Anatomy of a measles outbreak that began with an unvaccinated child
This article from MedicineNet on Monday provides a fascinating in-depth look at a 2008 measles outbreak in San Diego.
The outbreak began when a child who had not been vaccinated returned from Switzerland. Before symptoms appeared, he infected his siblings and his classmates, 11 percent of whom were unvaccinated.
In the end, 839 people were exposed to measles. Eleven were infected, and 48 exposed kids too young to be vaccinated were quarantined -- forbidden to leave their homes -- for 21 days. Jane Seward, MBBS, MPH, was the CDC's senior investigator for the outbreak.
"Even with the very high vaccine coverage that we saw in San Diego, if you have a community of vaccine refusers you can get an outbreak," Seward tells WebMD. "Had the local health department not been extremely aggressive in quarantining everyone who came in contact with a case who did not have immunity, the outbreak would have broadened."
Fortunately, nobody died or suffered neurological damage. But there was one very close call.
A 10-month-old boy who contracted the disease spent three days in the hospital, dropped from 18 to 12 pounds in five days, and took months to recover. His mother expressed frustration with non-vaxers.
Part of the investigation involved researchers reaching out to the anti-vaccination parents in the affected community and talking with them about the risks and benefits of immunizations. After these interviews, 40 percent of the parents chose to have their children immunized.
The State of Michigan (along with California and 18 other states) makes it very easy for parents to exempt their children from immunization requirements, by allowing philosophical and religious objections, along with medical exemptions. You just sign a form. I oversaw the health forms for my daughter's co-op preschool one year, and I was surprised at how many of the families claimed exemption from at least one immunization, and how easy the process was.
Some critics, including the American Medical Association, say the process should be more rigorous.
One plan, outlined in this article, would require parents to receive counseling about the risks and benefits of vaccines. They also would be required to present a signed, personal statement demonstrating how long they have held their beliefs and that they understand the risks and benefits of vaccines.
What do you think?
Jen Eyer is on the Community Team at AnnArbor.com. She oversees the Parenting and Home & Garden sections, and writes feature stories, blog posts and opinion pieces. She can be reached at 734-623-2577 or jeneyer@annarbor.com.
Comments
Max Peters
Mon, Dec 6, 2010 : 1:19 p.m.
My kids would be vaccinated against measles, except that the measles vaccination is lumped together with the rubella vaccine (i.e. MMR). The problem with the rubella vaccine is that it was derived from an aborted child. Give us vaccines that are clean of fetal tissue and we'll vaccinate away...
Amanda
Mon, Dec 6, 2010 : 5:42 a.m.
"Recent excellent 5 part series on measles, of which I'll point to part 5, where there are graphs of the very dramatic crash in measles incidence after start of vaccination: http://www.iayork.com/MysteryRays/2010/03/19/measles-week-part-v-what-about-the-vaccine/" But it's amazing what happens when you add the previous 15 years to the graph. All of a sudden that vaccine doesn't look so impressive. Page 3. http://genesgreenbook.com/resources/obamsawin/ImmunizationGraphs-RO2009.pdf Seems the crash began many years earlier.
Anonymous Due to Bigotry
Sat, Mar 27, 2010 : 11:47 a.m.
@JadziaDax: Genetic studies have shown that Autism is passed on genetically. All studies that claim that Autism is correlated with vaccination have turned out to be deeply flawed. Also: "Recent estimates from CDC's Autism Developmental Disabilities Monitoring network found that about 1 in 150 children have ASD. This estimate is higher than estimates from the early 1990s. Some people believe increased exposure to thimerosal (from the addition of important new vaccines recommended for children) explains the higher prevalence in recent years. However, evidence from several studies examining trends in vaccine use and changes in autism frequency does not support such an association. Furthermore, a scientific reviewExternal Web Site Icon by the Institute of Medicine (IOM) concluded that "the evidence favors rejection of a causal relationship between thimerosal-containing vaccines an autism." CDC supports the IOM conclusion." http://www.cdc.gov/vaccinesafety/Concerns/Autism/Index.html My guess is that the increase in Autism Spectrum Disorder diagnoses (which would include Asperger's Disorder) is simply due to increased awareness and more autistic people who would previously have been undiagnosed are now being diagnosed. It basically used to be that someone had to also be mentally retarded to be diagnosed with autism, and this is no longer the case.
