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Grrr, grrr, grrr

A few weeks ago, I found myself in the awkward position of agreeing with Bill Frist in a discussion with Bill Maher about vaccination.

Earlier today, I read a really sad account of a child who cannot go to daycare because one of the other parents at his daycare will not vaccinate their child. The author's child is immunosupressed because he has cancer.
So while this nonvaccinated cancer-free child (and I'm sure she is a lovely child!) enjoys a normal white blood count of anywhere between 5,000 to 10,000 on any given day, my son is lucky if his ever breaks 2,000. An ordinary virus or some other seemingly trivial illness can cause his white count to plummet to zero—"the big egg," as one of his oncologists describes it. A fever over 101 degrees earns him a couple of nights in the hospital. On top of all that, his chemotherapy—a bewildering array of pills, IV treatments, and spinal injections—prevents his own vaccinations from working, so he cannot be vaccinated at all in treatment. My son, like other children in treatment for cancers and HIV, is "medically exempt" from being vaccinated while in treatment. In fact, most children with cancer will have to be completely revaccinated when they finish their chemotherapy, because the treatment often wipes out any immunity they may have achieved from their pre-cancer vaccines.

According to Paul Offit, the chief of the infectious diseases division at Children's Hospital of Philadelphia and author of Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure, the danger that nonvaccinated children pose to immunocompromised children couldn't be clearer. Those who cannot be vaccinated, including young babies, transplant, and cancer patients, depend on the immunity of the herd to protect them. In recent years, in communities where many parents opt out of vaccinating their children, the herd has diminished. As a result, unvaccinated children have died from totally preventable infectious diseases such as measles, meningitis, and pertussis.

In 2008 in San Diego, a 7-year-old boy whose parents refused vaccines contracted measles while on a family trip to Switzerland. Before realizing how sick he was, the boy went to school and infected four other kids at school, after having already infected his two siblings. He then infected four other children who happened to be in the waiting room at his pediatrician's office. Three of those children were too young to have received their MMR vaccines. One of those infants was hospitalized; another traveled on an airplane while infectious. This case is a sobering example of how one family's decision not to vaccinate their children has serious consequences for other children.

But it isn't as sobering as the case in January in Minnesota in which an Hib meningitis outbreak severely sickened four children and killed one infant. Of those five children, one was too young to be vaccinated, one had an immune deficiency, and the other three had parents who refused the vaccine. The child who died was among those three children whose parents, out of fear or personal belief, opted out of the vaccine.

A study released this year in the journal Pediatrics demonstrated that children whose parents refused the pertussis vaccination were at a much higher risk of contracting the disease in spite of being surrounded by vaccinated children. In the case of pertussis, also called whooping cough, herd immunity does not even seem to protect the nonvaccinated, which means vaccination is the only option for protection against pertussis. Pertussis can be fatal to infants and the immunocompromised if it is not diagnosed in time to complete antibiotic therapy. My son's own pediatric oncologist noted the danger pertussis could pose to him as the No. 1 reason to seek a fully vaccinated daycare.


And then I read this post at Lawyers, Guns and Money, which led me to this Wired article, on the anti-vaccine fear.
Consider: In certain parts of the US, vaccination rates have dropped so low that occurrences of some children’s diseases are approaching pre-vaccine levels for the first time ever. And the number of people who choose not to vaccinate their children (so-called philosophical exemptions are available in about 20 states, including Pennsylvania, Texas, and much of the West) continues to rise. In states where such opting out is allowed, 2.6 percent of parents did so last year, up from 1 percent in 1991, according to the CDC. In some communities, like California’s affluent Marin County, just north of San Francisco, non-vaccination rates are approaching 6 percent (counterintuitively, higher rates of non-vaccination often correspond with higher levels of education and wealth).

That may not sound like much, but a recent study by the Los Angeles Times indicates that the impact can be devastating. The Times found that even though only about 2 percent of California’s kindergartners are unvaccinated (10,000 kids, or about twice the number as in 1997), they tend to be clustered, disproportionately increasing the risk of an outbreak of such largely eradicated diseases as measles, mumps, and pertussis (whooping cough). The clustering means almost 10 percent of elementary schools statewide may already be at risk.

In May, The New England Journal of Medicine laid the blame for clusters of disease outbreaks throughout the US squarely at the feet of declining vaccination rates, while nonprofit health care provider Kaiser Permanente reported that unvaccinated children were 23 times more likely to get pertussis, a highly contagious bacterial disease that causes violent coughing and is potentially lethal to infants. In the June issue of the journal Pediatrics, Jason Glanz, an epidemiologist at Kaiser’s Institute for Health Research, revealed that the number of reported pertussis cases jumped from 1,000 in 1976 to 26,000 in 2004. A disease that vaccines made rare, in other words, is making a comeback. “This study helps dispel one of the commonly held beliefs among vaccine-refusing parents: that their children are not at risk for vaccine-preventable diseases,” Glanz says.

