After all this time, Dr. Bob Sears finally tips his hand on vaccines, part IV

Where does he say not to tell your neighbors? I'd quite like to see the source of that.

Orac linked to Dr. Paul Offit's Pediatric Journal article. Dr. Offit, quotes directly from Dr. Bob's Vaccine book, about hiding in the herd:

http://pediatrics.aappublications.org/content/123/1/e164.full.pdf

Hide in the Herd

Perhaps the most disingenuous comment in the book is directed at parents who are afraid of the measles-mumps-rubella (MMR) vaccine. “I also warn [parents] not to share their fears with their neighbors,” writes Sears, “because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.” In other words, hide in the herd, but do not tell the herd you’re hiding; otherwise, outbreaks will ensue. Sears’ advice was prescient. Recent outbreaks of measles in 15 states,
caused by an erosion of herd immunity in communities where parents had chosen not to vaccinate their children, were the largest in the United States since 1996.

Research in Germany on recent cases of SSPE has shown a disturbing rising in the total number of cases of SSPE in relation to overall measles incidence rates (infants who get infected seem to be much more likely to develop the fatal SSPE later on)....this is a very bad thing, if confirmed, given the number of infants who could now be infected due to anti-vaccine stupidity.

Dr. Bob might poo-poo the relatively few cases,

Well, if most of the cases happen around the same place, "relatively" is the operative word.
Hippopotamuses maul a few people every year; planet-scale, it's a relatively very low number, but if you happen to live next to a river in Africa...
Seven cases of measles aren't a lot, but if they could be all tracked to the same patient zero...

I got the feeling Dr Sears is conflating "epidemic" and "outbreak". It may be true there is no epidemic yet, but as for outbreaks, facts are stubborn.
I'm also confused about his patients asking about vaccination: is he speaking of adult patients asking about a booster for themselves, or parents about their unvaccinated children?
If it's the latter (and I suspect it is), the way he said it, the children are just an appendage to the parents, e.g. "people wanting to know if they should come in for the vaccine".

Re: the advice "don't vaccinate and hide in the herd". Yeah, nothing wrong could happen. To quote a demotivational poster, no single raindrop believes it is to blame for the flood.

So there are issues with vaccination in Switzerland? I didn't realize it, but I didn't look into it either.

"You have to be in the same room, people. If THAT happens, call me. If not, then just relax and go about your life as usual."

Ah yes. Everyone who is measles infectious has a sign round their neck?

You have to be in the same room, people.

In addition to that little annoying fact of infectious prior to symptoms, really, it's more along the line of "you have to breathe the same air." There's a reason these people get negative air rooms completely separated from the rest of a hospital's HVAC system.

What strikes me most is his attitude towards his patients' concerns, which are very real and something I'm sure he assured them would never happen during the totally-science-based-vaccine discussions they had during well-visits. I can hear it now:
"Oh, don't worry, we won't see measles. Hide in the herd, herd immunity is strong, other people are taking on the risk of vaccination. It's not that big of a deal." Now, here it is, people are getting measles, many of whom are too young to even be vaccinated, and people are rightly scared because they were lulled into Dr. Bob's false sense of security.

Oh, and P.S. Dr. Bob, we can get rid of measles. We've gotten rid of two viruses already, through vaccination. What's keeping it around are people like you.

But, on a good note, I'm sure many have seen it but if not, search #jennyasks on Twitter for healthy innoculation of faith in mankind. I haven't seen anyone mention it in any of the comments. Some of it's getting a little mean, but, it's been going for a week now and Christmas came 9 months early.

Hiding in the herd seems pretty silly strategy. If you don't tell others about your fears of vaccines, what do you base your assumption that others are not doing the same? More like "hope that herd exists and hope for the best".

AnObservingParty, I saw the Twitter comments. The pwnage of Jenny was both epic and total.

"You have to be in the same room, people. If THAT happens, call me. If not, then just relax and go about your life as usual.

That "same room" is guaranteed soon to be this worthless excuse for a pediatrician's waiting room.

Sears has caused severe harm to vaccination rates in the US, helping create these clusters of non-vaccinating parents who use him as their crutch. It's not surprise some of the worst vaccine-preventable disease outbreaks we have seen in the last few years have been in California--the home court of Sears. And it's also not surprising that these outbreaks center on two very vaccine-preventable diseases that Sears regularly tells us are not dangerous (and not to vaccinate against)--whooping cough and measles. Well, we all saw in full HD resolution yesterday the boundless ego, arrogance and stupidity/ignorance of Sears. To have the nerve to publicly piss and moan about extremely legitimate medical phone calls to one's pediatric office in the middle of a measles outbreak--well, that's inexcusable.

And while I'm calling out those who have no excuse for not knowing better, the AAP owns part of this, too. Their continued pathetic inaction against this anti-vaccine loon of a pediatrician again casts severe doubt on whether they give a damn about their motto: "Dedicated to the Health of All Children". For the health of all children, dear AAP leadership, please call out this fool and toss him from your herd where you've let him hide far too long.

Chris Hickie, MD, PhD

I wonder if Dr. Bob would articulate exactly how many cases of measles would be required for him to get "concerned?"

How bad does it have to get before he'd change his tune?

I suspect Dr. Sears became anti vaccine due to the attachment parenting movement being closely linked to the anti vaccination movement. Basically since he couldn't win over his patients, he joined them.

My town was lucky, thus far we have had two cases of measles but no more. They're not letting unvaccinated kids return to the school where it happened until next Thursday.

@Fergus Glenncross

Everyone who is measles infectious has a sign round their neck?

Not only that, but every enclosed space (rooms, buses, subway/train cars, elevators, hallways, etc.) come equipped with measles virus detectors to they can alert you when someone who is infectious has been there within the last two hours or so.

I mean, it's not like anything bad could happen among "relatively few" cases.

So, when SHOULD someone worry? If an actual direct exposure has occurred from a known case, then you might be at risk.

But, but, but: If getting measles is a justified cause for concern, then doesn't it follow, as a matter of simple, inferential logic, that....Well. Never mind.

That's a horrifying and disgusting little homily.

I don't know more about the study than I learned from Reuters just now at the following link. But fwiw, there's also this cheery news:

http://www.reuters.com/article/2014/03/19/us-medical-conspiracies-idUSB…

Measles will never go away – it’s always going to be a very small risk.

The first part of that sentence would appear to be a self-fulfilling prophecy, the second part, wishful thinking.

I do sometimes wonder how large an outbreak and how many deaths would be required to scare Sears and his patients (more to the point their parents) into changing their views.

I also wonder what these unvaccinated people do when they reach adulthood and want to travel abroad, especially to parts of Asia or Africa, or even Europe, where these diseases and others are endemic. When I did a bit of traveling, getting all the typhoid, cholera, hepatitis A and other shots I have probably forgotten, along with anti-malaria medication was bad enough (in terms of expense and time). I can't imagine getting MMR, chicken pox, DTaP, polio and others as well. Presumably they either stay at home or just hope for the best and bring whatever infections they pick up home with them, as we have seen in the past.

Of course everybody should be vaccinated against measles!

One little irony is that the likes of Dr Bob may be right - though their conclusions wrong - that vaccination may increase the case fatality rates. Note, this does NOT mean mortality rates increase, as there will be many fewer cases.

The younger you get measles the more likely you are to develop SSPE which, as you have said, is a ghastly, progressive, and invariably fatal disease. The risk is much lower after the age of 2 or 3 years.

After that, people who get measles prior to adolescence tend to do better than those who get it later in life. Case fatality rates are higher in older (post-adolescent) people.

Vaccination leads to herd immunity, which provides a level of protection. Measles is extremely infectious, so you need the proportion of the population who are susceptible to be below about 5% to achieve herd immunity. (Since a single dose of vaccine is only about 94% effective, so you need a high proportion of the population to have had two doses of vaccine for this) Once measles is introduced into a population, unless you have this very high level of immunity, some of those who are not immune will become ill.

Historically, in the pre-vaccine era, most of us would have caught measles before we reached adolescence; but in the vaccine era more people can remain susceptible to measles and not become infected until later in life. Since case fatality rates are higher later in life, this may lead to an increase in average case fatality rates.

This is, of course, a strong argument for MORE measles vaccination; but it can be distorted by antivaccinationists who choose to misinterpret it.

Normally I love your hyperbole but this one seems a little over the top. I think discussions of relative risk are important and appropriate. He also tells patients that if they're that worried then to get vaccinated. I get that there is a large contingency out there who would like to see bodily autonomy go away and have all children forcibly vaccinated but it's not going to happen. The combination of hipster scoffing combined with pearl clutching doesn't seem in proportion to the statement at hand.

For full disclosure, I think my life has been greatly improved for not having had a host of crappy diseases and as a result I vaccinate my children. However I rarely give a damn about the "greater good" as it is commonly defined so if vaccination did not confer a greater benefit than a perceived risk, I likely wouldn't do it.

So, when SHOULD someone worry? If an actual direct exposure has occurred from a known case, then you might be at risk.

And if an unvaccinated patient has been exposed, what exactly is "Dr. Bob" going to do about?

I get that there is a large contingency out there who would like to see bodily autonomy go away and have all children forcibly vaccinated but it’s not going to happen.

Where do you get that?

for·ci·bly/fôrsəblē, adverb:

1. using force or violence.

However I rarely give a damn about the “greater good” as it is commonly defined

You must be a delight to sit next to at dinner parties and on airplanes.

"in the vaccine era more people can remain susceptible to measles and not become infected until later in life. Since case fatality rates are higher later in life, this may lead to an increase in average case fatality rates."

I thought the MMR offered very long term immunity against measles: MMR: http://www.cdc.gov/Mmwr/preview/mmwrhtml/00053391.htm.

for measles “…both serologic and epidemiologic evidence indicate that the vaccine induces long-term -- probably lifelong -- immunity, in most persons.”

If anyone knows different, I'd like to know.

"I think discussions of relative risk are important and appropriate. He also tells patients that if they’re that worried then to get vaccinated. I get that there is a large contingency out there who would like to see bodily autonomy go away and have all children forcibly vaccinated but it’s not going to happen"

Dr. Sears did not discuss relative risk. He downplayed the risk.
Telling a doctor not to encourage patients to decline from protecting their children against a dangerous disease - or to legitimize that problematic choice - is not forcing anyone to do anything.

I get that there is a large contingency out there who would like to see bodily autonomy go away and have all children forcibly vaccinated but it’s not going to happen.

Where? All I ask is the responsibility that comes with risky behavior; you don't vaccinate your kids, you must find an alternative education system that doesn't risk others. You work in healthcare and refuse a flu shot, you wear a mask. Much like if you drink, you are not allowed to drive.

The choice/freedom is there and always will be. But those things do come with responsibility. It needs to be better better enforced. That's all we ask.

@Dorit,

Dr. Sears did not discuss relative risk. He downplayed the risk.

There's a misconception, or rather, conspiracy, amongst antivaxxers that the medical/scientific community doesn't want people to be educated. No, we want PROPER education. Which you are right, Sears is not providing. Downplay risk of disease, inflate risk of vaccines. I like my education filled with facts, not nonsense.

I think truthful discussions of relative risk are important and appropriate. The statement by "Dr. Bob" does not meet that standard.

@ Mary #16 -I don't know anyone here advocating forced vaccination.

That being said, I believe it is necessary and very justifiable to work to change state vaccine exemption laws so that the only children who can attend school without all their vaccines are those with a valid medical exemption from a licensed MD or DO. Two states in the US have laws this strict--all other states have either personal belief or religious belief exemptions that anti-vax parents routinely exploit. Schools are unfortunately some of the worst places for infection exposure and we need to have herd immunity levels in them. If you electively don't want to vaccinate your child, you can keep them home.

And, there is no hyperbole today. When I checked with the publisher of Sears' book on vaccines (an execrable work) in 2012, they had sold over 250,000 copies of it. He has over 15,000 gulled followers on his FB page. There is no doubt Sears owns part of these outbreaks, and his behavior yesterday was inexcusable for a pediatrician.

@ Mary

hipster scoffing

Yeah, we are true rebels, we vaccinate. Not vaccinating is so last century...

Dr Bob and Dr Jay - Tweedledumb and Tweedledumber.

He seems to emphasize that close proximity is needed for transmission. However, uh, I must ask - does Dr. Bob realize how often a lot of us are in close proximity to others - including strangers?

I don't know the exact breakdown, but anti-vax people are very often (if memory serves me right) urban. Hence, they are probably living in fairly close proximity to each other. Why, just this morning, I took a bus, then a train, then a trolley to reach my job. It was rush hour, so all of them were quite crowded. I must have been in close proximity (at times, very close) to at least 50 people - and this is all before 9 am. I will repeat this same situation going home tonight. I think Dr. Bob has a case of willful blindness going on.

Couldn't get past the description of attachment parenting as a 'smothering' type of parenting, followed more for the parent than child. This demonstrates a complete lack of understanding of what attachment parenting is. Please, please don't denigrate a whole ethos of parenting without even a thought. I am pro vaccination but am tired of the sneering tone of these types of blogs.

I've enjoyed your articles and learned a lot but as one who considers herself an attachment parent (who vaccinates, by the way) I find your snarky dismissal of attachment parents very hurtful and I fail to envision myself being able to read any future posts without fear of continued bashing. I hope you do some real research into the practice and learn how beneficial it is for the child, parent and community.

I'd be willing to consider force vaccination is certain, narrow circumstances if by that we mean vaccinating a child below the age of consent over parental preference. If a child is at high risk - for example, a child bitten by a dog suspected of having rabies - I think it's justified for the state to step in.

That's because the parent is not making the decision for herself. I would not support force vaccinating an adult or force vaccinating a child in most circumstances.

"It is a truism that almost any sect, cult, or religion will legislate its creed into law if it acquires the political power to do so."

- Robert A. Heinlein

To clarify my previous statement.

This is something I read that one of the anti-vaxxers posted somewhere that I think actually has a point.

If we try to legislate and force vaccination on those who refuse this life-saving procedure, then it will provide them with more of the martyrdom complex that we've seen.

The only way we're going to be able to counter these idiots is with science.

@Arctic - again, no one is advocating for mandatory vaccinations....but if you are going to have your children in a public education environment, then there is a responsibility to the public health to mandate that vaccines be up to date or have a valid medical reason not to.....because there is always a choice to send kids to private schools or homeschool.

@Lawrence

Fair enough. I'm just cautious when it comes to talking about legal action against non-vaccinators. FSM knows that we hear enough of their drivel.

Alison, Tina - I understand that you were offended by Orac's comments about attachment parenting. Orac has his opinion about this; if you'd like to help him change that, please tell him why he's wrong in his assessment. Stating that you find his opinion offensive has not been, historically, the most effective way to get him to change his statements.

FWIW - I have not looked at attachment parenting in any detail and have no view on it.

Taken by themselves, I can't really argue with some of Dr. Sears's statements. His basic message - measles has not been eliminated, it is spread through the air over a relatively small range (typically measured in yards rather than miles), and if you don't get vaccinated you are taking a risk (so either get vaccinated or stop panicking about a risk you've chosen to take) - seems accurate enough.

I can also buy his message that if you're not going to vaccinate, for heaven's sake don't try to convince your friends not to vaccinate.

All that's necessary to make these reasonable is to add, "you really should vaccinate to help keep these diseases at bay as well as protecting yourself and your family".

By the way, I thought Dr. Offit's did an even better job highlighting the problems with Dr. Bob's book in the relevant chapter in Deadly Choices than he did in the article above.

I'm not sure why that 's ended up there after Dr. Offit's name.

@Tina

You can't "agree to disagree?"

That's a shame. A person who chooses to avoid a milieu that carries any risk of holding opinions different than their own rarely learns anything new, in my experience.

Granted, if I stopped visiting places like AoA and Fox News, my days might be somewhat more tranquil, but I prefer to keep an eye on the oppo...

I'm not sure what the objection to attachment parenting is about either. It seems to me that there's no reason why it shouldn't be an excellent thing when good parents practice it well and wisely (which fully assumes that it suits the child, btw.) And if the reverse, the reverse. There's no one-size-fits-all parenting style, obviously. But I don't see anything inherently self-serving in the basics, at least.

@Tina --

FWIW, that didn't read to me as sneering. I understood it more as "angry and upset about the irresponsibility wrt vaccines and in no mood to be scrupulously fair to any Sears enterprise."

I can see how attachment parenting might be stressful and oppressive for some children, if overdone. As might many other styles and approaches.

But I obviously don't know what Orac had in mind.

"The only way we’re going to be able to counter these idiots is with science"

That is not necessarily true. I thought there had been studies done that showed presenting scientific evidence to some people made them less likely to accept the science. It has more to do with trust than scientific literacy or knowledge.

I think some of the problem with the differences of opinion on attachment parenting is that it hasn't been defined in this conversation. My experience has been that AP isn't a very useful term because it means something different to different people. Based on some people's take of the meaning, I do AP but based on other people's definition, I clearly do not do AP. I think a more meaningful conversation could be had if the discussion was broadened to include what AP means to each of those who is disagreeing.

Discussing attachment parenting is off topic for this post, and I really don't want this thread to devolve into a discussion of attachment parenting. If that's what's going to happen (and it does appear that that's happening right now), I'll just remove the damned sentence or two about it, because it is such a very, very, very minor part of the post that has almost nothing to do with the main message of the post: Dr. Sears spreading antivaccine views and shirking his responsibility as a doctor. If any criticism of attachment parenting, no matter how tiny a part of a 2,000 word post, is so very, very distracting that people can't possibly stand to read the rest of the post or discuss anything other than their offense at having attachment parenting questioned, then I'll just get rid of it because I don't need the annoyance today.

And, yes, I'm being a bit pissy—unapologetically so. After all, it's known as "Insolence." :-)

There. It's gone. I hope everyone's happy now.

Now please stay a little more on topic, as there's plenty there to discuss, and leave attachment parenting for another time. Maybe I'll do a full post on it sometime.

So, the chance that any one of your unvaccinated children is going to be a case is very very very very very small. I love you all, and love caring for you all. But just chill out.

Forgot to mention in this post: If this isn't one of the most irresponsible, petty, whiny statements I've ever heard from someone who claims to be a physician, I don't know what is. The reason to fear these outbreaks is that they could well be harbingers of much bigger outbreaks.

Sears didn't love us all enough to leave most of our posts up on his Facebook page.

But did he ban you from commenting?

Then maybe we should start Tweeting at him. :-)

"I love you all, and love caring for you all."

And children with whooping cough, measles, and other VPDs require lots more caring for by the pediatrician than children protected by vaccination.

I do not like any kind of parenting style that has a label. I don't care what it is, it isn't good for anyone. It seems to lead to bullying.

Ugh - wading through Sears' FB page has left me feeling dirty. I mean, writing the forward to a book by TMR? Really? REALLY?? https://www.facebook.com/permalink.php?story_fbid=347646288669444&id=11…
Promoting a blog about curing autism?? https://www.facebook.com/permalink.php?story_fbid=10202362475015743&id=…
A pathetic excuse for a paediatrician.

Just yesterday, I encountered a former coworker who is now a parent and has fallen for the too-many-too-soon argument and pulled the ol' "What's the harm / I'll count on herd immunity" tropes.

I pointed out that if their infectious-but-asymptomatic child happened to be in the vicinity of my father around, oh, two months ago, he'd be dead by now as his then-undiagnosed leukemia was already doing a number on his immune system.

Unsurprisingly, I've not heard back from her. *sigh* Maybe she's actually re-thinking her decision...

"I wonder if Dr. Bob would articulate exactly how many cases of measles would be required for him to get “concerned?”"

He has been asked that many times over by many people. He blocks and deletes those questions/comments on Facebook, ignores those comments on HuffPo, and outright denies doing/saying some things. Seth Mnookin had an AUDIO RECORDING of Bob talking to him, and Bob still said he had never heard of or talked to Seth. It doesn't get more deluded than that.

You're too kind, Reuben. He's not deluded, he's a bald-faced liar.

Reuben at The Poxes blog has a post up about Dr. Bob, where I posted a comment and linked to Dr. Bob's list of hundreds of "Vaccine Friendly" doctors:

http://thepoxesblog.wordpress.com/2014/03/19/when-a-doctor-stops-behavi…

@janerella:

Holy crap. I either forgot (or didn't know) about Dr. Bob's having penned the foreword to The Thinking Moms' Revolution antivaccine book.

@Arctic Snowbird

Legislation to force vaccination will never come about. It won't happen not so much because of the populace opposition. It won't happen because law makers who don't vaccinate their kids would never risk being found out. (Just giving my two cents --- hee hee hee.)

Don't forget Sears is also an admin on the Parents and Others Against Vaccination (PAOV) Facebook page that includes the worst of the AV crowd.

And emphasizing the need for vaccination, there is an outbreak of mumps at Ohio State, which does not require students to be vaccinated.
http://news.msn.com/us/mumps-outbreak-at-ohio-state-university-reaches-…

law makers who don’t vaccinate their kids would never risk being found out.

Well, it is certainly heartening to think that our elected representatives wouldn't want to be thought of as fools (assuming their children don't have medical reasons not to be vaccinated).

Meantime, Jay Gordon, that FAAP-wit, is busy on Twitter condemning the news media for causing a "panic" about measles. No biggie, says Jay.

https://twitter.com/JayGordonMDFAAP

As I recall, Jay did a Bob Sears awhile back, noting that parents shouldn't be concerned about protecting their kids from measles with vaccination, since the measles rate is so low. You see, it takes a functioning neuron threshold to realize that the rate is so low because of vaccination. Jay isn't quite there yet.

Drug pushers,

Come to think of it -- in all my time here, I forgot to ask a simple question: It is said that the ''mystical' herd immunity is achieved if over ninety percent of the population is vaccinated, yet vaccines effectiveness wears off relatively quickly and this would leave a significant portion of the adult population who hasn't received boosters unprotected. How then can any claims be made about upholding herd immunity?

Let the lying, denials, obfuscations, deflections, distortions, and all other disengenuos tactics begin...

Dr. Jay is one of those doctors on Dr. Bob's "Vaccine Friendly Doctors" list. We did convince Dr. Jay to remove all traces of his whale.to links about vaccines, but haven't, as yet, convinced him to link to the California Department of Public Health or the CDC for reliable information about childhood vaccines. He's a work in progress, I suppose.

"But virtually all measles outbreaks are limited to 10 to 20 cases in any given county."

Yeah, Dr Bob, but what exactly does it say when all of the cases in a county are in one pediatrician's office -- yours? You recommend your patients hide in the herd, but then guide them to "antivax friendly" doctors, which means you're leading them out of the herd, to cluster where they are more likely to be infected. You are screwing them over twice -- discouraging them from vaccinating and discouraging them from getting the full protection of the vaccinated community around them, which means you are making it far more likely for *your* patients to get measles than, for instance, some kid who is allergic to the MMR and so doesn't get it for that reason.

And you have the gall to blame the media for pointing out that there are suspicious clusters? Sounds like somebody just doesn't want his pride pricked. Somebody's ego is more important than the lives of his patients, apparently.

Obviously you don't want this discussion to be about AP, but I feel I should respond to those who called me out. I'm open to other ideas - that's why I read (and sometimes shared) this blog. But Orac's characterization of and language directed at AP parents was uncalled for and demeaning. Orac, if you do in fact write an article about AP, I hope you will contact Dr. Laura Markham for her take on the topic.

No one "called you out." I simply made a snarky little side remark about AP, as I make snarky little side remarks about lots of things. If I were "calling out" AP parents, they would get a full heaping' helping or Orac's not-so-Respectful Insolence, not just a throwaway jibe.

