Tag: polio outbreaks

January 18 – This Day in Vaccine History

Would folks be more likely to get vaccinated and protected if they remembered what it was like in the pre-vaccine era?

Since anti-vaccine folks like to make it sound like cancer, heart disease, kidney disease, and everything else are caused by vaccines, will they be surprised to know that in addition to now vaccine-preventable diseases, they were big killers in the pre-vaccine era?
Since anti-vaccine folks like to make it sound like cancer, heart disease, kidney disease, and everything else are caused by vaccines, will they be surprised to know that in addition to now vaccine-preventable diseases, they were big killers in the pre-vaccine era?

A lot of people died of diseases that are now vaccine-preventable, and no, you can’t simply thank better hygiene and nutrition instead of vaccines for saving all of those lives.

A lot of people were still getting smallpox in 1920.
A lot of people were still getting smallpox in 1920.

Since the smallpox vaccine has been around for hundreds of years, can you believe that people were still getting and dying of smallpox 100 years ago?

How about 50 years ago?

January 18, 1970 - everyone was excited about all of the progress that was being made in getting smallpox under control.
January 18, 1970 – everyone was excited about all of the progress that was being made in getting smallpox under control.

That’s hard to imagine, isn’t it, as it was long known how to control smallpox with quarantines and vaccination.

On January 18, 1870, the Chicago Tribune described how Chicago was getting smallpox under control - by getting folks vaccinated.
On January 18, 1870, the Chicago Tribune described how Chicago was getting smallpox under control – by getting folks vaccinated.

Still, it took a long time before smallpox was finally declared eradicated.

And with smallpox under control, fifty years ago, many communities were eager to get kids vaccinated and protected to stop measles.

This paper in Nebraska announced "Stop Measles Day" on January 18, 1970.
This paper in Nebraska announced “Stop Measles Day” on this day in vaccine history – January 18, 1970.

Something changed once we got these diseases under control though.

Can you guess what it was?

Todd Wiley was convicted of manslaughter for shaking his child, but his “DPT defense” made the papers for months, including this article on January 18, 1995.

There were more and more vaccine scare stories in the media. Initially they were about the DPT vaccine and they then moved on to MMR once Andrew Wakefield hit the scene.

The Disneyland measles outbreak was well underway on January 18, 2015.

And even though none of the stories were true, that didn’t stop them from influencing people.

Have we learned our lesson?

Do we need to repeat history?

Vaccines are safe, with few risks, and are obviously necessary.

Anti-vax groups are raising money in Maine and elsewhere to influence parents and politicians and new vaccine laws.
Anti-vax groups are raising money in Maine and elsewhere to influence parents and politicians and new vaccine laws.

Vaccinate and protect your kids. Don’t bring back these deadly diseases.

More on History of Vaccines

Are More Polio Cases Now Being Caused by the Vaccine Than by Wild Polio Viruses?

Why would people think that more polio cases are now being caused by the vaccine than by wild polio viruses?

More polio cases are now being caused by the vaccine than by wild polio viruses.

Well, it’s true…

Are More Polio Cases Now Being Caused by the Vaccine Than by Wild Polio Viruses?

Wait, what?

“It is no exaggeration to describe it as a crisis. Even worse, looking more widely at the current state of polio eradication, the crisis has three peaks: the first is the level of wild polioviruses in Pakistan; the second is the way that the escalating restrictions in access in Afghanistan have created a huge immunity gap; and the third peak is the widespread occurrence of vaccine-derived polioviruses.”

Independent Monitoring Board 17th Report

Yes, as we are getting close to eradicating polio, we had been seeing fewer and fewer cases of wild polio in the world.

“In rare cases, the live virus in oral polio vaccine can mutate into a form capable of sparking new outbreaks.”

Report raises concern about rare polio cases caused by oral vaccine

And we have been seeing more cases of vaccine-derived polio, which is rarely caused by the oral polio vaccine.

Fortunately, something that most folks miss is that the polio vaccine protects against both wild polio and vaccine-derived polio.

“As recently as 30 years ago, wild poliovirus paralysed more than 350,000 children in more than 125 countries every year. In 2018 there were fewer than 30 reported cases in just two countries – Afghanistan and Pakistan.”

“Zero polio transmission and health for all”, WHO Director-General gives new year’s wish to the people of Afghanistan and Pakistan

And of course, if we weren’t using these polio vaccines, while that would solve the problem of vaccine associated polio, we would simply be seeing lots more wild polio.

More polio cases are now being caused by the vaccine than by wild polio viruses.

Even though cases of wild polio are up this year, after years of decline, they are still tremendously below what they were in the pre-vaccine era.

Remember, we are comparing about 300 cases of wild and vaccine-derived polio that we see today with more than 300,000 of wild polio that we used to see!

