An Open Letter To Parents Who Don't Vaccinate

There are a very few good reasons not to vaccinate -- for example, if your child has cancer or is recovering from chemotherapy.  If you are not vaccinating because of misguided fears of autism, or beliefs that vaccinations are dangerous, or beliefs that vaccines "weaken the immune system", shame on you.  You are letting your fears and beliefs put other people at risk, who have no idea that your children may endanger their health or well-being.

You are putting other people's health at risk, especially infants under 12 months (the earliest recommended age for the measles-mumps-rubella inoculation) and those susceptible for other reasons.  Your child is contagious four days before the rash appears.

Vaccinations prevent disease.  No medical procedure is without risk, but in the case of vaccination, the risks are vanishingly small, and the benefit to your child and your child's community are immense. Update:  Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States.

The current measles outbreak in San Diego was sparked by an unvaccinated 7 year old child who acquired the disease in Switzerland, and so far has infected two infants too young to be vaccinated.  The infants both acquired the highly-contagious disease by being at the Children's Clinic in La Jolla at the same time as the virus-shedding 7-year-old. 

One infant (the 10 month old) is hospitalized.  The other infant travelled to Hawaii on February 9 with its parents (exposing hundreds of people on the airplane) before being diagnosed and quarantined in Hawaii.

The 10-month-old attends Baldwin Academy; the infants' program is closed until February 26, and others at Baldwin Academy who are not vaccinated must also stay at home until February 26.

Today, there are a total of eleven cases:  seven at San Diego Cooperative charter (three siblings and four classmates), the two infants, and two others (age and vaccination status unknown).

Adults born between 1956 and 1970, even if vaccinated, are thought to have  a higher risk of contracting measles than vaccinated individuals born later than 1970, as the form of the vaccine used from 1963 to 1969 was not as effective as the current  version.

Update:
Aetiology (and comments)
Drug Monkey (and comments)
Autism Vox

more below the fold

 

The index case, the 7 year old traveler, attends a "progressive" charter school in San Diego, which serves grades k-7 and has an enrollment of 358.   

At the beginning of the outbreak, nearly 10% of the student body were unvaccinated and were quarantined at home.  Voice of San Diego reported on February 4:

34 unimmunized students at San Diego Cooperative Charter School (SDCC) are stuck at home, said principal Wendy Ranck-Buhr. The students can't come to school until Feb. 21, unless they get immunized against the illness.

By February 12, the 34 had dropped to 17, according to a bulletin from SDCC.

UPI reported that up to 50 children are quarantined, including the Baldwin Academy students, the SDCC students, and unvaccinated students at the Murray Callan Swim School (which has classes for infants as young as three months).

You parents who were so afraid of vaccination -- how do you feel about the illnesses your fear caused?  How about the financial hardship for parents whose children are excluded from school?  If I were a parent in the infant program  at the Baldwin Academy, I'd be furious.  I am sure that the Baldwin Academy isn't rebating tuition for the weeks the infant program is closed -- the parents of those infants are either suffering financial loss by staying home from work, or paying double for child care.

An unrelated case in Hawaii is an adult woman who was exposed in Italy, and showed symptoms on her return to her home.  Her age and vaccination status was not reported.  However, she took care to isolate herself and probably has not exposed any further people to risk of the disease.

Vaccines were the greatest public health achievement of the 20th century," said Steve Dettwyler, director of DPH's Immunization Program. "As we entered the 21st Century, immunization rates had reached record highs in the United States. We are striving to maintain those levels to prevent outbreaks of diseases such as measles, mumps, rubella and diphtheria." The Centers for Disease Control and Prevention (CDC) offers four examples of vaccine success to illustrate the importance of continued vigilance in obtaining childhood immunizations:    

• Polio - Before polio vaccine was available, 13,000 to 20,000 cases of paralytic polio were reported each year in the United States, leaving thousands of children in braces, crutches, wheelchairs and iron lungs. Though virtually eradicated here, polio still exists around the world. In 1994, wild poliovirus was imported to Canada from India, but high vaccination levels prevented it from spreading. If immunization rates fall in the United States, children could be exposed to imported strains of this deadly virus.
•    Measles - Prior to introduction of the measles vaccine, there were approximately 3-4 million cases each year, and 450 deaths annually between 1953-63. Widespread use of the vaccine has led to a greater than 99 percent reduction in the rate of measles infection in the United States. However, in the late 1980s, immunization rates against measles dropped, leading to 100,000 cases of the disease and more than 100 deaths.
•   Rubella (German Measles) - In 1964-65, before rubella immunization was used routinely in the United States, a rubella epidemic resulted in 11,000 miscarriages, 2,000 neonatal deaths and 20,000 infants born deaf, blind or mentally retarded. In 1998, only 19 pregnant women contracted rubella.
•    Mumps - Before the mumps vaccine was introduced, this viral disease was a major cause of deafness in children. About 212,000 cases occurred in 1964. After vaccine licensure in 1967, reports of mumps decreased rapidly, though a resurgence in 1987 led to 12,848 reported cases. Since 1989, incidence has again dropped, with a total of 606 cases reported in 1998. Mumps is easily spread among unvaccinated persons and would quickly return if immunization rates drop.

