Vaccine exemptions in California threaten herd immunity

I don't know if it's confirmation bias, faulty memory, or if my individual impression is correct, but it seems to me that over the years I've been blogging that stories like this one seem to be becoming depressingly more common:

Getting inoculated for diseases such as whooping cough and measles used to be a childhood rite of passage that few questioned. Now with shifting parental attitudes about vaccine safety, a growing number of California children are entering kindergarten without shots.

The trend worries public health officials because of the link between immunization rates and infectious outbreaks. As they grapple with the worst whooping cough surge in half a century, they are fighting back with outreach campaigns to promote vaccinations.

The Watchdog Institute, a nonprofit investigative journalism center based at San Diego State University, found that waivers signed by parents who choose to exempt their children from immunizations for kindergarten enrollment have nearly quadrupled since 1990. California allows parents to opt out of some or all shots on the basis of personal beliefs, be it religious objections or distrust of the medical establishment.

That California is ground zero for vaccine rejectionism is not a surprise to me or anyone else who's paid attention to the issue of the anti-vaccine movement. Indeed, when I last wrote about this a year and a half ago, I drily observed that when the outbreaks begin, they'll probably start in California. At the time, I was writing about an LA Times article that described the skyrocketing numbers of "philosphical" exemptions being claimed by parents in California. The story laid out the problem in considerable detail. Affluent parents in affluent suburbs, never having seen the diseases against which vaccines would protect their children, decide that these diseases are not a threat, confident in the delusion that there's no way their children could ever suffer from these horrible diseases. Oh, no! Those are diseases for children in Third World ghettos, not their precious children. After all, they're affluent and can afford everything their children need, and they care so much about their children. Besides, Jenny McCarthy and her fellow travellers in the anti-vaccine movement tell them that vaccines cause autism. Obviously vaccines are nothing more than a plot by The Man to make lots of money and turn their children autistic! Last year, unvaccinated children were clustered in certain areas. For example, at Waldorf schools (or, as I like to call them, pathogen repositories), vaccine exemption rates can be as high as 82%. Otherwise, the highest exemption rates appeared to be in Sonoma County, although Los Angeles and San Diego Counties were also up there.

What about this year? This year, it looks as though San Diego County has an exemption rate consistently higher than the state average, just as it has been for quite a while. The Watchdog Institute found:

  • Personal-belief exemptions granted to entering kindergartners reached a record high of 10,280 in public and private schools statewide last fall, up from 2,719 in 1990.
  • San Diego County's exemption rate is 2.64 percent, compared to 2.03 percent statewide. While those percentages seem small, public health officials are concerned that unvaccinated children tend to cluster in certain areas, creating pockets of vulnerability.
  • Schools with the highest exemption rates tend to be private schools, public charter schools, and traditional public schools in affluent areas. Among schools with 25 or more kindergartners last year, 14 had immunization opt-outs for more than 15 percent of their kindergarten class. The top was the Waldorf School of San Diego in City Heights, at 51 percent.

A 51% exemption rate implies that only 49% of the children at the Waldorf School of San Diego are vaccinated, far below a rate that even has a prayer of maintaining herd immunity.

Of course, anti-vaccine parents both demonize and have unrealistic ideas about what vaccines can do, which is part of the problem. They demonize vaccines as the cause of autism, autoimmune disease, and asthma, along with all sorts of other health problems, even though there is no scientifically credible evidence linking vaccines to autism or any of the other conditions attributed to vaccines. Yet, at the same time, they justify their refusal with the implicit belief that vaccines are 100% effective. I refer to this as an "implicit" belief because a frequent argument made by anti-vaccine parents when it is pointed out to them that they are endangering other children is that those other children are vaccinated; so how could their precious baby ever be a threat to other children? The reason, of course, is that no vaccine is 100% effective. Some, like the MMR vaccine, are "only" around 90% effective. Now, in medicine, 90% effectiveness is in general excellent, about as high as one can expect from any intervention. It's not 100%, though. Worse, pockets of unvaccinated children provide a repository for vaccine-preventable disease that can infect other unvaccinated children, as well as vaccinated children who, for whatever reason, did not develop effective immunity due to their vaccination.

