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Mynnion
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I know this topic is trending downward (at least until the next outbreak) but I found the following model telling on the power of herd immunity. Having a daughter who had leukemia and lost much of her immunity for a number of years this topic is important to me.

Measles spread rate projections.

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The Drake
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I think the reason this keeps carrying, is because of the lack of real evidence that immunizations are unsafe. If one in 500 immunized kids wound up in hospital, would people still be threatening to force immunizations by law? Once you do force them, and an immunization turns out to be dangerous, what happens?

The government does have a National Vaccine Injury Compensation Program. This isn't some crack pot site, this is the CDC themselves:

quote:
The NCVIA established a committee from the Institute of Medicine (IOM) to review the literature on vaccine reactions. This group concluded that there are limitations in our knowledge of the risks associated with vaccines. The group looked at 76 health problems to see if they were caused by vaccines. Of those, 50 (66%) had no or inadequate research to form a conclusion. [6, 7] Specifically, the IOM identified the following problems:
Limited understanding of biological processes that underlie adverse events.
Incomplete and inconsistent information from individual reports.
Poorly constructed research studies (not enough people enrolled for the period of time).
Inadequate systems to track vaccine side effects.
Few experimental studies were published in the medical literature.

Significant progress has been made over the past few years to monitor side effects and conduct research relevant to vaccine safety.

So, one way to read this is that without the rise in people questioning and refusing vaccinations, this significant progress would not have been made?

CDC vaccine safety

In the below report, I read that 14 transfers to claims courts totalled $1.7 Million. So I could reasonably conclude that there is some real risk associated with vaccines.

February 2015 report

Haven't seen this elsewhere, it is my own idle research, and I may well be reading that acccounting report incorrectly. I find it disquieting that vaccine manufacturers are indemnified by the government and ultimately not fiscally responsible for their product.

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Greg Davidson
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Mynnion, so sorry about your daughter. What type of leukemia? My son had ALL and I remember life with an immunosuppressed child. And we were home schoolers, which is a community with a propensity not to vaccinate.
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Mynnion
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She had ALL also. Shes 11 years off treatment and is well other than a lot of misc little things that are likely a result of the chemo rather than the cancer. Since you asked here how is your son?
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Mynnion
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Drake- I don't believe anyone is claiming that vaccines are 100% safe. Neither are antibiotics or any other medicine. Peanuts can kill. You have literally billions of people that have received vaccinations. There are almost certainly some that have had a negative reaction.

What makes the studies you mentioned difficult is that you would need to work with an unvaccinated population. There are pocket groups such as the Amish but the inbreeding in that type of group makes them more likely to have some illnesses and less likely to have others. Another issue is that when you have millions of children vaccinated at a specific age parents start to see patterns for illnesses that naturally occur in that age ranges.

Did you run the simulation I linked? That is with a 15% difference. If I remember correctly there is about a 4% rate of failure to provide immunity for measles from the MMR.

You asked would we insist on vaccination if 1 in 500 children ended up in the hospital. What is the hospitalization rate for the measles? What was it for polio?

Choice is important in our society but when those choices put others at risk we choose to draw the line.

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Pyrtolin
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quote:
If one in 500 immunized kids wound up in hospital, would people still be threatening to force immunizations by law?
What's the basis of comparison? If one in 5 kids ended up in the hospital without any use of vaccinations, I'd say that there was good basis for requiring them. Even moreso if 1 in 100 kids are dying in the absence of a vaccine.


quote:
In the below report, I read that 14 transfers to claims courts totalled $1.7 Million. So I could reasonably conclude that there is some real risk associated with vaccines.
Claims courts don't prove anything about actual risk, just about the ability to win cases, particularly to make the cost of fighting a case higher than the payout for settling on it.

That isn't to say there aren't issues with either allergies to ingredients or procedural errors (very commonly a doctor ignoring the guideline to only administer them to people in good health, and giving them on an ironclad schedule instead of waiting for another appointment if the patient in question is currently sick with something else), but the damages payments are mostly made on the basis of a lack of will or ability to conclusively show that a vaccine was not at fault, not on proof that it was.

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The Drake
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I saw the simulations, but I'm not positive about all their premises, part of which is you have to introduce measles in the first place. This has generally to come from an unimmunized person exposed to a precursor outbreak.

Pyr, point taken about cumulative risk, and I'd consider more than just death rates. Even those who recover from measles face a difficult time.

But we don't necessarily live in a culture or political environment where we decide to make things illegal based on a cumulative risk factor. If so, I would suggest that we would make peanuts illegal, since some fractional number of kids do die from peanut allergy, while there is no clear measurable benefit to making peanuts available.

I think the reason that this touches off, is because most people (including me) consider vaccination to be a no-brainer, even while we might scoff at the removal of peanuts on airlines.

