Tag: mumps outbreaks

Quarantine Signs for Vaccine-Preventable Diseases

If everyone breezed through vaccine-preventable diseases so easily back in the pre-vaccine era, then why were so many folks held under quarantine?

Quarantine Sign

Vaccine-preventable diseases have always been known to be dangerous and life-threatening.

If they were once thought of as a way of life, it was only because there was no way to avoid them!

As someone with an uncle who developed severe paralytic polio disease a few years before the first vaccine was developed, I can tell you that these diseases were no walk in the park.

Still, while quarantines are helpful to control disease outbreaks, they clearly aren’t enough. That’s evident by the way that vaccines were used in Leicester to control smallpox, even though some folks say it was all due to quarantines. It wasn’t.

How long would quarantine last?

Usually through at least one incubation period for the disease.

Quarantine Signs
Smallpox quarantine sign A Board of Health quarantine poster warning that the premises are contaminated by smallpox.
Diphtheria quarantine sign. Diphtheria quarantine sign.
Polio quarantine sign Polio quarantine sign.
In the pre-vaccine era, we had outbreaks of polio, and other, now vaccine-preventable diseases. Whooping cough quarantine sign.
Unvaccinated children exposed to measles are quarantined for at least 21 days. Mumps quarantine sign
Chickenpox quarantine sign Rubella quarantine sign.

Have you ever seen any of these quarantine signs?

If so, have you seen any of them lately?

That’s because vaccines work.

What to Know About Quarantine Signs for Vaccine-Preventable Diseases

In the pre-vaccine era, quarantines were the only way to try and help stop many diseases from spreading in the community.

More on Quarantine Signs for Vaccine-Preventable Diseases

The Benefits and Risks of Delaying Vaccines

Believe it or not, some pediatricians think it is a good idea to delay vaccines.

“Wait until a child is clearly developmentally “solid” before vaccinating because we just don’t know which children will react badly to immunizations.”

Dr. Jay Gordon

In fact, Dr. Bob wrote a whole book pushing his own immunization schedule!

Not surprisingly, there are no benefits to skipping or delaying your child’s vaccines, but there are plenty of risks.

What Are the Risks of Delaying Vaccines?

Of course, the biggest risk of delaying your child’s vaccines is that they will get a disease that they could have been vaccinated and protected against.

“In 1989, the Haemophilus influenzae type b vaccine was relatively new and not yet routine. I was aware of the vaccine’s availability, but, busy mom that I was, I had not yet made the trip to the health department to get the immunization for my two-year-old daughter, Sarah. I will always regret that bit of procrastination and the anguish that it caused.”

Peggy Archer

Although we are much more used to hearing vaccine injury scare stories, if you are thinking of delaying your child’s vaccines, there are also many personal stories of parents who regret not vaccinating their children that you should review.

You can wait too long to get a tetanus shot...
You can wait too long to get a tetanus shot… Photo by Petrus Rudolf de Jong (CC BY 3.0)

It is true that the risk may be very small for a disease like polio, which is close to being eradicated worldwide, but it is not zero.

Consider that the last case of polio occurred in 2005, when an unvaccinated 22-year-old U.S. college student became infected with polio vaccine virus while traveling to Costa Rica in a university-sponsored study-abroad program.

So you might not get wild polio unless you visit specific regions of Afghanistan or Pakistan, but you might want to be concerned about vaccine-associated polio if you go to a country that is still giving the oral polio vaccine.

And the risk is certainly much higher than zero for most other vaccine-preventable diseases, as we see from the regular outbreaks of measles, mumps, and pertussis, etc.

Some studies even suggest that delaying your child’s vaccines puts them at more risk for side effects once you do start to get caught up!

“…in the second year of life, delay of the first MMR vaccine until 16 months of age or older resulted in an IRR for seizures in the 7 to 10 days after vaccination that was 3 times greater than if administration of MMR vaccine occurred on time.”

Hambridge et al on Timely Versus Delayed Early Childhood Vaccination and Seizures

Why would that be?

It’s probably because that’s when kids are most at risk for febrile seizures.

What Are the Benefits of Delaying Vaccines?

Again, there are no real benefits of delaying vaccines, except that your child gets out of one or more shots. Of course, that means your unvaccinated child is left unprotected.

And it is going to mean more shots later, once you do decide to get caught up.

Will it mean a lower risk of autism, ADHD, eczema, peanut allergies, or anything else?

Nope.

“The prevalence of allergic diseases and non-specific infections in children and adolescents was not found to depend on vaccination status.”

Schmitz et al on Vaccination Status and Health in Children and Adolescents Findings of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

Unvaccinated kids are not healthier than those who are vaccinated. They are just at higher risk of getting a vaccine-preventable disease.

Why do some folks think that there are benefits to delaying vaccines? Because they have been scared into thinking that vaccines are harmful and that they don’t even work.

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

Obviously, that put us all at risk. If too many people skip or delay their child’s vaccines, we will see more outbreaks.

Get educated. Vaccines work. Vaccines are safe. Vaccines are necessary.

