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.
We have come a long way since the development of the first measles vaccines in the early 1960s…
Pre-Vaccine Era Measles Outbreaks
In the pre-vaccine era, measles was a very common childhood disease.
As it is now, it was also a deadly disease.
In the 1950s, there were 5,487,332 cases (just under 550,000 a year) and 4,950 deaths (about 500 each year).
In 1962, there were 469,924 cases of measles in the United States and 432 deaths.
Post-Vaccine Era Measles Outbreaks
The first measles vaccines were licensed between 1963 and 1965, but it was the first national measles eradication campaign in 1966 that got people vaccinated and measles rates down.
In 1970, there were only 47,351 cases and 89 deaths.
Rates continued to drop until the large outbreaks between 1989 to 1991, when there were 55,622 cases and 123 deaths. The addition of a measles booster shot got measles outbreaks under control again. By 2000, when measles was declared eliminated in the United States, there were just 86 cases and one death.
Post-Elimination Era Measles Outbreaks
Declaring measles eliminated in the United States didn’t mean that we didn’t have any more measles, after all, it hasn’t been eradicated yet. It just that we are no longer seeing the endemic spread of measles. Since 2000, all of the latest measles outbreaks have been imported from outside the country, or at least they are started by cases that are imported.
We have seen more than a few records in the post-elimination era, including:
the year with the historic low number of measles cases – 37 cases in 2004
the year with the largest number of cases since 1994 – 667 cases in 2014
the largest single outbreak since the endemic spread of measles was eliminated – 377 cases in Ohio in 2014
In 2015, we got a reminder of how deadly measles can be. Although there have been other measles deaths and SSPE deaths in the past ten years, unlike the 2015 death, they are usually buried in CDC reports and aren’t published in the newspaper.
2017 Measles Outbreaks
The first new case of 2017 was an unvaccinated adult in San Luis Obispo County, California who was exposed to international travelers over the holidays. The person exposed others to measles at the Twin Cities Community Hospital emergency department in Templeton while contagious in early January.
The second case of 2017 was related to an LA county outbreak that started at the end of 2016 – a resident of Ventura County.
And it went on, with other measles cases in 2017 including:
at least 122 cases
cases in 16 states, including California, Florida, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Utah, and Washington
an infant in San Luis Obispo County that was too young to be vaccinated and who had contact with an unvaccinated adult with measles
one new case in the Los Angeles County outbreak, which is now up to 20 confirmed measles cases (including 18 in LA County), all unvaccinated
four new cases in Ventura County, California that are linked to another Ventura County measles case and the LA County outbreak, which is now up to 24 cases
a case in Jersey City, New Jersey following international travel who exposed people at multiple places, including a hospital, pharmacy, mall, and on a commuter train
an unvaccinated 7-month-old baby from Passaic County, New Jersey who had been traveling out of the country and may have exposed others at area hospitals (a good reminder that infants who are at least 6 months old should get an MMR vaccine before leaving the country)
two cases in Salt Lake County, Utah – which began in a resident who had “received all appropriate vaccinations” and developed measles after traveling outside the US and then spread to another person “who had contact with the first case.” According to the SLCoHD, “One of the two individuals with measles had received one MMR vaccine.”
two cases in King County, Washington – a man and his 6-month-old infant, both unvaccinated, developed measles after traveling to Asia, and exposed many others around Seattle, including at a Whole Foods, a sandwich shop, their apartment building, and two Amazon buildings.
a confirmed case in Omaha, Nebraska, who exposed people on a Delta flight and multiple places in Douglas and Sarpy counties, including the Bergan Mercy Hospital Emergency Room.
two children in Minnesota without a known source of infection
another child in Minnesota – among the three Somali Minnesotans in this outbreak are two children who are just two years old – all of the cases were unvaccinated and two required hospitalization, although the common source is still not known. Vaccine hesitancy has been a problem among the Somali Minnesotans because of Wakefield‘s MMR study.
five more unvaccinated children in Minnesota, as the outbreak grows to 8.
a confirmed case in North Platte, Nebraska who may have exposed others at a middle school, church youth group, the Great Plains Health Emergency Room, a medical office, and a lab.
a resident of Livingston County, Michigan who exposed others at area restaurants and St. Joseph Mercy Brighton Hospital after getting measles on a plane ride with an unvaccinated child
another case in Minnesota, bringing the outbreak count to 9 unvaccinated children.