And that's all I want to say on the subject anymore here.

Dreg @57

"Legislation to force vaccination will never come about. It won’t happen not so much because of the populace opposition. It won’t happen because law makers who don’t vaccinate their kids would never risk being found out. (Just giving my two cents — hee hee hee.)"

Dreg, I doubt someone as intellectually bankrupt as you can muster enough neurons to rub together to even get a single penny.

I rather like this study, which was published in the Pediatrics journal, about the 2008 measles outbreak. I wonder if Dr. Bob has actually read it:

http://pediatrics.aappublications.org/content/125/4/747.full.pdf

Measles Outbreak in a Highly Vaccinated Population,
San Diego, 2008: Role of the Intentionally Undervaccinated

Abstract

Objective: In January 2008, an intentionally unvaccinated 7-year-old boy who was unknowingly infected with measles returned from Switzerland, resulting in the largest outbreak in San Diego, California, since 1991. We investigated the outbreak with the objective of understanding the effect of intentional undervaccination on measles transmission and its potential threat to measles elimination.

Methods: We mapped vaccination-refusal rates according to school and school district, analyzed measles-transmission patterns, used discussion groups and network surveys to examine beliefs of parents who decline vaccination, and evaluated containment costs.

Results: The importation resulted in 839 exposed persons, 11 additional cases (all in unvaccinated children), and the hospitalization of an infant too young to be vaccinated. Two-dose vaccination coverage of 95%, absence of vaccine failure, and a vigorous outbreak response halted spread beyond the third generation, at a net public-sector cost of $10376 per case. Although 75% of the cases were of persons who were intentionally unvaccinated, 48 children too young to be vaccinated were quarantined, at an average family cost of $775 per child. Substantial rates of intentional undervaccination occurred in public charter and private schools, as well as public schools in upper-socioeconomic areas. Vaccine refusal clustered geographically and the overall rate seemed to be rising. In discussion groups and survey responses, the majority of parents who declined vaccination for their children were concerned with vaccine adverse events.

Conclusions: Despite high community vaccination coverage, measles outbreaks can occur among clusters of intentionally undervaccinated children, at major cost to public health agencies, medical systems, and families. Rising rates of intentional undervaccination can undermine measles elimination.

You have to be in the same room, people.

Dr. Bob seems not to have heard. They have invented these things called airplanes. They allow people to travel rapidly between distant places: any two places in the world with airports are at most 48 hours apart. Some of these places are countries where measles is still endemic. Others, as Orac mentions in the post, are places where antivaccinationists have seriously damaged herd immunity.

That's why measles isn't going away any time soon, as Dr. Bob correctly notes. But contra Dr. Bob, it is an argument in favor of vaccination.

The attachment parenting movement and the antivaccine movement aren't unrelated. Especially when discussing the Sears. Admittedly, I did not read the offending sentences about attachment parenting before they were removed, but it's annoying that an offhanded mention of this parenting style--and really, that's a mild way to put it--became a cause celebre for some on this blog. I don't want to bring this topic back up out of context, but I think that ignoring attachment parenting when discussing the dangerous anitvaccine position and influence of Dr. B Sears is like ignoring the elephant in the room, pardon my trope. So my pared-down point: Dr. W. Sears encourages parents to rebuke the medical establishment and be wary of the advice of 'old-school' pediatricians and doctors. He also encourages parents to make medical choices based on 'feelings'. Having been exposed to Dr. W. Sears' rhetoric and ideas, many attachment parents are primed to rely on internet research and 'gut' when making parenting decisions. And this leads us to the son, Dr. B. Sears. Dr. B. Sears has a wide audience (attracted to the Sears Brand) that is predisposed to the idea that pediatricians/doctors aren't always reliable sources when it comes to vaccines and that parents should research vaccines independently (oh and create customized vaccine schedules!). And unfortunately but not unsurprisingly, this independent research can lead to, shall we say, unscientific ideas that are well documented on this blog.

So a disclosure: I'm a mom to a 9 month old who uses some 'attachment parenting' practices, but I am under no illusion that research backs up some of my choices--I find that the 'research' is not compelling on many parenting topics. But not vaccines! Oh and attachment parents: you don't want Orac to do a post on this...(sorry, sorry, sorry...unrelated)

sorry sorry...I did stray off topic and posted the above before reading the last couple posts. My bad.

I don’t want to bring this topic back up out of context, but I think that ignoring attachment parenting when discussing the dangerous anitvaccine position and influence of Dr. B Sears is like ignoring the elephant in the room, pardon my trope

I can well believe that, and even though it's tangential to the original post, I still find it interesting to hear about what it involves and the mindset it encompasses.

I have no direct interest - I have no kids and will not have any - but I live in the world with everyone's kids, so this is of interest nonetheless.

Um...there are additional cases of measles in California and the California Department of Public Health has provided us with the number of measles cases in children who were deliberately not vaccinated against measles.

http://www.scpr.org/news/2014/03/18/42870/majority-of-states-measles-ca…

"14 of California's 32 measles cases this year were intentionally unvaccinated"

"It was last month that public health officials first identified seven measles patients as having been intentionally not vaccinated. They were between the ages of 7 and 32, said CDPH spokeswoman Kathleen Harriman.

"They were all minors other than two young adults," said Harriman "And the young adults, it was their parents' decision, obviously, not to have them vaccinated when they were children."

CDPH officials could not immediately provide KPCC with the ages of the seven additional people it has determined were intentionally not vaccinated.

The 32 measles cases have been reported in Alameda (1), Contra Costa (4), Los Angeles (10), Orange (6), Riverside (5), San Mateo (1), San Diego (4) and Santa Clara (1) counties. The CDPH has not said where the 14 intentionally unvaccinated people live."

Sears didn’t love us all enough to leave most of our posts up on his Facebook page.

I'd say the odds of his personally managing this part of his media presence are nil.

lilady @73 -- If I were that 32-year-old measles case, I would be hopping mad at my parents.

Hopping. Mad.

@ #52 johanna:

"I pointed out that if their infectious-but-asymptomatic child happened to be in the vicinity of my father around, oh, two months ago, he’d be dead by now as his then-undiagnosed leukemia was already doing a number on his immune system.

Unsurprisingly, I’ve not heard back from her. *sigh* Maybe she’s actually re-thinking her decision…"

As you can see within their comments, part of the anti-vax mindset, among those who buy the full package is that people who succumb to VPD are weak due to bad choices or defective genes; they're Untermenschen in this new, enlightened natural age and it's best that the gene stock be cleansed of them.

Fantastic. The Canary Party reposted his nonsense. The very same people who brought the measles to the Somali community in Minneapolis in 2011. So next time there's a measles outbreak in the Canary Party's backyard, we can blame Dr. Bob, too. Maybe Dr. Bob will come out along with Andrew Wakefield and tell everyone not to get the measles vaccine.

http://www.voicesforvaccines.org/when-its-not-a-choice-measles-and-leuk…

When every anti-vaccine site proudly carries your post, if you're not anti-vaccine, you really should worry whether you're doing something problematic.

I wonder what Dr. Bob's lawyers think about this.

Rather than retain legal counsel, he'll probably just make it up.

The 32 measles cases have been reported in Alameda (1), Contra Costa (4), Los Angeles (10), Orange (6), Riverside (5), San Mateo (1), San Diego (4) and Santa Clara (1) counties.

That includes both the Bay Area and the LA/San Diego region. Are they distinct outbreaks, or did somebody transmit measles from one region to the other?

It is said that the ”mystical’ herd immunity is achieved if over ninety percent of the population is vaccinated, yet vaccines effectiveness wears off relatively quickly and this would leave a significant portion of the adult population who hasn’t received boosters unprotected. How then can any claims be made about upholding herd immunity?

This is why there are recommended booster shots for vaccines. If the immunity received is relatively short lived, then boosters should be taken more frequently. If immunity lasts a long time, they should be taken less frequently (if at all). That way personal immunity is preserved, the percentage of people who are immune remains high, and herd immunity is preserved.

@Eric Lund

There are several different outbreaks. Back in February, the CA Department of Health had a teleconference (when there were only 15 cases) and the question of case links came up toward the end.

@MoB - besides pertussis, are there are any other diseases that we vaccinate for that there has been any definitive proof that the immunity is not "life-long?"

@Lawrence

Influenza?

I imagine a few representatives have unvaccinated kids, like Rand Paul, Paul Ryan, Ted Cruz, and other assorted libertarians/tea partiers or narcissists from California.

However, most legislators are probably old enough to actually remember measles, mumps, HIB and polio, and they've traveled outside the United States. I imagine after seeing one kid with polio or measles, even the most self-interested legislator would get the hint.

One thing that concerns me is how an anti-vax parent would react to a kid who became disabled from mumps, measles or rubella. Considering how hostile they are to autistic kids or kids with other disorders (cerebral palsy, ADD..etc.) I suspect they'd abandon the disabled child very quickly.

I think, Lawrence, that there's indication that that's true for the meningococcal vaccines, that immunity from them wanes relatively quickly.
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/mening.pdf

Lawrence: Isn't tetanus pretty short lived?

Also, rabies, though that is rarely used on humans.

I figured there would be a short list - but that we have no evidence that Measles, Mumps, Rubella, the various Hep vaccines, etc. are less than lifelong.....

Td is a 10 year booster vaccine. It protects against tetanus and diphtheria. Tdap is (presently, a one-time booster), is recommended for children entering 7th grade, pregnant women during each pregnancy and people who expect to have contact with an infant under one year of age, including health care providers. Tdap provides immunity against pertussis and ten years do not have to elapse since your last Td.

http://www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.pdf

Rabies vaccine (4 doses), is administered to "civilians" as part of post-exposure prophylaxis for actual exposure to a rabies infected animal, or potential exposure, when the animal cannot be captured for testing. The four doses of rabies vaccine are given with HRIG (Human Rabies Immune Globulin). Certain lab technicians, veterinarians and animal control officers are immunized against rabies...before any potential exposures:

http://www.cdc.gov/vaccines/hcp/vis/vis-statements/rabies.pdf

I think some of the problem with the differences of opinion on attachment parenting is that it hasn’t been defined in this conversation. My experience has been that AP isn’t a very useful term because it means something different to different people.
My opinion is limited to wishing that Attachment Parents had chosen a different name, one which didn't invite confusion with Attachment Theory.

@MOB
Evasion duly noted!

Again, if a significant majority if the adult population is presumed to not be uptodate on their boosters, and thereby we are falling short of this recommended ninety percent herd immunity, what's the rub? Why pester parents to vaccinate their kids, and not adults?

Sears' (whom I cannot call doctor) claim floors me that because the chances of getting the disease are relatively small, they don't need to worry.

The chances of getting West Nile Virus is much smaller, but to those who contract it and become paralyzed, the chance is 100% for them. The chance of those who contract it and die is 100% for them, and so the quest for a vaccine is a worthy one. And when a vaccine is developed, what will the antivaxxers say?

lilady: Certain lab technicians, veterinarians and animal control officers are immunized against rabies…before any potential exposures:

This makes sense. Especially in light of my grandpa's tale of attempting to catch skunks when he worked for the Fish and Wildlife service. He maintains that he has the distinction of being sprayed by all three North American species in one day.

Also,most people who smoke are not cursed with the conditions that are laid out in those graphic anti-smoking ads; therefore, should we not worry about it? Someone should do an ad campaign like that about vaccines and interview those who were affected by diseases in the pre-vaccine years, including all the graphic imagery. They could name it "too few not soon enough".

Another condition for which there's a small chance of getting it, but you still want to take precautions: Lyme disease. If you're in an area where there is a species of tick that carries it, you want to use bug spray and wear long sleeves/pants, then do a tick check. Of course, the difference is that if you get infected with Lyme and catch it early, a round of antibiotics will clear it all up with a pretty low risk of complications. If you're infected with measles, though, you can't treat it with anything; just need to wait it out and hope that you do not have complications.

Because comments on AP did not throw the thread entirely off track I'd like to comment on Evan I.'s comment @70. A good summary of evidence for "parenting styles" is, studies can be found to back just about any parenting style and the quality of all of these studies is poor. For example, rarely is there any observation of adherence to "style" and there is typically some significant form of bias on the part of the research team (investigator with a vested interest in one style or another - can positively or negatively bias results relative to treatment effects) or the selected methods.

AP and many "theories of parenting" do have reasonable evidence of efficacy but that evidence must be taken with a grain of salt. Parent training studies that best measure outcomes tend to be those focused on specific skills (e.g., promoting communication skills in the child with deficits in VB; promoting academic success or healthy living habits) and that directly measure adherence to "treatment."

I promise to not say a word about AP in this thread again other than AP-adherents include a large number of woo-believers (obviously not everyone).

And, yes, I’m being a bit pissy—unapologetically so. After all, it’s known as “Insolence.”

I thought that was because a statement of fact can't be rude or disrespectful.

That's not a criticism. Because (for one thing) I have none. I'm a fan.

It's just an observation.

Again, if a significant majority if the adult population is presumed to not be uptodate

I dispute the word "again" and the word "evasion". Please point out where you said this before. I also want a source for your assumption that a significant majority of the adult population is not up to date on vaccinations, with a focus on which disease you are discussing.

#86One thing that concerns me is how an anti-vax parent would react to a kid who became disabled from mumps, measles or rubella. Considering how hostile they are to autistic kids or kids with other disorders (cerebral palsy, ADD..etc.) I suspect they’d abandon the disabled child very quickly.
There have been complete turnarounds after they witness the complications and harms from disease. During last years welsh outbreak news outlets carried the story of a woman whose child had to be hospitalized and has hearing loss from measles. She was urging people to be vaccinated. However it has to be personal. When I post about my experience with measles encephalitis they trivialize it. -You survived . -That wouldn't happen today. -Blame the victim that doesn't happen to healthy children. Don't mean to contradict my earlier example of complete turnarounds but I do believe that many anti-vaxers will complain that no one ever told me measles was bad when their child gets severe complications of measles

The thing that troubles me and humors me -- all at the same time -- is that anti-vaxxers are their own worse enemies when it comes to their fight against vaccines. Look at smallpox. One concentrated effort led to its demise, and we don't vaccinate against it. A similar effort would end measles, which is a virus that is only harbored in apes. (We're apes.) Look at polio. It's about to be wiped out, Pakistan and Nigeria notwithstanding.

If anti-vaccine people really wanted to end disease and suffering and bring vaccine programs to their knees, they would happily push for a concerted effort to wipe out these diseases through universal vaccination. But that would make sense.

Part the first on vaccination rates in Orange County.

Bob Sears's office is in Orange County, in the village of Capistrano Beach. The California Department of Public Health helpfully publishes a spreadsheet report on every school's kindergarten vaccine uptake rate:

http://www.cdph.ca.gov/programs/immunize/pages/immunizationlevels.aspx

From that, I found that for the 2012-2013 academic year (this year's report hasn't been posted yet) in Orange County, there were 562 schools (public and private) having kindergartens, with a total kinder enrollment of 42,260 students.

First, a remarkable statistic:

California allows permanent medical exemptions (PMEs). Only about 10 percent of Orange County schools enroll children with PMEs, and typically they run from 1-4 students per school. Overall in Orange County, the rate of PMEs is 0.3%.

Oddly enough, one school in Orange County has 16 children out of a kindergarten class of 78 with PMEs, accounting for 13% of all of the medical exemptions in Orange County. It's Palisades Elementary in Capistrano Beach. According to Health Grades, Sears Family Pediatrics is the only pediatric practice in Capistrano Beach. Of course, it's Southern California, where people blithely drive all over for everything.

Part the second on vaccination rates in Orange County.

California also allows a "Personal Belief Exemption" (PBE). Overall, the percentage of Orange County parents filing PBEs for their kindergarteners is 3%. The range is from 64% (Surprise! NOT The Waldorf School of Orange County) to 0% (262 public and private schools). The school with the largest number of kindergarteners with PBEs (49) is also a Waldorf school, Journey in Aliso Viejo, "Making Public Waldorf Education Possible in Orange County"

California allows and records a "Conditional Entrant", a student who does not meet all vaccination requirements. This student must be followed up because he/she:
* lacks,or is not yet due for, at least one dose and does not have a personal beliefs or permanent medical exemption; or
*has a physician affidavit of Temporary Medical Exemption for one or more doses; or
* is a transfer student who has no record available yet.

In Orange County, the percentage of conditional entrants runs about 7%.

Looking at all of the students in Orange County, 3,389 had zero or one doses of the MMR vaccine (the report does not distinguish between 1 dose and zero doses, only "<2"), or 8%.

The schools with the highest number of children who have <2 doses of the MMR:
Bergeson (Marian) Elem.(63), in Laguna Niguel
Journey (51), in Aliso Viejo [Waldorf Charter]
Cielo Vista Elementary (46) in Rancho Santa Margarita
Community Home Education Program (42) in Costa Mesa
Benedict (Truman) Elem.(39) in San Clemente
Fairmont Private (38) in Anaheim
Gates (Ralph A.) Elem. Charter (34) Lake Forest
Woodland Elem. (33) in Costa Mesa
Vista Del Mar Elem(32) in San Clemente
Laguna Niguel Montessori Center (30) in Laguna Niguel

Lawrence @84: Yellow fever vaccinations have to be updated every 10 years, at least if you travel between tropical countries. But I don't know if that's a case of "immunity is known to wear off" or "immunity has not been proven to be lifelong".

At the same time I got the yellow fever vaccine, I also got a vaccine against hepatitis A and B. In that case, I was told that it was probably good for life, but at the time they couldn't guarantee it would last more than 20 years.

MOB,

Even if an adult is up to date, it may be more that new findings are changing our understanding of what "up to date" should really mean.

For example, with measles it looks like "up to date" should include more than the two childhood doses of MMR. Studies are finding waning immunity during adolescence and 20-30 yr olds, suggesting that another booster dose should be implemented sometime during adolescence.

PGP -- "He maintains that he has the distinction of being sprayed by all three North American species in one day."

Yow! I got sprayed one, and only one, time, at close range. Both barrels, as it were.

Once was enough. More than enough, in fact.

skeptiquette,

Studies are finding waning immunity during adolescence and 20-30 yr olds, suggesting that another booster dose should be implemented sometime during adolescence.

Citation? I have seen evidence that antibody titers may decline, but when you give an antigen challenge we find that immunity is still intact, thanks to memory t-cells. If MMR immunity really waned that quickly we would expect to see hordes of 20-50 year-olds going down with measles in the US, since a measles vaccine either alone or as part of MMR has been part of the schedule since the 1960s and 1970s respectively, but we don't.

When measles etc. were endemic in the developed world, it may be that continual exposure as adults kept antibody titers high, but now we are no longer exposed. Even if we do find we need boosters later in life, it has to be better than almost every child spending weeks of their childhood in bed with very unpleasant illnesses, even if we ignore the more serious complications.

From what I have read, Dr. Sears is one of the most well known parenting advisors from the past twenty years, the father I think, up there with Dr. Spock in terms of name recognition. Any chance the son could be persuaded by respectful debate? He doesn't seem to be as ridiculous as some anti-science folks.

- from an attachment parent/ educator

I imagine a few representatives have unvaccinated kids, like Rand Paul, Paul Ryan, Ted Cruz, and other assorted libertarians/tea partiers or narcissists from California.

Maybe. But I think it's just as possible that being anti-vax is simply a pragmatic means to an end for some and/or all of them.

It can be pretty hard to tell what's cynicism and what's true, heartfelt belief when you're not dealing with rational people, though.

@ Krebiozen: skeptiquette has posted some provocative comments here about MMR vaccines. She's bound to link to some of these studies from China and Taiwan.

http://www.ncbi.nlm.nih.gov/pubmed/?term=waning+immunity+measles+vaccin…

There's no recommendation from the ACIP or the CDC, that I am aware of, "that another booster dose should be implemented sometime during adolescence."

Greg, why are you presuming (your word) enough adults are deficient in their boosters to compromise herd immunity? Surely you must have some actual evidece demonstrating this is the case in order to offer the question in good faith.

Secondly, why are you ignoring the fact that every year a large number of additional individuals enter the population (through birth) who are up to date with their vaccinations, contributing to the continued maintenance of herd immunity?

Please provide credible evidence demonstrating that a sufficient portion of the population has failed to receive necessary booster shots to compromise herd immunity.

@ #109

Dr. William Sears not ridiculous? Check out his Juice + video (disclaimer: I couldn't sit through the whole thing, but you can get a good idea of what it is about from the first minute):

http://www.askdrsears.com/topics/feeding-eating/family-nutrition/juice-…

Tough to defend that guy. Amiright?

Also, he endorses his son's book on vaccines. Really, just look at his website for 5 seconds, and you can tell that woo is in that family's blood.

Part the third on vaccination rates in Orange County.

OK, in Orange County, the number of Conditional Entrants, PMEs, and PBEs together account for about 10.5% of students.

The approximately 7% of entering kindergarteners who are Conditional Entrants (not up to date on all vaccines, but sans PMEs or PBEs) doesn't surprise me. The vax schedule is complicated, and lack of access to health care means that some kids will have some missing vaccines. Before running the numbers, I hypothesized that the HepB vaccine would be one of the ones accounting for the numbers. My hypothesis was incorrect.

DTaP 4 or more doses required for school entry; 8.1% missing one or more doses.
Polio 3 or more doses required for school entry; 8.2% missing one or more doses.
MMR 2 doses required for school entry; 8.2% missing one or more doses.
Hepatitis B 3 or more doses required for school entry; 4.7 missing one or more doses.
Varicella 1 or or more doses required for school entry; 8.2% missing one or more doses.

The only pattern I see is that the Hep B series can be completed as early as 6 months; maybe parents start to skip well-child visits after the child is 12 months old, and thus the child might be missing the last vaccines in the other series.

Any other thoughts?

@Evan I.

That's bad.

The text is signed by both Drs. Bob and Bill, though it's written in the voice of the latter::

At that time – as a father of eight, author of 28 books, and a pediatrician at the peak of his career – I was going to do everything I could to keep my health up and not let the cancer reoccur. Talk about motivation!

And what was he motivated to discover?

I realized that my life depended upon eating the right foods and taking the right supplements.

In a literal sense, there's no arguing with it. (The wrong supplements are presumed for the sake of argument to be full of lead.)

Shouldn't have been a newsflash to an MD, though.

ince taking Juice Plus+® daily and following an overall healthy eating and exercise program I have not even had so much as a cold, even though my wonderful little patients share their germs with me every day. The parents of children who are sick a lot often thank me: “Since my children have been taking Juice Plus+® they haven’t been sick as often.” Juice Plus+® is now the only whole food based supplement I take. I’m pleased to recommend the joy of taking Juice Plus+® to everyone who takes their health seriously.

I am very excited about Juice Plus+® and have seen the benefits in myself and my children. Start your family on Juice Plus+® today and see the benefits over a lifetime!

It's really, definitively not a good reflection one his judgment.

Okay.

I've revised my opinion.

If "attachment parenting" means "precisely as conceived, defined, and promoted by Dr. Sears on his website," I see reasons to object.

/off-topic.

I did AP and I definitely vaccinated AND I never heard of Dr Sears until my children were grown. I'm sorry to hear this fool is "attached" to AP.

I did AP and I definitely vaccinated AND I never heard of Dr Sears until my children were grown. I'm sorry to hear this fool is "attached" to AP.

Just yesterday, I encountered a former coworker who is now a parent and has fallen for the too-many-too-soon argument and pulled the ol’ “What’s the harm / I’ll count on herd immunity” tropes.

I have two dear friends who recently had their first child. She's closer to my age than he is, so this was (rightly) a worry-laden pregnancy. When she mentioned Sears – without any of the explicit baggage – I was stuck with nothing to do but hope for the best.

