Tag: skipping 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

We Know What Happens If We Stop Vaccinating

It’s no surprise.

If we stop vaccinating, diseases that are now vaccine preventable will come back.

How do we know?

Because it has happened already.

We Know What Happens If We Stop Vaccinating

It has happened a lot, actually.

Remember when Sweden stopped using the DPT vaccine?

Between 1979 and 1996, Sweden suspended vaccination against pertussis because of concerns about the DPT vaccine.

Justus Ström‘s data was wrong…

And what happened?

“In 1979, the Swedish medical society abandoned whole-cell pertussis vaccine and decided to wait for a new, safer, more effective vaccine – a strategy that was soon adopted as national policy. During 1980-83, annual incidence for children aged 0–4 years increased to 3370 per 100000, with rates of serious complications approaching global rates. In subsequent years, Sweden reported more than 10000 cases annually with an incidence exceeding 100 per 100000, comparable to rates reported in some developing countries.”

Ganarosa et al on Impact of anti-vaccine movements on pertussis control: the untold story.

Pertussis came back.

In fact, endemic pertussis came back.

“Our evaluation of pertussis in the unimmunized child population gave an answer to the question of whether pertussis nowadays is a harmless disease which does not demand general vaccination. The present situation regarding pertussis in Sweden and the low efficacy of the antimicrobial treatment indicate an urgent need to prevent the disease by general vaccination as soon as a safe and effective vaccine is available.”

Romanus et al on Pertussis in Sweden after the cessation of general immunization in 1979.

Of course, they already had a safe and effective vaccine at the time. All of the claims against the whole cell pertussis vaccine ended up being untrue.

The same thing happened when Japan stopped using the MMR vaccine.

“Due directly to these gaps in ‘herd’ immunization resulting from politicized transitions in vaccination policy by the government, there were outbreaks of rubella with 17,050 cases reported between the years of 2012 and 2014, and 45 cases of congenital rubella syndrome reported to the National Epidemiological Surveillance of Infectious Diseases from week 1, 2012 to week 40, 2014.”

Yusuke Tanaka on History repeats itself in Japan: Failure to learn from rubella epidemic leads to failure to provide the HPV vaccine

What happened in Ukraine when immunization rates dropped in the 1990s? There were 17,387 cases of diphtheria and 646 deaths from 1992 to 1997. Also high, were cases of measles (over 23,000 cases in 1993) and pertussis (almost 7,000 cases in 1993).

Remember the measles outbreaks that spread across Europe in 2010 to 11, leading to about 30,000 cases of measles each year, and at least 28 deaths?

That should have been enough to warn folks, but it didn’t.

Things are much worse now, with over 120 measles deaths in Europe over the past few years.

More recently, in Venezuela, shortages of most things have led to ongoing epidemics of measles and diphtheria, a “potential for reemergence of poliomyelitis,” and a risk to neighboring countries.

“Officials say the low coverage rate and widespread transmission of the virus is due to many factors, including transport costs for those in rural areas, a high number of people with weakened immune systems, such people living with HIV and tuberculosis – and vaccine refusal.”

Ukraine: Red Cross deployed to help contain largest measles outbreak in Europe in four years

And once again, there are measles outbreaks in Ukraine. This time, they have spread to many other countries, fueling outbreaks in Israel and the United States.

We know what happens if we stop vaccinating. Get vaccinated and stop the outbreaks.

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

More on What Happens If We Stop Vaccinating

How Often Should You Do Vaccine Titer Testing?

We sometimes hear about folks doing vaccine titer testing.

A vaccine titer is a blood test that can determine whether or not you are immune to a disease after you get a vaccine.

While that sounds good, after all, why not check and be sure, it has downsides. Chief among them is that the results aren’t always accurate.

That’s right. You can sometimes have a negative titer test, but still be immune because of memory B cells and the anamnestic response.

How Often Should You Do Vaccine Titer Testing?

So how often should you do vaccine titer testing?

It depends, but most folks might never have it done!

Why not?

Vaccines work very well, so you would typically not need to routinely check and confirm that you are immune after being vaccinated. And, this is also important, the vaccine titer tests don’t always work that well, titer testing isn’t available for all vaccines (you can’t do titer testing for Hib and pertussis), and the testing can be expensive.

So we usually just do the testing (a quantitative titer) for folks that are in high risk situations, including:

  • pregnancy – rubella titer only (HBsAg is also done, but that’s not a vaccine titer test, but rather to see if you are chronically infected with hepatitis B)
  • healthcare workers – anti-HBs (antibody to the hepatitis B surface antigen to confirm immunity after being vaccinated)
  • students in nursing school and medical school, etc. – anti-HBs
  • children and adults exposed in an outbreakmeasles, chicken pox, mumps, etc., but only if we are unsure if they were previously vaccinated and protected
  • after a needlestick injury, etc. – to confirm immunity to hepatitis B
  • babies born to a mother with hepatitis B – to confirm that their hepatitis B vaccine worked

Vaccine titer testing might also be done for:

  • internationally adopted children – to confirm that they are immune if we unsure about all of the vaccines the child got in other countries
  • children and adults with lost vaccine records – to confirm that they are immune, since we are unsure about all of the vaccines they got
  • evaluation of children and adults with immune system problems – to help identify what immune system problems they might have – typically involves checking pneumococcal titers, giving Prevnar, and then checking pneumococcal titers again
  • people at continuous or frequent risk for rabies – rabies titer testing every 6 months to 2 years
  • patients with inflammatory bowel disease, before starting immunosuppressive therapy – hepatitis A and hepatitis B titers, as they might be at increased risk for hepatitis

While checking titers is easy, it is sometimes harder to know what to do with the results you get.

Of all of these different titers, only one tells you that you are immune due to vaccination.
Of all of these different titers, only one tells you that you are immune due to vaccination.

It is especially important to know that:

  • most people don’t need to have their titers checked routinely if they are not in one of the high-risk groups noted above
  • it isn’t practical to get titers tested as a method of potentially skipping one or more doses of your child’s vaccines, after all, if the titer is negative, then you are still going to have to get vaccinated
  • a healthcare provider with a negative measles titer after two doses of the MMR vaccine does not need another dose of vaccine
  • a healthcare provider who has anti-HBs <10 mIU/mL (negative titer) after three doses of the hepatitis B vaccine should get another dose of vaccine and repeat testing in 1 to 2 months – if still <10 mIU/mL, they should then get two more doses of hepatitis B vaccine (for a total of 6 doses) and repeat testing. If still negative, these documented nonresponders will need HBIG as post-exposure prophylaxis for any future hepatitis B exposures, but no further doses of hepatitis B vaccine.
  • vaccinated women of childbearing age who have received one or two doses of rubella-containing vaccine and have rubella serum IgG levels that is not clearly positive should be administered one additional dose of MMR vaccine, with a maximum of three doses, and should not be tested again
  • postvaccination titer testing is not recommended after the chicken pox vaccine
  • in addition to not being able to test titers for pertussis and Hib immunity, it is becoming difficult to test poliovirus type 2 titers, as the test uses a live virus that isn’t routinely available anymore (type 2 polio has been eradicated)

Still think you need vaccine titer testing?

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