three more cases in Minnesota, bringing this outbreak case count to 12, with at least 200 people in quarantine.
eight more cases in Minnesota, bringing this outbreak case count to 20 young children under age 5 years, and now including an infant under age 12 months.
four more cases in Minnesota, bringing this outbreak case count to 24 young children under age 5 years and surpassing the size of the 2011 measles outbreak in the Somali community in the same area, which was also mostly among intentionally unvaccinated children.
five more cases in Minnesota, including the first outside of Hennepin County – spreading to nearby Stearns County, bringing this outbreak case count to 29 young children under age 5 years, with only one that was vaccinated.
three more cases in Minnesota, as the outbreak spreads to the third county – Ramsey County.
more measles (2 new cases) in Minnesota (Hennepin County, Ramsey County, Crow Wing County, and now Le Sueur County), where the ongoing outbreak is up to 66 cases, almost all unvaccinated children and where there has been a call to accelerate the two dose MMR schedule for kids over age 12 months.
a child in Maryland who was admitted to Children’s National Medical Center in Washington, D.C.
more measles (3 new cases) in Minnesota (Hennepin County, Ramsey County, Crow Wing County, and Le Sueur County), where the ongoing outbreak that has been confirmed to be from the wild type B3 strain is up to 68 cases, almost all unvaccinated children.
a case in Pennsylvania who exposed others at a visitor center
someone who visited the MIT Museum in Cambridge, Massachusetts.
two new cases in Minnesota, ending speculation that the outbreak, now up to 70 cases, was over…
one new case in Minnesota, raising the number of cases in this ongoing outbreak to 78 cases.
a healthcare worker in New York who is employed by Hudson Headwaters Health Network and also works at a Warren County medical practice.
someone in Franklin County, Maine (their first case in Maine in 20 years!) who traveled out of the country and caught measles, returning home and possibly exposing others at a movie theater, restaurant, farmers market, and hospital.
A case in Butler County, Kansas. Many remember that one of the largest outbreaks of 2014 was in Kansas.
an unvaccinated man who lives in Hennepin County, raising the number of cases in this ongoing outbreak (an outbreak that has already cost over $500,000 to contain and which many hoped would soon be over) that started in March to at least 79 cases. With the new case, the clock starts ticking again and Minnesota will have to wait to see if new cases appear over the next 3 weeks.
passengers from 13 states on an American Airlines flight from New York to Chicago were exposed to a person with measles in early July, including a 12-week-old infant who required preventative treatment with immune globulin (IG), as she was too young to be vaccinated.
a fully vaccinated resident of Onondaga County, New York who was exposed on a domestic flight, only developed mild symptoms, but did expose others.
someone who exposed others at the Penn State University Hetzel Union Building Bookstore and other places in State College, Pennsylvania.
a second case in the Wichita, Kansas area, this time in Sedgwick County, with exposures at a church, dental office, elementary school, and multiple stores over at least 3 days.
a possible case in Sedgwick County, Kansas, a child too young to be vaccinated who may have been exposed at a church. Three other exposed infants who were too young to be vaccinated and who were considered at risk to get measles in this outbreak received immunoglobulin treatment.
a traveler who spent time in Hampton Beach in New Hampshire, exposing others.
a 46-year-old male in Ohio that got the disease while traveling internationally.
2017 would have been a mild year for measles, except for the really big outbreak in Minnesota… 79 people got measles, 71 were unvaccinated, more than 500 people were quarantines, and the outbreak cost over $1.3 million to contain.
2016 Measles Outbreaks
Starting slow, 2016 ended as a fairly average year for measles:
cases in 17 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, 23 cases, linked to a private detention center
a large outbreak in Shelby County, Tennessee, at least seven cases, including six unvaccinated and one partially vaccinated child
a case in Colorado in which an unvaccinated adult traveled internationally and ended up exposing many people “from Dec. 21 to 29, 2016, who was at a wide variety of locations in the Denver-Boulder area,” including an Urgent Care center and the Parker Adventist Hospital Emergency Department
As in other years, many of these outbreaks involved unvaccinated children and adults. One case involved a child at the Yuba River Charter School in California, a Waldorf School with very high rates of unvaccinated children.
2015 Measles Outbreaks
With a large outbreak in California, 2015 got off to a very strong start.
