We should know that vaccine-preventable diseases were rarely mild, natural immunity comes at a cost, and that those who died from smallpox, diphtheria, measles, and polio aren’t around to talk about their experiences on Facebook (survivorship bias).
We should never forget that vaccine-preventable diseases were once big killers, and the only reason some folks have grown to fear the side effects of vaccines more than the diseases they prevent, is because we don’t see those diseases very much any more. If more people skip or delay getting vaccinated, we will though.
“A MenB vaccine series may be administered to adolescents and young adults aged 16–23 years to provide short-term protection against most strains of serogroup B meningococcal disease. The preferred age for MenB vaccination is 16–18 years.”
ACIP on Use of Serogroup B Meningococcal Vaccines in Adolescents and Young Adults: Recommendations of the Advisory Committee on Immunization Practices, 2015
The MenB vaccine, for example, unlike most other vaccines, only has a permissive recommendation – parents may get it for their kids, but they don’t have to.
“First-year college students living in residence halls should receive at least 1 dose of MenACWY before college entry. The preferred timing of the most recent dose is on or after their 16th birthday.”
ACIP on Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices
In contrast, the recommendation for most other vaccines state that kids “should” receive them.
Why the difference?
Experts aren’t yet sure that the pros of the MenB vaccine, helping avoid MenB disease, outweigh the cons, which include the high cost of the vaccine, short duration of protection, and that it doesn’t cover all MenB subtypes. The cons aren’t about safety.
Most people understand that measles can be deadly.
“Measles is a highly contagious, serious disease caused by a virus. Before the introduction of measles vaccine in 1963 and widespread vaccination, major epidemics occurred approximately every 2–3 years and measles caused an estimated 2.6 million deaths each year.”
WHO Measles Fact Sheet
In the United States alone, in the pre-vaccine era, “an average of 549,000 measles cases and 495 measles deaths were reported annually.”
That roughly translates into about one death for every 1,000 cases, or a case-fatality rate of about 0.1%.
That’s in line with the typical case-fatality rate of measles of 0.1 to 0.2%.
Just How Deadly Is Measles?
Not surprisingly, many others have reported a similar case-fatality rate for measles.
Because of a 1989 report that said that “Before measles vaccine was available, more than 400,000 measles cases were reported each year in the United States. However, since virtually all children acquired measles, the true number of cases probably exceeded 4 million per year (i.e., the entire birth cohort).”
Their idea is that if there were more cases (i.e., the entire birth cohort), then even if almost 500 people died each year, the extra cases would make the death rate lower.
There are a lot of problems with that reasoning though…
For one thing, 500 people dying each year of a now vaccine-preventable disease is a lot of people, no matter how you to frame it!
And the traditional stat about the measles fatality rate clearly mentions that this is about reported cases.
You can’t change the number of measles cases to a theoretical number, the entire birth cohort, and keep the number of deaths based on the number of reported cases, and think that you are still talking about the same thing. What if deaths from measles were under-reported too?
“Death from measles was reported in approximately 0.2% of the cases in the United States from 1985 through 1992.”
CDC Pink Book
And there are plenty of more recent statistics, when far fewer people were getting measles, that show a similar case fatality rate.
What Is the Measles Fatality Rate?
How else do we know that The Physicians for Informed Consent is misinforming people?
“…any parent who has seen his small child suffer even for a few days with persistent fever of 105 F, with hacking cough and delirium, wants to see this prevented…”
Alexander D Langmuir, MD on the Medical Importance of Measles
Their measles ‘information’ sheet, made by folks who have likely never treated a child with measles, say that “most measles cases are benign.”
That’s a bit different than Dr. Langmuir’s 1962 account of how the typical child suffered with measles and why he welcomed the new measles vaccine.
“Nevertheless, a resurgence of measles occurred during 1989–1991, again demonstrating the serious medical burden of the disease. More than 55,000 cases, 123 deaths, and 11,000 hospitalizations were reported”
Orenstein et al on Measles Elimination in the United States
What was the case fatality rate during the measles outbreaks in the late 1980s?
It was a little over 0.2%. Did we again under-count cases or was the case-fatality rate so high because most of the cases were in younger, preschool age children?
