Tag: risk perception

Who’s Getting Measles?

We will soon pass the last record high number of measles cases – 963 cases – set in 1994.

We will soon pass the last record high number of measles cases - 963 cases - set in 1994.

With 839 cases as of mid-April, it’s hard to believe that only 55 cases were reported during all of 2012!

Who’s Getting Measles?

So what do we know about the people who are getting measles?

More importantly, the thing that most parents want to know – are their families at risk?

We know that of the 839 cases right now:

  • 442 are in Brooklyn among the Orthodox Jewish community, where only 4% of cases have been fully vaccinated
  • 125 are in Rockland County, New York, among the Orthodox Jewish community, where only 3% of cases have been fully vaccinated
  • 78 were in the Pacific Northwest Outbreak (Washington and Oregon), where none were fully immunized – (ended)
  • 43 are in Michigan, mostly among Oakland County’s Orthodox Jewish community, triggered by a man who had recently traveled from New York

So just over 80% of cases are associated with four outbreaks, one of which has been declared over, and mostly among children and adults who were intentionally not vaccinated.

The rest of the 200 cases?

Among 45 cases in California, are 30 cases in these four outbreaks.
Among 45 cases in California, are 30 cases in these four outbreaks.

They are spread out in smaller outbreaks in other states, including Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Mississippi, Missouri, Nevada, New Hampshire, New Jersey, Oklahoma, Pennsylvania, Tennessee, and Texas.

Does that mean that you don’t have to worry about measles?

It means that you don’t have to panic about measles.

Get your kids vaccinated and protected, which might include an early dose of MMR, learn the signs and symptoms of measles, and keep up on news of outbreaks in your area.

That should help decrease the risk that they get caught up in an outbreak.

And double check your own vaccine records! Have you had an MMR vaccine? Have you had two doses?

Unfortunately, not everyone can get vaccinated and protected, which is causing some folks to panic. This includes those who are too young to be vaccinated, or fully vaccinated, and those with immune system problems.

That’s not fair.

Let’s stop the outbreaks so we don’t get to the point that measles truly is everywhere and even more high-risk people are put at risk.

More on Who’s Getting Measles

What’s Your Chance of Getting Measles Right Now?

It shouldn’t be a surprise that a lot of folks are thinking about their risk of getting measles right now.

But with record levels of measles cases this year, some of us are thinking about our level of risk much differently than others.

rIf you are unvaccinated and exposed to someone with measles, you risk is actually 1,000,000 times higher…

While most of us simply want to make sure we are vaccinated and protected, anti-vaccine folks are taking every opportunity to downplay their risks.

What’s Your Chance of Getting Measles Right Now?

So what’s your chance of getting measles?

“Measles is one of the world’s most contagious diseases. It is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions. The virus remains active and contagious in the air or on infected surfaces for up to 2 hours. It can be transmitted by an infected person from 4 days prior to the onset of the rash to 4 days after the rash erupts.”

WHO on Measles

That’s actually not that simple to figure out, but depends on:

Those who have had two doses, with no plans to travel, and who live in an area with no reported cases, are at extremely low risk to get measles – the risk won’t be zero until measles is eradicated.

In this kind of low risk situation, kids don’t need early doses of MMR vaccines and most adults can probably get away with just having one dose of MMR.

“Measles is highly contagious and spreads through the air when an infected person coughs or sneezes. It is so contagious that if one person has it, 9 out of 10 people of all ages around him or her will also become infected if they are not protected.”

CDC on Measles is Highly Contagious

On the other hand, if you are unvaccinated and were at the AMC Theater on Lemon Street in Fullerton, between 11 p.m. and 4 a.m. on April 25, then your chance of getting measles is about 90%!

Wait! That’s a little more than the 0.000092% chance that anti-vaccine folks are throwing around…

The odds of being hit by lightning are low because we practice storm safety and don’t run around outside when we see lightning!

To think of it another way, if you knew that your chances of getting hit by lightning were a little over 1 in a million, would that make you think it is okay to go outside and play golf during a severe thunderstorm?

Would you think the risk is so low that you could let your kids play outside if you heard thunder and saw lightning flashes nearby, or would you all rush inside?

That’s right! The risk of getting hit by lightning is low because most of us don’t take chances when we hear thunder or see lightning.

It’s the same with measles and other vaccine-preventable diseases.

The overall risk is low because most people are vaccinated and protected!

If you aren’t vaccinated and protected, as we see more and more cases, your risk of getting sick, and getting others sick, is going to continue to get higher and will always be much higher than someone who is fully vaccinated, no matter how much you want to believe in shedding, mild measles, or whatever myths help you justify keeping your kids unvaccinated and unprotected during an outbreak.