“Global efforts to immunise children with the oral polio vaccine (OPV) have reduced wild poliovirus cases by 99.9% since 1988.”

Fact Sheet: Vaccine-Derived Poliovirus

And even those 300 cases of wild and vaccine-derived polio cases can be eliminated if more kids get vaccinated.

“Today, global leaders convened at the Reaching the Last Mile (RLM) Forum in Abu Dhabi to affirm their commitment to eradicate polio and pledge US$2.6 billion as part of the first phase of the funding needed to implement the Global Polio Eradication Initiative’s Polio Endgame Strategy 2019-2023.”

Global leaders pledge US $2.6 billion to eradicate polio at the Reaching the Last Mile forum in Abu Dhabi

And we will get those kids vaccinated.

“Fourthly, rumours and deliberate social media seeding of misinformation about the polio vaccine has had a big impact on refusal rates. Fifthly, organised boycotts of the Polio Programme to gain political concessions have reduced some communities’ acceptance of the polio vaccine.”

Independent Monitoring Board 17th Report

And we will eradicate polio.

More on Polio Eradication

About That Amish Vaccine Exemption Lawsuit in New York

An Amish family has filed a lawsuit against a new vaccine law in New York that eliminated religious vaccine exemptions.

An Amish family has filed a lawsuit against a new vaccine law in New York that eliminated religious vaccine exemptions.

Folks who know that Amish do indeed vaccinate their kids are likely surprised by the lawsuit…

About That Amish Vaccine Exemption Lawsuit in New York

Wait, what?

The Amish vaccinate their kids?

While many Amish don’t vaccinate according to the recommended CDC schedule and get all vaccines, many do get at least some of them.

For example, when a large measles outbreak went through Amish communities in Ohio, many got in line to get vaccinated and stop the outbreak, which ended up getting at least 383 people sick.

That wasn’t the only outbreak among the Amish though.

Remember the last cases of wild polio in the United States?

“The 1979 outbreak occurred in unvaccinated Amish persons living in Iowa, Missouri, Pennsylvania, and Wisconsin. Overall, 15 cases of illness caused by wild poliovirus type 1 occurred among U.S. citizens: all 10 paralytic cases occurred among unvaccinated Amish persons; three cases of transient paralysis occurred among unvaccinated Amish persons; and two nonparalytic cases occurred among unvaccinated members of the Mennonite church who were in frequent contact with Amish persons. Epidemiologic and virologic evidence indicated this outbreak resulted from importation of poliovirus from the Netherlands through Canada (Ontario), where outbreaks had occurred during 1978 in members of religious groups with objections to vaccination.”

Poliomyelitis — United States, Canada

It was in 1979.

It was among the Amish.

And many Amish got vaccinated to help eliminate the endemic spread of polio in the United States.

“Immunization campaigns for the Amish are continuing; at least half of the nation’s Amish have now received 1 or more doses of oral poliovirus vaccine.”

Poliomyelitis — United States, Canada

So the Amish are clearly not against vaccines.

In 2004, there was an outbreak of pertussis (345 cases) in an Amish community in Kent County, Delaware.

“Of the 96 households interviewed in which a pertussis case was discovered, a total of 43 (45%) reported not vaccinating any children in their household, 40 (42%) households reported vaccinating at least some children, and 13 (14%) did not provide this information. Of the 43 households not vaccinating children, 19 cited “fear of side effects” as the reason, 13 reported that they “didn’t think about it,” and 11 did not provide specific reasons for nonvaccination. Of the 40 respondents who reported that their children had received vaccinations, 29 (64%) reported vaccination at vaccine clinics set up at Amish homes by DPH nurses.”

Pertussis Outbreak in an Amish Community — Kent County, Delaware, September 2004–February 2005

Although many of the kids weren’t vaccinated, religion didn’t seem to be what drove that decision.

“Religious factors and access to care were not among reasons most reported. “

Kettunen et al on Evaluation of low immunization coverage among the Amish population in rural Ohio.

It is usually fear, rather than religion that keeps the Amish from vaccinating and protecting their kids.

“The findings from the data analysis demonstrated that fear, especially concern over too many recommended immunizations and immunizations overwhelming the child’s system, was the most frequent reported reasons for not having children immunized according to recommendations.”

Kettunen et al on Evaluation of low immunization coverage among the Amish population in rural Ohio.

Unfortunately, this has meant that their children get a high rate of vaccine preventable diseases and that they end up getting hospitalized at higher rates than other children.