@rancidbrainmatter

I don't want to derail. But I've always thought of it as legit. In the letter, the Dr. Sears iteration has some problems. Even that could be understood differently, though. And very likely would be by a sound and loving parent.

I meant no offense.

/poor impulse control

"One thing that concerns me is how an anti-vax parent would react to a kid who became disabled from mumps, measles or rubella."

It's just a matter of time that we see more severe complications in the US, isn't it? Consider all if the cases of congenital rubella syndrome in Japan right now or the number of people who had measles encephalitis or died from measles in Europe the last few years.

"But virtually all measles outbreaks are limited to 10 to 20 cases in any given county. "

Does Dr Bob believe that these outbreaks end on their own? The outbreak in Texas cost the county health dept over $50,000 to contain and most outbreaks cost much more and use up a lot of resources.

He also does a good job of minimizing the problem. Seven cases in a county isn't a big deal? Most states don't see 7 cases in a typical year!

You know, many ski resorts now charge customers who skied out of bounds the cost of their rescue. Too bad we can't do the same to anti-vax folk.

Harriet Huestis:
There have been complete turnarounds after they witness the complications and harms from disease. During last years welsh outbreak news outlets carried the story of a woman whose child had to be hospitalized and has hearing loss from measles. She was urging people to be vaccinated. However it has to be personal. When I post about my experience with measles encephalitis they trivialize it. -You survived . -That wouldn’t happen today. -Blame the victim that doesn’t happen to healthy children. Don’t mean to contradict my earlier example of complete turnarounds but I do believe that many anti-vaxers will complain that no one ever told me measles was bad when their child gets severe complications of measles.

You may be right. However, given the blame-the-victim attitude and the ableist attitudes I mentioned, I have serious reservations about any disabled children staying under the care of an anti-vaccine parent.

Some may reform- that's good, but I think in most cases we'd be looking at an Alex Spourdalakis all over again, especially since there aren't many schools exclusively for deaf and blind children anymore, and few parents would be able to find resources.

And..my sympathies, both for your story and for having to deal with the anti-vax brigade.

VI: Even after checking out your blog I still can't tell if you're making fun of me or not. But yeah, I do worry about kids with serious problems from their illnesses. Especially since their parents tend to be nutballs.

Ann: Maybe. But I think it’s just as possible that being anti-vax is simply a pragmatic means to an end for some and/or all of them.

It can be pretty hard to tell what’s cynicism and what’s true, heartfelt belief when you’re not dealing with rational people, though.

Ah yeah. Considering Rand Paul's pretty much the face of sociopaths inc., I doubt he vaccinates his kids. Ryan.. I don't know. He's pretty hard-core Catholic, so again doubtful (stem cells in them rubella shots) and I'd honestly believe anything of Cruz or Kucinich. The one thing those two have in common is a complete disconnection from reality.
As for rational- I've seriously yet to meet a rational anti-vax person.

Palindrome: My sympathies. Skunk musk is nasty.

@ Dorit Reiss
Comments above related to duration of vaccine immunity

Here is a NEJM paper on humoral responses to viral vaccines.
http://www.nejm.org/doi/full/10.1056/NEJMoa066092#t=articleTop

The estimated half-life of protective measles antibody was calculated to be 3014 years

^ Hmmm...correction. Most of those tested had been naturally infected, but some had been vaccinated.

Considering Rand Paul’s pretty much the face of sociopaths inc., I doubt he vaccinates his kids.

Seems to me like he'd be equally sociopathic either way. But I really have no strong opinion on the matter, at the individual level.

I just wouldn't be surprised to learn that inciting popular distrust of and resentment towards the FDA (and/or CDC and/or other implicated branch of the Evil Tax-Dollar-Consuming Federal Gubmint) over any cause that happened to be handy was viewed as an end in itself and its own reward, from the perspective of some strategists on the libertarian right.

It's not necessarily an either/or, however.

I think you need to distinguish among "antivaxxers". There are the cynical profiteers like certain pediatricians, the crazies like Greg, and the parents who hate their autistic children but project their hatred onto vaccination and medicine in general, but there are also the people who are doing their best to make a reasoned decision but are misled by falsehood spewed by the others. An example of this second group is in this story:

http://www.abc.net.au/local/stories/2013/06/06/3776327.htm

The people in this group are no more to be vilified that parents who believed you treat frostbite by rubbing snow on it -- that only increases the damage, but that's what they heard growing up. That group needs education, preferably not through seeing a child suffer or die.

@ #109

"Dr. William Sears not ridiculous? Check out his Juice + video (disclaimer: I couldn’t sit through the whole thing, but you can get a good idea of what it is about from the first minute):

http://www.askdrsears.com/topics/feeding-eating/family-nutrition/juice-…

Tough to defend that guy. Amiright?

Also, he endorses his son’s book on vaccines. Really, just look at his website for 5 seconds, and you can tell that woo is in that family’s blood."

Hmm, maybe not. Seems kind of silly. :p

@MoB

Again, if a significant majority if the adult population is presumed to not be uptodate

I dispute the word “again” and the word “evasion”. Please point out where you said this before. I also want a source for your assumption that a significant majority of the adult population is not up to date on vaccinations, with a focus on which disease you are discussing.

Actually MoB, here is a 2010 study from the very CDC. For the DTaP vaccine for white adults, ages 10-64, it reports 51% coverage; for pneumococcal, ages 19-64, it is 18%; and for the HepB, ages 19-49 (high risk) it is 43%.

Given these figures, a significant amount of the adult population is under-vaccinated and nowhere close to that 'triumphant' 90% herd immunity figure. Again, what's with the incessant talk of vaccinating kids so that herd immunity can be maintained, when in fact, it never is with adults going largely under-vaccinated?

Also MoB, with the constant talk of un-vaccinated individuals spreading VPDs, could it be the case that it is these many adults who have lapsed with their boosters that are spreading the diseases, and not the fairly small percentage of kids who went deliberately un-vaccinated?

http://www.prnewswire.com/news-releases/cdc-unveils-new-adult-vaccinati…

@LW

Absolutely, wrt distinctions.

Also MoB, with the constant talk of un-vaccinated individuals spreading VPDs, could it be the case that it is these many adults who have lapsed with their boosters that are spreading the diseases, and not the fairly small percentage of kids who went deliberately un-vaccinated?

You understand what infectious disease is, right?

And that they're not all the same?

You understand what infectious disease is, right?

And that they’re not all the same?

But mostly the former.

Because if so, your question should answer itself.

@PGP. Catholics vaccinate. The Church endorses it.

Thank you, Dingo199!

Quite unintentionally, Greg asked an interesting question. Why *do* the authorities concentrate on getting children vaccinated when so many adults are undervaccinated?

I can think of a number of reasons. 

One, of course, is opportunity. Many adults don't see a doctor for years on end, so they have little chance of being offered vaccination. Small children, of course, tend to be taken to the doctor quite frequently.

Another reason is that many vaccines do provide protection for a very long time, so early vaccination provides protection for a greater percentage of the patient's life. 

Yet another reason is that children are still growing and developing. One reason* that adults today are on average taller than our ancestors of just a few generations ago is that our growth was not stunted by childhood illnesses, thanks to vaccines, and it would be good if later generations had the same benefit. 

Then too, in the context of school vaccination requirements, the State requires students to receive an education and provides public schools for that purpose; it has a duty to keep the children who attend those schools safe from foreseeable harm such as vaccine-preventable disease. Adults are not in the same position. 

Finally, there is the same reason that adults are permitted to drink and smoke and sleep around but children are not: adults are deemed competent to make many decisions that can potentially harm or kill them but children are not. And while parents have the right to make many decisions for their children, putting them in foreseeable danger is not really a parent's prerogative.

* I realize that there are other reasons such as better diet, but protection from childhood disease is one of them.       

@Shay --

Good point. I was asleep at the wheel. Ryan is pro-vax. Promoted investing:

$50 million annually for increased vaccine availability and bonus grants to states that achieve 90 percent or greater coverage of CDC‐recommended vaccines;

I suspect he's more conventionally conservative than his branding suggests.

The link I provided in my comment @ # 68, provides the monetary costs to investigate and contain the 2008 San Diego measles outbreak; just shy of $ 125,000.

@LW #137 - quite simply, children are quite the vectors of infectiious disease spread. Much more so than adults. They lick, drool, spit up, poop out, blow snot bubbles, cough, hack and rarely wash their hands. Put them in a day care and you have germ city. It's not much better in schools, either. In the days before vaccines, schools would be among the places closed during severe outbreaks of any infectious disease--this has happened much less likely since the advent of modern-era vaccines. Also, of course, children, especially infants and toddlers tend to be more vulnerable to many of these diseases. Additionally, back when vaccine rates were high in children, we didn't have all these electively non-vaccinated vectors clustering together.

The irony is when the smoke clears, these AV morons will have wound up proving they are wrong on every AV argument they make about vaccine efficacy, safety and also on herd immunity.

Shay: Well, there's Catholic..and then there's Catholic. I've become aware of a few fringe Catholics who are slightly to the right of the church. I assumed Ryan, given his public sentiments, was among them.

LW: Fair enough. However, given that a lot of the public faces and voices are so completely mired in anti-vax/ableism, after a while, it's doubtful that any of them could be educated. Heck, I pretty much stopped corresponding with a peripheral college friend when, during a lunch, she turned out to be on a glutenfree diet. She said it was just for the duration of her pregnancy, but I doubted it. That's gateway woo right there.

About adults getting vaccinated- one reason is that adults are more likely to have been exposed to a vaccine preventable disease anyway. I've had chickenpox, so I don't need the vaccine.
(Although I've known a few people who got chicken pox a couple times.)

Again, if a significant majority if the adult population is presumed to not be uptodate on their boosters, and thereby we are falling short of this recommended ninety percent herd immunity, what’s the rub?

Gerg, please explain, in your own words, how the "triumphant" figure is arrived at. It's not complicated.

@Publicguineapig,

"However, given that a lot of the public faces and voices are so completely mired in anti-vax/ableism, after a while, it’s doubtful that any of them could be educated."

Doubtless that's true of the public voices. I think it's less true of parents who don't trumpet their ignorance online. I have a friend whose wife was in the "kind of" antivax group. He got a flu shot; she and their eighteen-month-old baby didn't. She and the baby ended up in the hospital with the flu a couple of weeks ago -- the baby was so sick she had to be sent to a more specialized hospital than her mother. My friend didn't get sick at all. It appears that his wife is much less antivax these days. 

"About adults getting vaccinated- one reason is that adults are more likely to have been exposed to a vaccine preventable disease anyway."

Very true. Also, the "unvaccinated" adults may actually be vaccinated but not know their status. I for one don't know what vaccines I received as a child or exactly which childhood diseases I had. My mother knew, no doubt, but she alas is no longer with us, and no one else remembers. 

@Chris Hickie

"quite simply, children are quite the vectors of infectiious disease spread. Much more so than adults."

I suspected that but I don't have any experience with small children.

"Also, of course, children, especially infants and toddlers tend to be more vulnerable to many of these diseases."

It also seems to me that a lengthy illness in a child would be more harmful than the same illness in an adult. I once missed two months of work due to illness, but I was able to come back and go on working. If a child missed two months of school, I would think they might be way behind their classmates when they came back.

By the way, Dr. Hickie, I always look forward to reading your comments on RI.  

Judging by your general evasions of my argument that a significant proportion of the adult population are going un-vaccinated, not keeping up with their boosters, It would appear the I scored a direct hit. Herd immunity is indeed a lie!

I know I tease you guys a lot about suspecting that you don't vaccinate your kids -- some of you say you do --but, how many of you are bucking the trend and keeping up with your boosters? C'mon Orac, Lawrence, Kreb, Chris, Chis Hickie, Helianthus, MI Dawn, Narad, Johnny, Dorit, Shay, Tbruce, LW --do tell! Hypocrites!!

@LW

Another reason is that many vaccines do provide protection for a very long time, so early vaccination provides protection for a greater percentage of the patient’s life.

Please specify these vaccines, and how long their protection last -- 10, 20, 30 years? Are you saying that the average individual that may have been vaccinated against these diseases as a child, won't need boosters at the age of 35 and over?

@Chris Hickie

quite simply, children are quite the vectors of infectiious disease spread. Much more so than adults. They lick, drool, spit up, poop out, blow snot bubbles, cough, hack and rarely wash their hands. Put them in a day care and you have germ city. It’s not much better in schools, either. In the days before vaccines, schools would be among the places closed during severe outbreaks of any infectious disease–this has happened much less likely since the advent of modern-era vaccines

Yet, we hear of disease outbreaks occurring because of travelers coming from overseas and importing them. Are we to assume that these travelers are likely toddlers, who are better reservoirs for IDs?

1. some of those travelers, Greg, are unvaccinated Americans who come back here (with measles--witness the unvaccinated 8 year old patient of Dr. Sears who went to Switzerland in 2008, contracted measles and then came back to the US and spread it by simply being in another pediatrician's waiting room
2. In Tucson, also in 2008, a visitor from Switzerland exposed a whole lot of people in a Tucson ER when she went there twice with measles. ERs are also great places for disease spread in the waiting areas.

The key thing here Greg, and I'll type slowly to help you understand is that it's almost always an unvaccinated person importing the vaccine-preventable disease that now can find a foothold in the US if the disease is spread to any of the increasing number of clusters of electively non-vaccinated children in the US. That foothold comes thanks to uneducated, ignorant, lying, deceitful, and just plain moronic anti-vaccine people like you.

Actually MoB, here is a 2010 study from the very CDC. For the DTaP vaccine for white adults, ages 10-64, it reports 51% coverage; for pneumococcal, ages 19-64, it is 18%; and for the HepB, ages 19-49 (high risk) it is 43%.

And come to think of it, you guys are seeking infants' 100% compliance with the HepB vaccine, a vaccine for a sexually transmitted disease. Yet, you are perfectly fine with a 43% compliance rate for adults, who are actually sexually active?

Seriously guys, how do you preach you insanity with a straight face? I am really curious!

Judging by your general evasions of my argument that a significant proportion of the adult population are going un-vaccinated, not keeping up with their boosters, It would appear the I scored a direct hit. Herd immunity is indeed a lie!

That would be a wrong inference, in my case.

The reason I replied to you the way I did was that I felt sure that if you had two brain cells to rub together, a moment's reflection would be enough to inform you that your question was nonsensical.

When discussing vaccines with my parents I tell them truthfully that I wouldn't give their child any vaccine that I haven't given my own children--which would be everything on the CDC schedule, and ON schedule. And don't bother asking to see shot records. That's NOYB.

Aw, reservoirs does not equal vectors lil fella. Vectors. Toddlers/kids are better vectors. Big complicated concepts for you, I know, I know. Pay attention. you'll get there.

Please specify these vaccines, and how long their protection last — 10, 20, 30 years? Are you saying that the average individual that may have been vaccinated against these diseases as a child, won’t need boosters at the age of 35 and over?

AFAIK, although I'm open to correction:

They won't for measles, mumps, rubella, Hep A, Hep B, polio, Hib, and rotavirus.

Tetanus and diphtheria require ten-year boosters.

Pertussis and Chickenpox, I'm not sure.

"Herd immunity is indeed a lie!"

So why don't we have massive epidemics of measles, mumps, rubella, polio, smallpox, and chickenpox, as occurred in the good old days before vaccines against those diseases?

"I felt sure that if you had two brain cells to rub together..."

He doesn't. 

@Chris Hickie
While you are discussing your conversations with parents about giving their kids vaccines that you give your own kids, why don't you answer my earlier question 'bigboy'? How are you doing with your boosters? When was the last time you rolled up your sleeve and took one for the herd?

re pint-sized disease vectors

Here's something we imagine might have happened:
a guy , who has no direct contact with children, works in an office in a very hip area. Often, during lunch breaks he frequents the nearly-by, ultra-posh library to use the computer or to buy used books/ videos that they sell.

Then, he gets an awful cough that lasts for months. Most likely pertussis, which was reported to be rising in vicinity of said hip town which has a lower than average vaccination rate amongst children..
Also, he has asthma.

For the sake of argument, let us assume that immune response can wane over time, particularly in the absence of repeated exposure to the pathogen. Let us also assume that the current number of adults who are effectively immunized against some infectious and potentially disease is lower than the level needed to prevent an epidemic.

Were those things true, it would be time to look at more campaigns for adults to get their immunizations and boosters in addition to the existing efforts to immunize children. On a personal note, I am up to date on my vaccinations to the best of my knowledge with the possible exception of tetanus. I have also had some vaccinations over the years that are not on the common schedule, such as yellow fever and plague.

Herd immunity is a statistical outcome that is implicit in the mathematics that model how diseases spread. It is proven out in livestock (where the term came from) and for people. If the overall effective immunization rate (whether from actually catching the disease or from the less risky immunization) is high enough, the likelihood of an epidemic or major outbreak is small.

Now as to "evasion". I have answered directly, succinctly, and honestly. If that is evasion, then it is some alternative use of the word that I am not familiar with.

Up to date. Had blood work done for measles and rubella (and chicken pox, but there I had the disease, not the vaccine) in the past few years, positive.

@LW
You implied herd immunity must be true because vaccines appear to be keeping IDs at bay? Well, what's actually keeping scarlet fever at bay? Last anyone checked no vaccine was ever introduced for it.

@Chris Hickie
So it's unvaxxed individuals --not toddlers!-- returning from their travels with IDs. But again, does this not speak to my point that we (actually vaccine drug pushers) would be better off putting more effort into improving adult vaxxed rates, rather than badgering so much the 1.8 percent of parents who don't vaccinate their kids?

Also up to date. Old enough to have had chickenpox. Attended graduate school in the 1990s and was required to get that second dose of MMR,plus my titers were checked when I had kids. Not dumb enough to skip tetanus boosters, which now come with diphtheria and pertussis boosters as a bonus - and I would have asked for the pertussis booster when my niece was born if it hadn't.

Both children have been vaccinated according to schedule.

Thanks MoB, Dorit, and Chemmomo for sharing your vaxxed history. But what about the rest of you? C'mon Orac, Shay, Chris Hickie, Renate, Chris, Johnny (yes Jhonny!), LW, Helianthus, Narad, Kreb, Antaeus (Mr. Perfect), Lawrence (this is going to be funny), MI Dawn, Vicki -- how you doin wit dem damn boosters? Personally for me, I am doing a piss poor job. I just can't lie --- hee hee hee!

Ann states that the measles MMR protection would last more than 30 plus years. Not according to this site that lists it at 20 years. And the mumps component is considered much shorter. I will follow-up with other stats to her claim that the other vaccines offer long lasting protection?

http://www.nhs.uk/Conditions/vaccinations/Pages/mmr-questions-answers.a…

Both the wife and I are up to date - and got the flu vaccine back in the Fall. Both kids fully immunized and up to date as well.

I do put my money where my mouth is - too bad Derg has his too far up his rear end to matter at all......

I've got "natural innunity" to measles, mumps and varicella. Received a rubella shot prior to my second pregnancy. Smallpox vaccine X 3 (early childhood, prior to international travel 1972, and when I worked as a public health nurse). Hepatitis B vaccines and still immune. Tdap booster about two years ago and I had pertussis about seven years ago. One time adult pneumonia vaccine and yearly seasonal influenza vaccines.

^ "natural immunity"

I'm up to date on all my shots including (gasp!) for HPV and hepatitis.

Well, I'm busted. Greg has caught me.

My cholera (for sure) and yellow fever (probably) vaccines are out of date, and I do not plan on getting a booster for those. TDaP (or whatever it's called these days) was updated in 2011, flu shots are up to date, and I expect to get shingles shot later this year (mom had shingles, and I want no part of it).

Herd immunity is indeed a lie!

That's interesting. Greg is actually arguing that we should be making vaccines mandatory not only at school, but everywhere else. Not just for children and medical personal, but for all adults.
Well, if it's the society you want...

Re: my vaccines. DT booster in 2006. Flu shots about every other year (got the famous H1N1 with thimerosal). Hep B 15 years ago, should still be good.
This for someone who is afraid of needles and don't care much for visiting medical centers.

you are perfectly fine with a 43% compliance rate for adults, who are actually sexually active?

I have a little list of silly things a number of sexually active adults do, and which I'm not "fine" with. Not caring much for the possibility of STDs transmission is near the top.

The cake may be a lie, but the evidence confirms herd immunity.

I know I tease you guys a lot about suspecting that you don’t vaccinate your kids — some of you say you do –but, how many of you are bucking the trend and keeping up with your boosters? C’mon Orac, Lawrence, Kreb, Chris, Chis Hickie, Helianthus, MI Dawn, Narad, Johnny, Dorit, Shay, Tbruce, LW –do tell! Hypocrites!!

Hypocrites? Given that the result of your last demand was simply to claim that you didn't believe the answers, you get to put your money where your mouth is this time. Let's say five grand, in escrow. I'm sure there's a shop somewhere that will broker anonymous bets.

And come to think of it, you guys are seeking infants’ 100% compliance with the HepB vaccine, a vaccine for a sexually transmitted disease.

Perhaps you'd like to explain the estimated 12,000–25,000 nonperinatal infections with this "sexually transmitted disease" in ages 0–9 in the prevaccine era.

My other half was knocked sideways for a fortnight in the mid 90's along with many other 17-25 year old men ( I SAW the spike in positive results as I was running the rubella tests in the lab that year ) Gerg, they were in a window of boys that missed being vaccinated as the schedule changed. I knew 2 other guys that year who caught rubella in separate incidences - really brought home how contagious these diseases are in susceptible populations. Notifications in my state went from 1 in 1992, to 502 in 1993, rising to 730 in 1994, not dropping til 1997. Australia wide the incidence rate in males aged 15–22 years peaked at 152.6 per 100,000 in 1995 - absolutely reflecting the lack of immunisation in this cohort.
So you bet I have all 3 kids up to date, including Gardasil for teenagers - girl AND boy. #2 daughter hospitalised with Pneumococcal infection a few months before the vaccine came out.
Personally, old enough to have natural immunity to (and nasty memories of) rubella and measles. Naturally immune to chickenpox - sub-clinical infection presumably thanx to baby brother. Hep B vaccinations given while a uni undergraduate. Titres still high - checked during each pregnancy. Flu vax yearly since encountering H1N1 a few years back. DTaP current.

You'd lose, Greg. Not only did I get a flu shot this year, but a few years ago (2-3, I forget exactly) I updated my TDaP. As I had chicken pox, i'm waiting till I'm eligible for the shingles vaccine and the pneumonia vaccine - I'm not old enough for them yet. I've also had MMR boosters since I don't tend to create a mumps immunity (yes, I had the mumps, no, I don't test as immune). However, that last booster was about 10 years ago. I've had HepB. Haven't had HepA but have discussed with my doctor who will get it and give it to me for my next visit.

Another up to dater. Flu vaccine is medically contraindicated in my case but my kiddos and mother all get their jabs.

@Kreb

Citation? I have seen evidence that antibody titers may decline, but when you give an antigen challenge we find that immunity is still intact, thanks to memory t-cells. If MMR immunity really waned that quickly we would expect to see hordes of 20-50 year-olds going down with measles in the US, since a measles vaccine either alone or as part of MMR has been part of the schedule since the 1960s and 1970s respectively, but we don’t.

You are correct. I was looking at the citation that lilady linked to with her search (pmid: 24448194) that described it as waning immunity to measles, but in reality it was "a declining trend of seropositivity" (IgG antibodies). Which as you point out may not translate into reduced immuninty, due to the t-cell contribution to long-lived immunity. Thanks for pointing that out.