What to Know About the Risks of Delaying Vaccines

Delaying your child’s vaccines offers no benefits and lots of increased risks, especially an increased risk of getting the diseases that the vaccines protect us against.

More on the Risks of Delaying Vaccines

Do More Vaccinated or Unvaccinated Kids Get Sick in Outbreaks?

Some anti-vaccine folks continue to claim that vaccines don’t work and that most outbreaks of vaccine-preventable diseases are actually caused by kids who have been vaccinated.

They also push the myth that more vaccinated than unvaccinated kids get sick in most outbreaks.

Vaccinated vs Unvaccinated in an Outbreak

So are outbreaks usually caused by kids who have been vaccinated?

No, of course not.

Do we sometimes see more vaccinated than unvaccinated kids in some of these outbreaks?

Yes, sometimes we do.

Vaccine Epidemiology

Wait, what?

Yes, we sometimes see more vaccinated than unvaccinated kids in an outbreak.

How can that be if vaccines work?

It is actually very easy to understand once you learn a little math and a little more epidemiology.

Basically, it is because while vaccines work, they don’t work 100% of the time, and more importantly, there are way more vaccinated kids around than unvaccinated kids.

The Mathematics of Disease Outbreaks

That means that you need to understand that more than the absolute number of vaccinated and unvaccinated people that got sick in an outbreak, you really want to know the percentages of vaccinated vs unvaccinated kids who got sick.

For example, in a school with 1,000 kids, you might be very surprised if six kids got a vaccine preventable disease, and three of them were vaccinated, leaving three unvaccinated.

Does that really mean that equal amounts of vaccinated and unvaccinated kids got sick?

I guess technically, but in the practical sense, it only would if half of the kids in the school were unvaccinated. Now unless they go to a Waldorf school, it is much more likely that over 90 to 95% of the kids were vaccinated, in which case, a much higher percentage of unvaccinated kids got sick.

Before we use a real world example, some terms to understand include:

  • attack rate – how many people will get sick when exposed to a disease
  • basic reproductive number or Ro – different for each disease, Ro basically tells you  just how contagious a disease is and ranges from about 1.5 for flu, 8 for chicken pox, and 15 for measles
  • vaccine coverage – how many people are vaccinated
  • vaccine efficacy – how well a vaccine works

You also need to know some formulas:

  • attack rate = new cases/total in group
  • vaccine coverage rate = number of people who are fully vaccinated / number of people who are eligible to be vaccinated
  • vaccine effectiveness = (attack rate in unvaccinated group – attack rate in vaccinated group) / attack rate in unvaccinated group x 100

Unfortunately, it is often hard to use these formulas in most outbreaks.

Why?

For one thing, it is hard to get accurate information on the vaccination status of all of the people in the outbreak. In addition to those who are confirmed to be vaccinated or unvaccinated, there is often a large number who’s vaccination status is unknown. And even if you know the vaccination status of everyone in the outbreak, it can be even harder to get the vaccine coverage rate or a neighborhood or city.

Outbreaks of Vaccine Preventable Diseases

Reports of measles outbreaks among highly vaccinated populations are from before we started doing a second dose in 1994.
Reports of measles outbreaks among highly vaccinated populations are from before we started doing a second dose of MMR… way back in 1994.

We know what starts most outbreaks.

And no, it’s not shedding

For example, with measles, it is typically an unvaccinated person who travels out of the country, returns home after they have been exposed but are still in their incubation period, and then exposes others once they get sick. And the great majority of folks in these measles outbreaks are unvaccinated.

Some examples of these outbreaks include:

  • the 2014 Ohio measles outbreak that started with two unvaccinated Amish men getting measles in the Philippines while on a missionary trip and ended up with at least 388 cases before it was over, almost all unvaccinated
  • a 2013 North Carolina measles outbreak with 22 cases started after an unvaccinated traveler had returned from India
  • an outbreak of measles in New York, in 2013, with at least 58 cases, tarted with an intentionally unvaccinated teen returning from a trip to London
  • a 2011 outbreak of measles in Minnesota, when an unvaccinated child traveled out of the country, developed measles, and returned to his undervaccinated community, causing the state’s largest measles outbreak in 20 years

But what about mumps and pertussis?

Those outbreaks are all among vaccinated kids, right?

Nope.

In one of the biggest mumps outbreak, in Arkansas, only 71% of people were up-to-date on their vaccines!

And keep in mind that while we do know that there are issues with waning immunity with some vaccines, you are still much more likely to become infected and get others sick if you are not vaccinated. And you will likely have a much more severe disease.

A 2013 pertussis outbreak in Florida is a good example that even with all the bad press it gets, the DTaP and Tdap vaccines work too. This outbreak was started by an unvaccinated child at a charter school with high rates of unvaccinated kids. About 30% of unvaccinated kids got sick, while there was only one case “in a person who reported having received any vaccination against pertussis.”

