Tag: quarantines

A Legislative Guide to Advocating for Stronger Vaccine Laws

Having to get vaccinated to attend school isn’t a new idea.

In 1827, Boston mandated that all children attending public school must receive the smallpox vaccine.

Believe it or not, it wasn’t until the 1980-81 school year that there were laws in all 50 states mandating that children receive vaccinations before starting school. The smallpox vaccine wasn’t one of them…

A Legislative Guide to Advocating for Stronger Vaccine Laws

Not surprisingly, as vaccines did their job and rates of vaccine-preventable diseases dropped, politicians were able to weaken our vaccine laws.

Over just a few years, from 1998 to 2000, 15 states added personal belief vaccine exemptions!

We are now paying the price, with increases of vaccine-preventable diseases among clusters of intentionally unvaccinated children whose parents claim non-medical vaccine exemptions.

And that’s why we are seeing more and more states work to strengthen their vaccine laws.

Legislators who want to combat vaccine exemption abuse should enact laws that make it clear that:

  • medical exemptions are based on ACIP guidelines, current accepted medical practice, and evidence-based medicine – not anecdotes
  • medical exemptions should be reviewed and approved by the State Epidemiologist, Deputy State Epidemiologist, or other designated professionals at the health department
  • religious exemptions, if included at all, should specifically exclude philosophical exemptions and must reflect a sincere religious belief
  • philosophical exemptions, if included at all, should require some degree of education against the myths and misinformation that scares parents away from vaccinating their kids
  • exempted students will be excluded from school during outbreaks
  • exemptions should include a signed affidavit that is notarized
  • exemptions should be recertified each year
  • most exemptions are temporary
  • a separate exemption application should be required for each vaccine
  • exemption rates should be tracked at the school level and should be posted on school websites

Getting an exemption shouldn’t be easier than getting vaccinated!

Become an advocate and help get more kids vaccinated. You can also help stop bad vaccine laws from being enacted in your state, including some that would make it even easier to get an exemption.

More on A Legislative Guide to Stronger Vaccine Laws

What is the Natural Immunity Model?

It’s becoming a little clearer why some folks think it is safe to not vaccinate their kids, leaving them at risk to get vaccine-preventable diseases.

Who's calling the measles outbreaks a national emergency?
Who’s calling the measles outbreaks a national emergency?

Their idea of a natural immunity model of getting disease simply involves hiding in the herd and any outbreaks they trigger magically stopping.

What is the Natural Immunity Model?

Bob Sears thinks he has exposed some big news, that not everyone who gets measles dies.

Fortunately, that’s very true and something folks have always known.

With a death rate of about 1 in 1000 cases, you wouldn’t expect to have had any deaths after just 50 or 60 cases. But you never know. It’s not like every 1000th case dies. It could be the second case, the 562nd, or the 3043rd.

The hospitalization rates work the same way. They are statistical averages of what typically happens when people get measles.

That’s why measles was once called a “harmless killer.” It is often harmless, if you call having a high fever and feeling miserable for a week harmless, but it is sometimes a killer.

So is what we are seeing in Washington “what an outbreak looks like with the natural immunity model,” when no one is vaccinated and protected?

Of course not!

In a natural immunity model, up to 90% of the people who are exposed to someone with measles get sick!

In the pre-vaccine era, everyone got measles. That's the natural immunity model.
In the pre-vaccine era, everyone got measles. That’s the natural immunity model.

In a natural immunity model, everyone gets measles.

Not everyone survives having measles though.

Remember, the last measles death in the United States was during a 2015 outbreak in Washington. A immunocompromised women got caught up in an outbreak of mostly unvaccinated people, got measles, and died.

That’s the natural immunity model.

This family didn't have a choice about their son getting sick - he was too young to be vaccinated when he was exposed to an unvaccinated child with measles.
This family didn’t have a choice about their son getting sick – he was too young to be vaccinated when he was exposed to an unvaccinated child with measles.

Not having a choice about getting measles.

That’s the natural immunity model.