When measles etc. were endemic in the developed world, it may be that continual exposure as adults kept antibody titers high, but now we are no longer exposed. Even if we do find we need boosters later in life, it has to be better than almost every child spending weeks of their childhood in bed with very unpleasant illnesses, even if we ignore the more serious complications.

That makes sense regarding natural exposure and maintenance of antibody levels.

I am in complete agreement that a booster during adolescence would be a much better option than scrapping the measles vaccine and letting people acquire immunity naturally.

I think that you can look at both naturally acquired immunity (NAI) and vaccine acquired immunity (VAI) in a similar fashion from risk/efficacy standpoint.

NAI- usually is more efficacious at producing long-lived immunity, but the risk trade off is too high to take this route.

Whereas, VAI is not quite as efficacious (but definitely good enough in most cases), but the risk profile is so much better that it is an easy decision.

however, sticky situations arise such as the DTaP issues that we were discussing in the other thread and I agree that as new findings come in public health and clinicians consider the findings, hypothesize, figure more stuff out and eventually adjust the recommendations.

This is kinda what I was hinting at with regards to measles vaccine and possibly adding a booster dose during adolescence; new findings, re-evaluate, strategize, new recommendations.

Greggles, I'm up to date on the boosters that are required - not many, since I'm old enough to have had all the childhood illnesses back in the prevax era. At this age, however, I do need to get my shingles and pneumovax done. Thanks for the reminder!

Up to date on vaccines here, too. Flu vax yearly, measles disease as a child, and vaccinated in my 40s when I started working with live virus (occ health doc with an abundance of caution), natural chicken pox (thanks, kids!), tetanus (due for a booster in a year, will get it early due to impending grandchild), pneumonia fax, and, because I'm a vet, rabies, with a titer check every two years. Oh, and multiple doses of smallpox vax as a kid, because I'm an Air Force brat and we traveled, a LOT.

Hey y'all one of my favorite evidence-based vaccine advocates has started a new blog with a bang:

http://vaxplanations.wordpress.com/

See there's this popular Christian Parenting blog, The Gianelloni Family:

We invite you into our lives to learn, grow, & be encouraged.
We hope to provide inspiration and perspective. We will be honest and share truth.

We are passionate about many things: health, orphans, and Jesus just to name a few..

We hope to inspire, educate, and encourage (especially mothers), to never ignore their God-given instinct.
We won’t forget to add humor. And we will always strive to glorify God in everything we do!

Be blessed: The Gianelloni 7

It seems to be mostly written by the mother, Jessica Gianelloni, who believes her husband can heal all illnesses and hasn't a clue about the seriousness of vaccine-preventable disease.

Here's Vaxplanations' closer.

Dear Gianelloni Family. Wake up. Wake the hell up and stop making excuses for why you are sheltering under the protection of herd immunity. You’re not fooling anyone. You are not an expert in infectious disease, epidemiology, immunology, virology, or any of the other myriad disciplines that come together to forge the basis of the science of vaccination. To accept your erroneous claims against the weight of hundreds of thousands of experts in these fields who have produced study upon study, does indeed put everyone at great risk, including your own children.

Not only is my family fully immunized against the normal US range of diseases including annual flu shots, we have also been vaccinated against several diseases endemic to other parts of the world (typhoid, Hep A). In addition, I've asked for and received TDap and early pneumovax due to high risk factors, and Hep B for work. I also eat the occasional tuna sandwich to keep up my mercury levels, and apples to top off my formaldehyde. (Yes, anti-vaxxers, that last line was just for you.)

Judging by your general evasions of my argument that a significant proportion of the adult population are going un-vaccinated, not keeping up with their boosters, It would appear the I scored a direct hit. Herd immunity is indeed a lie!

Gerg, first off please realise that some vaccines are useful to confer herd immunity, some are only required for individual protection (eg tetanus) or as boosters before travel for infections like Hep A (yellow fever vax protection is likely to be lifelong, btw, according to recent work).

The concept of herd protection usually applies to infections that do in themselves confer long term immunity, or for their vaccines which also do. This means it is not so essential for adults to think about requiring boosters unless the vaccine is one for which duration of protection is relatively limited, such as pertussis. For other diseases like measles, mumps, chickenpox, rubella, Hep B the question of boosters need not really arise, since vaccine protection is pretty durable.

Now finally, will you please stop with the old misconception that you need 90% plus vaccination to get herd immunity? Not all infections are the same. The most highly infectious such as measles and chickenpox require levels of 90% plus becasue they are so infectious. But take another infection, like mumps. An index case would only transmit to around 5 others, so to reduce onward transmission, all you need is to ensure more than 4 out of 5 people in the population are immune (ie 80%). For influenza, which spreads to around 2 people per index case, you therefore need more than one in every 2 people to be immune to halt spread (50%). So those are the herd immunity thresholds for those particular diseases.

I can get more precisely mathematical if you like, but fear you would not follow (as I doubt you will even comprehend my rather simplified explanation above).

Herd immunity is a statistical outcome that is implicit in the mathematics that model how diseases spread. It is proven out in livestock (where the term came from) and for people.

It is not at all obvious to me that Topley & Wilson were aware of the agricultural literature when they introduced the term in 1923. The earliest attestation I can find is the "Report of Committee on Animal Food" in the 1893 Proceedings of the 30th Annual Convention of the United States Veterinary Association, but it doesn't seem to have really started to take hold for another 15–20 years.

If one looks at op12no2[.]me/stuff/herdhis.pdf, it is mentioned that "Wilson later recalled that he had first heard the phrase 'herd immunity' in the course of a conversation with Major Greenwood (G. S. Wilson, London School of Hygiene and Tropical Medicine, personal communication, 1981); and Greenwood employed it in his 1936 textbook Epidemics and Crowd Diseases (40)."

@MOB
Evasion duly noted!

Project much, Gerg?

@Narad

Name a single comment of yours here that you haven’t fled from, O lying sack of shıt.

You’re lucky it’s the weekend and I must be on my way again. Otherwise, you would be in big trouble for that comment. Woo hooo — I am outta here!!

Everybody is still waiting for this:

Chris, I keep providing you with the study that you been asking everyone for showing that infections from natural diseases are safer than infections from vaccines. The problem is Orac has me on automatic moderation, and at every turn, he is blocking my release of this information.

Don't forget the experimental design for your brilliant idea to use animals for a vax/unvax study, either.

Freaking blockquotes.

Since some are in a sharing mood about their vaccine history... I checked with my GP that I am up to date with everything less than a month ago, and she assured me that I am. I have been getting the flu vaccine annually since I became asthmatic a few years ago - before that I didn't want to deprive the vulnerable, as there were shortages. Now I am vulnerable so I get it free on the NHS.

In the UK a tdaP booster in adults is not (yet) recommended as it is in the US, and we don't have the chicken pox vaccine here so almost all children still have to endure that; as in most matters medical we are a few years behind the US. I shall be asking for a shingles vaccines soon, though I may have to pay for it.

I have had measles, mumps, rubella and chicken pox naturally, all of which were unpleasant and time consuming, and I had all the required childhood vaccines, and occasional tetanus boosters mostly after accidents. Also typhoid, cholera (with thanks to the London School of Hygiene and Tropical Medicine) and hepatitis B, and last week meningitis C and pneumococcus, though these last two are because my immunologist wants to see what titers I produce - almost all adults are already immune, he told me, having been naturally exposed.

By the way, Greg asked what happened to scarlet fever. Antibiotics happened. It's still around, it just isn't a big deal any more because it is quickly and easily treated, so it isn't as common. As with all bacterial infections, an effective vaccine would be challenging to produce.

Yep, I'm up to date too. I had rubella when I was too young to be vaxxed, I think in late 1975 or early 1976. I didn't get my flu shot this year, but not for lack of trying; got the flu instead. Fortunately, it wasn't as bad as it could have been, probably because of either previous years' flu vax, or else from having had the H1N1 before the vaccine was out. Tetanus shot up to date. I also routinely let the doctors pump my arm full of cyanocobalamin, which sounds like some kind of horrible Nazi chemical superweapon or something, but isn't. :)

I get a lot fewer really nasty sinus-and-everything-connected-to-them infections now that kids routinely get HiB vaccines.

Hepatitis is a fluid-borne pathogen, meaning you can get it from contact with blood or bodily fluids, not just from sexual contact. If grandma is a carrier and kisses unvaccinated baby on the mouth, baby can wind up with chronic hepatitis, which is why we vaccinate infants.

If I were a client of his I'd be pretty insulted right now because the tone of this article is pretty much belittling and dismissing my fears. If I turned to Dr Sears because I felt other pediatricians weren't taking my concerns seriously, I'd be ready to throw him into the paternalistic elitist doctor bin with them right now.

If grandma is a carrier and kisses unvaccinated baby on the mouth, baby can wind up with chronic hepatitis, which is why we vaccinate infants.

Maybe if grams Frenches babby, but otherwise, not so much (PDF).

Judging by your general evasions of my argument that a significant proportion of the adult population are going un-vaccinated, not keeping up with their boosters, It would appear the I scored a direct hit. Herd immunity is indeed a lie!

You really cannot distinguish between a evidence that we need to improve adult compliance with booster immunizations and evidence that falsifies herd immunity?

<blockquote.Well, what’s actually keeping scarlet fever at bay?

The current hypothesis is strain replacement--the emergence of new strains of s. pyogenes that are less likely to cause scarlet fever but more capable of spreading in a population.

And actually, thanks to adopting internationally a couple of times, even my cholera etc. immunizations are up to date.

ditto those freaking blockquotes

One more thing, greg: let's assume that you're correct, and herd immunity has been proven false. What is the only logical conclusion which proceeds from that finding?

Not that vaccines are of no utility, but instead that we need to increase vaccine compliance well above 90% to acheive the same degree of protection from infectious outbreaks we'd observe if herd immunity were in operation.

Are you sure you want to continue argung in favor of eliminating all non-medical exemptions from mandatory vaccination, greg?

Suffered through mumps and chicken pox as a child; don't remember experiencing measles and rubella, but titers run in adulthood showed continuing immunity. Received two full series of IPV and one series of OPV, along with all recommended diphtheria and tetanus immunizations. Updated TDaP 18 mos. ago and flu vaccine this year. Offspring and spouse fully immunized. Daughter, a very young adult when Gardasil first became available, sought it out on her own -- "If I can get a shot to prevent cancer, why wouldn't I?"

@Greg I am up to date with my vaccinations. Not only that I got extras. I got the Tdap along with Pneumovax a couple of years ago. Several years ago I got the HepB and polio vaccines (I'm a biologist). Each year I get the flu shot.

Rokujolady @ 187 -- You've stepped into the middle of a catfight that's gone on for many years, so of course the tone is a bit over the top. As for "belittling", I don't think anyone here is questioning the sincerity of people's beliefs about vaccines; what people do question is whether those beliefs are grounded in fact.

In the modern era, vaccine reactions are rare, almost always mild, and almost always far less destructive than the diseases that they prevent (and yes, they do in fact prevent the spread of disease). There is not one iota of reliable evidence that vaccines cause autism, despite huge studies designed to find such a connection if it existed.

A good physician would reassure you about this, but a good physician would not concede that your understanding is just as valid as the accumulated human understanding of infectious diseases. If that constitutes "belittling", well, so be it.

Quite unintentionally, Greg asked an interesting question. Why *do* the authorities concentrate on getting children vaccinated when so many adults are undervaccinated?

I can think of a number of reasons.

An addition to your list, at least for Hep B, is cost-effectiveness.

Just to dogpile on the rabbit some more.
Up to date with my vaccines, went to get a pertussis booster a few years ago, and I get the flu vaccine whenever I can.

@greg --

How are you doing with your boosters? When was the last time you rolled up your sleeve and took one for the herd?

2011, not including flu shots since then.

ctually MoB, here is a 2010 study from the very CDC. For the DTaP vaccine for white adults, ages 10-64, it reports 51% coverage; for pneumococcal,

But not all adults in the 19-to-64 age range need pneumococcal boosters in order to preserve herd immunity. The main risk being protected against is to children, the elderly, and people with conditions that render them vulnerable to pneumococcal disease.

Those aren't trivial, nuanced details. BTW.

@dingo199

The concept of herd protection usually applies to infections that do in themselves confer long term immunity, or for their vaccines which also do. This means it is not so essential for adults to think about requiring boosters unless the vaccine is one for which duration of protection is relatively limited, such as pertussis. For other diseases like measles, mumps, chickenpox, rubella, Hep B the question of boosters need not really arise, since vaccine protection is pretty durable.

^^Thank you.

That's the kind of point it typically takes me five or six thousand words to make, sadly.

Judging by your general evasions of my argument that a significant proportion of the adult population are going un-vaccinated, not keeping up with their boosters, It would appear the I scored a direct hit. Herd immunity is fevasionsindeed a lie!

The problem here, Gerg, as usual, is that you are profoundly stupid. Heterogeneous uptake modifies the equation; it does not eliminate it:

"If vaccination coverage differs between groups in a population, and these groups differ in their risk behavior, the simple results no longer follow. To illustrate this, consider a population consisting of 2 groups, high and low risk, and suppose that each high-risk case infects 5 high-risk individuals and each low-risk case infects 1 low-risk individual. Here, R₀ = 5, so V_c = 80%. Because the high-risk group is responsible for any increase in incidence, outbreaks could in theory be prevented by vaccinating 80% of the high-risk group alone, thus <80% of the entire population. In general, if highly transmitting groups can be preferentially vaccinated, lower values of coverage than predicted using random vaccination models can suffice to protect the entire population."

The reason that lower uptake of aP for adults (which, by the way, do not include 10-year-olds in the figures you attempted to report) is not as much of a concern is that they consitute the lowest incidence age group.

@palindrom: I read Rokujolady as saying Dr. Sears was belittling and dismissing patients' fears. This:

If I turned to Dr Sears because I felt other pediatricians weren’t taking my concerns seriously, I’d be ready to throw him into the paternalistic elitist doctor bin with them right now.

The above appears to say that Dr. Sears would be thrown on the heap of elitist pediatricians.

You’ve stepped into the middle of a catfight that’s gone on for many years, so of course the tone is a bit over the top. As for “belittling”, I don’t think anyone here is questioning the sincerity of people’s beliefs about vaccines; what people do question is whether those beliefs are grounded in fact.

I got the impression that Rokujolady found Dr. Bob's joint belittling.

I have to say that I found Dr. Sears' comment belittling too: "Well, if you get all panicky just because there's an outbreak of a potentially serious disease, and you insist on inconveniencing me with your whining, then yeah, we'll vaccinate your kid even though it's silly."

@palindrom -it isn't always about Orac.

@Narad --

YEAH.

I mean: Thanks. That's what I would have meant, were I capable of articulating it thus.

I understood it as palindrom did.

But I think y'all are right and I was wrong.

@grrg

Ann states that the measles MMR protection would last more than 30 plus years.

I did no such thing. I stated that (as far as I knew), 30 to 35 years after being vaccinated for them, the average adult did not need boosters for the diseases I then listed.

That's not the same.

And if you don't see why, the thing that's probably hanging you up is that the premises implicit in your question are nonsensical, as I already told you.

I quite literally have no idea where the "fevasions" in #198 came from, BTW. I don't like screwing up direct quotes.

Something from The Onion.
http://www.theonion.com/articles/antivaccine-movement-leads-to-rise-in-…
Sarcastic and cutting as ever.

Oops. I may very well have misread the comment. Hopefully there's no harm done.

I've been posting for days on the Daily Beast article about the New York City measles outbreak...which crank blogger Jessica Gianolloni tried to refute:

http://www.thedailybeast.com/articles/2014/03/13/thanks-anti-vaxxers-yo…

Well, must say this has been a productive outing, having garnered so much response on vaccination histories. I kindly ask though that you follow-up by providing your authentic vaccination records on the Net, so that I may peruse them and verify your claims. Failing to do so will result in you all being deemed liars. Julian needs not provide this info, since being autistic, it is naturally assumed that he is fully vaccinated, and raised to comply with all additional adult booster requirements. Ditto for Alain.

Anyway folks, it's quite amusing to see you try to dance around the inconvenient reality that probably over 50% of the population is not vaccinated, and your talk of herd immunity is utter nonsense. Yet, maybe you will set aside your disingenuity, if only briefly, and address this thought:

I really do find it hard to believe that the 1.8% of un-vaccinated children are causing the disease outbreaks that are often spoken of late. If un-vaccinated individuals are causing these outbreaks, then it's likely the 50% plus of the adult population who haven't kept up with their boosters.

Anyway guys, is it truly the case that you are taking deceitfulness to the next level by faulting anti-vaxxers for disease outbreaks, while you know perfectly well it's the result of adults who may not even particularly identify themselves as anti-vaxxers (and, in fact, may even be pro-vaxxers who vaccinate their own kids), but, nevertheless, lapsed with their own boosters? Do you pursue this under-handed tactic realizing it's easier to coerce parents into vaccinating their kids through scaremonger and shaming, rather than targeting adults to vaccinate their own self?

FFS Gerg, don't you have something else to do than get shot down over and over and over again. Shouldn't you be out "bedding women" or something swashbuckly and manly as is your wont? Hanging around with us spindly eggheads can't be good for your image with the babes.

Oh, and thanks a lot Liz, I lost a huge number of brain cells on the Gianolloni blog. Her "Dear Blog Bullies" list almost left me permanently damaged from intense headdesking. http://gianelloni.wordpress.com/2014/03/20/dear-blog-bullies-i-dont-see…

FFS Gerg, don’t you have something else to do than get shot down over and over and over again.

I suppose he has to occupy himself somehow when he's "at work" as a "behavioral therapist" for the "brain damaged" (i.e., "mentally retarded individuals"). His flounces are often announced as somehow being caused by "the weekend."

@ Greg

I kindly ask though that you follow-up by providing your authentic vaccination records on the Net, so that I may peruse them and verify your claims.

Sure.
http://youtu.be/2bqEn8AXzJ4

you know perfectly well it’s the result of adults who may not even particularly identify themselves as anti-vaxxers (and, in fact, may even be pro-vaxxers who vaccinate their own kids), but, nevertheless, lapsed with their own boosters

If you truly believe this, then you are going to tell us that you are up-to-date with your vaccines?
If you truly believe this, then the only conclusion is that you are advocating for more vaccination. Thanks for joining us, Greg.

Further to my question at #210, do you not bully adults who have lapsed with their vaccines, realizing that to do so would require releasing the information that 50% plus of the population is unvaccinated, and this has been the case for a very long time? Further, you would have to also admit that the 90% herd immunity threshold was a complete fabrication, and was never met. People would then wake up and start asking why the sky is not falling -- why we haven't had resurgent disease epidemics from the past! Could it be that the anti-vaxxers are right and vaccines never was the Holy Grail that they were purported to be -- they never really saved us? Could it be that the anti-vaxxers are right and they have caused more harm than good?

Of all the ones who didn't share their vaxxed history, Chris Hicke is a standout. As a pediatrician, who don't use a nymph is he concerned that responding to the request maybe setting himself up for a disaster. HHMMMNN!!

Oh Chistopher --do tell your vaxxed history! Again, I will reciprocate and admit that as an adult I have been completely negligent with my boosters and vaccines. See how honest I am? Now your turn....

#216, for the hipsters -- that's nymph as in pseudonym

I wonder if there are parallels between Greg (and other conspiracy theorists) and the 'imprinting' phenomenon in the natural world. Maybe the vaccines/autism trope is like the first moving object seen by the turkey as it hatches. Doesn't matter how many adult female turkeys the chicks see, the brain is wired to just 'know' that the interfering behavioral biologist is mummy dearest. Does it make it easier to know that they can't help it? That they are not just willfully ignorant?

Sorry. Random thought.

It was very interesting to read about all the exotic things commenters here have been vaccinated against. I feel quite plebian with my TDaP, flu, and pneumococcus shots. 

Greg responds as expected: 

I kindly ask though that you follow-up by providing your authentic vaccination records on the Net, so that I may peruse them and verify your claims. Failing to do so will result in you all being deemed liars.

Like anyone cares what Greg thinks, or believes that there is anything whatsoever that would cause him *not* to deem us all liars.

What I find funny however is that he acknowledges that almost half the adult population *is* up to date on vaccination ("the 50% plus of the adult population who haven’t kept up with their boosters") but then asserts that every single person in the self-selected group commenting about and supporting vaccination *must* be lying about belonging to the very large group -- almost half the population -- that is up to date.  Just by chance alone almost half would be expected to fall in that group.

One of Greg's many intellectual weaknesses -- I won't go into his moral failings -- is an inability to comprehend probability.

@Greg: Oh, no. I don't supply those to anyone without good, legal reason. Even schools accept a parent's documentation of a child's immunizations and dates. I have no plans to supply you with my "authentic vaccination records on the Net". When you supply me with a legal subpoena, then I'll give you that information. But just being a nosy jerk doesn't give you that right.

But since you don't give US the truth about your employment or immunization status, I suppose it makes sense that you think that other people lie to you. Tell you what- you supply US with your vaccination records on the Net and I'll supply mine.

I really do find it hard to believe that the 1.8% of un-vaccinated children are causing the disease outbreaks that are often spoken of late.

Another bogus figure plucked from the air? There are many areas of the US where antivaxxers cluster, and the unvaccinated greatly exceed 1.8%, even for MMR, sadly.

We already know that you find it impossible to overcome your delusional idee fixe about vaccines, even in the face of overwhelming evidence.

An intentionally unvaccinated individual aged 17 brought measles to New York City from London UK, starting the largest outbreak of measles in the US last year. There were 58 cases; none had documented measles vaccination at the time of exposure. All were aged 32 or under, so all those old enough should have had MMR as children, but didn't. Most were children; the median age of the first group of 28 infected was 10 years, and median age of the 30 subsequently infected was 19 months.

Even with pertussis, where waning immunity may be a problem, it is clear that low vaccine uptake plays a role. This study looking at pertussis outbreaks found that areas with many unvaccinated children were 2.5 times more likely to have a cluster of pertussis cases than areas with few unvaccinated children.

Anyway folks, it’s quite amusing to see you try to dance around the inconvenient reality that probably over 50% of the population is not vaccinated, and your talk of herd immunity is utter nonsense.

It's quite painful to see you parade your ignorance as some sort of badge of pride like this, yet again. I would be deeply ashamed if I exposed a lack of education and understanding the way you regularly do. Do you enjoy the disgust and scorn your idiotic comments provoke? If not, why do you do this?

@ Krebiozen

There are many areas of the US

I'm afraid Greg is unable to come to understand basic concepts like clusters of susceptible people.
Or in layman terms, like people tend to aggregate together. Children in schools, sick people in hospital, and upper-middleclass granola people in upper-middle class city blocks.

Do you enjoy the disgust and scorn your idiotic comments provoke?

I'm afraid so.
A late French humorist, Francis Blanche, pointed out how enjoyable it is to pass oneself as an idiot among morons. Of course, an objective definition for moron would be "whoever I'm not agreeing with".
Francis Blanche was a very good actor and artist. He was also quite smart. The clown gracing us with his intermittent presence... I suggest he keep his day job.

tl;dr: definition of a Troll.

It’s quite painful to see you parade your ignorance as some sort of badge of pride like this, yet again. I would be deeply ashamed if I exposed a lack of education and understanding the way you regularly do. Do you enjoy the disgust and scorn your idiotic comments provoke? If not, why do you do this?