In another 2013 pertussis outbreak in Florida, this time in a preschool, although most of the kids were vaccinated, the outbreak started with “a 1-year-old vaccine-exempt preschool student.” And the classroom with the highest attack rate, was “one in which a teacher with a laboratory-confirmed case of pertussis who had not received a Tdap booster vaccination, worked throughout her illness.”

In outbreak after outbreak, we see the same thing, sometimes with deadly consequences – an unvaccinated child or adult triggers an outbreak and then a lot of unvaccinated folks get sick. Unfortunately, others get caught up in these outbreaks too, including those too young to be vaccinated, those who can’t be vaccinated because of true medical exemptions, and those whose vaccines may not have worked as well as we would have liked.

Get educated.

Vaccines are safe. Vaccines are necessary. Vaccines work.

What to Know About Vaccinated vs Unvaccinated in Outbreaks

Most outbreaks are started by someone who is unvaccinated, often after a trip out of the country, and the resulting outbreak will likely get many more unvaccinated than vaccinated folks sick.

More About Vaccinated vs Unvaccinated in Outbreaks

Mumps Outbreaks

Pre-Vaccine Era Mumps Outbreaks

In the pre-vaccine era, mumps was a common childhood disease that could cause orchitis, meningitis, pancreatitis, deafness, and even death.

There were about 212,000 cases a year in the early 1960s, before the first mumps vaccine was licensed in 1968.

Post-Vaccine Era Mumps Outbreaks

Tips to prevent getting sick with the mumps.
A large Ohio mumps outbreak prompted an education campaign to help protect everyone from getting sick.

As with other vaccine-preventable diseases, there was a big drop in cases of mumps once the mumps vaccine was introduced.

In 1968, there were just over 152,000 cases and 25 deaths  and just ten years later, in 1978, that was down to 16,817 cases and 3 deaths.

Once the recommendation for the second dose of MMR came in 1990, it looked like mumps was on it’s way out.

We went from 5,292 cases and one death that year, to just 906 cases and no deaths in 1995. When measles hit its low point of 37 cases in 2004, there were just 258 cases of mumps.

That wasn’t the end for mumps though, as we had some up and down years, including big outbreaks in:

  • 2006 – 6,584 cases among Midwest college students and one death
  • 2008 – only 454 cases, but one death
  • 2009 – 1,991 cases and two deaths
  • 2010 – 2,612 cases mostly among Orthodox Jewish communities and two deaths
  • 2011 – 370 cases
  • 2012 – 229 cases
  • 2013 – 584 cases
  • 2014 – 1,223 cases involving a large outbreak in Ohio and in the NHL
  • 2015 – 1,057 cases mostly among university students in Iowa and Illinois
  • 2016 – 6,369 cases in 46 states (no cases in Delaware, Louisiana, Vermont, or Wyoming), with the most cases in Arkansas, Iowa, Indiana, Illinois, Maine, New York, Oklahoma, and Texas.
  • 2017 – at least 5,629 cases of mumps, with cases in all states except Wyoming and South Dakota. The latest outbreaks are at Syracuse University, in Anchorage, Alaska (many unvaccinated cases), and Hawaii.

Could this all be because of waning immunity?

The herd immunity threshold may need to be higher than the previously suggested 88%–92% to prevent community transmission and outbreaks of mumps.

Quinlisk on Mumps Control Today

Many of these outbreaks occur despite many of the cases having had two doses of the MMR vaccine. A third dose is sometimes recommended during these outbreaks.

That doesn’t mean that the MMR vaccine doesn’t work. After all, just compare today’s rates of mumps, even if they are a little higher than we would like, to pre-vaccine levels…

Unfortunately, this Syracuse University poster doesn't mention getting vaccinated...
Unfortunately, this Syracuse University poster doesn’t mention getting vaccinated…

And in the biggest outbreak, in Arkansas, only 71% of people were up-to-date on their vaccines!

Of course, getting two doses of the MMR vaccine is still the best way to avoid mumps.

There is no general recommendations to get an extra shot, although a third dose of MMR during an outbreak was recently recommended by the ACIP. The recommendation has not yet been formally approved though.

A recent study that was published in the New England Journal of Medicine, Effectiveness of a Third Dose of MMR Vaccine for Mumps Outbreak Control, found a lower risk of mumps in those who got a third dose of MMR.

Not surprisingly, the study also found a much higher risk of mumps, with the highest attack rates, in those who were unvaccinated or who had just one dose!

Keep in mind that the MMR vaccine isn’t just for kids. Adults who didn’t have mumps when they were kids (or who were born before 1957, when most kids got mumps), should make sure they are vaccinated (at least one dose) and protected too.

Vaccines work. They just aren’t perfect…

And these outbreaks show that they are definitely still necessary. In the latest outbreak in Hawaii, where “has been confirmed in children and adults, both vaccinated and unvaccinated,” there have been at least “16 reports of complications due to mumps infection,” including orchitis and hearing loss.

What to Know About Mumps Outbreaks

Although mumps outbreaks are occurring among those who are vaccinated, you still have a much higher chance of getting mumps if you are unvaccinated and unprotected.

For More Information on Mumps Outbreaks:

Updated on January 7, 2018