If you haven’t already heard, California is in the midst of a major outbreak of pertussis (whooping cough). The California Department of Public Health is predicting that this could be the biggest outbreak in 50 years.
Here is a graph from the CDC (via the LA Times) which shows the number of pertussis cases in the entire US as a function of time up to and including the 2004/5 outbreak:
That was not just the sort of cyclic bump seen every 4-5 years even with vaccines. That was a big outbreak. And, now, California is set to see an even bigger outbreak.
So far 7 infants have died. They were too young to be vaccinated. What is especially troublesome is that usually the worst part of the year starts in August. Here is a figure from the CDPH comparing this year to last year:
By this time last year, no children had died.
Why bring this up on an autism blog? Because unfortunately much discussion focuses on vaccines and pertussis is a vaccine-preventable disease. Many autism organizations promote under vaccination or skipping vaccination. Also, groups such as the self-named “National Vaccine Information Center” (NVIC) use autism as a major part of their message touting the dangers of vaccination. Because of this, these groups react strongly to accusations that these outbreaks are due to their activism. Such an accusation came from Nancy Snyderman of MSNBC
http://www.msnbc.msn.com/id/32545640
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Dr. Snyderman is an “unabashed advocate” for vaccines and points out that people who selectively undervaccinate put people like the immune compromised and the very young at risk.
As you might imagine, these strong comments brought a strong response. Becky Estepp of Talk About Curing Autism gave her response at the at the Age of Autism blog.
Barbara Loe Fisher of NVIC defended her group’s positions even before the MSNBC spot aired:
After watching the NVIC video I had a lot of questions. I posed a few of them to the California Department of Public Health. I appreciate them taking the time to reply:
NVIC states that there are outbreaks every 4-5 years and that “this is nothing new”. I asked CDPH:
There is an outbreak every 4 to 5 years (implying this is no big deal). I think this is correct as far as it goes, but the magnitude of this outbreak appears to be large. Is there public data on the size of previous outbreaks to compare this one to? I realize that will likely involve an estimate of the size of this year’s outbreak.
Yes, historically, there are “peak years” for pertussis every 3-5 years. This was true for other vaccine preventable diseases as well before they were controlled by vaccination. This is because once a disease sweeps through a population it takes at least a few years for adequate numbers of susceptible people to accumulate again in the population to allow sustained, widespread transmission of the disease. What is different about pertussis than other vaccine-preventable diseases such as measles, is that, unlike measles, neither pertussis vaccine or disease confers lifelong immunity. Pertussis susceptible people accumulate in the population via birth cohorts who are too young to be vaccinated, people whose immunity from vaccine or disease has waned, and people who are eligible to be vaccinated, but are unvaccinated.
The last peak year for pertussis in the U.S., including California was in 2005. This was a nationwide peak year with over 25,000 cases in the U.S, the most cases in 45 years, and over 3,000 cases in California, including 8 deaths. Although Tdap was first licensed in June 2005, not many people received it that year and it did not have an effect on the outbreak. We now have Tdap to use as a control measure that was not available in other peak years. Therefore, we are trying to increase the level of pertussis immunity in the population by encouraging the use of Tdap, particularly in people who have contact with infants.
California is having a peak year/epidemic in 2010. If current trends persist, there will be more cases in California this year than in 2005 and more cases than in 52 years (see attached document, which has been released to the public). Although some other states are reporting increases this year, no state has reported an increase similar to that seen in California, which has now had a six-fold increase from the numbers reported during the same time period in 2009, a non-peak year.
NVIC seems to be implying that parapertussis is the cause of the outbreak and that is not covered by the vaccine. Aren’t many cases, especially those hospitalized or the deaths, confirmed by PCR?
Parapertussis is also circulating and pertussis vaccine does not provide protection against parapertussis. However, we do not think parapertussis is the cause of our epidemic because most of the reported pertussis cases in California are laboratory confirmed to be pertussis. In addition, parapertussis does not kill healthy young infants. Tragically, there have been seven infant deaths in Calfornia this year, all of whom had laboratory confirmed pertussis.
NVIC is also claiming that B. Pertussis may be mutating away from the vaccine strain, so the vaccine would be failing. Besides being at odds with her own assertion that the outbreak is due to parapertussis, is there evidence for this? Are the outbreaks in unvaccinated individuals? The comparison is, of course, most valid in the very young, where immunity will not have had the chance to wane.
We are not aware of any evidence that the currently circuclating strains of pertussis are not covered by the vaccine. Of the reported cases for whom we have vaccination information, most were unvaccinated or undervaccinated. None of the seven infants ❤ months of age who died had received any pertussis-containing vaccines.
I have a lot more questions and there is much to deconstruct in the NVIC and TACA statements, but this is not the time for that.
Is the current outbreak due to the activities of groups like NVIC, TACA and the Age of Autism? Let me put it another way since accusations bring on such strong reactions from these groups: does it matter right now if they are at fault? People are dying. The goal right now is to minimize suffering and death. Vaccines do offer protection and could limit this outbreak.
Left Brain Right Brain 
As a Father of a child who has not received this vaccine I have one question for you? If it is so important to give children this vaccine then why isn’t the pharmaceutical companies making the vaccine for whopping cough by itself. I don’t want to give my child the DPT shot nor the DaPT shot. Too many known complications from this vaccine. Too many damaged children from this vaccine. I will role the dice and take my chances of my child getting the disease. I don’t want vaccines that have more than one disease in them. I am concerned about aluminum levels in vaccines. Why are they still making them with this dangerous compound, known to cause brain damage and inflammation in the body? If you want the parents who haven’t vaccinated to do so, why don’t you work with big pharma on meeting the needs of these people, instead of bashing us like we are uneducated individuals? Trust me, nobody wants children dying from the disease nor do we want children being hurt by the vaccine.