I've actually started to wonder if that's the case. If he gets a masochistic thrill out of being humiliated in front of an audience, it would explain why he reaches such dramatic heights of stupidity - e.g., not only suggesting by analogy that antivaxers might well deliberately injure children so that they can pretend vaccines were the cause, but asking for it to be spelled out all over again so that even more people can see his failure. It makes a lot more sense to conclude he's 'not here for the hunting'.

@218 Interesting you mention imprinting. As a learning theorist, I find imprinting is a fascinating phenomenon as it involves an overt, obvious interaction between phylogenic inheritance and early learning experiences. Autism, given that people are most likely born with it, is a social learning disorder very similar to the social learning that goes awry when there is an imprinting error. Any good behavioral therapist would be looking at social learning as their primary target during intervention. Teaching social behavior involves establishing the functions that social behavior should have not merely teaching people to do what other people do.

Kreb --buddy Kreb! -- why don't you quit with your prima donna hissy show ('omg- you're sooo stuupid'), and answer the million dollar question? If essentially half of the population is unvaccinated, why are we not seeing the blazing infernos of ID epidemics that are 'expected'. Instead, what we have are a few occasional brush fire outbreaks, that quickly extinguish themselves with little ado. In fact, the only inferno on the horizon -- actually, more akin to a nuclear fallout -- is the exploding rates of kids suffering from chronic, immune dysfunctions, and including many hand flapping, head banging ones, with a whole host of other debilitating medical issues.

I kindly ask though that you follow-up by providing your authentic vaccination records on the Net, so that I may peruse them and verify your claims. Failing to do so will result in you all being deemed liars.

I told you already, Gerg: put your money where your mouth is. Failing to do so will result in your demonstrating yourself to being yellow-bellied as well as a blowhard.

Altho' I tend to agree with Antaeus about the creature, I also have experienced a nagging doubt which I haven't as yet articulated but here goes:
maybe not 'hunting' but *fishing*.
He may be trying, with his constant taunts, insults and lack of judgment concerning written interpersonal communication, to get one of us to either say something that can be used as 'proof' of a conspiracy, malfeasance or whatnot
OR
- what I think is more likely to be the case- to provoke one of us to say something very awful, aggressive or threatening, in anger and frustration with him, which can then be posted and paraded around anti-vax sites to illustrate just how despicable vaccine supporters are.

I think for the most part that we've displayed great restraint even sublime patience with this entirely preposterous series of conversations which he initiated- if conversations include flinging faecal matter towards other participants.

I hereby nominate Kreb and Antaeus for sainthood ( do we sceptics have saints?) or at least, Patient Griselda-hood: we've probably got that..

If you post up your real driver's license, birth certificate and Social Security card, Greg, I'll post up my vaccine records.

And don't go redacting anything on them, either.

@Chris Hickie
Looks like Chris still hasn't weighed in with his vaxx history. Christopher --oh Christopher!-- come out and PLAAAYY -- ka cling! Help me Narad, you do it so much better.

Anyway, would anyone rank Sears as the most famous and loved pediatrician? Sorry Chris, did not to mean to diminish your status there! You definitely come second though. Well --actually there is also Dr. Jay. Chris, you are definitely third and no other pediatrician ranks ahead of you. (But then -- there is also my kids' pediatrician --never mind!)

Greg, if you were an honest man, you would be debating the facts and the evidence. Instead, you try to accuse us of a financial stake in the matter, and refuse to provide any evidence of said accusation. Read this carefully: We could just as easily, if not more so, make the same accusation against you. After all, treatment of a disease is a lot more expensive than prevention.

Instead, what we have are a few occasional brush fire outbreaks, that quickly extinguish themselves with little ado.

Leaving aside the fact that this is false, if one grants what your statement, you have just conceded that R < 1 and thus herd immunity.

You lose again.

^ The "what" is spurious.

Gregger:

If essentially half of the population is unvaccinated, why are we not seeing the blazing infernos of ID epidemics that are ‘expected’...

As was pointed out to you, many of the vaccines confer immunity for decades, maybe even over 100 years. Secondly, a lot of people are very diligent about getting their boosters. So...
Citation needed for your claim that adults whose immunity has waned are/should be a bigger threat to herd immunity than deliberately unvaccinated children.

Proceeding to why Gerg's assertion is false, one need only look at the costs. The 2011 Utah outbreak had 13 cases and cost $330,000 to contain. A single Iowa case in 2004 cost $142,452. Tucson 2008, 14 cases, $799,136 (PMID 21531693).

Gerg thus has two options: (1) Claim that this was wasted effort because herd immunity would have taken care of it or (2) admit that he was full of crap from the get-go.

Greg

I kindly ask though that you follow-up by providing your authentic vaccination records on the Net, so that I may peruse them and verify your claims.

Why? I’m a parent, and you’ve already told us that you accept all parent anecdotes without question.

@ Chemmomo:

Ha ha ha.
And that means that he must therefore accept all other parent anecdotes as well- Lawrence's, Dorit's, Kreb's, lilady's, Chris', MIDawn's, Calli's, Chris Hickie's et al.

If essentially half of the population is unvaccinated, why are we not seeing the blazing infernos of ID epidemics that are ‘expected’.

It is the fact that this has been addressed repeatedly, and more than adequately, that leads me to conclude you are either deeply intellectually challenged, or simply dishonest, unprincipled and lacking in any integrity, or perhaps that you get some perverse masochistic pleasure in repeatedly making the same baseless and frankly ludicrous claims, only to be shown to be utterly wrong over and over again. I see no possible alternative explanations.

Even if half the adult population isn't up to date with the boosters recommended in the US, that doesn't make them "unvaccinated", and it certainly doesn't mean they are not immune. Many are still immune because they were vaccinated and others are immune because they have been exposed to the pathogen naturally. It's immunity that establishes herd immunity, not the percentage of people who have been vaccinated or who have had their boosters, but I suspect that even you must be aware of this.

Look, Dr. Bob is now an armchair expert on autism and "toxins": http://tacanowblog.com/

One thing quacks are good for is claiming credit where they didn't earn it and shucking blame for what they did.

Finally, Gregger, and w.r.t. your demand for us to post our vaccination records...
Die in a fire.

" It’s immunity that establishes herd immunity, not the percentage of people who have been vaccinated or who have had their boosters, but I suspect that even you must be aware of this."

You overestimate his reasoning ability.

Look, Dr. Bob is now an armchair expert on autism and “toxins”: http://tacanowblog.com/

WHY the genetic changes are occurring in the first place. The answer: Environmental toxicity

Just the person you need interpreting and simplifying an already dumbed-down version of an original paper... someone for whom 'toxin' and 'teratogen' are the same thing.

Kreb @237 -- Good list of possibilities regarding the village idiot.

But -- what about ALL of the above?

I repeated all of my childhood immunizations on one day as an adult. I was moving to the US on a Visa and my pediatrician's records had been destroyed in a fire, and I needed proof of UTD status...so rather than screw around, I had them all done again, in one fell swoop.

I acquired natural immunity to chicken pox.

I get a yearly seasonal flu shot, I had a Tdap booster when I was pregnant a few years ago...plus I had titres drawn for rubella before commencing fertility treatment.

Those I'm UTD on that aren't on the schedule include yellow fever, typhoid, cholera, hep A/B...Greg, I am the herd. Come stand next to me!

Actually, don't...

(kid and husband UTD as well - just for funsies, ask my husband how he felt as a 14 year old boy, having chicken pox UNDER HIS FORESKIN)

And not wiling to let Sears bask solo in the anti-vaccine spotlight for pediatricians who don't deserve to be pediatricians, Dr. Jay Gordon shows his true colors as a twitter twit: http://thepoxesblog.wordpress.com/

What country were you from? Just curious about the typhoid, cholera and yellow fever. (in case I travel)

I'm from Canada, but I've lived/worked/traveled in developing countries...hence typhoid/cholera/yellow fever.

One of my fondest memories is of standing in line behind a young granola-ish couple trying to convince the immigration dude at the airport in Accra to let them in, despite not having proof of yellow fever immunization...the woman was all, "But we object to vaccines on principle because blah blah blah" and immigration dude was all, "Don't care, don't care, don't care, do not enter, do not pass Go..."

Delphine,

I repeated all of my childhood immunizations on one day as an adult. I was moving to the US on a Visa and my pediatrician’s records had been destroyed in a fire, and I needed proof of UTD status…so rather than screw around, I had them all done again, in one fell swoop.

Surely this is unpossible. Any antivaxxer worth their formaldehyde will tell you that such an enormous load of antigens and deadly toxins all at once, directly into the bloodstream (almost forgot that), would cause immediate death. [/sarcasm]

@Kreb #237

Kreb, you serious need to chill! Can't we have a calm, rational discussion without you always getting so hot under the collar and losing your cool? I swear Anger Management is in order for you!

Anyway, you are blasting me for speaking of the percentage of people in the general population who are vaccinated. I explained that the likely percentage (50% or less) wouldn’t confer herd immunity. You are now arguing that percentage of individuals vaccinated is not the precise gauge for determining herd immunity, but the actual percentage of individuals who are indeed immune to IDs. Excuse me there Kreb, but isn't percentage of vaxxed individuals been the only language that you guys have always spoken. Anyway, Kreb, let me see if I am understanding you by giving this take:

Essentially, within the population there are three groups: There are the kids, under the age of 20, who are being used as vaccine guinea pigs. They are being laced to the tilt with a solid brew of toxic concoctions, and which is understood as affording them immunity to IDs. (For the sake of not fanning the flame, for now, we will leave out the part that this group is experiencing exploding rates of chronic, debilitating disabilities, including autism.)

Then there are the young and middle-aged adults (20 -55 yrs). They were likely vaccinated as children, albeit definitely not so quite to the tilt. They are generally considered immune to IDs, except their immunity is often short lived, and even vaccines that were once thought to offer them life-long immunity are appearing to not be the case. They will have to keep up with their vaccines and boosters.

Finally, there are the older folks (over 55). They missed partaking in the one of mankind's 'greatest invention' and were not vaccinated. Yet, interestingly, being that they were likely exposed to the natural occurring diseases, they are considered to have obtained lifelong immunity. Also interesting, you need these folks to maintain your 'triumphant' herd immunity. Who is the parasite now?

Wrapping thing up, the problem for you guys are those 20 to 55 years individuals. With their waning immunity, you are left with the unpleasant task of explaining to them that the ‘mad scientist’ vaccination experiment did not go exactly according to plan, and they will need to keep rolling up their sleeves and keep taking their shots for the herd. Even more crucial (because given the numbers game, this is where the real money is at) you must convince them to keep vaccinating their kids, and especially in face of their growing skepticism after seeing how vaccine induced autism is ravaging their kids.

Kreb, is this a accurate summary of things, and are we on the same page? Also Kreb, you have been quite assertive in arguing that disease outbreaks are indeed being caused by individuals who go deliberately unvaccinated. I am now leaving you two links documenting two recent large outbreaks that are considered caused by vaccine failures and waning immunity. They include the Wales measles outbreak of last year.

http://www.fiercevaccines.com/story/uk-mumps-outbreak-linked-waning-mmr…

http://cid.oxfordjournals.org/content/46/8/11

Ooops --- my second link is not working....
http://cid.oxfordjournals.org/content/46/8/1172.full

@ Delphine:

I also had to be re-vaccinated because of lost records. For additional reasons to complicated to explain now**, I am more vaccinated than is usual.

** much as i"d like to stay for the impending pyrotechics ( see above), I've got a train in 30 minutes.

@Chris Hicke

If you post up your real driver’s license, birth certificate and Social Security card, Greg, I’ll post up my vaccine records.

In your case, Christopher (can I call you Christopher?), I won't request that you provide proof of your vaccination history. I am sure given your position, you wouldn't be so silly as to misrepresent that history, and potentially bringing ill-repute to yourself, to say the least. Simply, state whether you are fully compliant with the CDC recommended adult vaccination schedule. If not, please inform what vaccines or boosters you have missed. Again, I am sure we can all see the value in this exercise, in showing that you practice what you preach.

BTW -- thanks also for pointing out the Sears' article. Dr. Bob sure sounds smart, and knowledgeable. His name is everywhere! Christopher, how come your name doesn't get around the same way? Just considering.

"they will need to keep rolling up their sleeves and keep taking their shots for the herd."

If the price of preventing epidemics of measles, mumps, rubella, chickenpox, polio, diphtheria, pertussis, and flu, were for me to roll up my sleeve and get a few shots every year, I'd do it without hesitation. Of course. I wouldn't enjoy it because I hate shots, but I'd do it.

Fortunately that isn't necessary because, contrary to Greg's fevered fantasies, immunity to things like measles seems to be lifelong, and the TDaP seems to be good for ten years (I got my booster in 2012 so I'm good for a while).

Also, the experts on here may correct me, but it seems to me that boosters would not be scheduled for the time when the majority of people would have lost all immunity; it would be scheduled for when a substantial number would have started to experience waning immunity. In other words, someone whose last TD was twelve years ago -- meaning they're not up to date -- likely still has substantial immunity. Greg claims to believe that that person would be as vulnerable to diphtheria as if they'd never been vaccinated at all.

Greg's first link actually says that the measles vaccine in MMR did a bang up job during the MEASLES outbreak in Wales. What it does suggest is that the mumps component might not be as good as previously thought. Same in the second link. Meh! So what? It doesn't say it doesn't work. The anti-vaxers really do have a 100% or nothing mentality don't they?

Kreb, I also had a chest x-ray (TB) on the same day. Should have been stone dead...

@Delphine

That Dylan song is the source of my nsme. Wrll, after my mom explained to my dad why suggesting an ex-girlfriend's name was NOT a good idea. :)

Well, must say this has been a productive outing, having garnered so much response on vaccination histories.

It is our pleasure to serve you! (Editorial plural; I'm speaking only for myself.)

I kindly ask though that you follow-up by providing your authentic vaccination records on the Net, so that I may peruse them and verify your claims. Failing to do so will result in you all being deemed liars.

Oh noes! Anything but that!

To be called a liar by a stranger on the internet whose lightweight trolling I find it mildly amusing to watch getting kicked around is the worst fate imaginable.

Please. I beg of you. I'm fragile.

Anyway folks, it’s quite amusing to see you try to dance around the inconvenient reality that probably over 50% of the population is not vaccinated, and your talk of herd immunity is utter nonsense.

http://www.youtube.com/watch?v=htT4ErBz1Oc

Yet, maybe you will set aside your disingenuity, if only briefly, and address this thought:

I really do find it hard to believe that the 1.8% of un-vaccinated children are causing the disease outbreaks that are often spoken of late. If un-vaccinated individuals are causing these outbreaks, then it’s likely the 50% plus of the adult population who haven’t kept up with their boosters.

That's due to the nonsensical and inapplicable misapprehensions under which you labor, as mentioned earlier

I'd have addressed a thought per your request if I'd seen one, though.

.Anyway guys, is it truly the case that you are taking deceitfulness to the next level by faulting anti-vaxxers for disease outbreaks, while you know perfectly well it’s the result of adults who may not even particularly identify themselves as anti-vaxxers (and, in fact, may even be pro-vaxxers who vaccinate their own kids), but, nevertheless, lapsed with their own boosters? Do you pursue this under-handed tactic realizing it’s easier to coerce parents into vaccinating their kids through scaremonger and shaming, rather than targeting adults to vaccinate their own self?

Yeesh.

It’s quite painful to see you parade your ignorance as some sort of badge of pride like this, yet again. I would be deeply ashamed if I exposed a lack of education and understanding the way you regularly do. Do you enjoy the disgust and scorn your idiotic comments provoke? If not, why do you do this?

That's an excellent question.

The answer would seem to be "to annoy." But I guess it's possible that he thinks he's scoring points.

Surely this is unpossible. Any antivaxxer worth their formaldehyde will tell you that such an enormous load of antigens and deadly toxins all at once, directly into the bloodstream (almost forgot that), would cause immediate death. [/sarcasm]

Oh yes...I distinctly remember dozens of young men and women dropping dead the morning of my induction physical after teams of grinning medics finished pumping our arms full of toxins.

(Actually there were quite a few of the boys who keeled over and had to be revived. The docs were used to it, evidently there's something about adolescent males and needles....)

Greggles:

I'm a parent, too,therefore I never lie. You know what you can do with your demands.

Christopher, how come your name doesn’t get around the same way? Just considering.

You may find this hard to believe, but not everyone is an attention whore.

Dr." Bob" is basically selling out for money. That's it, pure and simple. He's thinking about book sales and that's his bottom line.

@G. Vazquez

Dr.” Bob” is basically selling out for money. That’s it, pure and simple. He’s thinking about book sales and that’s his bottom line.

Excuse me -- excuse me, but do I know you? How do you pronounce that again? Vaz-qu-ez? Sorry -- can't say I have heard that name!

Sure have heard of Dr. Bob though.

@Chris Hickie
Christopher -- oh Christopher -- the lights have dimmed and the curtains are up. The audience is waiting for your report of your vaccination history. Will you keep them waiting?

@Tbruce

"I’m a parent, too,therefore I never lie."

That has to be the biggest lie that I have heard lately. Tbruce, I am a parent too and guess what we do? We lie to our kids!

"Daddy, can I have that 'Elsa' doll"?
"Sorry kid, but I don't have any money."

How can any sane parent raise their kids without lying? Now I know for absolute certainty that you are lying about your vaccines.

Greg,

Kreb, you serious need to chill! Can’t we have a calm, rational discussion without you always getting so hot under the collar and losing your cool? I swear Anger Management is in order for you!

I'm as cool as a mountain stream; that doesn't mean I'm prepared to give your either moronic or deliberately infantile, offensive behavior a free pass.

Anyway, you are blasting me for speaking of the percentage of people in the general population who are vaccinated. I explained that the likely percentage (50% or less) wouldn’t confer herd immunity.

Let's be specific and talk about measles. People over the age of 45 or so almost certainly are immune due to natural infection, the great majority of those younger will have had MMR. This high level of immunity is sufficient to confer herd immunity.

You are now arguing that percentage of individuals vaccinated is not the precise gauge for determining herd immunity, but the actual percentage of individuals who are indeed immune to IDs. Excuse me there Kreb, but isn’t percentage of vaxxed individuals been the only language that you guys have always spoken.

No, of course not. Vaccine coverage in infants is more or less equivalent to immunity, but it is the percentage of people immune to measles in any given population that matters. Don't project your own ignorance onto others.

Anyway, Kreb, let me see if I am understanding you by giving this take:

I very much doubt it, but let's see.

Essentially, within the population there are three groups: There are the kids, under the age of 20, who are being used as vaccine guinea pigs. They are being laced to the tilt with a solid brew of toxic concoctions, and which is understood as affording them immunity to IDs.

Except they are not being used as guinea pigs, given the extensive safety and efficacy testing before they are marketed, and you know as well as I do that it is a blatant lie abut the "solid brew of toxic concoctions".

(For the sake of not fanning the flame, for now, we will leave out the part that this group is experiencing exploding rates of chronic, debilitating disabilities, including autism.)

Another blatant lie.

Then there are the young and middle-aged adults (20 -55 yrs). They were likely vaccinated as children, albeit definitely not so quite to the tilt.

Why do you think this? Vaccination uptake has been generally high in the US until recently; there are now a number of parents too young to remember the impact of vaccine preventable diseases and gullible enough to be deceived into believing that vaccines are dangerous by idiots like you.

They are generally considered immune to IDs, except their immunity is often short lived, and even vaccines that were once thought to offer them life-long immunity are appearing to not be the case. >/blockquote>
Sticking with measles, this isn't true. We have every reason to believe that immunity to measles from MMR will last as long as natural immunity.

They will have to keep up with their vaccines and boosters.

In some cases, perhaps, but not in the case of measles.

Finally, there are the older folks (over 55). They missed partaking in the one of mankind’s ‘greatest invention’ and were not vaccinated. Yet, interestingly, being that they were likely exposed to the natural occurring diseases, they are considered to have obtained lifelong immunity. Also interesting, you need these folks to maintain your ‘triumphant’ herd immunity. Who is the parasite now?

As these people die off they will be replaced with people who were vaccinated and will likely also have lifelong immunity. If outbreaks start occurring in older people no doubt boosters will be introduced, but there is no sign of that at present.

Wrapping thing up, the problem for you guys are those 20 to 55 years individuals.

Only if you accept the misinformation you keep presenting as facts.

With their waning immunity, you are left with the unpleasant task of explaining to them that the ‘mad scientist’ vaccination experiment did not go exactly according to plan, and they will need to keep rolling up their sleeves and keep taking their shots for the herd.

This isn't true, and even if it were, surely anyone in their right mind would prefer a shot every couple of decades to at best a week or two of misery and at worst pneumonia, encephalitis or death.

Even more crucial (because given the numbers game, this is where the real money is at) you must convince them to keep vaccinating their kids,

Any intelligent parent who has been spared the old childhood diseases by vaccination would be willing to do their children the same favor.

and especially in face of their growing skepticism after seeing how vaccine induced autism is ravaging their kids.</blockquote.
Except this isn't true, and I don't know anyone who believes this IRL.

Kreb, is this a accurate summary of things, and are we on the same page?

No, you are demonstrably wrong as has been repeatedly pointed out to you.

Also Kreb, you have been quite assertive in arguing that disease outbreaks are indeed being caused by individuals who go deliberately unvaccinated.

Outbreaks may have several causes, but non-vaccinators are undoubtedly a major factor. Vaccination is the only safe way to keep the percentage of immune people in a population high enough to prevent outbreaks. Not vaccinating without good reason decreases that percentage and increases the likelihood of outbreaks.

I am now leaving you two links documenting two recent large outbreaks that are considered caused by vaccine failures and waning immunity. They include the Wales measles outbreak of last year.

Those are about mumps, and the Welsh measles outbreak is only mentioned in passing.

We used to have the Urabe mumps component in MMR in the UK, but this was replaced by a safer mumps component because Urabe causes aseptic meningitis (which almost always resolved unenventfully) in a small number of recipients. Mumps itself causes aseptic meningitis in 10-30% of cases. It seems likely that Urabe is considerably more effective than the Jeryl-Lynn component that replaced it.

As with pertussis, I think we have traded efficacy for safety, a decision that is beginning to have unfortunate longer term consequences. We shouldn't have listened to those antivaxxers back then, Some vaccine side effects are worth tolerating for the sake of preventing the disease itself.

If it does turn out that mumps immunity from MMR wanes after a couple of decades, which is by no means clear, we may need to introduce a booster. It's surely better than 10-30% of all children suffering meningitis.

In any case, and more to the point, people not vaccinating their children with MMR makes the situation worse. From your own link:

"[It] makes it even more important for the unvaccinated to have the vaccine because herd immunity is not high, so individual protection relies on your own vaccination,"

I couldn't put it better myself.

With their waning immunity, you are left with the unpleasant task of explaining to them that the ‘mad scientist’ vaccination experiment did not go exactly according to plan, and they will need to keep rolling up their sleeves and keep taking their shots for the herd.

Wrong. This has already been explained to you, blockhead. Congregate settings are prime examples of high-risk populations. Did you bother to look at the age distribution? (Fig. 3.) No, I didn't think so.

Unsurprisingly, the question of a third booster has been examined (e.g., PMID 18419346) in the context of the 2006 Midwest epidemic in a relatively unaffected yet comparable locale:

"No major evidence for primary vaccine failure was observed among the seronegative persons.... The Jeryl Lynn mumps modified live vaccine virus and prior mumps virus infection does not seem to be as effective as the modified live measles vaccine virus in inducing immunity. Mumps virus infection has been documented among persons with previous mumps virus infection and among 2-dose recipients of mumps vaccine."

No recommendation for a third booster has followed.

I am now leaving you two links documenting two recent large outbreaks that are considered caused by vaccine failures and waning immunity.