Remember, you can’t hide in the herd if you are scaring away too much the herd

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

You can avoid getting measles.
You can greatly reduce your family’s risk of getting measles.

Make sure your family is protected so they don’t get caught up in a measles outbreak

More on Your Chance of Getting Measles


What Are the Greatest Tricks Anti-Vaccine Folks Use to Persuade Parents to Skip Vaccines?

We are hearing a lot about anti-vaccine misinformation these days.

John Birch (B) and the other anti-vaccine heroes of the day on their way to fight the vaccination monster.
John Birch (B) and the other anti-vaccine heroes of the day on their way to fight the vaccination monster.

And how the anti-vaccine movement is using social media to persuade parents to skip their child’s vaccines, leaving them unprotected.

So how do they do it?

What Are the Greatest Tricks Anti-Vaccine Folks Use to Persuade Parents to Skip Vaccines?

If you want to understand the anti-vaccine movement, the first thing to know is that they have been around for centuries. That they are using social media is of course new, but their messages are basically the same.

They use scare tactics to try and make you believe that:

  1. vaccines are dangerous and injure people
  2. vaccines aren’t necessary because diseases are mild
  3. vaccines don’t even work

And you need all three elements, after all, even if you thought that vaccines were sometimes dangerous, you might want to vaccinate your kids if you thought that vaccines could stop an even more dangerous vaccine-preventable disease, right?

That’s why they keep all of your fear focused on the vaccines!

It is this fear that allows several cognitive biases, heuristics, and logical fallacies to take hold and change your perception of risk into something that is much different from reality.

And that’s maybe the ultimate trick – making you think that the risks of vaccines are greater than the risks of catching a vaccine-preventable disease or even greater than the risks of having a vaccine-preventable disease.

But what about the graphs they have, the autism studies, the vaccine injury stories, Whistleblowers, complaints about saline placebos, the idea that better hygiene and sanitation fixed everything, and all of the claims of toxins and the conspiracy theories about Big Pharma?

Anti-vaccine folks are constantly moving the goalposts

These and every new argument they come up with are easily refuted.

When will you stop listening to them?

“Thank you Chairman Alexander, Senator Murray, and distinguished committee members for the opportunity to speak today. Good morning, everyone. My name is Ethan Lindenberger and I am a senior at Norwalk High School. My mother is an anti-vaccine advocate that believes vaccines cause autism, brain damage, and do not benefit the health and safety of society despite the fact such opinions have been debunked numerous times by the scientific community. I went my entire life without vaccinations against diseases such as measles, chicken pox, or even polio. However, in December of 2018, I began catching up on my missed immunizations despite my mother’s disapproval, eventually leading to an international story centered around my decisions and public disagreement with my mother’s views.”

Testimony of Ethan Lindenberger Student at Norwalk High school Before the Senate Health, Education, Labor, and Pensions Committee March 5th, 2019

Should kids really have to hope that they grow up without getting a vaccine-preventable disease so that they can get themselves vaccinated?

“I have discovered along the way that it is easy for parents to be misinformed. It is a real challenge to be well informed.”

Suzanne Walther on A Parent’s Decision on Immunization: Making the Right Choice

Vaccines are safe, with few risks, and necessary.

It might be a challenge, but it is worth the effort to be well informed about vaccines. It is worth knowing that your kids are vaccinated and protected.

More on the Greatest Tricks Anti-Vaccine Folks Use to Persuade Parents to Skip Vaccines


Everything You Need to Know About the Measles Vaccine

The measles vaccine is one of the most effective vaccines we have.

It is also one of the safest, having very few serious side effects.

Everything You Need to Know About the Measles Vaccine

So why are some parents still afraid to allow their kids to get vaccinated and protected, putting them at risk to get measles, a life-threatening disease?

“Existing evidence on the safety and effectiveness of MMR vaccine supports current policies of mass immunisation aimed at global measles eradication and in order to reduce morbidity and mortality associated with mumps and rubella.”