“I used to say that the tide would turn when children started to die. Well, children have started to die,” Offit says, frowning as he ticks off recent fatal cases of meningitis in unvaccinated children in Pennsylvania and Minnesota. “So now I’ve changed it to ‘when enough children start to die.’ Because obviously, we’re not there yet.”
This is just insane. Vaccines save lives. Maybe parents are too young to remember small pox, but they should ask their own parents about the scars on their arms. Polio shouldn't be around anymore. Measles shouldn't be a disease we have to worry about. Whooping cough is making a dramatic comeback? Why? Why on earth is this allowed to happen. It's absolutely insane.

A report by the WHO, UNICEF, and World Bank called State of the world’s vaccines and immunization was released today. It is dedicated to "to all those individuals who work tirelessly to improve and save lives through vaccines and immunization." And it begins with this quote:“With the exception of safe water, no other modality, not even antibiotics, has had such a major effect on mortality reduction…” The report details the efforts worldwide to vaccinate children and the effects vaccination has in saving lives and ensuring quality of life. It baffles me that so many efforts are made in third world countries to ensure that vaccinations happen, that people in countries with no healthcare fight tooth and nail to get these important immune boosters, and wealthy Americans dismiss them with no basis of scientific fact at all. Read the whole Wired article, excerpted above, people are fighting vaccines as they do for religion. It's downright strange, and wrong.

I'm, coincidently, getting my 'flu shot tonight. It's not an essential vaccine to get every year, but I work in an area where lots of sick people congregate, and I think it's a good idea for me.

Comments

( 13 comments — Say something )
charlayne
Oct. 21st, 2009 10:12 pm (UTC)
I don't understand it either. It makes me nuts to think my grandchildren could be going to school with children who are walking germ factories. They've had all their shots and we make sure they get boosters. I remember when they stopped giving the small pox vaccine, about the time my older children were born in 1977. I begged the doctor to find the vaccine to give them, I knew it was that important. Same with the polio. I didn't want my kids getting the illnesses. They didn't get the small pox but they got polio vaccine at the time.

I've never had the chicken pox (never exposed, I guess) and my kids ended up at their grandmother's when they got it so I didn't get them as an adult. Now there's a vaccine and my grandkids got that. I really worry that some parent won't vaccinate and then their kid will get it and, like the measles story you had, I will get it from some kid whose parents are uneducated or blind to the risks; it's even more risky for an adult to get it.

I got my flu shot between my operation and the radiation so I could hopefully avoid getting it while my immune system is low.
stexgirl2000
Oct. 21st, 2009 11:13 pm (UTC)
These idiots who are opting out getting their children vaccinated are going either kill their children or other people's children killed. And I hope they get arrested for child endangerment or manslaughter or sued or all of the above.

I know of two mothers who are seriously thinking of not getting the H1N1 shot for their kids. I want to hit them upside the head. The flu can kill. It shouldn't be an issue to protect your child from it.

I read the WIRED article a few days ago and unfortunately I think Dr. Offit is right when he says that it's going to take more children dying for people to wake up and realize that measles, mumps, rubella and pertussis aren't going to go away with just wishful thinking and good hygiene.
erbie
Oct. 22nd, 2009 12:00 am (UTC)
I'm not planning to get the H1N1 shot for me or my kids. There's so much panic about the H1N1 flu, because the media has whipped it all up. This flu is no more dangerous than the seasonal flu, and in fact, has been less dangerous. There have been fewer than 5000 deaths *worldwide* from it, when with seasonal flu, there are 36,000 annually just in the US. And those deaths are in individuals who are otherwise compromised, such as immune systems or underlying medical problems. I'm not too keen on getting an untested vaccine or allowing my children to either. I worked in the pharma industry for seven years, and it's just not enough time to test the new vax, afaic, for me and my family. I keep them home when they are sick. I stay home when I am sick.

Instead of the vaccine, I'm doing things to boost our immune systems, like taking vitamins C and D, taking probiotics, and taking elderberry extract. I'm also making sure the kids get enough nutritious food, rest and exercise to keep their immune systems strong, washing hands more often, teaching them to cover their sneezes and coughs with their elbows rather than their hands, and teaching them not to touch every surface they see, keep their hands out of their mouths, eyes and nose, etc.

