On 6 October 2016, the Appellate Division of New York’s Supreme Court held invalid an influenza vaccine mandate that required that children attending certain child care, prekindergarten and kindergarten programs in the city receive an influenza vaccine each year in order to attend. While the decision may appear, on first glance, as a loss for public health and the children of New York City, in reality it gives city health authority broader powers to act for children’s health than did the decision appealed, and offers the board guidance – albeit confusing, and somewhat tricky guidance – for future actions that can withstand scrutiny. If the board chooses to take advantage of this opportunity, it can pass a much more far-reaching regulation.
Recently, I wrote an article discussing how antivaccination trope inventors could not understand the most basic elements of mathematics in reading a vaccine label. They misinterpreted some simple math like that the toxic level of a substance is several million times higher than what is injected. I suppose in the minds of vaccine deniers, 1=1 billion. Or 1 trillion. Or 4783.2226. It just depends. Antivaccine activists misuse vaccine statistics to invent scare tactics. Don’t be fooled by their bad math.
And if they can’t understand the simplest of math principles, assuming that they would understand population level statistics might be a really bad assumption.
I was pointed to an antivaccination article, on the Political Blindspot website, which is dedicated to finding news articles swept under the rug by mainstream media. The raptor always gets his feathers ruffled whenever the word “mainstream” is used. Continue reading “Vaccine statistics – scare tactics and bad math don’t fool anyone”
Updated 28 November 2014.
According to the unsurprising results reported in a new study, published in the Morbidity and Mortality Weekly Report, in areas where laws mandate that children receive a seasonal flu vaccination, before entering preschool or day care, the rate of flu-related hospitalizations drops significantly. In this study, after Connecticut enacted a law that mandated the vaccine, the rate of children requiring hospitalization because of the flu declined by 12%.
Connecticut’s regulation for flu vaccination (pdf), which took effect in 2010, increased the uptake of childhood flu vaccinations from 67.8% to 84.1%. According to Dr. James Hadler, the lead researcher for the study, “That difference, we feel, has resulted in children attending daycare being better protected against influenza and its severe complications.”
Even though Connecticut’s regulations for flu vaccination allows for some exemptions (the child has a scheduled appoint for the shot soon after the start of school, medical contraindication, or religious belief), it’s obvious that the effort was highly successful in driving up the level of uptake of the flu vaccination, a vaccine that is often ignored by parents for occasionally odd reasons. Continue reading “Why we vaccinate–mandatory flu vaccines reduce risk of hospitalization”
For a moment, I want to step away from my typically snarky commentary about things I see in the pseudoscience world. I want to talk about my own experiences on that day, which, in retrospect, ended up being a closer call than I ever wish to have.
You see, on September 11, 2001, I was taking a morning flight from New York’s JFK airport to my home. I had spent the weekend in New York City with my girlfriend–we had good food and drinks with her brother and her sister-in-law, and we all got good seats for the hit musical on Broadway that year. Even after 13 years, I’ve never seen the movie based on that musical nor listen to the songs, despite how funny they are. It’s because, to me, that musical is intimately tied to 9/11.
On Monday, September 10, I had to go down to Wall Street (in a building close to the World Trade Center) to meet with a group that was doing an analysis of one part of the medical device industry, and we spent all day examining numbers, evaluating companies, and discussing future technology. It was highly analytical, and something I enjoy doing.
I also met with a hedge fund operator in the Twin Towers, whom I had befriended in a previous job. His whole investing strategy was to root out liars and frauds in the small medical companies, then short the stock (that is bet that the stock price will drop and profit from it). He had an amusing and colorful internet nom de plume, which I remember to this day.
After the meetings, I was originally going to stay in the Marriott Hotel on Wall Street, but I decided to just stay in my more uptown hotel for better restaurants and things to do.
At this point, the world was perfect for me. New York’s weather was feeling a bit like autumn was just around the corner. I was in a wonderful relationship. And I was going to close on a new house on Tuesday afternoon, so I was in a hurry to get back. Continue reading “The anniversary of September 11–my personal experience”
As you may be aware, there was a relatively large measles outbreak in New York City (pdf), hitting 26 individuals according to the New York City Department of Health. Some have stated that the outbreak was small, but compared to the historical average of around 60 measles cases per year for the whole United States, and when it was thought that we had “defeated” measles in the USA, 26 is a surprisingly large number.
In light of these outbreaks, the New York State Department of Health (DOH) announced that it has updated its immunization requirements for school attendance to meet the revised standards recently published by Advisory Committee on Immunization Practices (ACIP), which is a group of medical and public health experts that have developed vaccine and immunization recommendations to reduce the incidence and prevent disease amongst America’s children. The goal of these recommendations is to reduce the incidence of vaccine preventable diseases.