Most concerning, more and more, cases don’t seem to have an source that is easy to find, which could mean that the endemic spread of measles has returned in the United States. So instead of having to travel out of the country or be exposed to someone who got measles with a link to international travel, you could get measles just by going to a ball game, a movie theater, or to Disneyland. That makes it more important than ever to learn how to avoid measles.
Among the 189 measles cases and outbreaks in 2015 were:
113 cases that were associated with a multi-state outbreak that was linked to Disneyland in California. Before it was declared over on April 17, a few unvaccinated travelers also help spread measles from this outbreak to large outbreak in Quebec, Canada. All in all, the outbreak was linked to at least 113 cases in California and an additional 169 cases in Arizona (5), Nebraska (1), Utah (3), Colorado (1), Washington (2), Oregon (1), Mexico (1), and Canada (155).
13 cases, including an adult worker and 12 infants too young to be vaccinated at the KinderCare Learning Center in Illinois.
At least 13 cases, all intentionally unvaccinated, in a South Dakota outbreak that started with an unvaccinated adult traveling to India.
Five cases in Clallam County, Washington, including four who were not vaccinated, which cost at least $36,000 to contain and led to the death of an immunosuppressed woman.
In addition to these large outbreaks, 2015 also saw a number of quarantines for unvaccinated students, closing of daycare centers, and a recommendation from a California Department of Health state epidemiologist that people who are not vaccinated against measles “avoid visiting Disney” and “crowded places with a high concentration of international travelers, such as airports.”
Other measles cases in 2015 include:
A student at UC Berkeley who may have exposed others to measles on a public bus.
A confirmed case in Fairbanks, Alaska – their first case in 15 years, who flew in from Seattle (and is probably the King County case discussed below) and may have exposed others at an area Walmart, Home Depot, Walgreens, several supermarkets, the airport, and hospital, etc.
A confirmed case in King County, Washington, who may have exposed others in Seattle, including at an area McDonalds, the Baroness Hotel, a drug store, and the Sea-Tac Airport.
A confirmed case in Branson, Missouri, a traveler from Asia, who was contagious when visiting the ER, three local businesses, and perhaps his flight to town.
A confirmed case in the Washington D.C. area.
Another case of measles in Spokane County, Washington – an unvaccinated person that was exposed to the other case in the area.
An unvaccinated student from Europe in Boston, Massachusetts who also traveled to Maine and New Hampshire.
Another unvaccinated child in St. Lucie County, Florida – bringing the total to five cases in central Florida in what so far looks like two separate outbreaks.
Another case in Indian River County, Florida – an unvaccinated child.
An unvaccinated adult in Spokane, Washington – the first case in the area since 1994.
Two unvaccinated adults in Indian River County, Florida, one of whom contracted measles while traveling out of the country.
An unvaccinated 6-year-old in St. Lucie County, Florida who attended Fairlawn Elementary School in Fort Pierce – leading to five unvaccinated students being kept out of school until early May.
The first case in Oklahoma since 1997, a case in Stillwater.
A case in Florida, a traveler who was contagious while attending a conference at the Gaylord Palms Resort and Convention Center and also in Maimi-Dade, Orange, and Sarasota counties.
A new case in Illinois, the 15th – and so far not linked to the other two outbreaks in the state.
A student at Princeton University in New Jersey.
Another case of measles in the Washington D.C. area, a case without a known source.
A case in a student at Elgin Community College in Kane County, Illinois.
A hospitalized infant in Atlanta, Georgia.
An unvaccinated 1 year old in Jersey City, New Jersey.
A traveler in King County, Washington that may have exposed others in Seattle. The unvaccinated visitor is from Brazil, where there was a large outbreak of measles last year (almost 400 cases).
At least one more case in Clark County, Nevada and four more possible cases in Southern and Northern Nevada, which led to the quarantine of at least 11 students at the Spanish Springs Elementary School.
A case in Franklin County, Pennsylvania.
Four cases of measles in travelers, including two international travelers, who visited Florida.
A case in Washington D.C.
A student at Bard College in Dutchess County, New York, who exposed many people while traveling on an Amtrak train to Penn Station in New York City.
An unvaccinated woman in New Castle County, Delaware who had recently traveled out of the country.
A case on the University of Minnesota Twin Cities campus in a student that had recently returned from out of the country. Although others were exposed, it is considered to be a “highly immunized” population, so hopefully the outbreak won’t spread.
Two more cases in Arizona that are tied to the Disneyland outbreak, including a woman in Phoenix who may have exposed others up to 195 children at the Phoenix Children’s East Valley Center, including a 3-year-old getting chemotherapy for leukemia.