Worry about your child with leukemia after an exposure to measles…

That’s the natural immunity model.

“Well, what does this mean? Much like the outbreak in 2014 in a large Amish community (around 400 cases), and the recent NY outbreak in an orthodox Jewish community (around 100 cases), these types of outbreaks are centralized and self-limiting—which means they don’t spread like wildfire. These cases are also almost exclusively in communities who are CHOOSING not to be vaccinated. In other words, they are not random people “victimized” by measles. #dontfeelsorryforthem”

Melissa Floyd

Do anti-vaccine folks really think that these outbreaks are self-limiting? That they just stop on their own?

Do they not understand that the only thing that keeps them from “spreading like wildfire” is the intensive work of the local and state health departments, efforts to get folks vaccinated, and quarantines?

The Disneyland measles outbreak, for example, was hardly centralized or self-limited. It spread to Arizona, Nebraska, Utah, Colorado, Washington, Oregon, Mexico, and Canada.

And like many other large outbreaks, it cost millions of dollars to contain.

“Measles outbreaks can be very costly to communities, a new report suggests. For example, the 2013 measles outbreak in New York City cost the city’s health department nearly $395,000 and more than 10,000 personnel hours, according to a report in JAMA Pediatrics. And there were other non-monetary costs, including the loss of a pregnancy, researchers reported.”

Measles outbreaks come with serious consequences

That hardly sounds like something that is harmless or self-limited.

“Now, the ACIP is preparing to add a 3rd dose for all college-age students to try to stop adults from getting and spreading measles—THAT’S how common adults cases are. Yet in Washington, there were only three??”

Melissa Floyd

Not only is there no call for a third dose of MMR to help stop the spread of measles, the CDC actually says a third dose isn’t necessary.

“In the event that a HCP who has 2 documented doses of MMR vaccine is tested serologically and determined to have negative or equivocal measles titer results, it is not recommended that the person receive an additional dose of MMR vaccine. Such persons should be considered to have presumptive evidence of measles immunity.”

Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Any talk about a third dose of MMR has to do with outbreaks of mumps…

“Is this all a coincidence my friends? Is the panic generated because of motive rather than data? In other words, could the media actually be encouraged to shift public beliefs on an issue to help pass legislation with a vested interest? #HerdImmunityDoesntApplyToVaccines”

Melissa Floyd

It’s not a coincidence that we are seeing so much anti-vaccine measles panic and propaganda these days. Outbreaks always bring it out.

Why?

It becomes harder to justify your decision to leave your kids unvaccinated and unprotected when you actually start to see that intentionally unvaccinated kids are getting sick.

More on the Natural Immunity Model

Remembering When Everyone Had Measles

In the pre-vaccine era, everyone got measles.

What was that like?

Remembering When Everyone Had Measles

Although the first measles vaccine was licensed in 1963, an improved version wasn't available until 1968.
Although the first measles vaccine was licensed in 1963, an improved version wasn’t available until 1968.

Well, for one thing, before we had a measles vaccine, having measles was considered a rite of passage for kids, but only because they had no choice except to eventually get it!

And when measles came to town, as it inevitably did, most folks got it, leading to missing weeks of school, play, and work, etc.

But it wasn’t all fun and games.

At best, measles left you feeling miserable.

Tragically for some, they didn’t survive having measles.

“Before a vaccine became available in 1963, measles was a rite of passage among American children. A red rash would spread over their bodies. They would develop a high fever. Severe cases could cause blindness or brain damage, or even death.”

CDC says measles almost eliminated in U.S.

It should be clear that when measles was everywhere and everyone had measles, it could affect every aspect of your life.

