutrition children in the U.S. now enjoy, it can cause one quarter of those who contract it to need hospitalization.
Pediatricians like Dr. Bob should know this. So should all doctors and patients. Thanks to the antivaccine movement, I fear we will be forced to learn old lessons again.
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One in four, EGAD. That information wasn't on the public health site last I looked, so thanks Orac & the LA Times. I also noticed some of the cases are as far north as Alameda County, hope this doesn't lead to a secondary cluster of infections in the Bay Area (and further hope that all my high school and college pals got their kids vaccinated).
Spreading is what meaasles excels at. Marin County is another anti-vax moron filled area just across the Golden Gate from San Francisco. I expect they are next.
One in Four matches up with recent experiences in Europe as well - where one in four in the French outbreak were hospitalized.......modern medicine can keep people alive a lot better than in previous mass outbreaks, but when it comes to preventing infections in the first place, vaccines are the one best tool that exists to prevent this suffering in the first place.
I'm glad the anti-vaxxers are feeling the heat on this one - because it validates what we've been saying for years - that it was only a matter of time before we suffered a large VPD outbreak in an undervaccinated population.
Dr. Bob remains, as ever, a petulant idiot.
The problem, of course, is that he is a persistently loud petulant idiot. who only seems to scream more when rebuked. If Sears presented his grossly incorrect understanding of vaccines and infectious disease to just the families in his practice, he'd probably only be known (as a quack, of course) to other physicians in his community. But Sears has some pathological desire to be even more famous than his dad, and he's harmed public health across this country. Sears and other AVers deserve all the blame for this and we need to keep reminding people of this.
If Disney wanted to do right by its employees and their customers, which include large numbers of children, it would require all of its employees to receive all recommended vaccinations or face termination.
I still think Disney should find a way to require vaccination of young children visiting their facilities. As a private company, they should be entitled to be more strict than the government. There must be a way to do this electronically that won't be onerous.
Any suggestions for good articles/reports on why the hospitalization rate for measles appears higher now than it did in (for example) the 1960s? More severe signs and symptoms/sequelae? More emphasis on defensive medicine?
Whatever the reason, it demonstrates how complicated, expensive and dangerous a full-blown return of measles would be.
I think I have mentioned before on this site that one of my great-grandmothers was orphaned in a measles epidemic. Both her parents died of this "mild" disease.
I don't know of any off-hand, but I would suspect that access to hospitals/healthcare may play a pretty big role. I've not had a chance to look yet, but I'd wager that 50 years ago, there were fewer hospitals, fewer hospital beds available, and getting to a hospital was more difficult.
Changes in knowledge about the complications/sequelae could also play a role. We may know more about the bad things that could happen, so there may be a greater emphasis on early intervention to prevent (or at least decrease the likelihood of) those bad outcomes.
That would be the San Francisco Bay Area, California, where we already know that at least two cities, Berkeley and Marin, have appallingly high rates of 'personal belief exemptions.' If this gets loose in that area, you will see it hit the mid three figures within a month.
Perhaps that will be enough to convince California's elected officials to eliminate the 'personal belief exemption' altogether.
"Any suggestions for good articles/reports on why the hospitalization rate for measles appears higher now than it did in (for example) the 1960s?"
Could it be that those infected are more likely to be unable to be vaccinated or unable to respond to vaccination than would have been the case back in pre-vaccination days?
Uh, I failed to finish my thought. Those unable to be vaccinated or unable to respond might have more serious complications from the disease and might require hospitalization at a higher rate.
Also, in the middle of an epidemic with hundreds of thousands or millions infected, probably a lot weren't and couldn't be hospitalized even though they should have been. The hospitals likely simply ran out of beds.
Or at the very least get rid of that damn checkbox Gov. Brown asked CDPH to put on the exemption form that allows someone to avoid talking with a provider about the benefits and risks of vaccinations/opting out before they get their exemption.
The NYT published an article full of false balance that quotes Dr. Jay and—ack—Barbara Loe Fisher.
"We don’t hospitalize people lightly these days anymore, given how insurance companies, HMOs, and other entities have been trying to crack down on cost and medicine has moved to treating as many cases as possible without hospitalization"
Man, you're not kidding. I had a piece of a cervical disc removed a few years ago, and it was done in an outpatient surgery center,
I joke that the outpatient surgery building at our local medical center was built in the form of a giant cash register.
I had a procedure done there a little while back. Everything went great -- the staff were friendly, competent and efficient, so I was in and out in a couple hours, and still managed to rack up a stupendous bill.
Not to be petulent myself, but I'm not sure an account of the measles by an author known for his hyperbole is the most effective example of the reality of the disease. This essay could be straight-forward enough, but the author just doesn't carry the same weight as an observer not bent toward entertainment in his work. I just don't know if he's serious or not that everybody was in mortal fear at every moment due to measles.
That being said, the bit by the doctor is very good. I mean, I'm already convinced, but it convinced me all over again. One in four hospitalized. Thank God I live nearer the other Disney, where vaccination rates are much closer to CDC goal.
For the sake of completness, subacute sclerosing panencephalitis, very rare, but particularly nasty late-onset complication of measles should be mentioned. Children who acquire measles before two years of age are more likely to develop SSPE. Not a condition one would wish to a child ... who has had those mild, benign measles couple of years ago.
There's a great post up on the SBM website and I had the opportunity to post comments at our old friend Dr. Jay Gordon. Dr. Jay replied with his same old, same old tired arguments. Here's my first comment; scroll down to see Dr. Jay's comments as he refuses to answer questions posed to him about his not-based-in-science opinions about vaccines.
"Doctor Jay" was just quoted in the New York Times as indicating that "the problems" with MMR are related to the timing of its administration, only days after an article was published that thoroughly refuted his evidence-free position. “I think whatever risk there is — and I can’t prove a risk — is, I think, caused by the timing,” he said, referring to when the shot is administered. “It’s given at a time when kids are more susceptible to environmental impact."
"There were no significant differences in MMR vaccination and thimerosal dosage between cases and controls at any age. [Uno Y et al. Early exposure to the combined measles-mumps-rubella vaccine and thimerosal-containing vaccines and risk of autism spectrum disorder. Vaccine. 2015 Jan 3.]
@ Todd / Dangerous Bacon #6-8
Just guessing, but another factor may have been measles' contagiousness.
Better let the child being nursed home by its parents rather than taking the risk of the measles spreading to other patients in the hospital. That is, except if complications develop.
I expect this factor would have increased the weight of factors like bed availability and hospital size in the decision process.
If the lecture from Dr J. Mayer in 1904 quoted by Orac and a previous reader is any hint, there may have been a widespread culture of "oh, it's just measles" among doctors (well, with polio, tuberculosis and whooping cough around... So many dangerous illnesses vying for attention) and they would have been less likely to recommend hospitalization.
Antivax people - along Dr Sears, but I repeat myself - are thinking we are now over-reacting to a measles infection.
But back in the old days, we may actually have been under-reacting, maybe out of desperation as much as lack of knowledge. Under this hypothesis, the decrease in measles mortality before the introduction of measles vaccine would reflect a better awareness by medical practitioners of the risks and the subsequent adjustment of the provided care.
I’d wager that 50 years ago, there were fewer hospitals, fewer hospital beds available, and getting to a hospital was more difficult.
I'm not sure about 50 years ago, but 80 years ago, this definitely would have been the case. I have mentioned before that four of my mother's six siblings (born in South Dakota in the 1920s and 1930s) did not survive to adulthood. It wasn't measles that killed them, but at least three of the four would probably have survived if they had had access to modern medicine (the one who died in a prairie fire probably would have died anyway). My grandfather's ranch (now owned by one of my cousins) is about 30 miles from the nearest town big enough to have a hospital. Before the highway was paved, it would have taken well over an hour, closer to two (and that's in good weather; with rain or drifting snow the road would have been virtually impassable), to drive to town.
