Tag: clusters

The Plano Smallpox Outbreak of 1895

In May 1895, a smallpox outbreak hit west Plano.
1895 Fort Worth Gazette

North Texas is no stranger to outbreaks of vaccine-preventable diseases.

After all, this was the site of a large measles outbreak in 2013 at the Kenneth Copeland Ministries Eagle Mountain International Church.

And it has also been the site of chicken pox parties, mumps outbreaks, and a few clusters of unvaccinated kids.

Mostly though, parents in North Texas do a good job of getting their kids vaccinated and protected.

The Plano Smallpox Outbreak of 1895

Of course, that’s not what’s keeping smallpox away.

Routine smallpox vaccination, which was typically given when children were about 12 months old, ended in 1972 in the United States. And smallpox was declared eradicated in 1980.

“Today, Preston Lakes is a quiet, manicured neighborhood in an affluent area of Plano. Almost 120 years ago, it was the site of one of Plano’s darkest hours.”

Plano Smallpox Outbreak of 1895

Driving around Plano now, it is hard to imagine that this city once battled smallpox.

While that is probably true of any modern city, the curious thing is that the area in and around Plano wasn’t settled until the early 1840’s, at which time an effective smallpox vaccine had been available for over 40 years.

Remember, Edward Jenner developed his smallpox vaccine in 1796. And before that we had variolation.

“On May 6, 1895, Plano City Council called an emergency meeting, establishing a strict quarantine “to protect our citizens from this loathsome disease.” Anyone within the area between what is now Spring Creek Parkway, Park Boulevard, Coit and Preston Roads was forbidden to leave. An armed guard patrolled the border.”

Plano Smallpox Outbreak of 1895

Farwick Collinsworth, whose family owned large portions of what is now West Plano, lost his 11-year-old granddaughter in the smallpox outbreak.

Next, his wife and two sons died.

Then two more grandchildren and a nephew.

All together, at least 15 people died in the smallpox outbreak of 1895 in Plano, Texas.

“In 1806 the first smallpox inoculations were administered in San Antonio de Béxar. After initial resistance to the experiment, the townspeople came to accept the procedure, and the threat of smallpox was lessened for a time.”

Texas State Historical Association Public Health

While the Plano outbreak is certainly sad, it is truly tragic that smallpox was already a vaccine-preventable disease at this time.

History of Smallpox in Texas

Still, as late as 1900, 894 people died of smallpox in the United States. Globally, at least 300 million people died of smallpox during the 20th century.

So why weren’t folks vaccinated against smallpox in the late 19th century in North Texas?

In 1901, the editor of The Texas Medical Journal discusses the "prejudice against vaccination" in Texas at the time of a widespread smallpox epidemic.
In 1901, the editor of The Texas Medical Journal discusses the “prejudice against vaccination” in Texas, at the time of a widespread smallpox epidemic.

While some people talking about issues with vaccine availability, remember that this is just after almost 100,000 people participated in the Leicester Demonstration March of 1885 to protest the smallpox vaccine.

While Leicester is quite a ways from Plano, a little bit closer to home we had the Laredo Smallpox Riot.

“When he realized that Laredoans were not fully embracing the quarantine program, especially the mandatory inoculation, he asked the governor to send in Texas Rangers. A contingent of rangers under Captain J.H. Rogers arrived on March 19, 1899, and began enforcing the health official’s orders more vigorously than some of the city’s residents thought proper. Milling protestors pelted rangers and health workers with harsh words and harder rocks, leading to a couple of minor injuries.
The next day, when the rangers got word that someone had telephoned a local hardware store to order 2,000 rounds of buckshot, the officers began a house-to-house search of the part of town where the order had come from. The situation soon deteriorated into a riot, with the rangers killing two citizens and wounding 10 others. It took cavalry from nearby Fort McIntosh to restore order.
The inoculation and fumigation program continued, and by May 1, Dr. Blunt lifted the quarantine in the border city.”