An adult in Cook County, Illinois which in not linked to Disneyland.
A student at Valley High School in Las Vegas which led to the quarantine of 36 unvaccinated students until early February.
Four cases among an unvaccinated family in Kearny, Arizona that is directly linked to the Disneyland outbreak.
A child in Sioux Falls, South Dakota that is unrelated to 13 recent cases in the area and which has no link to travel out of the area.
A new case in Oakland County, Michigan that is likely linked to the Disneyland measles outbreak, meaning that the outbreak has now spread to include 7 states and 2 countries.
A case in Maricopa County, Arizona has been linked to the Disneyland outbreak.
A person in Nebraska who could have exposed others in Omaha and Blair, including at the Omaha Children’s Museum.
A case in Lane County, Oregon that has been linked to the Disneyland measles outbreak.
A resident of Tarrant County in North Texas who developed measles after a trip to India.
Another unvaccinated person in Utah with links to the Disneyland outbreak has tested positive for measles, bringing the total in that state to 3 cases.
In addition to the 36 measles cases that have been associated with the Disneyland outbreak, California already has 5 additional measles cases this year with no link to Disney, including cases in Alameda, Orange, and Ventura Counties.
Now all toddlers begin to get a two dose hepatitis A vaccine series beginning when they are 1 to 2 years old, with 6 to 18 months between the doses.
Unfortunately, unlike many other vaccines, there was never a catch-up plan for those who were unvaccinated, so some teens and many adults are still not vaccinated and still not protected against hepatitis A infections.
Getting Exposed to Hepatitis A
How do you get hepatitis A?
“The hepatitis A virus is able to survive outside the body for months. High temperatures, such as boiling or cooking food or liquids for at least 1 minute at 185°F (85°C), kill the virus, although freezing temperatures do not.”
CDC on Hepatitis A Questions and Answers
Unlike hepatitis B, which is spread through blood and body fluids, people who are infected with hepatitis A shed the virus in their stool.
So you can get infected by having close contact with someone who has hepatitis A or by eating or drinking contaminated food or water.
How do you know if you have been exposed?
Exposures are most common in local common-source outbreaks caused by sick food handlers at restaurants and grocery stores and multi-state hepatitis A outbreaks caused by contaminated foods. These types of exposures are usually announced by your local or state health department.
Other exposures occur if you are living with someone who develops hepatitis A or travel to a country where hepatitis A is still common.
What to Do If Your Unvaccinated Child Is Exposed to Hepatitis A
If your unvaccinated child is exposed to hepatitis A, you should talk to your pediatrician or local health department about starting post-exposure prophylaxis as soon as possible and not longer than 14 days, including either:
the first dose of hepatitis A vaccine, with plans to get the second dose of vaccine in 6 months, or
a dose of immune globulin (provides a passive transfer of antibodies)
In general, getting the hepatitis A vaccine is preferred over getting immune globulin for most healthy people between 12 months and 40 years of age. For infants less than 12 months (too young to be vaccinated) and unvaccinated adults over age 40 years, immune globulin is preferred after an exposure to hepatitis A.
Immune globulin is also preferred for anyone who is immunocompromised or chronic liver disease.
What if it has been more than 14 days since the exposure?
While it is likely too late for immune globulin, your unvaccinated child should still likely get a dose of hepatitis A vaccine to protect against future exposures. And watch carefully over the next 15 to 50 days (the incubation period) for symptoms of hepatitis A, which can include jaundice, fever, and vomiting, etc. Many children don’t have symptoms though, so your child could develop hepatitis A, and be contagious and expose others without your even knowing it.
If post-exposure vaccination works, can’t you just wait until your child is exposed to get vaccinated? That might work – if you could be sure about each and every exposure that your child will ever have. Since that’s not possible, don’t delay getting vaccinated and put your child at risk of getting hepatitis A.
What to Do If Your Vaccinated Child Is Exposed to Hepatitis A
One dose provide 95% protection against hepatitis A infections and the second dose boosts the efficacy rate up to 99%.
If your child is partially vaccinated, with just one dose and has been exposed to hepatitis A, get the second dose if it has been at least six months since he was vaccinated. Otherwise, talk to your pediatrician or local health department, but your child is likely considered protected.
What to Know About Getting Exposed to Hepatitis A
Learn what to do if your child is exposed to hepatitis A, especially if they aren’t already vaccinated and protected.