More Update:
California does mandate vaccinations for school attendance, but the exemptions are easy to get.  The quote is from the article "Nonmedical Exemptions to School Immunization Requirements: Secular Trends and Association of State Policies With Pertussis Incidence"

For example, California offers a personal belief exemption whereby the parent simply signs a prewritten statement on the school immunization form. This personal belief exemption is available to anyone regardless of the nature of their beliefs (religious or philosophical) and it is easier to claim this exemption than to complete the school immunization form that requires a health care clinician to obtain the child's medical record and transcribe the dates of vaccine administration.

The article concluded that:

Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence. States should examine their exemption policies to ensure control of pertussis and other vaccine-preventable diseases.

Sources

• Voice of San Diego.org February 4 2008
• Sign-on San Diego February 11 2008
• Sign-on San Diego February 12 2008
• Sign-on San Diego February 16 2008
• KITV News, Hawaii, February 16 2008
• CDC: Vaccines and Immunizations
• National Network for Immunization Information: Measles
• CISP
• Publc Health of Seattle and King County: Measles Information
• Dr. Razavi's Good To Know Blog: Measles in Adults
• Measles Outbreak in A Community With Very Low Coverage, the Netherlands
• Journal Watch of Infections Diseases: Outbreaks in the US--Why?
• NPR: Boston Outbreak Shows Risk Even to the Vaccinated
• Boston.com Measles Outbreak Shows a Global Threat June 10 2006
• NEJM: Implications of a 2005 Measles Outbreak in Indiana for Sustained Elimination of Measles in the United States August 3 2006
• JAMA: Nonmedical Exemptions to School Immunization Requirements: Secular Trends and Association of State Policies With Pertussis Incidence  October 11, 2006
• Ed-Data: San Diego Cooperative Charter School
• San Diego Cooperative Charter School
• Roush, S., Murphy, T.V.,  and the Vaccine-Preventable Disease Table Working Group (2007)  Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States. JAMA. 2007;298(18):2155-2163.

 

Comments

[Karoli]

resounding applause!

In this day and age of research, one common theme continues to emerge: Vaccinations do not cause autism.

Those who claim it does based on anecdotal evidence are the ones contributing to the dumbing-down of this country by rejecting science in favor of stories and folk-tale fantasies.

Well done.

[merxxx]

my son suffered a seizure and subsequent brain damage after recieving the Dtap. I have to care for a mentally retarded child for the rst of my life (one who was completely normal before the shot). Do you know how badly I wish I could take it back???? I'll take measles over brain damage anyday. And vaccines are not 100% effective, you're being lied to. Look at India where they are vaccinating some people up to 13 times each against polio and they're still contracting the disease.

Deaths rates from these diseases were on the steady decline LONG BEFORE vaccines were even introduced. That's a historical fact- go look it up.

[Liz Ditz]

Merxxx, I am sorry that your child is impaired. But no medical procedure is 100% risk-free.

No one is arguing that vaccines are 100% effective. Take the case of pertussis (whooping cough) -- it is thought that immunity from pertussis conferred by the DTaP wanes after 10-12 years, resulting in outbreaks centered on high schools, as happened in Palo Alto in 2006.

As far as India "some people up to 13 times", I think you are mixing up "vaccination drives" -- concerted efforts to vaccinate segments of the population -- with individuals being vaccinated multiple times.

Polio is so resistant to eradication in this part of India because of the combination of extreme poverty, poor sanitation and the high population density. Such conditions facilitate transmission of the virus and compromise the efficacy of the oral vaccine.

In 2005, India moved away from its exclusive reliance on traditional trivalent oral polio vaccine and started using monovalent oral vaccines, which target either of the remaining two serotypes – type-1 and type-3. These newer vaccines are more efficacious per dose and boost immunity faster than trivalent vaccines.

The following year, however, another outbreak of type-1 polio occurred in India, again in western Uttar Pradesh, following a decline in vaccination coverage. From there, it spread quickly throughout the state and beyond. By the end of the year, 648 confirmed cases of type-1 polio had been declared throughout India.

The government of India embarked on an intensified vaccination strategy in western Uttar Pradesh and the neighbouring Bihar state at the start of 2007. By mid-September Bihar had already conducted 10 vaccination campaigns – a higher level of polio vaccination activity than anywhere else in the world.

This September, the eighth vaccination round was conducted in Moradabad. On the first day of the campaign 604 294 children were immunized at 3445 booths across the Moradabad district. By the end of the round a week later, 946 082 children had been immunized through the district.