The new 2014 standards did not add any new vaccines for school entry; however, they did update the number of doses required and the minimum intervals between doses. Generally, ACIP makes several recommendations a year, and state health departments “catch up” with the newest recommendations when they set the standard for the upcoming school year.
According to said Acting State Health Commissioner Howard Zucker, MD, JD, “immunizations protect children from serious childhood diseases, like whooping cough and measles, and have an excellent track record of safety and effectiveness. I encourage parents to talk to their children’s healthcare provider and work with their school’s health services to ensure that all immunizations are up-to-date.”
New School Immunization Requirements
The new requirements, which apply to daycare, head start, nursery, pre-kindergarten and grades kindergarten through 12, represent the best evidence and data available to public health researchers, and is the first update to the New York State requirements in over a decade.
- Students entering kindergarten or 6th grade in the 2014-2015 school year will now be required to have two doses of the varicella (chicken pox) vaccine and 3-5 doses of poliomyelitis vaccine. The updated varicella and polio vaccination requirements will be phased in over the next seven years and will be required for all grades by the 2020-2021 school year.
- For all other required vaccines, students in day care, head start, nursery, pre-kindergarten and grades kindergarten through 12 will be required to have age-appropriate doses in accordance with the ACIP schedule (pdf).
- A student who is in process is defined as one who has had the first dose of vaccine in all of the required immunization series and has appointments to complete the series in accordance with the ACIP catch up schedule.
- Students may present proof of immunity by serology (blood test) for the following immunizations: measles, mumps, rubella, hepatitis B, varicella, and poliomyelitis.
- Medical exemptions to immunizations must be reissued annually. The written exemption must identify the immunization exempted, the medical contraindication for the exemption, and the length of time the immunization is contraindicated. A sample medical exemption form is available one the website.
- Any child who has been vaccinated according to the ACIP recommendations, which are followed by most health care providers, should not need further vaccinations in order to attend day care or school.
New York State and City allow for legitimate medical exemptions to some or all of these vaccines, but they require certification and renewal each year. The state and city also allow religious exemptions, but recent court decisions (also here) have empowered school administrators to restrict or disallow those exemptions.
I cannot be sure that the New York State Department of Health was responding to outbreaks of measles and whooping cough to re-examine its vaccine requirements, but it would make sense. And hopefully it, along with the reduction or elimination of nonsense religious exemptions (there are simply no legitimate anti-vaccine religious groups), will reduce or eliminate outbreaks of vaccine preventable disease.
Yesterday, I tried to show in the most simple mathematical terms that the risk of contracting measles, in the New York City outbreak, was 30X higher in unvaccinated children than it was for vaccinated. I knew I vastly underestimated the actual rate because I used a larger population than I should, because I lacked the more specific geographic spread of the disease. I’ll leave that to a peer-reveiwed paper that I’m sure will be published in the next few months that will accurately describe everything about the outbreak. Don’t hold your breath vaccine deniers–their conclusions will only vary from mine because they’ll present a much higher risk of contracting measles amongst non-vaccinated children.
Someone suggested that I discuss another article that analyzed a measles outbreak in Corpus Christi, TX, which compared those who were vaccinated with the MMR vaccine to those weren’t. The results are clear and relatively straightforward:
- 1732 children were seropositive (meaning they had antibodies to measles) and over 99% of them were vaccinated. None, and not close to none, but absolutely 0 of these children contracted measles.
- 74 children were seronegative (they lacked measles antibodies). Fourteen (14) of these children contracted measles.
So, let’s look at the math. All of the kids who had measles antibodies (presumably as a result of the MMR vaccine, since 99% were vaccinated) avoided the disease and its consequences. On the other hand, 18.9% of the children who lacked antibodies got sick.
Again, if this isn’t clear…0% contracted the disease if they had antibodies from vaccines, 18.9% contracted the disease if they didn’t have antibodies.
Now, the 74 children who were seronegative also were vaccinated (though the paper did not tell us how many vaccines were given, it takes at least 2 to confer full immunity). If there are no other issues (and again, the article didn’t report that) like some type of compromised immune systems in some of the 74 children), the vaccine was 96% effective in seroconverting and preventing measles.
This story is rather basic. The MMR vaccine is extremely effective in boosting the immune system to produce anti-measles anti-bodies. A small group seems to have not seroconverted for unknown reasons. But even though most of the population in this study were protected against measles, the disease is so pervasive, so pathogenic, even a small group of susceptible individuals can catch it. But because the vast majority, 96% were protected against the disease, this measles outbreak didn’t spread further.
But think about this. If the number isn’t 96%, but 70% because parents refuse to vaccinate. What happens is that the random chance that an infected child encounters an unvaccinated child increases dramatically, increasing the risk of a much larger outbreak. With all of the consequences of measles.
