Tag: quarantines

Quarantine Signs for Vaccine-Preventable Diseases

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

Quarantine Sign

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

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

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

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

How long would quarantine last?

Usually through at least one incubation period for the disease.

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

Have you ever seen any of these quarantine signs?

If so, have you seen any of them lately?

That’s because vaccines work.

What to Know About Quarantine Signs for Vaccine-Preventable Diseases

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

More on Quarantine Signs for Vaccine-Preventable Diseases

The Unvaccinated Child

We know that your unvaccinated child is not healthier than vaccinated children.

And we know that among pediatric flu deaths, most are unvaccinated.

What else do we know about unvaccinated children?

Who’s Who Among Unvaccinated Children

Many children with cancer and other medical conditions benefit from herd immunity.
Many children with cancer and other medical conditions have medical exemptions to getting vaccinated and benefit from herd immunity. (CC BY 2.0)

Although it seems like unvaccinated kids all get grouped together, it is important to remember that not all unvaccinated kids are intentionally unvaccinated.

Some are too young to be vaccinated or fully vaccinated, some have medical exemptions, usually to just one or a few vaccines, and sometimes just temporary, and some have skipped or delayed one or more vaccines because of a lack of access to health care.

Whatever the reason, they are all at risk because they are unvaccinated.

The intentionally unvaccinated child poses the bigger risk though, because they tend to cluster together and are more likely to be either completely unvaccinated or to have skipped multiple vaccines. A child with a medical exemption because she is getting chemotherapy, on the other hand, very likely lives with a family who is completely vaccinated and protected. Similarly, a child with an allergy to a vaccine likely isn’t missing multiple vaccines.

Risks to the Unvaccinated Child

Of course, the main risk to the unvaccinated child is that they will get a potentially life-threatening vaccine-preventable disease.

While many vaccine-preventable diseases are no longer endemic in the United States and other developed countries, they have not been eradicated.

People do still get vaccine-preventable diseases in the United States.

And tragically, people do still die of vaccine-preventable diseases in the United States.

Can’t you just hide in the herd, depending on everyone else to be vaccinated and protected to keep these diseases away from your unvaccinated child? While that ends up being what happens most of the time, as there are no real alternatives to getting vaccinated, that strategy doesn’t always work. And it is a gamble that’s not worth taking and won’t keep working if more parents skip or delay getting their kids vaccinated.

Risks of the Unvaccinated Child to Everyone Else

Unvaccinated kids are also a risk to those around them, as they are more likely to get sick with a vaccine-preventable disease, since they have no immunity. No, they are not an instant danger if they don’t actually have a vaccine-preventable disease, but since you can be contagious a few days before you have symptoms, you are not always going to know when your child is sick and a risk to others.

Why does that matter if everyone else is vaccinated and immune?

Well, obviously, everyone else is not vaccinated and immune, including those with medical exemptions and those who are too young to be vaccinated. And since vaccines aren’t perfect, some people who are vaccinated can still get sick.

That’s why it is critical that if your unvaccinated child is sick or was exposed to someone who is sick, you are sure to:

  • notify health professionals about your child’s immunization status before seeking medical attention, as they will likely want to take precautions to keep you from exposing others to very contagious diseases like measles, mumps, and pertussis
  • follow all appropriate quarantine procedures that may have been recommended, which often extends up to 21 days after the last time you were exposed to someone with a vaccine-preventable disease
  • seek medical attention, as these are not mild diseases and they can indeed be life-threatening, even in this age of modern medicine

Hopefully you will think about all of these risks before your unvaccinated child has a chance to sick.

Getting Your Unvaccinated Child Caught Up

Fortunately, many unvaccinated kids do eventually get caught up on their vaccines.

It may be that they had a medical exemption that was just temporary and they are now cleared to get fully vaccinated.

Or they might have had parents who were following a non-standard, parent-selected, delayed protection vaccine schedule, but they have now decided to get caught up to attend daycare or school.

Others get over their fears as they get further educated about vaccines and vaccine myths and decide to get caught up and protected.

Is it ever too late to get vaccinated?

Actually it is.

In addition to the fact that your child might have already gotten sick with a particular vaccine preventable diseases, some vaccines are only given to younger kids.