CLX
Fri, Mar 26, 2010 : 7:36 p.m.
Those who choose not to vaccinate their children do so knowing that most people will. If 1/2 of the population did not vaccinate their children, I am guessing that many more parents would change their mind because the risk for their own kids to develop a disease would be much greater. It is a classic free-loader problem. There was a suspected scare at an elementary school here in Ann Arbor within the last year or two. Measles maybe? I can't remember the disease at issue. In any event, there was a number of kids in the school who had not been vaccinated. My understanding from the information shared by the school is that all unvaccinated children opted to be vaccinated in the face of an actual, close to the home threat. That's what makes it hard for many of us to to believe that most people who do not vaccinate have serious, idealogical objections to vaccinations.
tracyann
Thu, Mar 25, 2010 : 5:10 p.m.
I had my children vaccinated because I feel the risk of a reaction to the vaccines is small compared with the effects of the diseases they are meant to protect against. It is within your right to not vaccinated your children, however, I can't help but notice that as the number of those who choose not to vaccinate rises so does the number of illnesses that aren't considered common anymore, i.e. measles, mumps, & whooping cough.
JadziaDax
Thu, Mar 25, 2010 : 4:15 p.m.
I'm very sorry for the complications you suffered wolffiemann. Perhaps I am too ignorant to notice that your experience also sounds very similar to the reports of thousands of parents who have witnessed vaccine reactions in their children. You are very lucky that you fully recovered. Many of these children will never be able to communicate, much less ever be able to insult a person on the internet.
wolffiemann
Thu, Mar 25, 2010 : 3:25 p.m.
JadziaDax - Here is a dose of reality for you. I am a 55 yr old white male who grew up in a suburban environment (Chicago suburb)similar to Ann Arbor. In 1961 I GOT MEASLES - this is in the pre-vaccine era. My best friend who lived across he street also got it. He missed 4 days of school which was about an average.I spent 4 days in the hospital in a paralytic coma and my fever spiked to 104. Another degree or two and I would have had permanent brain damage. I recovered completely or so it seemed.I later developed multiple sclerosis - note that there was a suspected link between the two diseases although from there reading I have done this has now been disproven. This is analogous to the now disproven link between vaccines and autism. It just happens that autism presents itself at the same ages during which kids are vaccinated. I find your ignorance appalling and would not wish what happened to me to ever happen to you or your children. You need to be aware of what the consequences of your actions could be. I urge you to protect your children and their friends
Rork Kuick
Thu, Mar 25, 2010 : 2:54 p.m.
Finally about the poll: If we make opting out of childhood vaccines "harder", that means giving preferential treatment to whoever still gets to opt out (perhaps for religious reasons) so it's not fair, and that's why people should not have to argue about opting out. It also might mean we'd need an inquisitor to determine whose religious or philosophical reasons are sufficient - hopefully a ridiculous idea in the U.S. An alternative is to require a certain minimal schedule of vaccines for every kid, or else they do not get to go to public schools. I'd favor that except that it can backfire: The antis complaining about their freedoms, and elaborating their conspiracy theories, will just be further enabled. So that's why we are where we are right now, where it's easy to opt out. All we can do is appeal to people's self-interest, and their willingness to help protect others by helping with herd immunity. The second reason alone is enough for me to get jabbed regularly.
Orange577
Thu, Mar 25, 2010 : 2:35 p.m.
