Tag: Amish

Costs of a Measles Outbreak

The endemic spread of measles was eliminated in the United States in 2000, but unfortunately, that hasn’t stopped us from having outbreaks of measles each year.

Since reaching a record low of just 37 cases of measles in 2004, other milestones in the measles timeline we should all know about include that there were:

  • 220 measles cases in 2011, a 15-year record and the highest number of cases since 1996 at least until 2014, when we had at least 667 cases
  • 58 cases in the 2013 New York City measles outbreak and for a short time, the largest outbreak since the endemic spread of measles was eliminated in the United States
  • 382 cases in the 2014 measles outbreak in Ohio and now the largest outbreak since the endemic spread of measles was eliminated in the United States
  • 170 measles cases in the first few months of 2015, including a large outbreak in California that was linked to Disneyland.
  • 188 cases and a measles death in 2015

That’s still far below where we used to be though, especially when you consider that before the first measles vaccine was licensed, there was an average of about 549,000 measles cases and 495 measles deaths in the United States each year.

Containing a Measles Outbreak

Several factors help to limit the measles outbreaks that we continue to see in the United States. Most important is that fact that despite the talk of personal belief vaccine exemptions and vaccine-hesitant parents not getting their kids vaccinated, we still have high population immunity.

In the United States, 90.8% of children get at least one dose of the MMR vaccine by the time they are 35 months old and 91.1% of teens have two doses. While not perfect, that is still far higher than the 81% immunization rates the UK saw from 2002 to 2004, when Andrew Wakefield started the scare about the MMR vaccine. Instead of overall low immunization rates, in the U.S., we have “clusters of intentionally under-vaccinated children.”

It also helps that the measles vaccine is highly effective. One dose of a measles vaccine provides about 95% protection against measles infection. A second, “booster” dose helps to improve the effectiveness of the measles vaccine to over 99%.

To further help limit the spread of measles, there are a lot of immediate control measures that go into effect once a case of measles has been suspected, from initiating contact investigations and identifying the source of the measles infection to offering postexposure prophylaxis or quarantining close contacts.

That’s an awful lot of work.

A 2013 measles outbreak in Texas required 1,122 staff hours and 222 volunteer hours from the local health department to contain.

Costs of a Measles Outbreak

In addition to requiring a lot of work, containing a measles outbreak is expensive.

A study reviewing the impact of 16 outbreaks in the United States in 2011 concluded that “investigating and responding to measles outbreaks imposes a significant economic burden on local and state health institutions. Such impact is compounded by the duration of the outbreak and the number of potentially susceptible contacts.”

We still don’t know what it cost to contain many big outbreaks, like the ones in New York City and Ohio, but we do know that it cost:

  • over $2.3 million to contain the 2017 outbreak in Minnesota – 75 people got measles, 71 were unvaccinated, and more than 500 people were quarantined over a 5 month period
  • up to an estimated $3.91 million (but likely much more) to contain the 2015 outbreaks in California
  • two unrelated cases in Colorado in 2016 cost $49,769 and $18,423, respectively to investigate
  • $50,758.93 to contain an outbreak at a megachurch in Texas
  • $150,000 to contain (13 cases) an outbreak in Cook County, Illinois
  • $223,223 to contain (5 cases, almost all unvaccinated) to contain another outbreak in Clallam County, Washington, an outbreak that was linked to the death of an immunocompromised woman.
  • more than $190,000 of personnel costs in Alameda County, with 6 cases and >700 contacts, it is estimated that over 56 staff spent at least 3,770 hours working to contain the outbreak
  • $5,655 to respond to all of the people who were exposed when a 13-year-old with measles was seen in an ambulatory pediatric clinic in 2013
  • $130,000 to contain a 2011 measles outbreak in Utah
  • $24,569 to contain a 2010 measles outbreak in Kentucky
  • $800,000 to contain (14 cases, all unvaccinated) a 2008 measles outbreak at two hospitals in Tuscon, Arizona
  • $176,980 to contain a 2008 measles outbreak in California
  • $167,685 to contain a 2005 measles outbreak in Indiana – unvaccinated 17-year-old catches measles on church mission trip to Romania, leading to 34 people getting sick, including an under-vaccinated hospital worker who ends up on a ventilator for 6 days
  • $181,679 (state and local health department costs) to contain a 2004 measles outbreak in Iowa triggered by a unvaccinated college student’s trip to India
Ending with 667 cases, 2014 became the worst year for measles in the United States since 1994.
Ending with 667 cases, 2014 became the worst year for measles in the United States since 1994. How much did these outbreaks cost to contain?

