Are unvaccinated people to blame for outbreaks?

[Rrrrrachel]

This seems to come up a lot in other threads, so maybe it deserves a thread of it's own, anyway.  I came across this article in the New England Journal of Medicine that does a good job summarizing why outbreaks often get "blamed" on unvaccinated children.

Basically it says that outbreaks tend to be correlated geographically with areas where there is a larger population of unvaccinated people and a greater proportion than expected of people who got sick were infected by contact with a non-vaccinated person (I don't really know how they can tell this, I'm just saying that's what it says).  For example, in a community if 4% of people are unvaccinated we would expect about 4% of cases of whatever disease to be attributed to contact with an unvaccinated person.  If, in fact, 11% are that's a clue that they're infecting people at a higher than expected rate.  

Anyway, I know lots of people will disagree, take it FWIW, I just thought people might e interested in where that claim comes from and what the data behind it is like.

[nukuspot]

Speaking about the current pertussis outbreak here in WA:  It is a ridiculous statement to blame the pertussis increase on a random anti vaccine movement. Secretary Selecki (our WA state health department secretary) has publicly stated that the pertussis outbreak is not linked to an anti vaccine movement. If you read any of the health department statements to the press, they say it is specifically linked to 1. Adults who have not had boosters since childhood (since the adult booster is new, only been around since 2005) and 2. The fact pertussis cases go on waves. This is a peak year in a cycle. The vaccine for pertussis is ineffective in preventing the spread of the bacteria. Even a fully vaccinated person can get and transmit pertussis. The vaccine only makes the individual's case less severe. That is why the disease will never be permanent eradicated from our country as was polio, diphtheria, etc. Blaming this on a theoretical anti vaccine movement is frankly ridiculous. I've also seen it blamed on illegal immigrants which is also preposterous.  But...that is not stopping the MEDIA from doing so.  Even though the health officials have said it is not the case, I can't even tell you how many media articles I get in my inbox about the pertussis here spreading because of an anti-vaccine movement.  Each time the bias is clearly the journalist's take on things.

Now...That's not saying if this was a measles outbreak it would be the same situation.  But for pertussis when everyone who is even a little involved in health care recognizes that vaccinated people can still get and spread the disease, it is a silly and dangerous statement for the media to shift the blame away from the faults in the vaccine and to us "misinformed parents who don't vax" who (to them) get all our information from Jenny McCarthy.
 

[Rrrrrachel]

Thy can still get and spread it, but they get and spread it less often. You know a lot more about what's going on in wa than I do, but nationally pertussis outbreaks are correlated to areas where vaccine rates are lower.

The pertussis vaccine doesn't just keep you from getting as sick, it often keeps you from getting sick at all. With pertussis, which is spread by coughing, someone whose not actively sick or even not as sick is going to spread the disease much less.

[Rrrrrachel]

(and by the way: I agree that blaming pertussis outbreaks on unvaccinated children is silly.)

[slmommy]

Originally Posted by Rrrrrachel 

(and by the way: I agree that blaming pertussis outbreaks on unvaccinated children is silly.)

hahahaha, are you going to write CHOP to tell them? Last I knew you had no problem blaming unvaxed kids for outbreaks, we already discussed this language in another thread:

Quote:

Facts about whooping cough:

Although the disease can be prevented with the vaccine, it does still occur (because of the children who are not vaccinated).

 

http://www.chop.edu/healthinfo/whooping-cough-pertussis.html

I would blame crappy vax efficacy and possible pertussis mutation, coupled with issues about diagnosis/testing/treatment. Oh yeah and the fact pertussis is ENDEMIC with 3-5 yr epidemic cycles, (as per CDC).

Although NOW there is a new adult Tdap to push...

[Rrrrrachel]

I could write chop, but I doub theyd listen to me.

It's still true that the unvaccinated contribute to the prevalence of pertussis. When vaccination rates go down incidences of pertussis go up.

[Rrrrrachel]

I think what we were discussing before was how that statement was consistent with another one about most kids being infected by an adult caregiver? not whether I thought the statement was silly.

[Belkin]

80% to 90% of WA state pertussis cases are in the vaccinated – Skagit County Health Department  http://therefusers.com/refusers-newsroom/80-to-90-of-wa-state-pertussis-cases-are-in-the-vaccinated-skagit-county-health-department/

92% of pertussis cases in California were in vaccinated individuals – Reuters Health http://therefusers.com/refusers-newsroom/92-of-pertussis-cases-in-california-were-in-vaccinated-individuals-reuters-health/

False Alarm Over Pertussis “Outbreak” – by Lawrence B. Palevsky MD FAAP http://therefusers.com/refusers-newsroom/false-alarm-over-pertussis-outbreak-by-lawrence-b-palevsky-md-faap/

[Rrrrrachel]

It is expected that the bulk of cases would be in vaccinated individuals, even if the vaccine works very well, 95% effective, if you expose a population of 1000 people 95-99% of whom are vaccinated, to a disease the bulk of the cases would bei n vaccinated people just because there are so many more of them. 5-10% of 995 people is more than 100% of five people. So those statistics are very misleading.

Despite the numbers, unvaccinated people, according to this paper, account for more than an expected number of cases and more than an expected number of infected people. They get sick at a higher rate and they spread the disease more than vaccinated people, in other words.

[purslaine]

Blame is an ugly thing.  

