On April 18, 2019, a New York Supreme Court Judge (see Note 1) rejected a challenge to the New York vaccine mandate (pdf) brought by three lawyers (attorneys Robert Krakow, Patti Finn, and Robert F. Kennedy Jr., all of which have litigated cases on vaccines issues in the past). The litigation involved New York City’s order for an MMR vaccine mandate in certain zip codes.
Given how much the anti-vaccine religion abuses social media to push their lies and deception, this article will refute some of the most egregious false claims. Of course, most anti-vaxxers won’t read this, but let’s hope that someone reading the false narratives about New York City’s mandatory measles vaccinations will come here to find evidence-based facts.
As of 9 April 2019, approximately 285 people have contracted the disease in New York City since September, mostly in Brooklyn’s Williamsburg neighborhood, which has a large number of ultra-Orthodox Jews. New York City public health officials said that of the 285 individuals, 246 were children. Furthermore, 21 of those children have been hospitalized, five in an intensive care unit. Yes, measles is dangerous, and children will be hospitalized.
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.
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.”
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.
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.
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.
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.
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
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.