“As a Father of a child who has not received this vaccine I have one question for you? If it is so important to give children this vaccine then why isn’t the pharmaceutical companies making the vaccine for whopping cough by itself”
I don’t know why they don’t have a single pertussis vaccine. At this point, it is a moot question. I’ll say it again: people, infants, are dying in California, now. We can ask questions back and forth about what you or I think should be happening. What does that do to solve the current problem?
“instead of bashing us like we are uneducated individuals?”
If you have a segment of the above post which you consider to be “bashing”, please let me know. While I disagree strongly with the positions taken by NVIC and TACA, disagreement is not bashing. Obtaining and distributing accurate information which goes against the assertions made by those organizations is not bashing.
The vaccine works. Children in the age bracket to have the vaccine have a low prevalence. Older children where the immunity is wearing off have a higher prevalence. Del Norte county had an early outbreak. They instituted a vaccination program and it made a big impact on reducing the spread.
There is an impression that the pertussis vaccine is not safe. Much of this impression results from the old DPT vaccine. The old DPT vaccine had a lot more problems associated with it. Some, including some of the most serious, were not real. But, the fact of the matter is, DPT is gone. It has been gone for a long time.
“Trust me, nobody wants children dying from the disease nor do we want children being hurt by the vaccine.”
I agree with that statement completely. But, there is no perfect solution. Or, as TACA and NVIC say, “there are no guarantees”. But there are. Not for the individual, but for the group. People are getting sick. Infants are dying. Now. Increased vaccination will reduce that number. People need accurate information to make informed choices. Unfortunately, the “National Vaccine Information Center” is not a place to turn for that information.
My heart goes out to the children who died from this disease. This is tragic and horrible.
I have questions concerning the children who died:
Did they have a natural child birth?
Were drugs used in the labor?
Did the mothers have a c-section?
What was their gestation age at birth? Weight? APGAR Scores? Overall health?
Did the mothers test positive for strep B? Were IV antibiotics used during labor?
Were their other health complications for these children?
Were the Mothers induced?
Did their mothers exclusively breastfeed these children or were they formula fed, or a mix of both?
Did they receive other vaccines?
What was the timing of those vaccines in connection to the time of getting the whopping cough?
I think it would be very helpful to have this information to understand specifically the deaths of these children.
Jim – what serious known complications does the DTaP carry? Also did you know there’s more Aluminium in a years worth of breast milk than the combined 0 – 6yo paediatric schedule?
Knowing this, does it change your mind about vaccines? Are you happy to get your child vaccinated now? If not, why not?
Jim, nobody is calling you uneducated. Quite the contrary – Kev just handed you an opportunity to demonstrate your education on this matter.
So tell us: what complications does DTaP carry? How many antigens are present in that vaccine? What is the difference between elemental aluminum, and the aluminum salts present in some vaccines?
How many antigens does a newborn ingest on his first day of life?
[sullivan say] If you have a segment of the above post which you consider to be “bashing”, please let me know. While I disagree strongly with the positions taken by NVIC and TACA, disagreement is not bashing.
COMMENT
as one who enjoys bashing…i was disappointed…LBRB’s discussion and videos were a measured, fair, presentation of pro/cons…separate fact and opine…then;
with this info and personal experience one is able to vax or not.
stanley seigler
[ltr say] In most of the fatal cases, pertussis was not diagnosed until after multiple visits to outpatient clinics, the emergency room, or inpatient wards.
not a med school grad…but this doesnt seem like that difficult a dx…maybe miss first time. but not multiple…
stanley seigler
FYI CDPH’s LETTER
California Department of Public Health
August 3, 2010
TO: All General Acute Care Hospitals (GACHs)
SUBJECT: Pertussis (aka Whooping Cough)
1) Recent Infant Deaths Associated with Delayed Diagnosis
2) Immunization of Patients, Health Care Workers and Others
The California Department of Public Health (CDPH) is dedicated to protecting the health and well-being of the people in California. Pertussis (whooping cough) is currently an epidemic in California. Pertussis during early infancy is frequently severe and potentially fatal. Seven California infants, all younger than three months of age, are known to have died from pertussis so far in 2010. In most of the fatal cases, pertussis was not diagnosed until after multiple visits to outpatient clinics, the emergency room, or inpatient wards. CDPH is sending this letter to facilities to support the timely diagnosis of pertussis.
[…]
CDPH Pertussis Immunization Recommendations
Immunity to pertussis from either disease or vaccine wears off over time, leaving fully immunized children susceptible again by adolescence. Unfortunately immunization rates are low for the recommended ‘Tdap’ pertussis booster vaccine, which has been available since 2005. The most recent CDC survey data indicates that 44% of adolescents in California and only 6% of adults nationwide had received a Tdap booster shot by 2008.
[…]
the above are clips from a 3 page letter (pfd)…i dont know how to attach to post and cant find a link.
LH, what evidence do you have that your criteria have anything with an infant surviving the toxins created by the pertussis bacteria? Please provide the references.
“not a med school grad…but this doesnt seem like that difficult a dx…maybe miss first time. but not multiple…”
Well, I suppose it is possible to miss the diagnosis. My wife and I happen to be graduates of US medical schools. Like her pediatrician, we thought that our daughter’s illness was likely respiratory syncytial virus, which happened to be peaking in our part of California at the time of our child’s illness. We did discuss whooping cough, but tested for it mainly because the illness had been diagnosed and reported in two other children in our town. (The PCR-based test isn’t inexpensive, and obtaining the appropriate sample is quite a bit more uncomfortable than an injection.) Following the incubation period, the symptoms of the early (catarrhal) phase of the disease, which lasts seven to ten days, are not distinctive, but are generally those of typical viral respiratory infections (which are generally left untreated). The paroxysmal phase, which may last six to ten weeks, involves the distinctive cough. Unfortunately, the infection can be readily spread during the week or week and a half that infected persons have coughs that resemble those produced by viral respiratory infections and who have not yet progressed to the paraxysmal phase.
brian:
Which is why herd immunity is so important. It is better to prevent the disease than have the consequences of it being diagnosed to late.