Anyway, whether the case fatality rate is 1 in 1,000 or 1 in 10,000 (the UK lists their measles case fatality rate at 1 in 5,000), it doesn’t mean that someone will die when you hit case number 1,000, 5,000, or 10,000. It could be the 1st case in an outbreak or the 15,000th.
Measles can be deadly. That’s why most of us choose to have our kids vaccinated and protected.
Do you know how many people had measles in the 2013 outbreak in Brooklyn when a pregnant woman developed measles and had a miscarriage? The outbreak that was started by an unvaccinated teenager included a total of 58 cases.
How about the 2015 outbreak in Clallam County, Washington in which an immunocompromised woman died of pneumonia due to measles? There were only five other cases, almost all unvaccinated.
And in many European countries last year, many of the deaths are in countries with few cases. When the 17-year-old unvaccinated girl in Portugal died, there were just 31 cases. In Switzerland, a vaccinated man with leukemia died in an outbreak with just 69 cases. There were only 163 cases when an unvaccinated 10-month-old died in Bulgaria. And there were fewer than 1,000 cases in Germany when a partially vaccinated mother of three children died.
More Myths About Measles
The Physicians for Informed Consent pushes a lot of other myths and misinformation about measles:
about using vitamin A to treat measles – where this works, in developing countries, untreated measles has a case fatality ratio of 5 to 40% because of malnutrition! It isn’t usually thought to be very helpful in an industrial country without malnutrition. And no, simply having a picky eater or one who eats a lot of junk food doesn’t mean that he will be helped by vitamin A if he gets measles
about using immunoglobulin to treat measles – the MMR vaccine and immune globulin can be used for post-exposure prophylaxis, but it is not a treatment once you have measles!
they misuse VAERS data to try and say the MMR vaccine is more dangerous than getting measles
The Physicians for Informed Consent even talks about benefits of getting measles, but somehow leaves out any talk about the risk of getting SSPE after a natural measles infection.
What else do they leave out? The idea that people who survive a measles infection can have some immunosuppression for up to two to three years! This measles-induced immune damage puts them at risk of dying from other diseases and helps explain why kids who are vaccinated against measles are also less likely to die from other childhood infections.
They even published a press release claiming that they “recently reported in “The BMJ” that every year about 5,700 U.S. children suffer seizures from the measles, mumps and rubella (MMR) vaccine.”
Their report? It was a “letter to the editor” that anyone can submit online…
People with Guillain-Barré syndrome develop the rapid onset of muscle weakness and then paralysis. They may also have numbness and a loss of reflexes.
Unlike some other conditions that cause weakness and paralysis, GBS is a symmetrical, ascending paralysis – it starts in your toes and fingers and moves up your legs and arms.
What Causes Guillain-Barré Syndrome?
GBS is an autoimmune disorder and often starts after a viral or bacterial infection, especially one that causes diarrhea or a respiratory illness.
One of the biggest risk factors is a previous Campylobacter jejuni infection, that is often linked to drinking raw milk, eating undercooked food, drinking untreated water, or from contact with the pet feces.
In less half of cases, no specific cause is found.
Fortunately, although progress can be slow, many people with GBS recover.
“On very rare occasions, they may develop GBS in the days or weeks after getting a vaccination.”
CDC on Guillain-Barré syndrome and Flu Vaccine
It is not common though.
For example, the increased risk of GBS after getting a flu vaccine is thought to be on the order of about one in a million – in adults.
Flu vaccines have not been shown to cause GBS in children.
“The risk of GBS is 4–7 times higher after influenza infection than after influenza vaccine. The risk of getting GBS after influenza vaccine is rare enough that it cannot be accurately measured, but a risk as high as one case of GBS per 1 million doses of flu vaccine cannot be reliably excluded.”
Poland et al on Influenza vaccine, Guillain–Barré syndrome, and chasing zero
It is also important to keep in mind that you are far more likely to get GBS after a natural flu infection than after the vaccine, plus the flu vaccine has many other benefits.
What about other vaccines?
“In this large retrospective study, we did not find evidence of an increased risk of GBS following vaccinations of any kind, including influenza vaccination.”
Baxter et al on Lack of association of Guillain-Barré syndrome with vaccinations
No other vaccines that are currently being used routinely have been associated with Guillain-Barré syndrome.
In fact, many studies do not even find an association between GBS and the flu vaccine.