Cochrane Systematic Review on Vaccines for measles, mumps and rubella in children

Let’s see if you still are after we get all of your questions about the measles vaccine answered…

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 in 1917 because of measles epidemics.
  1. How long has the measles vaccine been around? The very first measles vaccine was licensed by John Enders in 1963. An improved measles vaccine was developed by Maurice Hilleman and licensed in 1968, and that is the measles vaccine that we still use today, at least in the United States. It was combined into the MMR vaccine in 1971.
  2. How effective is the measles vaccine? A single dose of the measles vaccine is about 93% effective at preventing a measles infection. Two doses (the second dose was added to the routine immunization schedule in 1994) are up to 97% effective. That’s why almost all of the people who get measles in an outbreak are unvaccinated.
  3. How long does immunity from the measles vaccine last? Immunity from the measles vaccine is thought to be life-long. It is important to understand that the second dose isn’t a booster dose, but is instead for those few folks who don’t respond to the first dose.
  4. Who should get the measles vaccine? Everyone without a true medical contraindication should get the measles vaccine (MMR), with the first dose at 12-15 months and a second dose at 4-6 years.
  5. Can my kids get their measles vaccine early? An advanced immunization schedule is available for kids in an outbreak or if they will be traveling out of the country. The first dose can be given as early as age 6-months, but is repeated when the child is 12 months because of concerns of interference with maternal antibodies. The official second dose can be given early too, as early as 4 weeks after the first dose, as long as the child is at least 12 months old.
  6. Do I need a booster dose of the measles vaccine? People who are fully immunized do not need a booster dose of the MMR vaccine, but it is important to understand whether or not you are really fully immunized to see if you need a second dose. Some adults who are not high risk are considered fully vaccinated with only one dose, while others should have two doses. Are you at high risk to get measles? Do you travel, live in an area where there are measles outbreaks, go to college, or work as a health care professional?
  7. Should I check my measles titers? In general, it is not necessary to check your titers for measles. If you haven’t had two doses of the MMR vaccine, then get a second dose. If you have had two doses of the MMR vaccine, then you are considered protected. Keep in mind that there is no recommendation to get a third dose of MMR for measles protection, although it is sometimes recommended for mumps protection during a mumps outbreak.
  8. If my child gets a rash after getting his MMR, does that mean that he has measles? No. This is a common, very mild vaccine reaction and not a sign of measles.
  9. Can the measles vaccine cause seizures? The MMR vaccine can cause febrile seizures. It is important to remember that without other risk factors, kids who develop febrile seizures after a vaccine are at the same small risk for developing epilepsy as other kids. And know that vaccines aren’t the only cause of febrile seizures. Vaccine-preventable diseases can cause both febrile seizures and more serious non-febrile seizures.
  10. Why do people think that that the measles vaccine is associated with autism? It is well known that this idea originated with Andrew Wakefield, but the real question should be why do some people still think that vaccines are associated with autism after so much evidence has said that they aren’t?
  11. What are the risks of the measles vaccine? Like other vaccines, the MMR vaccine has mild risks or side effects, including fever, rash, and soreness at the injection site. Some more moderate reactions that can rarely occur include febrile seizures, joint pain, and a temporary low platelet count. More serious reactions are even rarer, but can include deafness, long-term seizures, coma, or lowered consciousness, brain damage, and life-threatening allergic reactions.
  12. Why are there so many reports of measles vaccine deaths? There are extremely few deaths after vaccines. The reports of measles vaccine deaths you see on the Internet are just reports to VAERS and are not actually reports that have been proven to be caused by a vaccine. As with other vaccines, the risks from having a vaccine-preventable disease are much greater than the risks of the vaccine. The only reason that it might not seem like that now is because far fewer people get measles now than they did in the pre-vaccine era, when about 500 people died with measles each year.
  13. When did they take mercury out of the measles vaccine? Measles vaccines, including the MMR, have never, ever contained mercury or thimerosal.
  14. Why do we still have outbreaks if we have had a measles vaccine since 1963? In the United States, although the endemic spread of measles was declared eliminated in 2000, many cases are still imported from other countries. As measles cases increase around the world, that is translating to an increase in outbreaks here. Even though overall vaccination rates are good, because there are many pockets of susceptible people in areas that don’t vaccinate their kids, they get hit with outbreaks.
  15. Can we eradicate measles? Because measles is so contagious, the vaccine does have failures, and some folks still don’t get vaccinated, there is some doubt that we can eradicate measles without a better vaccine. That doesn’t mean that the current measles vaccines can’t prevent outbreaks though…

Are you ready to get your kids their MMR vaccine so that they are vaccinated and protected against measles, mumps, and rubella?

If not, what other questions do you have?

While you are thinking, here is a question for you – Do know why they used to call measles a harmless killer?

More on the Everything You Need to Know About the Measles Vaccine

Are Infants More Likely to Die from Vaccines Than the Natural Diseases They Prevent?

Someone made a chart about vaccine deaths, saying it came from the CDC, and is using it to compare to an infant’s risk of natural death from vaccine-preventable disease.

