“…California patients were genotyped; all were measles genotype B3, which has caused a large outbreak recently in the Philippines…”
Measles Outbreak — California, Dec 2014–Feb 2015
It wasn’t a vaccine strain.
For example, during 2011, 222 cases of measles and 17 outbreaks were reported in the United States, with most cases originating from just five countries (France, Italy, Romania, Spain, and Germany). Six different genotypes were identified, including B3, D4, G3, D8, H1, and D9. No vaccine strains…
And no, it doesn’t matter that the vaccine strain of measles, genotype A, differs from all of the wild strains of measles we see in the outbreaks.
“Vaccine induced immunity protects against all virus strains. Measles is considered a monotypic virus despite the genetic variations.”
Factsheet about measles
Unlike the flu, HPV, and pneumococcal bacteria, in which vaccines only protect against different serotypes, in the case of measles, the genotype simply helps us figure out where the measles case came from.
But if it isn’t the vaccine strain, then why do they that is it important to rapidly identify wild strains vs vaccine strains?
“During measles outbreaks, it is important to be able to rapidly distinguish between measles cases and vaccine reactions to avoid unnecessary outbreak response measures such as case isolation and contact investigations.”
Roy et al on Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR
That’s easy to answer.
Outbreaks typically trigger a lot of folks to get vaccinated. While that’s great, one possible problem is that some of those folks might develop a fever and/or rash after their MMR vaccine. So it is important to quickly figure out whether they are part of the outbreak and have a wild strain (maybe they were exposed before their vaccine could start to work) or are having a common, mild vaccine reaction.
But couldn’t they have vaccine-associated measles if they have a rash and fever and a vaccine strain? Theoretically, but then they would likely have true measles symptoms. And even in these rare case reports, the children didn’t spread the measles to anyone else.
So why are you waiting to know the genotype of the measles strain causing the outbreak in your area? Hopefully, it isn’t to help you decide whether or not to vaccinate and protect your kids. While it is interesting to know where the outbreak originated, you can bet that it isn’t a vaccine strain.
And chicken pox parties, while not as common as some folks imagine, were definitely a thing, because you didn’t want your child to become an adult and get chicken pox, when it was more dangerous. But since most kids got chicken pox so easily, most got it when they were kids, even without a chicken pox parties, and tragically, many learned that it wasn’t only dangerous to adults.
These days, most cases and outbreaks of chicken pox are in unvaccinated children and adults.
7 new cases in the outbreak associated with the Asheville Waldorf School in West Asheville, North Carolina, bringing the case count to 41 in that outbreak, including 4 cases in the community as the outbreak continues to spread (Nov 2018)
6 new cases at the Asheville Waldorf School in West Asheville, North Carolina, bringing the case count to 34 in that outbreak (Nov 2018)
at least 5 cases at Daybreak Primary School in Battle Ground in Clark County, Washington, leading to quarantine of at least 38 unvaccinated students who will be kept out of class for at least 21 days (Oct 2018)
at least 5 cases at two schools in Ottawa County, Michigan, including Waukazoo Elementary and Kids First – Early Childhood Center in Jenison, leading to the quarantine of at least 34 children (Oct 2018)
a cluster of chicken pox cases in Grant County, Washington at Park Orchard Elementary, North Elementary and Longview Elementary schools (Sept 2018)
at least 5 cases at the The Little Red School House Too daycare in Westbrook, Maine (May 2016)
These cases are just the tip of the iceberg though, as there are still about 7,000 to 10,000 chickenpox cases reported in the United States each year. And that’s with some states, like Oregon and Washington, not reporting cases of this Nationally Notifiable Condition to the CDC.
Still, since chicken pox caused a few hundred deaths and at least 10,000 hospitalizations each year less than twenty-five years ago, that’s a lot of progress.
Getting Chicken Pox
How do you get chicken pox?
Since it is very contagious, if your child is exposed to someone with chicken pox or shingles, then they might develop chicken pox in about 10 to 21 days (incubation period).
are unvaccinated, either intentionally, because they have a true medical exemption, or because they are too young for the vaccine, which is first given when kids are 12-months-old
are partially vaccinated, with only one dose of the chicken pox vaccine
have a problem with their immune system, including kids getting chemotherapy
In addition to being at risk for chicken pox, non-immune pregnant women, newborns born to women who develop chicken pox at around the time of delivery, premature babies, and those are immunocompromised can be at risk for severe disease.