By the way, is it just me, or do LH’s questions on how the babies were born and cared for (formula instead of breastmilk) seem a little presumptuous? It is almost as if LH thinks that if the birthing and parenting were not up to his/her standard then the babies did not deserve to live.
So if a couple adopts a newborn, feeding he/she formula… then that is why he/she is vulnerable to pertussis. Not that the child was too young to be vaccinated.
How about we all make our own decisions about what is best for our children and respect each others choices.
Laurie,
I can respect another’s decision and disagree with it at the same time. My viewpoint differs from, say, that of Barbara Loe Fisher. Is she disrespectful towards me when she puts out youtube videos with information I disagree with both on interpretation and content? Am I disrespectful when I point out where we differ and the consequences of following her advice?
Yes, Laurie. Just as long as you can make sure you and your children do not spread pertussis or other diseases to vulnerable populations. While you are making such profound statements, can you please tell me how what happened to these two boys could be prevented:
http://www.timesonline.co.uk/tol/news/uk/article1055533.ece
You do need to make sure your choices do not affect others. Keep that in mind while riding your high horse.
Disclaimer: My son needed to be protected as a child until age 18 from pertussis by herd immunity. Unfortunately, there was a pertussis epidemic in our county at the time he was born. I did actually ask the vaccine status of anyone he came in contact with.
“How about we all make our own decisions about what is best for our children and respect each others choices.”
I’m not sure that, if I thought it was best for my child, my choice to hold my infant in my lap while driving rather than to put her in a car seat would be worthy of respect.
Because few of us can be expert in more than one area, sometimes well-meaning people who are extraordinarily competent in a particular field can be profoundly ignorant of the scientific evidence in other areas and therefore may base make important choices based on anecdotes, hearsay, and misinformation. It’s useful to have expert opinion based on careful scientific research guide our choices.
[brian say] Well, I suppose it is possible to miss the diagnosis….tested for it mainly because the illness had been diagnosed and reported in two other children in our town. (The PCR-based test isn’t inexpensive, and obtaining the appropriate sample is quite a bit more uncomfortable than an injection.)
knew it wasn’t simple…thanks for perspective…
is it either test or vax…seems its both…that it’s epidemic (numerous cases before declared epidemic) provides a clue to test…as two cases provided you a clue…further;
when there is 90% immunization…docs should be even more vigilant…no cases to provide a clue… to ensure a child doesn’t die of a possible miss diagnosis
possible to miss diagonals: chief pediatrician at prestigious hosp…dxed our daughter’s autism, colic…and as young first time parents we were over reacting…she is non verbal with classic kanner autism…another miss;
30 years later a CA regional center (funding agency) PhD psychologist (hired gun)…spent 45 mins with her and said she wasnt autistic.
hope today’s young parents realize it is indeed possible to miss dx and miss prescribe remedies and programs…
[brian say] It’s useful to have expert opinion based on careful scientific research guide our choices
in a world of, eg, BP (not oil) and cure autism promotional science…what’s a parent to do with two opposing pseudo expert opines…
indeed: “How about we all make our own decisions [w/ guidlines] about what is best for our children and respect each others choices.” [laurie say]…seems its the only choice.
ever vigilant, ever skeptical
btw tho did not see blasting in sullivan’s discussion intro…i am as skeptical of CDPH as NVIC…many CDPH policies/decisions based on short sighted budget issues vice science and compassion.
stanley seigler
Chris, perhaps it is you who needs to dismount from your high horse. I’m sorry but for me it comes down to this; choose to potentially compromise my children’s health and well being (by vaccinating)in hopes of preventing potential harm to someone else’s child who may be more at risk, or choose to protect my healthy children from potential harm (by not vaccinating), while risking that it might potentially impact another’s child’s well being. It’s obvious what you choose, you choose your child’s well being, naturally, like any loving parent would, and thus, it should be obvious to you what parents who are not willing to vaccinate are choosing. I don’t blame you for wanting everything done to protect your children, you love them and it is your job. It is my job to protect my children, and I’m not willing to vaccinate for the same reason. My heart goes out to you and your son, I can only imagine how scary it would be to have a sick child, I’m sorry you had to go through that.
You have left out the fact that you would also be protecting your own child from infectious disease by vaccinating. Or are you counting on herd immunity to protect your child? It appears you have already factored that into the decision.
So, my family gets to protect not only Chris’ family, with a clear need, but yours as well?
Rachel, exactly how do you compromise your child’s health by vaccinating him or her from a disease? What ill effects come from the DTaP compared to now the very real chance a child who is unvaccinated (and even vaccinated, due to the vaccine either not taking effect or wearing off) getting pertussis in Marin County, California?
You seem to have all of the information, so please share. Just make sure it is real evidence.
I also want a real answer as to how you think what happened to the two boys in the article I posted could have been prevented. Please, tell us. With references.
Blaming the victims and their parents? Classy. Meryl Dorey of the AVN just took this tact and she isn’t faring too well right now. I do know that the infants were too young to have received ANY vaccines so you can tuck that one away. I know it is hard for people like you to understand that healthy infants do die of vaccine preventable diseases or any other diseases for that matter, because it shakes your worldview too much. So maybe your ‘education’ isn’t all it’s cracked up to be after all.
That is a false dichotomy. You are basing your decision to not vaccinate on very faulty information. Not to mention that so many others have chosen to vaccinate provides you with the luxury of eschewing vaccines.
Science Mom:
The problem with that tactic is parents of like mind often gather together. This is why vaccine preventable diseases often start and spread in certain schools and churches. Arthur Allen reported this happening in private school in Boulder, CO, then there was the 2006 measles outbreak in an Indiana church, a 2008 pertussis outbreak in a private Monterey, CA school, and the measles spreading in a San Diego charter school (where the child came back from vacation and infected babies in a doctor’s office).
I noticed this over ten years ago when measles started in a nearby private school by a child returning from a trip to Korea. My oldest had just received his second MMR for admission to middle school. I took the precaution and had my two younger children (kindergarten and third grade) vaccinated with their second MMR (this was when the second dose was for eleven or twelve).