What to Know About Guillain-Barré Syndrome and Vaccines
Guillain-Barré Syndrome may be associated with the flu vaccine in adults in about 1 in a million cases, but does not occur with any other vaccines, and occurs far more commonly after a natural flu infection.
Pertussis has been known since at least the Middle Ages, although the bacteria that causes pertussis, Bordetella pertussis, wasn’t discovered until 1906.
That discovery led to the later development of the first pertussis vaccines, but before then, pertussis was a big killer, with epidemic cycles every 2 to 5 years.
During one of these cycles in the United States, from 1926 to 1930, there were:
909,705 cases, and
Unfortunately, even natural infection doesn’t provide life-long immunity, so adults would get pertussis and give it to susceptible kids, who were most likely to die during these epidemics.
But even in non-epidemic years, a lot of folks got pertussis. The number of reported cases ranged from “just” 161,799 in 1928 to 202,210 in 1926. And during one of the biggest years, 1934, there were 265,269 cases!
Post-Vaccine Era Pertussis Outbreaks
That changed in the vaccine era.
The first pertussis vaccines were developed in the 1930s and became more widely used in the 1940s when it was combined into the whole-cell DTP vaccine.
This was replaced with the acellular DTaP vaccine in 1997, with the Tdap vaccine being added to the vaccine schedule in 2006.
These vaccines helped to greatly reduce how many people got pertussis and how many people died from pertussis:
1940 – 183,866 cases
1950 – 120,718 cases and 1, 118 deaths
1960 – 14,809 cases and 118 deaths
1970 – 4,249 cases and 12 deaths
1980 – 1,730 cases and 11 deaths
1990 – 4,570 cases and 12 deaths
2000 – 7,867 cases and 12 deaths
2010 – 27,550 cases and 26 deaths
They never eradicated pertussis though, and as you can see, recently, pertussis cases have started to rise again.
In 2012, there were 48,277 cases of pertussis in the United States, the most since 1950, when we had 68,687 cases. Unfortunately, with the rise in cases, we are also seeing the tragic consequences of this disease – 20 deaths in 2012, mostly infants under age 3 months.
Pertussis cases remained steady, but high, in 2013 and 2014, at around 30,000 cases in the United States.
In California, pertussis reached epidemic levels. The California Department of Public Health reported at least 11,114 cases in 2014 – the highest numbers of pertussis cases in the state in 70 years!
And as expected with the rise in cases, there were 3 pertussis related deaths in California that year – all infants who had contracted pertussis when they were less than 8 weeks old. Two of the infants became sick in 2013, but the third, a 5-week-old baby, got infected in 2014.
Another baby, only 25 days old died in early 2015, but will be counted as the 2nd death of 2014 since that is when the illness started. About 383 patients, mostly infants who are less than 4 months old, were hospitalized in California that year, including 80 who required intensive care. And according to the California Department of Public Health, about 82% of the cases in infants were born to mothers who did not receive a dose of Tdap during their third trimester of pregnancy.
What’s happened since then?
Pertussis cases are continuing to fall each year! In fact, with about 16,000 cases in the United States, 2017 may have ended with the lowest number of pertussis cases since 2008.
Still, with just 1,830 pertussis cases in California in 2016, there were two deaths – both infants who were younger than 3 months of age when they got sick. And there was at least one death in 2017, with similar rates of disease, although reports are still preliminary.
Why So Many Pertussis Outbreaks?
Ever since a 2010 California pertussis outbreak, in which there were 9,154 cases of pertussis, the most in 63 years, and 10 infants died, many people, especially parents, began wondering why we were seeing more pertussis these days.
Is it because the pertussis vaccines simply don’t work, as the anti-vaccine movement would have you think?
A commentary, Why Do Pertussis Vaccines Fail?, by James Cherry, MD, gave us some answers.
While the title of the article might have you think that all of the blame lies with the pertussis vaccines, that certainly isn’t the case. While there can be vaccine failures with the pertussis vaccines, just like any other vaccine, that doesn’t mean that the vaccine doesn’t work for most children.
One of the problems is that the DTaP vaccine likely isn’t as effective as the older DTP vaccine. So instead of efficacy of 84 to 85%, as was once believed, it is likely closer to just 71 to 78%.
Other issues, including waning immunity, the possibility of an incorrect balance of antigens in the vaccine that could create a blocking effect, and genetic changes in the B. pertussis bacteria, could also possibly lead to increased vaccine failure rates.
