Tag: titers

Can Schools Remove Unvaccinated Kids?

Why do parents think that their intentionally unvaccinated kids can not or will not be removed from school?

This school in Michigan was right to send unvaccinated kids home during a chickenpox outbreak.
This school in Michigan was right to send unvaccinated kids home during a chickenpox outbreak.

After all, when available, part of their choice when signing their child’s immunization waiver is to accept that their child could be excluded from school “as a disease control measure.”

Keeping unvaccinated kids out of school during an outbreak is the only way to keep more kids from getting sick. It is not a form of discrimination or segregation.

Well, I guess accept is a strong word…

Can Schools Remove Unvaccinated Kids?

Why is this coming up again?

“Last week, Marysville High School forcibly removed over 37 students from the high school due to an alleged outbreak of chicken pox, which consisted of two students.”

Parent: School wrong to remove unvaccinated students

Why send unvaccinated kids home when someone at the school has chickenpox?

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.

Because chickenpox is very contagious!

For every case of chickenpox, up to 12 others who are not immune will catch it, which used to lead to large outbreaks in the pre-vaccine era.

“Homecoming events are happening all week long. The school has barred any Marysville student who cannot provide immunity status from attending these week long events including the homecoming parade and the homecoming dance. This group of banned students consists of band members, cheerleaders, and football players. HOWEVER, the school is allowing students from other school districts to attend without checking immunity or vaccination status of the visiting student.”

Parent: School wrong to remove unvaccinated students

To be clear, any of the kids with non-medical exemptions could have gone back to school if they had just gotten a chickenpox vaccine. It was their parent’s choice to avoid vaccinating and protecting them and that is what is keeping them out of school.

Why allow students from other school districts to visit the school?

Those students, even if they are unvaccinated, would not have already been exposed to the Marysville kids with chickenpox! They aren’t a risk to keep the outbreak going.

That is unlike the unvaccinated kids at Marysville High School. They could have already been exposed and could come down with chickenpox anytime over the 10 to 21 days following that exposure. If they stayed in school, they could then expose others, especially as you can be contagious even before you know that you have chickenpox.

“The Marysville School District released the private health, educational, and personal records of these students to the health department without parental consent. This is a clear violation of federal law.”

Parent: School wrong to remove unvaccinated students

And while the Family Educational Rights and Privacy Act (FERPA) does protect student privacy, there are exceptions for health or safety emergencies, including “the outbreak of an epidemic disease.”

As St. Claire County has a high rate of vaccine exemptions, it is not surprising that they are being so pro-active in trying to prevent the outbreak from growing.

“According to Michigan state law, there are three ways to provide immunity to a school. One, is a vaccination record. Two, is a titers blood test that shows immunity. Three, is an affidavit signed by a parent, guardian, or doctor that states the child has had the chicken pox. Despite the fact that at least one parent submitted an affidavit, the school has admitted they will not follow state law, but instead continue based on what the heath department recommends.”

Parent: School wrong to remove unvaccinated students

What about the idea that the school should have accepted the parents affidavit that their child is immune to chickenpox?

“(4) When a local health officer confirms or reasonably suspects that a student or individual attending school or a group program has a communicable disease, the health officer may, as a disease control measure, exclude from attendance any individuals lacking documentation of immunity or otherwise considered susceptible to the disease until such time as the health officer deems there to be no likely further risk of disease spread.”

MDHHS Communicable and Related Diseases Administrative Rules

Because chickenpox is now becoming more and more uncommon, many states are requiring titers to confirm immunity if a child is unvaccinated.

So what happens next?

When an intentionally unvaccinated Kentucky teen was banned from school during a chickenpox outbreak his family sued. They lost and he ended up getting chickenpox! Although he is now at increased risk to get shingles, he didn’t expose anyone else at his school.

We will see what happens in Michigan…

Parents of children affected by the quarantine and removed from school did choose. Their choice was to leave their kids unvaccinated and unprotected.
Parents of children affected by the quarantine and removed from school did choose. Their choice was to leave their kids unvaccinated and unprotected. Hopefully no one at their protest gets exposed to chickenpox.

Unless there is a new case, there is less than a week left to go and of the original 37 students, only 14 students are still being quarantined.

More on Removing Unvaccinated Kids from School

Why Are Vaccinated Australians Now Catching Measles?

Measles is on the rise in Australia, like many other places. But why are vaccinated Australians now catching measles?

More vaccinated Australians are catching measles because there is more measles in Australia.
More vaccinated Australians are catching measles because there is more measles in Australia.

And has this got folks thinking it is because the disease is evolving?

Why Are Vaccinated Australians Now Catching Measles?

Well, apparently it has some folks thinking that.

Remember, Andrew Wakefield has also been talking about mutant measles.

Is that what this story in Australia was about?

No.

“In recent years, 13 Victorians have been hospitalized with measles despite having one or two vaccinations that should have made them immune. Why? Well, experts believe that because measles is so rare in Australia, we pretty much never come into contact with it, so our immune systems are starting to let their guards down and wane a little bit.”

Nathan Templeton on Measles Immunity Concerns

What is he talking about?

It’s the idea of exogenous boosting from being around natural infections. In other words, after you become immune from being vaccinated, you could get a boost in your immune protection if you are around someone with the disease.

“The exogenous boosting (EB) hypothesis posits that cell-mediated immunity is boosted for individuals reexposed to varicella-zoster virus (VZV).”

Talbird et al on Understanding the role of exogenous boosting in modeling varicella vaccination.

While this is thought to happen with chickenpox, we aren’t sure if it happens with measles.

It might, but the “problem” is that it is known that folks can have an amnestic response, so can be immune even though they have low antibody levels.