Frontier Medicine: Texas Doctors Overcome Disease and Despair

And we had folks pushing homeopathic vaccines, anti-vaccine talking points about the “evil results from vaccination,” all contributing to a “prejudice against vaccination.”

The Texas Medical Journal, in 1902, describes how other areas have controlled or eliminated smallpox with vaccines - but not Texas.
The Texas Medical Journal, in 1902, describes how other areas had controlled or eliminated smallpox with the vaccine – but not Texas.

It maybe shouldn’t be surprising that the last smallpox outbreak in the United States was in Texas – in 1949. Eight people got sick, and one person, Lillian Barber, died.

But Texas wasn’t at the center of the anti-vaccine fight against protecting kids against smallpox. In Utah (the McMillan bill), Minnesota, and California, laws were passed banning mandatory vaccination for attending school. While the governors of Utah and California vetoed their bills, in Utah, legislators overcame the veto.

What came next?

Outbreaks of smallpox.

In 1906, AMA President William J. Mayo, a Minnesota physician, charged that his state’s “inability to enforce vaccination” had unleashed a smallpox epidemic, infecting 28,000 of the state’s citizens – “all due to a small but vociferous band of antivaccination agitators.”

Pox: An American History

That was over a hundred years ago.

What comes next?

Will we let today’s “vociferous band of antivaccination agitators” guide  vaccine policy and put our kids at risk for vaccine-preventable diseases, as they push the same old anti-vaccine propaganda and fight against vaccine mandates, which are only necessary because they scare parents away from vaccinating and protecting their kids?

Let’s hope not.

What to Know About the Plano Smallpox Outbreak of 1895

Fifteen people died in Plano, Texas in 1895, even though a smallpox vaccine was available at the time that could have prevented this and most other smallpox outbreaks and epidemics. Tragically, the fight against its use mirrors much of what we see in today’s anti-vaccine movement.

More on the Plano Smallpox Outbreak of 1895

The First Measles Case of 2018 is at IU Bloomington

And the first measles case of 2018 is in…

  • Bloomington, Indiana

Unvaccinated children exposed to measles are quarantined for at least 21 days.

A student at Indiana University in Bloomington was diagnosed with measles on January 6.

The student may have exposed others between the time they arrived on campus on January 2, moved into her dorm (McNutt Residence Hall), and got diagnosed on January 6.

Fortunately, classes haven’t started yet, so exposure to others might have been lower than they typically might have been.

She likely did expose others on January 2:

  • on a flight from Mumbai, India to Newark Liberty International Airport
  • during a layover in Newark Liberty International Airport
  • on a flight from Newark to Indianapolis International Airport
  • at Indianapolis International Airport

Because measles has a long incubation period, remember that it might not be until January 23 that you develop symptoms if you were exposed are not immune (two doses of vaccine or natural immunity).

Indiana Measles Outbreaks

Surprisingly, this is not the first case of measles at this campus in recent years. Just four years ago, another student at Indiana University Bloomington was diagnosed with measles.

Or maybe it shouldn’t be so surprising.

Indiana has had some large measles outbreaks triggered by unvaccinated travelers returning to the state.
Indiana has had some large measles outbreaks triggered by unvaccinated travelers returning to the state.

There has been a lot of measles in Indiana in recent years:

  • an outbreak caused by an unvaccinated traveler who got 13 other people sick in 2011
  • another outbreak in 2012, also triggered by an unvaccinated traveler, also got 13 other people sick

In fact, since 2010, there have been at least 34 cases of measles in Indiana, including the latest case at IU Bloomington. Almost all have been unvaccinated.

And that’s with a pretty good vaccination rate.

Why?

Pockets of susceptibles, or so-called clusters of unvaccinated people, who get measles and then put the rest of us at risk.

Get educated.

Stop the outbreaks.

Vaccines work. Vaccines are safe and vaccines are necessary.

What to Know About Measles in Indiana

Indiana has been one of the states where we have seen measles outbreaks linked to clusters of unvaccinated people and is home to the first measles case of 2018.

More on Measles in Indiana

Updated January 13, 2018

Ask Amy About Intentionally Unvaccinated Kids at a Holiday Party

How do you avoid fighting with friends and family when you get together at the holidays?

