Tag: cost-effectiveness

10 Myths About Chicken Pox and the Chicken Pox Vaccine

You remember chicken pox, don’t you?

Is this really a disease that we need to vaccinate our kids against?

Obviously, the folks who posted the following comments don’t seem to think so.

It is just as obvious that they are wrong though.

That she doesn't understand survivorship bias doesn't mean that you shouldn't vaccinate your kids.
That she doesn’t understand survivorship bias doesn’t mean that you shouldn’t vaccinate your kids.

No one ever says that chicken pox, measles, mumps, and rubella kills everyone that gets them.

Even in the pre-vaccine era, when measles would kill 500 people a year in the United States, there is a very good chance that you wouldn’t have known anyone that died of measles. Of course, that doesn’t mean that nobody died of measles or chicken pox or any other now vaccine-preventable disease.

You likely know someone that plays football, right? Maybe on a youth football team or in middle school or high school? Do you know anyone that plays on a team in the NFL? While millions of kids might play football, only a few thousand play in the NFL.

Benign diseases don't kill kids.
Benign diseases don’t kill kids.

Chicken pox was never a benign disease. It was considered a rite of passage because we all had to endure it, but it wasn’t something anyone looked forward to. You don’t die from a benign disease.

Trying to scare people into thinking that vaccines are poison... Anti-vaccine propaganda is all about fear.
Trying to scare people into thinking that vaccines are poison… Anti-vaccine propaganda is all about fear.

Part of that is actually true – “they keep you a customer for life” because you didn’t die from a vaccine-preventable disease!

The UK doesn't haven't routinely vaccinate against chicken pox, but they do have chicken pox deaths...
The UK doesn’t routinely vaccinate against chicken pox, but they do have chicken pox deaths and the same rise in shingles rates…

Many countries don’t have the chicken pox vaccine on their routine immunization schedule because they don’t think it is cost-effective and they were concerned about what controlling chicken pox could do to rates of shingles.

“About 3 in every 1000 pregnant women in the UK catch chickenpox. Between 1985 and 1998, nine pregnant women died in the UK from chickenpox complications. Their unborn babies are also at risk from a rare condition called foetal varicella syndrome (FVS). This can result in serious long-term damage to the baby or even death, particularly if the mother catches chickenpox in the first 20 weeks of pregnancy.”

Vaccine Knowledge Project on Chickenpox (Varicella)

These countries have the same rates of shingles as countries that do use the chicken pox vaccine, but still have high rates of chicken pox and complications of chicken pox!

The UK does not vaccinate for chicken pox, but young, otherwise healthy kids die with chicken pox in the UK.

Don't trust the CDC, but do trust anyone with a website or Facebook page that says what you want to believe.
Don’t trust the CDC, but do trust anyone with a website or Facebook page that says what you want to believe…

Most folks should understand that when anti-vaccine folks say “do your research,” they mean look at their websites and Facebook groups that regurgitate misinformation and anti-vaccine propaganda.

Natural immunity is not better than vaccine induced immunity when you consider the risks of a natural infection, which can include death.
Natural immunity is not better than vaccine induced immunity when you consider the risks of a natural infection, which can include death.

We don’t need disease.

There is no diet that will help you beat chicken pox.
There is no diet that will help you beat chicken pox.

While you will be at higher risk for complications from chicken pox and most other diseases if you have a compromised immune system or are malnourished, if you are otherwise healthy, there is nothing you can do to boost your immune system to try and beat chicken pox – besides getting vaccinated.

Homeopathic vaccines do nothing.
Homeopathic vaccines do nothing.

There is also no homeopathic remedy or homeopathic vaccine that can help you avoid chicken pox.

Adults don't need boosters to most vaccines, so actually are up-to-date and immune to most diseases.
Adults don’t need boosters to most vaccines, so actually are up-to-date and immune to most diseases.

The chicken pox vaccine provides long lasting protection. Ironically, anti-vaccine folks often misunderstand how herd immunity works, the one thing that can protect their unvaccinated kids as they try to hide in the herd

Chicken pox parties were never as common as folks think they were, but when done, it was out of necessity, as we didn't have a vaccine.
Chicken pox parties were never as common as folks think they were, but when done, it was out of necessity, as we didn’t have a vaccine.

Chicken pox parties kind of made sense in the pre-vaccine era. Since it was inevitable that your child would get chicken pox, you wanted them to get it at a young age, so they weren’t at increased risk for complications as an adult.