Jadzia "We're not the problem, the problem is the problem." Do you know you just quoted Jim Carrey? "The problem" is when people do not vaccinated when there is not good science to support such a decision. Then when we have an outbreak it is everyone's problem. "...the government is refusing to pay for vaccine-damaged children..." This is just not true. The government compensates for possible vaccine injuries, even when the injury is not proven to have been caused by a vaccine. I'm certain you are familiar with the NVICP. "Most of these "outbreaks" occur among the VACCINATED." True, but misleading. This is because so many more people are vaccinated than unvaccinated. If a vaccine is 95% effective, there are still going to be 5% of vaccinated people who are not immune. But 100% of unvaccinated people are going to be not immune. Nobody says that vaccines are 100% effective, but they are still very effective. "Fix your product, offer individual vaccines again, maybe more parents would use them." You need to show that a product is broken in order to fix it. If we start trying to fix a vaccine based on hunches and not science, it will be a waste of time and money, and will not be science-based. "Never mind the fact that MMR is a live virus vaccine, one of the risks being actually contracting the disease." This is also simply untrue, the MMR vaccine is attenuated (disabled) and cannot cause the disease. "Let's not forget that measles used to be a normal childhood illness. I don't remember the Brady kids dropping dead and being hospitalized from it." Measles kills in 1 in 1000 cases. The Brady kids did not drop dead from it, because like the autism/vaccine link, they are fictional.
Rork Kuick
Thu, Mar 25, 2010 : 1:47 p.m.
Good point Adam. About the mumps math: http://skeptico.blogs.com/skeptico/2010/02/ and look at the report of Feb 13. But that's mumps. With measles it's even easier.
Adam Jaskiewicz
Thu, Mar 25, 2010 : 1:34 p.m.
"here is an article about the recent mumps outbreak, 77 percent of the kids were vaccinated" So, 77 percent of the kids who got sick were vaccinated. That means 23 percent weren't vaccinated. What is this supposed to tell us? It could tell us any number of things depending on how much of the population actually is vaccinated. If 95% of the population is vaccinated, your stat tells us that being vaccinated reduces your chances of contracting the disease drastically.
Rork Kuick
Thu, Mar 25, 2010 : 1:24 p.m.
Recent excellent 5 part series on measles, of which I'll point to part 5, where there are graphs of the very dramatic crash in measles incidence after start of vaccination: http://www.iayork.com/MysteryRays/2010/03/19/measles-week-part-v-what-about-the-vaccine/ Again: Measles used to be common as dirt - almost everybody got it, and we nearly wiped it out with vaccine. Maybe anti-vaxers have a different theory about the cause of the decline though.
ameliajayne
Thu, Mar 25, 2010 : 12:58 p.m.
To JadziaDax-- your one time witnessing of measles isn't relevant unless you tell me you have a degree in Public Health, or have done extensive research into the world wide impact. What if I said that autism shouldn't be treated or researched because when I was a kid it wasn't a problem-- the autism industry is just making it up. I would be wrong. We have to move past our limited exposure to something and look at the facts. When we were kids, there was no internet and we didn't have immediate access to medical information. It's a dangerous disease for some people and there is little evidence that the vaccine is dangerous.
JadziaDax
Thu, Mar 25, 2010 : 12:35 p.m.
"The way that you portray the risk as a "lost week at work" shows that you are ignorant of the impact of this disease." Actually, no, I have witnessed measles firsthand. Have you? My friend who was ill and I helped care for was sick for about a week. It seems like most people's opinion of the measles is based on articles like this one. I have a World Book parenting encyclopedia from the 1970's, published just a few years after the vaccine was introduced, and it describes measles as a mostly benign illness. It is interesting to see how the availability of a vaccine starts to impact the public's view of a disease. We are witnessing a similar thing happen with chickenpox. Chickenpox was a disease we all got as kids and sailed through. Now that the vaccine has been on the market for a while, I am starting to read articles about how dangerous it is. After a few more years this will take hold and we will all start freaking out about the possibility of a chickenpox outbreak as if it is Ebola or something.