Some say to talk about whatever you want, but just have empathy for others when you talk about controversial topics.

Other experts say to simply avoid talking about things like politics, religion, and sex.

Going that route, it is easy to imagine that the list of things that you can’t talk about can get pretty long in some families.

Topics Too Dangerous To Avoid

Are some topics too dangerous to avoid talking about?

I’m not talking about in the long-term, what’s going to happen to our world kind of dangerous, but short term dangers to your kids and the rest of your family.

For example, what if you instinctively think that you should avoid talking about guns when visiting your uncle’s house, because you remember seeing all of his Facebook posts about the NRA. But you want to make sure there aren’t any unsecured guns lying around the house that your toddler could find. Do you ASK about guns in the house?

Ask Amy About Intentionally Unvaccinated Kids

What about vaccines?

That’s another topic that’s too important to avoid talking about.

Ask Amy took on the issue of the risk of an intentionally unvaccinated child to the rest of the family.
Ask Amy takes on the risk of an intentionally unvaccinated child at a holiday party.

What’s the problem? Some family members don’t want to come to a family gathering if their sibling is going to bring their intentionally unvaccinated child.

And why is that a problem if they are all fully vaccinated (a common argument posed by anti-vaccine folks)?

It should be clear that they are not all fully vaccinated. At least one of the grandchildren is just 6-months-old, so is too young to be fully vaccinated. She will not get her first dose of MMR and chicken pox vaccine, for example, until she is at least 12 months old.

But she isn’t the only one at risk. The other children and adults could be at risk because no vaccine is 100% effective. Vaccines work and they work very well. They just aren’t perfect.

What Ask Amy Gets Right and Wrong

Ask Amy was smart to turn to a pediatrician for help on this question.

And Dr. Thoele is right, this intentionally unvaccinated child is getting away with hiding in herd (at least so far) and won’t get anyone else sick unless he is exposed first and gets sick himself.

“If you choose to delay some vaccines or reject some vaccines entirely, there can be risks. Please follow these steps to protect your child, your family, and others.”

CDC on If You Choose Not to Vaccinate Your Child, Understand the Risk and Responsibilities

Many of us would take exception to the part that it is “highly unlikely” that this child could get a vaccine-preventable disease though. There are usually one or more outbreaks of chicken pox, mumps, pertussis, and measles, etc., going on in different parts of the United States throughout the year. And because parents who don’t vaccinate their children often cluster together in groups, it increases the chances that their kids will catch something.

Have they traveled out of the country? Have they been exposed to someone who has? That increases their risk too.

And what about the flu?

“(Dr) Thoele and I both hope that everyone attends the family get-together and that all family members should try their best to be nice to one another. There is, fortunately, no vaccine preventing that.”

There is also nothing preventing those parents from vaccinating their child.

Unvaccinated Kids at a Holiday Party

So should this intentionally unvaccinated toddler come to the holiday party?

Should other kids come if the unvaccinated child will be there?

While no one wants a family to be split over such a matter or for grandparents to be put in the middle, it is a much more complicated issue than wishing that everyone play nice.

Not Vaccinated? No Kisses!
A billboard advocating that teens and adults get a Tdap booster.

Not surprisingly, pediatricians get asked about these kinds of situation all of the time:

  • Should new parents allow family members to visit if they won’t get a flu shot?
  • When can they allow a family member to see their new baby if they won’t get a Tdap booster?
  • What do they do about the family members who don’t get vaccinated and don’t even take their kids to the doctor for regular checkups?

And what’s the answer?

Understand that kids aren’t at least partially protected against:

  • pertussis until after the third dose of DTaP at six months
  • the flu until after getting a first flu shot at six months, keeping in mind that they are actually going to need a second flu shot for full protection, since it is the first time that they are being vaccinated against influenza
  • measles, mumps, and chicken pox until they get their first dose of MMR and the chicken pox vaccine when they are 12 months old

And that’s why many parents would not, if they had a choice, expose their children to an intentionally unvaccinated child until after they had at least had their 12 to 15 month vaccines. By this time, they have also gotten 3-4 doses of Hib and Prevnar, and have completed their rotavirus vaccines.

