Infectious Diseases, Vaccinations, Responsibility, and Irresponsibility

A single person contracted an infectious disease in Switzerland sometime during the week before January 15th. Within 10 days, new cases of the disease had been identified in San DIego. Less than two weeks later, the disease was known to have spread to Honolulu. People exposed to the disease are known to have attended a performance of Cirque du Soleil and a major sporting event. This isn't a Tom Clancy novel or a Homeland Security exercise, and the illness in question isn't some obscure new infectious disease. It's measles.

If you're wondering how a disease for which there is a very safe and very effective vaccine managed to travel so far, so fast, it's very simple. Vaccines only work if they are actually administered. In Switzerland, there's no requirement that schoolchildren be vaccinated. In California, vaccination is "required" before children attend school, but parents are permitted to opt out of that "requirement" for religious or "personal" reasons.

The person who contracted measles in Switzerland is an unvaccinated 7-year old. That person spread the disease to two (also unvaccinated) siblings. Between them, they managed to infect two other (unvaccinated) students who attend school with them. When the parents took the first patient to the doctor, four other children who were waiting at the office were exposed to, and contracted, measles. When they returned to the same office, they exposed a total of sixty other people (although it's not yet clear how many of them may have actually contracted the disease).

One of the children who was initially exposed at the doctor's office flew to Honolulu during a period when he or she was contagious, potentially exposing up to 250 more people on the airplane and an unknown number of people who were at the gate area of the airport during the three hours that the family was waiting for their flight. Another of the children exposed at the doctor is a 10-month old. Apparently, the parents of both of these children are big believers in the benefits of early childhood development, because a day care center and a swim school have had to temporarily close their programs for children under one year old.

All of this brings us to the subject of responsibility.

This entire measles outbreak has a single cause: the decision that two parents made to not vaccinate their children. I do not know why they made that choice - it might have been because they're afraid that there's a link between measles and autism, it might be because they have religious objections, it might be for some reason comprehensible only to them - but that doesn't really matter. The key here is that these parents decided that they would not vaccinate their children. As a result of this decision, three of their children got sick. Unfortunately, the consequences of their bad decision did not stop there.

Some of the other parents involved also share some of the blame for the consequences that their children have suffered. Two of the children who attend school with the index case have become sick, and 17 others were quarantined at home because they were not vaccinated, missing three weeks of school in the process. I have a great deal of sympathy for those children, but none at all for their parents. They (almost certainly) made the same bad decision as the first set of parents, and any missed work or other inconvenience that they suffer is entirely earned. Unfortunately, the consequences of the bad decision didn't stop there, either.

Two of the children who contracted the disease were under one year old. Children don't normally get their first measles vaccination before their first birthday. They are sick. Both have been hospitalized for multiple nights. In addition to the worry that goes along with a sick baby, their parents are dealing with expense and inconvenience because somebody else didn't bother having their children vaccinated. And the bad decision consequences keep on rolling.

The infants who are sick both attended programs with other infants. Those infants weren't vaccinated, either. They're quarantined, and the programs they attend are temporarily closed. A lot of parents are now dealing with the worry that their children will get sick, and many of them are also dealing with the additional expense and inconvenience that comes with the need to make other child care arrangements or miss work. In the mean time, the programs involved are losing income. None of these parents or businesses has done anything wrong. They're simply suffering the consequences of someone else's selfish, stupid behavior.

This entire situation is a perfect example of why vaccination opt-out laws are so friggin' stupid. Parents who decline to vaccinate their children aren't just putting their own kids at risk, which is bad enough, but they're also putting other children at risk, which is inexcusable. What makes it worse is that many of the parents involved make that choice content in the knowledge that measles, mumps, polio, and the other diseases involved are rare, and there's very little risk that their precious darlings are going to actually get sick. Why? Because other parents have taken the (very, very slight) risks that come with vaccinating their children.

(Minor update: Janet pointed out to me that Tara and DrugMonkey blogged this case earlier - which I somehow managed to miss. DrugMonkey's post is particularly worth reading - it's a much more eloquent rant than I managed. The comment sections for both are also worth a hit.)