As I said before, it really is simple math. So simple that a vaccine denier could do it.
- Gustafson TL, Lievens AW, Brunell PA, Moellenberg RG, Buttery CM, Sehulster LM. Measles outbreak in a fully immunized secondary-school population. N Engl J Med. 1987 Mar 26;316(13):771-4. PubMed PMID: 3821823.
As you may be aware, there is a relatively large measles outbreak in New York City, hitting 26 individuals according to the most recent report (pdf) from the New York City Department of Health. An outbreak of 26 cases of measles may seem small, but compared to the historical average of around 60 measles cases per year for the whole United States, it really is a relatively large outbreak.
According to the most recent data, 12 of the cases are children and 14 are adults, and nine of 12 children were unvaccinated (2 were because parents got an exemption, and the other 7 because they were too young to be vaccinated with the MMR vaccine). In addition, it was difficult to determine the vaccination status of the adults, but we’ll focus on the children.
If you read the most obnoxious antivaccination websites (and I did it for you), you’d see claims that only 2 of the 26 were unvaccinated (simply not true or an ignorant misreading of the actual data), implying that 90% of those who caught measles were vaccinated. In fact, it’s at least 9 who were unvaccinated.
So let’s go with some simple math, just based on this small sample. But if the antivaccination lunatics are going to invent numbers, it is my job to obtain real numbers that show factually what is happening.
The outbreak is centered in Upper Manhattan and The Bronx areas of Manhattan, a total population of just under 2 million individuals. Now the outbreak is actually more focused than those areas, but it makes the math easier for the anti-science crowd.
- Total population: 1,945,000
- Total school age population (pdf, Appendix Table 4 and 10), which we will assume covers the the ages of the children in the measles outbreak: 550,222
- Number children vaccinated (based on the CDC’s estimate of the MMR vaccine uptake rate in New York City of 90.3%): 496,850
- Number children not vaccinated: 53,372
I’m going to vastly oversimplify the risk of the measles outbreak, because I am aware that the antivaccine crowd is math challenged. If I used real epidemiological data, measure the risk in the exact geographical areas of the outbreak, data that I don’t have, the incidence rate would be much higher. If I did this by actual age, say 0-18 months, the risk would absolutely frighten you. But we’ll keep it simple.
- Total risk for measles for vaccinated children, 3/496,850 or 6 out of one million
- Total risk for measles for unvaccinated children, 9/53,372 or 169 out of one million
So, despite what you’ve heard from the antivaccination squad, the risk for contracting measles in an outbreak is nearly 30X higher in the unvaccinated group. Again, my numbers here vastly underestimate the risk, because the actual calculation would be done using data from the small area that this outbreak occurred, with the risk for the unvaccinated group probably being 10,000X higher than stated here. And I’m not even getting to risk reducing strategies like increasing the vaccination uptake rate to 95 or 96%, and the herd effect would have stopped this outbreak in its tracks.
It really is simple math. So simple that a caveman could do it.
- Centers for Disease Control and Prevention (CDC). Vaccination coverage among children in kindergarten – United States, 2012-13 school year. MMWR Morb Mortal Wkly Rep. 2013 Aug 2;62(30):607-12. PubMed PMID: 23903595.
This article has been updated, and you can read it here. The comments section to this article have been closed, but you can comment at the newer version.
A few days ago, I wrote an article discussing how antivaccination trope inventors could not understand the most basic elements of mathematics in reading a vaccine label. They misinterpreted some simple math like that the toxic level of a substance is several million times higher than what is injected. I suppose in the minds of vaccine deniers, 1=1 billion. Or 1 trillion. Or 4783.2226. It just depends.
And if they can’t understand the simplest of math principles, assuming that they would understand population level statistics might be a really bad assumption.
Recently, I was pointed to an antivaccination article, on the Political Blindspot website, which is dedicated to finding news articles swept under the rug by mainstream media. My skeptical radar always goes into full energy mode whenever I see the word “mainstream.” Continue reading “Hey vaccine deniers–it’s just simple math. Part deux.”
The reach of the crazy creationists always seemed like a southern thing. Mississippi and Alabama are backwards states with bad education where they invest more in football than science education. Tennessee is trying to relive the Scopes Monkey Trial. Oklahoma and Louisiana are trying to have their students deny all kinds of science from evolution to climate change.
But we have always assumed that the northern progressive parts of the USA were resistant to these science denialists. Unfortunately, the stupidity has reached north into the New York City Department of Education, by far, the largest public school district in the United States with over 1.1 million students. They have decided to ban the following words for testing, because it might offend some of their students: Continue reading “Antievolution and anti-science education–New York City?”