Since the government fund to pay for vaccination settlements is flush with cash, I'd recommend releasing a billion dollars of that for PSA, free vaccination vans cruising through neighborhoods, etc. All to promote greater coverage.

What I would not do, is have the national guard go door to door jabbing needles in people's arms, or deny people access to public services paid for by their taxes unless they can demonstrate paperwork that they have complied with all vaccination regimens.

I can understand why anyone who has children too young or ill to be able to immunize them would have a strong feeling that their child's risk outweighs any minor risk being taken by another's child. I'd urge those people to reach out and educate the other parents, rather than demanding that the government use its force to compel them.

Finally, I think this is a self-correcting problem. If we get to one or two outbreaks of any scope, more parents will get scared about the disease than the vaccine, and the trend swings back. Cold comfort to vaccinated or compromised kids in those areas, but not quite the envisioned doomsday of measles sweeping the land.

Most measles cases are coming from overseas. Global picture available from WHO

quote:
Accelerated immunization activities have had a major impact on reducing measles deaths. During 2000-2013, measles vaccination prevented an estimated 15.6 million deaths. Global measles deaths have decreased by 75% from an estimated 544 200 in 2000 to 145 700 in 2013.
quote:
Measles is still common in many developing countries – particularly in parts of Africa and Asia. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.

Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection.

Can an argument be made that the best way to prevent measles outbreaks in the US and elsewhere actually be the application of resources in global initiatives?

According to Measles & Rubella Initiative it only costs $1.50 to vaccinate a child in one of the six worst countries - India, Nigeria, Pakistan, Ethiopia, Indonesia, and Congo.

At the website you can donate, but they also have advocacy tools to help persuade, rather than force, people to get vaccinated!

I signed up for a modest monthly donation. Thanks for starting the thread, I had seen all the news about measles, but never bothered to look into the international picture until now.

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The Drake
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Pyr, yes the payouts don't prove anything. In fact the payouts might actually be to people who were improperly immunized (failed to develop immunity) rather than actually injured through side effects. I do find it mildly interesting, but not enough to reasearch deeply.
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scifibum
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quote:
I can understand why anyone who has children too young or ill to be able to immunize them would have a strong feeling that their child's risk outweighs any minor risk being taken by another's child. I'd urge those people to reach out and educate the other parents, rather than demanding that the government use its force to compel them.

Finally, I think this is a self-correcting problem. If we get to one or two outbreaks of any scope, more parents will get scared about the disease than the vaccine, and the trend swings back. Cold comfort to vaccinated or compromised kids in those areas, but not quite the envisioned doomsday of measles sweeping the land.

It's tricky. The anti-vaxxers tend to think they've done their research and are more educated than any layman who would advocate for vaccines, and think the actual experts are corrupt. They often fail to understand the scientific method and the basic principle that correlation does not prove causation. They are incredibly hard to persuade, from what I've seen.

While outbreaks of measles might frighten some out of their stubbornness, others will check to see if anyone died, and if the answer is no, they will feel vindicated. If anyone does die, they will look for reasons that it wasn't the measles's fault. Those who recognize that herd immunity is necessary to protect various people for whom vaccination isn't an option or isn't effective, but counter with "my only responsibility is to do what I THINK IS BEST for my own children" will continue to see it that way.

But actual inconvenience has a way of working for some people. Some people are sure they aren't going to let their kids have screen time until they, you know, really really want some easy way to distract their kids for a couple of hours. If someone's kid can't attend public school, that might lead to some serious inconvenience, and that might be the key to making someone rethink their convictions. (Not everyone, to be sure.) In the meantime, there is a legitimate public interest being served. Schools are disease vectors and one of the places that herd immunity is most important.

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The Drake
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The problem, scifi, is that once you start down that road, it truly is a slippery slope. Measles is the strongest example in favor of using forced vaccination policy, because it is so very infectious and serious.

What about all other vaccines? Varicella, how long before you make that one mandatory? Annual flu shots? I'll admit - I don't get flu shots. By some estimation, I am that ignorant sob who just doesn't get that I'm putting the elderly and the ill at risk. Should I be denied access to public buildings?

Of course a creative approach to our public school germ factories might be to educate electronically from home, saving tons on lighting and real estate as well, but lets set that aside.

At the end of the day, I'd be surprised if measles ever even approaches the level of kids being injured in MVA by parents dropping kids off for class. It's an emotional issue, not a statistically relevant one.

Guess what, we no longer need herd immunity from smallpox because we eradicated it. Why not focus on that goal instead?

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DonaldD
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Smallpox was eradicated only as a result of universal and mandatory vaccination programs, so that may not be the example you want to hang your hat on...