Well, will wonders never cease! Even Fox News is calling out the anti-vaxxers via a real, live, non-quack:
Another story where measles is incidental but treated somewhat lightly in the sag of Apollo 13. All the accounts I have read seem to indicate that the astronaut corps did not see a problem with Ken Mattingley possibly developing measles during a mission (he was the one who was not immune and had possibly come into contact with someone carrying the disease). The story usually says that a spaceship with zero g, nice and warm, is probably a nice place to be ill. The hard headed NASA doctors are portrayed as being mean and nasty. Certainly the take away message from the movie is that he would have been all right. As we know, even if the flight had gone to plan, developing measles 250,000 miles from home would have been a bad idea.
@Martin - to add to your point about SSPE, not that rare when you get measles very young. At least 31 cases in Gernany in past year, for a rate of 1:1750-3300: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0068909
Anti-vax hypocrisy - side effects from real diseases are rare & therefore aren't a problem & should be ignored.
Even more rare side effects from vaccines are life-threatening to all & so vaccines should be avoided at all cost.
When to we get to publicly stone Jenny McCarthy in the town square? I know its inappropriate and primitive, but it makes me feel good thinking about it. At least chase the woman around with cameras and mic's
Where is the news for the masses 60 minutes piece or the "Frontline" investigation "Diseases long forgotten"?
@ Dorit - Thank you for the link, I did not know the paper, which is indeed very interesting. The numbers are scary for small children, you usually find the overall 1:10 000 incidence when SSPE is discussed. The paper should be mandatory reading for dr.Jay and Dr.Bob, although I won't hold my breath.
I can't suggest any articles, but I can think of a number of reasons for this:
a) The different age demographics in the 1960s - we know the disease is more serious in younger children (under 5) and in adults (over 20) and these age groups are more commonly affected now than in the 1960s.
Before vaccination measles was a periodic disease that would sweep through the population when there were enough children old enough to have lost maternal antibodies and who had not previously had the disease to fuel an outbreak ( i.e. above the herd immunity threshold). That meant that most children got it between the ages of 5 and 15.
These days it is the unvaccinated and the small minority of people who did not develop immunity from the vaccine who are likely to catch it, meaning the range of ages affected is much wider.
b) A lack of residual maternal immunity in younger children - an unvaccinated child is more likely to have an unvaccinated mother who, given the rarity of measles in the US currently, will likely not have had a wild measles infection either, and so will not pass any antibodies on to her offspring.
I believe measles vaccination does lead to lower antibody titres than wild virus infection, so even the children of vaccinated mothers are more likely to get measles than those of mothers who had wild measles infection. That's not an argument against vaccination, it's an argument to keep vaccine uptake high enough to prevent outbreaks.
c) Despite an increase in outpatient procedures - I had a four-hour sinus operation as an outpatient last year - I do think we are more likely to admit a sick child to hospital than we did even 30 years ago. Attitudes change, and what was once considered a disease that could be nursed at home is more likely to be considered as better treated in the hospital today. The same thing is true of childbirth which carries risks of morbidity and mortality of the same order of magnitude as measles.
The same thing goes with the vaccine. It has been established before that the measles vaccine can cause SSPE.
Emma @1: There have also been two cases in this outbreak up here in Washington.
MIchael @5: I am not a lawyer, but I suspect Disney wouldn't want to be in the position of having someone turn around and sue them after a child gets measles because the requirement to show vaccination status assured them that it would be safe to bring an immune-compromised child to the park.
As a fan of 19th century and early 20th literature, I can honestly say that most books did *not* take measles lightly. Most of them mention being 'thankful that [child/children] were recovering." Yes, deaths were rare in the books, although some did happen.
My grandmother, in the 1940's, as the wife of a doctor, was terrified of measles and nursed her children through (including one uncle who nearly died at age 2 from them). If my mother hadn't had us vaccinated with the MMR when it was available, my grandmother would have marched us to the doctor's office.
None of my family is anti-vaccine. We all have heard the stories of what the vaccines have saved us from.
Regarding hospitalization: it was certainly rarer 50 years ago when most hospital beds were in wards. Putting a child with measles in a children's ward (or an adult in an adult ward) would have led to an epidemic in the hospital. And while there were isolation rooms, they were limited in number. It was safer for the hospitalized people for those infected with measles to be cared for at home, in more relative isolation/quarantine, than admitted. Now, with most rooms either single or double rooms in hospitals, more may be hospitalized in "comparative" safety (as long as all personnel AND visitors observe the requirements).
@H1N1: citation definitely needed. Please give the pubmed number. Do not give anything that will let us invoke Scopie's law.
So H1Troll - if that's the case, then why hasn't there been a single SSPE case in the United States in decades, despite millions upon millions of vaccinations?
Measles virus infection induces acute and profound immunosuppression, therefore it is not the measles virus that kills you per se; it is the opportunistic infection wrought upon oneself by ones unhealthy lifestyle, or reactivation of latent infections, again, ones own fault. In this sense it is just like a temporary case of AIDS, which as we know, is not the result of HIV. Both are totally benign. In fact measles could even be a good way of knocking out autoimmune disorders and giving one the opportunity to realign ones vital something or other.
Uncle Dave - I would settle for pelting Jenny McCarthy with rotten produce.
Michael (#35) has to be joking or a Poe, right?
What did I just read? Am I having a stroke?
Yes, I often forget that text does not convey emphasis adequately.
@37 & 39
"again, ones own fault" and "opportunity to realign ones vital something or other" are the tells.
Well played Michael
@Vicki: there are probably also serious enforcement problems. Two options here:
1) Require people to sign a statement they are vaccinated; how do you know it's true?
2) Require documentation - burdensome on Disney, burdensome on people.
And in any case it could lose clientele - and wouldn't solve the problem of those too young to vaccinate or, as you point out, the immune compromised.
"I had a procedure done there a little while back. Everything went great — the staff were friendly, competent and efficient, so I was in and out in a couple hours, and still managed to rack up a stupendous bill.
Interesting, I had the same experience about 3 years ago except the out-of-pocket expenses were about CDN$6.00, My “escort” does not drive so we needed to take a taxi home.
Ah the perils of socialized medicine. (:
One solution would be to make hiding in the herd expensive. A financial penalty for endangering the community would help defray the costs of dealing with outbreaks.
The penalty could be related to risk assessed by population size and density so that anti-vaxxers would try to move to smaller, more isolated communities. Over time, many like-minded morons would be getting sick together in droves.
That would be the San Francisco Bay Area, California, where we already know that at least two cities, Berkeley and Marin, have appallingly high rates of ‘personal belief exemptions.’
I have a lot of co-workers who live in the East Bay, fewer but still some in the North. I am not looking forward to this. I can't imagine what the ones with young children must be feeling right now, knowing that their kids are in the middle of an antivaccination hotspot that's one sneeze away from an outbreak.
Perhaps that will be enough to convince California’s elected officials to eliminate the ‘personal belief exemption’ altogether.
I'd like to think it'd be a wake-up call, but I somehow doubt it.
I was hospitalized for measles in the 1950s. I was put in the hospital because I had pneumonia. As soon as they realized I had measles, they sent me home because the hospital didn't have any place to put me where I wouldn't endanger the other patients.
I was as sick as a dog for three weeks.
I am appalled to hear that five Disney staff members have measles, and it seems Disney doesn't even know the vaccination status of its employees. That's irresponsibility on a mammoth scale.
@ Fragmeister #23
I have this feeling that the people who expressed this opinion didn't have the opportunity to care of a sick child by themselves for some time.
At the risk of being gross, a teammate with an unusual output of bodily fluids in zero G is not exactly a situation you may like - and the nearby electronic boards even less.
At the very least, one should consider the sudden reduction of the already limited workforce by two units: one sick, and one taking care of the first.
Excellent article, as usual! I have a question about the measles vaccination. My daughter is 6 months old and won't receive her MMR until 12 months. We live in Seattle, and I don't believe there have been a large amount of cases recently, but in the event there is a local outbreak before she 12 months old, can she be vaccinated early? She has her well-child visit tomorrow and I already have a note to the doctor that I want to discuss this, but I thought I'd pose the question here, too. I know if there's any group of people that would know, this would be the place! :) I looked around on the CDC website but I couldn't find anything after 10 mins or so of searching. (That's about my search-time limit these days - in addition to the 6 month old, we're potty training our preschooler, too. It's a laugh-riot around our house! :D) Thanks in advance!
jrkrideau @42 : Commie.
I bet you don't drink tap water, either. Because, you know, Essence.
