Tag: clusters

Fact Checking the Truth About Vaccination Rates in California

In general, higher immunization rates should translate into lower rates of disease.

And it is true that in most states, including California, overall immunization rates are up.

So what’s happening?

Fact Checking the Truth About Vaccination Rates in California

Everyone knows what’s happening!

Clusters of unvaccinated kids and adults.

Pockets of susceptibles.

Abuse and overuse of vaccine exemptions.

And folks who continue to scare parents away from vaccinating and protecting their kids.

There are measles outbreaks in this part of northern California...
There are measles outbreaks in this part of northern California…

What’s the truth about California’s immunization rates and the reason they are still having outbreaks of measles and other vaccine-preventable diseases?

“Oh, but wait! What do you mean we have higher vaccination coverage NOW than we did back then? How can that be? I thought rates have been declining steadily for two decades putting us in a terrible position of falling wayyyy below herd immunity levels!?

I thought the reason we are now “in danger of disease outbreaks” is because of the increasing number of children being exempted from vaccines? Hold on, wait. You’re telling me there are LESS kids exempted now than there were in the year 2000 when we were free of outbreaks because of “high vaccination rates”? That can’t be right…can it?”

Melissa Floyd

You aren’t going to get it from anti-vaccine folks

73% is actually pretty good for a Waldorf school!
73% is actually pretty good for a Waldorf school!

But it’s not surprising that you get misinformation about herd immunity from folks who think vaccines don’t actually create herd immunity.

And it shouldn’t be surprising that you can’t hide in the herd when your herd is a cluster of unvaccinated kids at a Waldorf school.

Vaccines are safe, with few risks, and are obviously necessary. Vaccinate your kids and help stop the outbreaks.

More on Fact Checking the Truth About Vaccination Rates in California

A Legislative Guide to Advocating for Stronger Vaccine Laws

Having to get vaccinated to attend school isn’t a new idea.

In 1827, Boston mandated that all children attending public school must receive the smallpox vaccine.

Believe it or not, it wasn’t until the 1980-81 school year that there were laws in all 50 states mandating that children receive vaccinations before starting school. The smallpox vaccine wasn’t one of them…

A Legislative Guide to Advocating for Stronger Vaccine Laws

Not surprisingly, as vaccines did their job and rates of vaccine-preventable diseases dropped, politicians were able to weaken our vaccine laws.

Over just a few years, from 1998 to 2000, 15 states added personal belief vaccine exemptions!

We are now paying the price, with increases of vaccine-preventable diseases among clusters of intentionally unvaccinated children whose parents claim non-medical vaccine exemptions.

And that’s why we are seeing more and more states work to strengthen their vaccine laws.

Legislators who want to combat vaccine exemption abuse should enact laws that make it clear that:

  • medical exemptions are based on ACIP guidelines, current accepted medical practice, and evidence-based medicine – not anecdotes
  • medical exemptions should be reviewed and approved by the State Epidemiologist, Deputy State Epidemiologist, or other designated professionals at the health department
  • religious exemptions, if included at all, should specifically exclude philosophical exemptions and must reflect a sincere religious belief
  • philosophical exemptions, if included at all, should require some degree of education against the myths and misinformation that scares parents away from vaccinating their kids
  • exempted students will be excluded from school during outbreaks
  • exemptions should include a signed affidavit that is notarized
  • exemptions should be recertified each year
  • most exemptions are temporary
  • a separate exemption application should be required for each vaccine
  • exemption rates should be tracked at the school level and should be posted on school websites

Getting an exemption shouldn’t be easier than getting vaccinated!

Become an advocate and help get more kids vaccinated. You can also help stop bad vaccine laws from being enacted in your state, including some that would make it even easier to get an exemption.

More on A Legislative Guide to Stronger Vaccine Laws

Dr. Bob Puts the Nail in the Coffin of the Herd Immunity Argument

Dr. Bob Sears, who actually wrote a book about vaccines, seems to think that he and his podcasting sidekick have put the nail in the coffin “of trying to use the herd immunity argument to justify coerced vaccinated.”

Dr. Bob seems to think that herd immunity doesn't apply to vaccines.

The meme he shared even includes the hashtag stating that herd immunity doesn’t apply to vaccines.

Dr. Bob Puts the Nail in the Coffin of the Herd Immunity Argument

While arguing against the idea of herd immunity and for coerced vaccination are common among anti-vaccine folks, neither is true.

Herd immunity is real and no-one is going to force anyone to vaccinate their kids. Vaccine mandates do not mean forced vaccination.

What about the idea that “all vaccines wane within about 2-15 years, leaving vaccinated children & adults unprotected?”