But intentionally exposing your child to a life-threatening infection when a safe and effective vaccine is available?

Do your research. Get vaccinated and protected.

More on Chicken Pox Myths

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
  • an outbreak in Rockland County, New York that has been going on since September 2018, making it the longest outbreak since the endemic spread of measles was eliminated in the United States

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 one in Ohio, but we do know that it cost:

  • at least $1.6 million to control the 2019 measles outbreak in Clark County, Washington
  • 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
  • $394,448 and 10,054 personnel hours in total personnel time and total direct cost to the New York City Department of Health and Mental Hygiene responding to and controlling the 2013 outbreak in NYC
  • 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

Updated April 10, 2019

Recommendations for Reporting on Measles Outbreaks

Unfortunately, we hear news reports about measles outbreaks a lot more than we should.

We don’t get much information in many of those news reports though…

Anatomy of a Measles Outbreak Report

The big reason we don’t get a lot of information in those news reports is that many of them are simply repeating health department press releases.

A news release from the Texas Department of State Health Services.
A news release from the Texas Department of State Health Services.

Those press releases often leave a lot of important information out though.

Although that information might not be available yet, if you are a journalist covering a measles outbreak, instead of simply repeating the health department news release, you might call the local or state health department and ask a few questions:

  • Where did the person get measles? Most cases these days are imported – an unvaccinated person travels out of the country and returns home with measles, starting an outbreak. If they didn’t recently travel out of the country, then there’s a problem – where did they get measles? Unless there is already an ongoing outbreak in the area, then that means someone else in the area has measles that we don’t know about.
  • Where did the person go while they were still contagious and might have exposed others?
  • Hold old are they and were they vaccinated?

Do we have a right to this information? While the Health Insurance Portability and Accountability Act (HIPAA) protects a person’s medical information, those rules don’t necessarily always apply in an emergency or outbreak situation. Plus, you are still getting de-identified information.

“Health care providers may share patient information with anyone as necessary to prevent or lessen a serious and imminent threat to the health and safety of a person or the public.”

HHS on HIPAA Privacy in Emergency Situations

How is knowing someone’s vaccination status going to be helpful? Unvaccinated folks tend to cluster together, so knowing the person is unvaccinated, especially an unvaccinated child, might indicate that many more people have been exposed. But then, most measles outbreaks are started by someone who is unvaccinated

Important Points for Covering Measles Outbreaks

An infant hospitalized during a measles outbreak in the Philippines in which 110 people died.
The symptoms of measles include a high fever, cough, runny nose, and red, watery eyes. The rash doesn’t start until 3-5 days later, as the fever continues. Photo by Jim Goodson, M.P.H.

In addition of covering the basics about the person with measles, there are other important points to cover, especially that measles is a vaccine-preventable disease!

Two doses of the MMR vaccine offers great protection against measles, and is especially important if you are unvaccinated and are going to travel out of the country. Even infants as young as six months old should get an MMR before international travel.

While most people hopefully know all that, they may not know:

  • the vaccination rates in your area schools
  • the non-medical vaccine exemption rates in your area schools
  • the number of measles cases in your area and in your state over the past few years
  • that measles is very costly to contain
  • that the incubation period for measles is 10 to 21 days after you were exposed, so it can take that long before you show symptoms
  • that they should warn their doctor or hospital before getting evaluated so that they can make sure you don’t expose other people, as measles is very, very contagious
  • that the quarantine period for unvaccinated people who have been exposed to someone with measles is typically up to 21 days after their last possible contact
  • that a dose of MMR within three days of exposure can help prevent your child from getting measles if they aren’t already fully vaccinated

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

You should also consider interviewing and quoting a local pediatrician and reinforcing the facts that vaccines work and they are safe.

And obviously, as we see with these outbreaks, vaccines are necessary.

You should avoid also false balance in your reporting.

You should fully cover each outbreak in your area, as they help remind people to get vaccinated and protected.

What to Know About Reporting on Measles Outbreaks

Journalists can help reduce the size of measles outbreaks with good reporting that vaccines work and that they are safe and necessary and by reminding folks to get vaccinated and protected.

More on Recommendations for Reporting on Measles Outbreaks

Vaccines Statistics and Numbers

To help you get better educated about vaccines, it can help to learn some vaccine statistics and some other numbers behind vaccines.

Vaccine Court payouts come from an excise tax and are not taxpayer dollars...
Vaccine Court payouts come from an excise tax and are not taxpayer dollars…

Including the numbers that anti-vaccine folks throw around.