The MMR can be given as early as 6 months in a high-risk scenario (e.g., living in an area with an active, large outbreak or traveling to a country with endemic measles), but if I recall correctly, the dose doesn't count in the two-dose series. A dose under 12 months of age generally only gives temporary protection, so you'd still need to get vaccinated at 12-15 months and again at 4-6 years. That said, I'd talk with your doctor about it.
The Immunization Action Coalition has more info on this here (about half-way down the page).
Dangerous Bacon @ #6
I am no virologist,but is it possible that the antivaxers have caused viruses to mutate,becoming more virulent,and causing even more serious disease than they did in the past?
Has anyone done studies about this? If there are studies I would love to see them.If not,it would seem such studies are desperately needed.
I like to use the term "dry kindling" to describe the un-vaccinated. IF EXPOSED - They are multitudes more likely to become infected and thus start a chain reaction of infections among both other un-vaccinated and the vaccinated with waning immunity because they didn't get their booster.
Methinks Michael is channeling Bill Maher.
@ Jessica S.
The central problem with an early vaccination is interference from congenital/maternal antibodies. Essentially the vaccine could be rendered useless.
Right up until "realign ones vital something or other" I thought Thingy had embraced a new sock puppet
I've posted this in the past, but it's on topic with old references to the impact of measles.
Dead baby picture
Scroll down to find the comment that states, in part -
Shorpy sells large size prints of these pictures - maybe we could send this on to Dr. Jay to decorate his waiting room.
About the Mark Twain quote being hyperbolic, from "Mark Twain and Medicine" >>According to the "History of Marion County," measles broke out in Hannibal in the spring of 1844, "with uncommon virulence." Nearly forty people died, and there were seven deaths from measles in a single day.<<
Sounds like the Th1Th2 troll has squeaked past the filters. The response to this is no it hasn't. Not a single case of SSPE has been found to be of vaccine strains.
Sadly, you know what antivaccinationists will say. The boy was obviously not healthy; so that's why measles killed him.
Yep. Not any more.
Other Thingy aliases: Schneck, Virchow, The One.
Zathros not serve The One, if it is This One.
Thanks, that's great info, lest anyone doubt. Wow, I guess that also answers the question of whether or not the disease has mutated and gotten worse over the years.
I was pleased to hear a report on Morning Edition that gave no time to the idea that vaccines were "controversial" but just stated that there is no connection to autism and very rarely any problematic side effects to the vaccine. They also quoted two doctors who had parents flat out lie to them when they asked about immunization status (both doctors followed up with the pediatrician and found out it was otherwise), because lying about your child's medical history is totally 'thinking.'
MI Dawn, I read a lot of those classic children's books too! Polly Pepper nearly going blind is the one that sticks out to me.
First off, it was actually *rubella* Mattingly was exposed to, not measles. The confusion is that rubella is also called German measles. It's a far less severe disease.
Regarding the astronaut corps' apparent disdain for the risk of disease, you have to understand their point of view. They want to go to space. They want *badly* to go to space. It would be the pinnacle of their entire careers to go to space, and they are all, without exception, highly focused and highly motivated Type A people. You pretty much have to be, to advance highly enough to be even considered; the idea of being sidelined by a damn *quarantine* (as in, you don't even know you caught the bug) would have to be infuriating.
And then there's the relative risk thing. The flight surgeons were absolutely right to ban Mattingly from the flight, but here's what the astronauts would've seen. They would've seen NASA too afraid to let them risk rubella, a disease which most of the time passes without even showing symptoms, yet happily asking them to climb into a tiny capsule on top of millions of pounds of highly flammable rocket fuel, to be accelerated to fantastical speeds, slung around the Moon, then returning to Earth while a hairsbreadth away from flaming death the entire time, in a situation where just one screwup could mean they all die.
Yeah, they didn't take the rubella risk very seriously. To them, it was pretty minor compared to the other risks they were already taking. From NASA's perspective, it was a mission assurance thing; you don't want someone with a fever and joint pain trying to control the CSM that is the only way home for the two guys who go down to the lunar surface. Bad Things Could Happen. But astronauts tend to rankle at any suggestion that they could ever be at less than maximum performance. ;-)
This is probably also why they are petitioning to have the lifetime radiation exposure limits raised or even abolished. As it is, it's an open secret that astronauts will, very much against regulations, hide their dosimeters in the best shielded part of the spacecraft during their missions so as to delay the inevitable time when their cumulative dose rises to the "enjoy your new desk job" level.
Bonus: Mattingly did not contract measles, but his replacement, Swigert, developed a bladder infection during the mission. Irony!
I'm not a virologist either, except in my armchair sometimes, but in principle viruses should evolve towards maximum coverage of their host species, which "ideally" would be maximally contagious and minimally virulent or pathogenic. The "ideal" virus would infect everyone and kill no one. of course nature isn't ideal, and mutations are random so anything is technically possible. However if increased pathogenicity negatively impacts transmission, that should in principle be selected against. Furthermore you have to consider what impact those disease causing mutations would have in and of themselves on other aspects of the replication cycle; ie would it alter tropism.
An analysis of current anti-vax clusters.
I was rather dismayed at the suggestion that vaccine refusal is primarily a crunchy, liberal phenomena. The first poster in the comments points out that this is very much a bipartisan problem. There are many, many vaccine refusers in the increasingly (unfortunately) red Missouri. I know because I have argued with lots of them.
@ Jessica S. Todd W. provided you with correct information. The reason why the first of the 2-dose MMR vaccine is recommended between 12-15 months is because a baby has lingering maternal passive immunity which will interfere with the baby's immune response to the vaccine.
Babies 6-12 months old, who live in areas which are highly endemic and babies who will be traveling to a measles-endemic are of the world should be given one MMR vaccine at least two weeks before departure. They will require the 2-dose MMR series after age one.
If a baby has a documented exposure to a measles case, within the last 6 days, then your doctor would probably administer immune globulin which provides almost immediate temporary immunity.
I knew H1N1 sounded familiar - right from its first post.
@lilady, Todd W. and MarkN - thank you!! Wonderful information. I knew I'd find good help and company here. I'll discuss with her doctor tomorrow, too. Here's hoping it won't become an issue here. Myself, my husband and my son are all up-to-date, so she's got that coverage at least. :)
@ Helianthus # 46:
@ Fragmeister #23
I have this feeling that the people who expressed this opinion didn’t have the opportunity to care of a sick child by themselves for some time.
At the risk of being gross, a teammate with an unusual output of bodily fluids in zero G is not exactly a situation you may like – and the nearby electronic boards even less.
At the very least, one should consider the sudden reduction of the already limited workforce by two units: one sick, and one taking care of the first.
And Jim Lovell, the commander of Apollo13, had been on Apollo8 with Frank Bormann and his diarrhea. You'd think that would have made him think otherwise.
Hmm... blockquote didn't work. Last two lines are me.
Yodel Lady @#45: Generally employers are only allowed to ask about vaccination status if it is directly related to your work. For example, I work with human blood, so my employer is allowed to ask about my HepB vaccination status. Hospitals are allowed to ask staff about some vaccinations because they are at risk of diseases (from patients) and at risk of transmitting diseases to patients.
Maybe some schools are allowed to ask teachers/staff about vaccinations, but I can't imagine that a place like Disneyland would be allowed to ask that kind of medical information from their employees. It would be a legal nightmare.
On a different note, if anyone wants a quick and easy rebuttal to the "Brady Bunch measles", how about the series of Peanut strips where Lucy explains to Linus why he has to get a measles shot. Originally published in January of 1967, I saw them in my newspaper just last year. Here's a link: http://www.gocomics.com/peanuts/1967/01/02
"On a different note, if anyone wants a quick and easy rebuttal to the “Brady Bunch measles”, how about the series of Peanut strips where Lucy explains to Linus why he has to get a measles shot."
Or the Friends episode where they all get Chicken Pox.
That is clearly strong evidence that adults getting chicken pox is comical and no big deal right?!
@Justatech: "Generally employers are only allowed to ask about vaccination status if it is directly related to your work. For example, I work with human blood, so my employer is allowed to ask about my HepB vaccination status. Hospitals are allowed to ask staff about some vaccinations because they are at risk of diseases (from patients) and at risk of transmitting diseases to patients.