“The outcome of pregnancy was determined for the 94 Amish mothers who reported illness or had serologic evidence of maternal rubella (Table 1). CRS occurred in 10 infants, all of whom were born to mothers who had histories of rubella-like illness in the first trimester; seven had possible manifestations of CRS; nine were miscarried/stillborn; and 68 infants appeared normal at birth. During the study period, medical personnel identified one additional infant with CRS from Lancaster County whose mother was a conservative Mennonite. “

Congenital Rubella Syndrome Among the Amish — Pennsylvania, 1991-1992

So not only do the Amish get sick, they get sick for the same reason as typical anti-vaxxers – misinformation and fear of vaccines.

Is that what’s driving this lawsuit in New York?

I don’t know, but if it was just about religion, why does it include typical anti-vaccine talking points about:

  • fetal DNA contaminating our vaccines
  • that unvaccinated children were not responsible for the 2018-19 NYS measles outbreak, going so far as to cite an affidavit from Lawrence Palevsky, who said that “a measles infection in first world countries such as the United States, in 2019, is not deadly.”
  • how the 2018-19 NYS measles outbreak might not have been “true wild-type measles infections.”
  • that the theory of herd immunity is flawed
  • that vaccinated children pose more of a risk to other vaccinated children than the unvaccinated

More than anything though, how can the lawsuit say that New York’s vaccine law unreasonably burdens his “sincere religious beliefs without a compelling state interest,” when we know that the Amish aren’t really against vaccinating and protecting their kids?

You have to wonder what method his lawyer’s used to pick their “examples” of schools with religious exemptions.

About that compelling state interest…

As many parents have come to abuse religious exemptions, using them as personal belief exemptions, we have ended up in a situation in which over 30 schools in New York had religious exemptions rates of at least 50%, including 14 schools in which each and every student had a religious exemption for all vaccines.

All that even though no major religion is against vaccines!

With such a weak case, forum shopping might be his only strategy that could work…
With such a weak case, forum shopping might be his only strategy that could work…

What happens next?

More court stuff, but in the end, it hopefully means that more kids will be vaccinated and protected and we will #StopTheOutbreaks.

More on the Amish and Vaccines

Are Kids With Religious Exemptions Spreading Disease?

One common anti-vax talking point is that kids who are unvaccinated can’t spread disease because they aren’t sick. One lawsuit against New York’s new vaccine law went so far as to say that “there has not been one instance of a child with a religious exemption spreading disease in a school.”

Did Assemblymember Colton look for evidence?

Is that true?

I’m guessing it isn’t, but let’s do a little research…

Are Kids With Religious Exemptions Spreading Disease?

Before I considered the latest measles outbreak in New York and how many of those cases occurred in unvaccinated kids in school with religious exemptions, I found a few other examples.

“During April 4-May 17, 1994, the largest U.S. measles outbreak since 1992 occurred among students in two communities that do not routinely accept vaccination. This report summarizes the investigation of and control measures for this outbreak. The outbreak began in a 14-year-old Christian Science high school student who developed a rash on April 4, 2 weeks after skiing in Colorado where a measles outbreak was occurring. The student lived with her family in a community associated with a Christian Science college in Jersey County, Illinois, and commuted approximately 30 miles to a Christian Science boarding school (kindergarten through grade 12 {K-12}) in St. Louis County, Missouri.”

Outbreak of Measles Among Christian Science Students — Missouri and Illinois, 1994

At least 189 people got measles in these communities during this outbreak, including a student in New York.

“Eighteen prospective students from outside St. Louis County attended a carnival at the boarding school on April 16; eight developed measles after returning home (three to Maine, two to California, and one each to Missouri, New York, and Washington).”

Outbreak of Measles Among Christian Science Students — Missouri and Illinois, 1994

During another measles outbreak among Christian Scientists in 1985 in Illinois, there were at least 136 cases, including 3 deaths.

There were even more deaths during a measles outbreak in Philadelphia in 1991.

“According to Assistant Health Commissioner Robert Sharrar, four victims from Philadelphia – two girls 9 years old and two girls 11 and 13 – were affiliated with the Faith Tabernacle Congregation, which shuns medical treatment. The children, who attended the church’s school, had not been vaccinated. “

Philadelphia’s Measles Death Toll Rises

By the end of the 1991 Philly outbreak, 9 children were dead.

Back to New York, during a 2009 mumps outbreak in New York and New Jersey, even though many were vaccinated, “the outbreak primarily has affected members of a tradition-observant religious community.”

Are there any other examples?

Four children in Florida with a religious exemption developed measles in 2012 and although they didn’t get anyone at school sick, they did likely expose someone at an Orlando-area theme park who did later get sick.

Also in Florida, in 2013, in a charter school where 84% of kids had religious exemptions, 316 students developed pertussis, with attack rates of 57%!

What’s the usual attack rate for pertussis?

In another Florida outbreak in 2013, this one at a preschool, attack rates ranged from 23% for kids who were up-to-date on their pertussis vaccinations to 40% if they had fewer than three doses of a pertussis vaccine.

