Ethan Posard's The Shots Book

Be a community immunity superhero!

I meant to do this post at the beginning of the month. I really did. But life finds ways of interfering. In case you didn't know, August is National Immunization Awareness Month. I've posted stuff for NIAM before, like my lineup of vaccine preventable disease wanted posters. I've also written other posts for past Vaccine Awareness Weeks that could fit in well with NIAM, too, like the myth that if vaccines work, then it doesn't matter if you vaccinate your kid or not. Some years, though, I've let August slip past without writing anything specifically for NIAM, even though I have written posts with some vaccination issue as the main topic.

Not this year. I could write about outbreaks of diseases or the activities of the anti-vaccine movement, but I'd rather keep things nice and positive, at least for now. In July, I received a review copy of The Shots Book: A Little Brother's Superhero Tale, by Ethan Posard. Rather than publishing a post about the book right away, I wanted to hold off until Immunization Awareness Month. Then, as sometimes happens, life decided to muck up my good intentions and delay me for a while. Better late than never, right?

Ethan is the younger brother of Camille Posard, one of the talented young high schoolers who wrote and produced the film Invisible Threat, which I discussed last year. Although the film was met with exceptionally harsh criticism from the anti-vaccine movement (without their even having viewed the documentary), the teens who produced it proudly stood up to the bullies that tried to silence them and shut down screenings. One portion of the film follows Ethan as he goes in for one of his scheduled shots, and it's that experience with both the shot and the film that inspired him to write this book.

Vermont Steps Toward Improved Public Health

Vaccination requirements for entry to day care programs and schools tend to be a bit of a touchy subject among those who, for one reason or another, are opposed to immunization. They tend to view such requirements as violations of their personal rights, all the while ignoring the rights of their own children, to say nothing of the rights of the other people around them, to not be infected with diseases that can be quite serious. As I recently wrote, the state of Alaska Section on Epidemiology came out with several recommendations following a chicken pox outbreak at a day care facility, which started after an unimmunized child infected their infant sibling who attended the day care. In my post, I suggested that the recommendations did not quite go far enough, arguing that philosophical or religious exemptions should require speaking to a physician before being granted. Personally, I don't think that there should be exemptions for anything other than legitimate medical reasons, but that's a topic for another post. In the meantime, requiring discussion with a medical professional seems, to me, to be a reasonable compromise for the time being.

The issue of philosophical exemptions came up last summer, as the Massachusetts state legislature considered a proposal to add philosophical exemptions to that state's immunization laws. It's a proposal that pops up just about every year in Massachusetts and is consistently, and, in my opinion, correctly shot down. Well, it looks like the state's neighbor to the north, Vermont, is considering making its laws similar to those of Massachusetts. A bill was recently passed by the Vermont state Senate, in a vote of 25-4, to remove philosophical objections as a reason to forego immunization, leaving only medical and religious exemptions. As the bill goes to the House for consideration, there is, not surprisingly, a vocal few who see the legislation as a Bad Thing^TM.

Take, for example, Charlotte Gilruth, who wrote in to the Barre-Montpelier Times Argus with her opinion in a letter titled "'Herd immunity' is misleading". From the second sentence, her letter is a treasure trove of errors and misinformation. Before I delve into it, go ahead and click on her name above to read her thoughts. See how many mistakes you can find.

Vaccine Awareness Week: If Vaccines Work...

I haven't had much time lately to generate new posts, but one thing I've noticed lately is that there is a certain anti-vaccine talking point popping up. So I felt it might be a good time to put up an old post again addressing this point.

So, without further ado, here is a post from November 3, 2010 talking about why pro-vaccine people are concerned about those who refuse vaccines.

"If vaccines work, then it shouldn't matter if I don't vaccinate my kid."

That argument, or some variation thereon, is fairly common among anti-vaccine folks and the parents who fall for their propaganda. The thinking is something like this: vaccine proponents claim that vaccines work; if they work, they must be 100% effective; if they are 100% effective, then my kid getting sick won't affect anyone that's been immunized; therefore, why should it matter to anyone else what I choose for my child?

