Religious exemptions to vaccines elevates whooping cough rates
©Centers for Disease Control and Prevention, 2012
According to a new study published in Pediatrics, the number of New York state parents who skipped at least one required vaccine for religious reasons has increased over the past decade. And New York counties that had this increase in religious exemptions to vaccinations also had more whooping cough (Bordetella pertussis, or simply pertussis) cases, even among children that had been fully vaccinated.
For this study, the researchers tracked data from the New York State Department of Health on both religious exemptions and new whooping cough cases. Children were reported as having a religious exemption if they had been allowed to skip at least one required vaccine for non-medical reasons.
The key results from the study were:
- The overall state annual mean rate of religious exemptions increased significantly from 0.23 % in 2000 to 0.45% in 2011, almost doubling the rate over the decade.
- The prevalence of religious exemptions varied greatly among counties with no obvious trends, although all of the counties around New York City showed large increases in religious exemptions.
- Counties with mean religious exemption rates of >1% reported a higher incidence of pertussis. For counties with higher exemption rates, the rate of pertussis was 33 per 100,000 compared to counties with lower exemption rates, which had a pertussis infection rate of 20 per 100,000. The researchers determined that this difference was statistically significant.
- In addition, the risk of pertussis among vaccinated children living in counties with high exemption rate increased with increase of exemption rate among exempted children, also statistically significant.
The increase in whooping cough rates is particularly troubling since unvaccinated children not only put themselves at risk, but also those who have been vaccinated (as result of the lower effectiveness of the currently available pertussis vaccine). Also, as the exemption rate increases and there is a lower than expected effectiveness of the vaccine, the herd immunity becomes weaker.
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Vaccine denier claims sanitation ended diseases, not vaccines
And here we go again. Over the Memorial Day weekend, I was catching up on some reading, which sometimes leads me to reading pseudoscience claims of some random vaccine denier. In this case, it was an article that claimed that it had “irrefutable evidence” that vaccines had any impact on preventing infectious diseases. Well, I am always one to read up on “irrefutable evidence”, but it’s possible that my standard for “irrefutable evidence” is different than most others. And in fact, real science assumes that most evidence can be scientifically refuted, so it never speaks in such absolutes. So that’s hint #1 that I’m going to be disappointed.
The author of this article, Dave Mihalovic, is a naturopathic doctor (typically someone who eschews science-based medicine in favor of pseudoscience like homeopathy and acupuncture), who claims to be a “vaccine researcher.” If he’s a vaccine researcher, he has published exactly zero indexed articles about vaccines, or any other field of real medicine. In other words, his research probably means he spent a few hours on Google and thinks he’s now as smart as anyone who actually has a bachelor’s and doctoral degree in immunology, virology, biochemistry or some other biomedical science along with a decade or two research in a world class laboratory. Mihalovic is as much a vaccine researcher as I am an NBA basketball player. I can say that I play basketball. I can claim that I can dunk over LeBron James. But there’s no evidence of it, and you’d just think I was being silly. Mihalovic, of course, isn’t being silly, he thinks he’s as smart as real researchers. But let’s see what Mihalovic has to say:
A summary review of data on neurological adverse events and the historical role of vaccination in the natural course of infectious disease in Switzerland and Germany, supports data from other regions with evidence that vaccines had no impact on disease prevention efforts from the early-mid to late 20th century. The data contradicts widespread misinformation campaigns by mainstream medicine which claim that vaccination led to immunization and a subsequent decline in infectious disease. The review supports other data around the world and mounting evidence that vaccine effectiveness is unproven, unjustified and lacking evidence-based medicine.
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Comparing effectiveness of two types of pertussis vaccines
Over the past year or so, there have been several outbreaks of whooping cough (Bordetella pertussis), including one that reached epidemic levels in Washington state, which has been considered one of the worst pertussis outbreaks in the USA during the past several decades. The disease lead to 18 infant deaths from whooping cough during 2012.
The original DTP vaccine (diphtheria, tetanus and pertussis) became available in the USA in 1948 and was critical to dropping the number of cases of whooping cough from 260,000 in 1934 to less than a few thousand per year in the 1990′s. The original vaccine contained what was called “whole-cell” pertussis, which includes all of the antigens of the pertussis bacterium, partially because it wasn’t understood (and to some extent still not fully understood) which antigens on the bacteria actually induce the proper immune response to have the body destroy a pertussis infection.
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Consequences of not vaccinating–Report 5
A baby died in Florida from whooping cough (Bordetella pertussis) last week. According to the report, “officials said the family chose not to vaccinate their child. Some parents are choosing not to fully vaccinate their children because they worry there is a link between the vaccinations and autism.” Of course, there is no evidence that vaccines cause autism.
