Help me figure this out "vaccinated populations contain outbreaks"... - Page 2

[miriam]

The island of Molokai used to be a leper colony; Hansen's disease has been greatly reduced in our society because of the isolating of the affected.  I am old enough to recall county required yellow flags on homes for quarantine purposes.  Yellow flags used to be used on ships to keep others away.  There were rumors but I have not been able to locate a verifiable source from that tolerant Sweden is isolating AIDS patients on an island.  

People can be forced to stay away from others.  If carriage of a disease is a problem, then that needs the attention and energies of the local health department to protect others.  

http://www.cdc.gov/eid/content/17/4/584.htm?source=govdelivery

What is carriage?

[QUOTE]What is carriage?   A carrier is a person who harbors a specific infectious agent in the absence of clinical illness with or without a detectable immune response (4). The carrier state may reflect carriage of the organism in the incubation period before clinical symptoms appear, during an illness, or after recovery from illness. The carrier state may be short or long, and it may be intermittent or continuous. Carriers may spread infection to others. Latency should be distinguished from the carrier state, in that a latent organism is not transmissible. Hib carriage can be synonymous with Hib colonization and is defined as the presence of viable Hib organisms in the human pharyngeal mucosa. This definition depends on the sensitivity and specificity of the process used to identify viable bacteria in a healthy host.[/UNQUOTE]

[no5no5]

Originally Posted by miriam 

There were rumors but I have not been able to locate a verifiable source from that tolerant Sweden is isolating AIDS patients on an island. 

  If that is true, it is horrible.  How can you possibly include that in a list of quarantine successes?  And leprosy?  It's not highly contagious, has a very long incubation period, is easily treatable, and 95% of the population is naturally immune.  Oh, and the stigma attached to it, which has been aggravated by quarantine, has prevented and continues to prevent early diagnosis and treatment.  It's not exactly the poster case for quarantine's effectiveness. 

[heathergirl67]

From what was written in your original post it didn't sound like you understood how immunity affects disease transmission. And it's my opinion that if someone doesn't know that then they shouldn't be making decisions regarding infectious diseases for their children. Infectious disease and vaccines are huge, complicated topics. But I think that understanding immunity and disease transmission are the basics. I don't expect parents to know about that, though, to be good parents. We can't all know everything. But I think that if someone doesn't know at least the basics of something, they should probably leave it up to an expert until/if they gain more knowledge on the subject. Especially when it's something that could have a serious affect on the health of children.

And to answer your question: I do think that if people don't understand "fully vaxed people getting VPDs when exposed, not vaxed people not getting the disease when exposed " then they also don't fully understand the "risks/benefits of each disease and each vaccine separately ." Like I said, I think that transmission and immunity are the basics and if you don't understand those, then you aren't aware of the risks of diseases especially. It seems that that's not a popular sentiment around here, but that is my opinion.

Originally Posted by Tee25 

Hmm not sure that you can take that statement any other way THAN harsh lol. But I'll try I guess.

Actually, my question came off an article I was reading that involved about 2/3rds of "vaccine failures"...so maybe I should have posed my question better.

So are you saying that because someone doesn't understand the complexity of disease transmission completely (ie, fully vaxed people getting VPDs when exposed, not vaxed people not getting the disease when exposed) that also means they must not understand the risks/benefits of each disease and each vaccine separately? Not to mention how to treat each VPD if it were to occur? Not sure I understand where that correlation comes from in your line of thinking as it relates to making vaccine decisions. There is so much more to know about making a vaccine decision than just how disease transmission occurs in general populations...or why it occurs in vaccinated populations. I apologize if my question came off as ignorant in some way...I would hate to give anti-vaxers a bad name... [couldn't find a sarcastic smilie]

[miriam]

Leprosy is NOW highly treatable, but it was not until antibiotics came along. Before antibiotics, yes, lepers were isolated.  We NOW know it has a long incubation period and is not highly contagious.   There are currently two Hansen's disease clinics in San Diego, CA.