So it isn’t that the pertussis vaccines don’t work.
That should be easy to see when you look at the pertussis rates in California, when the highest rates by far were in infants less than 6 months of age (434 per 100,000 people). In contrast, children who were 6 months to 6 years old had a rate of only 62 per 100,000.
And the results of a study that were presented at the 49th annual meeting of the Infectious Diseases Society of America in Boston show just how important the pertussis vaccine is, as:
vaccine effectiveness was 98.1 percent among children who received their 5th dose within the past year
long term effectiveness – children who were five or more years past their last DTaP dose – was about 71 percent
children who had never received any doses of DTaP (unvaccinated children) faced odds of having whooping cough at least eight times higher than children who received all five doses
It is also important to note that the high rates seen in 2010 in California are still well below the rates that were seen in the pre-vaccination era, when the attack rate of pertussis in the United States was as high as 157 per 100,000 people, with about 200,000 cases a year.
What’s the answer?
“The present “resurgence of pertussis” is mainly due to greater awareness and the use of PCR for diagnosis. There are also many other factors which have contributed to the “resurgence.” New vaccines are clearly needed; with our present vaccines (DTaP and adolescent and adult formulated tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap)), if used correctly, severe pertussis and deaths in infants can be prevented.”
James D. Cherry, MD on The History of Pertussis (Whooping Cough); 1906 – 2015: Facts, Myths, and Misconceptions
It certainly isn’t for more kids to follow non-standard, parent-selected, delayed protection vaccine schedules or to simply skip vaccines all together. Since natural immunity isn’t going to keep newborns and infants from getting pertussis, the ages which are most at risk for life-threatening infections, they can catch pertussis from people around them, including those working on their natural immunity. Natural infections don’t even provide life-long protection against pertussis, as some people believe. That natural immunity wanes fairly quickly too.
The future of pertussis control is more likely going to be in maximizing our current vaccination program, including getting more teens and adults to get the Tdap vaccine, especially when women are pregnant.
That’s the best strategy, at least until new pertussis vaccines are developed. It provides a lot of benefits. According to the CDC, like with the flu vaccine, when you get a pertussis vaccine, in addition to protecting yourself and those people around you, “people who do catch whooping cough after being vaccinated are much less likely to be hospitalized or die from the disease.”
Unfortunately, not everyone has gotten the message. And because of waning immunity, children who aren’t vaccinated against pertussis can’t “hide in the herd” and rely on the rest of us who do vaccinate our children to provide them with protection. Instead, since they are at a higher risk, they get pertussis and get even more people sick.
In one study, Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children, researchers found that “vaccine refusers had a 23-fold increased risk for pertussis when compared with vaccine acceptors, and 11% of pertussis cases in the entire study population were attributed to vaccine refusal.” The highly contagious nature of pertussis then means every primary case is probably going to infect as many as 17 other people. That’s why it makes sense that higher rates of children using vaccine exemptions could be at least one of the factors in these outbreaks.
In fact, several studies, including, Geographic Clustering of Nonmedical Exemptions to School Immunization Requirements and Associations With Geographic Clustering of Pertussis, found that “geographic pockets of vaccine refusal are associated with the risk of pertussis outbreaks in the whole community.”
Many factors are responsible for the rise in pertussis outbreaks in recent years, but it is clear that being unvaccinated and unprotected put you at greatest risk for getting pertussis and passing it on to others.
Extremely few people can’t get at least some, if not most, of their vaccines, even if they do have contraindications to some others. And many exemptions are temporary.
“Parents need to balance the need of the immunoreconstituted child (post-transplant SCID) to be protected from exposure to infection from live vaccines and close contact–transmitted vaccine-derived infection with the need of the child to integrate into society and develop social and learning skills in group environments.”
Medical Advisory Committee of the Immune Deficiency Foundation
They also try to avoid people who are sick and try to make sure that everyone around them is vaccinated to help maintain herd immunity levels of protection.
Neither is always possible though.
Post-exposure prophylaxis is another option that is available to help prevent some vaccine-preventable diseases. For example, if your unvaccinated child is exposed to measles, they can often receive immune globulin to help them avoid getting measles.
