Vol. 212 May 1, 2019 MMR Vaccination Updated and DTaP Explained

May 1, 2019

YET ANOTHER STUDY PROVES THAT MEASLES VACCINE DOES NOT CAUSE AUTISM
An eleven year study of 657,000 Danish children showed that those who received the MMR vaccine had no increased incidence of autism. In fact, the girls who received the vaccine had a 5% reduction in their risk for autism. In Denmark all vaccinations are free of charge and voluntary. When 95% of children in a community are vaccinated against measles the 5% of unvaccinated children are protected through “herd-immunity” due to the reduction of exposure to the highly contagious measles virus.

Measles was declared “eradicated” in 2000. Since then we have had unexpected U.S. measles outbreaks in 2014 and presently we are breaking all records for new cases (78 cases just this very week). Since January 1, 2019 the U.S. has had 465 cases in 19 states. Recent U.S. measles outbreaks in Brooklyn, NY, Portland, Oregon, and Rockland County, NY were caused by unvaccinated visitors to an annual Jewish pilgrimage in the Ukraine returning to their unvaccinated orthodox Jewish communities in the U.S.

Surrounded by states with nearly 700 new measles cases Dayton, Ohio is voicing concern about a measles outbreak in their city. Of the 9 counties in Ohio 8 have measles vaccination rates between 90 – 93%. Montgomery County, Dayton is the county seat, has a rate of only 88%. Remembering that herd immunity is achieved at 95%, Ohio, which requires proof of vaccination within 14 days of school attendance, is considering rewriting their current reasons for exemption (about 9% in Montgomery County) of “religious, medical, or reasons of conscience.”

THERE IS NO HERD-IMMUNITY FOR TETANUS
The “T” in the DTaP vaccine stands for tetanus. Tetanus is not a contagious disease like measles. It is caused by wound contamination with a bacteria that causes intense, painful muscle spasms, clenched jaw (“lockjaw”), and extremely unstable vital signs.  The tetanus vaccine is the only protection against tetanus.  It is rare because most children receive the tetanus vaccine. Oregon in 2017 reported its first case of tetanus in thirty years. An unvaccinated 6 year old sustained a cut on his forehead while playing on a farm and developed tetanus. His 2 month hospitalization cost $800,000. The total bill for his care including rehab services and transportation exceeded $1 million. Upon discharge the parents continued to refuse any immunizations for him  including a tetanus vaccine booster to complete their child’s protection!

PERTUSSIS (“WHOOPING COUGH”) OUTBREAKS HAPPEN IN THE SPRING
The “P” in DTaP immunization stands for pertussis and the standard recommendation is to get 4 DTaPs before age 18 months ,starting at 2 months, with a booster at 6 years and as a teenager. Our periodic pertussis outbreaks can not be blamed wholly on anti-vaxxers who refuse immunizations because the pertussis vaccine is not as effective as other vaccines in maintaining protection; the immunity created by the vaccine wanes over time. The little “a” in front of the “P” stands for “acellular”. The acellular vaccine has less of the side effects of injection site pain, temporary fatigue, and a fever than the earlier vaccine that contained cells of the bacteria. But, this newer vaccine (introduced in the late 1990s) produces a smaller increase in and a shorter duration of immunity. “P” vaccinated people can get pertussis, but unvaccinated children and adults are 8 times more likely to get pertussis.

Pertussis immunization is now recommended for all pregnant women since protective antibodies pass through the placenta to the unborn child affording protection to the infant in the first months of life. Pertussis can be diagnosed in some one with a persistent cough by a simple nasal swab done in the office, and it can be treated effectively with antibiotics.

WHAT ABOUT THE “D” IN DTaP?
Diphtheria is a bacterial disease with a terrible sore throat. When severe it can form a membrane in your throat that blocks off your air and sometimes it produces a toxin that attacks the heart, causing death.  In 1921 the U.S. had 206,00 cases of diphtheria with 15,420 deaths.  The diphtheria vaccine is so effective that such cases are extremely rare in the U.S. Herd immunity is important in diphtheria. The CDC estimates that 94% of kindergarten pupils in U.S. are immunized against it. The Soviet Union, India, and Yemen remain areas with large numbers of diphtheria cases.

“Good ole” Montgomery County, Ohio had one of the last reported U.S. diphtheria cases; a teen age girl with a bad sore throat in 2014. That rare event got lots of press coverage which might be why Montgomery County is a particularly skittish about a possible measles outbreak in 2019.

Diphtheria can be treated effectively with antibiotics and anti-toxins. Any contacts of the person with diphtheria can also be treated to prevent spread of the disease. A simple skin test (Schick test) identifies people with no immunity to diphtheria, so efforts to control its spread can be highly targeted.