As for AIDS/HIV and Sweden, ask the Swedish health care system; I do not know how much of a problem with AIDS/HIV they have there, but that was their way of treating and controlling it when I researched how other countries handled AIDS. 

Originally Posted by no5no5 

  If that is true, it is horrible.  How can you possibly include that in a list of quarantine successes?  And leprosy?  It's not highly contagious, has a very long incubation period, is easily treatable, and 95% of the population is naturally immune.  Oh, and the stigma attached to it, which has been aggravated by quarantine, has prevented and continues to prevent early diagnosis and treatment.  It's not exactly the poster case for quarantine's effectiveness. 

[stik]

Due to some family connections, I am fairly well informed on approaches to treatment of AIDS and HIV worldwide.  I have never heard of any country isolating AIDS patients on an island, and the Scandinavian countries are often considered models for public health, so I would think it would have come up. 

So I'm utterly blown away by your comment about Sweden.  I'm sure you have a good reason for believing this to be true.  However, it is a hideous (and counterproductive) human rights violation.  If you still have your notes lying around, would you please share your sources?

I'm digging - so far, I've found one reference in an article in Spin magazine in 1988: http://books.google.com/books?id=5oyYjDeNc_AC&pg=PA88&lpg=PA88&dq=Does+Sweden+quarantine+people+with+AIDS?&source=bl&ots=3q1F3PVOlS&sig=ZXGo-euOnDyeSfDoAw94iUMVPkE&hl=en&ei=2M2TTZunEYzGsAOt1YC4BQ&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBoQ6AEwAA#v=onepage&q=Does%20Sweden%20quarantine%20people%20with%20AIDS%3F&f=false

1988 was very much a time of crisis and fear, and an article about cultural responses to AIDS is not a great source of information on public health strategies.   It's possible that this article reflected a real Swedish policy that reflected the understandings and attitudes of 1988.  Or, alternately, this statement (made by a writer promoting a play that dealt with the theme of quarantine and civil rights) might reflect a zeitgeist of fear and uncertainty in re. the personal vs. societal costs of handling the AIDS outbreak.

Still looking . . .

I can see the first page of an article that claims that, in 1983, Sweden was the first country to have recourse to legislation in re. people living with AIDS.  The rest of the article is behind a pay wall, and I can't see it. 

Several other sources report that Sweden has no travel restrictions for people with AIDS/HIV, and that treatment centers are available throughout the country.  This one is typical: http://www.hivtravel.org/Default.aspx?PageId=143&CountryId=170

In a statement to a a High Level Meeting on AIDS at the UN in 2008, Sweden's ambassador emphasized the importance of of respecting human rights (and gender equality) in the fight against AIDS.  http://www.un.org/ga/president/62/issues/hiv/sweden.pdf

The first page of an article on LexisNexis describes Sweden's laws about AIDS from 1983 and 1985 - quarantine is not mentioned:

Sweden was the first country to introduce legislation on AIDS. Promulgated on March 8, 1983, these regulations made mandatory the reporting of confirmed and suspected AIDS cases to the National Bacteriological Laboratory. ² Sweden also adopted the first legal instruments dealing with protection against HIV transmission in the health care environment. In March 1985 Sweden's National Board of Occupational Safety and Health (the Board) issued general recommendations "concerning protection against AIDS in the course of the care and administration of patients" along with highly detailed recommendations which laid out "measures to be taken in work entailing a risk of infection with HTLV-III." ³ The Board addressed the latter recommendations to the staff of inpatient and outpatient services, personnel working in laboratories, dental personnel, and pathologists and other staff performing autopsies.

link: https://litigation-essentials.lexisnexis.com/webcd/app?action=DocumentDisplay&crawlid=1&doctype=cite&docid=48+Md.+L.+Rev.+77&srctype=smi&srcid=3B15&key=7510a87c2a9efe5d175e14b0f14d002f

Again, the rest of the article is behind a pay wall, but it does at least clear up my questions about the nature of Sweden's early-80s legislation.