Maybe some schools are allowed to ask teachers/staff about vaccinations, but I can’t imagine that a place like Disneyland would be allowed to ask that kind of medical information from their employees. It would be a legal nightmare."
I'm not sure what this is based on. It's certainly not covered by HIPAA - do you have a different statute in mind?
Vicki @30 yep, plus the woman from CA who came and spent a week up in Snohomish county and Seattle after exposure and before falling ill. The "local" pair are in Greys Harbor iirc, which is not as densely populated as most of the places in CA where there are cases, so I'm choosing to remain hopeful it won't be as bad up here (while still being glad both my kids are fully vaccinated, even though I know they have classmates who aren't).
(I cannot count how many people told me to not vaccinate the younger one because the older one is autistic. Ugh.)
Dorit@ #72: I guess I was thinking about how most businesses don't want to ask about medical information because if they know things then it can be used against the employer in a wrongful termination lawsuit. As in, the employer might discriminate against an employee based on a medical condition.
I don't know, I could be totally wrong. Maybe it's because of all the questions HR doesn't allow you to ask in an interview, and I just assumed that continued after a person was hired. But I could have also been thinking of HIPAA. IANAL.
Please let me know if I'm way off base!
@Justatech: that would probably be true if there is a disability involved - an employer, rightly or wrongly, would worry about running into the ADA - but not generally, as far as I know.
HIPAA isn't directed at employers.
I don't think there's a barrier for a private employer requiring proof of immunization.
@Justa Tech -- thank you. Once you said that I see that it makes sense. I would think Disney is damned if they do and damned if they don't at this point. Their PR people must be going through the month from Hell.
Heath care workers definitely have to have proof of immunization (in my County health department prospective employees underwent a physical exam and blood tests for all V-P-Ds which the CDC recommends for all HCWs), plus TB Mantoux test. If the Mantoux test was positive you were required to have a chest X-Ray, as well.
IIRC, some Counties in the United States have a regulation that food handlers must have hepatitis A vaccines...paid for by their employers.
The Onion gets it:
I'm hopeful that the antivaxxers are losing traction. (I'm also hopeful that global warming deniers are starting to lose the argument, too.)
They're all too bloody young. One of my friends is profoundly deaf because of measles, and another lost a testicle due to mumps. And when I was young, people who had had polio were quite common. Once you've seen that sort of thing you vaccinate.
In 1824, King Kamehameha II of Hawaii and his queen Kamemalu visited England, caught measles (along with most of the delegation) and they both died.
Please excuse me if this is covered elsewhere, but is it correct that if a vaccinated person does after all get the disease, it's liable to take a milder course than with an unvaccinated individual?
Peter Dugdale, all the evidence I've seen says it is correct.
@ Peter Dugdale
It's the basic principle underlying vaccination. It is actually true whether you got vaccinated or you already got sick in the past.
In short, if your immune system managed a good reaction during your first exposure to a specific pathogen, its response to a second exposure is going to be much faster and efficient. For antibody production, we are talking 2-3 weeks of time for a first exposure versus less than a week for a second exposure.
If the pathogen has less time to develop and establish a hold, the illness is going to be less severe, maybe to the point of being unnoticeable.
Of course, if your immune system didn't reacted correctly to the first exposure, that's not going to work this way. It's not going to work either if the pathogen infecting you is different enough from the one you got on first exposure, hence all of this buzz about the genetic drift of the flu virus.
To complement some of the others' replies, another piece of information is the antibody titers. This is where genetics can play a role along with getting vaccinated. Not only to get the vaccination, but what also matters is the result -- are you producing an effective defense. Some people have a poor genetic predisposition, and they need to rely more upon the herd defense. Getting a titers for "everything" is not possible, but it is common in some areas of health care that we get a report to show we can actually defend against the infectious disease so that we can work in that environment without engaging personal protective equipment protocols.
A reason why age and not getting the Shingles vaccine until a certain time is that those with a previous chicken pox infection (or vaccine) have an effective titers level. As age plays a role, titers levels decrease, allowing the recurrence of symptoms from the virus when it reactivates, ie Shingles.
(btw, getting the vaccination for shingles is a big save for our seasoned family members -- the continuance of pain from the disease and risk of stroke from blood vessel remodeling are both risk factors after the disease process finishes. This vaccine will help keep your elder family members around on the right side of the grass a little while longer, provided they get vaccinated before the recurrence.)
So, in a roundabout way to your question, you get vaccinated, but you still get symptomatic from infection. You can still have some titers level to mitigate the disease, based on your genetic predisposition, and reduce the disease process.
Another tactic we can use is to try vaccinating after infection. It's not nearly as effective as what we think of as 'traditional vaccination,' but if there's no choice, we can do that even though we're already behind the 8-ball so to speak. Again, this reactionary treatment plan is not nearly as effective as following the vaccination schedule.
@CalliArcade: "Bonus: Mattingly did not contract measles, but his replacement, Swigert, developed a bladder infection during the mission. Irony!"
I could have sworn that it was Fred Haise who had the bladder infection and that Swigert was healthy over the flight but tragically died only a few years later of some kind of cancer.
At least when the local news covered it - there is 1 confirmed case of measles here in Arizona from the CA outbreak -- they did not try to play the dumbass "Tell both sides" card, and just stuck with the public health official's information.
At least, so far. They have of course been playing the panic card, but then, that's what I expect out of local news.
To Wikipedia! Which says it was Haise who had the bladder infection; but it was caused by restriction of fluids, and not something he'd contracted on Earth.
GregH -- I looked it up. You're right; I misremembered. It was Haise. They weren't drinking enough, and he got sick as a result. (MCC had advised them to discontinue urine dumps for a while, since they had very little delta-vee to get them back home and they didn't want to waste it correcting from a urine dump, which does impart a bit of thrust. The crew misunderstood and stopped for the remainder of the flight, and since nobody wants to be in a spacecraft full of bags of pee, they reduced their fluid intake and held it as much as possible.)
And yes, Swigert did die of bone cancer in 1982. It spread terrifyingly fast, killing him less than a year from diagnosis.
They're allowed to test your urine for drugs without your knowledge or consent, so why wouldn't they be allowed to ask if you'd had your vaccinations? They couldn't compel you to answer, but you could adjust their work assignment or even fire them if they refuse to answer. For one thing, since measles is so contagious, it absolutely relates to their work, since they interact directly with the public.
Honestly, given that there's an *ongoing* outbreak that has already sickened several Disney employees, I would think they would not only be allowed to ask but actually *obligated* to do so on the basis of worker safety.
Joy. Confirmed case of Measles in Michigan.
Beana...It's a confirmed case of measles and it may well be epi-linked to the Disneyland measles outbreak:
Yes that is what our local news said, but I forgot to link it, thank you lilady. Such a waste. Should have been gone back in 1990. Now to see how under vaccinated Michigan really is. :(
@6 .. Dangerous Bacon "Any suggestions for good articles/reports on why the hospitalization rate for measles appears higher now than it did in (for example) the 1960s? More severe signs and symptoms/sequelae? More emphasis on defensive medicine?"
When my older sister had the measles, during an outbreak in the mid 1950s, she was in a darkened room because she was intensely photophobic, with round the clock home nursing care from my mom and g-mom and a couple of SAHM neighbors, on IV fluids and antibiotics and tepid sponge baths for the fever and constant feeding of small quantities of liquids. And the adults were also taking care of the household cooking, laundry, etc.
She would have been hospitalized today, BUT the hospital then was full of kids sicker than she was. My dad (pharmacist and ex-medic) spent most of that outbreak running all over the valley starting IVs and showing parents how to maintain them and swap bottles. He was working closely with county health and local docs to keep kids out of the hospital if at all possible because they were stuffed to the rafters with sick children.
It would be hard, now, to get 4 adults with that much practical home nursing experience for each measles patient who needed that level of care, along with a visiting health person qualified to start IVs and train those caretakers on how to change out an IV.
If there is a largish local outbreak, it could come to that ... tell the parents to round up a couple of reliable friends to share the nursing, tell their boss they'll be out for a week or more and give them a crash course in IV management because their obviously sick child is not sick enough to get a bed, or because children equally sick are already in the beds.
