Thursday, April 11, 2019

Vaccinate, Vaccinate, Vaccinate

If you are an anti-vaxxer, you might just want to unfriend me now.

The situation that flat out ignorance and self-absorbed importance has caused is getting out of control.  Let's just focus on measles for a second.  According to the CDC, measles cases for this year have already topped the total for 2018, with 465 reported cases.  And we're not even half-way through the year.  That number was reported on April 10, 2019, and reflected an increase of 78 cases from the previous week.  This is the second highest outbreak since the measles were eliminated in 2000.  We're on track to have a record year.

This outbreak is occurring across 19 of our states, with particular concentrations of outbreaks in California, Washington and New York.  New York is particularly troubling.  There are 285 confirmed cases of measles in New York City alone, since the outbreak started last fall, the largest outbreak in decades, centering primarily in Hasidic Jewish communities in the outer boroughs.

What's worse, is news of reckless parents hosting "measles parties," where parents bring their unvaccinated children together to purposely help them contract the disease.  Officials in New York City have reported multiple cases of these gatherings.  This mimics old "chicken pox parties," but chicken pox is much less dangerous and those parties are likewise unnecessary thanks to a vaccine.

Here's what we know about the disease.  Measles is highly contagious, infecting up to 90 percent of unvaccinated people who are exposed to it, according to the CDC.  The virus can live in the air for up to two hours after an infected person sneezes or coughs, meaning people can be exposed to it without knowing it.  People can be infected for days before showing signs of the virus, like fever, runny nose, or a rash.

Measles can be especially dangerous for young children.  It can lead to pneumonia, brain swelling, and even death.  Measles can also be extremely problematic for the old and the already sick.  These are the most likely populations that have not and cannot be vaccinated.  For example, in January an unvaccinated cancer patient in Manila died not from their cancer, but complications from the measles.

Further, there have been 11 deaths from acute measles infections from 2000 to 2015.  Measles can also lead to deaths later on in a child's life.  Wild type measles can cause subacute sclerosing panencephalitis (SSPE).  About 6 to 8 years after having measles, children with SSPE develop progressive neurological symptoms, including memory loss, behavior changes, uncontrollable movements, and even seizures.  As the symptoms progress, they may become blind, develop stiff muscles, become unable to walk, and eventually deteriorate to a persistent vegetative state.  Children with SSPE usuually die within 1 to 3 years of developing symptoms.  There have been 33 SSPE related deaths since 2000, largely attributed to the last great measles outbreak from 1989 to 1991.  This means our current measles outbreak is going to carry repercussions years into the future.

The good news is that we have a vaccine that works, if we would just use it.

The CDC recommends children get their first dose of MMR vaccine at between 12 and 15 months old and a second dose when they're between 4 and 6 years old.  The combination of doses is 97% effective in preventing contraction of the measles.  One dose alone is 93% effective.  Further, vaccine strain measles has never been found in the brain of anyone who died from SSPE, meaning that the vaccine is likewise effective in preventing that unfortunate outcome.

Before immunization in the United States, there were three and four million cases of measles each year.  The United States was declared free of circulating measles in 2000, with just 911 total cases from 2001 to 2011.  In 2014, the CDC said endemic measles, reubella, and congential rubell syndrome had not returned to the United States.  Prior to the current situation, occasional outbreaks had occurred primarily as a result of cases imported from abroad.

Why are we in such a rush to bring back this disease?  What has convinced us that these vaccines are so bad?

Bad science and outright lies that have linked vaccinations to autism?  Those have been debunked flatout.  Repeated studies have proven there is no link between vaccines and autism, no matter what a mommy blogger or celebrity is trying to peddle.  The only British scientist who has been cited as providing a link, Andrew Wakefield, has admitted to falsifying data in his study and attempting to profit from itSo can we please stop spreading this nonsense.

And even if it were true, even if there were some remote link, using this as an excuse is insulting to people who are dealing with autism or have autism in their family.  As if increased deaths from preventable diseases was somehow preferable to having to deal with a genetic condition.  It's the ultimate offensive "can't be bothered" argument.

Let's also discuss the idea of vaccine overload or the complaint that children are getting too many vaccines at a time.  This whole concept is flawed for many reasons.  First, despite the increase in the number of vaccines over recent decades, improvements in the vaccine design have reduced the immunologic load from vaccines, such that the total immunological component load in the 14 vaccines administered to children is less than 10% of what was in the 7 vaccines in 1980.  Likewise, though the schedule has more vaccines, the number of antigens a child is exposed to by the age of two is less than pathogens naturally encountered by a child in a typical year from fevers and middle ear infections.  Further, studies have shown that vaccinations, even multiple concurrent vaccinations do not weaken the immune system or compromise overall immunity.

There is literally no excuse for not vaccinating unless your child is one of the unfortunate children who cannot receive immunizations because of other medical issues.  And that brings us to the other reason why these vaccinations are so important - herd immunity.  Herd immunity is a form of indirect protection from infectious disease that occurs when a large percentage of the population has become immune to an infection, thereby providing a measure of protection for individuals who are not immune.  Herd immunity against measles requires that at least 90-95% of the entire population is immune.  Here's the trick though, we know a certain percentage of the population cannot be immunized - those with severe, life-threatening allergies, those with weakened immune systems due to disease or medical treatments, those that bruise or bleed easily, those with tuberculosis, those under 12 months, etc.  Because of this, our actual immunization percentage of the potential vaccination population (those that are eligible) needs to be higher than 95% to account for those that cannot be vaccinated.

And that's the real problem.  People who oppose vaccinations aren't only endangering themselves and their children, they are endangering people who wish they could be vaccinated but are not allowed because of other conditions.  They are literally endangering the most vulnerable of us all.

Again, we're only talking about measles here.  Heaven forbid we see polio, or outbreaks of diphtheria, hepatitis, or bacterial meningitis.  Even worse if we somehow see smallpox brought back from eradication.

So please, please - vaccinate your kids.

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