Let’s place the blame for this death right where it belongs, right at the feet of Mr. Andy Wakefield, the de-licensed physician, who caused the drop in MMR vaccine uptake through his fraudulent claim that MMR caused autism. Wakefield is a horrible excuse for a human being, and probably should take responsibility for this and many other deaths that resulted from his fraudulent and retracted study claiming that vaccines cause autism.
Parents have a moral obligation to vaccinate their children.
We have a moral responsibility for the health of our children and this has to dominate any other belief systems we hold. Even worse, by not vaccinating children, we are putting other people’s children at risk, as well as our own. If another child dies of measles, or whooping cough, or meningitis, and was infected by our own, non-vaccinated child, are we partly responsible?
And they should start by ignoring Wakefield’s lies. Because vaccines would have saved this baby’s life.
Use the Science-based Vaccine Search Engine.
Key citations:
- Retraction–Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 2010 Feb 6;375(9713):445. doi: 10.1016/S0140-6736(10)60175-4. PubMed PMID: 20137807.
- Carrillo-Marquez M, White L. Current controversies in childhood vaccination. S D Med. 2013;Spec no:46-51. Review. PubMed PMID: 23444591.
Vaccines saved lives–scientific evidence
There are many canards propagated by vaccine denialists to support their personal beliefs (or denialism) about the safety and effectiveness of vaccines. One of their more popular beliefs is that vaccines didn’t end many of the deadly diseases, but improved sanitation, healthcare, nutrition or magical fairies (also known as homeopathy) ended these diseases. There is even a subgroup of these believers who think that the CDC, historians, and everyone else is lying about the epidemics that existed prior to vaccinations–let’s call this group history deniers.
So, is there scientific evidence that vaccines actually ended these epidemics? Yes there is, and it’s unequivocal. Unless you want to deny history, and somehow all of the health care records and epidemiological information was faked.
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Waning whooping cough immunity after DTaP–a new analysis
Despite the fact that over 95% of kindergarteners in the United States are properly vaccinated against whooping cough(Bordetella pertussis) with the DTaP vaccine, there are persistent reports that the rates of whooping cough have risen during the past few years. Several outbreaks, along with an outright epidemic in Washington state, seemed to indicate that the vaccine’s effectiveness is waning faster than expected.
A recently published study in Pediatrics evaluates reports of increased rates of pertussis in the six years after receipt of the fifth (of five) DTaP doses. These reports suggest that waning of immunity to pertussis from DTaP is occurring before the recommended booster age of 11 to 12 years. The researchers tracked more than 400,000 Minnesota and Oregon children using immunization records and state health department whooping cough data. All of those children were born between 1998 and 2003 and received the recommended series of five DTaP shots, the final one usually given at 4-6 years old.
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Whooping cough vaccine–facts about waning immunity
A new article published this week in the Journal of the American Medical Association (JAMA) by Misegades et al. analyzed a recent whooping cough (Bordetella pertussis) outbreak in California children. Misegades determined that those who had not been vaccinated against the disease were nine times more likely to get pertussis than those who had received the entire five-shot series. However, among children who were fully vaccinated, the longer it had been since their final dose of the DTaP vaccine (which protects against diphtheria, tetanus and pertussis), the higher the risk of contracting whooping cough. This is in line with the decrease in effectiveness of the vaccine that has been discussed here and elsewhere.
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Whooping cough update: outbreak in Montana continues
The Montana Department of Health has reported (pdf) that as of November 15, 2012, a whooping cough (Bordetella pertussis) outbreak has reached over 500 cases since the beginning of the year, compared to only 129 cases during the same time period in 2011. As of November 15, 33 cases of pertussis were found in infants of less than one year of age. Of these, four have been hospitalized. Because Montana is has a small population (about 1 million people), the overall incidence rate year to date is 50.5 pertussis cases per 100,000 Montana residents.
This past spring, there was a pertussis outbreak in several Montana counties, but it seemed to abate during the summer. The Department of Health is reporting that Flathead county, a northern county that borders Canada, is currently struggling to contain an outbreak in five school districts. “Since the beginning of October, we have 35 cases,” said Community Health Services Director for Flathead County Jody White. “Usually we won’t even see 35 in a year, so it is definitely unusual to have this many.”
Whooping cough update: Colorado outbreak hits 1000 cases
The Colorado Department of Public Health and Environment has reported that as of October 6, 2012, a whooping cough (Bordetella pertussis) outbreak has hit over 1000 cases since the beginning of the year, far exceeding the 5 year average of 2007-2011. The chart below shows the dramatic weekly increases in cases in Colorado since beginning of the year.