My opinion as a mother that lost her child to Pertussis at 7 weeks old is that no parent should have to watch what we did. A helpless child die in 9 short days, as we stood by helplessly watching.
I feel that people should make educated decisions on whether to vaccine your children or not. I also feel that if you make the choice not to vaccine your children then you should respect the opinion of others that disagree. If I had a choice of taking a “risk” by vaccinating my child or having him die like Carter did I would vaccinate.
What you guys seem to be missing is the outbreak of Pertussis is due to adults not getting the Tdap booster vaccine. Take the discussion away from to vaccinate or not to vaccinate a child. The outbreak is due to the lack of booster vaccination by adults who give it to the children that have or have not been vaccinated.
Just for information I am not speaking out uneducated. I do speak about Pertussis and tell Carter’s story, as a mother and someone who has experienced a great loss.
I would ask that instead of attacking each other and drawing uneducated conclusions you check out http://www.soundsofpertussis.com and http://www.marchofdimes.com, they have information and statistics that you can read.
Again remember this outbreak is due to unvaccinated adults.
Felicia,
thank you for sharing your experiences here and elsewhere. Your logic is sound. Adults are passing the disease on to children too young to be vaccinated.
Andrew Wakefield makes a point of stating that if he had his present level of knowledge years ago, he would have made different decisions about vaccinating his family. So would I. I would have made 100% sure all the adults around my kids were vaccinated.
[Felicia say] lost her child to Pertussis at 7 weeks old
moat heart felt sympathy for your lost…i couldnt handle it…
stanley seigler
[ref say] CDC scientists have collected only seven biological samples of the illness since the state-wide epidemic began this year.
COMMENT
seems woefully inadequate…as does miss dxs mentioned previously…ie:
[ltr say] In most of the fatal cases, pertussis was not diagnosed until after multiple visits to outpatient clinics, the emergency room, or inpatient wards
bet if cases were in beverly hills/malibu…there would be biological samples from all cases…
stanaley seigler
ref xxxxxxxxxxxxxxxxxx
CDC Asks For More Whooping Cough Tests
By Joanne Faryon
August 9, 2010
SAN DIEGO — The Centers for Disease Control is encouraging California doctors to do more advanced tests to diagnose whooping cough. CDC scientists have collected only seven biological samples of the illness since the state-wide epidemic began this year.
Whooping cough, also known as pertussis, is a respiratory illness caused from bacteria. Different strains of bacteria can cause the disease. There have been 2,500 whooping cough cases confirmed so far this year in California.
But CDC scientists have bacterial cultures for just seven of those cases.
Dr. Tom Clark is a medical epidemiologist with the CDC in Atlanta.
“We definitely encourage culture which means growing the bacteria because…you can do a lot more to understand the strains that are circulating,” said Clark.
Labs in San Diego typically run tests that only generate a positive or negative result for whooping cough, rather than classifying the strain.
Two of the seven samples the CDC is studying are from infants who died earlier this year from whooping cough. The California Department of health has also requested test samples from the San Diego baby that died of the illness last month.
Carol J. Risley, Chief
Office of Human Rights and Advocacy Services
Department of Developmental Services
1600 9th Street, Room 240, MS 2-15
Sacramento, CA 95814
(916) 654-1888
(916) 651-8210 Fax
crisley@dds.ca.gov
Felicia– you are so right in that the main thing to remember here as far as the current pertussis outbreak is that adults need to be getting their Tdap, and that it’s the adults passing it to the infants. So incredibly sorry for you loss, I can’t imagine. You are right to stay focused on this current issue. But, I think it does stir frustrations about people who are not vaccinating their children to protect against these disesases when they CAN be protected, and other diseases that are making their way back into our communities. So, while pertussis is the issue right now, what is going to pop up next year? or, next week even. I recently heard about the measles case so close to my home. It scares me, and at the same time, I’m not surprised. As vaccination non-compliance steadily increases, people will begin to see the consequences. It’s just so sad to me that this is what it will take to wake people up.
It’s also so sad, thinking of the person who seems so unconcerned for whether her choices can kill other people’s children. She says that she will do that if it means protecting her own child– but, as somebody else here already said… what is it she thinks she is protecting her child from by NOT getting him/her vaccinated? Autism? Really? Show me the evidence of the correlation.
and, …oh goodness…. LH….. really? So sad. So pathetic to imply that these babies died because they were born via C-section? Because the mom had an epidural? …I won’t even address all the other ridiculous implications. If this is not what you were implying, what is the point/relevance of all your questions?? It seems to me that LH wants to say that these babies that died, that had positive lab tests for pertussis, really died because of these other factors. As if there were so many other reasons and contributing concerns for why these babies died. Yet, ….(and, i say this cynically) we have ONE REASON/CAUSE source of blame for autism– vaccines. right? Can you imagine if we were to turn the tables around and ask parents of children who have been diagnosed with autism all those questions about ‘natural childbirth,’ ‘GBS status,’ ‘breast or formula fed babies,’ ……I mean, talk about hypocracy. If your baby gets pertussis and dies, it’s because you didn’t have a totally natural soothing-water birth experience, ….but, if your kid gets Autism, ….let’s blame doctors and the medical community for it, and label it: Vaccines. How convenient. (please understand I’m NOT saying that autism is related to the birthing experience– just showing the absurdity of making such claims!).