Regimens for post-exposure prophylaxis are also available for:
chicken pox – varicella zoster immune globulin or immune globulin
diphtheria – antibiotics
hepatitis A – immune globulin
hepatitis B – hepatitis B immune globulin
influenza – oseltamivir (Tamiflu) and zanamivir
meningococcal disease – antibiotics
pertussis – antibiotics
rabies – rabies immune globulin
tetanus – tetanus immune globulin
When possible, immunization typically accompanies these post-exposure prophylaxis regimens.
There is one big problem with these types of post-exposure prophylaxis regimens though. You are not always going to know when your child is exposed to someone else with a vaccine-preventable disease. While some exposures might be obvious, like if your child steps on a rusty nail or is bitten by an unvaccinated dog who has rabies, you might miss some others.
Bogus Alternatives to Getting Vaccinated
What other alternatives to getting vaccinated are out there?
Unfortunately, there are none that work.
Many bogus alternatives to getting vaccinated are pushed by those opposed to vaccines as ways to boost your immunity, and they can include:
breastfeeding – while breastfeeding is great and always encouraged, the passive immunity it provides will not protect your baby from most vaccine-preventable diseases, as it contains IgA antibodies, not the IgG antibodies you would need to prevent diseases like measles, tetanus, chicken pox, and Hib, etc.
homeopathic vaccines – nosodes are homeopathic vaccines that have been diluted so much that they are supposed to retain a memory of the original substance. Even if they did – that’s not how immunology works.
herbs – neither echinacea, goldenseal root, nor elderberry syrup is going to boost your child’s immunity
vitamins – unless your child is severely vitamin deficient, taking vitamins isn’t going to boost their immunity, whether they are taking extra vitamin C or extra vitamin D
foods – Japanese mushrooms, kale, broccoli, lettuce, cabbage, avocados, ginger, black currants, graviola, green veggies, onion seeds, and berries might all be great to eat, but they aren’t going to boost your immunity
probiotics – they may help prevent antibiotic associated diarrhea, but there is not much evidence that taking them regularly does anything else
essential oils – they sometimes smell nice, but they aren’t going to boost your child’s immune system
sun exposure – in addition to the worries about skin cancer, not only does extra sun exposure not boost your immune system, the WHO reports that “Several studies have demonstrated that exposure to environmental levels of UV radiation alters the activity and distribution of some of the cells responsible for triggering immune responses in humans. Consequently, sun exposure may enhance the risk of infection with viral, bacterial, parasitic or fungal infections, which has been demonstrated in a variety of animal models.”
fermented cod liver oil – this is not going to boost your child’s immune system, but folks should also know that there have been reports that the products that people have been buying and using for years were rancid and actually making them sick! There are much better ways to get vitamin D and vitamin A in your diet than taking fermented cod liver oil each day.
What about natural immunity?
While natural immunity can in some ways be more effective than vaccine induced immunity, it often comes at a price. You have to recover from the disease, hopefully without any long term consequences, to develop natural immunity.
What to Know About Alternatives to Getting Vaccinated
People who truly can’t be vaccinated rely on herd immunity, because in most cases, there are no effective alternatives for vaccines.
For most of us, the greatest benefit of any vaccine is that it keeps us from worrying that our kids will get a vaccine-preventable disease. If they do get sick, we don’t worry that every fever is measles or that every cough is pertussis either.
“It is also much cheaper to prevent a disease than to treat it. In a 2005 study on the economic impact of routine childhood immunization in the United States, researchers estimated that for every dollar spent, the vaccination program saved more than $5 in direct costs and approximately $11 in additional costs to society.”
NIH: National Institute of Allergy and Infectious Diseases
Among the other benefits of available vaccines are that:
they are associated with a protective effect against SIDS
vaccines save money
The benefits of vaccines become more obvious when folks stop vaccinating.
Invariably, we start to see outbreaks.
Then they quickly remember why vaccines are necessary, vaccines rates go up, and the outbreaks get under control.
And everyone understands that all of great benefits of vaccines far outweigh any of their small risks. They also begin to hopefully understand that not everyone can attempt to hide in the herd or follow an alternative immunization schedule. That too can simply lead to more outbreaks, as the number of unvaccinated folks increases, at least temporarily.
What to Know About the Benefits of Vaccines
The great benefits of vaccines, which include that they have saved millions of lives, far outweigh any small risks.