State legislatures making vaccine exemptions more difficult to obtain
Outstanding news. Tara Haelle reported in Nature News & Comment that US state legislatures are beginning to pass laws that make it more difficult for parents to obtain so-called personal exemptions to vaccinations before children attend public schools.
According to Haelle, “Each US state sets its own vaccination policies, and most will not generally allow children to attend public school unless they have been vaccinated against diphtheria, tetanus and pertussis (whooping cough); hepatitis B; the Haemophilus influenzae bacterium; measles, mumps and rubella; polio; and varicella (chicken pox).” In general, most states require that students meet the Centers for Disease Control and Prevention schedule (pdf) for children between 0 and 6 years old, which is set by the Advisory Committee on Immunization Practices.
All states allow legitimate medical exemptions from the immunization schedule, because of certain medical conditions that might make vaccinations problematic for young children. Some of these medical issues are: allergies to some of the components in the vaccines, immunocompromised conditions, family history of seizures, and other issues outlined in the General Recommendations on Immunization of the Advisory Committee on Immunization Practices.
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Protecting infants from whooping cough by cocooning
Infant being treated for pertussis infection. ©CDC, 2012.
This year, 2012, was one of the worst whooping cough (Bordetella pertussis) outbreaks in the USA for the past 70 years, which included an outright epidemic in Washington state. Some of the reasons for the spread of the disease were a reduced whooping cough (Dtap) vaccination rate and reduced effectiveness of the Dtap (or TDaP) vaccine. Whooping cough is a serious disease, especially to children under the age of one year old, who have not been fully vaccinated. According to the Centers for Disease Control and Prevention, of those infants who are hospitalized with pertussis about:
- 1 in 4 (23%) get pneumonia (lung infection)
- 1 or 2 in 100 (1.6%) will have convulsions (violent, uncontrolled shaking)
- Two thirds (67%) will have apnea (slowed or stopped breathing)
- 1 in 300 (0.4%) will have encephalopathy (disease of the brain)
- 1 or 2 in 100 (1.6%) will die
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Washington state makes it harder to get an immunization exemption
Paul Offit, MD
After one of the worst whooping cough (Bordetella pertussis) epidemics in 70 years in Washington state, there is some good news. The New York Times has reported that the state, after passing a law that made it more challenging for a parent to get a personal exemption for a vaccination for their children, the exemption rate in Washington state has dropped by 25 percent. This is good news, because until recently Washington state was dead last in the immunization rate, or, if you like exemptions, it was number 1!
In 2011, the state’s legislature passed a law making exemptions a bit more difficult, by requiring parents to actually speak to a healthcare professional about the risks and benefits of vaccinations. That person then must sign off on the exemption. Parents who opted out of state immunization requirements for kindergartners peaked at 7.6 percent in the 2008-2009 school year, setting off alarms among public health experts in the state, according to the New York Times.
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Vaccines aren’t tested–Myth vs. Science (updated)
Background
There are so many silly memes that have arisen from the anti-vaxxers, all of which have been thoroughly debunked. Everything from the well-worn (and worn-out) “vaccines cause autism” fable, quashed here, to the “these diseases aren’t dangerous”, which, of course, couldn’t be farther from the truth. One of the more annoying of the tales pushed by the vaccine denialists is that vaccines aren’t tested thoroughly before being used on unsuspecting infants. I do not know where this started, or why it started, but like much in the anti-vaccination world, it really doesn’t matter. It just passes from one person to another across google, and individuals with no research background hold this particular belief as if it were the Truth™.
This article was posted a couple of months ago, but I wanted to update it slightly based on those crazy photos that keep being passed around Facebook and Twitter. It’s easier to read 17 words and say “YES!” instead of doing some real research. And I wanted move ahead with my new “Myth vs. Science” series.
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Effectiveness of pertussis vaccines–myth vs. reality
Over the past few months I have written extensively about the the current whooping cough (Bordetella pertussis) outbreak which has reached epidemic levels in areas like the Washington state, and has been considered one of the worst outbreaks in the USA during the past several decades. The outbreak has lead to several deaths here in the USA and in other countries such as the UK. Of course, this outbreak has lead to the blame game from the antivaccination crowd, because they claim that since A) most kids are vaccinated, and B) we’re having this outbreak then C) either the vaccines are useless or are actually the cause of the outbreak. Seriously. They blame the vaccines.