The way that these laws and exemptions are set up leaves a lot of room for abuse though.
Abuse of Religious Exemptions
How many religions are actually against kids getting vaccinated?
That’s right, almost none.
So why are there so many religious vaccine exemptions in most states, especially in states that don’t have a personal belief exemption?
Folks who don’t want to vaccinate their kids, and can’t use a personal belief exemption, just say that vaccinating them would be against their religion.
Abuse of Medical Exemptions
There are some children who shouldn’t be vaccinated.
These children can get a true medical exemption to one or more vaccines because they have a real contraindication or precaution to getting vaccinated.
“If a child has a medical exemption to immunization, a physician licensed to practice medicine in New York State must certify that the immunization is detrimental to the child’s health. The medical exemption should specify which immunization is detrimental to the child’s health, provide information as to why the immunization is contraindicated based on current accepted medical practice, and specify the length of time the immunization is medically contraindicated, if known.”
Dear Colleague letter regarding guidelines for use of immunization exemptions
a moderate or severe acute illness with or without fever (precaution)
a progressive neurologic disorder (precaution)
Most other things are “incorrectly perceived as contraindications to vaccination” and should not be a medical exemptions, including having :
a mild acute illness with or without fever
a mild to moderate local reaction
relatives with allergies
a family history of seizures
a stable neurologic condition
an autoimmune disease
a family history of an adverse event after DTP or DTaP administration
A medical exemption can also exist if your child already had the disease and so has natural immunity. In most cases, except for chicken pox disease, titers will likely need to be done to prove that your child already has immunity.
Stopping the Abuse of Vaccine Exemptions
We know that vaccine exemptions are being abused.
How do you stop it?
“Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence.”
Omer et al on Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence.
You likely have to make it harder to get a vaccine exemption.
Strong exemption laws, which are needed in many states, make it clear that:
many exemptions are temporary
medical exemptions are based on ACIP guidelines, current accepted medical practice, and evidence based medicine – not anecdotes
religious exemptions specifically exclude philosophical exemptions and must reflect a sincere religious belief
exempted students will be excluded from school during outbreaks
exemptions should include a signed affidavit that is notarized
exemptions should be recertified each year
a separate exemption application will be needed for each vaccine
“Because rare medically recognized contraindications for specific individuals to receive specific vaccines exist, legitimate medical exemptions to immunization requirements are important to observe. However, nonmedical exemptions to immunization requirements are problematic because of medical, public health, and ethical reasons and create unnecessary risk to both individual people and communities.”
AAP on Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance
You could also get rid of nonmedical vaccine exemptions.
Of course, for that to work, you can’t allow just anything to count as a medical exemption.
“Review of all medical exemption requests will be conducted at the Mississippi State Department of Health by the State Epidemiologist or Deputy State Epidemiologist.”
Mississippi Medical Exemption Policy
In Mississippi, for example, where medical exemptions are reviewed and approved by the State Epidemiologist or Deputy State Epidemiologist, there were just 208 medical exemptions in the whole state during the 2016-17 school year.
In some states, rates of medical exemptions might be six or seven times higher. This is mostly seen in states that don’t allow personal belief exemptions and make it difficult to get a religious exemption.
That seems to be the case in Nebraska, where there are no personal belief exemptions and you have to submit a notarized statement to get a religious exemptions. Their high rates of medical exemptions likely reflect some abuse and the fact that medical exemptions aren’t reviewed or approved by anyone, they just reflect “that, in the health care provider’s opinion, the specified immunization(s) required would be injurious to the health and well – being of the student or any member of the student’s family or household.”
As we are seeing, that simply invites vaccine exemption abuse.
Very few states currently require that exemption applications go to the health department for review. Those that do include Alabama, Arkansas, Michigan, Minnesota, Mississippi, and West Virginia.
California is notably absent. I guess they didn’t see the potential for abuse when they passed their latest vaccine law. I mean, who could have guessed that doctors would actually be selling medical exemptions to parents based on unrelated conditions, like a family history of diabetes, celiac disease, or autism?
At the very least, until we have stronger exemption laws, parents who want to get a nonmedical exemption should acknowledge that they understand the risks they are taking when they skip or delay their child’s vaccines.
What to Know About Abuse of Vaccine Exemptions
While medical exemptions are necessary for kids who have true contraindications to getting vaccinated, stronger laws can help decrease the abuse we see in medical, religious, and personal belief vaccine exemptions.