hello people your birthing experience as well as what happens immediately following birth DOES play a role in your childs immunity. If immunity was down due to any number of reasons it very well could be why the infants died. IT IS A KNOWN FACT THAT BREASTFED CHILDREN RECEIVE LIFE SAVING IMMUNITIES and a birth complications such as strep , antibiotics, or receiving the hep b vaccine (which is a complication) would lower the child’s immunity making them more vunerable. No body is saying one birth option is superior to another however educate yourself before you call something absurd. Those are very real immune comprimising situations that may very well have contributed to these children catching and dying from pertusis. Vaccinations work by in essence giving you the disease so you can build an immunity to it, therefor…USE YOUR BRAIN ALL vaccinations lower / comprimise the immune system immediately following injection. This makes you vunerable to other disease because your immune system is down. If you had a sick friend in the hospital…you would not want to visit them if you had a cold right? that is what we are saying here. the complete senerio of what was happening and the circumstanced surrounding the deaths should be looked at… Vaccinations contribute to many autoimmune disorders it is a proven fact do ten minutes of research and you will find that. people opting out of vaccines does not contribute to putting a vaccinated child at risk..how could it be? if they are vaccinated than whats the problem??? clearly this article is saying that the current whooping cough vaccine may not protect against the strain causing the outbreak… so sick of people being mindless herd mentality ..open your eyes. If you wanna vaccinate go for it .. but if you don’t don’t. it is a choice… and not your right to impose said choice on other people. vaccinations are SERIOUS medical interventions and they are not right for everyone. and BTW birthing experiences play a LARGE role in the overall health of a newborn.
kat, show your work… what evidence do you have that:
… would make a difference to an infant and pertussis.
You say lots of things, but we deal with science; not argument by assertion.
Plus a ninth infant has died in California.
Breastfed children also receive more aluminium than the entire US paediatric vaccine schedule. Go figure.
First, the death of any infant is tragic. If several infants die or are permanently disabled from a reaction to the components of a vaccine, it’s tragic. If a pertussis epidemic takes the lives of infants, it’s also tragic. However, only the latter situation is considered national news, and only the latter situation becomes used as a political and policy-making point of argument.
In the United States, most of our liberties and protections are based around individual freedoms, not utilitarianism–i.e., the good of the community trumps the risk to an individual. Moreover, we’ve never let a group of “experts” decide when one risk outweighs the other. I would be curious as to whether you’re consistent in this utilitarian perspective about other health issues and political issues.
Here is how I would rephrase the weighing of risks being made by our public health officials. Let me know if it is incorrect:
“There are some risks associated with the practice of vaccination. History has shown that mistakes have been made in their composition and production that have led to severe complications and death, and we acknowledge that even current vaccinations have risks. Some of these are unknown because testing is often limited, and is focused on short-term consequences. Moreover, the schedule on which they are given is a relatively recent practice with unknown risks. However, we are scientists, and our current knowledge–which is agreed to by a majority in our field though far from all–is truth. The opposing risk is that of becoming infected with a certain virus, and suffering complications or death from that virus. This latter risk is quite low, but is undesirable if our goal is a) no one getting sick and b) no one dying. At least, not from natural processes. Vaccines do not guarantee against this risk for everyone, nor do they last more than a few years. We’re not sure how many years, but we have a good idea. Even if everyone were 100% vaccinated, people could still get the disease. But we should strive for that number because of something called herd immunity. Herd immunity was originally a concept about natural immunity, and was around 68%, but we’ve borrowed that idea for vaccines. Vaccination herd immunity is an unknown threshold. We think it’s very high, and the higher, the better. Indeed, it is so high that the presence of unvaccinated individuals in a community should be blamed for deaths from a virus. This is because we are certain in each case that the disease must have been passed by such individuals, even though vaccinated individuals may not have immunity either, and that no other risk factors exacerbated the situation. Even though a spatial analysis has not confirmed this, we are sure this is true because it makes sense (rather, rates of disease have long been the same across communities with widely varying rates of vaccination in the US). We don’t have evidence right now, but urgency dictates that we change our public policies because absent knowledge we must rely on the instinct of the scientist as a proxy for hard evidence. In summary, when weighing these risks, we think that we should require parents to vaccinate because of this ever-changing herd immunity threshold. If they don’t vaccinate, then epidemics will surely result even though this doesn’t regularly occur even when the majority of the population has not had a booster shot and/or grew up before knowledge about the supposed need for boosters was even present. So, we take this risk of non-vaccination by a small group of concerned parents, and non-vaccination update by a relatively large sector of the population, as being known and causally linked to epidemics and death absent further evidence. If reactions or deaths occur because of requiring vaccines, that’s unfortunate but in this case individual rights are subordinate to those of the community. The community, unfortunately, will not be present to help those unfortunate individuals. Moreover, public health officials will work to deny such cases even exist, instead preferring to operate under an astonishing bias that cuts again the dictates of the pursuit of knowledge in any truly scientific paradigm.”
P.S.–I did notice “bashing” in the presentation of this article, in the final paragraph: “Let me put it another way since accusations bring on such strong reactions from these groups: does it matter right now if they are at fault? People are dying. The goal right now is to minimize suffering and death. Vaccines do offer protection and could limit this outbreak.” If this isn’t bashing, then I’m not sure what qualifies.
Thomas Stefan,
You do not know what qualifies as bashing. Sorry to put it so bluntly. Perhaps you will take that as bashing rather than a direct statement of where you are obviously incorrect.
“Even if everyone were 100% vaccinated, people could still get the disease.”
Please expand the above statement in regards to smallpox.
“This is because we are certain in each case that the disease must have been passed by such individuals, even though vaccinated individuals may not have immunity either, and that no other risk factors exacerbated the situation. ”
Who is “we”? It isn’t me and, I assume, it isn’t you.
Your arguments are a classic straw-man style. Sorry if that seems to be “bashing” as it is not. It is an objective read of your attempt to “rephrase” statements made by others in a manner to color opinion about those statements.
Thomas Stafan, you wrote that there are risks and all that with the DTaP. Would you care to show us how much more dangerous the vaccines is versus the three diseases it protects against? Plus, before there was a Tdap, did you remember to get your tetanus booster every ten years?
Do you consider asking questions to clarify what you know, and what your points are “bashing”?
