Monday, January 12, 2009
Not really unprecedented
Outbreaks of measles in U.K. mirrors problems we've had here. About 10 or so years ago, several universities started requiring incoming students to be vaccinated for measles.* This was at a point where the ACIP changed its recommendations for MMR vaccines (measles, mumps, and rubella/German measles). The traditional vaccination practices, they were discovering, were inadequate for long-term immunity. Fair enough; hey, this is why CDC has a reportable disease requirement. I realized that I am old enough to fall into that period. I figured I'd get vaccinated again. That's another story. I did. Not so for thousands of people who have decided to abrogate their personal & social responsibility. Yes, this is one point upon which I am both conversant and very strongly opinionated. Sure, I'm often opinionated; I try to be knowledgeable about it; I try to see other points of view. I've seen them here and they're irrational and scientifically unsubstantiated. Don't get me going on the whole thimerosal 'controversy' or 'conspiracy'. Maybe I'll make a different post on that, using the concepts of Risk Assessment to explain my opinion; it will take more time than I have right now to do this well and accurately. While I realize measles is far more common than mumps and rubella, and is therefore more immediate in people's minds, it is also the least risky of the 3 to long-term health. [I don't recall where I read this, so if it's not correct, please let me know.] It is a cogent example of ignoring a greater risk due to the fact that it's less likely to happen, and thus less likely for people to believe it has anything to do with them. Eventually the herd immunity will fall below the level necessary to effectively control these diseases. At which point, we're going to have an large outbreak, if not an epidemic. And, at which point, all of these "don't vaccinate my child; I'm the parent and know better" parents are going to line up and demand to know why the government hasn't done anything to prevent this. Failure to vaccinate your child or yourself against the major communicable vaccine-preventable diseases is inexcusable. Before you think I'm an ideologue on the point, there are other vaccine-preventable diseases for which I also consider less important. It's not an absolute yes/no question. But, it is not only the potential for disease, but also the potential consequences of communicating the disease. Polio - well, this is one where I understand a reluctance to vaccinate; however, considering the extent of global travel, it is no longer a valid argument that "we don't have it here, it's only over there [i.e., in some 3rd world country]." I understand, but do not agree with their argument. An interesting article in Minnesota Parent magazine addresses puts forth the problem in personal terms. (The stats are Minnesota-based.) There are also vaccines for rabies, anthrax, and monkey pox. I'm not about to get in line to have any of these, much less ask for them for my kids. [Although, as a point of disclosure, I have actually been vaccinated for the first two, but that was occupationally related and justified based upon a much higher risk of exposure than I have now.] Hey, cool - "Warning, some of these photos are quite graphic" notice for medical photos of these diseases (measles, mumps, rubella, polio (still & video), tetanus, diphtheria (personal note: these are the grossest) & pertussis . I bet if these were more widely available, it might change some people's choice about whether to get vaccinated, considering the current American obsession with body images. I realize there is legally an option to refuse to be vaccinated.** This in the past was generally used by some religious sects which object to any 'modern' medicine. We need to seriously and objectively assess the effectiveness and appropriateness of our current policies. The objectivity needs to be placed on all sides of the argument. * Currently, the Academic Health Center at the University of Minnesota (schools of medicine, nursing, dentistry, pharmacology, veterinary medicine and public health) require vaccination for HepB, DTP, MMR and annual TB tests. What a pain trying to get all the documentation for this, when school started! ** Non Medical Exemptions to School Immunization Requirements, secular trends and association of state policy with pertussis incidence, Omer, Pan, Halsey, et al., J. Am. Med. Assoc., 2006;296:1757-1763 as pdf and .htm ~~ concludes that the looser exemption rules are, the higher the incidence of disease. Other information: Advisory Council of Immunization Practices has an extensive list of vaccine-preventable diseases and individual information on both the disease and vaccine. ACIP is part of the Centers for Disease Control & Prevention (CDC). There is a new adult schedule posted here in .pdf and .htm versions. Summary of Notifiable Diseases (several years worth) The photos linked above are on the CDC website, but are from the Public Health Image Library.