I think the media is doing a great disservice to the world in whipping this H1N1 scare up to a frenzy. it's just the flu, and not even as bad as the seasonal flu we see every year. Why do they need to make this one into something it's not?

I've done my research, and gone back and forth as to whether to get that vax. Ultimately, I decided not to. We don't get seasonal flu shots every year, and this one is really no different from the other strains as far as virulence and is actually somewhat less contagious than seasonal flu.
erbie
Oct. 21st, 2009 11:46 pm (UTC)
I'm on several groups with a high proportion of non-vaccinating parents. Goes hand in hand with a lot of the non-mainstream parenting choices that I have made. The ones I know have done a lot of research and made their decision based on that research. I have to respect that they have made informed choices. They also remove their kids from school if they are sick, or if there is an outbreak of something they are not vaxed for. Actually, most of them homeschool. A high proportion of them actually can not get their kids vaxed, because of reactions or other medical issues. I'm one of the few on those groups that vaxes fully. I don't do it on the same schedule as the CDC recommends, but I do get all the vaxes that are recommended, except the flu. My oldest had her CP shot, but my youngest has not, and I'm waiting til she's older. If she doesn't contract CP naturally, and it's likely that she won't, since it's mostly been eradicated, then I will get her the shot when she's 11 or 12.
clynne
Oct. 22nd, 2009 06:38 pm (UTC)
The ones I know have done a lot of research and made their decision based on that research. I have to respect that they have made informed choices.

I don't know these particular people, but everyone I know who has "done a lot of research" and ended up deciding not to vaccinate has done bad research. There's a lot of pseudoscience out there obfuscating the issue, and not everyone is capable of sorting through the chaff to find the wheat.

The bottom line is, there's no link to autism from vaccinations, and there are definitive links between a lack of vaccination and sickness/death. Those folks you share that board with are the victims of charlatans and hysterics.
erbie
Oct. 22nd, 2009 07:48 pm (UTC)
Clearly, there is a lot of bad info out there. The people I'm talking about are not depending on internet information. Fear of vaccines inducing autism is not the reason they do not vaccinate. A lot of these people are scientists and doctors themselves. They are not the victims of charlatans and hysterics. They are extremely intelligent people who have read and understood the original studies and chosen not to blindly follow what the pharmaceutical companies want them to do. The US government is so beholden to special interests, including the pharma industry, that they are not necessarily to be trusted when they say something is perfectly safe. (Case in point: Gardasil is getting a lot of scrutiny right now, because it's causing many severe reactions in girls who have received the vaccine.)

While I don't choose the same path as some of the people I'm talking about, I do respect that they have done their research and they have made decisions that are a lot more informed than blindly following a doctor's or the government's recommendations.

Pharma companies are not in it for our health. They are in the business of making lots and lots of money. Working at a very large multinational pharma company gave me a healthy skepticism about drugs and vaccines. They're obviously not eager to admit that their products might do more harm than good sometimes. (Case in point: When I worked at BigPharma, there was an antibiotic, new class, very effective, almost no resistance. There were massive trials and the safety profile was pretty good. Then it went to market, and people started dying of heart issues. It wasn't pulled from the market, but it was given a black box warning and is only used as a last resort in extremely abx-resistant infections. The scrambling at that company that took place to reduce liability and shift blame was shocking. And people were actually dying from it, clearly from it, not from something else.)

There are valid reasons not to vaccinate for some people. I agree that most of the people who choose not to are not doing any kind of valid research and are just listening to Jenny McCarthy, but the people I know do not fall into that category. Some of them also have philosophical or religious objections to some of the ingredients and processes used to make vaccines. While I don't share those objections, I'm not going to tell someone that their objection to using fetal cells in vaccines is not valid.
cz_unit
Oct. 22nd, 2009 12:00 am (UTC)
People are just... plain... stupid

CZ
cosmicbob
Oct. 22nd, 2009 10:47 pm (UTC)
I would say that if someone's refusal to get a medically accepted vaccination caused my child to die, that no amount of philosophical objections would stop me from killing them.

Fortunately, we are able to get both H1N1 and seasonal flu vaccines this year. We got the seasonal one and we have already gone through the H1N1 but the pediatrician recommends getting the H1N1 anyway.
captainsodium
Oct. 23rd, 2009 03:54 pm (UTC)
"This is just insane. Vaccines save lives."

Well yes. And I agree that the benefits far outweigh the risks.