There's a couple problems with this line of reasoning.

Report on MN Measles Outbreak from IDSA

Several weeks ago, from October 20-23, Boston, MA played host to the 49th Annual Meeting of the Infectious Disease Society of America (IDSA). This conference gives physicians, scientists and other health care professionals an opportunity to continue learning about the pathophysiology, diagnosis, treatment and prevention of infectious diseases, as well as to connect with colleagues from around the country. The conference presents speaker sessions, poster presentations, exhibits and networking opportunities.

One of the poster presentations at IDSA covered the measles outbreak in Minnesota earlier this year. Presented by several members of the Minnesota Department of Health (lead author, Pamela Gahr, MPH, Cynthia Kenyon, MPH, David Boxrud, MS, Karen White, MPH and Ruth Lynfield, MD) and Hennepin County Human Services and Public Health (Erica Bagstad, MS, MPH), the poster offered a closer look into how and why measles was able to spread, as well as insight into some of the difficulties involved in investigating and controlling the outbreak.

Third Case Identified in Latest Measles Outbreak in Minnesota

A brief post to provide an update on the latest measles outbreak in Minnesota. On August 26, 2011, the Minnesota Department of Health announced that a third case has been identified. The latest is a 43-year-old woman who was exposed to the index case in a health care setting. She had unknown vaccination status and was identified through follow-up of people who had been exposed to the two initial cases.

As of this writing, the 12-month-old child, who had contracted the illness while in Kenya, is still in critical condition, but the second case, the 15-month-old, has been released from the hospital. Neither of the children had been vaccinated against measles.
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Related Posts:
New Measles Cases in Minnesota
Minnesota Measles Outbreak - A Recap
Acute Thrombocytopenic Purpura, the MMR and Natural Infection
"Soft" Hospitalizations in Minnesota Measles Outbreak?
Minnesota Measles Outbreak by the Numbers: A Timeline
Measles Outbreak in New South Wales, Australia
Climbing Numbers in Minnesota Measles Outbreak
More Cases of Measles in Minnesota, 3 of 4 Hospitalized
Minnesota Infant Contracts Measles - Why Immunization Is Important
Measles Outbreak in Boston

New Measles Cases in Minnesota

The Minnesota Department of Health reported on August 19, 2011 that there are two new cases of measles in that state. The index case is a 12-month-old infant who was infected while on a trip to Kenya. The second case is a 15-month-old child who acquired the measles virus after exposure to the first infant. Neither child, both residents of Dakota County, had been vaccinated against the disease. Both children have been hospitalized. The Shakopee Valley News and the Columbus, IN paper The Republic, as well as news station KARE11, report that the 12-month-old child is in critical condition. These cases are not connected with the measles outbreak in Hennepin County earlier this year, which resulted in 21 cases, almost all unvaccinated, with 14 hospitalizations.

Although both children were unvaccinated, it should be noted that they are right around the age when the first dose of MMR is recommended, according to the CDC schedule (PDF). Sources do not report any reason for the infants being unimmunized; it may be that the parents simply had not scheduled the appointment yet. It is also possible that the parents had avoided the MMR due to misinformation promulgated over the past several years in Minnesota by anti-vaccine activists which has negatively impacted herd immunity.

I will try to keep an eye on this situation, in case any further cases arise.