For an idea on how herd immunity works, check out this video from a dyed in the wool libertarian (really!):
Before this reply, I want to note I’m not writing an anti-vaccine response. Rather, I’m writing against the notion of mandatory vaccination with only medical exemption, and against the use of propagandistic tactics and hyperbole by public officials and the media rather than education and information. I wanted to make that more explicit. Sullivan, I’m not sure if mandates were your position, or if you were taking more a “vaccines are good” position. On to my response:
Sullivan first:
Regarding bashing. First, calling someone “obviously incorrect” by your own subjective standards is not bashing, but is far from a position of respectful debate. Second, you’re right that disagreement is not bashing, but in the final paragraph of your article you moved beyond disagreement into almost assigning blame. You’re pointing to people with a view opposing yours as either part of the problem causing the pertussis deaths or not part of the solution, which would be, I presume, across-the-board vaccination. Do you have evidence establishing a causal relationship between non-vaccination and these deaths, or that widespread vaccination will itself provide a solution? I respect your views on this though I disagree, and if you could clarify your preferred policy outcome (particularly regarding those personally opposing vaccinations), that would be helpful.
As to smallpox, I’m not sure why you bring this up as a case of 100 percent vaccination coverage. Worldwide coverage is estimated at 10-20 percent in every source I’ve seen; per country coverage ranges considerably. There was not a correlation between morbidity or mortality and vaccine coverage, either, as one would expect. The smallpox vaccine eradicating smallpox is an oft-repeated line, but many factors went into eradicating smallpox, chief among them basic attention to community health and hygiene. So, even with very low vaccination rates, smallpox was eradicated. These rates are far below what even the vaccination rates are in Europe, and are of course considerably lower than the oft-referenced herd immunity rates in the U.S. If anything, smallpox seems to undercut the cornerstone of vaccination herd immunity.
As to my arguments being a straw-man: I specifically asked that my impressions be corrected about how I interpreted the position of California (and nationwide) public health officials. This wasn’t rhetorical. Also, the “we” (which I felt was clear) was me writing as if I were a member of the public health community. If I was presenting my paragraph as if it were your arguments and then refuting these, this would be a straw-man argument. So, please point to where I was trying to get away with straw-man arguing. I strenuously try to avoid that.
——–
On to Chris:
Good question. I agree that the three diseases pose risks, but I also agree (and the cdc.gov site concurs) that there are risks to the DTP vaccine. If there are known and unknown risks to two different behaviors, then why is one set of risks privileged over the other? I acknowledge that I haven’t “shown” how much more dangerous one set of risks is, but my argument doesn’t depend on this. I’m simply arguing that an individual should not be forced to incur a risk on the altar of a good to the community that remains in many respects unproved and speculative. I could in turn ask that you quantify (with real evidence and not just policy statements, or news reports of deaths) how much more morbidity and mortality risk is associated with X decrease in herd immunity, and then ask that you weigh this against the risks of the vaccine. I feel like this goes to the core of the debate but remains surprisingly undiscussed.
By the way, I appreciate your tone, Chris, considerably more than Sullivan’s. I don’t consider your questions asking for clarification to be bashing at all. Believe it or not, I am open to having my mind changed, and I am coming at this from an honest, inquiring position that has formed over time.
Lastly, I’ve been having trouble getting youtube videos to play, but I do plan to watch the one at the link provided. You were right to read a somewhat libertarian skew in my position, so I’m sure I’ll find the video informative. My position isn’t purely based on a libertarian philosophy as much as it is an anti-utilitarian perspective with regard to matters of personal health decision; I’ll leave that parsing for another time.
You still did not answer my question: What are the risks of the DTaP and Tdap compared to pertussis? This answer should involve actual numbers with actual references that are indexed at PubMed.
Do you think your rights come before that of a not fully protected child under the age of one year? (the DTaP is only really mostly protective after four injections)
Have you kept up with your tetanus boosters?
Thomas Stefan:
Where does this happen? Even West Virginia and Mississippi have private schools and provisions for home schooling. And since the call is mostly for adults to get Tdap, where do you see adults being forced to get it?
I do not see anything like when I lived in Panama. After some people came down with yellow fever, you were required to carry proof of vaccination if you went into the interior. If you were stopped by the Guardia Nacional without that proof, they would make sure you got a yellow fever vaccine — you would not be given a choice. Should tell you, I have lived in a country with a dictatorship, so I find your stance on “rights” very amusing.
(Sorry for a long reply, but it was unavoidable.)
>>>>Here are some references from cdc.gov:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5926a5.htm
This gives morbidity and mortality rates per 100,000 population for various groups. It can be easily updated by checking the weekly M&M reports.
http://www.cdc.gov/mmwr/preview/mmwrhtml/00046738.htm
Gives details on known adverse events from vaccines, including those for pertussis.
I have read many studies, and I’ll try to update this soon with PubMed links, but I think this is at least a good start and that you’ll view it as reliable information. So, there is info about the risks on both sides. I haven’t found anything from the CDC, WHO, etc.–beyond policy statements and conjecture–establishing that the risk on one side is caused (where causation = at least statistically significant correlation across studies) by a certain behavior on the other (i.e. non vaccination).
>>>>I’m not putting my rights ahead of anyone, Chris. The big assumption you’re making–and that, again, I’ve yet to see well researched across multiple sources–is this: my right to not be vaccinated is linked to the right of a child to not contract pertussis or die from it. How exactly do you establish this dependent, causal link beyond generalities about “herd immunity”, “full protection”, etc., that remain unestablished?
>>>>You asked if I kept up with tetanus boosters. I’ve never been vaccinated, so the answer is no. Was there a further, implied question here?
>>>>As to your second post: I never said we lived in a dictatorship. In Mississippi and West Virginia, you could add up legal education requirements with the impossibility of private or home schooling for some families, and the vaccination laws in those states, and you’d have a system with a de facto medical-only exemption. But you’re right: theoretically there are ways around this in those states. In Panama, you could theoretically avoid going into the interior, too, or theoretically have false proof, etc. The point is that laws are translated through to the real world. You said you find my stance on “rights” amusing….why? My concern is that whenever vaccine-preventable disease makes the news, one of the first targets (and often the primary target) is the philosophical and religious exemption. If that’s the target, I presume the proposed solution is ending these exemptions.