I have seen people play the blame game, and there are several issues at play when it happens:

1.  People are often unwilling to look at their role in whatever happened.

2.  Blame is an angry emotion - and it often eats at people and prevents them from moving on or leading their best life.

3.  There is such a thing as bad luck or coincidence in this world.  Sometimes crap happens - and sometimes it happens to you.

I have no issue with blame where it is appropriate - a clearly neglectful surgeon. pilot, etc. 

With the exception of this past winter (when my Dh's moronic co-worker decided it was fine to go to work with influenza and gave it to half the office)  I have never wasted one minute trying to figure out where I got a virus from.  Deal and move on.  I know this is harder with more serious diseases (ex: pertussis) but with the exception of pertussis and chicken pox, you are incredibly unlikely to get any VPD anyways.  

The blame, if we need to ascribe any, lies with people who wander around when they know they are symptomatic with any disease.  I think that is irresponsible.  I if decide I will risk my child being one of the very few who get measles rather than getting MMR that is my business.  If I bring said measle-y child (or child with the flu) to the store and expose a whole bunch of people, that is irresponsible.  

[Rrrrrachel]

I agree that blame is an ugly emotions and sort of pointless, especially on an individual level. It matters to public health policy, though, which is why you see it come up.

[rachelsmama]

Are unvaccinated people to blame for outbreaks?

I'd say that the relevant microbes are to blame for the outbreaks.  Does the relevant vaccination rate play a roll in how easily the disease spreads?  Sometimes, maybe, but lots of other things play a roll too.  I think that people's biases play a huge roll in whether a disease is under-diagnosed or over-diagnosed in an area, and whether a group of cases gets labled an "outbreak".   At one point a few years ago, I could have walked into a doctor's office here with mumps and been told I had a bad cold, and the next week, I could have walked into the same office with a bad cold and been labled as a confirmed case of mumps (blood tests weren't required to be considered "confirmed").  That particular outbreak had more to do with the inadequacies of the vaccine schedule than with unvaccinated people.  Because the affected people had been vaccinated as children, they hadn't caught mumps as children.  Because the vaccine wore off sooner than expected, they got to experience mumps as adults.  So no, I don't think that the statement that "unvaccinated people are to blame for outbreaks" even begins to cover the issues that contribute to an "outbreak".
 

[Taximom5]

Originally Posted by Rrrrrachel 

I agree that blame is an ugly emotions and sort of pointless, especially on an individual level. It matters to public health policy, though, which is why you see it come up.

If you are going to bring up what matters to public health policy, then the corruption and financial conflicts of interest of those who make public health policy must also be brought up--which certainly gives us pause when considering the validity of many aspects of public health policy.

If you're going to ask if unvaccinated people are to blame for outbreaks of vaccine-preventable diseases, you also have to ask who is to blame for those who suffer devastating vaccine reactions.

Those who fear vaccine-preventable diseases and believe in the pharmaceutical industry seem happy to lay responsibility for herd immunity on their fellow human beings.  Those who have lost a child to such an illness insist that everyone should be vaccinated. But those who have had severe vaccine reactions, or whose children have had them, NEVER ask anyone else to take that same risk.

It's kind of a double standard.

[Rrrrrachel]

I thought we already had a thread on that?

[Turquesa]

Originally Posted by Rrrrrachel 

I thought we already had a thread on that?

Yea, but it's still germaine to this discussion. 

One of the tricky minefields to navigate in the vax discussion are all of the GENERALIZATIONS.  The article in the OP is guilty of plenty of them, broadbrushing all diseases and all vaccines as thought they were one in the same.  Example:

Vaccine refusal not only increases the individual risk of disease but also increases the risk for the whole community.

Right.  Because my children aren't vaxed against Hep B, they're going to shoot up heroine and then chase other kids around the playground with the contaminated needle.  Oh, herd immunity: Where art thou?  Seriously, though, where measles are concerned, there is compelling scientific evidence that it's usually the unvaccinated catching and spreading the disease. 

But pertussis?  The article only mentions one single pertussis outbreak in Michigan....what you would call an anecdote.   The cases that I've previously cited in England, Australia, California, Wisconsin, Long Island, Kentucky, and Washington State--in which the majority of disease carriers were fully vaccinated-- likely won't make their way into articles like this.  So this is definitely a gray issue, one that cannot be summarized and simplified in a single NEJM article by pharma shills. 

And about that: I do appreciate the article disclosing all of the authors' pharmceutical ties.  If you do a search on his name, you'll find that Dr. Salmon has long been a vociferous advocate of forced vaccinations.  It's actually a little creepy to me that Merck even has a Vaccine Policy Advisory Board.  Surely in this great US of A, corporations wouldn't be usurping the power of We the People in order to influence and form public pol.....  Oh.  Wait.     

Edited by Turquesa - 5/17/12 at 5:07pm

[Taximom5]

Originally Posted by Turquesa 

  It's actually a little creepy to me that Merck even has a Vaccine Policy Advisory Board.  Surely in this great US of A, corporations wouldn't be usurping the power of We the People in order to influence and form public pol.....  Oh.  Wait.     

As long as you brought that up, there is also the issue of vaccine inventors/patent holders making decisions about the entire pediatric immunization schedule as members of ACIP, as well as the former head of the CDC taking a position as president of the vaccine division of Merck, and a former Monsanto executive becoming head of the FDA.

Conflicts of interest and resulting corruption everywhere.