As far as measles mortality - in developped countries, measles is fatal in between .1% and .2% of cases - say 1 in every 750 cases. Without vaccination, because of the ease of transmission, just about every person in a population would become infected at some point. Extrapolating to the USA and its population of ~300,000,000, that would mean roughly 300,000 more people dead today than otherwise. Not as deadly as motor vehicles, but still pretty bad. And that is not counting the effects of serious complications that also arise as a result of measles, which are even more prevalent than mortality.

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The Drake
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Donald - good point about smallpox, didn't notice the degree to which that happened in history. Noted. There was probably some very real acceleration of timeline through compulsory methods.

I'm assuming you mean without any vaccination - and of course if a bunch of unvaccinated people die - well that's their own business.

I think you have to calculate the number of contractions and fatalities affecting those for whom the vaccine is ineffective or cannot be taken based on the realistic drop in vaccine coverage.

Various numbers are available for all these, but I suspect any rational calculation of societal impact (which could include externalities like health care costs) isn't really the point. I think mostly what I hear from those vehemently arguing in favor of compulsory vaccine in various media is the "if only one child dies" argument.

What does CDC say the snapshot of the situation is?

quote:
Since 2000, when measles was declared eliminated from the U.S., the annual number of people reported to have measles ranged from a low of 37 people in 2004 to a high of 644 people in 2014. Most of these originated outside the country or were linked to a case that originated outside the country.
Wow, not quite as scary as some 300,000 dead, is it Donald?

"The most frequent sources of importations were unvaccinated U.S. travelers returning from abroad, with subsequent transmission among clusters of unvaccinated persons" [CDC]

A less invasive approach would be to require immunization for those exiting or entering the country, rather than those going to school.

But lets forget that freedom is supposed to allow for people to do stupid things sometimes not in their own interest, nor in those of their neighbors and just jab away, shall we? I'm sure we'll all agree with other similar policies, so here we go!

Do you have a right to determine your own healthcare, control over your own body or not? It comes down to that, and when the government comes to give us all our untested AIDS vaccines in the interests of public health, we'll roll up our sleeves with a smile. We know we'd never see government agencies force a dangerous vaccine onto our citizens.

Well, except for that one time that the DOD forced anthrax vaccines on our fighting men and women (during peacetime in 98-00) , prompting 85% of them to have an adverse reaction according to a GAO study.

But, civilian government wouldn't do that, right? Except for communities forcing HPV vaccine onto children. A health problem which, while not insignificant, is not as transmissible, as widespread, or as dangerous as anything like measles.

Yes, I know court cases have largely upheld compulsory immunization (well, now I know, thanks to this interaction). I'm not digging it, even when I wholeheartedly believe in the efficacy, value, and safety of most vaccinations.

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Pyrtolin
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quote:
I'm assuming you mean without any vaccination - and of course if a bunch of unvaccinated people die - well that's their own business.
Except it's not just their business, because in the process of dying, not only are they actively raising the risk profile for those who tried to be responsible, but the vaccine didn't take, or otherwise couldn't take it because of an immunocompromise, but because of the nature of mutations within viruses, they're actually putting the general population at a much higher risk, because they serve as incubators for viral variants that the current vaccines don't protect against as well.

Where you swing your fist and where my nose begins is all well and good, but when it comes to virulent diseases, your hand (or viral output, as it is in this case) may as well already by up my nose right at the start, which is what makes them such a tricky issue to sort out where freedom ends and imposition begins.

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The Drake
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Could one also say that the presence of an kid who can't take a vaccine for medical reasons is also swinging the proverbial fist by not accepting that they are putting herd immunity at risk? They also transmit those and other viral infection? But nobody is barring cancer patients from being at that school.
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Greg Davidson
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Mynnion, wow, sounds like our excitement pretty much overlaped in time. My son was treated from August 2001 (yeah, right before 9/11) to October 2004 - off chemo for 11 years. We've been lucky. He now just turned 21, is pretty healthy (rock climbing is his latest thing) and a junior computer science major at Harvey Mudd College.
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Mynnion
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Closer than you think. She was diagnosed on 911 (I was working in Manhattan that day too. Great day all around). My guess is your son had an extra year of chemo though (better to be a female with ALL).
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scifibum
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Just for an example of how persuasion works when people are committed to pseudo-science, check out the comments on this article:

http://www.iflscience.com/health-and-medicine/homeopathy-ineffective-study-concludes

The evidence doesn't matter. Placebo happens to other people. Controlled studies are for nerrrrrds.

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D.W.
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Thanks for the link. I, like it seems some of the commentors, had an incorect definition of what homeopathy actually is.
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philnotfil
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quote:
Originally posted by Greg Davidson:
Mynnion, wow, sounds like our excitement pretty much overlaped in time. My son was treated from August 2001 (yeah, right before 9/11) to October 2004 - off chemo for 11 years. We've been lucky. He now just turned 21, is pretty healthy (rock climbing is his latest thing) and a junior computer science major at Harvey Mudd College.