Mostly though, it is important to keep in mind that most of the people who get measles are unvaccinated, often intentionally unvaccinated.

“The key to measles elimination is increasing vaccination coverage and monitoring of measles antibody status for all ages, as well as enhancing surveillance of both domestic and overseas incidences.”

Inaida et al on Measles elimination and immunisation: national surveillance trends in Japan, 2008-2015.

So how many vaccinated Australians are getting measles?

Overall, there are 154 cases of measles in Australia so far this year.

“In Australia, the majority of measles cases are due to unvaccinated individuals becoming infected while travelling to countries in which measles is either common or there are outbreaks occurring. As measles is highly contagious, these people can then spread the disease to others, causing outbreaks, often before they are aware that they have the virus.”

Australia’s Measles Outbreaks 2019

And just as in the United States and most other countries, most of their outbreaks are started by folks who are unvaccinated.

More on Measles in Australia

How Do You Know If You Have Measles Immunity?

With all of the measles cases, you might be wondering if you have immunity to measles?

Are you worried that you might get measles?

Should you get a booster dose of MMR?

Or a titer test?

How Do You Know If You Have Measles Immunity?

Fortunately, most of us can feel confident that we do have measles immunity and that we won’t get caught up in any of the ongoing outbreaks.

Why?

If you have had two doses of MMR, then you can be confident that you have measles immunity.
If you have had two doses of MMR, then you can be confident that you have measles immunity.

Because we are vaccinated and protected!

If you haven’t had two doses of MMR (or any measles containing vaccine since 1967), then understand that two doses is your best protection against measles.

Is There a Blood Test for Measles Immunity?

What about titer tests?

While there is a blood or titer test for measles immunity, it isn’t routinely used.

The one situation in which a measles titer test might be useful though, is for those born before 1957 to confirm that they really had measles.

For others considering a titer test in place of vaccination, it is typically better to just get another dose of MMR, but only if you haven’t already had two doses.

Why Was My Measles Titer Negative?

A positive measles titer does mean that you are immune, but what about a negative measles titer?

“For HCP who have 2 documented doses of MMR vaccine or other acceptable evidence of immunity to measles, serologic testing for immunity is not recommended. 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. Documented age-appropriate vaccination supersedes the results of subsequent serologic testing.”

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

If you have had two doses of MMR and have a negative measles titer, you don’t need another dose of MMR. You are likely immune, even with that negative titer.

“Most vaccinated persons who appear to lose antibody show an anamnestic immune response upon revaccination, indicating that they are probably still immune.”

Epidemiology and Prevention of Vaccine-Preventable Diseases

And since you would need a second dose if you had a negative titer after having just one shot, you might as well just get the second dose instead of checking your titer.

Do You Need a Measles Booster?

Have you had two doses of MMR?

If so, then you don’t need another dose.

The second dose isn’t technically a booster anyway. It is just for those who might not have responded to their first dose.

And two doses of MMR are about 97% effective at preventing measles.

That’s why most of the people in measles outbreaks are unvaccianted.

Neither primary nor secondary (waning immunity) vaccine failure are common with the measles vaccine.

What’s the biggest issue with the MMR? Folks who are still too scared to get their kids vaccinated and protected!

More on Measles Immunity

How to Avoid Getting Caught up in a Measles Outbreak

By now, you have likely heard the news that we are on track for record-breaking numbers of measles cases this year, both in the United States and around the world.

You may also have heard that some of the folks getting caught up in these outbreaks weren’t actually anti-vaccine, but were people who thought they already had measles or thought they were already vaccinated and protected.

How to Avoid Getting Caught up in a Measles Outbreak

Are you and your family protected against measles?

Six ways to avoid measles.

You might be thinking, “of course we are, we get all of our vaccines!”

But you still might want to double check, keeping in mind that:

  • only people born before 1957 are thought to have natural immunity to measles, because measles was very common in the pre-vaccine era
  • the original measles vaccine that was used between 1963 and 1967 was not thought to be effective, so if that’s the only dose you had, it should be repeated
  • a recommendation for a second dose of MMR didn’t come until 1990, so many people born before that time have only had one dose, especially since there was never a catch-up program to make sure older people had two doses. Even now, adults don’t necessarily need two doses of MMR unless they are in a high-risk group (foreign travel, healthcare workers, living with someone who has a compromised immune system, people with HIV, and students).
  • children don’t routinely get their first dose of MMR until they are 12 to 15 months old (one dose is 93% effective at preventing measles), with a second dose at age 4 to 6 years (two doses are 97% effective)
  • a third dose of MMR isn’t typically recommended for measles protection

Still think you and your family are protected?

In addition to routine recommendations, to avoid measles in a more high risk setting (traveling out of the country or during an outbreak), you should:

  • get infants an early MMR, giving them their first dose any time between 6 and 11 months of age (repeating this dose at age 12 to 15 months)
  • get toddlers and preschoolers an early second dose of MMR, giving them their second dose at least 28 days after the routine first dose that they received when they were 12 to 15 months old, instead of waiting until they are 4 to 6 years
  • get older children and adults two doses of MMR if they haven’t already had both doses

What if your baby is exposed to measles before you have a chance to get him vaccinated?

Younger infants who are less than six months old can get a dose of immunoglobulin within 6 days if they are exposed to measles. Older infants, children, and adults can get a dose of MMR within 72 hours if they are not vaccinated and are exposed to someone with measles.

And the very best way to avoid measles is to keep up herd immunity levels of protection in our communities. If everyone is vaccinated and protected, then we won’t have outbreaks and our kids won’t get exposed to measles!

More on Avoiding Measles