Rork Kuick
Thu, Mar 25, 2010 : 12:34 p.m.
JadziaDax said "This has been the case with every one of these outbreaks I have read about", but it may be largely due to what they read. Try this brief history: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm57e501a1.htm which shows several lines of evidence that people not getting vaccinated really is a problem. With vaccination, we had nearly eliminated measles, until recently. British folks suffer similarly: http://news.bbc.co.uk/2/hi/health/7259338.stm
ameliajayne
Thu, Mar 25, 2010 : 12:14 p.m.
Re Social Contract-- Yes, I do believe that you have a responsibility to vaccinate. We are not talking about a cold. We are talking about a serious life threatening illness. The way that you portray the risk as a "lost week at work" shows that you are ignorant of the impact of this disease. The risk of your child getting damaged from the vaccine is infinitesimal compared to the risk of the actual disease. And if most of us didn't take the small risk, then many more children would die. And I don't hear you saying that you will take the cost of not doing it (staying out of schools). You benefit from the fact that the rest of us take the risk and cost of getting the vaccine.
A2zoo
Thu, Mar 25, 2010 : 11:43 a.m.
I like the introduction to this commentary of the social contract. You cover your mouth when you cough or sneeze so others don't get sick. At that moment you're thinking of the other social beings around you. When you don't get your child vaccinated and introduce him/her into the social world, you are not thinking of the other social beings around him/her. You are being very selfish. You are risking the lives of infants/newborns that you don't even know with that decision. Yes, the decision to vaccinate my son was daunting with lots of research and lots of back and forth as to whether I wanted to get him vaccinated. But this is the thing that swayed me - do I want to risk his life and the lives of other children/people because there may be a slight chance that these vaccines might cause autism (which research shows they do not)? For me it came down to I would rather have a child with autism than a dead child because I did not get my son vaccinated.
JadziaDax
Thu, Mar 25, 2010 : 11:42 a.m.
Right on, Susanna! You know what I think violates the "social contract"? Expecting parents of vaccine-injured children to sacrifice their child just so the rest of the "herd" isn't inconvenienced by taking a week off from work to care for a sick child.
Michael Psarouthakis
Thu, Mar 25, 2010 : 11:40 a.m.
JadziaDax, I guess you can call measles a normal childhood disease if you want, but it is certainly no chicken pox like childhood disease, it is a real killer. Measles is estimated to have killed 200 million people in the last 150 years. While there is some risk with reaction to measles vaccines, the benefits are clear and risks extremely minimal. Your children are dramatically much more likely to have complications or die from measles than from the vaccine. Historically, measles was prevalent throughout the world, as it is highly contagious. According to the National Immunization Program, 90% of people were infected with measles by age 15 prior to the vaccine being available. Before the vaccine was introduced in 1963, there were an estimated 3-4 million cases in the U.S. each year, tens of thousands of children died during the past 100 years in the US alone. Life is full of risk and making decisions for ourselves and our children, the conspiracy theories surrounding vaccines is hurting more people than it is helping. You certainly have the right to not vaccinate, but this country would grind to a standstill if every risk taken had to be indemnified by the government and/or the companies that make a product that literally saves millions of lives and theoretically puts a few at risk. As a matter of fact some people argue this is already happening..
Susanna
Thu, Mar 25, 2010 : 11:31 a.m.
Directed to "Anonymous"- You said, "Vaccinations are part of the social contract. Those who are not vaccinating, you are benefiting from the fact that most of us who do and are violating that social contract.". So you are saying if a parent has made the decision to not put their child in a lottery that they believe has the potential to maim or kill their child they have violated the "social contract"? Sorry, I still believe each parent has the right to evaluate and choose what they feel is best for their own child. Some vaccinations are valid and safe. And imho, some are not. This is my decision, not yours. I wonder how many parents actually investigate each and every vaccination and drug they put into their childs body. Sadly, I believe the numbers are higher for parents who allow someone else to tell them it's ok and they *must* do it.