If that were true, then wouldn’t everyone who got sick in latest outbreaks be vaccinated? Why are most folks unvaccinated?

So we are either getting a lot of outbreaks because of waning immunity or your titers are getting boosted because you are getting exposed to so much natural disease. Got it?

While waning immunity is an issue for some vaccines, like mumps and pertussis, the primary and secondary failure rates are still not as bad as Dr. Bob suggests, which is why, in an outbreak, the attack rate of disease is always higher among those who are unvaccinated and unprotected.

The numbers don't always add up correctly when anti-vax folks try to do math.
The numbers don’t always add up correctly when anti-vax folks try to do math.

Is herd immunity the main argument that’s made when experts suggest we need stronger vaccine laws? I always thought the main argument is that folks should just vaccinate and protect their kids, but maintaining herd immunity so that your intentionally unvaccinated kids don’t put everyone else at risk is a good reason too.

Does everyone see the problem with Melissa Floyd’s math? This probably won’t be on the SAT, but you still want to get this right…

Like many others are doing right now, she used state level data. Since many of the folks who don’t vaccinate their kids cluster together in the same communities and schools, the “2% of those filing for exemptions” end up making up 10, 20, or even 30% of some school’s student population.

“This means if you are a primary non-responder, you are walking around every day with a false sense of security, clinically unvaccinated for that particular disease.”

Melissa Floyd

This is the whole point of herd immunity!

Because vaccines aren’t 100% effective, we can walk around all day without actually thinking about it much, hoping that we can rely on the fact that most other people are also vaccinated and protected. That keeps disease out of our community or herd.

The system typically breaks down though, not because vaccines aren’t effective enough, but because too many folks don’t get vaccinated.

“A 2011 article in “Vaccines”, edited by Stanley Plotkin, says, “Much of the early theoretical work on herd immunity assumed that vaccines induced solid immunity against infection…” Theoretical… Assumed…”

Melissa Floyd

She should have read the whole article, or at least used the whole quote…

“Much of the early theoretical work on herd immunity assumed that vaccines induce solid immunity against infection and that populations mix at random, consistent with the simple herd immunity threshold for random vaccination of Vc = (1-1/R0), using the symbol Vc for the critical minimum proportion to be vaccinated (assuming 100% vaccine effectiveness). More recent research has addressed the complexities of imperfect immunity, heterogeneous populations, nonrandom vaccination, and freeloaders.”

Herd Immunity: A Rough Guide

It doesn’t say what she thinks it says…

“Indeed, one might argue that herd immunity, in the final analysis, is about protecting society itself.”

Herd Immunity: A Rough Guide

So why haven’t we eradicated measles like we said we would?

“What’s funny is after the measles vaccine was licensed in 1963, the medical community declared a goal of eradicating measles by 1967. But 1967 came and went and it still wasn’t gone, 1977, 1987, 2000… the dates kept getting pushed, and the result was always the same. Meanwhile they continued to increase the hypothesized “herd immunity threshold”, eventually winding up at the extremely high 95% you hear today. “

Melissa Floyd

That’s actually a good question.

What happened to the previous goals of eliminating measles?

“In 1966, the USA began an effort to eradicate the disease within its own borders. After a series of successes and setbacks, in 2000, 34 years after the initial goal was announced, measles was declared no longer to be endemic in the USA.”

Orenstein et al on Eradicating measles: a feasible goal?

Along the way, we have gone from an estimated 100 million cases and 5.8 million deaths in 1980 and an estimated 44 million cases and 1.1 deaths in 1995 to “just” 7 million cases and 89,780 deaths in 2016.

“Under the Global Vaccine Action Plan, measles and rubella are targeted for elimination in five WHO Regions by 2020.”

Measles

While there is doubt that we can truly eradicate measles with the current vaccine, we can certainly control and eliminate measles if folks stop listening to anti-vaccine propaganda and they get vaccinated and protected.

More on Dr. Bob and His Herd Immunity Arguments

Why Are We Having Measles Outbreaks If MMR Vaccination Rates Are Not Declining?

Some folks just can’t understand why we are having so many measles outbreaks these days.

It is actually really easy to figure out and find the decline in vaccination rates if you really look for it…

Why Are We Having Measles Outbreaks If MMR Vaccination Rates Are Not Declining?

And it is easy to understand why we are having these measles outbreaks, even though overall vaccination rates in a state might be good.

The problem is the clusters of unvaccinated people in very specific areas of each city, county, and state.