UPDATE: The 12-month old who has been hospitalized since August 10 appears to finally be recovering. Measles left Mahi Abdallah susceptible to a secondary pneumonia infection that very nearly killed him. He has been cared for in the pediatric ICU at Children's Hospital in Minneapolis. His mother, Nuria Koto, had planned to have him vaccinated against measles, but he was only 9 months old when the family left to visit Kenya. She thought he was too young to receive the MMR (typically recommended to first be given at 12 months) and was unaware of travel recommendations that allow for administration of the vaccine as young as 6 months old. I urge those considering whether or not to delay vaccinating against MMR to read his story. No parent should have to go through this, and my heart goes out to Nuria, Mahi and the rest of their family.
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Related Posts:
Minnesota Measles Outbreak - A Recap
Acute Thrombocytopenic Purpura, the MMR and Natural Infection
"Soft" Hospitalizations in Minnesota Measles Outbreak?
Minnesota Measles Outbreak by the Numbers: A Timeline
Measles Outbreak in New South Wales, Australia
Climbing Numbers in Minnesota Measles Outbreak
More Cases of Measles in Minnesota, 3 of 4 Hospitalized
Minnesota Infant Contracts Measles - Why Immunization Is Important
Measles Outbreak in Boston

For the People or For the Person?

One of the arguments that I hear fairly often regarding the recommended childhood vaccinations is that the government has no right to force someone to undergo a medical intervention or procedure, that personal liberties trump concerns about public health. This got me wondering how those who are opposed to vaccines in some regard and believe that vaccines should not be "forced" upon people feel about how the government should respond to someone who has a highly communicable disease.

So for them, I have a couple questions:

Disease Burdens More Than Just the Patient

Often, when we talk about infectious diseases and outbreaks, the focus tends to be on those who got sick: the symptoms they experienced, how likely they might have been to infect others and so forth. We may talk about whether or not they were vaccinated, what complications they may have suffered and the costs that they bore through lost work/school days or how much treatment cost. Only occasionally do people think about the effects of an infection or outbreak on the government. After all, infections only have a direct impact on the person who has the disease and maybe those around them, right? How could a disease have any significant impact on a government. They're big, faceless things that just kind of exist in the background, except when there's a problem or it's election season.

The fact of the matter is, outbreaks of infectious disease actually have quite an impact on governments, particularly local ones. As just one example, I recently received the following from an anonymous reader:

If Everyone Else Had Done It, I Didn't Need To - Rachel's Story

I learned about the following story from Phil Plait over at Bad Astronomy. The video is one of many stories you'll find at Shot by Shot.

Minnesota Measles Outbreak - A Recap

UPDATE: On June 8, 2011, the Minnesota Department of Health declared that the measles outbreak in Hennepin County is considered over. The outbreak involved 20 individuals who were all connected to a child who was infected in Kenya. In addition there were two unrelated cases reported this year.

I just thought that I would provide a brief update on the measles outbreak in Minnesota. According to the Minnesota Department of Health, as of this writing, the last update was on April 27, 2011. Here's what they report:

Situation Update (4/27/11)
There have been 23 confirmed cases of measles reported in Minnesota, ranging in age from 4 months to 51 years old.

Infection acquired:

• Twenty of the cases have been linked to a case that acquired infection in Kenya (21 total)
• One case acquired infection in Florida
• One case acquired infection in India

Vaccination status:

• Seven of the cases were too young to receive vaccine
• Nine were of age but were not vaccinated
• One was vaccinated
• One was vaccinated prior to the recommended age
• Five have unknown vaccine status

There have been fourteen hospitalizations and no deaths.

Measles Outbreak in New South Wales, Australia

Australia generally has a much better situation, regarding popular views of vaccination, than the U.S. Over there, the primary anti-vaccine group, the Australian Vaccination Network, is openly called an anti-vaccine organization by the mainstream media. Their non-profit status was revoked last year and they have been sanctioned by the Australian Health Care Complaints Commission. Furthermore, they have been caught breaching copyright law on several counts. There are no major celebrities endorsing antivaccine nonsense.

With all of that going for Oz, you'd think things would be fine. Not so.

More Cases of Measles in Minnesota, 3 of 4 Hospitalized

UPDATE: On Wednesday, 3/23/11, a 10th case of measles has been confirmed in Minnesota. Like 4 of the other cases, the latest was in a child old enough to be vaccinated but had not been. The current tally is: 4 too young to be vaccinated, 5 old enough but unvaccinated and 1 of unknown vaccination status. Half of the cases have been hospitalized and there are, as yet, no deaths from this outbreak.