Avoiding Chicken Pox
Want to avoid chicken pox and the chance of ending up in a chicken pox quarantine and having to stay out of school for 3 weeks or more?
That’s not an option for some kids with true medical exemptions though, including most kids who are immunocompromised. When they get caught up in one of these outbreaks and get exposed to chicken pox, it becomes a matter of life and death to work to try and prevent their getting chicken pox.
“Chickenpox (varicella) is generally a much milder illness in children than in adults, with considerably lower rates of severe disease and death. Varicella is also virtually universal in many populations, meaning that very few individuals escape infection over a lifetime. Thus, a sound logic underlies the idea of chickenpox parties, at which susceptible children can acquire the contagious causative pathogen, varicella zoster virus (VZV), from their peers. However, chickenpox is not without risks, even for children of this age; severe, complicated, and occasionally fatal varicella occur in previously healthy children, as well as the immunocompromised (who are at very considerable risk).”
Hambleton et al on Chickenpox Party or Varicella Vaccine?
Most folks understand that. They get their kids vaccinated and have helped get chicken pox under very good control, with outbreaks of chicken pox declining over 95%.
“Each year, more than 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented by varicella vaccination in the United States”
CDC on Monitoring the Impact of Varicella Vaccination
Apparently, not everyone has gotten the message though.
Remember when CPS had to investigate the mom who was having chicken pox parties in Plano, Texas a few years ago?
“On the page, parents post where they live and ask if anyone with a child who has the chicken pox would be willing to send saliva, infected lollipops or clothing through the mail.”
CBS 5 Investigates mail order diseases
Or when anti-vaccine folks were selling and mailing lollipops contaminated with chicken pox to folks so that they could skip the trouble of finding a chicken pox party?
And then there’s that time that a family served chicken pox contaminated punch at their chicken pox party. Oh wait, that was The Simpsons…
So what are they up to now?
More of the same…
Apparently, there are still plenty of folks looking for chicken pox parties to infect their kids.
It is easy to see a lot of cognitive biases at play in the decision to host or bring a child to a chicken pox party, including ambiguity aversion (prefer what they think are the known risks of getting the disease), bandwagoning (they think everyone else is doing it, because in their echo chambers of anti-vaccine propaganda, everyone might), and optimism bias, etc.
There is also a very poor perception of risks, as the risks from a natural chicken pox infection are far, far greater than any risk from the vaccine.
In bigger news, Facebook has groups who’s mission is “finding pox,” so that parents can get their kids sick!
How many other PoX type groups are there on Facebook?
Do they understand the consequences of having these pox parties?
Of course, an investigation from CPS, the health department, or a medical board isn’t the most serious consequence that should discourage folks from hosting or attending a chicken pox party.
Chicken pox can be a serious, even life-threatening infection. Sure, many kids just get a mild case, but others get more serious cases and have bad complications, including skin infections, encephalitis, sepsis, or stroke.
And some people do still die from chicken pox, which is supposed to be a mild, childhood illness.
“This report describes a varicella death in an unvaccinated, previously healthy adolescent aged 15 years.”
Varicella Death of an Unvaccinated, Previously Healthy Adolescent — Ohio, 2009
Fortunately, these deaths have been nearly eliminated thanks to the chicken pox vaccine.
And that’s why parents who are on a mission for “finding pox” should rethink things and switch to a mission to get their kids vaccinated and protected.
Analogies and metaphors are a good way to explain things, including that vaccines are safe and necessary.
Here are some of my favorite vaccine analogies and metaphors.
Getting vaccinated is like:
applying sunscreen before going to the beach
applying insect repellent before going camping in the woods
making sure that your kids are wearing a seat belt or sitting in an age-appropriate car seat or booster seat when you get in the car
installing anti-virus software on your new computer
When do you put on your seat belt? When you get in the car, before you get in an accident. Just like a vaccine. You get it before you get sick. Yes, some vaccines do work after you have been exposed to an illness, but they don’t work after you are already sick.
There is a problem with these metaphors though; they don’t include the risks to other people.
taking driver’s ed and getting your license before driving
taking swimming lessons before going in the water without a life jacket
putting your gun in a locked safe
putting a fence around your backyard so that no one in your neighborhood can drown in your pool
making sure folks don’t text and drive
Vaccination equals protection.
And not just protection for the person getting vaccinated. Being unvaccinated puts others at risk too, as you might start an outbreak.