Edited by stik - 3/30/11 at 6:16pm

[rhiandmoi]

Sweden does have on the books laws that allow under extreme circumstances forceful detention for I think around 30 diseases. They have pretty strict testing and reporting guidelines, and if you have a disease of significant public health concern you are given mandatory treatment and transmission prevention plans. And if you don't comply you can be forcibly detained at a hospital until you're healthy or you comply.

I don't have a link handy, but one of the main laws is the Communicable Disease Act.

[no5no5]

Originally Posted by miriam 

Leprosy is NOW highly treatable, but it was not until antibiotics came along. Before antibiotics, yes, lepers were isolated. 

Um.  Leprosy was first treated with antibiotics long before quarantine laws were rescinded.  Quarantine for leprosy is actually still in use today in some parts of the world.  Personally, I don't think that's a good thing. 

[pers]

Originally Posted by miriam 

You do not think the NHIS have an agenda here?  

Quarantine and sanitation  have been a time honored method of preventing the spread of disease.  

True.  Quarantine certainly did the spread of many diseases, and it is unlikely that the smallpox vaccine could have eradicated smallpox on it's own without quarantine - it was the double whammy tactic of quarantining everyone known to be exposed and vaccinating all possible contacts among them (to cut down on cases slipping by due to not knowing about exposure) that finally rid us of Smallpox.  Quarantine is still used effectively for very scary diseases such as Ebola, and you can bet that if smallpox was ever released as biological warfare, they would be quarantining everyone who may have been exposed as well as vaccinating.   But yet quarantine couldn't rid us of many diseases such as leprosy, smallpox, measles, scarlet fever, tuberculosis, German measles, mumps etc.  

Modern sewage treatment and such keeps us free of diseases such as cholera and typhoid fever which are spread by contaminated water and food.  Handwashing and wiping down surfaces and such can help keep people from getting sick, but how many kids wash their hands every time someone coughs or sneezes or wipes their nose?  How many teachers go around wiping down all the desks around someone who sneezes?  Colds and the flu still go around, and somehow the modern sanitary conditions of the eighties couldn't keep my generation from getting chicken pox - pretty much all of us did. 

How effective quarantine is also depends on how contagious the disease is and how it is spread.  Quarantine was completely ineffective in the case of polio because so many people were wandering around spreading the disease while showing no signs of it themselves.  It would be pretty hard to fight measles, for instance, with quarantine too.  Measles is much more contagious than say smallpox, and unlike smallpox which most of the time is only contagious after the start of symptoms (though occasionally people were contagious with smallpox for a bit before they were sick or what they had) measles is typically contagious for two to four days before there are any symptoms.  So in the case I made up of little Andy in kindergarten, as soon as he started showing symptoms, should they have put all the kids in his class who hadn't had measles yet under house arrest for three weeks?  And the kids who rode the bus with him?  Sat anywhere close to him at lunch?  Had an extracurricular activity with him or played with him on the playground?  Were in the doctors office waiting room at any point with or just after Andy?  What about the kid who didn't even know that he'd sat at the same place at a library table as Andy had been sitting at and left his measles germs all over just fifteen minutes before?   How would you even track all these kids down?  And then a few months later, when Emily in the same kindergarten class got measles from a kid she'd been sitting near on a city bus without ever even having known she'd been exposed, would you do it all over again and keep all those kids locked up for another three weeks?  

It would be impossible to eradicate a disease like measles through quarantine.  At best, you could slow the spread, resulting in most kids getting it when they were older rather than younger, which could be dangerous if they got it as teens or young adults when it was more dangerous.  

There is no one-size-fits-all solution to the problem of all diseases.  Instead there are a lot of different tools to use in fighting disease, each with its advantages and disadvantages, and for many diseases, vaccination is by far the best tool we have.