UPDATE: On Tuesday, 3/22/11, the Minnesota Department of Health announced that the measles outbreak now includes 9 cases. 4 in children too young to have received the vaccine, 4 in children old enough, but who had not been vaccinated and 1 whose vaccination status is unknown. To date, 5 of the 9 have been hospitalized, but are recovering.

UPDATE: On Monday, 3/21/11, a seventh case of measles, in a 7-month-old, was confirmed. That brings the tally to 3 too young to be vaccinated, 3 old enough but unvaccinated due to fear and 1 with unknown vaccination status.

UPDATE: According to the Star Tribune today, March 18, 2011, the total number of cases is up to six. Three are Somali children. Two of the six were too young to be vaccinated. Four of the six have been hospitalized.

Last Friday, one week ago, I wrote about a Minnesota infant contracting measles. That child, too young to be immunized, was hospitalized. In that post, I also called out Dr. Jay Gordon who, on his own web site, states that he does not give or recommend the MMR vaccine. Well, in the past week, three more cases of measles have been reported in Minnesota. Two of the three new cases, like the initial case, were also hospitalized.

And now it looks like I'm going to have to call out Age of Autism's J.B. Handley and disgraced gastroenterologist Andrew Wakefield, because two of the latest cases are in the Somali community. Two children who, although old enough to be vaccinated, were not because of the fears that Handley and Wakefield fueled in their parents. Two children in a community with declining vaccination rates, thanks to the callous and flat-out wrong nonsense spouted by Handley and his ilk.

Four kids, one too young to be vaccinated, two unvaccinated because of fear of the vaccine and one of unknown vaccination status. Four children, three hospitalized.

Some people, like the aforementioned Dr. Gordon, would suggest that four cases is nothing to worry about, that it is not an outbreak:

The problem here is that we shouldn't be seeing any cases of measles in the U.S. We have an extremely effective (95% or higher) and safe product to prevent measles. Not only that, but measles only infects humans, which means that if enough people worldwide are vaccinated, then, like with smallpox, we would no longer need to use the vaccine.

However, until measles is eradicated worldwide, then, as I've said before, a new infection is just a plane ride away. People like J.B. Handley, Wakefield and the goons at Age of Autism and pediatricians who should know better and do a grave disservice to their patients, like Dr. Gordon, must stop. Through their actions, they promote outbreaks like the ones in Boston and Minnesota. Although currently small, these cases could almost certainly have been prevented through vaccination, either of the children themselves or, in the case of the infant too young to be vaccinated, of those around the kids. Behavior such as suggesting the erroneous notion that vaccines cause autism or actively choosing to tell people that the risks of vaccines outweigh the benefits, despite mountains of scientific evidence to the contrary, is not only reckless and irresponsible, it is abhorrent and despicable.

Vaccinate your children. Protect them, their friends, their families and everyone around them. Do what is right.

Update: Just to put this in perspective, in the past 5 years, there have been six cases of measles. In the past week, there have been 4 6 cases. Let me repeat that: in the past 5 years, only 6 cases; in the past week, 4 6 cases. Got that, Dr. Jay "4 cases is an outbreak?" Gordon?

Update 3/21/11: If there was any doubt that Dr. Gordon displays an amazing level of callousness, he had this to say about the Minnesota measles outbreak and how an outbreak is defined:

Yep, taking "a few extra cases" seriously is "pointless." Stay classy, Dr. Gordon. I'm sure the families of those 6 kids think that it's pointless to take the outbreak seriously.

Vaccine Awareness Week: If Vaccines Work...

"If vaccines work, then it shouldn't matter if I don't vaccinate my kid."

That argument, or some variation thereon, is fairly common among anti-vaccine folks and the parents who fall for their propaganda. The thinking is something like this: vaccine proponents claim that vaccines work; if they work, they must be 100% effective; if they are 100% effective, then my kid getting sick won't affect anyone that's been immunized; therefore, why should it matter to anyone else what I choose for my child?

There's a couple problems with this line of reasoning.