Need help fact checking this image about vaccine deaths that anti-vaccine folks like to post?
Need help fact checking this image that anti-vaccine folks like to post?

Do you see any problems?

Are Infants More Likely to Die from Vaccines Than the Natural Diseases They Prevent?

Yes, that’s right.

They are misusing VAERS reports and claiming that they are vaccine deaths.

“When evaluating data from VAERS, it is important to note that for any reported event, no cause-and-effect relationship has been established. Reports of all possible associations between vaccines and adverse events (possible side effects) are filed in VAERS. Therefore, VAERS collects data on any adverse event following vaccination, be it coincidental or truly caused by a vaccine. The report of an adverse event to VAERS is not documentation that a vaccine caused the event.”

Guide to Interpreting VAERS Data

They are also leaving out the fact that deaths from vaccine-preventable diseases are low because most people are vaccinated and protected. Remember, one of the benefits of vaccines is that they got us out of the pre-vaccine era, when a lot of people died of these diseases. And most of us don’t want to go back!

As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks.
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

If they scare enough people with this type of propaganda though and more people skip or delay their vaccines, then the diseases will come back and the risk of death increases.

“In a review of reports of death following vaccination submitted to the Vaccine Adverse Event Reporting System (VAERS) from the early 1990s, the Institute of Medicine concluded that most were coincidental, not causally associated.”

Moro et al on Deaths Reported to the Vaccine Adverse Event Reporting System, United States, 1997–2013

That’s not even all that’s wrong with their little chart though.

They clearly say that they are talking about infants, but their chart says that it includes data for vaccines from birth to 18 years.

That should be evident when you realize that infants get neither hepatitis A nor MenB vaccines and there weren’t even any VAERS reports of deaths for infants for the hepatitis A vaccine in 2014. In fact, there has never been a report of a MenB vaccine death in VAERS for an infant.

So basically, these folks used inflated reports of deaths from VAERS that are likely coincidental and not associated with getting a vaccine and compared them to deaths that were reduced by the fact most folks are vaccinated and protected.

Don’t believe them. Vaccines are safe and necessary, with few serious side effects.

More on Misusing VAERS Reports

What Is the Morbidity/Mortality Rate of the Polio Vaccine vs the Wild Virus?

Some anti-vaccine folks still think that the risks of vaccines are far greater than the risks of the vaccine-preventable diseases they keep you from getting.

As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks.
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

They aren’t, but you can kind of understand why they might think that with a disease like polio, when they might never actually have known anyone to have the disease.

What Is the Morbidity/Mortality Rate of the Polio Vaccine vs the Wild Virus?

Still, even though polio is under good control and close to being eradicated, the risk/benefit ratio clearly favors getting vaccinated and protected.

That’s because the polio vaccines are very safe and if we stopped vaccinating, polio could come back.

In fact, morbidity/mortality from polio vaccines are decreasing, as we are using much less oral polio vaccine (OPV) in the transition (OPV cessation) to just using inactivated polio vaccine (IPV).

“Over the past ten years, more than 10 billion doses of OPV have been given to nearly three billion children worldwide. More than 16 million cases of polio have been prevented, and the disease has been reduced by more than 99%. It is the appropriate vaccine through which to achieve global polio eradication.”

OPV Cessation

And while most developed countries already use IPV, those that are still using OPV recently switched from a trivalent (tOPV) to a bivalent (bOPV) form of OPV. We could do this because type 2 poliovirus has already been eradicated (2015)!

Of course, the issue with the OPV vaccines is that they rarely cause vaccine-associated paralytic polio (VAPP) and circulating vaccine-derived polioviruses (cVDPV).

Fortunately, this is even less common with bOPV.

As this chart from the WHO shows, polio vaccines are very safe.
As this chart from the WHO shows, polio vaccines are very safe.

So morbidity (getting sick)/mortality (dying) from polio vaccines is low.

There were only 31 cases of wild polio in 2018, in Afghanistan and Pakistan, and an additional 102 cases of cVDPV in 7 countries.

What about morbidity/mortality from 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

With a 99.9% drop in polio cases since 1998, your risk of getting polio in most parts of the world is very low, but you still have to consider both the morbidity/mortality of polio in the pre-vaccine era and the risk of polio returning if we stop vaccinating before it is eradicated.

What about the idea that you don’t have to worry about polio because only 1% of kids with polio developed paralysis?

“The mortality rate for acute paralytic polio ranges from 5–15%.”

Disease factsheet about poliomyelitis

Well, when everyone gets polio, even 1% is a lot.