At the Asheville Waldorf School in North Carolina, at least 36 students got sick with chickenpox in 2018. The school had the highest rate of religious exemptions in the state.

And there was an outbreak in Alaska linked to religious exemptions.

“Among the 30 who were not vaccinated, 24 (80%) were eligible to be vaccinated (i.e., aged ≥ 12 months and born on or after January 1, 1957); of the 24 who were eligible to be vaccinated, all 12 school-aged children had religious exemptions, and two of nine children aged 1–4 years were siblings of these unvaccinated schoolchildren. Although no source case was identified, this outbreak coincided with a measles outbreak associated with the Seattle-Tacoma (Washington) airport, the major airport gateway to Juneau.”

Measles Outbreak Among School-Aged Children — Juneau, Alaska, 1996

Remember the last imported case of vaccine associated paralytic polio?

In 2005, an unvaccinated 22-year-old U.S. college student from Arizona became infected with polio vaccine virus while traveling in Costa Rica in a university-sponsored study-abroad program. She had never been vaccinated because she had a religious exemption.

How about the last cases of wild polio in the United States?

“The 1979 outbreak occurred in unvaccinated Amish persons living in Iowa, Missouri, Pennsylvania, and Wisconsin. Overall, 15 cases of illness caused by wild poliovirus type 1 occurred among U.S. citizens: all 10 paralytic cases occurred among unvaccinated Amish persons; three cases of transient paralysis occurred among unvaccinated Amish persons; and two nonparalytic cases occurred among unvaccinated members of the Mennonite church who were in frequent contact with Amish persons. Epidemiologic and virologic evidence indicated this outbreak resulted from importation of poliovirus from the Netherlands through Canada (Ontario), where outbreaks had occurred during 1978 in members of religious groups with objections to vaccination.”

Poliomyelitis — United States, Canada

It was in 1979.

It was among the Amish and may have been linked to religious exemptions, although many Amish got vaccinated to help eliminate the endemic spread of polio in the United States.

Before that, in 1972, there was an outbreak of paralytic polio at Daycroft, a Chris­tian Science boarding school in Greenwich, Connecticut. At least 12 students, all unvaccinated, were affected in the first polio epidemic in the US in seven years.

11 kids got paralytic polio at a Christian Science school in 1972.

Also among the Amish, an outbreak of rubella and congenital rubella syndrome in 1991, including 16 cases in New York.

“The outcome of pregnancy was determined for the 94 Amish mothers who reported illness or had serologic evidence of maternal rubella (Table 1). CRS occurred in 10 infants, all of whom were born to mothers who had histories of rubella-like illness in the first trimester; seven had possible manifestations of CRS; nine were miscarried/stillborn; and 68 infants appeared normal at birth. During the study period, medical personnel identified one additional infant with CRS from Lancaster County whose mother was a conservative Mennonite. “

Congenital Rubella Syndrome Among the Amish — Pennsylvania, 1991-1992

There have also been cases of tetanus among the Amish.

“In 1997 a 12-year-old Amish boy in Pennsylvania contracted tetanus. His medical bills were $600,000. The Amish community refused to apply for Medicaid because of their religious opposition to accepting government assistance and were able to pay only $60,000 of the bill.”

Some Outbreaks of Vaccine-Preventable Disease in Groups with Religious or Philosophical Exemptions to Vaccination

More recently, the measles outbreaks in New York occurred almost exclusively among completely unvaccinated children, including many school aged children.

“Persons who claim exemptions from immunizations for any reason may be at increased risk of contracting a VPD compared with immunized persons. In addition, persons who claim philosophical and/or religious exemptions (exemptors) may create some risk to the community because unvaccinated or undervaccinated persons may be a source of transmission.”

Salmon et al on Health Consequences of Religious and Philosophical Exemptions From Immunization Laws

Remember diphtheria?

You probably think that it has been a long, long time since a child has died from diphtheria in the United States, especially since we have had an effective vaccine for well over one hundred years.

Well, it has been a long time since anyone who was vaccinated has died…

Tragically, in 1982, a 9-year-old girl died after getting diphtheria at a Christian Science camp in Colorado.

Even more recently, an unvaccinated 4-year-old boy died in Massachusetts died with diphtheria. His mother was a Christian Scientist.

It should be very clear that kids with non-medical exemptions, including religious exemptions, are getting sick and are spreading disease.

We should have acted in 2007, instead of waiting for more and more kids to get sick in outbreaks, as non-medical exemptions to continued to increase.
We should have acted in 2007, instead of waiting for more and more kids to get sick in outbreaks, as non-medical exemptions to continued to increase.

Increasing in the post-Wakefield era, religious exemptions from immunizations put our kids at risk.

More on Kids With Religious Exemptions Spreading Disease