Failure to vaccinate also endangers the unvaccinated children as well. Last year, in fact, this risk was quantified in a study that found that unvaccinated children have a 23-fold elevated risk of catching pertussis compared with vaccinated children. Given how nasty and contagious pertussis is and how safe the vaccine is, there really is no good reason not to vaccinate at least against pertussis. Of course, parents have their reasons not to vaccinate, virtually all of which rely on either exaggerated fears of autism, a woo-ful belief that "natural" must be better, and, perhaps, one of the most common delusions among the "natural health" set." This last delusion is one shared by Bill Maher and consists of the belief that if you eat the right foods, excercise, and keep yourself healthy "naturally," you can't get sick from vaccine-preventable diseases. In other words, good living (whatever that means) is as good as any vaccine in their view. In fact, one anti-vaccine mother named Yvonne Haines was interviewed in the article is quoted thusly:

"We do find that the unvaccinated kids are extremely healthy because their bodies have been allowed to develop their own immune system, rather than relying on vaccinations, which are like substitutes," she said.

Uh, no. They aren't any healthier than vaccinated children, and microbes don't care how "healthy" your children are.

Yes, it's true that it's better to be well-nourished and in good physical shape than not. It will even help fight off disease. But it won't protect your children the way a vaccine will. You can have the healthiest child in the world, but if that child is exposed to, for example, measles, which is highly contagious, chances are that your child will catch the measles. Ditto pertussis. Unfortunately, what public health officials are fighting against is attitudes like this:

Rebecca Estepp of Poway, a mother of two boys 12 and 10 years old, is familiar with that logic, but she cannot square it with her maternal instinct.

After her first son suffered adverse reactions from vaccines and developed autism, she decided to not to go through with the full schedule of immunization for her second son.

"I don't know if there is an acceptable level of collateral damage in the war against infectious diseases," said Estepp, who is also the government and media relations manager for SafeMinds, a nonprofit that investigates the link between vaccine ingredients and neurological disorders.

We've met Estepp before. She frequently lays down swaths of burning stupid about vaccines of this sort. She's so utterly convinced that vaccines caused her child's autism that nothing will convince her otherwise. Meanwhile, she continues to promote the false dichotomy that it's a choice between "autism and the measles" and that she'd pick the measles. In actuality it's a choice between measles and not getting the measles, given that the MMR vaccine is, by any measure, incredibly safe. It is also a choice of preventing measles at a very low risk versus the risk of getting the measles and its potential complications. Nonetheless, Estepp decided that she'd put her her son at high risk of contracting measles, which, contrary to the misconception, is not a benign disease. Worse, she did it because she believed in a myth promulgated by the anti-vaccine movement.

One aspect of this article that perfectly encapsulates the thinking of a lot of these crunchy anti-vaccine moms is an interview with Johannes Lasthaus, Waldorf's administrator:

Schools that top the list of highest exemption rates in the county in 2009 are almost all either private or charter schools. The private Waldorf School of San Diego, where tuition ranges from $7,500 to $14,000 a year, has the highest exemption rate.

"Our parents are really educated. They are trying to make their own decisions, not being influenced by pharmaceutical companies," said Johannes Lasthaus, Waldorf's administrator.

His school, he noted, has had no outbreaks and maintains a policy of keeping sick children at home.

"It's all about people's right to choose what is right for their child and their family and really respecting people's choices, whether they choose to vaccinate or choose not to vaccinate," said Julie Joinson, Waldorf's director of admissions, speaking for herself. She noted that her daughter, 14, who has never been vaccinated, is "super healthy."

"It's not that I think that vaccinations are terrible," Joinson said. "If I lived in a third-world country with open sewage running down the streets, I would probably vaccinate my child. At this point, I really have concerns about what goes into vaccinations."