With such a safe vaccine, why put your kids at risk of getting polio?

Do you even understand what the risks are?

No, it isn’t just the risk of wild polio in Afghanistan and Pakistan.

Since the oral polio vaccines shed, if you are unvaccinated, in addition to the risk of wild polio, there is a small risk of getting circulating vaccine-derived polioviruses (cVDPV) if you are not vaccinated and protected. No, it is not a big risk, as there were only 102 cases of cVDPV in 7 countries in 2018, but it isn’t zero either.

And the other big risk is that if enough folks stop getting vaccinated, taking their chances hiding in the herd, polio will come back and our chance to eradicate another vaccine-preventable disease will fail.

More on the Morbidity and Mortality Rates of Polio

What Happens When You Research the Disease?

We know how anti-vaccine folks think.

Anti-vaccine math…

And now we know how they do their research

How Anti-Vaccine Folks Research Disease

If you’re like me, you are probably wondering why they picked 2016 as the year to research.

Why look just at 2016?

And, there you see it.

In the past 6 years, 2016 was the year with the fewest cases of measles. Why not choose 2017 or 2018 to do their research?

But let’s look at 2016, even though the information isn’t complete:

  • 86 cases
  • cases in 19 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 (31 cases) linked to a private detention center and all that is known is that 7 of 9 staff members who got measles had received at least one dose of MMR, and 3 had received their dose very recently
  • a large outbreak in Shelby County, Tennessee, at least 7 cases, including 6 unvaccinated and one partially vaccinated child
  • a large measles outbreak (17 cases) in Los Angeles County and Santa Barbara County that was linked to the Los Angeles Orthodox Jewish community
  • two cases in Colorado, including an unvaccinated toddler and an unvaccinated adult – outbreaks which cost at least $68,192 to control

And of th cases in 2016, it seems that just 16% were vaccinated.

What about the claim that 26% were vaccinated?

That wasn’t 26% of the total number of cases, but rather 26% of the cases among US residents.

So if you do the math, that’s just 14 cases that were vaccinated, and out of 86 cases, that’s really just 16%. And a lot of those cases are skewed by the one outbreak at the detention center, in which they may have only received one dose of MMR and nearly half may have gotten vaccinated after the caught had already started!

What about the claim that “the odds of dying from the measles are like 0.00000013%” using numbers “before the vaccine was introduced in 1963?”

“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.

In the pre-vaccine era, your odds of getting measles were very high. Remember, everyone eventually got measles.

And looking at statistics of reported measles cases and reported measles deaths, we know that death occurred in about 1 to 3 in every 1,000 reported cases.

So everyone got measles, but not everyone survived having measles.

Even if you use a more liberal count of 1 death in 10,000 cases, when all kids get measles, that’s a lot of deaths. Remember, about 450 people used to die with measles each year.

What about your odds of dying with measles now?

If you are fully vaccinated, then they are extremely low.

They are pretty low if you are unvaccinated too, in most cases, because you are benefiting from herd immunity and the fact that most folks around you are vaccinated, reducing your risk of being exposed to measles. Still, the risk is much higher than most anti-vaccine folks expect, because they often make the mistake of using the entire population of the United States in their calculations. They should instead just use the folks who are unvaccinated and susceptible, a much smaller number.

Want to increase your risk?

  • travel out of the country
  • hang out in a cluster with other unvaccinated people
  • stay unvaccinated

The odds aren’t in your favor to avoid measles if you are unvaccinated. Eventually, your luck might run out.

Starting to see the mistakes anti-vaccine folks make when they say they have done their research?

“How do they know how many people would have gotten measles and how many of them would have died?!?”

It’s not rocket science.

It’s epidemiology.

“We constructed a state-space model with population and immunisation coverage estimates and reported surveillance data to estimate annual national measles cases, distributed across age classes. We estimated deaths by applying age-specific and country-specific case-fatality ratios to estimated cases in each age-country class.”

Simons et al on Assessment of the 2010 global measles mortality reduction goal: results from a model of surveillance data.

Unfortunately, after years of improvements, measles deaths increased in 2017. And they will continue to increase, as our risk of getting measles continues to increase if folks don’t get vaccinated and protected.

Lastly, why does it “sound like millions of people would have died without the measles vaccine?”

Maybe because millions of people died in previous years, before they were vaccinated and protected.

Indeed, do your research, but you will find that vaccine-preventable diseases aren’t as mild as anti-vaccine folks believe. That’s why it is important to get vaccinated and protected.

More on Researching Vaccine-Preventable Disease