@81 ... the "anamnestic response" is what does it.
After something produces an immune response (vaccination or infection), a population of "memory cells" that are dedicated to making that specific antibody remain for years to decades.
The next time that pathogen shows up in the body, it's a matter of hours before the cells activate and start making antibodies. The amount of circulating antibodies is less important than the ability of the memory cells to quickly mobilize and multiply their clan and crank out antibodies.
Often the only sign that you have been infected is a spike in antibody titers. The supposedly "lifelong immunity" people had against the childhood diseases was more likely to have been a series of infections defeated by the anamnestic response before the person had any sign of illness. So their "booster shots" were the sick kids in the neighborhood.
Tsu Dhu Nimh says (#95),
"After something produces an immune response (vaccination or infection), a population of “memory cells” that are dedicated to making that specific antibody remain for years to decades."
This is why vaccines made with natural rubber latex (NRL) are dangerous.
The numerous antigenic-proteins from NRL can leach into the vaccine solution and induce "memory B-cells" that are dedicated to making undesirable antibodies (e.g., allergies) for years to decades."
Only use vaccines that follow FDA guidelines for NRL and state, "not made with natural rubber latex".
Reducing the risk of allergy-induced regressive autism one shot at a time!
Go away MJD. Honestly, you're like a stuck record.
Julian Frost says (#97),
"Go away MJD. Honestly, you’re like a stuck record."
My apologies Julian Frost but if there are fewer vaccine safety check-and-balances everyone suffers, suffers, suffers, suffers...
I agree with Julian, and you're starting to get on my nerves too. If you don't back off, I might make that decision for you. You're irritating my regulars with pointless blather.
Go away MjD. Your son had a reactive airway episode and his autism is not caused by vaccines.
Graced by the presence of a true American loon.....who fails to realize or understand that vaccines are one of the most rigorously tested and tracked biologics on the planet.
Just go away.
I realize I'm late to this one, and much else. I have been lurking for a while and want to thank all of you for the wealth of information you provide.
I agree wholeheartedly with the thrust of the main post and comments but think there it important to put the quote Todd found from J. Mayer in context. There is a risk of cherry picking the quotes we like and presenting a too simple if comfortable opposition between enlightened science and benighted opposition.
Yes, doctors have long realized that measles could be deadly, but medical opinion was divided for a considerable time over just how dangerous it was and what to do about it. @Helianthus makes a fundamental point (#20): with TP, whooping cough and -- especially in the 1940s, polio -- measles did not seem so bad. There is a history of doctors like Sears wondering if measles was “worth worrying about” (1). In the 1960s, the head of the CDC, David Spencer and chief epidemiologist Alexander Langmuir called measles a disease of “only mild severity,” that entailed “infrequent complications” and only rarely killed patients. In 1964, the Advisory Committee on Immunization Practices said that “rarely would there appear to be a need in the U. S. for mass community immunization programs” for measles. Then, the next year, they changed their position. The discussion over whether or not to launch a universal vaccination campaign did not take place in a political vacuum, and the result was not inevitable. It had less to do with a careful weighing of benefit and risk for individuals and communities than the simple fact that it could be done. This was the age of eradication campaigns: “To those who ask me,” Langmuir said, “ ‘Why do you wish to eradicate measles?’ I reply with the same answer that Hillary used when asked why he wished to climb Mount Everest: ‘Because it is there . . . and can be done’ ” (2). Scientists did not know how long the immunity vaccines conferred would last, and they worried about creating new problems by leaving adults vulnerable. In 1971, a state health official said: “Measles is still characterized as an uncomfortable but not very threatening interlude of childhood. Immunization is ‘nice’ but not critical” (3).
It is important to acknowledge the double standard in the ways the scientific community discussed risk within its own confines, on the one hand, and presented those risks to the public, on the other. To the public, health authorities left behind the idea that measles was relatively benign. In particular, the vaccine campaign took advantage of suburban anxieties over increasingly poor, increasingly black inner cities. The Vaccination Assistance Act could be seen as a step away from the Great Society, in the sense that earlier bacteriologists like Charles Chapin had said with respect to T.B. that it is unnecessary to improve living conditions across the board; it was sufficient to prevent active cases from infecting others (4). Or we could see the Act as one of the few Great Society measures to survive the 1960s. We got the mass vaccination campaigns thanks to a combination of good science, hubris, and suburban white racism. It was the challenges of the measles campaign that led to school mandates, to get to hard to reach inner city populations. The result was massively to lower the incidence of disease in vulnerable populations. The political climate that made mass vaccination possible was a sort of Whistleblower in reverse, which, to my mind, makes the recent demagoguery doubly reprehensible.
On all of this, see James Colgrove, State of Immunity: The Politics of Vaccination in Twentieth-Century America (Berkeley, 2006), esp. chap. 5; and Elena Conis, Vaccine Nation: America’s Changing Relationship with Immunization (Chicago, 2015), chap. 2.
1. Norman Leak, “Importance of Vaccination Against Measles,” Pediatrics 34, no. 3 (1964): 438-39, quoted in Conis, Vaccine Nation, 52.
2. Quotes in Conis, Vaccine Nation, 54-55.
3. William Schaffner, “Measles Eradication: The Impossible Dream? Or the New Heresy of an ‘Old Boy,’” in U.S. Dept of Health, Education and Welfare, 8th Immunization Conference Proceedings (Atlanta, 1971), 16, quoted in Colgrove, 170.
4. On Chapin, see Judith Walzer Leavitt, Typhoid Mary: Captive to the Public’s Health (Boston, 1996), 23-25.
It’s a confirmed case of measles and it may well be epi-linked to the Disneyland measles outbreak:
A few years back I met an RN from the Las Vegas county health department (communicable diseases division) at a conference. She had some hair-raising tales to tell about contact tracing when 95% of the exposed and potentially exposed had not only left town, they'd left the country.
They're waiting for serotyping, which reminds me that I haven't seen the lineage of the Disneyland strain reported yet.
MarkN @ #85
I had shingles twice before I was forty.The first time led to another of my many major regressions.I have had a real hard time trying to explain to antivax parents,that with true mitochondrial disease,any fever is dangerous,and causes autistic regression.Not once,but over and over again.It is a danger you live with your entire life.
I also had serious heart complications when I had chicken pox as a child.Of course this was before any of my medical problems were identified.Multiple inborn errors of metabolism,cerebral folate deficiency,secondary immune deficiency,and mitochondrial disease.I don't know what would have happened had I not been vaccinated for most everything else.
I would really like to see more of a push for giving the shingles vaccine to medically fragile,but younger,adults like we do now with pneumonia vaccines.As far as I know,most doctors do not do this.If there are doctors who do,I would love to know.
Tsu Dho Nimh @#94 :D
You do have to wonder about these anti-vax parents who talk about how sick their kids are,yet are completely unafraid to have them exposed to something as deadly as measles.I have spent enough time in online groups with parents whose children have both an autism,and either a mitochondrial or severe autoimmune diagnosis.These are parents who have seen what an infection,any infection,can do to their child.Most,but not all,are both decidedly pro-vax,and are very resentful of what the antivaxers have done to put their child at risk.
@Roger Kulp I inquired my last checkup and was answered that a shingles vac would only be covered by insurance if I was age 65. I considered this strange considering I had already had one episode of, thankfully, mild shingles, five eruptions only on the chest on one nerve trace. I have been since asked why I just didn't pay the full cost out of pocket.
The CDC adult schedule (PDF) has VZV recommended at age 60, so this kind of invites fruitless speculation about your age, date of last checkup, or insurance coverage.
Maybe you should check again whether its covered. I'll be first in line at age 50.
@Narad No need to speculate, greater than 50, less than 60. As an individual with heart failure, I see my internist twice a year for lipids and check-up. My internist is my Primary Care Physician.
I asked this question eight months ago, but reflection brings that I did not re-ask two months ago. We were more focused of working the camel through the needle to get insurance to pay for my cholesterol medicine.
In my case, the eruptions were only moderately painful. Far less than the second degree burns I've endured and easier to numb.
I did ask if the current vaccine (chicken pox) would eliminate the young ones from ever having to go the pain. Not sure if I trust his answer or not.