>>>>I’d also mention a few other numbers: the use of philosophical and religious exemption in states with such laws hovers between 1 and 2.5 percent. Does this violate herd immunity? Even where clustering occurs, I haven’t seen a consistent correlation with morbidity (i.e. that most clusters face epidemics in their population, or that epidemics are traceable to first cases in these clusters, or that epidemics only happen in areas of such clustering). Moreover, even if you assume increased morbidity in all such areas, the mortality rates do not significantly differ.
>>>>A final point, at least until our next exchange: the questions and concerns about vaccines have been around nearly as long as vaccines. Rather than dismiss these through fair and unbiased scientific research, what I regularly see is this: (1) correlations between non-vaccination and epidemics are treated as causal facts once translated into policy and public information (2) correlations between vaccination and adverse health events, particularly those outside a 1-2 day post-vaccination window, are deemed coincidental and not further explored. Chris, can you explain why this is?
The links you posted show that vaccines are much safer than the diseases. I really want you to post the risks posed by the Tdap and DTaP versus the diseases in your own words, with documentation.
The fact that you have never had a tetanus booster means that you don’t care about your own health, much less anyone else.
Being stationed and living in the Canal Zone also meant dealing with their rules. It was essentially run by the Army Corps of Engineers before the 1990s. Going into the Republic was a different kind of situation.
And seeing a libertarian complain about public school rules is amusing. Any libertarian worth their salt would avoid “gov’t” schools, and not be bothered conforming to “gov’t” rules.
I see now that you are not amenable to reason, and that your knowledge of vaccines, diseases, herd immunity, science and libertarianism is severely limited. Come back when you have a better education.
Gosh, Chris, you certainly devolved into mean-spiritedness rather quickly: “you are not amenable to reason, and that your knowledge of vaccines, diseases, herd immunity, science and libertarianism is severely limited. Come back when you have a better education.” This is typical of someone who can’t debate by attacking a position (versus a person) because they don’t have evidence (which, I notice you’re curiously never willing to provide?).
“The links you posted show that vaccines are much safer than the diseases. I really want you to post the risks posed by the Tdap and DTaP versus the diseases in your own words, with documentation.” They show that the risk incidence from one is lower–they don’t show that one decision has no risk, or that a decision not to vaccinate is more risky for the community. Again, a careful reading of my positions in earlier comments coupled with this information shows that I’m being consistent. I’d also ask that you start answering my requests and questions instead of just attacking. That’s the route to persuasion, you know.
“The fact that you have never had a tetanus booster means that you don’t care about your own health, much less anyone else.” Again, a personal unsupported attack. Incurring puncture wounds outdoors without seeking medical treatment? That would imply not caring about my own health. But not getting a vaccine that is part of a compound vaccine with a known risk profile and not guaranteed efficacy? That’s called reaching an informed decision about my own health. And since tetanus is not contagious, how does this example translate into not caring about anyone else?
“And seeing a libertarian” (I never said I was, see earlier comment) “complain about public school rules is amusing.” (I didn’t complain about those rules, I was merely showing how the package of rules led to a certain de facto policy). “Any libertarian worth their salt would avoid “gov’t” schools, and not be bothered conforming to “gov’t” rules.”” (Again, not claiming libertarianism as a mantle, so if I’m not worth my salt as one then what is the point? This combines a straw man argument (Sullivan, take note) with ad hominem attack–how creative of you Chris.
“I see now that you are not amenable to reason, and that your knowledge of vaccines, diseases, herd immunity, science and libertarianism is severely limited. Come back when you have a better education.” Chris….ditto. I’d invite you to acquire better skills at persuasion and civil debate, as well as a more discerning mind. I guess this is the point at which we agree to disagree.
The trouble is Thomas Stefan is one of these barrack-room doctors, who doesn’t know how to read CDC and industry adverse event statements. In fact, in very few instances is there any admission whatsoever of these being events “from” vaccines, as he says.
Take encephalopathy following measles vaccination: “The incidence of encephalitis or encephalopathy after measles vaccination of healthy children is lower than the observed incidence of encephalitis of unknown etiology. This finding suggests that the reported severe neurologic disorders temporally associated with measles vaccination were not caused by the vaccine.”
A lot of anti-vaccine loons rant on about adverse events being admitted, when in fact they are not. It’s just another way that people of insufficient education, or malicious intent, mislead.
In short, an adverse event following a pharmaceutical or biologic is not necessarily a side effect from that product.
I’m afraid it’s garbage in, garbage out with Thomas.
Stay away from open flames with your straw man arguments. No one here has ever claimed vaccines are without risk. What you have failed to do is show that the risk from the vaccine is in any way worse than the disease.
Tetanus is not just from puncture wounds, and there is no herd immunity for it. The fact that you have not kept up with tetanus boosters shows your lack of knowledge, therefore there is no need to continue this conversation until you actually show a minimum of education.
Or you are just afraid of needles.
too cute by half, gotcha, ad hominem, arguments/remarks add little…prove nothing…i keep telling myself…maybe one day i will get it.
stanley seigler
Chris,
my take on this: Thomas Stefan appears here and first thing misinterprets a statement which clearly states that at this point the first priority is to preserve human life to accuse me of attacking people.
The closest he comes to being on point is this question:
“Do you have evidence establishing a causal relationship between non-vaccination and these deaths, or that widespread vaccination will itself provide a solution”
Which is a question of whom to blame. The very point of that last statement in the post–now is not the time for this. Vaccination can and does provide protection. At this point, there is an outbreak. An individual can protect him/herself with vaccination and help offer protection to others he/she comes in contact with. So, yes, it will provide a solution.
One county (and I apologize for not remembering which at this time) was hit early in this outbreak. That county mounted a large vaccination effort and the outbreak was stopped. Was this causal? I don’t have that evidence. But the possibility is very real that the vaccine program was causal.
Frankly, if my family weren’t immunized already I would get us all up to date right now. Makes sense for us and helps others too.
The very simple fact is this: individuals in California have the highest chance of catching pertussis in decades (for many, it is the highest chance in their entire lives). That risk goes down with vaccination.