With all due respect, Ms. Joinson has "concerns" because she doesn't know what he's talking about. Think of it this way. Before the polio vaccine, the U.S. was not a "Third World coutnry with open sewage running down the streets." Yet, as recently as the 1950s, every summer there were polio scares in which public swimming pools were closed down. Periodically there were polio epidemics, and there were thousands in iron lungs. Does Ms. Joinson know what ended that? No, it wasn't sanitation. Sanitation was just fine in the 1930s, 1940s, and 1950s. It was vaccines. Similarly, it was the vaccine that eradicated smallpox. The fact is that the single biggest source of microbes causing vaccine-preventable diseases is not raw sewage, as Ms. Joinson seems to think. It's other children. These days, it's unvaccinated children far more than vaccinated children.

As for the Waldorf school having had no outbreaks, it's only a matter of time. In fact, Waldorf schools, which are widely known for their resistance to vaccines and scientific medicine, have had a number of outbreaks. For example, just this year there was a measles outbreak in Essen, Germany where the majority of cases were linked to a Waldorf school. In 2008, the East Bay Waldorf School was shut down due to a pertussis outbreak, and a Waldorf School in Salzburg, Austria was hit by a measles outbreak. There are numerous other examples, and, as vaccine uptake falls, Mr. Lasthuase is fooling himself if he thinks his school is not at risk, no matter how strict he is about sending children home when they appear to be sick.

I believe that we are approaching a tipping point. Although vaccine uptake is generally high throughout the U.S., there appear to be more and more pockets of vaccine refusal, leading to populations of unvaccinated children who can serve as vectors to result in outbreaks as herd immunity breaks down. Although I doubt that vaccination rates will fall to the point where mass epidemics are likely, although Generation Rescue and Jenny McCarthy are sure enough doing their best to make sure that happens (if you don't believe me, just wait a while to see what sorts of comments appear on AoA after this post triumphantly trumpeting this article). There are likely to be more and larger outbreaks of vaccine-preventable diseases.

It's the face of the future. I hope I'm wrong, but I fear I'm not.

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@ Sid "goalpost shifting" Offit,

That does nothing to address your contention that case fatalities were increased in the infant population post-vaccination, that measles fatalities weren't under-reported and the question of how many measles-fatalities in the last decade have there been.

You and augie are quite the pair. Maybe let him fight his own battles next time.

@Science Mommy

Dear you are digging. You NEED to move the goalposts on this one. read 483.

Pre vaccine error measles case fatality ~1:7000. After vaccine 1-3:1000.

According to the CDC numbers it appears that measles has become more deadly post vaccination era.

By augustine (not verified) on 01 Sep 2010 #permalink

Augie, I'm beginning to wonder if you even possess a brainstem. The whole thrust of the argument is how measles-related deaths are also under-reported, along with cases. You keep using the same tired, unsubstantiated figure.

Tired of getting your ass kicked by a chick yet?

And because augie has set the tone, I will add some insult to injury.

Science Mom, you cannot comprehend your links in context. Sid has shown you. Your friends know it. They are embarrassed for you . Promotheus is trying to help you out by steering the conversation away from your argument into something other argument.

Sid has shown nothing but his own ignorance of the subject. Prometheus pointed out the need for clarification and he was absolutely right, hence I did just that. He is entitled to his own observations, so why you would deign to twist that into a deflection is pathetic. Of course you need to believe that 'my friends' are embarrassed for me, how else can you compensate for your own ignorance. You remind me of a scene from Monty Python and the Holy grail

King Arthur:[after Arthur's cut off both of the Black Knight's arms] Look, you stupid Bastard. You've got no arms left.
Black Knight:Yes I have.
King Arthur:*Look*!
Black Knight:It's just a flesh wound.

I read your links. You've confused yourself.

No, you didn't read past the abstracts.

No matter how many links you provide, if there were 4 million measles cases (prevacccine era) and the death rate were 1-3:1000 then there would be 4000-12,000 deaths not 500 per year. There would also have been over 600,000 thousand hospitalization from measles per year. Didn't happen. Not even close. You have no evidence to support your fantasies. Zero. Zilch. It's your own personal theory. Nothing wrong with that but you should expect to have your feet held to the fire just like those you burn yourself.