So I decided to search the internet (or just read the comments section of my blog) to find the most popular vaccine denialist arguments regarding pertussis vaccinations, and deconstruct and debunk them. Hopefully, it will be a useful tool for you when you’re engaging a ridiculous argument with one of those antivaccinationists. Of course, I could use the information too.
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Whooping cough: North Carolina reports first infant death in 2012
The North Carolina Department of Health and Human Services has reported North Carolina’s first infant death from whooping cough on August 20, 2012. The child was only 2 months old. “Babies and young children are not fully immunized until they have finished a series of vaccinations, so their only protection against whooping cough is the people around them,” said State Health Director Dr. Laura Gerald. “Anyone who lives with or will be around a baby should be vaccinated.” In other words, someone who was not vaccinated or not fully vaccinated passed the infection to this child.
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Vaccine denialism causes USA’s worst whooping cough epidemic in 70 years
Steven Salzberg, at Forbes Magazine, has reported that the USA is experiencing the worst whooping cough epidemic in 70 years. In addition, the CDC has stated that as of August 4 2012 (pdf), there are 21,000 cases and 10 deaths in the United States from whooping cough(Bordetella pertussis) year-to-date. Wisconsin has the highest rate of infection, while Washington, as I have discussed on a number of occasions, has one of the highest total number of pertussis infections.
Increases in pertussis outbreaks by state from 2011 to 2012.
Whooping cough update: Washington state epidemic hits 3400 cases
The Washington State Department of Health is reporting that as of August 4, 2012, the current whooping cough (Bordetella pertussis) epidemic has hit 3400 cases, over 15X more than the 214 cases reported at the same time last year. The epidemic has finally shown a big drop off in new reports this past week (pdf), although there are concerns that the numbers will increase against this fall as children return to school in the autumn.
Pertussis cases by week 2012 (red) vs 2011 (blue)
According to the Centers for Disease Control and Prevention, pertussis (whooping cough) can cause serious illness in infants, children and adults. The disease usually starts with cold-like symptoms and maybe a mild cough or fever. After 1 to 2 weeks, severe coughing can begin. Unlike the common cold, pertussis can become a series of coughing fits that continues for weeks. In infants, the cough can be minimal or not even there. Infants may have a symptom known as “apnea.” Apnea is a pause in the child’s breathing pattern. Pertussis is most dangerous for babies. More than half of infants younger than 1 year of age who get the disease must be hospitalized. Approximately 1-2% of infants who are hospitalized from pertussis will die.
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Whooping cough–effectiveness of pertussis vaccines
This year has been a bad one for whooping cough (Bordetella pertussis) throughout the world. There have been large outbreaks of pertussis in the United States, England and Australia in 2012. There have been some hypotheses as to why it has been happening. For example, there is some speculation that a subtype (or genotype) of pertussis was responsible for the Australian outbreak, but the evidence is complicated and equivocal. I think there is some evidence that the epidemic in Washington state results from the much lower vaccination rates in the area as a result of the anti-vaccination lunacy.
But the story may be much more complicated, and may need a more open discussion amongst those responsible for protecting us from these infectious diseases. These pertussis outbreaks may be a result of the reduced performance of the pertussis vaccine currently being used. The problem with an open discussion regarding the current vaccine is that the vaccine denialists will make an absolute claim that the pertussis vaccine does not work (of course, a complete fabrication, typical of the anti-vaxxers), instead of the more accurate position that the pertussis vaccine might not have the high level of effectiveness that was originally thought. Ironically, the current vaccine, the acellular pertussis version, replaced the older and more effective whole pertussis vaccine because critics believed the older version had too many side effects.
(more…) «Whooping cough–effectiveness of pertussis vaccines»
Whooping cough–Washington state epidemic is very scary thanks to vaccine denialism
The Washington State Department of Health is reporting that, as of July 30 2012, there have been 3,285 cases of whooping cough (Bordetella pertussis) in the state. This compares to just 253 through the same time period in 2011. If you want to be scared, look at it graphically.
Debunking the “vaccines aren’t tested” myth
There are so many silly memes that have arisen from the anti-vaxxers, all of which have been thoroughly debunked. Everything from the well-worn (and worn-out) “vaccines cause autism” fable, quashed here, to the “these diseases aren’t dangerous”, which, of course, couldn’t be farther from the truth. One of the more annoying of the tales pushed by the vaccine denialists is that vaccines aren’t tested thoroughly before being used on unsuspecting infants. I do not know where this started, or why it started, but like much in the anti-vaccination world, it really doesn’t matter. It just passes from one person to another across google, and individuals with no research background hold this particular belief as if it were the Truth™.
(more…) «Debunking the “vaccines aren’t tested”…»