"Considered caused by"? It is known that mumps vaccine is "only" ≳88% effective. There are two studies that I'm aware of that found a signal of waning effectiveness in the 2006 epidemic; if this were the "cause," the pattern would have repeated by now. Yet all there is, is the 2009–2010 New York outbreak, which was almost entirely limited to a population with inadequate coverage to sustain herd protection (PMID 20150887). At best, it's contributory. A percentage point here or there can make a substantial difference in a concentrated in a high-risk population.

"Fortunately," there's a test on the horizon: There are 40 cases at Ohio State (the Fordham outbreak in February didn't "pan out"; note that nearly half of students don't live in University housing), which does not require vaccination for attendance, index case so far unreported.

BTW, if anybody's looking for a CME credit, mumps is available.

^ "in a concentrated in a high-risk population."

Dr. Bob sure sounds smart, and knowledgeable. His name is everywhere!

That's odd, as a G—gle News search turns up exactly one mention. On LB/RB.

New 2013 ACIP/CDC recommendations for MMR vaccines, here, which includes the elimination of a physician-diagnosed measles case as an acceptable criterion; now replaced with a blood test for proving immunity to measles.

http://www.cdc.gov/mmwr/pdf/rr/rr6204.pdf

Got one dose of MMR in infancy, a second dose at eleven, four OPV doses in infancy, five DTP in my first and second year, a TD when I was sixteen, a DTaP a few years ago, one HiB when I was two (early in the vaccine developmenT) , and the Hep A/Hep B vaccine in 2001, three doses, just after I started college. My sister got the exact same ones (besides the hep a/b) except she's got Asperger's syndrome. Oh, and we're identical twins. Only childhood illness was varicella, and while it was mild it also left a gigantic chicken pox scar on my left leg. Of course, since Gerg doesn't know my real name, even if I scanned a vaccination record he'd probably disbelieve it. I could supply a DNA sample, but he'd probably say it was from my sister.

Of course, since Gerg doesn’t know my real name, even if I scanned a vaccination record he’d probably disbelieve it.

Once again, all he has to do is pony up the cash.

So how long does vaccine protection really last? Although you will probably dismiss this as anti-vaxx quackery --like you do everything else that is not favourable to your side-- I found it an interesting read.

http://www.modernalternativemama.com/blog/2011/2/8/vaccines-how-long-do…

How long does vaccines protection lasts? Although you will probably dismiss this as anti-vaxx quackery (like you do everything else that does not sit well with your side), I found this article an interesting read.....

http://www.modernalternativemama.com/blog/2011/2/8/vaccines-how-long-do…

Of course, Greg won't counter to my offer. Nameless cowards never do--and that is the face of anti-vaccination in the US--nameless liars who lie.

#86 Source for the claim in the first sentence? Or this this simply your imagination?

So, here’s the situation in the O.C., where I live and practice. Seven cases. Seven. That’s 7.... Everyone is quick to blame those who don’t vaccinate, AND those who don’t vaccinate start to panic.

I noticed that Chris Hickie posted a link to this on FB.

Twenty out of 36 cases unvaccinated.

^ Fourteen intentionally.

In spite of the crank hateful conspiracists who post vile remarks about undocumented aliens (usually from Mexico, according to armchair haters), once the California and New York measles outbreaks are fully investigated and the "index case" is identified, I would bet the farm, that the index case is a young deliberately non-vaccinated child, whose parents took him/her to a measles endemic country, where the child contracted measles and returned home to infect other deliberately unvaccinated kids, babies too young to have received MMR vaccines, those with valid medical contraindications...and adults, who do not have records of immunizations against measles.

No matter how many times I have posted about the circumstances as I described above...there are always those who post their ignorant comments.

Cripes, I hate these these ignorant people and there persistent posts.

I would bet the farm, that the index case is a young deliberately non-vaccinated child

California looks to have had 10 separate importations.

@ dedicated lurker

Of course, since Gerg doesn’t know my real name, even if I scanned a vaccination record he’d probably disbelieve it. I could supply a DNA sample, but he’d probably say it was from my sister.

Like anyone set in their twisted beliefs, he will always find something to object to.
After all, antivaxers already believe that everybody else, including FDA and scientists, are just lying about herd immunity, vaccine effectiveness, and so on, faking data if need be. Why would they believe a random entity on the internet?
(except when the entity shares their beliefs, of course)

That's why in an earlier post I posted a video about some guy making public the video of his birth and the original of his birth certificate. That didn't stop a lot of people to keep thinking he is not a true American.

@Chris Hickie

Of course, Greg won’t counter to my offer. Nameless cowards never do–and that is the face of anti-vaccination in the US–nameless liars who lie.

So challenged to state publicly (for benefit of everyone who you are trying to convince of the sensibility of vaccination) whether you practice what you preach and are fully compliant with the CDC recommended adult vaccination schedule, you gingerly side-step the matter by faulting me. HMMMNNN!

Come now Christopher, surely you can do better!

Based on the link in #274, there are 36 cases. Twenty are known to be unvaccinated, fourteen intentionally, six not (maybe they're too young or have medical contraindications). Twelve more are of unknown status. That leaves ten who are known to have been vaccinated, but we don't know whether they had had the full sequence. Still, 10/36 is only 28% of the cases. Given that the vaccinated percentage of the population is well over 28%, even in areas with high vaccine refusal, any reasonable person (which excludes Greg, of course) can see that an unvaccinated person is far more likely to get the measles than a vaccinated person.

@Derg - since most of us are parents, you should accept our statements unconditionally...as you do with the stories from all other parents....or are you now admitting that you are a liar?

So, according to the article I gave, if falling antibodies indicate that vaccines protection may last from 7 to 16 years tops (and not a lifetime), how is this not an accurate measure? By what measure do you base your lifetime claim?

@Lawrence
Setting aside the rest of you, Mr Hickie still haven't made any claim whatsoever about is vaccination status. I find it strikingly perplexing.

As for the part about being a parent and not lying, please see my earlier post where I explained that being an excellent liar goes part and parcel with being a good (and effective) parent.

So far Sears has been silent about the fact that there are now 10 cases of measles in Orange County (that would by 3 more than 7, Greg, as I know you AV types can't even correctly count the number of vaccines on the CDC schedule).

So, if one of the infected dies, what will be anti-vax response be, you think?

If one of the infected dies, the anti-vax response will be one of the following:

"Vitamin C would have saved the child."

"Homeopathy would have saved the child."

"The child was probably sick from its vaccines to begin with."

"The child was probably not healthy to begin with."

Or a variation of the above four.

I'm having trouble posting comments - anyone else?

Your comment got through. I'm posting to see if I have a problem.

Grrr. Will try again later.

Trying again as I just succeeded on another thread. Sorry if all my previous attempts suddenly appear.

Greg #273,

Although you will probably dismiss this as anti-vaxx quackery –like you do everything else that is not favourable to your side– I found it an interesting read.

It's written by someone who is breathtakingly ignorant on the subject so it doesn't surprise me that you liked it. Why is it that people who don't know the first thing about a subject think they are qualified to write a blog post like this? There are some very stupid statements and some serious misinformation in that post:

There are no long-term studies proving that vaccines are effective.

That's a flat lie for a start. There are many, for example PMID 1509566:

Serological investigations carried out with follow-up periods of up to 16 years after vaccination for measles, 21 years after vaccination for rubella and 12 years after vaccination for mumps reveal that loss of antibodies occurs with the elapse of time but that the clinical significance of this is probably very limited.

She continues:

Independent studies show far less effectiveness than government position papers. There were even notes in several papers that “we assume protection continues even if antibodies fall below detectable rates.” As antibodies are the primary means of determining protection, there is no way they can logically make such a leap; yet they have.

It seems the author isn't aware of the existence of memory t-cells, which still provide adaptive immunity even if antibody titers are low through an anamnestic response.

It is also important to note that non-mainstream sources say that antibodies prove exposure to the disease, but not immunity to it.

Precisely, you can still be immune to a disease even with undetectable titers, but the author clearly misunderstands this.

One interesting thing I saw was that all vaccines were noted as “highly effective and very safe,” without any data citations. Studies I ran across did not always support this conclusion.

But she gives no actual citations to support this. I wonder why.

According to the WHO, up to 15% of children fail to develop immunity to the first dose, which is why a booster dose is recommended.

It's not a booster dose then, is it?

“Protection” is supposed to last up to 11 years. This means that assuming a child actually gains immunity (some will not even after 2 doses), it will have worn off completely by 16 years of age.

Nonsense. Her own source says:

up to 11 years without substantial decline, and "continued surveillance will be necessary to determine further duration of antibody persistance." [sic]

She presents no evidence that MMR wears off by 16 years of age. If a study follows a person for 11 years after vaccination and finds they are still immune, it doesn't mean that the day after the study their immunity vanished.

The vast majority of adults in this country are not protected (yet we haven’t seen measles outbreaks among these adults, have we?).

That's because they are protected. It beats me how someone can present evidence that flatly contradicts their position as somehow supporting it. Bizarre.

Also according to the WHO, vitamin A supplements and adequate nutrition are key to preventing measles and complications.

Adequate nutrition reduce the risk of severe sequelae, they don't eliminate it.

According to the WHO, vitamin A also helps to prevent deaths and other complications from polio. 95% of people who get polio, though, show absolutely no symptoms; only 1 – 2% ever develop paralytic polio (and less than 1% of these are permanently affected).

Is she suggesting that vitamin A prevents paralysis from polio? Or that 1-2% paralysis is acceptable? If not, I don't what she is suggesting.

Length of protection is unknown, but thought to be “many years.” (This is really untestable since there are no wild cases in the U.S.)

Not true, as PMID 2831621 found people in Sweden were still immune to polio 25 years after vaccination.

Rubella [...] About 95% of people who are vaccinated are then “protected.” Another source says that only 75% of people are “protected” and that this protection wanes after 3 – 5 years.

Her source for this is from 1975.

This means that babies and children who are vaccinated are likely not protected in adulthood.

Not true. PMID 18419470 found 100% seropositivity to rubella 20 years after vaccination.

Tetanus shots are said to last around 10 years, which is why doctors recommend a booster every 10 years. It is interesting and important to note that people who have been naturally infected do not have permanent immunity (which calls into question how a vaccine can produce lasting immunity).

The tetanus vaccine is designed to produce lasting immunity, unlike a natural tetanus infection. Is she seriously suggesting that the tetanus vaccine doesn't work? Why does she think we are advised to get ten yearly boosters?

This vaccine also has a higher than average rate of reactions and has been linked to Guillian-Barre.

Minor adverse reactions like fever from DTaP, I assume she means, but not GBS - PMID 23580737:

In this large retrospective study, we did not find evidence of an increased risk of GBS following vaccinations of any kind, including influenza vaccination.

She goes on:

Hep B [...] The idea is that if babies are vaccinated, that they will be protected later when they are actually at risk, as teenagers (Hep B is spread through sexual contact, sharing needles, etc.).

Not just this; many babies are infected vertically and children through close contact with other infected children.

Unfortunately, one source estimates that “protection” lasts up to 10 years.

One source? It was from 1993, more than 20 years ago, only about ten years after the vaccine was introduced, when we didn't know for sure if it lasted longer. PMID 24101865 found:

Immunity after primary vaccination with hepatitis B recombinant vaccine persists for at least 20 years post-vaccination, with significant association with the number of vaccinations. Furthermore, the presence of anamnestic response to booster vaccine indicates long-lasting immunity despite decreasing antibody levels; therefore, the need for hepatitis B vaccine boosters may not be of significant benefit after complete infant vaccination.

So the rest of the author's claims:

This means that babies who are vaccinated are no longer protected when they are at greatest risk.

Simply not true.

HPV [...] Sources estimate protection lasts for about 5 years, but this is highly uncertain — “we don’t really know” is more accurate.

Not true again. We know it lasts at least 7 years and have every reason to believe it will last much longer. PMID 24618824 states that 50 year duration of protection is a "realistic assumption".

If protection lasts about 5 years, girls are no longer protected during their greatest risk period. There is no data available on what the rate of “protection” is. (Sorry, but it seems to me if they’ve done no long-term studies that they shouldn’t be recommending it….)

It's hard not to describe this as deliberate falsehood. The safety and efficacy of HPV vaccines is excellent.

HIB [...] The first source I check says “length of protection is unknown.”

PMID 14615157 found children were still protected 10 years after vaccination.

The HIB vaccine is, as usual, assumed to confer 95 – 100% “protection” but there are no studies that determine this is the case.

That's a flat lie. PMID 14583937 is a systematic review and metaanalysis of several such studies that concluded:

Hib vaccine is safe and effective. The size of the effect could plausibly be anywhere between a 46% and 93% reduction in Hib invasive disease, before the effect of herd immunity is taken into account.

She ends with:

So, in conclusion, I have found a lot of assumptions and shaky or non-existent science surrounding vaccine immunity, protection, length of protection, etc.

No, she has lied and distorted the available evidence appallingly in an effort to support what are presumably her irrational prejudices against vaccines.

It seems that the scientific community is extremely optimistic and enthusiastic, but cannot provide much evidence to support this position.

Not at all true.

In some cases the available studies contradicted the general “information” that I found on major scientific websites.

She means, "if I looked hard enough I could find some studies that contradicted the consensus".

My conclusion? A despicable piece of deliberate disinformation designed to put parents off vaccinating their children and to put public health at risk.

Thanks for sharing Greg, it's nice to have a chance to expose this kind of garbage for what it is.

So challenged to state publicly (for benefit of everyone who you are trying to convince of the sensibility of vaccination) whether you practice what you preach and are fully compliant with the CDC recommended adult vaccination schedule, you gingerly side-step the matter by faulting me. HMMMNNN!

Funny, you're entirely silent when challenged to make it an honest bet. And about this. And this.

I see no reason to deal with Greg until he has answered my question, which I have been trying for months to get him to address:

Please provide the PubMed indexed study from a reputable qualified researcher that shows any vaccine on the American pediatric schedule causes more seizures than the actual disease.

Here might be an easier way to consider the issue:
when vaccination coverage dips below a certain point, WHO is it that gets sick?
Are they 20-50 year olds, 50 year olds + or children?
*IN GENERAL*.
Why don't those who are allegedly 'not up to date' - or suchlike- not getting sick?
EXACTLY who gets measles, etc?

-btw- I had a lovely day yesterday traisping through ancient buildings, viewing antique portraiture and even seeing an urban archeology project-
it was a deep hole revealing deteriorating foundations and it was littered with refuse and broken shards of past culture hundreds of years old....
it reminds me a great deal of anti-vax material.

TRAIPSING

I haven't replied to The Troll directly during the past eleven months that he has haunted Respectful Insolence...it is an exercise in futility.

Someone upthread made an interesting observation about The Troll...he derives pleasure from evoking responses to his fact-free comments. He's a proven pathological liar, has no education...no less an education to be a "behavioral specialist". Most probably, he's a cellar dweller who sponges off his mommy.

Just ignore, ignore, ignore and post comments around The Troll.

The vast majority of adults in this country are not protected (yet we haven’t seen measles outbreaks among these adults, have we?).

That’s because they are protected. It beats me how someone can present evidence that flatly contradicts their position as somehow supporting it. Bizarre.

This is precisely what Gerg has been doing in these very comments. One might wonder whether he came up with it on his own.

Tetanus shots are said to last around 10 years, which is why doctors recommend a booster every 10 years. It is interesting and important to note that people who have been naturally infected do not have permanent immunity (which calls into question how a vaccine can produce lasting immunity).

The tetanus vaccine is designed to produce lasting immunity, unlike a natural tetanus infection. Is she seriously suggesting that the tetanus vaccine doesn’t work?

This is not all that uncommon: the trope is that it's impossible to vaccinate against a toxin. Back on MDC, the same people oddly used to suggest HTIG "instead."

Anyway, it turns out that the disparate recent subjects of Gerg's source, Dr. Tuteur, and attachment parenting can be tied up with a neat little bow.

^ For completeness, naturally acquired antibodies to tetanospasmin do exist.

@Lawrence--if someone dies of the measles and was unvaccinated, anti-vaccine groups will either be silent or snarkily post that it was somehow the dead person's fault that their immune system couldn't fight the infection (despite that it's been show there will always be deaths from measles--see most recently a very good discussion of this on Left Brain Right Brain (http://leftbrainrightbrain.co.uk/2014/03/21/yep-measles-is-still-a-kill…). If the person who dies is vaccinated, they will all jump on their soap boxes and squeal in delight (with no respect for the dead) that this is proof vaccines don't work.

Shameful either way--but that is their nature.

@156 Gerg: As a child in the mid 1960s,I was fully vaccinated with the current-for-the-time recommendations, plus a fair number of bonus vaccines related to international travel as a missionary kid. But I got an MMR booster when I went to nursing school in 1992, as well as the Hep B series. When I went back for my Masters in 2007, I had to get titers, which showed I was MMR-V immune, but oddly, completely negative on the Hep B panel, so I repeated that series, which after completion, showed I was now immune, with plenty of Hep B SAb.
I order titers and booster vaccines all the time for adults entering health care professions, and immunity from the Hep B series seems to be the only one that wears off or never "took" in the first place, and needs to be boosted.
I am also vaccinating many many adults of all ages with the TDaP for the protection of the infants and elderly in their families.
So, yes, we are encouraging adults to get vaccinated, and not only with their annual flu shots. And I've "rolled up my sleeves and taken jabs for the team" quite often, thank you! Feel free to crawl back into your nasty hole now.

Meanwhile, yesterday (March 22), CNN has an article on the last case of polio in India and the declaration that India is polio-free. The three keys to this fantastic success are "immunize, immunize, immunize".
I don't really care how the moronic anti-vaxxers will try to spin this, or ignore it. I'm just happy that one more region of the world is free from this disease. Just 3 countries left, Afghanistan, Pakistan and Nigeria, where vaccinations are being blocked by religious ignorance.

Greg: What happened to Scarlet Fever?
Kreb: Antibotics

Yet, this article tells a bigger story, explaining that the incidence of Scarlet Fever was well on the decline even before antibiotics...

Why did scarlet fever, once a scourge of childhood, end up as a relatively rare infection in developed countries? While some of this can be attributed to antibiotics (particularly from the 1950s on), both the incidence of scarlet fever and mortality from the illness started to decline well before the antibiotic era (seen on the graph above)–a phenomenon that may be attributable to the emergence of novel strains of S. pyogenes in the population which were less likely to cause scarlet fever, but more likely to spread in the population. (A similar strain replacement may have occurred in the late 1970s/early 1980s, leading to the increase in the aforementioned “flesh eating” strains of strep). Other biological factors such as herd immunity to epidemic strains, as well as social factors including decreased crowding, improved hygiene, and even milk pasteurization (milk was responsible for several large group A strep outbreaks) also probably contributed to this decrease.

http://scienceblogs.com/aetiology/2011/07/06/scarlet-fever-in-hong-kong/

So, are we not seeing a massive re-emergence of IDs because most individuals are protected by vaccines, and the herd immunity effect?

Gerg’s source, Dr. Tuteur, and attachment parenting can be tied up with a neat little bow.

Kate Tietje is an eedjit, but Amy Tuteur does not come across as much better in that splurge of pop-psych.

@Lilady

Someone upthread made an interesting observation about The Troll…he derives pleasure from evoking responses to his fact-free comments. He’s a proven pathological liar, has no education…no less an education to be a “behavioral specialist”. Most probably, he’s a cellar dweller who sponges off his mommy.

Thanks again for reminding me that I must get in touch with Mom about depositing the money in my account, with rent being passed due. That freakin landlord is even threatening to cut my cable and internet. How will I then educate you guys about the harms of vaccines? What -- get a job so I can afford this lousy basement apartment? (Hee hee hee.)

(Screwed up with blockquote at #303 -- wasn't Julian's fault this time.)

Just saw a story on my Facebook news feed.
Four more cases of measles in California. Four who caught it abroad were intentionally unvaccinated.
http://mcqsjazz.com/1/4-more-measles-cases-in-california-4-who-got-it-a…
So much for "waning immunity" posing a bigger threat.

“I’m a parent, too,therefore I never lie.”

That has to be the biggest lie that I have heard lately. Tbruce, I am a parent too and guess what we do? We lie to our kids!

Hear that "whoosh" sound? Oh, I forgot, you don't hear a damn thing that you don't want to hear.

anti-vaccine groups will either be silent or snarkily post that it was somehow the dead person’s fault that their immune system couldn’t fight the infection

No.

Wait, I mean yes.

So, are we not seeing a massive re-emergence of IDs because most individuals are protected by vaccines, and the herd immunity effect?

You've already stated as much yourself.

Gerg’s source, Dr. Tuteur, and attachment parenting can be tied up with a neat little bow.

Kate Tietje is an eedjit, but Amy Tuteur does not come across as much better in that splurge of pop-psych.

I don't know what she's talking about, quite.

But it's not attachment theory or attachment parenting.

Or attachment therapy, god forbid.

I don’t know what she’s talking about, quite.

Tateur's primary complaint seems to be that Tietje worded her self-awareness about her (Tietje's) parenting flaws in the wrong terms, having failed to word it in Insightful Psychotherapeutic language.

It doesn't help that Tateur outsources a lot of her psychobabble to a couple of psychoanalytic woo-vendors, and resorts to hand-wavy claims that some things are so well-accepted in popular culture as to need no evidence:

Indeed, research appears to support the notion of intergenerational origins of exploitive and abusive parent-child relationships

I mean, research either supports a notion or it doesn't. If it only appears to support a notion, then perhaps it's time to conduct some proper feckin research rather than appeal to this kind of vague "everyone-knows".

Thanks herr doktor bimler. I gave up half way through Dr. Amy's post. Amy's loyal minions seem to understand her.

@ herr doktor bimler:

I made the great mistake of reading through that post which precipitated an intense flashback in which I relived memorising the arcane psychodevelopmental sequences imagined by Melanie Klein and others of that ilk. The horror!

Now I entirely understand that we must, of necessity, tolerate misery and futility in order to get degrees, but these people aren't going to get degrees out of it!
They may actually believe it.

Dr Tuteur’s pop psychology aside, the Babble piece by Kate Tietje is a piece of work, and has been heavily edited since it first came out (March 2011). Even after the editing, the piece makes my skin crawl, and I hope her daughter never reads the original version.

Greg: "Yet, this article tells a bigger story, explaining that the incidence of Scarlet Fever was well on the decline even before antibiotics…"

And again he demonstrates reading comprehension fail. The article said the strains of strep that cause Scarlet Fever declined, but other kinds of strep infections increased.

Scarlet Fever is a type of strep infection. Strep infections have not declined.

I relived memorising the arcane psychodevelopmental sequences imagined by Melanie Klein and others of that ilk

Oh yes. I had reason once to try to get my head around Klein, and Hanna Segal's attempts to interpret her ideas for uninitiated readers.
There may well have been *something* behind the verbiage and the ad-hoc ipse-dixit pattern of reasoning... but it seemed to be an approach from which one could equally easily predict (or explain) X, or not-X. I ended up sympathising with Laing's difficulties in distinguishing post-Freudian psychodynamics from paranoid ideation.

WIll post the Babble link if requestd
PLEASE NO.

WIll post the Babble link if requestd
PLEASE NO.

Is it available on Yammer?

I only use Gibber.

Indeed, research appears to support the notion of intergenerational origins of exploitive and abusive parent-child relationships

I mean, research either supports a notion or it doesn’t. If it only appears to support a notion, then perhaps it’s time to conduct some proper feckin research rather than appeal to this kind of vague “everyone-knows”.