Such rookie mistakes. Measles case estimates roughly correspond with birth cohorts and occurred in epidemic cycles, this leaves us with a range of estimated cases, not a point estimate. No where have I claimed any estimate for pre-vaccine measles case-fatalities, that is a strawman, thus it is impossible to determine what the actual under-reported value is, only that we know they were under-reported. Although you seem to think it is perfectly acceptable to use an estimate of non-reported cases as the denominator for the reported deaths to calculate a case fatality ratio. Pure dumb. And you call my supported statements fantasy?

If what you think you did is holding my feet to the fire, I can't see it. You're great to have around though augie, your representation of the average anti-vaxxer truly is parody and you deserve to be marginalised. Now run along and play with your [imaginary] friends.

Yeah!!!!! Orac gets a pony!!!!!

[Momma: You keep using the same tired, unsubstantiated figure.]

I gave the reference. Its the CDC's quote. It's unsubstantiated because it is an estimate. Measles was so overwhelmingly widespread and mild that they knew they could not just use the 500,000 figure and pretend that were the only cases. Especially when they estimate that the real number of cases was 6-8x that confirmed number. Or... they just threw that number in to make it seem like measles was worse than is reported. The problem is they screwed the numbers up. They use 1-3:1000 case fatality but also use 3-4 million cases. They don't go together. It's CDC math.

As opposed to your personal theory? Do you believe your theory actually changes the case fatality that is so commonly used as a fear tactic?

[Science mommy: Tired of getting your ass kicked by a chick yet? ]

You're a chick?

"Mama says that alligators are ornery because they got all them teeth and no toothbrush"

"Well, folks, Mama's wrong again." Bobby: "No, Colonel Sanders, you're wrong. Mama's right. You're all wrong. Mama's right. Mama's right!"

By augustine (not verified) on 01 Sep 2010 #permalink

After all the claims regarding autism and vaccines I have to ask, just what the heck is autism and how is it diagnosed? Where is a good place to learn this?

I ask because I have been assessed with Aspergers and I'd like a good introduction to autism and autism spectrum disorders.

I don't know why little Augie thinks there would have been that many hospitalizations pre-vaccine era. Most people didn't go to the hospital if they could avoid it; it was expensive, had very limited visiting of your children (would you like to see your sick child for maybe 15-30 minutes a night, after having traveled 20-30 minutes? Or would you have wanted to be with them? Not allowed) and very strict rules. A lot of doctors kept the kids at home if the moms were at all willing. I can readily recall my brother being at home with pneumonia - oxygen tent, IV, antibiotics and all (in the late 1960's).

So, no, you would not have seen

"There would also have been over 600,000 thousand hospitalization from measles per year. Didn't happen. Not even close."

Hospitals tried very hard NOT to admit people during epidemics (and still try today) if the people can be treated at home. (Of course, we are rather out of the days when you would probably treat pneumonia at home with O2, IVs and antibiotics... but neither do you have the doctors making home visits and the neighborhood nurses who were more prevalent then.)

Do you REALLY think your doctor has YOUR wallet in mind when he tells you to go home, go to bed, rest, take plenty of fluids and antipyretics for the flu? Unless you are very ill, they want you at home so the hospitals have beds available for the really sick people.

@Alan Kellogg: there are a lot of books out there, but I am not sure I would recommend many. If you are near a medical library, a copy of the diagnostic criteria (DSM-IV) will help you. You can also google "dsm criteria for autism and asperger" and get several sites that give the DSM criteria for both Autism and Asperger's syndrome.

By triskelethecat (not verified) on 01 Sep 2010 #permalink

@ Alan Kellogg, for a start, fire up the google and see : Autism Information Page, NINDS, NIH.gov and NIMH, Autism Spectrum Disorders. ( Also for a discussion about the differences between AS and other conditions see pages on NVLD.)