Getting your kids vaccinated is like taking them to swimming lessons instead of just throwing them in the lake. Either way they can learn to swim and have protection/immunity from drowning. But one method (throwing them in the lake) is much more dangerous than the other.
“Vaccines are a like a wanted poster, they just show your body what the bad guys look like, so when faced with them for real you are ready, prepared, and able to stop them before they cause harm.”
Can vaccines overwhelm the immune system?
Are there analogies that explain the idea of free-riders – folks who intentionally don’t vaccinate their kids and attempt to hide in the herd?
“If all my child’s friends are vaccinated, won’t he be protected by herd immunity? Why should I put my child at risk for vaccine reactions if all the other children around him are already immune?
This is like riding in a carpool where everyone contributes each month to pay for gas, repairs and parking. One morning, a new neighbor shows up and says, “I think I’ll ride along with you. But I’m not going to pay, since you’re going downtown anyway and you have an empty seat.” If enough people choose to take a free ride on other children’s immunity, herd immunity will soon disappear.”
“I have found that it sometimes helps to give parents an analogy. I ask them the following: If they were to put gas in their car and then later got a flat tire, would that mean putting gas in the car had caused the flat tire? No. The two events were just a coincidence.”
There are plenty of other good analogies that help to explain the importance of vaccines.
“Clusters of unvaccinated people are like patches of dry grass that, with a single match, can start a wildfire that will burn not only dry material, but sometimes wet as well. The match could be a student who returns from a trip abroad with measles or a train commuter with whooping cough.”
It’s also important to remember that anyone, even those who are well prepared, can get burned in a wildfire. That’s why the analogy works so well.
“Vaccinating one’s children is like paying taxes. We all have a moral and a legal duty to pay taxes because we have a moral and a legal duty to contribute to the upkeep of our society and to its public goods (e.g., a good public health system, national defence, etc.).”
Vaccine Refusal Is Like Tax Evasion
Why are we concerned about those who are unvaccinated if our own children are fully vaccinated?
“Think of camping as an analogy. If everyone at a campground properly stores their food, bears won’t be enticed to come around. If even one person leaves their food unprotected, it invites bears in to investigate all the campsites for opportunities to eat.”
How does choosing not to immunize affect the community?
“Being intentionally unvaccinated against highly contagious diseases is, to carry Holmes’ analogy a bit further, like walking down a street randomly swinging your fists without warning. You may not hit an innocent bystander, but you’ve substantially increased the chances that you will.
One might usefully analogize the risk of disease to a crapshoot. A person’s chance of being infected is, as Dr. Singer acknowledges, a matter of luck. But is it really OK for the unvaccinated to load the dice to increase the odds against other people? If so, by how much?”
Ronald Bailey on Vaccines and the Responsibility To Not Put Others at Risk
Of course, there are plenty of bad vaccine analogies and metaphors that anti-vaccine folks push:
“genes load the gun but the vaccines pull the trigger”
vaccine manufacturers are like tobacco manufacturers
I won’t set my child on fire to keep yours warm (this doesn’t work as a vaccine analogy, mostly because there is no benefit to setting your child on fire. Would an anti-vaxxer let their child start a campfire to keep their friends from dying in the cold?)
getting a vaccine is like eating a handful of M&Ms out of a big bowl when you know that a few have been poisoned
getting a child vaccinated is like giving 1,000 kids 1,000 cupcakes, telling them to pick one and eat it, knowing that one of the cupcakes is poisoned (it’s maybe like letting a child with a severe peanut allergy choose a cupcake, knowing that there is a one in a million chance that the cupcake he chooses has been made with peanuts…)
I want safer cars, but that doesn’t make me anti-car
You understand why the anti-car one is a bad analogy, right? Folks who want safer cars generally still drive and ride in cars!
Have you heard any good or bad analogies or mataphors about vaccines?
Does it sometimes seem like anti-vaccine folks are speaking a foreign language?
It definitely seems like they misunderstand and misuse a lot of scientific terms, like evidence, research, and toxin, doesn’t it?
The first step to understanding someone who is truly anti-vaccine and unnecessarily puts their kids at risk for vaccine-preventable diseases, might be to understand how they misunderstand most things about vaccines…
anything and everything bad that happens to you in the days, weeks, months, and years after you get vaccinated or in the days, weeks, months, and years before you were born because of the vaccines your parents or grandparents received