MY MODEST PROPOSAL MAY NOT BE THAT “FAR OUT”
My previous blog suggesting that one way to change the behavior of anti-vaxxers would be to sue the parents of an unvaccinated child for neglect to recover the cost of the medical treatment, loss of wages of caretakers, loss of school performance, continued rehabilitation of complications, etc. of any person who then got measles from the unvaccinated case. Perhaps that might send an effective message to anti-vaxxers of a personal financial risk where scientific data holds no sway. What if the parents of the Oregon tetanus-afflicted child were sued by tax payers in Oregon to “recover” the medical care costs of nearly a million dollars presumably borne by Oregon’s tax payers?


Vol. 211 April 15, 2019 A Modest Proposal To Eradicate Measles In The U.S.

April 15, 2019

Measles was declared “eradicated” in 2000. Since then we have had unexpected U.S. measles outbreaks in 2014 and presently we are breaking all records for new cases (78 cases just this very week). In 2014 there were 667 cases of measles in Amish country of Ohio. Since January 1, 2019 the U.S. has had 465 cases in 19 states.

For those of us who are used to hearing big numbers every day—size of the national debt, baseball player salaries, number of immigrants pounding on our door, etc.—these numbers don’t sound very compelling. BUT, measles is a preventable disease. One measles vaccine shot protects the recipient 93% of the time. When you add the second shot years later the individual’s protection goes to 97%. 

 Measles, the most infectious disease we know, can cause debilitating encephalitis (brain swelling), pneumonia, and, very rarely in the U.S., death in both infants and adults. Madagascar is not so lucky. Because of its poverty Madagascar has a vaccination rate of only 58% despite the population’s desire for vaccination. They had 1200 deaths in the115,000 who got measles last year. Europe had 41,000 measles cases in 2018. A community vaccination rate of 90-95% is necessary for effective “herd immunity” in which the vaccinated keep the un-vaccinated safe just be reducing their chances of exposure.

You are not likely to be exposed to a case of Madagascar measles, but if you happen to be in the Williamsburg section of Brooklyn, or Rockland County, NY, or  Portland, Washington, or near Sacremento, California, you may be exposed. These four hot spots of current measles outbreak apparently share an unintended consequence of easy-access global travel.  Unvaccinated Orthodox Jews returning from the September annual Hasidic Pilgrimage from Israel to Uman, Ukraine unexpectedly brought measles back to their unvaccinated, ultra-orthodox Jewish U.S. communities.

There is no aversion to vaccination in the Bible, the Quran, or even Sanskrit texts. It is speculated that these communities have low measles vaccination rates because of “anxiety about science”, “concern about risks of new technology”, and, especially in Soviet emigres, “distrust of the government”. 

In 1896 a Jewish man in Britain refused vaccination contending that it was against his religion. The prosecutor, also Jewish, asked the opinion of the Chief Rabbi of Britain who answered, “Hogwash.” The London court agreed.

Anti-vaxxers don’t respond to facts, They reject scientific data. They are apparently immune to dreaded stories about sick, dying children but appear to believe dreaded stories of assumed vaccine reactions. The mayor of New York City has declared a public health emergency and wants to fine any Williamsburg orthodox Jew who refuse the measles vaccine $1000. He has threatened to even close non-compliant Yeshivas. Rockland County tried to bar unvaccinated persons from public places including . . . gasp, . . . malls! A judge with a cooler head put that on hold.

After reading about the British 1896 court case a modest proposal just sprang out of my head: We should sue an anti-vaxxer, the parent of an unvaccinated child, for civil damages!

It has been recently and repeatedly affirmed that one way to get things done in America, to effect change, is to sue somebody—your spouse, your neighbor, the police, the National Enquirer, the President, whomever. 

So, all we have to do is wait until an unvaccinated child with measles exposes a vaccinated child. Since we know that the measles vaccine is not truly 100%  effective, the vaccinated child has a small chance (probably 3% – 7%) of getting measles. If the vaccinated child now with measles develops the more common complication of pneumonia, or the rare one of encephalitis, or the even rarer one of death, his or her parents could sue the unvaccinated child’s parents for all present and future medical bills, loss of school days, future loss of income due to brain damage, loss of companionship, and other compelling emotional stresses dear to personal injury lawyers. If encephalitis were the complication, the huge jury award would be enough to get the attention of even the most adamant anti-vaxxers. They would learn that their stance is not just a risk to society; it could be a large monetary risk to them personally.

References:
1. “A Modest Proposal”, Jonathan Swift, 1729 


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