What was his answer?
Oh, holy f-ck, it has only now floated to my immediate attention that Mr. Dinner Jacket has appeared in Vaccine...
... with an impressively insane back-story.
^ A perusal of that list of search results, however, leads to one Susan "Cornelia" Franz and "The Franz Center."
^^ Eh, with the homeopathy per se on the record, this might as well be chucked in:
What, you might ask, is "AIR Tea"? Well, best to clear up one thing (emphases added):
My best guess is that this "tea" is ultimately Yangyin Qingfei Tang, or these.
Persistence in mystification of the word "decoction" is left as an exercise for the reader, as is investigation of any relevant toxicology.
@Narad - who the hell is that guy?
Gary Goldman, the guy with the bought PhD in computer science who does not like the varicella vaccine.
And, Narad linked to this professor from Australia who defends Goldman:
Roger, I hear you. Right now, the evidence-based guidelines are 60+ with FDA approval 50+ (as the others already posted). My kid sister had the recurrence at age 20, and she'll probably get it again before 50.
I'm sure you're aware, but maybe others aren't, post-herpatic neuralgia is friggin awful. Some of us believe it's a major underlying reason for elderly suicides. The other work in process is vascular remodeling by the virus leading into higher chance for a stroke. Both pathologies can possibly be limited if the vaccine is provided before the recurrence.
But, there can also be complications going outside of the evidence-based guidelines of a vaccination schedule. Out of an "abundance of caution/just in case" fearing terrorism, the political machine knee-jerked and called for a small pox re-vax, and which tagged a doc with a later life threatening complication of percarditis, major surgery to alleviate the problem. Was it necessary to re-vax? no.
I'd say get the titers, but if you already know you've got a bad predisposition, I could vax you all day long but your immune system just isn't getting with the program. What good would it do? I don't know, everyone is different.
Have you tried the route of a research/university hospital to work with a specialized department? That would be my thought.
Colonel Tom: My insurance covered the shingles vaccines a couple of weeks after my fiftieth birthday (I had other reasons to see the doctor, and I asked for that vaccine, and she said sure and wrote the prescription). But I have lucked into a fairly good insurance plan; they even pay for my routine dental cleanings.
The drugstores around here have signs up advertising that as well as flu and whooping cough vaccines. It might be worth asking about cost and/or coverage the next time you're at the pharmacy for any reason. I suspect this is one of those things where everyone is covered past age 65, but they'll make an exception and cover you if your doctor tells them you need it because you have already had shingles.
I had measles in 1st grade in the 60s. My mom took me to get the vaccine, which was new, and I had a sore throat so the doctor didn't give it to me. The next day I broke out with measles. I didn't end up in the hospital, but I was seriously ill for about 10 days. A terrible experience complete with delirium and hallucinations. Also diarrhea and vomiting. I don't know why anyone would let their kids be at risk for that.
Vicki, your are right. I am scolding myself for not considering the idea of just paying for the vaccine. Partially because of my days in insurance, partially because I must admit that I am a bit of cheap bast. The best of us, (and myself,) can get fixated on a single aspect of the problem and fail to see the big picture. I fixate on what I guesstimate is a poor insurance practice, cost of vac versus cost of later treatment for shingles
I am not mislead with my initial and mild case , that responded well to topical relief and ?anti-viral? . Chances are that my next case might be as bad as some of the cases I see at the Vets Administration. I will, upon my next checkup in four months follow up on the matter.
I did not take the initial measles vac, and felt incredibly guilty as my mother was carrying my half-brother at the time. I had, checked "allergic to eggs" on my form and was denied the vac. At the time, my skin test did indicate I was allergic to eggs. I was so scared that I left her household for the last four months of her pregnancy least I harm her child by being a measles vector.
@ Narad He was of the opinion that even with the vaccine people are likely to develop enough embedded virus that shingles will still be a problem. That was his opinion and the opinion of a couple of non-specialist. However, other than a internet search to look for a paper on the subject I don't have much of a reason to pursue that errant thought train.
My internist is a nice guy, I like his level of detail and concern he shows about my hypercholemia. However, he is not a virologist so I give his opinion measured weight on the shingles developing in the vaccinated population. By the same measure I discuss ABPA with him, but don't expect him to take a primary role in the monitoring of that disease either.
Gary Goldman, the guy with the bought PhD in computer science who does not like the varicella vaccine.
Co-author of "Infant mortality rates regressed against number of vaccine doses routinely given: Is there a biochemical or synergistic toxicity?", which drew down the attention of Respectful Insolence upon Mr Goldman, and earned him an entry in the Encyclopedia of American Loons. The subtitle of his paper leaves me wondering how many non-biochemical forms of toxicity there are.
… with an impressively insane back-story.
If I read that story correctly, Goldman is now belatedly claiming that he does too have relevant experience in epidemiology, but he was driven from that position for daring to question the cover-up, and has since been the victim of a black-helipcopter-related campaign to prevent him from reporting his observations. His evidence for these claims being the fact that, at the time of making them, no-one had bothered to refute them.
I am not making that up:
I see that Time has managed to outdo AoA with this graphic as a snapshot for one of the videos accompanying this otherwise dull Reuters retread.
So I'm one of those people who lean sorta a bit on the side of the anti-vaccers. (Well okay, more than a bit.) Mostly because, the vaccines are not 100% effective and do have side effects which appear as if they would be more harmful to me personally than the original disease. My attitude and my reasons are most likely incomprehensible to the "pro-vaccers" but it might be more understandable to them if they knew that I come from a long line of extremely healthy genetic stock. In my family -- and from personal experience this has been true for several generations now, nobody ever needs surgery or medication, very few ever exercises "enough", eats "healthy" or any of those other things which everyone is "supposed" to do. Some in my family have smoked all their lives and yet we all live to be around 95-100. I'd guess about half of us have above average intelligence and in addition, we all tend to be above average in appearance, and physical coordination. We won the genetic lottery due to sheer luck.
Anyway, it has occurred to me to finally notice an important point and to contrast that with my own family history -- I've finally noticed that many of the people who are literally screaming in various forums about the need for "other people" to be forcibly vaccinated, will eventually mention their compromised or weak immune systems. I bet they have "lost" the genetic lottery in other ways as well. These are the folks who need other people to accommodate their genetic weaknesses in order for them to continue to reproduce their genetic weaknesses.
But you know, it's not my fault or responsibility that they all are genetically weak. It's not fault when people choose to ignore the signs that their prospective reproductive partner might not be the best option if healthy children is the goal. It's not my responsibility to continually accommodate them, or pay for the life-long medical bills of an ever-increasing number of Darwin experiments. It's not my moral obligation or in the best interest of a healthy society to pretend that their poor choice of reproductive partner is okay. If somebody has genetic weaknesses then holy flying spaghetti monster, stop crying when Darwin is trying to remove them from the gene pool.
Please tell me Reality hurts' post is sarcasm.
Because historically going down that philosophical road has led to some pretty horrendous things and do you really trust the people in power to see the magnificence of your genes just because you think they are great.
The reality challenged Reality Hurts: "If somebody has genetic weaknesses then holy flying spaghetti monster, stop crying when Darwin is trying to remove them from the gene pool."
You really have no idea how this evolution thing works do you? Sickle cell anemia is from from a evolved blood trait that helps people survive malaria, but only if they have one copy of the gene.
You must be very proud that European diseases like measles and smallpox wiped out 90% of the native peoples of the Americas in just a couple of centuries.
If it isn't a Poe, then it shows the moral bankruptcy of the anti-vaccine movement....clear as day.
Vulnerable to childhood diseases =/= genetically weak.
Claims that no one in your family for several generations has needed medication or surgery are going to be taken with a heaping spoonful of salt.
Speaking of genetically weak, my plan is just to chuck the vaccines and infect everyone with rabies. The 0.01% remaining will just reap the benefits of natural selection over a round of golf with a scotch and a Vegas hooker.
Have a nice day.
If you have such a robust immune system, then it should be unfazed by getting a vaccination, no? So why eschew them?