Good to hear, no math problems? One of the things that the doctors told us could be a concern is math processing. Being good at math is something our family does. So far we haven't noticed any issues, but then again our son is only ten and not doing much that takes any great amount of computing power.
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Mynnion
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She had no issues that we noticed with math but she was sharp to begin with so it is hard to know what if any cognitive abilities she lost. What she does have is a lot more general aches and pains than someone her age should have as well as frequent migraines. The cure had drawbacks but when the alternative is a very painful death......
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The Drake
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OH, yeah. Believe me. I know people don't appreciate scientific method and studies. At least in part because the media screws it up before regular people ever get close.

I didn't say persuade them with science by laying out facts, I mean persuade them with peer pressure, celebrity spokespeople, Rob Lowe doing a "don't be this me" in a hospital bed.

Anti-smoking ads are a good model.

The anti-vaxxers are far better at this so far. And the response is people demanding that those ads be taken down.

Found a neat article 9 Ways Advertisers Think We Could Convince Parents to Vaccinate.

Two of my favorites:

quote:
Launch a social media campaign. Find a way for everyone who gets vaccines to raise their hand and say so. Wright suggests creating a shareable graphic on Twitter and Facebook that says: “I got my kids vaccinated, did you?”
quote:
Market them to kids. There’s a reason Saturday morning ads are all about food, toys and games. Getting kids to ask their parents for a product—a strategy called “pester power”—works. And it could work for vaccines too, says Bill Wright, global executive creative director for McCann Worldgroup (the firm behind ads for Verizon FiOS, General Mills and Mucinex
quote:
Whatever you do, don’t preach. The Internet has chastised anti-vaxxers, but simply yelling at them isn’t going to change a parent’s mind.
Admit that they are right about a couple of things while you are at it, perhaps? Like the efficacy of influenza vaccine? Or that vaccines probably should pass double blind studies just like other medications? But then again, its so much easier to just take away any freedom of choice. You're stupid, we know best, comply.

BTW, if you are going to solve these outbreaks with force, focusing on child immunization is likely insufficient.

quote:
Most of the 92 cases of measles confirmed in California are among adults — more than 62 percent. Maybe they or their parents chose not to vaccinate, or maybe those people are allergic to one of the ingredients in the measles vaccine.
NPR article
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D.W.
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Can your Dr. tell if you've been vaccinated as an adult? Do your medical records currently travel with you with enough efficiency they would have it documented?

Would a child even know if they were vaccinated? It seems to me that not all parents who choose not to do so are activists about it and many children or young adults wouldn't even know without asking their parents right out. And even if they did, would all parents answer honestly?

If the anti-vacc movement grows there could be large volumes of people who assume they are protected.

And if doctors DO have that info / can test for it along with regular blood work, should they? And should they bring it up to their patient / patient's parents and continue to ask them about it? Or does the window close on effective vaccination too young?

[ March 12, 2015, 03:37 PM: Message edited by: D.W. ]

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MattP
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quote:
Can your Dr. tell if you've been vaccinated as an adult? Do your medical records currently travel with you with enough efficiency they would have it documented?
I believe some states have a vaccination registry, so it depends on where you live.
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The Drake
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Apparently there are some methods to detect if the immunity exists (you might have been vaccinated but it didn't take).

I personally was in the situation of going to graduate school as an adult, and my school forced me to prove I had been immunized for MMR. Turns out, my doctor and his office were long gone after almost 30 years. So, I had no choice but to take the shot again. An inconvenience, but not scary.

My grammar school might have a had a record, assuming they did that in the 70s, but it had long since been turned into condominiums.

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Greg Davidson
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My son who had ALL also has awesome math skills - when we were home schooling, we had to tell him to stop giving the answers to the math problems that his older two siblings were working. Although there is always a discussion of the cognitive impedances from chemo, either we've been very lucky or he would have been scary smart without the chemo handicap.
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Mynnion
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If there are any doubts about whether you were immunized or not you can always have your blood tested. Of course it is cheaper just to be re-vaccinated.
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Pyrtolin
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quote:
Originally posted by Mynnion:
If there are any doubts about whether you were immunized or not you can always have your blood tested. Of course it is cheaper just to be re-vaccinated.

Many, if not most vaccines can also lose effectiveness over time, especially if you're not exposed to the virus they protect from. There actually is a recommended adult booster schedule that's not pushed the way the childhood schedule is.

I'd like to see titre checks become a more routine part of checkups so people can have better information on if and when they need to have one immunity or another re-upped.

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