Here is what Medline has to say about the DTap vaccine:

Moderate to serious reactions are uncommon. They may include:

* Non-stop crying for more than 3 hours (1 in 1000 children)
* Fever over 105 degrees (1 in 16,000 children)
* Seizures (1 in 14,000 children)

Severe reactions are extremely rare, but may include severe allergic reaction such as breathing difficulties and shock. Such reactions occur in less than 1 per 1,000,000 children. Long-term seizures and brain damage are so rare that the association with vaccine is questionable.

Mark C. Chu-Carroll, in the comments on this blog post, wrote:

Don't want your child to become a statistic? Which route seems safer? The vaccine, with a one or two chance in a million of complications? Or the infection, with risks in the 1 in 100 range?

Another of Chu-Carrol's commentors wrote

The acceptance of vaccination is a form of Social Contract Theory [Locke et al.] in the area of Public Health. One gives up certain rights, which in this case, is the acceptance of the small possibility of negative side effects, for the greater social good of herd immunity. Social Contract Theory has certainly had a long history in our society, with the benefits to the many being much greater than the restrictions placed on the few.

Having a special-needs child is difficult. I am not minimizing your family's suffering in any way. I am saying that the public benefits of very small private risks are part of being a civil society.

[Liz Ditz]

A twelfth child is ill with measles, also a student at SDCCS.

Measles Outbreak Report February 20 2008

This is a child that has been on home quarantine since the outbreak began, so there is no risk to the general public, as the child has been home during the infectious period,” said Dr. Wilma Wooten, the county's public health officer.

Twelve children – ages 10 months to 9 years – have contracted measles since an outbreak in San Diego started early this month, according to the HHSA. Two other suspected cases of measles are awaiting confirmation.

Eight of the measles cases originated from the Cooperative Charter School, while another four stemmed from the Children's Clinic in La Jolla, according to county health officials.

Additionally, there are about 70 children on home quarantine, according to the HHSA.

[isles]

Thanks for this post, Liz. It's about time people started speaking out against the willfully uninformed segment of the population that refuses to participate in protecting us all against preventable infectious diseases.

[LK]

So - these children acquire NATURAL immunity from getting measles and will NEVER have to worry about getting them again. There hasn't been any deaths or further complications --- and the problem is???? You have obviously bought into the media/drug company hype about vaxes and drugs being the only way to health....or maybe the real truth is that you have been bought!!!

[Laura]

You are an unintelligent person. If an unvaccinated child did contract measles or mumps, and exposed your child to it...isn't your child vaccinated? Isn't your child "immune"? What are you worried about? You seem 100% confident in your vaccines. Or are you? Think. Think think think.

Or don't think. There's a good sheep.

[tracy]

I'll take the natural way any day! 1 in 1,000,000 REALLY?? So if that is true then why within 12 - 72 hours after having MMR do we have deaths and autistic children? Does that not count for brain damage????????? Shouldn't the number go up???? 1 in every 166 boy

So let me get this straight:
12 - 72 hours after shot
healthy 15 month old boy

MOM: doctor my son is screaming and has been for 4 hours
DOCTOR: it's just a reaction from the shot
MOM: doctor my son has a fever of 105
DOCTOR: it's just a reaction from the shot
MOM: 911 my son is dead (or has autism)
DOCTOR: it's not the shot
Do you think the doctor called that in for severe reaction?
The severe reaction statistics 1 in 1,000,000 should be 1 in 166. If it happened to your child you would think twice about what people get paid to tell you to do.
How about feed our children good food so their bodies can fight off the infection. It's so much easier to let the doctor play God than take control over our own children.
So will your child be in line for the cocaine vaccine? Yes cocaine. You know your child will be a cocaine user so when it comes out you better be the first in line. Because so many people overdose on it. I am not kiding this shot will make your child unaddicted to cocaine. Because you got the one for sex, your daughter will be having sex by the age of 13. Mark my words vaccines are not done yet. They are working on them right now and plotting and waiting for the right time to bring it out.
Those people will not touch my children.

So is it 1 in 1,000,000 or 1 in 166 think about it!

[J.J.]

I just love how the pro-vax community, love to run there pie holes. That is the one beauty of this country freedom speech. The other is that we have the right to make an informed choice on our children’s safety.
It’s so refreshing to here their true compassion for those families that have lost a child to vaccinations! Oh sorry but but, but, but whatever. You feel nothing for these families, and if you want to believe it or not there are very dangerous side affects. You can down play them all you want. Someone please crunch the numbers for them on vaccine injured children yearly, or children harmed by outbreaks yearly. What is the greater number? Oh but that doesn’t count because, because, because whatever!
In closing I do care about your children! I wouldn’t harm them by not vaccinating, but you have to respect my rights as well I have respected yours. My child was just one of those oops to you people that you want to sweep under the rug, but the fact is she would still be here if I would have not vaccinated! I would also suggest if you don’t like my freedoms to choose to vax or not vax. Move my rights are protected, no matter how much you fear mongers lie that will never change.

[c lo]

I couldn't even read your post. Once you accept that it's not about fear, it's about education, then I can begin to consider that you have a valid point. Until then, until you see me as a rational, thinking, educated parent, I can't even begin to think you are actually the same.