Of course, if the child, or any of the adults, had an immune system problem, were getting treated for cancer, or had any other condition that would put them at higher risk for getting a vaccine-preventable disease, then they would likely never voluntarily expose themselves to someone who was intentionally unvaccinated.

I say voluntarily, because we often don’t have a choice.

In most states, folks are allowed to send their intentionally unvaccinated kids to school and daycare. And those kids put us all at risk.

And yes, there are vaccines to prevent that.

What to Know About Unvaccinated Kids at a Holiday Party

Many parents would avoid voluntarily exposing their kids to an intentionally unvaccinated child until they have at least completed their primary series of vaccines, when they are 12 to 15 months old.

More on Unvaccinated Kids at a Holiday Party

Is the Anti-Vaccine Movement Growing?

Boston Reverend Cotton Mather  actively promoted smallpox inoculation during a local epidemic.
Boston Reverend Cotton Mather actively promoted smallpox inoculation during a local epidemic.

We often have to remind people that the anti-vaccine movement didn’t start with Bob Sears, or Jenny McCarthy, or even with Andy Wakefield.

Did you know that the Reverend Cotton Mather’s house was bombed in Boston in 1721? Well, someone through a bomb through his window. Fortunately, it didn’t go off.

That’s 77 years before Jenner developed his smallpox vaccine!

What was Mather doing?

He had started a smallpox variolation program. He was trying to protect people in Boston from smallpox during one of the most deadly epidemics of the time.

So essentially, the anti-vaccine movement started before we even had real vaccines…

Is the Anti-Vaccine Movement Growing?

You see reports of more and more outbreaks of vaccine-preventable diseases, hear about new vaccine laws and mandates, and depending on who your friends are, may see a lot of anti-vaccine articles and vaccine injury stories getting shared on Facebook.

You have probably even heard about pediatricians firing families who refuse to vaccinate their kids.

So what’s the story?

Is the anti-vaccine movement growing?

Is there a growing resistance among parents to getting their kids vaccinated?

“Parents are taking back the truth. It is my expectation that this crack in the dam will serve to sound an alarm. To wake women up. To show them that they have relinquished their maternal wisdom, and that it is time to wrest it back.”

Kelly Brogan, MD

Is the world finally “waking up to the dangers of vaccines,” like many anti-vaccine experts have been claiming for years and years?

The Anti-Vaccine Movement is not Growing

Many people will likely tell you that the anti-vaccine is in fact growing.

You can read it in their headlines:

  • The worrying rise of the anti-vaccination movement
  • Will 2017 be the year the anti-vaccination movement goes mainstream?
  • Pediatricians calling anti-vaccine movement a growing problem
  • There’s Good Evidence That The Anti-Vaccine Movement Is Growing
  • I was skeptical that the anti-vaccine movement was gaining traction. Not anymore.

But the anti-vaccine movement is not necessarily growing.

The overwhelming majority of parents and adults are fully vaccinated.

What we do have is a very vocal minority of people who do their best to push misinformation and conspiracy theories about vaccines and vaccine dangers, and not surprisingly, they have some new ways to do it. Unfortunately, they use their anti-vaccine talking points to scare vaccine hesitant parents and those who might now be on the fence about vaccines to sometimes delay or skip some vaccines.

Most parents do their research though, don’t jump on the anti-vaccine bandwagon, and know that vaccines work, vaccines are safe, and vaccines are necessary.

The Anti-Vaccine Movement is Changing

A lot about the anti-vaccine movement hasn’t changed over the last 100 plus years.

Many early critics of vaccines were alternative medicine providers, including homeopaths and chiropractors, just like we see today. And like they do today, they argued that vaccines didn’t work, vaccines were dangerous, and that vaccines weren’t even necessary.

alicia-silverstone

The big difference?