For example, you have to be less than 15 weeks old to start the rotavirus vaccine. And you should get your final dose before 8 months. That means that if you decide to start catching up your fully unvaccinated infant at 9 months, then you won’t be able to get him vaccinated and protected against rotavirus disease. Similarly, Hib vaccine isn’t usually given to kids who are aged 5 years or older and Prevnar to kids who are aged 6 years or older, unless they are in a  high risk group.

Still, you will be able to get most vaccines. And using combination vaccines, you should be able to decrease the number of individual shots your child needs to get caught up. An accelerated schedule using minimum age intervals is also available if you need to get caught up quickly.

You should especially think about getting quickly caught up if there is an outbreak in your area or if you are thinking about traveling out of the country, as many vaccine-preventable diseases are still endemic in other parts of the world.

What to Know About The Unvaccinated Child

The main things to understand about the unvaccinated child is that they aren’t healthier than other kids, are just at more risk for getting a vaccine preventable disease, and should get caught up on their vaccines as soon as possible.

More on The Unvaccinated Child

The Value and Cost Savings of Getting Vaccinated

We often hear a lot about the benefits of vaccines.

Even the schools were closed in San Antonio when polio came to Texas in 1946.
How much would it cost to close all of the schools in a big city today?

Well, most of us do.

But can getting vaccinated really help save us money?

Cost Savings of Getting Vaccinated

Vaccines are expensive, so it probably doesn’t make a lot of sense to many people that saving money is one of the big benefits of getting vaccinated.

That’s just because vaccines work so well.

“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.

Getting sick is expensive.

How much is a liver transplant?

How much does it cost to treat someone with cervical cancer?

How much does it take to care for a child with congenital rubella syndrome?

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
  • improved cognitive and educational outcomes
  • community-level health gains through herd effects
  • prevention of antibiotic resistance
  • 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

If you are making a decision to get vaccinated vs. trying to hide in the herd, you want to have all of the information about the benefits of vaccines, not just about the risks, or what you might think are risks.

Vaccines Are Expensive

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.

More on the Cost Savings of Getting Vaccinated

When Measles Epidemics Would Close Schools

Remember when measles epidemics and outbreaks used to close down entire schools and school districts?

No, I don’t either, but of course, like many of us, I’ve been fortunate enough to have grown up in the post-vaccine era for measles and many other vaccine-preventable diseases.

When Measles Epidemics Would Close Schools

Schools in California were closed for at least two weeks in 1917 because of measles epidemics.
Schools in California were closed for at least two weeks because of measles epidemics. Red Bluff Daily News, April 14, 1917

On April 16, 1917, as measles epidemics swept the United States, grammar schools in Red Bluff, California would shut down for at least two weeks.

Why?

Officials found that it was “impossible to cope with measles under present conditions” and they hoped this would help end the epidemic.

The city board of health also urged parents to “use every effort to stamp out the spread of the disease by keeping children at home, by having no child attend picture shows or even Sunday schools.”

This was hardly an isolated event though. School officials in Los Molinos and Redding, California had closed their high school and all grammar schools in late March for two weeks in the hopes “that the disease will wiped out in that time.”

Why the big push to end the outbreaks?

As experts warned that measles dangers were “too generally disregarded” by some, they also knew that “over 11,000 American children died of measles in 1910” and that “this did not include a large number who died of broncho-pneumonia.”

Tragically, there were many deaths in the 1917 measles epidemic too.

In nearby Chico, California, a mother and her 8-year-old died on the same day, while seven other family members were seriously ill and it was stated that “little hope is held for their recovery.”

Schools in Red Bluff didn’t open again until May 7, when finally the “epidemic of measles seems to have lessened its grip.”

Measles Were Never Marvelous

Some folks like to use the fact that there was a Brady Bunch episode about measles to make it seem like it was a mild disease.

If that’s true, then why do old newspaper clippings describe the “scourge of measles” and repeatedly warn how deadly it can be?

“Measles is often fatal to children under five years of age and on this account, special protection should be given to very young children. It is a mistake to expose a child to the disease so that he may “get ’em and have ’em over with.” The after results may effect the health of the individual all through his life.”

Red Bluff Daily News, Epidemic Measles Is Sweeping Over State California

Why were schools closed for three weeks?

Why did so many people die?

While some folks will blame it on a lack of modern medical care, poor nutrition, or poor sanitation back in the early 20th Century, you don’t have to go back that far to find reports of a lot of people dying of measles in the United States.

Even as improved nutrition, sanitation, and health care made many things less deadly, in the pre-vaccine era, in the late-1950s, there were about 450 measles deaths each year in the United States.