MMR vaccination rates have dropped over the years in Washington (red line) and Clark County (yellow line). Can we thank Andrew Wakefield, Jenny McCarthy, and Bob Sears, etc.?

These pockets of susceptibles put everyone at risk, especially those who are too young to be vaccinated, too young to be fully vaccinated, and those with true medical exemptions who can’t be vaccinated.

Looking at the state and county level rates of MMR vaccination by kindergarten, you can see that a lot more kids haven’t been getting vaccinated since 1990. In fact, while 97.6% of kindergarteners during the 1998-99 school year had their MMR vaccination, it quickly fell to about 90%, where it remains today. In Clark County, where we are currently seeing a large outbreak of measles, the drop was even worse.

Not surprisingly, this mirrors the vaccine exemption rates in these areas.

“What’s so important about all this data is that it destroys the false narrative. Vaccination rates haven’t gone down lately. Period. Ask any epidemiologist you know to run these numbers.”

JB Handley on CDC, Check YOUR Data: MMR Vaccination Rates are NOT Declining

Speaking of false narratives, many states now publish school and county level immunization rates, so it is easy to see past anti-vaccine propaganda and see that vaccination rates truly have gone down lately in areas that are dealing with outbreaks.

Immunization rates are very low at the Portland Waldorf School.

The Oregon Health Authority actually publishes annual lists of child, adolescent, and school immunization rates.

“I wanted to make sure and corroborate that data with data from the Oregon Health Authority, which they conveniently don’t publish very often, but someone sent me their data from 2014, showing that 97.1% of 7th graders in Oregon have received an MMR vaccine! Where’s the decline?”

JB Handley on CDC, Check YOUR Data: MMR Vaccination Rates are NOT Declining

In 2017, 95.5% of teens in Oregon had received one dose of the MMR vaccine. Only 90% had received the recommended two doses. Rates in Multonah County, near the current outbreak in Washington, were actually a little better, at 96.7% (one dose) and 92% (2 doses).

Still, there are plenty of schools with much lower rates, creating the pockets of susceptibles that are causing these outbreaks.

Where’s the decline?

Have you checked the Portland Waldorf school?

While schools with higher rates help to boost the average rates for the county and state, the schools and communities with low rates are prime for outbreaks.

SchoolMMR Rates
Orchards Elementary School71.4%
Minnehaha Elementary School89.3%
Cornerstone Christian Academy?
Hearthwood Elementary School72.2%
Home Connection86.7%
Homelink River61.1%
Slavic Christian Academy?
Image Elementary School78%
Eisenhower Elementary School89%
Tukes Valley Primary and Middle School​?
Maple Grove School?
Evergreen High School?

In Washington, for example, the schools involved in the outbreak (at least the ones that report) all have immunization rates below the state and county levels.

If you are on the fence about vaccinating your kids, check where you’re getting your information from if what you are hearing is scaring you.

Vaccines are safe, with few risks, and necessary. Get vaccinated and stop the outbreaks.

Why Are We Having Measles Outbreaks If MMR Vaccination Rates Are Not Declining?

Why Are We Worried About 60,000 Unvaccinated Kids?

In the recent New York Times OpEd, How to Inoculate Against Anti-Vaxxers, the editorial board mentioned the 60,000 children in Texas who “remain wholly unvaccinated thanks in part to an aggressive anti-vaccine lobby.”

“But there’s like 74 million children, so I think that’s a pretty small number. I don’t know why you guys are freaking out about 60,000 really healthy babies running around. Do you know?

Hillary Simpson

Hillary Simpson obviously doesn’t understand how herd immunity works.

Do you?

Why Are We Worried About 60,000 Unvaccinated Kids?

First things first, though.

Just how many unvaccinated kids are there in Texas? How about the United States?

It is actually hard to know exactly.

It's easy to forget, with so much talk about anti-vaxxers these days, but the great majority of parents vaccinate and protect their kids!
It’s easy to forget, with so much talk about anti-vaxxers these days, but the great majority of parents vaccinate and protect their kids!

In Texas, for instance, while only a small percentage of kids get non-medical vaccine exemptions, with about 7 million children in the state (yes, there are 74 million children in the United States, but that’s not how you measure herd immunity), that adds up to a lot of unvaccinated kids.

In addition to about 60,000 unvaccinated kids in school, there are homeschooled children who aren’t vaccinated.

“We’re probably looking at more than 100,000 kids in the state of Texas who are not getting their vaccines.”

Dr. Peter J. Hotez: “A Scary Anti-Science Movement Has Become Very Strong in Texas”

But still, should we be worried about 100,000 unvaccinated kids, when there are 7 million kids in Texas?