It's very poorly phrased. But it's just a foolish remark anyway. Nothing could really make it applicable. Because overdetermination,

I like Melanie Klein. I was just reading a case history by her. But object-relations theory is a little more jargon-y than one might wish, I do admit.

JerryA @302 -- So polio has disappeared in India?

I'm sure it's all due to better sanitation.

/heavy sarcasm

@302 "India’s dramatic turnout in polio eradication, though, has seen a consistent sidelining of the increasing incidence of non-polio acute flaccid paralysis (NPAFP) cases. In the last 13 months, India has reported at least 53,000 cases of NPAFP."
http://www.livemint.com/Politics/XS6vPor5jFX3vKkaE7Ri6H/India-to-get-po…

@ palindrom:

Interestingly, two people I know just returned from India and Bangladesh - separately- and whilst neither mentioned polio, many other vaccines and prophylactic meds appear to have been involved.

So I guess that sanitation is highly selective in its effects.

-btw- my relative was working on a water system design project.

@anon --

The reason there's an apparent uptick in NPAFP cases in India is that the surveillance that goes with the polio eradication program is picking up previously uncounted instances of a variety of other illnesses:

“The increased non-polio AFP rate is due to increased reporting of AFP cases due to deliberate efforts of the programme to increase the sensitivity of the surveillance system since 2004,” according to the WHO Country Office for India. In a written response provided to this correspondent, the health body said these efforts were more intense and closely monitored in the traditionally polio-endemic states of Bihar and U.P., resulting in even higher rates of reporting of AFP cases in those States.

In 2004, a number of steps were initiated to strengthen surveillance in order to accurately and more rapidly detect all polio cases in the country, it said. Those measures included expanding the definition of AFP; increasing the number of AFP reporting sites; increasing the number of active surveillance visits; and more training for health professionals on what constituted an AFP case.

Since then, the number of AFP cases that were reported and investigated continued to increase, it noted. This was not due to an increase in the incidence of a specific disease that might cause these symptoms. Rather, it was the direct result of surveillance activities for AFP cases being strengthened.

(Link.)

I know that's not what Mercola says. But he's wrong.

I just answered that question for another poster about non-polio AFP cases, on another blog. It must be making the rounds:

http://www.polioeradication.org/Dataandmonitoring/Surveillance.aspx

Olmsted at AoA reported on some California youngsters who were diagnosed with polio-like paralysis...caused by another enteric virus. Let's see if Dan is able to spin those cases into a polio or polio vaccine epidemic.

@ann- Off topic
I don't know what Mercola says- just reporting on India.
"Malnutrition is more common in India than in Sub-Saharan Africa. One in every three malnourished children in the world lives in India"
http://www.unicef.org/india/children_2356.htm

@ann- Off topic
I don’t know what Mercola says- just reporting on India.
“Malnutrition is more common in India than in Sub-Saharan Africa. One in every three malnourished children in the world lives in India”

Congratulations, rather than trying to understand the point, you're now simply repeating a comment that made no sense in the first place.

(Link.)

(Broken.)

Apologies.

I took a couple graphs from this here:

http://www.thehindu.com/opinion/lead/polio-free-does-not-mean-paralysis…

@ann- Off topic
I don’t know what Mercola says- just reporting on India.
“Malnutrition is more common in India than in Sub-Saharan Africa. One in every three malnourished children in the world lives in India”
http://www.unicef.org/india/children_2356.htm

I see.

And one might think it was where paisley came from. But it's Persian,

http://en.wikipedia.org/wiki/Paisley_%28design%29

We should probably return to topic, though.

"One in every three malnourished children in the world lives in India"

And that's relevant to your prior statement about AFP because ... ?

Hey, I can do it too! I don’t know what Mercola says- just reporting on Ireland. Red hair is caused by several different mutations.

It must be making the rounds

Yah, it's the revivification of Vashist & Puliyel. I take it that that poliomyelitis interruptus is giving some folks blue balls. The Royal Society transacted an entire issue last year.

“One in every three malnourished children in the world lives in India”

And yet they've been polio-free for three years. So much for nutrition being enough to take away disease.

#334 Obviously the polio vaccine does work.

#332 Didn't know that-must tell my red-haired friend.

#331 I love paisley, did think it was Indian, thanks for the link,,,,
(Narad checks my commas)

Red hair is caused by several different mutations.

Hell, the new kitten has sharp bilaterally asymmetric pigmentation.

The kitten's name is Hell?

Or the kitten is named something else and l'enfer, c'est un discourse marker?

Chemmomo: I dunno, it doesn't strike me as all that damaging. If that were me, I'd just shrug- or go 'knew it.' Moms always prefer sons over daughters.

Moms always prefer....

Has sloganeering ever panned out for you?

Unintended irony can always brighten a grey and dreary day for Orac's minions:

Ann Dachel instructs professional journalists about covering stories for autism awareness month:
( quoting an investigative reporter/ caps her own, I suspect)
"CHECK SOURCES
you need DOCUMENTATION
CHECK UP FIRST HAND".

A "good reporter" would talk to "real parents" about the "stunning leap in the rate"** and would "hold officials accountable" for the research they discuss and would ask about the source of funding for studies and COIs.

I swear, I thought that this weekend's contributions by Olmsted and Jameson were off the charts but this one takes the cake/ biscuit!
And,-btw- where is our own SBM antidote to Dachel, lilady?

** she uses 'stunning' frequently, here and elsewhere.

@ ann

Or the kitten is named something else and l’enfer, c’est un discourse marker?

Something else, of course. L'enfer, c'est les autres.

@PGP
My mother loved having a son and my aunt wanted a daughter and stopped trying after 4 sons.

Narad: It's not sloganeering, just fact.

Renate: Life really likes to be ironic, doesn't it?

@PGP
Yes, even more ironic than you might think.

Let me step in and see if I can bollux this up even more-

Really. I think that PGP *might* possibly be using hyperbole to emphasise that she thinks that MOST prefer boys. And that it's not fair.
Amirite?

At any rate we can check it out via suveys, research et al and guess why that that is so ( opposite sex attracts, men have more social power, are valued more, fears husband's rx to girl, evolutionary pressures for extra expendable males etc).

HOWEVER if it is not hyperbole in the service of sarcasm, social criticism or suchlike,
then it might have to be re-configured because at least a few men prefer having a daughter ( like my father)..

PGP, what exactly do you mean? Do you mean "all, always" or "most" and "it's not fair" ?
The English langiuage is our friend: we can say exactly what we mean in many divers and exotic ways.

Here's the SBM antidote to Anne Dachel. Today, Anne lectures mainstream reporters on the proper way to interview subjects...as if she has ever been a reporter, instead of the "Media Editor" whose media updates are sponsored by a crappy compounding pharmacy factory.

The bot doesn't like our choice of resources and experts such as Dr. Paul Offit and she's p!ssed that mainstream journalists and science bloggers post articles about AoA spokespersons such as Jenny McCarthy, Kristin Cavallari, and Dr. Andrew Wakefield.

So, here we have a retired history teacher, whose own drive-by posts on each and every internet site are off topic and canned Spam, lecturing us. That's rich.

"When you mention Dr. Wakefield, you do the same thing. The man is a gastroenterologist and the children he wrote about were brought to him by their PARENTS. THEIR PARENTS said they were normally developing until they received the MMR vaccine. They got sick with BOWEL DISEASE AND AUTISM. How come no one ever interviews any of them? Why don't you ever mention the fact that the British government indemnified the manufacturer of the MMR and that the government has everything at stake in denying any link?

I could go on and on. I've been following all of you for years and your claims never change. It's so obvious to us out here in the real world that you're not doing your jobs.

It's all about telling the truth. And it's all about covering up the truth."

@PGP or maybe they don't - http://www.slate.com/articles/health_and_science/medical_examiner/2012/…

Narad: It’s not sloganeering, just fact.

MDC doesn't seem to find this "fact" to be as obvious as you do.

PGP@340
Your comment is as offensive as Tietje’s.

PGP one more thing:

Get back to me after you become a parent.

I'm not a parent. I think most parents who want at least two children would like to have children of both sexes, but the only people I've known who didn't want a child of a particular sex were really, really creepy.

I think most parents are happy with a healthy pregnancy that results in a healthy child, at least most that I have interacted with.

It's pretty simple, really.

Something from Greg I missed:

So, according to the article I gave, if falling antibodies indicate that vaccines protection may last from 7 to 16 years tops (and not a lifetime), how is this not an accurate measure? By what measure do you base your lifetime claim?

Look up "anamnestic immune response". A lack of circulating antibodies does not necessarily mean a person is not immune. They may still not be infected if exposed because their immune system will immediately produce copious antibodies (an adaptive response) when re-exposed to the antigen/pathogen.

There are several studies looking at the antibody response of people vaccinated several years previously who have low circulating antibodies. Their anamnestic antibody response is far greater than the primary response of an unvaccinated unexposed person. For example this study of individuals vaccinated against hepatitis B 17 years previously which concluded:

This finding shows that the immune memory for HBsAg persists beyond the time at which anti-HBs disappears, conferring long-term protection.

Short version: falling antibody levels do not necessarily mean a lack of immunity to the disease. For public health purposes it is sensible to aim for high levels of circulating antibodies as this ensures immunity, but in practice those with lower levels may still be immune.

Because I have some spare time before I have to leave....

Our friend PGP may understand the following analogy which I will sneakily uncover after I have led everyone down a garden path or two- but garden paths are necessary:

researching what people think about various issues is something which is fraught with difficulty for myriad reasons but social scientists trudge onwards nevertheless:
- people may not be honest
- they may want social approval
- they may want to blend in with what others say
- they may not want to sound prejudiced or mean
- they may simply answer the same way to each question
- they may be influenced by the experimenter
- ETC.

Other meaningful problems involve questions about long-standing attitudes and whether they predict how a person will actually behave. AMONGST other things, like whether long standing attitudes exist at all.

Be that as it may, we can measure attitudes, preferences and beliefs in a SOMEWHAT scientific manner. With statistical tests even.

WE can therefore test out our own beliefs about what others believe and how they relate to other sets of beliefs.
Perhaps I think that liberals are MORE LIKELY than conservatives to accept SBM ( I don't know if this is true or not- it's purely an example) I can dream up a questionaire, control for different variables, testing issues, sampling problems et al and see if my hypothesis pans out- or not- and if it does, to what degree it's true.

Suppose I find that my supposition is indeed borne out by the data: I learn that 70% of a large-enough representative sample of liberals as defined by a standard survey support SBM and a lesser number- 50%- of conservatives do and this difference between groups is significant statistically.

Then I can say that a greater proportion of liberals support SBM than do conservatives. AND that's about all I can say.

This may remind you of studies that test the efficacy of vaccines or other medical products. However, we are not testing a physical effect when we test attitudes and how they line up against other socially derived variables. If we're testing a bp med, we can measure bp. Thus it's not the same level of reality.

SO what I venture is that whilst PGP finds it easy to support SBM results when we're talking about vaccines' efficacy or meds' usage, she has more trouble with comprehending the flimsier, slipperier scaffolding of testing arcane belief systems and how they interrelate. AND how to discuss them as well.

But let me just say that if someone can "get" the SBM part about meds and vaccines, I would never call that person a 'lost cause.
Just a step or two away.

Something else, of course. L’enfer, c’est les autres.

...
http://www.youtube.com/watch?v=epUk3T2Kfno

I've never seen the problem with them, myself.

The kitten’s name is Hell?

Or the kitten is named something else and l’enfer, c’est un discourse marker?

It would be very silly to give a cat a monosyllabic name. Not that she responds to either the full or the nickname. I might be forced to change it, but the only thing she's answering to at the moment is "Meepers," which would be ridiculous.

Anyway, if it were appositive, I would have added the other comma.

I've been admiring your punctuation. So please don't think for a moment I haven't. It's just that sometimes elves steal the commas.

Or put an apostrophe in "its." I hate that. But, oh well. They laughed at Newton.

DW: Almost always. I always believed my little brother was the 'favorite.' I think the youngest always ends up in the favorite slot, but that could just be my experience.

@ PGP:

Exactly! We can't extrapolate to general rules from only our own experience.
What we can do- however- if we suspect a relationship between particular naively observed events or categories, is to just state that we *suspect* that that is happening.

Unless of course if we can find data to show that our guess is reality or do our own research in order to investigate that possibility. If we have the luxury of resources to do studies

What's interesting is that there are data that show relationships between attitudes both social and political.
and often what they show is not pretty.

Which leads me to.....
wait a minute! MEEPERS! Where in holey h3ll did that come from? What is a meeper?

Skeptiquitte: I think most parents are happy with a healthy pregnancy that results in a healthy child, at least most that I have interacted with.

From what I've seen, the definition of health can be easily abused. Do you mean 'a physically healthy child, a 'neurotypical child,' a 'non-disabled child?"

DW: The problem is that medicine and science come with easily understood rules, people and "social sciences" don't come with rules or helpful guides. It's like the difference between cricket, baseball, and Calvinball. One of the three comes with easily understood rules, the other requires a guide, but still has rules (if esoteric ones) and the last one has no rules at all.

Which leads me to…..
wait a minute! MEEPERS! Where in holey h3ll did that come from? What is a meeper?

Although G—gle readily coughs up tens of thousands of attestations of the term in the context of F. catus, I'm pretty sure that its presence in my head is de bonis propis. It's a pretty natural coinage for certain vocalizations, which differ wildly among cats.

Not that she even really makes these. Plus, if I were to switch, I'd have to come up with a three-syllable version as a full given name, because that's how I roll.

The problem is that medicine and science come with easily understood rules

Not really, no.

Biology is an inexact science, medicine even more so. In physics, something works or it doesn't. Beings made out of a lot of cells have much more gray area.

I’d have to come up with a three-syllable version as a full given name, because that’s how I roll

So the number of syllables corresponds to some information about the pet, similar to NATO rules for code-names for Warsaw Pact weapons? Or to intelligence-community systems where the syllable counts (in code names for cipher systems, and dossiers, and even level-of-classification) are themselves informative?

So the number of syllables corresponds to some information about the pet, similar to NATO rules for code-names for Warsaw Pact weapons?

It corresponds tonally to information for the pet.

@Kreb

There are several studies looking at the antibody response of people vaccinated several years previously who have low circulating antibodies. Their anamnestic antibody response is far greater than the primary response of an unvaccinated unexposed person. For example this study of individuals vaccinated against hepatitis B 17 years previously which concluded:

This finding shows that the immune memory for HBsAg persists beyond the time at which anti-HBs disappears, conferring long-term protection.

Short version: falling antibody levels do not necessarily mean a lack of immunity to the disease. For public health purposes it is sensible to aim for high levels of circulating antibodies as this ensures immunity, but in practice those with lower levels may still be immune.

Kreb, just how well researched is this “anamnestic immune response” effect. You mentioned 'several studies' but only provided one, and it was on the HepB vaccine. Has the same effect been replicated for other vaccine, and if so, can you please provide them? Kreb, and even if this effect is 'real', what is the exact science that establishes that 'anamnestic immune response" will confer protection for countless years, and even over a lifetime? It does sound rather speculative.

@Chris Hickie
Haven't heard lately from that next best loved and famous pediatrician -- of course behind Dr. Bob and Dr. Jay --and maybe my kids' pediatrician. Christopher --oh Christopher!-- for the last time, why don't you tell all the readers whether you practice what you preach and are complaint with your vaccines. Again Christopher, it's not a contsest between me and you, but you showing how much you support the vaccination agenda that you espouse, and are willing (if not eager) to share your own vaccination status.

Greg,

While following this back and forth between you, Krebiozen and others is somewhat entertaining and even awe-inspiring (at least the immense patience shown by Krebiozen),...

...is there an actual number of studies which if provided would convince you? The one provided obviously didn't, for reasons unspecified except it only deals with one vaccine or would providing you with additional evidence just be another exercise in futility? And besides, why would you dismiss the response even if it worked with only some of the vaccines?

I think Hell is a good name for a cat, because when you are disappointed by its actions (as you will doubtless be from time to time) your reaction of "Oh! Hell!" will be appropriate.

"Something Else" is also a good name given the nature of cats, in that when expected to do one thing they will likely do something else.

@Greg

It's basic immunology. You can read about it here:

https://www.inkling.com/read/the-immune-system-peter-parham-3rd/chapter…

I've made a bet with myself about what parts you're going selectively to misconstrue as meaning that protective immunity wears off completely as time passes.

So please don't disappoint me.

I think that both "Hell" and "Something Else" are ideal names for kitty-cats owned by someone named "Mephistopheles O'Brien."

One would be the punk kitten, and one would be the rockabilly kitten.

https://www.youtube.com/watch?v=TP3x-VdOb44

https://www.youtube.com/watch?v=mgQg4ze1_KU

why don’t you tell all the readers whether you practice what you preach and are complaint with your vaccines.

I'm complaint with life-experience as a whole.

Just a born malcontent.

@Greg: while not trying to speak for Dr Hickie, by doing a simple search of RI comments you can find he answered your question a long time ago, just not in THIS thread.

I, on the other hand, answered, not for you, but for those who may lurk and wonder if those of us who promote responsible vaccination practice what we preach, and I want THEM to know the answer is "Yes, we do. Barring medical contraindications, we do get vaccinated, update them, and make sure our families are also."

@MI Dawn
Cannot seach RI 's history at this time to obtain Christopher's answer. Can you be so kind as to provide me with the link?. Or Christopher, you can jump in anytime. We are all 'friends' so there shouldn't be any link between us.

@Ann
Kreb mentioned several studies on 'amnesiac immune response', so what's the harm in asking for them. You say the theory is well established, but what about the science. Seriously guys, I keep hearing how vaccines protection will last a lifetime, while encountering little supporting evidence. BTW -- I couldn't open your link from my phone. Will try later.

Kreb, just how well researched is this “anamnestic immune response” effect.

Ah, yes, it's this routine again:

Also, does your ’4% more likely’ equate to the ‘test value’ in the formula? Also, please explain a little ‘sample average’.

First, what exactly is a ‘person-year’?

@Orac.
We haven't conversed lately. I don't understand why since coming up with these boring blogs shouldn't consume too much of your time. Anyway, why don't you also jump in and share your vaccination status?

Orac, you also teed me off about something. Somewhere it was reported that Thingy was banned for accusing parents who vaccinate their kids as being child abusers, and for targeting Lilady. Surely I have been just as offensive, Orac, if not more. What's the rub? That 's discrimation, Orac!!

Greg,

Kreb, just how well researched is this “anamnestic immune response” effect.

Immunological memory has been known about for thousands of years, exploited for two centuries and is now understood in considerable detail. You would know this if you knew the first thing about immunology, which you evidently do not.

You mentioned ‘several studies’ but only provided one, and it was on the HepB vaccine. Has the same effect been replicated for other vaccine, and if so, can you please provide them?

PMID: 1181188 anamnestic response to tetanus vaccine 8-13 years after initial vaccination.
PMID: 17241256 anamnestic response to rabies vaccine 14 years after initial vaccination.
PMID: 19265481 anamnestic response to pneumococcal conjugate vaccine (PCV) 5 years after initial vaccination.
PMID: 14695659 hepatitis A 12 years after original vaccination.
PMID: 22209292 HPV 8.5 years after initial vaccination.
I could go on and on, but that should do for now.

Kreb, and even if this effect is ‘real’, what is the exact science that establishes that ‘anamnestic immune response” will confer protection for countless years, and even over a lifetime? It does sound rather speculative.

If it's real? What do you think is behind the (usually) lifelong immunity after natural infections that you and your antivaxxer friends like to fetishize? Anamnestic immune responses by memory lymphocytes, of course; DNA changes in these white blood cells mean they remember pathogen antigens forever - over 60 years in the case of measles, as related in the link ann suggested at #372.

We have every reason to expect most vaccine-induced anamnestic responses to last a lifetime as well. Why wouldn't they? Even if infection occurs it will be much milder and more quickly cleared than in the unvaccinated. If we do find these responses don't persist, we can introduce boosters as necessary.

If the cat is of the female persuasion, there was a minor Greek deity named Helle who hung around the (wait for it) Hellespont.

We briefly considered naming our second German Shepherd that but since we live across the street from the Catholic church we decided that it might be misconstrued, particularly when trying to call her in at night.

Orac, you also teed me off about something. Somewhere it was reported that Thingy was banned for accusing parents who vaccinate their kids as being child abusers, and for targeting Lilady. Surely I have been just as offensive, Orac, if not more. What’s the rub? That ‘s discrimation, Orac!!

OK, have it your way. Bye.

If it’s real? What do you think is behind the (usually) lifelong immunity after natural infections that you and your antivaxxer friends like to fetishize? Anamnestic immune responses by memory lymphocytes, of course

One might also note that disease-acquired immunity may well require boosters itself in the form of exposure to endemic disease. It's not just the quantity of circulating antibodies, but also their quality.

Personally, I'd rather do that on my own rather than insisting that others become ill in order to achieve the same goal.

(As an aside, I was surpised that only now has secondary transmission from a measles-vaccinated individual been detected.)

@Orac - well, he did ask for it, didn't he? (I mean specifically)

@Orac

Wow. That may be the first time that I've seen someone actually complain about and ask for getting banned. Of course, he'll probably use the banning as some point against you, but all one has to do is show that comment and he loses.

@Orac – well, he did ask for it, didn’t he? (I mean specifically)

Yes, he did, and he asked at a time when I was in the mood to grant him his request.

Looks like I'll have to find another chew toy...

Well, Orac, it's ABOUT time, Mr!

But now we have no one to make fun here of on a near daily basis as we entertain the lurkers...

Oh right, back to scanning AoA, TMR, GreenMedInfo, Gaia, ANH, NaturalNews, PRN, AI, etc-
a sceptic's work is never done.

@Krebiozen: Fortunately (or unfortunately), it's a target-rich environment.

@Krebiozen: Me too. That was the only thing Gregger was good for.

He had to ask before getting the banhammer? What a loser.

My day needed a lift. Thanks!

That may be the first time that I’ve seen someone actually complain about and ask for getting banned.

Nah, he's done it before. I imagine he thought it a convenient attempt at diversion this time around.

back to scanning AoA, TMR, GreenMedInfo, Gaia, ANH, NaturalNews, PRN, AI, etc-

Same as every night, Pinkie.

Looks like I’ll have to find another chew toy…

Well, if there's an overwhelming request, I could always reverse my decision... :-)

@Orac - I certainly won't complain....after all, you just gave him what he asked for (nicely even).

So far Sears has been silent about the fact that there are now 10 cases of measles in Orange County

Make that twenty.

While troll genetics does not, apparently, allow the importation of new information, I've gotten a great education from all your patient and detailed explanations. So thank you. if you lived closer I'd bake you cookies or pour you a liberal tot of maple gin goodness.

Certainly I wouldn't want Orac to ignore gurgi's wishes, that would be disrespectful and this is a resptful blog. I'm sure there will be others I can learn from.

Well, if there’s an overwhelming request, I could always reverse my decision…

Please no. I just had a quick journey through some old comments, and I'd forgotten what an irritating little pr!ck Greg could be, deliberately so. Greg would make a great mascot. for the glorification of ignorance, which I despise.

from Narad's link. The ten new cases:

Stanfield said for the 10 most recent cases, seven adults and two children were unvaccinated. The vaccination history of the tenth adult is unknown. The recent cases had come into contact with earlier measles patients, she said.

Sigh.

I would be interested to see interviews with the infected - to see how they feel about their anti-vaccine stance.....