So how did a vaccinated child in Canada get diphtheria?
He has cutaneous diphtheria, not respiratory diphtheria.
What’s the difference?
“Extensive membrane production and organ damage are caused by local and systemic actions of a potent exotoxin produced by toxigenic strains of C. diphtheriae. A cutaneous form of diphtheria commonly occurs in warmer climates or tropical countries.”
Vaccines Seventh Edition
Cutaneous diphtheria occurs on your skin. It is usually caused by non-toxigenic strains of Corynebacterium diphtheriae.
On the other hand, respiratory diphtheria is usually caused by toxigenic strains of Corynebacterium diphtheriae.
The diphtheria vaccine (the ‘D’ in DTaP and Tdap), a toxoid vaccine, covers toxigenic strains. More specifically, it covers the toxin that is produced by toxigenic strains of Corynebacterium diphtheriae. It is this toxin that produces the pseudomembrane that is characteristic of diphtheria.
It was the formation of this pseudomembrane in a child’s airway that gave diphtheria the nickname of the “strangling angel.”
So why the fuss over this case in Canada? They likely don’t yet know if it is a toxigenic strain. If it is, then it could be a source of respiratory diphtheria.
But remember, even if these kids developed an infection with the toxigenic strain of Corynebacterium diphtheriae, those that are fully vaccinated likely wouldn’t develop respiratory diphtheria. Again, it is the toxin that the bacteria produces that cause the symptoms of diphtheria. The vaccine protects against that toxin.
For example, when an intentionally unvaccinated 6-year-old in Spain was hospitalized with severe diphtheria symptoms a few years ago, although many of his friends also got infected, non of them actually developed symptoms because they were all vaccinated.
Diphtheria Is Still Around
Tragically though, especially since diphtheria is still endemic in many countries, we are starting to see occasional lethal cases of diphtheria in many more countries where it was previously under control:
at least 7 diphtheria deaths in Venezuela this past year
a family that became infected in South Africa in which at least one child died (August 2017)
an unvaccinated 3-year-old who died in Belgium (2016)
a 22-year-old unvaccinated women who died in Australia (2011)
It is even more tragic that diphtheria is not under control in so many more countries.
In 2016, the WHO reported that there were just over 7,000 cases of diphtheria worldwide. While that is down from the 30,000 cases and 3,000 deaths in 2000, thanks to improved vaccination rates, there is still work to be done.
And as this recent case in Canada shows, diphtheria is still around in many more places than we would like to imagine.
“Analyses showed that routine childhood immunization among members of the 2009 US birth cohort will prevent ∼42 000 early deaths and 20 million cases of disease, with net savings of $13.5 billion in direct costs and $68.8 billion in total societal costs, respectively.”
Zhou et al on Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009
Few of us remember the pre-vaccine era when there were polio and diphtheria hospitals and “pest houses” at the edge of town.
We don’t remember when outbreaks of vaccine-preventable diseases would close schools and these diseases were more deadly, not because they were more severe, but simply because they were more common.
Costs Associated With Getting Sick
If we don’t remember these diseases and outbreaks, we certainly don’t remember how much it cost to control and treat them.
We should though.
Just look at how much it costs to control the recent measles outbreaks that continue to plague us.
“The estimated total number of personnel hours for the 16 outbreaks ranged from 42,635 to 83,133 and 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.”
Ortega-Sanchez on The economic burden of sixteen measles outbreaks on United States public health departments in 2011
Not including the direct costs for outpatient visits and inpatient care, recent outbreaks have cost anywhere from $3,000 to $50,000 per case to contain. Why the difference? Localized outbreaks, like in a church group or among a single family, will be easier and less expensive to contain, as they will likely involve fewer contacts to track down to see if they were exposed and are already vaccinated.
Again, these costs don’t include the costs of going to your doctor or the ER because your child is sick, getting hospitalized, or lab tests, etc.
It also doesn’t include the costs associated with living under quarantine, which is happening in many of the recent outbreaks.
How do anti-vax folks usually counter this important message?
They typically say that taking care of a vaccine-injured child is expensive too. While that can be true, the problem is with their idea of what constitutes a vaccine injury. While vaccines are not 100% safe and they can rarely cause serious or even life-threatening reactions, most of what they describe as vaccine-induced diseases, from autism to SIDS, are not actually associated with vaccines.