A measles epidemic hit New York City in 1951, as this front page NYTimes article reports.
A measles epidemic hit New York City in 1951, as this front page NYTimes article reports.

And at a time of modern nutrition, sanitation, and health care, at least 123 people died in the United States during the large measles epidemic from 1989 to 1991. Another 11,000 were hospitalized, among only about 55,000 cases.

“Two major causes of this epidemic were vaccine failure among a small percentage of school-aged children who had received 1 dose of measles vaccine and low measles vaccine coverage among preschool-aged children”

Dr. Walter Orenstein on the 1989-91 Measles Epidemics

Instead of “mild,” during the 1989-91 epidemics, you were more likely to hear terms like measles “emergency alert,” “Real Crisis Situation,” and “serious problem.”

Measles Still Keeps Kids From School

Fortunately, measles doesn’t close schools anymore. But not because measles has become more mild or easier to treat, after all, there is still no treatment for measles, but rather because most folks are vaccinated.

It can still lead to quarantines for those who aren’t vaccinated though. It is one of the ways that health officials work to control outbreaks.

During the Disneyland measles outbreak in California in 2015, a day care center in Santa Monica was closed (and 30 babies were put in home quarantine) and kids were kept from school at:

  • Amelia Earhart Middle School in Riverside – at least 6 unvaccinated students were kept from school after another student contracted measles
  • Palm Desert High School – 66 students were excluded from school because they are not fully vaccinated against measles
  • Huntington Beach High School – at least 24 unvaccinated students were excluded from school

But you don’t even have to go back that far to find these types of quarantines. In March, an unvaccinated student with measles led to the quarantine and exclusion of 7 other unvaccinated students from Laguna Beach High School in Orange County, California.

But a three week ‘vacation’ is hardly the worse thing that can happen when a measles outbreak comes to town. Measles is still deadly, even today.

Get educated and get vaccinated.

What To Know About When Measles Epidemics Would Close Schools

While you likely don’t remember when large epidemics of measles would close schools, it’s a reminder that measles wasn’t thought of as the mild disease that some claim it was.

More Information About History of Measles Epidemics

Is the Chicken Pox Vaccine Creating a Shingles Epidemic?

Once upon a time, with no treatment or vaccine, families would just be quarantined when they had chicken pox.
Once upon a time, with no treatment or vaccine, families would just be quarantined when they had chicken pox. Photo by Howard Liberman.

Shingles is a reactivation of a past chicken pox infection, so both are caused by the same varicella-zoster virus (VZV).

While chicken pox rates are decreasing, as more and more children are vaccinated and protected with the chicken pox vaccine, it is true that we are seeing a rise in shingles cases.

Is the Chicken Pox Vaccine Creating a Shingles Epidemic?

There is actually a plausible theory for why routine use of the chicken pox vaccine could cause a rise in shingles cases in adults.

“Some experts suggest that exposure to varicella boosts a person’s immunity to VZV and reduces the risk for VZV reactivation. Thus, they are concerned that routine childhood varicella vaccination, recommended in the United States in 1996, could lead to an increase in herpes zoster in adults due to reduced opportunities for being exposed to varicella. ”

CDC – Shingles Clinical Overview

And that is why some countries, like the UK, haven’t added the chicken pox vaccine to their routine immunization schedule yet.

There are problems with that theory though, including that:

  • we started seeing a rise in rates of shingles in the US before we even started giving the chicken pox vaccine
  • the rise in shingles cases did not increase after we started giving the chicken pox vaccine
  • other countries that do not routinely give the chicken pox vaccine, like the UK, are seeing  similar trends and increases in shingles cases

So while anti-vaccine folks continue to blame the chicken pox vaccine for a rise in shingles, it has been proven again and again that the chicken pox vaccine is not creating a shingles epidemic.

“Among children aged <10 years during 2000-2006, those with a history of varicella vaccination had a 4 to 12 times lower risk for developing herpes zoster compared with children with history of varicella disease.”

Varicella Active Surveillance Project

If anything, since vaccinated children are thought to have a lower risk of shingles than those with natural immunity, it will hopefully lead to a decrease in cases of shingles in the future.

What To Know About The Chicken Pox Vaccine and Shingles Trends

The chicken pox vaccine is not creating a shingles epidemic and will likely help kids be at less risk of shingles later in life as compared to those with natural immunity.

More Information on Trends of Shingles and Chicken Pox