Our old pal Dr. Jay, was "tweeting" about the measles outbreaks...until Reuben at The Poxes blog posted a scathing article about the pediatrician to the stars and put up screen shots of Jay's "tweets":

http://thepoxesblog.wordpress.com/2014/03/21/when-another-doctor-stops-…

Measles cases at 21 in Orange County this am: http://cms.ocgov.com/gov/health/phs/about/dcepi/epi/disease/measles.asp

@Lawrence -- that megachurch in Texas backtracked fast enough when their parishioners started getting sick. Some people can learn.

Maybe.

There is an interesting paper reported in Medscape this month.

Summary, about 2500 parents were given scientific evidence of the safety of vaccines to see if their perception of safety was altered. Result - it didn't make any difference.

In the conclusion the authors state ""Given that parents rate their childhood's doctor as their most trusted source of vaccine safety information," future research could focus on exploring whether pediatricians "would be an especially persuasive source" for parents on vaccines."

and ""We suggest in the article that one of the most promising areas for research is to see whether clinicians might be more effective messengers because they are so trusted by parents,"

Maybe not if your clinician is Dr Bob?

@Shay

Unfortunately, adults and children will get sick, some will have lasting effects, and some will die in order to learn that VPDs are nothing to laugh at.

A bit OT, but dealing with the same.

Mumps outbreak spreads beyond Ohio State campus

http://www.cnn.com/2014/03/24/health/ohio-mumps/index.html?hpt=he_c2

I know some of y'all don't frequent Facebook, and I'd keep out if I could (long story, sort of job related)

Anyway for all of your edification, here's Bob's latest self-justification. (Disclosure: I haven't read it carefully. In fact, I haven't even skimmed it )

https://www.facebook.com/permalink.php?story_fbid=688983454473475&id=11…

Orange County Measles Epidemic . . . Not (yet, anyway)!

Wow. Who would have thought that a few simple sentences in my last post would cause such an uproar? If you missed it, check it out below. All it says is “don’t panic. If your child hasn’t had a measles vaccine, you can get one now. If you don’t feel comfortable with it, don’t panic, because there are only seven cases (at the time).” That’s it.

But it’s interesting what people took from it:

Some people seem to believe the post advises people to not get the vaccine, which the post clearly doesn’t say. The post says get the vaccine, or don’t – it’s up to you. I guess what the vaccine militants wanted me to say, instead, is that every single person, without fail, should get the vaccine no matter what.

Some have attacked me for starting a measles outbreak seven years ago in my waiting room, which is false because no one with measles has ever even been inside my office (except for one child about 15 years ago who came down with a live measles infection from the vaccine, which is pretty rare but known to happen); so much for journalistic integrity for whoever wrote that (to be fair, most journalists do have integrity).

Some took my post to say that the MMR vaccine causes autism. WTF? The post doesn’t even include the “A” word.

Oh, and some thought my post said measles is harmless. My post didn’t even comment on the severity of the disease at all. Of course measles is sometimes harmless. It’s a tough disease. It’s no fun at all. The measles chapter in the book makes that very, very clear. My mistake though – I didn’t reiterate that in the post. So, for the record, measles CAN be very serious. It RARELY causes severe complications though. Almost everyone who catches measles here in the U.S. will be fine. You’ll be sick for a week, need to be quarantined, then you’ll be fine. IF your case is typical. BUT, in a small percentage of cases, even in the U.S. where we don’t have Vitamin A deficiency and protein malnutrition, complications can occur. About 1 in 1000 may die from it (studies vary – some say 1 in 3000, some say 3 in 1000). We haven’t had a measles death in the U.S. in over 10 years. But you know what? We will someday. May be this year. May be next. May even be here in the O.C. Every death from a vaccine-preventable disease is tragic. I’ve never said otherwise. So, just to make a few of you pro-vaccine militants happy, there you go. Measles can be bad. In developing countries with malnourished children, it’s even worse.

But for most, it’s a harmless disease. Old pediatric textbooks call measles a harmless and routine disease of childhood. IN DEVELOPED, WELL-NOURISHED COUNTRIES, for most people, that’s true. But not for all.

Finally, some love to blame me for the outbreak. As if people aren’t getting the MMR vaccine because of me. In the measles chapter of the book, AND in my alternative vaccine schedule, the MMR vaccine is very clearly listed at 1 year and 5 years. I very clearly recommend the vaccine in the book.

The post was simple – there’s a small outbreak, don’t panic. Get the vaccine or don’t. Up to you. Perhaps I should have said, “It’s really NOT up to you. It’s your social responsibility to get your children fully vaccinated so you don’t infect others. That way, NO ONE would ever need to have measles.” Keep reading – more on this later.

So, now we have about 21 cases in Orange County. We all knew it wouldn’t stop at seven. In my last post I gave a heads up that we’d see more. I thought maybe a few more, and didn’t think it would jump to 21. But it did. 5 cases are children, all unvaccinated. 5 are healthcare workers exposed to patients. They were vaccinated when younger, but the vaccine had worn off. As for the other 11 cases, I don’t know. Those details weren’t disclosed. But they are adults, according to the public health department notice. The outbreak won’t die out until everyone who’s been exposed either gets infected (which will be a very small few) or doesn’t, because they’ve been immunized or their immune system fights it off. Most outbreaks nationwide are restricted to a small number. The largest outbreaks from last year (58 in New York and 20 in Texas) occurred because the exposures were in large groups of unvaccinated people. Here in the O.C., almost everyone is vaccinated, so we are unlikely to see such a large outbreak. But it WILL extend a bit more. Who knows what the final number will be? But in the absence of a large unvaccinated group, it isn’t likely to spread much more than it has now. IF it hits a particular school or group where many are not vaccinated, it will likely spread through that group.

Finally, a message to those who chose to not get the MMR vaccine. I would still say don’t panic. The chance that your child will be caught up in this small outbreak is still very low. I understand your reasons for not wanting the vaccine. Every parent is required to read the CDC-mandated list of side effects to every vaccine before it is given. And the list of side effects to the MMR vaccine is quite daunting, and would scare any parent. You’ve probably read this list and opted out of the vaccines. The CDC handout tones it down a bit, but the MMR vaccine product insert doesn’t. And that’s what is spelled out in the measles chapter of the book. I simply list the side effects as described in the vaccine product insert. So, if any mandatory vaccine militants are going to be mad at me for that, then what you are really saying is that parents should NOT receive informed consent about this medical treatment. They should NOT be informed of the risks of a vaccine; they should just be reassured that the risks are small, they don’t need to worry their pretty little heads about the details, and just go ahead with the vaccine. If that’s how you feel, then you are justified in being angry with me. For the rest of you who like to follow proper medical procedure and medical ethics, you provide informed consent for vaccinations. Allow the parents to be involved in this decision. Some will decide NOT to vaccinate; this puts their child at a small risk of disease, and it poses a risk of their child spreading the disease to other unvaccinated or too-young-to-be-vaccinated or those-who-got-vaccinated-but-it-didn’t work (I don’t think that was grammatically correct), but parents have that right to make that decision.

If we could guarantee that every single dose of MMR vaccine would be harmless to every child who received it, then we could be justified in making the vaccine mandatory. Since that’s not the case, we must allow parents to decide.

Bottom line: if your child has had one vaccine, then there is a 95% likelihood that he or she is protected. If two doses, it’s about 98 to 99%. So, you’re in good shape. You likely have nothing to worry about. Unfortunately, as we’ve seen in this outbreak, some adults will lose their immunity, and may catch the disease. If you decided to not get the vaccine yet, then you have a decision to make. Read all the pros and cons. Understand the side effects of the vaccine as well as the disease. Consider the importance of public health protection. If you were planning to have your child get the vaccine at some point anyway, but you were waiting until an older age, maybe now’s a good time to consider it. But the outbreak is still small enough where you don’t have to rush into it. If you decide against the vaccine, the disease risk is still acceptably low. Stay tuned.

And, on a completely unrelated note, the CDC just released new autism rates: 1 in 68 kids, and 1 in 42 boys. I still have to process this, and will blog next week. But don’t worry: it’s not a REAL rise. It’s just a pretend rise. Or, it’s not rising at all – it’s ALWAYS been 1 in 42 boys, right?

I am quite grumpy this evening over a number of things that have nothing to do with RI, or vaccine-preventable disease and the like.

You know what I would like?

I would like to take away Bob's stethoscope and his bank account and make him take care of 3 or 4 measley kids, in series not in parallel, without a paycheck. In fact, without enough money to pay for additional diapers, because you know, diarrhea is one of the measles effects.

In fact, with out a paycheck for the time that the kids' daycare is closed because of some non-vaccinating OTHER numpty.

Hey, Bob? Ever heard the phrase, "check your privilege"? No, I don't think you ever have...or maybe even the majority of the people who use your services.

Anyway for all of your edification, here’s Bob’s latest self-justification.

And lest anyone doubt his effect, the swooning comments are rolling right in:

"Liz Gonzalez My son goes in for his one year check up tomorrow. Thus far we have been on an alternative vaccine schedule yet, I decided back at his 9 month check-up that I was going to delay his MMR until after 3 at least I was 100% sure I was going to delay it, than this outbreak happened and scared the crap out of me. Since, I have been so unsure of my decisions, I've been going back and forth but I FINALLY decided to go forth with my original decision and delay MMR 3. I'm way more afraid of all the crap in the vaccine, then him getting measles. Thank you for giving me the reassurance I need."

"Works at Nurse
"Lives in Anaheim Hills"

Let's clarify what Dr. Bob said about an accusation that his deliberately unvaccinated patient exposed children in Dr. Bob's waiting room. Simply put, the last time his 7-year-old patient was discussed on a public forum, was my comment directed at him on the Ho-Po...and I definitely did not accused that child of exposing patients in Dr. Bob's waiting room. That child, who was identified as the index patient responsible for the 2008 San Diego measles outbreak, exposed young patients in two other physicians' waiting rooms...and in two hospital Emergency Rooms. The verbatim comments between me and Dr. Bob are available on the Ho-Po and available on Orac's post here (along with the MMWR report about the child's travel history to Switzerland, the secondary and tertiary transmissions from Dr. Bob's patient, the genotyping of the measles virus implicated in the outbreak and the hospitalization of one infant infected during the outbreak, for supportive rehydration. Dr. Bob is still lying and I'm calling him out for his blatant lies:

http://scienceblogs.com/insolence/2012/03/27/dr-bob-sears-vs-seth-mnook…

You really know how to pique my interest by referring to a nurses comment on Dr. Bob's FB page, don't you Narad.

I've got someone who claims she's a nurse on a Skeptoid blog, who managed to pull some anti-vaccine sh!t. Stay tuned to see how I whup her butt. I take "nurse's" dumb comments quite seriously...just in case you hadn't noticed:

http://skeptoid.com/blog/2014/03/26/international-vaccine-terrorists/

@ LIz Ditz

Dr Bob Sears is either disingenuous, or has very poor communication skills. At the same time, we got:

Some took my post to say that the MMR vaccine causes autism. WTF? The post doesn’t even include the “A” word.

And, on a completely unrelated note, the CDC just released new autism rates

Yeah, completely unrelated. *wink, wink, nudge, nudge*

OK, I guess it's that we call pandering to the audience. And it answers my question about the level of his communication skills - and if he is disingenuous.

On the other hand, he does acknowledge that the measles outbreaks are closely related to and finding traction inside unvaccinated populations.
Something to throw at the passing trolls.

Sears won't own that those unvaccinated children in his geographical backyard are directly due to his giving medically incorrect advice to parents in Orange County. So he backpedals--maybe enough reporters started bugging him about his AV stance. He is the most reprehensible of the AV crowd because he hides in either herd, depending on which herd suits him best.

Exactly, Chris.

He's playing both sides for all the $$ and attention he can garner from them.

He doesn't care about the kids he sees. If he did, he'd encourage them to be vaccinated.

@Liz Ditz, "I would like to take away Bob’s stethoscope and his bank account and make him take care of 3 or 4 measley kids, in series not in parallel, without a paycheck."

Ah, but you know his paycheck comes from caring for children, and he *loves* to care for them. A nice little measles outbreak among his unvaccinated victims -- er, I mean patients -- will give him the opportunity to do what he*loves*, and quite coincidentally fatten up that paycheck considerably.

I simply list the side effects as described in the vaccine product insert. So, if any mandatory vaccine militants are going to be mad at me for that, then what you are really saying is that parents should NOT receive informed consent about this medical treatment. They should NOT be informed of the risks of a vaccine; they should just be reassured that the risks are small, they don’t need to worry their pretty little heads about the details, and just go ahead with the vaccine.

He reserves that approach for measles, evidently.

Maybe I'm old-fashioned. But I don't think a family doctor should be saying "WTF" in publicly posted comments addressed to patients.

I wondered about this claim Dr. Sears made about the Orange County measles outbreak (my emphasis):

5 cases are children, all unvaccinated. 5 are healthcare workers exposed to patients. They were vaccinated when younger, but the vaccine had worn off. As for the other 11 cases, I don’t know. Those details weren’t disclosed. But they are adults, according to the public health department notice.

That isn't quite what the Country of Orange Health Care Agency said yesterday:

Five cases occurred in healthcare workers who cared for patients with measles, several of whom had previously been vaccinated. The MMR (Measles, Mumps, Rubella) vaccine is 99% effective, but occurrence of disease in some vaccinated individuals is not surprising, given that measles can spread in an airborne fashion and well over 1000 patients, their family and friends, and medical staff have been exposed to measles in hospitals, emergency departments and clinics where measles cases have been evaluated.

There is nothing there about the vaccine having "worn off". With a vaccine that is 99% effective, you would expect around 1% of those vaccinated to become infected when exposed to the virus because they didn't develop full immunity from the vaccine, and this is exactly what we see.

This may be a minor quibble, but this kind of spin is clearly designed to persuade people that measles isn't so bad and MMR wears off anyway, which irritates me.

I also think it very unlikely that there is no "protein malnutrition" in the USA. We certainly see it in the UK; low serum albumin and total protein is common in the very young, and in elderly and chronically sick people.

YES autism is an epidemic of great economic and emotional cost to society.
Blogs ought to screen comments so as not to aggravate the prevalent misinformation.
We know now VACCINES ARE NOT causing autism. Polio etc are on the rise, etc. Not vaccinating kids is irresponsible.
New medial research suspects Autism is due to environmental and dietary etiologies. Look at most reputable medial journals: Lancet and Elsevier articles on gut flora that point to be one of the most serious causes. Dr. Natasha Campbell has done excellent work in this arena. Unfortunately, many try to criticize her work, but science is confirming her studies. It behooves us o start eating WHOLE organic plant food, and stay away from GMO's processed foods filled with noxious substances and chemicals that are destroying our health and children. See movie of top physicians from Cleveland Clinic and Cornell U FORKS OVER KNIVES. Bill Gates and Bill Clinton who have access to best medical care have opted to follow this advice. It is time we stop the stream of misinformation and change our diets.

courtesy lifewatchgroup

It behooves us o start eating WHOLE organic plant food, and stay away from GMO’s

Do you have any proof of this? If not, what makes you different than Dr. Bob?

"steps over the garbling troll"

"several of whom had previously been vaccinated."

Several? Bit wishy washy. Documented vaccination or merely assertations I wonder.

I knew you could get through medical school without being able to write in cursive (I kid, I kid), but is it believable that a real MD could be quite as illiterate as "Dr." Kaplan, above?

@ G Kaplan #417,

Dr. Natasha Campbell has done excellent work in this arena. Unfortunately, many try to criticize her work, but science is confirming her studies.

Campbell-McBride is a quack who runs her "Cambridge Nutrition Clinic" out of her home in a village several miles from Cambridge UK. The name is clearly designed to make people think she is connected with the academic community in Cambridge, where I trained and qualified, which she is not. The "excellent" work she has done is apparently limited to applying her dubious theories to autistic experimental subjects and charging them for the privilege.

A couple of years ago I started fact-checking a talk given by Campbell-McBride but gave up just a few minutes in as there was just so much inaccurate nonsense it quickly became obvious I was wasting my time. She claimed, for example, that salmon contains almost twice as much cholesterol as beef fat, lamb fat and dairy fat - which is blatantly untrue; it contains less cholesterol than even lean beef, lamb and cheddar cheese.

Here's a little amuse-bouche of Campbell-McBride's idiotic advice:

"Make no mistake, your body knows the nutrient composition of foods on this planet. "
"Respect your desire! Desire is your inner body intelligence talking to you, letting you know what it needs to keep you healthy, energetic and happy. If you listen to your desire every time you eat, you will be able to digest that food well and it will do you only good, because you have eaten it at the right time, just when your body asked for it."
"So, consume plenty of animal fats with your meals. In order to keep your blood sugar at a stable level between meals make a mixture of raw butter (or coconut oil) with some raw honey to taste, put it into a glass jar which you can carry with you, and eat a few spoonfuls every 20-30 minutes all day."

Is she unaware that obesity is epidemic in the developed world? Bonkers.

Janerella,

Several? Bit wishy washy. Documented vaccination or merely assertations I wonder.

I wondered too. Don't US hospitals insist on evidence of immunity to measles et al.? Even in Orange County? It might be interesting to see if there are records of antibody titers in those healthcare workers that succumbed to measles.

Dr. Natasha Campbell has done excellent work in this arena.
She's a gladiator?

Krebiozen:
A couple of years ago I started fact-checking a talk given by Campbell-McBride but gave up just a few minutes in as there was just so much inaccurate nonsense it quickly became obvious I was wasting my time.

Remember when she featured in her own RI thread?

Buggrit. Campbell-Bride's own RI thread.

I knew you could get through medical school without being able to write in cursive (I kid, I kid), but is it believable that a real MD could be quite as illiterate as “Dr.” Kaplan, above?

Nonnative speaker.

Blogs ought to screen comments so as not to aggravate the prevalent misinformation.
Self-awareness is much over-rated.

HDB,

Remember when she featured in her own RI thread?

I remembered (thanks to my chaotic notes) she had been mentioned here before, but I had forgotten she had been the subject of a whole post here. One day, perhaps, I will attain the strength of will to watch her entire talk without succumbing to the need to curse out loud.

Dear Dr. G. Kaplan, M.D. I suggest you read herr doktor bimler's link to Orac's post on Natasha Campbell-McBride, before you post any more comments here.

“Respect your desire! Desire is your inner body intelligence talking to you, letting you know what it needs to keep you healthy, energetic and happy

Funny, when I listen to my body it tells me "Beer! Chocolate! Fried Okra! Braunschweiger!" I think it's gone over to the dark side.

(Please. No lutefisk comments).

My body agrees on the beer but otherwise it's demanding coffee, blutwurst and chillies. Some language, different dialect. One of these days my ambition is to write a best-selling nutrition guide announcing the Hanseatic Diet as the new pathway to health.

My body tends to scream: chocolat, nuts, fish, other sea-stuff, meat, noodles, tea and white wine.

And if we are talking about misleading names, in the Netherlands we seem to have a 'Vaccinatieraad', which would translate as 'Vaccinationcouncil', or something likewise. They could better name themselves 'Vaccinationpanic', because they tell all kinds of nonsence, even linking vaccinations with Shaken-babysyndrome.

I listened to my body and ended up with 5lbs of jellybeans. Fortunately my mind prevailed and I've got hungry co-workers.

Orac’s post on Natasha Campbell-McBride

On that whole gut-biota research area, I am reminded that Maddy Hornig (of rain-mouse fame) parachuted into it and was last seen promising dramatic results real soon now which will show that one's gut bacteria cause CFS as well as autism. Judging on past performance, her enthusiasm was pretty much the knell of death* for any prospect of anything useful coming out of it.

* Not to be confused with Death-Nell, a goth girl I used to go out with.

HDB, you are truly Der König of the one liners!

@Shay 429,
My dad used to like braunschweiger!

I talked my body out of a Black Forest cake yesterday, but it insisted on a molten chocolate cake with ice cream as compensation.

"... In 2013 there were 1,843 confirmed cases of measles, compared to 56 cases in 1998, the year Andrew Wakefield first published his case series in which he implied that measles was..."

"... that now can find a foothold in the US if the disease is spread to any of the increasing number of clusters of electively non-vaccinated children in the US. That foothold comes thanks to uneducated, ignorant, lying, deceitful, and just plain moronic anti-vaccine people like you."

Most children are vaccinated during their first year of life and allegedly obtain immunity so, how do you explain the large numbers of people succumbing to measles in the mostly vaccinated population?

Also, any "foothold" gained by this virus would according to you be allegedly in the a tiny fraction of the population who have "elected" to go unvaccinated. So you don't believe these people have a right to control what goes into their own bodies or the bodies of their children? Do you also believe in forced feedings of populations who you don't think are eating proper food?

It is extremely ignorant and unscientific to imply that Wakefield's single article was the cause of the increase in measles cases (2013 in 1,843) without even substantiating the number of vaccinated vs unvaccinated cases in this group; how many in this group chose not to vaccinate due to this article; or even to mention the number of other health factors that could have influenced this increase in cases.

Have you even read the vaccine package list of ingredients? People have the right to choose whether to inject known toxins such as formaldehyde and other "listed" ingredients contained in vaccines into their bloodstream or the bloodstreams of their babies. Stop trying to take away other peoples rights.

IIBliss,

The WHO provides percentages of 1 year old children who were immunized against measles by year by country at http://apps.who.int/gho/data/node.main.A826?lang=en. For the UK (per the quoted numbers) in 1993-1998, the annual immunization rate was 92-92%; afterwards it started dropping to the mid-low 80s. Rates started to come back to 90% or above in 2011.

Now, I for one would not say that Dr. Wakefield's paper and the press coverage of it were the only reasons that UK immunization rates dropped so dramatically. However, the timing is interesting.

IIBliss

Most children are vaccinated during their first year of life and allegedly obtain immunity so, how do you explain the large numbers of people succumbing to measles in the mostly vaccinated population?

If we were to examine the UK numbers, there were 13 years where 10%-20% of the children age 1 or under were not immunized. As measles is a highly contagious and easily transmissible disease, having as many as 1 in 5 children in an age group unimmunized is a substantial risk.

@IlBliss

In addition to what Mephistopheles O'Brien notes regarding UK immunizations rates, there are a couple other misconceptions you seem to be laboring under. First, while vaccines work quite well, they are not perfect. When you scale up to a large enough population, you find that there will be a large number of people who, despite having been fully vaccinated, end up not being immune. The outbreaks we see (e.g., of measles) are nearly invariably started by someone who is unvaccinated traveling abroad, getting infected, then coming back to spread it among their community. The outbreak largely consists of other unvaccinated people (either intentionally unvaccinated or too young to have been vaccinated) and a few who have been fully vaccinated. In the end, it's a numbers game. For a look at how this all works, you might find this post educational.

Second, you seem quite frightened of formaldehyde, which is certainly harmful in large enough doses. But that's the thing: the dose matters. The amounts found in vaccines are not harmful. This post goes into that in a bit more detail.

Finally, not a single vaccine on the childhood schedule is injected into the bloodstream. They are administered orally, under the skin (subcutaneously) or into the muscle (intramuscularly).

IIBliss: "Most children are vaccinated during their first year of life and allegedly obtain immunity so, how do you explain the large numbers of people succumbing to measles in the mostly vaccinated population? "

Except, not for measles. The first MMR vaccine is only after the child's first birthday, usually around fifteen months. Many babies have been infected in a doctor's waiting room by someone bringing in a child with measles, which is very infectious.

What is your plan to protect babies too young for the MMR vaccine from measles?

"And if we are talking about misleading names, in the Netherlands we seem to have a ‘Vaccinatieraad’, which would translate as ‘Vaccinationcouncil’, or something likewise."

Holy crap, I read that as "vaccinerated".

Now the antivax loons will have a new Scary Word.