Quarantines for measles were once very common, although everyone still ended up getting measles eventually.
Quarantines for measles were once very common, although everyone still ended up getting measles eventually.
In 1959, the Los Angeles Times reported that 80% of the kids in this school’s lower grades would be absent in an outbreak that had been ongoing since the previous month
Could you imagine your child’s college shutting down for two weeks because kids were getting sick? This was in 1956.
If measles was so mild, why were colleges shutting down for two weeks?
Quarantines were common to control outbreaks in 1949.
Too bad they didn’t have laptops in 1947, although even if they did, Will Jones would have been too sick to have worked from home when he had measles…
Remember the Lassie episode when Timmie had measles...
Remember the Lassie episode when Timmie had measles… When everyone got measles, measles was every were, even on TV.
Delaying a movie isn’t so bad…
But what about almost delaying a trip to the moon? Remember Apollo 13?
Measles deaths were common in 1952.

When everyone got measles, everyone had problems with measles.

We know what happens when immunization rates drop…

That’s why most of us are very glad to vaccinate and protect our kids. We don’t want them to get measles or any other vaccine-preventable diseases.

More on Remembering When Everyone Had Measles

Is My Fully Vaccinated Child at Risk from Your Unvaccinated Kids?

Parents who skip or delay their own child’s vaccines often seem surprised that the rest of us are so concerned about their decision.

If vaccines work, they say, why do we care if their kids aren’t vaccinated?

Vaccines are protecting our kids, so they shouldn’t be at risk, right?

“Think of camping as an analogy. If everyone at a campground properly stores their food, bears won’t be enticed to come around. If even one person leaves their food unprotected, it invites bears in to investigate all the campsites for opportunities to eat.”

How does choosing not to immunize affect the community?

Of course, the issue isn’t just the risk to our fully vaccinated kids, but also the risk to those who are too young to be vaccinated, too young to be fully vaccinated, and those who can’t be vaccinated because of true medical contraindications.

In addition to those who are intentionally unvaccinated, these others often get caught up in outbreaks of vaccine-preventable diseases.

Is My Fully Vaccinated Child at Risk from Your Unvaccinated Kids?

But there is also a risk to those who are fully vaccinated, and no, that doesn’t mean that vaccines don’t work.

It just means that they don’t work 100% of the time.

And most of us don’t think that your vaccine choice should put our kids at extra risk.

Anti-vaccine propaganda pushes some folks to make bad decisions about vaccines.
Anti-vaccine propaganda pushes some folks to make bad decisions about vaccines.

Did you hear about the one measles outbreak in 2011 that was started by someone who was fully vaccinated?

“She had documentation of receipt of MMR vaccination at 3 years and 4 years of age. There was no travel during the incubation period and no known sick contacts. However, the index patient worked at a theater frequented by tourists.”

Outbreak of Measles Among Persons With Prior Evidence of Immunity, New York City, 2011

The thing about that outbreak, is that of the 222 cases that year, she was the only one known to be vaccinated. So she was almost certainly exposed to measles by someone who wasn’t vaccinated.

As someone who was fully vaccinated, is it fair that she got caught up in those outbreaks?

It is especially unfair that our kids are at extra risk for vaccine-preventable diseases because some folks make a decision to leave their kids unvaccinated and unprotected because they believe anti-vaccine misinformation like:

  • you have nothing to worry about because your child is vaccinated – again, vaccines aren’t 100% effective, so there is still some risk until a disease is finally eradicated
  • someone who is vaccinated could also get your child sick – yes, but someone who is vaccinated would be less likely to get sick than someone who is unvaccinated
  • vaccinated kids are shedding virus, making everyone sick – no, they aren’t, not even during “shedding season
  • getting vaccinated doesn’t prevent disease, it just makes it so you have fewer symptoms, but you still get others sick – in most cases, vaccines keep you from getting sick altogether – they so prevent disease in most cases, but yes, if you still got sick, you will likely have milder symptoms than if you were completely unvaccinated
  • you can’t spread a disease you don’t have – that’s true, but if you are unvaccinated and unprotected, you are at much higher risk to get these diseases and then spread them to others
  • vaccines don’t prevent diseases from spreading anyway – if you don’t get a disease because you are vaccinated, you aren’t going to spread it
  • getting vaccinated just turns you into a carrier – this is about the study in baboons, but it doesn’t mean you shouldn’t get vaccinated

What about the idea that you will just keep your unvaccinated kids home if they do catch something?