The Value of Vaccination
So yes, getting vaccinated is cost effective.
“Cost-effectiveness analysis has become a standard method to use in estimating how much value an intervention offers relative to its costs, and it has become an influential element in decision making. However, the application of cost-effectiveness analysis to vaccination programs fails to capture the full contribution such a program offers to the community. Recent literature has highlighted how cost-effectiveness analysis can neglect the broader economic impact of vaccines.”
Luyten et al on The Social Value Of Vaccination Programs: Beyond Cost- Effectiveness
The value of getting vaccinated goes way beyond saving money though.
Most of the ways this has been studied in the past still leaves out a lot of important things, including:
increased productivity later in life following vaccination
vaccination-related benefits to macroeconomic factors and political stability
furthering moral, social, and ethical aims
Why are these important?
“Vaccination has greatly reduced the burden of infectious diseases. Only clean water, also considered to be a basic human right, performs better. Paradoxically, a vociferous antivaccine lobby thrives today in spite of the undeniable success of vaccination programmes against formerly fearsome diseases that are now rare in developed countries.”
Andre et al on Vaccination greatly reduces disease, disability, death and inequity worldwide
Although getting vaccinated is certainly cost-effective, that doesn’t erase the fact that vaccines are expensive.
If they weren’t so expensive, then we likely still wouldn’t have so many deaths from vaccine-preventable diseases in the developing world, where the problem is access to vaccines, not vaccine-hesitant parents.
“We conclude that the vaccination portion of the business model for primary care pediatric practices that serve private-pay patients results in little or no profit from vaccine delivery. When losses from vaccinating publicly insured children are included, most practices lose money.”
Coleman on Net Financial Gain or Loss From Vaccination in Pediatric Medical Practices
Parents should also be aware that vaccines are expensive for the average pediatrician too, who no matter what anti-vax folks may claim about bonuses, aren’t making much or any money on vaccinating kids.
And because vaccines work, pediatricians also don’t make as much money when vaccinated kids don’t get diarrhea and dehydration that is prevented by the rotavirus vaccine, recurrent ear infections that are prevented by Prevnar, or a high fever from measles, etc., all things that would typically trigger one or more office visits.
It should be clear that the only reason that pediatricians “push vaccines” is because they are one of the greatest achievements in public health.
A great achievement at a great value.
What to Know About the Cost Savings of Getting Vaccinated
There is no question that there is great value in getting fully vaccinated on time and that getting immunized is a very cost effective way to keep kids healthy.
You probably don’t know anyone who ever had polio.
The Last Case of Polio
After all, the United States has been free of polio since 1979. At least that’s when we had the last endemic case or the last case that originated here.
The last case was in 1993. At least that’s when we had the last imported case of polio in the United States.
A 2005 outbreak of vaccine derived poliovirus in 2005 among a group of unvaccinated Amish in Minnesota didn’t cause any symptoms. They had probably been exposed to someone outside the United States that was still shedding after getting an oral polio vaccine, which hadn’t been used in the United States since 2000.
And then there were these following “last cases:”
The last case of VAPP that was acquired in the United States – 1999.
The last case of VAPP that was acquired outside the United States – 2005 – an unvaccinated 22-year-old U.S. college student who became infected with polio vaccine virus while traveling in Costa Rica in a university-sponsored study-abroad program.
And then there is the final last case of VAPP – 2009 – a patient with a long-standing combined immunodeficiency who was probably infected in the late 1990s, even though she didn’t develop paralysis until years later.
Polio Survivor Stories
Since vaccines work and the United States has essentially been polio free since 1979, it wouldn’t be surprising if you don’t know anyone who ever had polio.
Or do you?
“The doctors told my parents that little could be done for me, so my father prepared for my funeral. Fortunately, I recovered, except for the use of my right hand.”
Archbishop Desmond Tutu on Vaccination’s Lifetime of Blessings
You might not have ever have even heard of anyone who had polio?
Or have you?
A few recent news stories highlight just how common polio used to be in the pre-vaccine era:
Mitch McConnell Wouldn’t Meet with the March of Dimes Even Though They Treated His Polio as a Child
Joni Mitchell – after the stuff about Morgellons, you can read about how she battled polio as a child
“When Joni turned 10 years old in late 1953, she woke up one morning paralyzed. It was quickly diagnosed and she was shipped to a polio colony in Saskatoon – similar to a leper colony designed to halt the spread of the disease.”