By Denice Walter (not verified) on 01 Sep 2010 #permalink

[I don't know why little Augie thinks there would have been that many hospitalizations pre-vaccine era.]

In a piece by the CDC called

"What Would Happen If We Stopped Vaccinations?"

http://www.cdc.gov/vaccines/vac-gen/whatifstop.htm#measles

they say:

"In the U.S., up to 20 percent of persons with measles are hospitalized."

the propaganda assumption is that this is "what would happen if we stopped vaccinations."

All we have to do is look back at what DID happen when we didn't have the measles vaccine to see if what "will happen" did happen. It didn't.

By augustine (not verified) on 01 Sep 2010 #permalink

@Little Augie: yes, nowadays, probably up to 20% of people who get measles would be hospitalized because society is different now. You don't have the stay-at-home moms, the doctors making house calls, the neighborhood nurses visiting daily that you had pre-MMR. More people are more likely to use the hospital for care. But hospitals don't have the beds to handle up to 20% more people (many are running at 80-90% capacity NOW, without any major epidemics).

Again, Augie, you didn't take societal changes in account between then and now. You are too young to know how things were back then, and too uneducated to understand when people point things out to you.

If we are going to look at the information, why look only at augustine's excerpt? Here is all of the section on measles:

Before measles immunization was available, nearly everyone in the U.S. got measles. An average of 450 measles-associated deaths were reported each year between 1953 and 1963.

All we have to do is look back at what DID happen when we didn't have the measles vaccine to see if what "will happen" did happen. It didn't.

In the U.S., up to 20 percent of persons with measles are hospitalized. Seventeen percent of measles cases have had one or more complications, such as ear infections, pneumonia, or diarrhea. Pneumonia is present in about six percent of cases and accounts for most of the measles deaths. Although less common, some persons with measles develop encephalitis (swelling of the lining of the brain), resulting in brain damage.

they say:
"In the U.S., up to 20 percent of persons with measles are hospitalized."
the propaganda assumption is that this is "what would happen if we stopped vaccinations."

That is not stating that this is what would happen if we stopped vaccinating.

That is stating what is happening now, with vaccination.

In the U.S., up to 20 percent of persons with measles are hospitalized.

Part of reading comprehension is understanding the difference between are and could be expected.

If that is the percentage of people with measles being hospitalized now, why should we believe that things would be better without vaccines?

Oh yeah! The Good Old Days. Living in the past, that wasn't as good as the nostalgist imagines.

Back when people had big families, because we needed to have some spares - if we wanted to have some children live long enough to take care of us in our old age, or just wanted some of our children to outlive us.

Why augustine is using a computer (and using Al Gore's Internet/) if augustine is so nostalgic?

Back when a lot of bad things were just not reported. Priests and children getting Biblical! We can't report that!

Better to pretend it never happened. It is a new development. Blame it on the women, or the immigrants, or the commies, or the transgendered.

So it seemed that things were better, that people were more moral, as long as you close your eyes and click your silver slippers together augustine, you can go to that home!

Home to the land of the illness/complication/whatever that is underreported/unrecognized.

As many as three of every 1,000 persons with measles will die in the U.S. In the developing world, the rate is much higher, with death occurring in about one of every 100 persons with measles.

Measles is one of the most infectious diseases in the world and is frequently imported into the U.S. In the period 1997-2000, most cases were associated with international visitors or U.S. residents who were exposed to the measles virus while traveling abroad. More than 90 percent of people who are not immune will get measles if they are exposed to the virus.

According to the World Health Organization (WHO), nearly 900,000 measles-related deaths occurred among persons in developing countries in 1999. In populations that are not immune to measles, measles spreads rapidly. If vaccinations were stopped, each year about 2.7 million measles deaths worldwide could be expected.

In the U.S., widespread use of measles vaccine has led to a greater than 99 percent reduction in measles compared with the pre-vaccine era. If we stopped immunization, measles would increase to pre-vaccine levels.

.

That these waivers exist in the first place is a mockery of the Law.