What are the chances that you could be exposed to measles during an outbreak?
What are the chances that you could be exposed to measles during an outbreak?

Looking at all of the places that the folks in the Clark County measles outbreak exposed others, it should be clear that waiting to quarantine your child if they get sick isn’t very effective.

What’s the problem?

An infant with measles during the 2014 outbreaks in the Philippines.
An infant with measles during the 2014 outbreaks in the Philippines. Photo by Jim Goodson, M.P.H.

With many diseases, you are contagious before you show symptoms. That is especially true with a disease like measles, when you may not even realize it is measles until you finally break out in a rash, after having 3 to 5 days of high fever.

That’s why it is important to vaccinate and protect your kids. When you skip or delay a vaccine, it is not just your own family that you are putting at risk.

More on Risks from Unvaccinated Kids

People with Cancer Are at Risk from Unvaccinated Kids

We know that kids with cancer aren’t at risk from shedding if someone has recently been vaccinated.

Johns Hopkins Medicine, which includes the Johns Hopkins University School of Medicine and The Johns Hopkins Hospital and Health System went out of their way to correct this anti-vaccine misinformation.
Johns Hopkins Medicine, which includes the Johns Hopkins University School of Medicine and The Johns Hopkins Hospital and Health System went out of their way to correct this anti-vaccine misinformation.

The real risk comes from those who are unvaccinated.

People with Cancer Are at Risk from Unvaccinated Kids

Confused on how that works?

Kids with cancer typically have a compromised immune system, so are at greater risk for getting sick and catching infectious diseases. This includes a risk from vaccine-preventable diseases because they often can’t be vaccinated and any vaccines they had in the past might no longer provide protection.

Don’t believe me?

Want some examples?

  • a 6-year-old girl who was in remission for ALL and had just received her final dose of chemotherapy was admitted with fever and neutropenia, found to have measles, and died after 28 days of intense therapy (1989)
  • an 8-year-old being treated for leukemia developed chicken pox and died two weeks later (1998)
  • a partially vaccinated 4-year-old girl who was being treated for acute lymphoblastic leukemia (ALL) was exposed to a cousin with chicken pox and later developed multi-organ failure and died (2012)
  • a 26-year-old man who was being treated for chronic lymphocytic leukemia died in Switzerland after he became infected with measles (2017)
  • a 6-year-old boy with leukemia died in Italy after catching measles from his intentionally unvaccinated sibling (2017)

Of course, there are many more, including many kids with cancer who get exposed to a vaccine-preventable disease and have to get treated with immunoglobulin and hope they don’t get sick. And many more who do get sick and are treated in the hospital for weeks and months and thankfully, get better.

And there are even more who get caught up in quarantines because they have true medical contraindications to getting vaccinated, and so have to stay home from school with the intentionally unvaccinated kids whenever there is an outbreak of measles or chicken pox, etc.

What can we do about this?

Vaccinate our kids! We have a choice. These kids with cancer don’t.

More on People with Cancer at Risk from Unvaccinated Kids

Seven New Year’s Vaccine Resolutions for 2019

If you’re making New Year’s resolutions, here’s one for the top of your list:

  1. I won’t complain about my kids being kept out of school during an outbreak, if I intentionally didn’t vaccinate them.

Yes, apparently that was a thing this past year…

Not surprisingly, parents lost their challenge to get their unvaccinated kids back into their Waldorf school during a chicken pox outbreak.
Not surprisingly, parents lost their challenge to get their unvaccinated kids back into their Waldorf school during a chicken pox outbreak.

It is an important reminder that there are consequences if you choose to not vaccine your kids.

In addition to the risk of getting a vaccine-preventable disease, the risk of getting a vaccine-preventable disease and getting someone else sick, there is the chance that your kids will be quarantined and kept out of daycare or school until the outbreak is over.