Unlike when Lora Little, at the end of the 19th century, had to travel around the country to distribute her anti-vaccine pamphlet, Crimes of the Cowpox Ring, anti-vaccine folks can now just tweet or post messages on Facebook. It is also relatively easy to self-publish an anti-vaccine book and sell it on Amazon, put up your own anti-vaccine website, post videos on YouTube, or even make movies.

“Whatever you think about Andrew Wakefield, the real villains of the MMR scandal are the media.”

Ben Goldacre on The MMR story that wasn’t

Fortunately, all of that is balanced by something they don’t have anymore.

No, it’s not science. That was never on their side.

It’s that the media has caught on to the damage they were doing and isn’t as likely to push vaccine scare stories anymore.

Explaining the Popularity of the Anti-Vaccine Movement

The anti-vaccine movement has always been around and they are likely not going anywhere, whether or not they are growing.

Looking at the history of the anti-vaccine movement, it is clear that they have their ups and downs, times when they are more or less popular, but they are always there.

“By the 1930s… with the improvements in medical practice and the popular acceptance of the state and federal governments’ role in public health, the anti-vaccinationists slowly faded from view, and the movement collapsed.”

Martin Kaufman The American Anti-Vaccinations and Their Arguments

Why so many ups and downs?

As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks.
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Chart by WHO

It is easily explained once you understand the evolution of our immunization programs, which generally occurs in five stages:

  1. pre-vaccine era or stage
  2. increasing coverage stage – as more and more people get vaccinated and protected, you pass a crossover point, where people begin to forget just how bad the diseases really were, and you start to hear stories about “mild measles” and about how polio wasn’t that bad (it usually wasn’t if you didn’t get paralytic polio…)
  3. loss of confidence stage – although vaccine side effects are about the same as they always were, they become a much bigger focus because you don’t see any of the mortality or morbidity from the diseases the vaccines are preventing. It is at this point that the anti-vaccine movement is able to be the most effective.
  4. resumption of confidence stage – after the loss of confidence in stage three leads to a drop in vaccine coverage and more outbreaks of a vaccine-preventable disease, not surprisingly, more people understand that vaccines are in fact necessary and they get vaccinated again. It is at this point that the anti-vaccine movement is the least effective, as we saw after outbreaks of pertussis in the UK in the 1970s and measles more recently. You also see it when there is a report of an outbreak of meningococcal disease on a college campus or a child dying of the flu on the local news, etc.
  5. eradication stage – until we get here, like we did when smallpox was eradicated, the anti-vaccine movement is able to cycle through stages two to four, with ups and downs in their popularity,

So the anti-vaccine movement is able to grow when they have the easiest time convincing you that the risks of vaccines (which are very small) are worse than the risks of the diseases they prevent (which are only small now, in most cases, because we vaccinate to keep these diseases away, but were life-threatening in the pre-vaccine era).

“As vaccine use increases and the incidence of vaccine-preventable diseases is reduced, vaccine-related adverse events become more prominent in vaccination decisions. Even unfounded safety concerns can lead to decreased vaccine acceptance and resurgence of vaccine-preventable diseases, as occurred in the 1970s and 1980s as a public reaction to allegations that the whole-cell pertussis vaccine caused encephalopathy and brain damage. Recent outbreaks of measles, mumps, and pertussis in the United States are important reminders of how immunization delays and refusals can result in resurgences of vaccine-preventable diseases.”

Paul Offit, MD on Vaccine Safety

Fortunately, most parents don’t buy into the propaganda of the anti-vaccine movement and don’t wait for an outbreak to get their kids vaccinated and protected. They understand that you can wait too long.

The bottom line – except for pockets of susceptibles and clusters of unvaccinated kids and adults, most people are vaccinated. If the anti-vaccine does grow, it eventually gets pulled back as more kids get sick.

What to Know about the Growing Anti-Vaccine Movement

Although they may have an easier time reaching more people on Twitter, Facebook, YouTube, and with Amazon, the overwhelming majority of parents vaccinate their kids and aren’t influenced by what some people think is a growing anti-vaccine movement.

More on the Growing Anti-Vaccine Movement

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