JadziaDax
Thu, Mar 25, 2010 : 11:26 a.m.
@ Anonymous Due to Bigotry, The author of this article conveniently left out the stats of how many kids who got the measles in this outbreak had been vaccinated. But here is an article about the recent mumps outbreak, 77 percent of the kids were vaccinated: http://www.cnn.com/2010/HEALTH/02/08/mumps.outbreak.northeast/index.html This has been the case with every one of these outbreaks I have read about, the vast number of people affected are those who are already vaccinated. I know blaming it on unvaccinated children makes for a sexier headline, but it is not accurate. You asked about autism. Important research needs to be done on children who have regressed. (Poorly done epidemiological studies will not identify a sub-set of children who may not be able to tolerate certain vaccines). But if you read the vaccine inserts, encephalopathy is a reported adverse affect. Does it really seem that outside the realm of possibility that a vaccine that can cause brain damage might be associated with autism? The government has acknowledged this in a handful of cases, such as Hannah Poling and Bailey Banks. The parents in those cases were fortunate that they had brain scans that proved their case, but most parents do not have that information.
Lisa
Thu, Mar 25, 2010 : 11:20 a.m.
@Jen - nope, not confused. That article is talking about immediate post-vaccination transmission. I'm talking about me, vaccinated person for 30 years now, being exposed to measles today, becoming infected (though not diseased) and passing that infection on (potentially) to whomever I encounter who has not been vaccinated.
tracyann
Thu, Mar 25, 2010 : 11:20 a.m.
I don't think that anyone should be forced to have their kids vaccinated, however, if you choose not to it does become a public health issue. Someone brought up "herd immunity" and they're absolutely correct. Not all vaccines work for everybody and likewise most people do not have adverse reactions to vaccines, which is the fear among those who refuse to immunize. This article is no more full of "scare-mongering" than the parents who claim that vaccines cause autism.
ameliajayne
Thu, Mar 25, 2010 : 11:10 a.m.
Vaccinations are part of the social contract. Those who are not vaccinating, you are benefiting from the fact that most of us who do and are violating that social contract. I would like to ask the non-vaccinators if they are willing to expose their own kids as a condition of opting out. No? Don't want to keep your kids quarantined for 21 days and miss school and all of the fun? Then get your vaccinations or keep your kids away from mine.
Anonymous Due to Bigotry
Thu, Mar 25, 2010 : 11:06 a.m.
@atnaap, Lisa: Good points. http://en.wikipedia.org/wiki/Mathematical_modelling_of_infectious_disease The mathematics of mass vaccination If the proportion of the population that is immune exceeds the herd immunity level for the disease, then the disease can no longer persist in the population. Thus, if this level can be exceeded by vaccination, the disease can be eliminated. An example of this being successfully achieved worldwide is the global eradication of smallpox, with the last wild case in 1977. Currently, the WHO is carrying out a similar campaign of vaccination in an attempt to eradicate polio. The other ignorant thing I hear is that "such and such disease has been eliminated so we don't need to vaccinate for it anymore".
Lisa
Thu, Mar 25, 2010 : 10:55 a.m.
it was my understanding that there's a difference between 'infected' and 'diseased' - a vaccinated person can be 'infected' - and s/he will not become 'diseased' (i.e. be symptomatic) but may be able to transmit the pathogen to an unvaccinated person. As such, a vaccinated person CAN be a part of an outbreak.
theodynus
Thu, Mar 25, 2010 : 10:51 a.m.