Yet there are risks and when Celeste was born I found it hard to get the actual data to look at those risks. CDC keeps it close. I did manage to scrounge up data, found some folks who work on vaccine development and found that there's some very reasonable measures a person can take to minimize vaccination risks. This is perhaps the middle ground that is not really out there in the discussion. You either vaccinate because it's the right thing to do or you're a nut for refusing vaccines with known but ill defined risks.

What I was able to come up with was:
1) Family History: if there's a history of vaccine sensitivity precautions are warranted.
2) Sensitivity is built up: generally speaking the first exposure is not the one that will develop a reaction.
3) Sensitivity is enhanced by multiple vaccines: take them one at a time to limit sensitivities.
4) Use non-prescription ibuprofen preemptively. The most severe vaccine reactions result in swelling and can be dramatically reduced with simple medicines.

Another main concern is the goofy crap that gets put in vaccines as a preservative. This stuff, thymerisol in particular, seems to mostly be harmless but is unnecessary except where packaging allows for multiple doses that will be administered at different times. Each needle stick introduces bacteria that must be held in check. Using single dose ampules in most cases eliminates these.

And the last concern I tried to address in our scheme to limit risks was the dreaded MMR (Mumps, Measels, Rhubella) vaccine. It had the highest incidence of reactions (1:10,000 in my recollection) and a really bad reputation even under the reformulated version. So we had those applied separately. Most physicians were happy to cooperate with us and if they grimaced did so behind our back and effectively out of sight. We only had one grumble about having to order the vaccines we were requesting but left it at that.

And our daughter didn't have any reactions that I ever noticed.

So what's the point of this? There's a middle ground. The non-vaccinators are, in my experience, concerned with the vaccination risks (real risks, not imagined) and are having trouble with the balance of protecting their child from harm. No one has spoken with them about what they can do to limit vaccination reactions and the most common refrain is to call their concerns stupid or uninformed. In fact the concerns are informed to a point but not particularly well informed and it's pulling teeth to get the information to make actual informed decisions.

The middle ground is pretty straight forward too. There are reasonable, effective, simple measures that can be taken to limit these risks.

It's a grass/lawn problem. From the CDC perspective the lawn is the measure. From the parents perspective it's the grass shoot that matters most.

Vaccines keep the lawn healthy (herd immunity).
So who keeps the grass healthy when treating each shoot makes some unhealthy?

(Anonymous)
Oct. 23rd, 2009 08:16 pm (UTC)
Grrr.
Just got a note from the Braznette's school that a kid in her grade has chicken pox. That's another one that shouldn't be going around....

Bn'B
peterfuhry
Oct. 24th, 2009 04:25 am (UTC)
They really pressure you hard to get the kid vaccinated very early in life, and, like sodium, it just felt right to me to do one at a time and not to start until he was about 9 months old.

AND

I just want to say that I don't think that the H1N1 shot is really a vaccine in the same way the others are. I absolutely feel manipulated by all this flu shot business, and I think it is giving other vaccinations a bad name. I understand people in this country not trusting what comes out of our health care system.
banana767
Oct. 26th, 2009 03:58 am (UTC)
Interesting article, thanks for posting. Parents who don't vaccinate drive me crazy. Yes, there are risks with vaccines like there are with all medications but the benefits are so much greater. The pedi clinic I was working at last month had a case of pertussis in a little 2-3 month old. The baby probably got it from an unvaccinated adult, not another kid, but it's still out there. We also had tons of moms begging for the H1N1 vaccine before it came in, but for all of those there was still the one we would offer it to that didn't want it.
pegster
Oct. 28th, 2009 02:00 pm (UTC)
i know some parents who don't object to vaccinations but object to how they are administered, especially if they are required to be close together, and these parents also work in the medical field.

on the other side, as a former public school teacher who worked with a majority of students from first-generation immigrant families, the diligence that i had to exhibit to keep myself from getting sick was a million fold, and in my short career as a public school teacher (less than 5 years), i only got sick once..it was strep, thankfully, but i wouldn't wish strep on my worst enemy, much less mumps or h1n1 or any other infectious disease.

even for kids who are home schooled, and i count friends in my life who home school their kids as well, it's not as if home schooled kids are always at home as part of their learning. they are out and about with the general population of other children. i also think about sports in which both public, private, and home schooled kids participate.

i'm not a parent, i live alone, i work in manhattan and i am just as diligent about illness now as i was as a public school teacher. if i can get a vaccine for h1n1, i'll take it. that also goes for a flu shot. that also goes for any other shot that is necessary for me to take. big pharma is in it for profit, of course, but i'm more than willing to help their profit margin if it will keep me healthy and well. i've been surrounded by too much death, especially this year, to not take my own life and health and wellbeing seriously.
( 13 comments — Say something )

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