Don’t those immunization levels still keep us above herd immunity levels of protection?

Well, they likely would, and this would indeed be less concerning if the unvaccinated children were spread out randomly throughout the entire state. Of course, that’s not what happens and we instead get clusters of unvaccinated children (and adults) in very specific schools, neighborhoods, and even churches.

There are higher numbers of unvaccinated kids in very specific parts of the states, leading to pockets where it is more likely that an outbreak could happen.
There are higher numbers of unvaccinated kids in very specific parts of the states, leading to pockets where it is more likely that an outbreak could happen.

So while it can seem like we have herd immunity levels of protection at the state or city level because of high average vaccination levels, these pockets of susceptibles who are unvaccinated and live in the same neighborhood or go to the same school (where is the Waldorf school in Texas?) can mean that we don’t have herd immunity in those places, leading to outbreaks.

And that’s why we get concerned about 60 to 100,000 unvaccinated children who:

Still, remember that the great majority of parents understand the benefits of vaccines, are not scared by anti-vaccine propaganda, and vaccinate their kids.

In 2015, for example, only 1.3% of children in the United States had received no vaccines by age 24 months. And more than 90% of children completed their primary series of vaccines.

That doesn’t mean that we shouldn’t be concerned about those who don’t, but maybe you should be a little bit more concerned about your decision to not vaccinate your kids.

More on Clusters of Unvaccinated Kids

What Happens When You Research the Disease?

We know how anti-vaccine folks think.

Anti-vaccine math…

And now we know how they do their research

How Anti-Vaccine Folks Research Disease

If you’re like me, you are probably wondering why they picked 2016 as the year to research.

Why look just at 2016?

And, there you see it.

In the past 6 years, 2016 was the year with the fewest cases of measles. Why not choose 2017 or 2018 to do their research?

But let’s look at 2016, even though the information isn’t complete:

  • 86 cases
  • cases in 19 states, including Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon, Tennessee, Texas, and Utah
  • a large outbreak in Arizona (31 cases) linked to a private detention center and all that is known is that 7 of 9 staff members who got measles had received at least one dose of MMR, and 3 had received their dose very recently
  • a large outbreak in Shelby County, Tennessee, at least 7 cases, including 6 unvaccinated and one partially vaccinated child
  • a large measles outbreak (17 cases) in Los Angeles County and Santa Barbara County that was linked to the Los Angeles Orthodox Jewish community
  • two cases in Colorado, including an unvaccinated toddler and an unvaccinated adult – outbreaks which cost at least $68,192 to control

And of th cases in 2016, it seems that just 16% were vaccinated.

What about the claim that 26% were vaccinated?

That wasn’t 26% of the total number of cases, but rather 26% of the cases among US residents.

So if you do the math, that’s just 14 cases that were vaccinated, and out of 86 cases, that’s really just 16%. And a lot of those cases are skewed by the one outbreak at the detention center, in which they may have only received one dose of MMR and nearly half may have gotten vaccinated after the caught had already started!

What about the claim that “the odds of dying from the measles are like 0.00000013%” using numbers “before the vaccine was introduced in 1963?”

“Before a vaccine became available in 1963, measles was a rite of passage among American children. A red rash would spread over their bodies. They would develop a high fever. Severe cases could cause blindness or brain damage, or even death.”

CDC says measles almost eliminated in U.S.

In the pre-vaccine era, your odds of getting measles were very high. Remember, everyone eventually got measles.

And looking at statistics of reported measles cases and reported measles deaths, we know that death occurred in about 1 to 3 in every 1,000 reported cases.

So everyone got measles, but not everyone survived having measles.

Even if you use a more liberal count of 1 death in 10,000 cases, when all kids get measles, that’s a lot of deaths. Remember, about 450 people used to die with measles each year.

What about your odds of dying with measles now?

If you are fully vaccinated, then they are extremely low.

They are pretty low if you are unvaccinated too, in most cases, because you are benefiting from herd immunity and the fact that most folks around you are vaccinated, reducing your risk of being exposed to measles. Still, the risk is much higher than most anti-vaccine folks expect, because they often make the mistake of using the entire population of the United States in their calculations. They should instead just use the folks who are unvaccinated and susceptible, a much smaller number.

Want to increase your risk?

  • travel out of the country
  • hang out in a cluster with other unvaccinated people
  • stay unvaccinated

The odds aren’t in your favor to avoid measles if you are unvaccinated. Eventually, your luck might run out.

Starting to see the mistakes anti-vaccine folks make when they say they have done their research?

“How do they know how many people would have gotten measles and how many of them would have died?!?”

It’s not rocket science.