Six More New Year’s Vaccine Resolutions for 2019

Need some more?

  1. I will not travel out of the country without getting caught up on my vaccines. Remember, most outbreaks are started when an intentionally unvaccinated person travels out of the country, gets exposed to a vaccine-preventable disease, comes home while they are still in the incubation period and not showing symptoms, and then eventually get sick, exposing others.
  2. I won’t let a small, yet vocal anti-vaccine minority scare me into a poor decision about my child’s vaccines
  3. I will not lie to get a religious vaccine exemption. Is your religion really against vaccinating and protecting your child?
  4. I will avoid anti-vaccine echo chambers when doing my research about vaccines.
  5. I will learn about the cognitive biases that might me keeping me from vaccinating and protecting my kids.
  6. I will not repeat an anti-vaccine point that has already been refuted a thousand times.

Vaccines are safe, effective, and necessary.

This year, resolve to make the right choice and get your kids vaccinated and protected.

More on Seven New Year’s Vaccine Resolutions for 2019

What Is a Vaccine?

You know what a vaccine is, right?

The word vaccine comes from the vaccinia virus that was in the original smallpox vaccine.
The word vaccine comes from the vaccinia virus that was in the original smallpox vaccine.

The flu shot you get each year is a vaccine.

Vaccine: A product that stimulates a person’s immune system to produce immunity to a specific disease, protecting the person from that disease. Vaccines are usually administered through needle injections, but can also be administered by mouth or sprayed into the nose.

Immunization: The Basics

The smallpox shot that Edward Jenner developed was a vaccine.

Vaccine Definitions

While that is an easy enough definition to understand, that there are many different types of vaccines does make it a little more complicated.

There are:

  • Live-attenuated vaccines – made from a weakened or attenuated form of a virus or bacteria
  • Inactivated vaccines – made from a killed form of virus or bacteria
  • Subunit, recombinant, polysaccharide, and conjugate vaccines – made from only specific pieces of a virus or bacteria
  • Toxoid vaccines – made to target a toxin that a bacteria makes and not the bacteria itself

And of course all of these types of vaccines work to produce immunity to specific diseases – vaccination.

Immunization: A process by which a person becomes protected against a disease through vaccination. This term is often used interchangeably with vaccination or inoculation.

Immunization: The Basics

What other definitions are important to know when you talk about vaccines?

  • active immunity – immunity that you get from having a disease (natural immunity) or getting a vaccine and making antibodies
  • adjuvant – a substance that helps boost your body’s immune response to a vaccine so that you can use a minimum amount of antigen, reducing side effects
  • antibodies – protective proteins that you make against antigens
  • antigens – specific substances (can be part of a virus or bacteria) that trigger an immune response
  • attenuation – a virus or bacteria that is made less potent, so that it can produce an immune response without causing disease
  • elimination – getting rid of a disease in a specific area
  • endemic – the baseline level of disease in an area
  • eradication – getting rid of a disease everywhere (smallpox)
  • epidemic – an increase in the number of cases of a disease over a large geographic area
  • herd immunity – when enough people in a community are protected and have immunity, so that disease is unlikely to spread
  • immunity – protection against a disease
  • incubation period – how long it takes to develop symptoms after you are exposed to a disease
  • outbreak – an increase in the number of cases of a disease over a small geographic area
  • pandemic – an increase in the number of cases of a disease over several countries or continents
  • passive immunity – temporary immunity that you get after being given antibodies, either via a shot of immunoglobulin or a mother’s antibodies are transferred to her baby through her placenta
  • placebo – classically defined as “a comparator in a vaccine trial that does not include the antigen under study”
  • quarantine – isolating someone so that they don’t get others sick
  • titer – an antibody count that can often be used to predict immunity

Got all of that?

So what about variolation, the process that was used before Jenner developed his smallpox vaccine? Was that also a vaccine?

It did produce immunity to smallpox, which is the basic definition of a vaccine, but still, variolation is typically concerned an immunization technique and not a vaccine.

More on Vaccine Definitions