It is important to keep in mind that these costs are often only for the direct public health costs to the county health department, including staff hours and the value of volunteer hours, etc. Additional costs that come with a measles outbreak can also include direct medical charges to care for sick ($14,000 to $16,000) and exposed people, direct and indirect costs for quarantined families (up to $775 per child), and outbreak–response costs to schools and hospitals, etc.

We should also consider what happens when our state and local health departments have to divert so much time and resources to deal with these types of vaccine-preventable diseases instead of other public health matters in the community. Do other public health matters take a back seat as they spend a few months responding to a measles outbreak?

There were 220 cases of measles in the United States in 2011. To contain just 107 of those cases in 16 outbreaks, “the corresponding total estimated costs for the public response accrued to local and state public health departments ranged from $2.7 million to $5.3 million US dollars.”

In contrast, it will costs about $77 to $102 to get a dose of the MMR vaccine if you don’t have insurance. So not only do vaccines work, they are also cost effective.

What to Know About the Costs of a Measles Outbreak

Containing a measles outbreak is expensive – far more expensive than simply getting vaccinated and protected.

More on the Costs of a Measles Outbreak

Myths About Thimerosal in Vaccines

Over the years, especially since thimerosal was removed from most vaccines, the myths about thimerosal have surprising been increasing.

“Currently, the actions taken by the vaccine manufacturers, the FDA and the CDC have increased the possible maximum childhood exposure to mercury from vaccines to twice the level that triggered the 1999 call to remove mercury from all vaccines as soon as possible!”

Rev. Lisa K. Sykes on “Ten Lies” Told About Mercury in Vaccines

Of course, none of them are true.

Myths About Thimerosal in Vaccines

To begin with, there was no “call to remove mercury from all vaccines as soon as possible.”

Instead, as a “precautionary measure,” the AAP asked vaccine manufacturers “for a clear commitment and a plan to eliminate or reduce as expeditiously as possible the mercury content of their vaccines.”

“In addition, today most tetanus shots and the multi-dose Sanofi Menomune vaccine that are approved by the US Food and Drug Administration (FDA) still contain 25-micrograms-a-dose mercury.”

Rev. Lisa K. Sykes on “Ten Lies” Told About Mercury in Vaccines

Other myths about thimerosal include that:

  • After “realizing” the amount of mercury in the childhood vaccination schedule recommended by the CDC exceeded all national and global maximum safety limits, the American Academy of Pediatrics and the United States Public Health Service called for the immediate removal of Thimerosal from all vaccines on July 7, 1999. – the amount of thimerosal in the childhood immunization schedule actually only exceeded EPA guidelines and was well below the guidelines of the Agency for Toxic Substances Disease Registry (ATSDR) or the FDA. Also, since thimerosal-free versions of DTaP and Hib have always been available, only “a minority of infants could receive as much as 187.5 mg of ethylmercury during the first 6 months of life.”
  • children are getting even more mercury from vaccines today than when mercury was removed from vaccines, because pregnant women and kids get flu shots now – this theory doesn’t take into account that thimerosal-free flu vaccines have been available since 2003 and until recently, many kids didn’t get flu shots. For example, during the 2008-09 flu season, only 25% infants and toddlers were fully vaccinated against flu and even fewer pregnant women got flu shots (about 15%). The only way this myth could possibly be true would be if these folks all got a flu vaccine with thimerosal each and every year.
  • even as thimerosal was removed from the DTaP, Hib, and hepatitis B vaccines, kids still got exposed to thimerosal from other vaccines, like Menomume, the meningococcal vaccine –  Although Menomume contained thimerosal, it had only been recommended for high risk kids since it was approved in 1981. It was later replaced by Menactra and Menveo, both of which are thimerosal-free, and which were recommended to all kids as they provided better coverage. Menomume was discontinued in 2017 and it is unlikely that many kids got it once Menactra and Menveo became available.
  • kids still get a tetanus shot with thimerosal – yes, they did, at least until the Tdap vaccines were approved in 2006. Tdap is thimerosal-free.
  • Thimerosal has never undergone even one modern safety test. – although mercury can be toxic, the thimerosal in vaccines has been shown to be safe. That’s not surprising – remember, “the dose makes the poison.”
  • Published studies have shown that Thimerosal and its mercury breakdown product contribute to: Alzheimer’s, Cancer, Autism Spectrum Disorders, Attention Deficit Disorders, Bipolar Disorder, Asthma, Sudden Infant Death Syndrome, Arthritis, Food Allergies, Premature Puberty, and Infertility. – thimerosal in vaccines doesn’t cause any of these things, but you can probably find a published study somewhere saying that thimerosal causes Alzheimer’s, cancer, or food allergies, etc., but that just points to how important it is to look to trusted sources of information, as almost anyone can publish a bad study
  • Contrary to sound bites you hear on the nightly news, to be “anti-mercury” is not to be “anti-vaccine.” – if this is true, then why did Robert F. Kennedy, Jr write an editorial against University of Colorado students who passed a resolution for meningococcal B vaccines, which are thimerosal-free? And why push so much propaganda about thimerosal?
  • Corresponding to the sharply increasing level of mercury in the immunization schedule globally, which started in the late 1980’s, there has been an increasing rate of autism among children. This also explains why autism among 40-, 50-, 60-, 70- and 80-year-olds is not epidemic, but rather rare. – this is one of the main problems of the anti-vaccine movement… if you believe that autism is an epidemic, then there must be a cause and it becomes easy to blame vaccines. You also have to ignore the fact that there are plenty of autistic adults.
  • Among the Amish who do not vaccinate, the rate of autism is strikingly low. – there are autistic Amish
  • Unused vaccines with a preservative level of Thimerosal, however, are considered hazardous waste because of their high mercury content. If not injected into patients, discarded vials of these mercury-preserved vaccines, therefore, must be disposed of in steel drums, by law. – this is not true – at all… you also don’t have to call a Hazmat team if you break an unused vaccine vial with thimerosal…
  • …instead of requiring immediate removal, the CDC allowed the pharmaceutical companies to save money by using up their inventories of mercury-containing vaccines. By 2003, the industry had finally used up stocks of thimerosal-containing vaccines and Thimerosal is no longer used in these three vaccines. – the only basis for this statement is that the last thimerosal containing DTaP, Hib, and hepatitis B vaccines expired in 2003, but it is important to keep in mind that most vaccines are used well before their expiration date. In fact, many doctors order vaccines every month, so as to not keep large supplies of vaccines in their office, and since thimerosal-free versions were already available, those likely would have been ordered.
  • The term “trace amounts” means less than 1 microgram (mcg). Thimerosal-containing flu shots contain what in biochemical terms is actually a massive dose of mercury: 25 mcg. – vaccines labeled as having a trace amount of thimerosal have less than or equal to 1mcg, while others are clearly labeled as having up to 25mcg.
  • Why do I call that massive? Because the Environmental Protection Agency’s maximum exposure limits for methyl mercury is .1 microgram per 1 kilogram of bodyweight, which means a baby would have to weigh 550 pounds to safely absorb 25 micrograms of mercury. At these levels, a growing fetus in a mother receiving the flu shot could get up to a million times the EPA’s safe levels. – wait, what? First, that is the maximum recommended daily exposure limit based on the assumption that the exposure to mercury will continue for long periods of time. That’s not the case when a pregnant woman gets a one time flu shot. And it is the pregnant mother who is getting the flu shot, not the baby. Although some thimerosal will cross the placenta, it is still not in levels that will cause harm, so calling the dose massive ends up just being an obvious propaganda tool to scare folks.
The review, Thimerosal and Autism?, explains why autism and mercury poison really don't share symptoms.
The review, Thimerosal and Autism?, explains why autism and mercury poison really don’t share the same symptoms.
  • Autism and mercury poisoning have the same symptoms. – they don’t… In fact, there are many reports of epidemics of mercury poisoning throughout history that weren’t associated with autism, including in Minamata and Niigata, Japan, exposures from mercury in teething powders and worm medicines (pink disease), and food contamination in many countries.

“Yet mercury had long been the every-day treatment of infants at the time of teething in the form of teething powders.”

Ann Dally on The Rise and Fall of Pink Disease

Although it is hard to believe now, mercury wasn’t taken out of teething powders until 1957, after which time pink disease quickly disappeared. Why was mercury in teething powders in the first place? Unlike thimerosal in vaccines, I don’t think it was acting as a preservative, as it sounds like it was present in very high doses. So there was a lot of risk with no benefit.

Sounds like the opposite of what we had with thimerosal in vaccines – lots of benefit (vaccines didn’t get contaminated) with no risk.

But taking thimerosal out of vaccines was risk-free too, wasn’t it?

Nope. That’s another myth.

“Unfortunately, the precautions taken by the AAP and CDC calling for thimerosal removal from vaccines appears to have led to unintended risks. In particular, inappropriate recommendations by autism advocacy groups regarding treatment of autism (e.g., use of chelation) and avoidance of vaccines (e.g., influenza vaccine) may mislead parents to place children at unnecessary risks.”

Hurley et al on Thimerosal-Containing Vaccines and Autism: A Review of Recent Epidemiologic Studies

In addition to anti-vaccine folks continuing to push myths about thimerosal to scare parents away from vaccinating and protecting their kids, some missed out on getting vaccinated and caught life-threatening vaccine-preventable diseases.

What to Know About Thimerosal in Vaccines Myths

Don’t believe any of the myths about thimerosal in vaccines. Vaccines are safe and necessary.

More on Thimerosal in Vaccines Myths