How certain are you of your superhuman immune system? Would you be willing to test it? If you are certain in your belief, then you should not fear being deliberately exposed to a disease and observed to see what happens. Of course, you'd have to also agree to be quarantined for the incubation period to ensure you don't infect others.
As for caring or sharing responsibility about others, while it is true that many of those with compromised immune systems are so due to genetics, some are also due to damage from an infectious disease. Others may be transplant recipients who suffered trauma to an organ. Suppose, for example, you were to suffer physical trauma to your lung and needed a transplant. In order for your robust immune system to not reject the donated lung, you would be put on immunosuppressive therapy. This would keep you alive and ensure your donated lung kept working, but it would mean that you would be more susceptible to deleterious effects of infectious diseases.
And don't try to weasel out of this scenario by saying you'd just be careful about who you interact with. For some diseases, like measles, you wouldn't even need to come face to face with them. All it would take is for you to share the same indoor space as someone who had been there within the last two hours while infectious. Now, suppose that the only reason that they got infected was because they refused the vaccine and were thus not immune. Their refusal leads to your getting infected, and with a suppressed immune system, you are much more likely to suffer severe consequences, like pneumonia or perhaps even encephalitis.
It's not your fault that you are immunocompromised. It is that other person's fault that they became infected, at least in part. And it is their fault that you were infected by them. But if you are hospitalized as a result, or if you die, oh well. That's your own responsibility. Long live eugenics! Long live social darwinism!
What, Wakefraudy trousers is 6' 6'' tall?
In his dreams....
Fairly simple considerations of inheritance suggest that the only way the distinct "lottery winnings" could have been conserved over time is through inbreeding, of course.
It’s not fault when people choose to ignore the signs that their prospective reproductive partner might not be the best option if healthy children is the goal.
I don't really imagine "prospective reproductive partner" becoming a serious issue for Reality Hurts.
Does winning the genetic lottery on immunity also mean losing out on the portion of cerebral cortex responsible for intelligence and empathy*?
*Research suggests that the right supramarginal gyrus is important in governing empathy. It would be fascinating to scan the brains of antivax and pro-immunization people and precisely measure the area of their brains available for empathy (those reading the scans would have to be blinded as to the opinions of the brain-holder, of course).
@Chris #127. No, personally it has always bothered me more than a little. Even if, that contact plaques had as much to do with the fact we'd never had the benefit of exposing our children to your disease. You Europeans, you bred and lived in such filthy disgusting hovels, it is no wonder that you were natural plaque carriers.
That was partially sarcasm.
The great sadness, that while the idea of "biological darwinism" is thankfully rare, "social darwinism" has become the agenda of a majority of the EuroAmerican Society. People are poor, because they are unfit. People are rich, because they are fit.
P.S. Not that don't believe in most evolution science, I mean "they" are applying it completely wrong.
@herr doktor bimler.
I was afraid of being too snarky, but your excellent jest has show me that I will need to leap to get over that bar!
Thank you, for the most excellent laugh.
You are too kind, Colonel Tom. My contribution to Respectful Insolence as to emphasise the civility and fair-mindedness of other commenters.
No, Herr Doktor, you should have no false modesty. it truly was a wonderful remark. I have always found there to be a relationship between those that have a sense of humor and those that know how to effectively persuade an audience.
For the record, I have passed my DNA to the next generations four times with four different women. I question the wisdom of this, potentially ABPA is an indicator of problems in offspring. Almost certainly I have the gene for some form of familial hypercholesterolemia, although I have never been genetically tested to confirm this fact
Colonel Tom: "You Europeans, you bred and lived in such filthy disgusting hovels, it is no wonder that you were natural plaque carriers."
There is some truth in that, especially the living very close to their domesticated animals.
Also, it is a bit more complicated. If you read Plagues and Peoples, you will learn that the native peoples got it at the same rate of the Europeans, but the age distribution was completely different. In Europe they got exposed early in life, so if they survived (and about half did not) they were immune as adults.
But when those pathogens were introduced to a naive population (meaning had not been exposed), the rate of disability was distributed to the adults. These were the ones who provided food, shelter and care for the younger. It turns out that a good percentage of deaths were not due to disease but caused by starvation.
@Chris, apologies. I was attempting humour. More times than not, when I hear this subject it is because some racist is spouting a bizzaro version of the facts in attempt to prove their own racist views. Apologies for a knee-jerk.
On a side note, we watched a terrible show last night on why the Knights Templar had came to the New World in the 13th century. Apparently they were protecting the living descendants of Jesus and Mary Magdalene. Complete B.S. If Europeans had been in the Americas, then they'd have brought their disease with them. Just as the old trade routes allowed Michigan Copper and Kentucky lead to show up in artifacts in Maine, and Virginian seashells to show up in Arkansas; European disease would have ran through the populations.
Ah, I see. That Knights Templar bit sounds as good as the book The Da Vinci Code, which had plot holes big enough to drive a semi-truck through.
Part of my reaction to the "natural selection" excuse to not protect children from diseases is that I remember the diseases, I have taken basic college biology so I know they don't understand Darwin nor evolution, and I have one kid with multiple medical issues that we think was a de novo mutation.
Oh, and I just happen to live in the corner of the country with a very large and active native population.
@Chris, I do not wish to imply that my beloved one (aka wife) is not brilliant. She has a degree in Engineering, an IQ well above the 95 percentile. She does, however, like to watch some strange "history" shows. Not that she buys any of bizarre stuff, but she enjoys something about the stuff. I don't.. Some how this Knights Templer in America idea was tied into the Da Vinci Code stuff, I didn't understand the relationship.
I do not reject the idea that Jesus and Mary Magdalene had children, I reject the idea that "bloodlines" have meaning. In the hundreds of generation since then, given that genetic material is diluted by a little over 50.2% for female/female and 49.8% for male/male, then bloodline means nothing.
Diluted per generation, so that for female decedents after 50 generation the percentage of maternal DNA is likely restricted to a single X and the mitochondrial DNA.
I would never assume anything based on reading or watching material. Some people find it entertaining, like I like history and medical history. Some of it kind of wacky like the Russian who tried to colonize the west coast of North America: Glorious Misadventures: Nikolai Rezanov and the Dream of a Russian America.
Ha! Bloodlines! My brother and I have done some genealogical snooping in our family. He is presently stationed in the UK, so he has dug up stuff on the family going back to the Normans and actually Norway. I tried the maternal line and found out my dad's mother was adopted, and that kind of ended that hunt.
Well, most of it is from the shoulders up. He's apparently built a bit like Dorf.
The Alaskan/Russian bloodlines still run strong. I was stationed there for a while, lot of interesting heritage, strange buildings, strange food. There is a great "alternative history" where Russia never sold Alaska to the U.S, and the Russian royal family fled to "New Russia"/Alaska. A fun book.
I used to read "alternative history" books, but tastes change. But I have not read much fiction lately. I did recently read a steam punk future history that is supposed to take place in my city, but I kept being pulled out with "No, that is not where that building is located" and "No, that historical figure did not do that."
"Claims that no one in your family for several generations has needed medication or surgery are going to be taken with a heaping spoonful of salt."
Well, maybe only the surviving ones didn't....
Not too long ago, I read a very disturbing book about the efforts to prosecute people for faith-based medical neglect of their children in Oregon. It ends on a positive note, as it led to substantial changes in the law, but you see a population of people who firmly believe they are all incredibly healthy, fit members of society who don't need vaccines or any other modern medicine because they have God. This despite the fact that they *also* have a cemetary full of very small coffins, and a high rate of genetic disorders due to inbreeding.
The ability to ignore uncomfortable evidence is very human and also very powerful.
Truth is, we simply don't know who is "more fit" right now, much less who will be "more fit" in a couple of generations, and we haven't even the foggiest of dim notions what would be fit in a million years. Attempting to apply our pathetically limited knowledge on the topic to our own species would probably be, in the long term, suicidal. Just look at all the plants and animals we've selectively bred; we've made them compete very well only when we're helping them. What we've actually given them, in the pursuit of fitness, is terrible genetic handicaps. And we'd do the same to ourselves, given half a chance. I really do not understand why so many people think we should.