"Most of these "outbreaks" occur among the VACCINATED" This isn't strictly false, AnonymousDuetoBigotry. It's just wildly misinformed. Vaccines are not 100% effective. Some vaccines only make 50% of people immune. That's not really the point. The point is, if everyone gets vaccinated, even those for whom the vaccine didn't work will be protected. The disease won't move through the "herd" if a large enough percentage of people are immune. However, if 30% of people refuse to get vaccinated, they put not only themselves, but plenty of vaccinated-but-not-immune people at risk. There's absolutely no reason to believe there's a link between autism and vaccines. It's no different from saying there's a link between The Simpsons and autism (autism diagnoses have gone up since the show started in 1989, ZOMG!). People who don't vaccinate are putting themselves AND EVERYONE ELSE at risk and that makes them dangerous and seriously frickin' inconsiderate.
JadziaDax
Thu, Mar 25, 2010 : 10:51 a.m.
a2girl, of course measles is a devastating illness in third world countries. Vitamin A is a very effective treatment for the measles so it is not surprising that someone who is malnourished will not recover from the illness. Add to that the lack of clean drinking water, and lack of medical care and any illness will will be much more serious under those conditions. The article and my comment was about the United States. Measles is rarely fatal in developed countries. I had a (vaccinated) friend who was sick with the measles back in 1994. He went to the doctor and she just told him to rest and take it easy for a week. The CDC was not called in, there was no "outbreak" reported on my the local news media. It is amazing now to see such scare-mongering. One-sided articles like this do not help the pro-vaccine side, which just looks more and more desperate. People are waking up and realizing that not all vaccines are created equal, nor are they all as safe and as effective as the manufacturers like to tell us.
Wolverine3660
Thu, Mar 25, 2010 : 10:47 a.m.
Lots of anti-vaccine folks here in Ann Arbor. I am always amazed, when I see well-educated women, spouting all manner of BS reasons why vaccines are a bad thing for their kids. You would never catch the same people saying anythingas irrational or ridiculous when the yare working at their jobs in law firms, U-M research etc.
Anonymous Due to Bigotry
Thu, Mar 25, 2010 : 10:36 a.m.
@JadziaDax: You must provide a reference for the statement "Most of these "outbreaks" occur among the VACCINATED". Pasting a link into a comment will work fine. Let me say that again another way: [citation needed] Do you also believe that autism is caused by vaccines? I hear people making these sorts of claims, but usually when they're forced to come up with legitimate references and cost-benefit analyses they're unable to do so. It's easy to come up with a few isolated cases, especially when people don't bother to establish causality. If some tragic death of one child occurs supposedly due to a vaccine, and you have to kill another 1,000 children to save that child by not vaccinating anyone, it really doesn't make sense now does it?
a2girl
Thu, Mar 25, 2010 : 10:31 a.m.
JadziaDax, FYI, some stats from the World Health Organization's website: * Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available. * In 2008, there were 164 000 measles deaths globally nearly 450 deaths every day or 18 deaths every hour. * More than 95% of measles deaths occur in low-income countries with weak health infrastructures. * Measles vaccination resulted in a 78% drop in measles deaths between 2000 and 2008 worldwide. * In 2008, about 83% of the world's children received one dose of measles vaccine by their first birthday through routine health services up from 72% in 2000.
JadziaDax
Thu, Mar 25, 2010 : 10:18 a.m.
We're not the problem, the problem is the problem. The vaccine manufacturers are indemnified from any liability, the government is refusing to pay for vaccine-damaged children, you're damn straight we better be able to opt out. Most of these "outbreaks" occur among the VACCINATED. So you want parents to assume all the risks for something that is not all that effective. Fix your product, offer individual vaccines again, maybe more parents would use them. Never mind the fact that MMR is a live virus vaccine, one of the risks being actually contracting the disease. I'd be more concerned about the recently vaccinated child who sheds the virus causing your so-called outbreaks. Let's not forget that measles used to be a normal childhood illness. I don't remember the Brady kids dropping dead and being hospitalized from it.
Adam Jaskiewicz
Thu, Mar 25, 2010 : 9:50 a.m.
Maybe we should tack on a fee under ObamaCare so that people can help pay for the public health risk they create by not having their children vaccinated.