Tag: polio outbreaks

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

Why Do Anti-Vax Folks Get Excited About Polio Outbreaks?

At least two things happen whenever we hear about a new polio outbreak. And yes, I said polio outbreak.

One is that many people assume it is wild polio and that we are moving further away from finally eradicating polio.

Hopefully folks understand that polio outbreaks wouldn't just stop if we stopped vaccinating...
Hopefully folks understand that polio outbreaks wouldn’t just stop if we stopped vaccinating…

And the other?

Anti-vax folks assume that it is an outbreak of vaccine strain polio and very wrongly use this as a reason to try and scare parents away from vaccinating and protecting their kids.

“The polio outbreak in the Philippines is confirmed to be from a circulating vaccine-derived poliovirus type 2. This is of particular concern, as wild poliovirus type 2 was certified as globally eradicated in 2015. Poorly conducted immunization activities, when too few children have received the required three doses of polio vaccine, leave them susceptible to poliovirus, either from vaccine-derived or wild polioviruses. Full immunization protects them from both forms of the virus.”

WHO, UNICEF and partners support Philippine Department of Health’s polio outbreak response

As expected, that’s the response we are seeing from anti-vax folks to news of the latest outbreak of polio in the Philippines.

Why Do Anti-Vax Folks Get Excited About Polio Outbreaks?

But isn’t bad that the polio vaccine can actually cause outbreaks?

Of course!

No one wants people to get sick after getting vaccinated. And that’s why we are moving towards stopping the use of the oral polio vaccine that causes vaccine derived polio.

It is also very important to consider the alternative. A lot more people getting wild 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

We also need to remember the reason we typically see outbreaks of vaccine strain polio. It is because vaccination rates have dropped in an area!

Wait, what?

Yes, that’s right. The polio vaccine, in addition to protecting you from wild polio can prevent you from getting the vaccine strain polio too.

But isn’t the polio vaccine causing many more cases of polio than the actual polio virus?

Bob Sears recently shared an article that was two years old about mutant strains of polio causing outbreaks

It once was, but that’s simply because we are getting very close to eradicating polio and there were fewer cases of wild polio!

While there were far more cases of vaccine derived polio than wild polio last year, there were more cases of wild polio earlier in 2019 and it is now about even.

Tragically, we are starting to see more and more cases of wild polio.

Science event in Washington, D.C. reminding folks that Vaccines Work.
Pediatricians at the March for Science event in Washington, D.C. reminding folks that Vaccines Work.

Still, we are no where near the numbers of cases of polio and kids getting paralyzed when polio was epidemic in most countries.

And the outbreaks of vaccine derived polio?

They demonstrate what happens when we don’t keep up our immunization rates. And how anti-vax folks either don’t understand or intentionally try to misinform parents about how vaccines work.

More on Polio Outbreaks

Why Do We Still Vaccinate If Polio Has Been Eliminated?

It’s true, polio has been eliminated in the United States.

Are these folks serious with this anti-vaccine nonsense?
Are these folks serious with this anti-vaccine nonsense?

But that doesn’t mean that we can stop vaccinating kids against polio yet.

Why Do We Still Vaccinate If Polio Has Been Eliminated?

For one thing, the last polio case in the United States was a lot more recent than 40 years ago.

What happened 40 years ago?

That was when we had the last endemic case of polio in the United States, in 1979. After that, in addition to cases of VAPP, there were at least 6 cases of imported paralytic poliomyelitis. In fact, the last case of wild polio in the United States was in 1993, just 26 years ago.

And just ten years ago, in 2009, was the very last case of VAPP, 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.

But still, why couldn’t we stop vaccinating against polio in the United States, even though polio isn’t eradicated yet? After all, we stopped using the smallpox vaccine in 1972, before smallpox was declared eradicated (1980).

While that is true, smallpox isn’t as contagious as polio and there hadn’t been a case of smallpox in the United States for over 30 years when we stopped using the vaccine.

Until wild polio is eradicated and the oral polio vaccine isn’t used anymore (OPV switch), we must continue to vaccinate against polio to prevent new outbreaks.

That is the polio eradication and endgame strategic plan.

Over the next few years, the world will hopefully switch to using just the injectable form of the polio vaccines, which eliminates the risk of VAPP.

But if we are so close, why not just stop vaccinating in those parts of the world that don’t have polio?

Because we are so close to eradicating polio.

Why take the risk of polio spreading from one of the remaining endemic countries, paralyzing kids, and putting eradication efforts further behind?

Should we stop vaccinating kids because anti-vaccine folks are pushing misinformation about DDT, renamed diseases, or vaccine induced diseases?

Of course not!

Vaccines are safe, effective, and necessary.

Let’s continue the work and eradicate polio, once and for all!

And for the record – we don’t pump “kids full of polio” when we give them a polio vaccine. The polio shot is an inactivated vaccine, so doesn’t contain live polio virus.

More on Why Do We Still Vaccinate If Polio Has Been Eliminated?