And as far as fitness goes . . . who says the intelligence to invent a vaccine doesn't count as fitness? And anyway, measles vaccination isn't justa bout individual protection. The idea is to eradicate the virus entirely. If we're successful, the idea of being more able to fight it becomes entirely irrelevant. Seems smarter (and a lot faster) than hoping we someday evolve into a form that measles cannot infect.
In other news, Laura Hayes does a bang-up job today demonstrating that no, really, AoA isn't a roiling pit of antivaccinationism. Her lead point is that nobody has proved to her satisfaction that there's any measles at all or, if there is, that it's not the vaccine strain.
Naturally, Cynthia Parker demonstrates that she's a lying shіtweasel willfully dishonest by continuing to babble that measles protects against (now plural) cancers later in life, despite having had the Mayo oncolytic virotherapy result explained to her multiple times.
@Calli #149. A quote that I do not remember the author, A committee of apes designing the next step in super-ape evolution would likely design a stronger, more robust version of ape-kind. Never would they conceive of a hairless, weak-jawed, thin skulled weakling as their successor.
Crap on a cracker, I might not be protected against measles .
I've been kind of wondering about my own childhood vaccination records lately. Unfortunately, my mom (who almost assuredly kept them) passed away in September, and I doubt that my dad would know where to look, or when he was done.
I just mentioned this fact on the Aspergillis (ABPA) support group, and a nice person said I (we) could get our blood titers checked to see if we have the proper immunity. Between Rez (PHC), military, and private records I seriously doubt that I could prove which vacs I have had. I am safe against smallpox and I think leprosy.
I also started a crap storm by telling a person that "too many people are, to put this lightly, betraying their fellow man with callous indifference that borders upon sociopathic insanity".
A child on heavy prednisone dosage had been exposed to mono and possibly measles.
Those overlapping records might give you some information. They won't tell you what vaccines you didn't get, of course, but if any of those records says you had a vaccine, that's some information.
On the other hand, checking the titers would give you more definite information about immunity, and might be simpler than trying to get at old records.
@Vicki, thanks I will investigate. How embarrassing. I no longer test positive on a skin test to eggs, which I understand is no longer a concern.
There's no vaccine yet against M. leprae.
It's unclear to me at first glance what the platform is (BCG?) for the most promising candidate.
Narad, old joke played on those going to Clark AFB in the Philippines. There was also a gag involving showing a horse syringe with a large gauge needle and convincing enlisted that it would be required to protect them from jungle clap. I won't repeat the punchline. Before going to Clark, with my orders being changed mid transit to go to the Aleutians, there were a lot of shots.
Supposedly, Infectious Disease Research Institute, is starting phase 1 trials in the Philippines. Based upon the bacteria recovered from armadillos.
Sigh. If it were up to me, anyone wanting to claim a "Philosophical Exemption" to vaccinating their child should be given two choices:
1.) Pay a $10,000 fine, and if their kid gets the VPD, they lose custody.
2.) Be literally tarred and feathered for 6 months. Then if their kid gets the VPD, they lose custody.
Either way they should at least sack up and show they actually believe their philosophy, rather than just following a trend.
Excellent post. Don't know how "Dr Bob" can live with himself.
It's worth reminding of the statistics in the last major measles outbreak in the US - 1989-1991 saw 55,000 cases and over 200 deaths: 90% unvaccinated. Statistics from one year are here:
"Complications were reported in 6274 (22.7%) cases, including diarrhea in 2606 (9.4%), otitis media in 1829 (6.6%), pneumonia in 1803 (6.5%), and encephalitis in 36 (0.1%). Hospitalization was reported for 5844 (21.1%) persons. A provisional total of 89 measles-associated deaths were reported (in 1990 alone), for a death-to-case ratio of 3.2 deaths per 1000 reported cases (1 in 313 mortality rate). Deaths were reported from 15 states. Forty-nine (55.1%) deaths occurred among children less than 5 years of age, including 15 (16.9%) children less than 12 months of age and 13 (14.6%) children 5--19 years of age. The other 27 (30.3%) deaths occurred among adults greater than or equal to 20 years of age. Eighty-one (91.0%) suspected measles-associated deaths occurred among unvaccinated persons."
There is an excellent, detailed journal paper (one of many) that discusses this outbreak and measles mortality in the US from 1987-2002 here:
The authors looked into the death certificates, side effects, and other statistics; it's sobering.
So 10% of the cases were from vaccinated individuals? Troubling when looking at propagation, 10% of the population unvaccinated (90%*10%) could supply enough vectors to infect 10%*90%. 18% of the population.
For my next trick I'll prove aspirin has killed more people than ebola.
One in four hospitalized.... oh, my. You are using a fallacy here. Just because one in four were hospitalized does not speak to the seriousness of their case. You say we don't hospitalize people lightly anymore. I beg to differ. People are hospitalized for observation all the time. You go ahead and be the HMO guy who denies hospitalization for the dreaded measles and see how that flies.
In the years prior to vaccine introduction, the average number of measles cases was 3-4 million per year. Average number of deaths was 450. Do the math. It is a mortality rate of 0.015% on the high side.
Given the expense of hospitalisation and the miserliness of medical insurance providers, you are talking out of your backside.
Only for serious things. I should know. I've had to go to hospital twice thanks to injuries from car crashes. Both times, I was released within a few hours.
Citation needed. That seems a little high.
Officially. I would say a lot more deaths and things like SSPE fell through the cracks.
You're off by about an order of magnitude on # of cases. There were not 3-4 million per year. There were about 400,000-500,000 cases per year, about 48,000 hospitalizations and about 450-500 deaths per year. That's a mortality rate of about 0.1% (i.e., ten-fold higher than your figure. Hospitalizations occurred at about a 10% rate.
Sorry, forgot to include a source for those figures. They are from the CDC.
Bill is giving us a reader's digest of the numbers crunched on these parts for some time now.
From another thread from 4 years ago, in which Dr jay was already doing his sniveling passive-aggressive cowardly act, we got this citation, courtesy of another long-lost troll.
“Before 1963, approximately 500,000 cases and 500 deaths were reported annually, with epidemic cycles every 2–3 years. However, the actual number of cases was estimated at 3–4 million annually”
If you do the math using the available data, i.e. the recorded numbers, we got the 1:1000 mortality rate.
But, fair enough, not all cases were recorded, and one could put the argument that mild cases were more likely to avoid record than life-threatening cases. On the other hand, before DNA typing of viruses, the link between a measles infection and a number of complications like pneumonia could well have been easy to overlook, if the patient only came to the attention of health providers after the complication settled in.
If you assume that all deaths and other complications were recorded, but the total number of cases was in the 3-4 millions, then you get Bill's number, in the 1:8000 zone.
That's a bold assumption. And it was before 1963. Red tape did some progress since then.
Now, what to believe?
Recent outbreaks of measles in Europe were in the 3:1000 mortality rate, if memory serves.
Another clue is that measles is one of the top-ten child killer in 3rd-world country, if that counts.
Even the most recent major measles outbreak in the US - 1989-1991, 55,000 cases and at least 165 deaths:
presents strong evidence that measles mortality prior to vaccination was higher than 'reported' by the CDC, not lower.
165 deaths in 55,000 cases in 1989-1991 gives a mortality rate of 1 in 333 (similar to recent measles mortality data from Europe). With modern sanitation, nutrition, antibiotics, and medical technology at hand, why would the measles mortality 20 years ago be HIGHER than that suggested by either the 'reported' data from the CDC 60+ years ago, i.e., ~500 deaths per year with 500,000 cases - 1:1000, or the larger figure for 'estimated' cases, i.e., the same ~500 deaths per year with 3-4 million cases - 1:6000+?
Simple answer: Regardless of whether the number of measles cases was under-reported to the CDC prior to vaccination, the number of measles-related deaths must have been under-reported even more so.
But Adam - the anti-vaccinators will believe the numbers from the CDC when it serves their purpose.....
Here's an account of a case of measles, without complications (complications are common).
I wonder if someone can clarify something for me about this statistic: "Of the cases in California, one in four sickened have had to be hospitalized." Presumably, the denominator here is reported cases. But isn't there evidence that the number of measles cases during outbreaks are often under-reported? A study in the CDC Journal Emerging Infectious Disease linked in the blog post below estimates that cases in the 2008-2011 outbreak in France were under-reported by about 50%.