Vaccine Statistics

For all of the talk of some folks delaying or skipping vaccines, do you know how many vaccines are given each day?

According to the CDC, from 2006 to 2017, at least 3,454,269,356 doses of vaccines were distributed in the United States. These are the vaccines that are covered by the National Vaccine Injury Compensation Program, such as DTaP, MMR, Hepatitis A and B, HPV, and flu, etc.

That’s over 287 million doses each year!

The WHO reports that 85% of infants around the world receive vaccines against DTP, polio, measles, and hepatitis B.
The WHO reports that 85% of infants around the world receive vaccines against DTP, polio, measles, and hepatitis B.

How about worldwide?

That’s harder to know, but consider that the World Health Organization reports that 85% of infants worldwide, or almost 100 million infants, get at least:

  • 3 doses of DTP
  • 3 doses of hepatitis B
  • at least one doses of measles
  • 3 doses of polio

Plus, an increasing number are getting vaccines to protect them against Hib, pneumococcal disease, rotavirus, HPV, meningitis A, mumps, rubella, tetanus, and yellow fever.

“UNICEF supplies vaccines reaching 45 per cent of the world’s children under five years old as part of its commitment to improving child survival.”

How many vaccine doses are we talking about?

A lot. UNICEF alone buys 2.8 billion doses of vaccines each year! Those vaccines are then distributed to children in over 100 countries.

Vaccine-Preventable Disease Statistics

As impressive as the number of vaccines that are given each year are the numbers about what happens when we give vaccines:

  • there are 2 to 3 million fewer deaths in the world each year because people are vaccinated and protected
  • in the Unites States, every $1 spent on vaccines provides $3 in direct benefits and up to $10 in benefits if you include societal costs
  • in developing countries, every $1 spent on vaccines provides $16 in direct benefits, but that goes up to $44 when you take “into account the broader economic impact of illness”
  • for children born in the United States during “1994–2013, routine childhood immunization was estimated to prevent 322 million illnesses (averaging 4.1 illnesses per child) and 21 million hospitalizations (0.27 per child) over the course of their lifetimes and avert 732,000 premature deaths from vaccine-preventable illnesses,” and it also “will potentially avert $402 billion in direct costs and $1.5 trillion in societal costs because of illnesses prevented”
  • only two countries continue to have wild polio – Afghanistan and Pakistan – and together, they only had 21 cases in 2017

Still, only one vaccine-preventable disease, smallpox, has been eradicated.

And worldwide, more than 3 million people still die from vaccine-preventable diseases every year, many of them young children.

Other Vaccine Numbers

There are some other numbers about vaccines and vaccine-preventable diseases folks should know:

  • the number of pediatricians who got a $3 million vaccine bonus – zero
  • the number of doses of vaccines kids get today – 69 72 54 doses (including yearly flu shots) by age 18
  • the number of vaccines that contain antifreeze as an ingredient – zero
  • the number of vaccines that contain peanut oil as an ingredient – zero
  • the number of studies that link vaccines to autism – zero
  • the number of diseases that homeopathic vaccines can prevent – zero
  • the number of anti-vaccine sites that mention any benefits of vaccines – zero
  • the number of VAERS reports that are thought to be unrelated to a vaccine – 53%
  • the number of VAERS reports that are thought to be definitely caused by a vaccine – 3%
  • the number of definite VAERS reports that were serious – 1% (anaphylaxis)
  • the number of myths about vaccines that can scare you away from vaccinating and protecting your kids – 100s
  • the number of measles outbreaks that have been caused by a vaccine strain – zero
  • how long you have to stay in quarantine if you are unvaccinated and are exposed to someone with measles – at least 21 days
  • the number of new vaccines in the pipeline300

And yes, $4,060,857,713.42 has been paid by the Vaccine Court for 6,355 compensated claims for vaccine injuries since 1989, during which time billions of doses of vaccines were given.

“This means that for every 1 million doses of vaccine that were distributed, 1 individual was compensated.”

Vaccine Injury Compensation Data

And many of those claims were simply settled.

Vaccines work. Vaccines are safe. Vaccines are necessary.

Get vaccinated and protected.

What’s the biggest number you should be thinking about? Way too many people are still getting and dying from vaccine-preventable diseases.

What to Know About Vaccine Statistics

Although more work needs to be done to protect more people, vaccine statistics clearly show that vaccines work and that they are safe and necessary.

More on Vaccines Statistics

Updated February 2, 2019