Yes! You read that right: The Supreme Court of the United states decided this stuff is...1905!! See or ask any friend who's a lawyer to pull up the Jacobson v Commonwealth case for your reading pleasure.

By Dr. Frankie (not verified) on 02 Sep 2010 #permalink

You couldn't pay me a million dollars to take a vaccine.

By Melissa A. (not verified) on 26 Aug 2010 #permalink

adelady begged, "I know you're talking about MMR and pertussis here, but please, please tell me these people are vaccinating against polio. "

Sorry adelady, but apparently Dr. Gordon doesn't even vaccinate against polio:

My vaccine schedule? Either none or just a DPT in the first 24 months of life. I think that there's a greater risk vaccinating males under 24 months and would prefer not to unless there are special circumstances. I use very few other shots except the Varivax as a child approaches ten years because teen and adult pox are nasty and even a little dangerous especially during pregnancy. I give Hep B vaccines to nursing student/moms and dads, other medical moms and dads and higher risk teens and college kids.

You'll notice he doesn't vaccinate against rubella either, although even I, a non-doctor, know that rubella is "a little dangerous especially during pregnancy". More than chicken pox, I believe.

What is 'Dr' Jay thinking of? When I was child in the very early 1970s my mother took us to meet an old friend of hers - in an iron lung.I have NEVER forgotten that experience and I thank God - or would if I was religious - for the wonderful gift of vaccines. My kids are fit as fleas - in fact the youngest had her first ever sick day from school (aged 9)last week, and it was really just an excuse to hang out with Mum and do some baking!

By NZ Sceptic (not verified) on 05 Sep 2010 #permalink

Jeez! I go away for a short holiday and when I come back I find that "Augustine" has been distorting my statements again (or has severe reading comprehension "issues").

Augustine claims:

"Science Mom, you cannot comprehend your links in context. ... Promotheus is trying to help you out by steering the conversation away from your argument into something other argument."

Ummm, no. What I was trying to do show that attempts by "Sid", "Dr. Jay" and "Augustine" to compare measles death rates today and measles death rates prior to vaccination are not valid unless you compare case-fatality rates. Since we don't have a good handle on the number of cases prior to the vaccine - since there were certainly more cases than were reported or even diagnosed - all we can know is the minimal case-fatality rate for that time.

The "problem" with Science Mom's question was that it had multiple "correct" answers, some of which would have been highly misleading (and which I predicted would be provided by "Augustine", "Sid" and others of their ilk.

"Augustine" further shows his/her true nature by quoting a CDC "What if?" paper out of context (and, apparently, not reading it very carefully"):

"In the U.S., up to 20 percent of persons with measles are hospitalized."

The little word "are" is in contrast to "were". People with measles in the pre-vaccination era weren't hospitalised as often for several reasons, not the least of which is simple logistics.

If 20% of people with measles had been hospitalised in the prevaccination era, that would have been between 30,000 and 150,000 people per year, based only on the reported cases. Since the number of measles cases per year would actually have averaged out to to the number of births per year (figure it out for yourself - if 95+% of all people had clinical cases of measles in their childhood, the number of cases over any length of time will be roughly equal to the number of births - new victims - produced in that time), those numbers would have been even higher.

For example, in 1960 there were 441,703 cases of measles reported. That year, there were 4,257,850 births - a number in keeping with the preceding decade. So, if the number of reported measles cases is accurate, we are left with the conclusion that only about 10% of the population ever contracted measles, a conclusion completely unsupported by the data (which, to remind, indicate that 95+% of the population had measles in their childhood prior to vaccination).

Now, plugging in the "new" numbers, it looks like hospitalising 20% of measles patients would result in about 800,000 admission per year. Even if these were spread evenly throughout the year (they wouldn't be), that works out to almost 2,200 measles admissions per day, 365 days a year.

It would appear that "Augustine" needs to take a "reading for comprehension" class.

Prometheus

" Since we don't have a good handle on the number of cases prior to the vaccine - since there were certainly more cases than were reported or even diagnosed - all we can know is the minimal case-fatality rate for that time."

You can't possibly support that with scientific evidence, Prometheus.