Thanks, I was getting lost in his hyperbole. I was just trying to understand how much he knew about the issue.
Oh, and there are studies that show more pertussis in areas with more exemptions:
http://aje.oxfordjournals.org/content/168/12/1389.long
and
http://jama.ama-assn.org/cgi/content/full/296/14/1757
(1) First, a response to the oddest line here: no, I’m not afraid of needles. I was raised by a doctor, two of my uncles and a grandfather were also M.Ds, and my aunt was a D.O. I’ve been to hospitals plenty of times and have even worked part time in a lab drawing blood. You might be surprised to know that I’m quite embracing of the majority of western medicine.
(2) I never set out to show that one risk was greater than the other! To restate (yet again, and it’s getting exhausting): there are risks on both sides, and I am merely arguing that individuals have the right to weigh these risks and come to an informed decision.
(3) I think you agree with (2), Chris, but your point is that my decision has a community impact. Again, prove that this community impact is linked to the behavior of a non-vaccinating individual. Note that I’m not arguing against the theory of vaccination, but against how it’s been exercised in practice and against unproved “truisms” about herd immunity. If you can point me to some useful sources, I’ll happily read them and might change my mind about some of this. One would think you (or someone on this thread) would welcome this opportunity.
(4) I know that tetanus is not just related to puncture wounds; I was simply giving a commonly-recognized example. I realize there is no herd immunity for it. So, I’ve weighed the risk of getting it against the risk of vaccinating for it, and made a decision regarding my own health. Are you seeking to now dictate personal health decisions that have no impact on your health? I don’t think you are, so how is this even part of the core argument?
(5) Visitor: what is a barrack room doctor? I can read the CDC report quite well, and would ask: do you honestly read that and come away from it thinking that there are no adverse events from vaccines? Yes, with regard to some reactions the evidence is ambiguous and open to interpretation (hence words like suggest, imply, etc.). But for others the reactions are known, and this has even been admitted in case settlements from the so-called “Vaccine Court”. The fact (and I use that word sparingly) is that adverse events ARE an admitted aspect of every vaccine. You seem to not understand the difference between the terms “adverse event” and “side effect”. Neither term implies causation, merely correlation. Perhaps what you meant to say was that the adverse events associated with the vaccine administration are not necessarily causal? If not causal, then the rates of statistically significant correlation between a vaccine and its adverse events still equate to a risk. All public health and epidemiology literature acknowledges this, which is why even they use terms like “risk” and recommend non-vaccination for certain individuals after certain adverse events. How is it a “loon”y position to cite fact?
A barrack-room doctor (or lawyer) is someone who annoying pontificates on stuff like he knows what he is talking about, but it is clear he is just talking bollocks.
So, you don’t want to get the tetanus vaccine because of the risks? Do you mind then actually answering the question of what the risks are to the DTaP and Tdap compared to tetanus, diphtheria and pertussis? Give some real numbers, is it 100 times greater or 100000 times less, with some real documentation. You might want to distinguish between an owie on your arm to not being able to actually breathe.
Oh, and I just gave two studies on the effect of non-medical exemptions and levels of pertussis. Try reading them.
Chris–thanks for the links. This is the kind of response I was looking for, and now I can use it as a starting point for learning more and maybe clarifying some of my own views.
Also, I don’t think I was engaging in hyperbole. Maybe in my very first comment to Sullivan’s piece I was using a snide tone in some spots, and for that I apologize. But, after that I felt I was pretty above-board and fairly responded. I never trotted out many of the typical anti-vaccination arguments that even I consider loony, nor did I deride your positions, nor did I initially engage in suppositions about you or your behavior or education. In future arguments you might consider just offering links like these first and letting research speak for itself. Indeed, I wish this was done more often. The public is not as ignorant as many might think, and good science still holds a lot of value to most people. Unfortunately, more often than not we are presented with pseudo-science or policy statements masquerading as fact, or exposed to personal attack. It’s akin to me trying to convince you with a link to NVIC videos and/or saying that you’re ignorant, uneducated, etc., which even I know is a ridiculous tactic. So, thanks for finally offering some useful links–I look forward to reading them.
You might try asking a question more directly with lots less spurious verbiage.
Is that what you meant by annoyingly pontificate? I favor clarity over brevity, and not straying from the core of an argument. If you behaved similarly, we could have had a much shorter discussion.
I won’t be reading the articles until this weekend, so don’t take my silence as non-participation. Cheers!
Thomas, read this and watch the videos:
http://skepchick.org/blog/2010/09/beyond-anti-vax-the-pertussis-problem-a-dragoncon-tale/#more-16481
Thomas Stefan: Sorry. You are wrong about the smallpox eradication. It was NOT just improved sanitation and nutrition. The CDC sent teams all over the world and vaccinated HUGE numbers of people (sometimes against their will). They ALSO enforced strict quarantine for those with the disease and those exposed to the disease, often utilizing local police departments for aid in enforcement. (Why, yes, I did just recently finish “Inside the Outbreaks”, why do you ask?)
It was vaccination that eradicated smallpox. NOT sanitation, not nutrition. Quarantine stopped the spread of disease within areas, but vaccination ended it.
Dawn:
Perhaps a good read for Mr. Stefan. They were literally running after people, catching them and forcing vaccines on them. I don’t think that is done in the USA or Europe.
And I missed his comment on smallpox. He clutters up his comments with too much stuff. Long does not mean clear (as I was told by a statistics professor when I used too much paper for an essay question).
How would improved sanitation prevent the spread of smallpox?
@ANB: I guess I was thinking, improved sanitation meant fewer deaths from other diseases during smallpox epidemics. IIRC, in “Outbreaks” the CDC officers did work on sanitation issues along with doing vaccines but there may have been little/no effect on smallpox, since it is airbourne.
Thanks, Dawn. My question was directed at Mr. Stefan and others who claim that VPDs were falling before the development of a vaccine, due to improved sanitation and better nutrition.