It’s epidemiology.

“We constructed a state-space model with population and immunisation coverage estimates and reported surveillance data to estimate annual national measles cases, distributed across age classes. We estimated deaths by applying age-specific and country-specific case-fatality ratios to estimated cases in each age-country class.”

Simons et al on Assessment of the 2010 global measles mortality reduction goal: results from a model of surveillance data.

Unfortunately, after years of improvements, measles deaths increased in 2017. And they will continue to increase, as our risk of getting measles continues to increase if folks don’t get vaccinated and protected.

Lastly, why does it “sound like millions of people would have died without the measles vaccine?”

Maybe because millions of people died in previous years, before they were vaccinated and protected.

Indeed, do your research, but you will find that vaccine-preventable diseases aren’t as mild as anti-vaccine folks believe. That’s why it is important to get vaccinated and protected.

More on Researching Vaccine-Preventable Disease

Vaccine-Preventable Diseases – Year in Review 2018

Does it seem like we are moving in the wrong direction?

The eradication of smallpox shows just what vaccines can do!
The eradication of smallpox shows just what vaccines can do!

No, smallpox isn’t coming back, but many other vaccine-preventable diseases are.

Vaccine-Preventable Diseases – Year in Review 2018

With the availability of new vaccines and the expanded use of other vaccines, many of us were hopeful of the progress that was being made against vaccine-preventable diseases so far this decade.

Remember, it was just four years ago that the WHO certified India as a polio free country. And after years of declining numbers of wild polio cases, 2018 will be the first year with a higher number of cases than the previous year.

This hasn’t been a good year for measles either. The WHO Region of the Americas has lost its status as having eliminated measles!

In Bolivarian Republic of Venezuela, endemic transmission of measles has been re-established, with spread to neighbouring countries. As a result, the Region has lost its status as having eliminated measles. The Regional Technical Advisory Group, which met in July 2018, emphasized the importance of Regional action and an urgent public health response to ensure re-verification of measles elimination in Bolivarian Republic of Venezuela.

Meeting of the Strategic Advisory Group of Experts on Immunization, October 2018 – Conclusions and recommendations

After years of declining rates, global measles cases and deaths began to jump in 2017, a trend that continued in 2018.

“Outbreaks in North America and in Europe emphasize that measles can easily spread even in countries with mature health systems. Due to ongoing outbreaks, measles is again considered endemic in Germany and Russia.”

2018 Assessment Report of the Global Vaccine Action Plan

And no, this isn’t just a problem in other parts of the world.

Vaccine preventable diseases are just a plane ride away.
Vaccine preventable diseases are just a plane ride away.

More cases in other parts of the world mean more cases in the United States because unvaccinated folks travel out of the country and bring these diseases home with them, getting others sick.

But it wasn’t just measles outbreaks, including the second largest number of cases in 22 years, that we were seeing in 2018:

  • chicken pox – although the 41 cases involving a North Carolina Waldorf school got the most attention, there were at least 6,892 cases of chicken pox last year, which continues to trend down from recent highs of over 15,000 in 2010
  • hepatitis A – clusters of outbreaks in 15 states with at least 11,166 cases, many deaths, with exposures at popular restaurants
  • mumps – from recent highs of over 6,000 cases the last few years, we were “back down” to just over 2,000 mumps cases in 2018
  • pertussis – cases were also down in 2018, with a preliminary count of about 13,439 cases last year
  • meningococcal disease – isolated outbreaks continued last year, with cases at Smith College, Colgate University, and San Diego State University

And of course, we had one of the worst flu seasons in some time last year, with 185 pediatric flu deaths.

Fortunately, there were no cases of diphtheria, neonatal tetanus, polio, or congenital rubella syndrome. At least not in the United States.

Why are some disease counts down when so many folks say the anti-vaccine movement is more active than ever?

Remember, the great majority of people vaccinate and protect their kids!

And vaccines work!

It is best to think of the anti-vaccine movement, which has always been around, as a very vocal minority that is just pushing propaganda to scare parents away from vaccinating and protecting their kids.

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 these diseases are, allow themselves to be influenced by anti-vaccine propaganda, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

Also remember that many of these diseases occurred in multi-year cycles in the pre-vaccine era. When an up year hits a cluster of unvaccinated kids, we get bigger outbreaks. And then more folks get vaccinated, starting the cycle all over again. At least until we finally get the disease under better control or finally eradicated.

Want to avoid getting a vaccine-preventable disease this year?

Get vaccinated and protected and encourage everyone else to get vaccinated too.

More on Vaccine-Preventable Diseases – Year in Review 2018