Jay

you can't possibly support that with scientific evidence

Well anecdotal evidence rates higher than scientific evidence in your world...doesn't it Jay?
I've spoken a large number of people whose children suffered through measles prior to vaccine availability and their experiences of the outbreaks support Prometheus. According to this same stream of anecdotal evidence, there were only a few cases where there was a medical diagnosis.

By Sauceress (not verified) on 24 Sep 2010 #permalink

In fact, those I've spoken to on this issue all appear that they would be only too willing to recall their experiences of such diseases for a public record. Perhaps I'll start seeking permission to record such conversations on my little you-beaut mp3 voice recorder.

By Sauceress (not verified) on 24 Sep 2010 #permalink

Of course he can support it. 

1) it's been pointed out more than once that upwards of 95% of Americans over the age of 18 showed immunological evidence of having had the disease. Therefore, on average, in each year the number of cases was at least 95% of the number of births, whether or not all those cases were recorded.  

2) you're old enough to actually remember when measles was endemc. Do you seriously contend that only one person in ten got the measles in their whole life?

3) Measles was a "childhood disease" when it was endemic, not beause it is only contagious to children -- it isn't -- nor because it is more dangerous to children than to adults -- it isn't -- but because it circulated almost exclusively among children.  Whenever an endemic disease is highly contagious, like measles, and produce lifelong immunity, like measles, then it becomes a "childhood disease" precisely because all the adults have had it and are immune, and it circulates almost exclusively among the non-immune children.  The mere fact that measles *was* a childhood disease proves that nearly all adults had had it, whether their illnesses were recorded or not.     

"Dr. Jay" comments (at #518):

"You can't possibly support that with scientific evidence, Prometheus."

Ummm, I think that my point was that there wasn't any scientific evidence available for the time period.

The problem (as I stated) is that measles was clearly under-reported in the pre-vaccination era (as LW puts so succinctly above). Additionally, it is reasonable to assume that - in those days prior to interlinked computer databases and mega-conglomerated insurance companies and HMO's - that the same under-reporting was also seen in the attribution of deaths to measles.

Finally, given the measles case-fatality rate we see today (2 per thousand cases), we are left with two alternative interpretations of the historical data:

[1] Children today are much more likely to die from measles, despite significant improvements in pediatric critical care.

[2] Deaths dues to measles in the decades prior to the introduction of the vaccine (when about 10% of measles cases were reported) were more often attributed to "pneumonia" (the most common complication of measles, affecting up to 6% of cases, and the proximal cause of death) rather than "measles".

Since many states only relatively recently expanded their death certificates to include multiple causes or contributing causes, logic suggests that option [2] is more likely.

Of course, I can't guess what "Dr. Jay" might think - for all I know, he'll favor the idea that humans have become "weaker" because of our exposure to "toxins" and vaccines, none of which were present back in the pre-industrial 1950's and 1960's.

Prometheus

I know Dr Jay is a very busy doctor who probably doesn't have a lot of time to read old books. But, I can point out numerous books where measles is greatly feared (one book obviously reflects the fears that measles brought, when the characters were(paraphrase)rejoicing that the children were recovering and did not suffer from the consequences so frequently seen with the disease.

Yes this was written in the late 1800s, but the characters were presented as wealthy, well-fed, healthy individuals. So, fear of measles was prevalent.

@Sauceress: I have to dig through the letters, but if you would like written memoirs of children ill with mumps and measles, I can send you the letters my grandmother wrote to my overseas during WWII grandfather about the events when my mother (age 7) and uncle (age 3) had them. My uncle was quite ill and my grandmother was unable to get his fever down. My mother's report card for that marking period had a comment that no children (in the entire school!!) would receive grades due to excessive illness (mumps, measles and chicken pox decimated grades K-6 for several months). And the boy across the street from my mother, had pneumonia and other problems after the measles. (My grandmother's comment - if he hadn't been a strong, husky child, she doubted he would have lived; as it was he was now quite frail).

My grandfather LOVED vaccines; he gave his patients every one that he could. Sure, he had fewer home visits to make, and less money, but healthier patients. He happily made that trade.

You couldn't pay me a million dollars to take a vaccine.

By Melissa A. (not verified) on 26 Aug 2010 #permalink

You couldn't pay me a million dollars to take a vaccine.

By Melissa A. (not verified) on 26 Aug 2010 #permalink

So Orac, if the Cochraine Collaboration in England concluded after a 96 season study that the flu jab had no evidence base to support its use where do you get your stats on vaccine efficacy? All vaccines are exempt from RCT placebo follow up studies, there are none that show efficacy.

It's not about anti or pro it's about evidence, and there isn't any as it is not required to go to market. The Amish community in the US has total non compliance, where are the death stats to support your position? The WHO studied measles fatalities in Africa and found at autopsy that the ones who died invariably had very low vitamin A reserves in the liver. In a trial all the kids and adults in one village were given a carrot a day, when the disease struck the region not one child or adult in this village died, the surrounding region the stats stayed unchanged. The WHO concluded that measles is fatal only in the malnourished, plenty of them in the western world living of the Maccy D.

Ok eating a carrot a day is not sexy, granted, but selling the idea that all these disease states can only be fought with knights is the sort of conspiracy that ordinary citizens would get locked up for under the new terror laws, shame on you.

By smoky mirror (not verified) on 07 Mar 2011 #permalink

Oh and maybe you heard of the 'Wakefield effect', the measles rates in the uk 10 years before compared with 10 years after Wakefield show a 85% fall in the rate of measles in England, that's with the vaccine rate falling to the lowest on record.

Just where do you get your facts from? And what is this silly red dot map thing below?

By smoky mirror (not verified) on 07 Mar 2011 #permalink

I *heart* trolls who dredge up six month-old threads and spew a bunch of ridiculous nonsense. But I'm not sure if "smoky mirror" is a new troll, or a familliar one under a new handle. This is about the only intrigue.

And I see it is still leaping from one old post to another. I wonder when it will come back here to spew some more now that someone has responded.

vacinnes are bs straight up. If there was a thing as evolution we wouldnt need vaccines. If God wanted us to be born with all that shit in those needles we wouldve been. Scientifically the avg person cant test what is going in their kids arm so you are surrendering all your faith to someone you do not know to inject some poison into your kids. Face the facts we all live to die its not like you can stop that fact of life and if you only extend your life till the point when you cant even take care of yourself is it really worth living. Luckily we live in America and even though the media says you dont have rights untill we are all brainwashed the people who still fight for thier rights will always win the battles vs the zombies who can only obey without using thier own brain.

By the truth (not verified) on 19 Aug 2011 #permalink

vacinnes are bs straight up. If there was a thing as evolution we wouldnt need vaccines. If God wanted us to be born with all that shit in those needles we wouldve been. Scientifically the avg person cant test what is going in their kids arm so you are surrendering all your faith to someone you do not know to inject some poison into your kids. Face the facts we all live to die its not like you can stop that fact of life and if you only extend your life till the point when you cant even take care of yourself is it really worth living. Luckily we live in America and even though the media says you dont have rights untill we are all brainwashed the people who still fight for thier rights will always win the battles vs the zombies who can only obey without using thier own brain.

By the truth (not verified) on 19 Aug 2011 #permalink

I wonder who "the truth" really is.

He could be a government agent masquerading as a troll...

Well we have a poop storm of troll posts and sock puppet posts today. Just ignore (Rule #14) all the posts.

Well, it is kind of humorous where "the truth" totally screws up how evolution works, that everyone here lives in America, and that God really cares about kids --- because the last time I looked it wasn't any god that reduced child mortality from less than a century ago when almost every family had a funeral for child.

I think the zombies already got the poster who signed as "the truth."

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@535 - Since when is spam "traditional botanical medicine"?

By Mephistopheles… (not verified) on 21 Dec 2011 #permalink

"Since when is spam "traditional botanical medicine"?"

Since about 4 hours ago.