The Herd Immunity Myth and How it Pits Parent Against Parent

[Mirzam]

http://www.thehealthyhomeeconomist.com/the-herd-immunity-myth-and-how-it-pits-parent-against-parent/

With vaccination rates continuing to fall each and every year as more parents delay or forgo shots entirely for their children, authorities are blaming unvaccinated children for putting the population at large at risk or worse, for outbreaks themselves.

This relentless blame game being played out in the media and at doctor’s offices has caused some parents of vaccinated children to fear and look down on unvaccinated children as potential harbingers of disaster for society and even lash out in rage at parents who choose not to vaccinate.

[kathymuggle]

Thanks for posting this.  I had been meaning to post something about herd immunity here - but you beat me to it, lol.

I will post more later, but suffice to say I do not think herd immunity is all it is cracked up to be. I don't think it is complete garbage, but I hate the way it is applied as some sort of blanket argument (tetanus is a clear example of where herd immunity does not apply, it is not contagious).  

At the end of the day, though, it does not matter to me, a parent, whether herd immunity is a good argument for vaxxing or not. Even if I thought herd immunity was significantly more important that I do, I still would not vaccinate unless i thought vaccination was safe.  I consider it unethical to put my child at risk for  the betterment of society. I believe it runs counter to our biological imperative, as well (to a degree) a societal one.  

It does drive a wedge between parents (at least online, but sometimes offline as well, which is much more sad).  It is ironic - they vaccinate because they think it is best for their child, we do not vaccinate because we do not think it is best for our child, but we are the villains here.

Edited by kathymuggle - 2/25/13 at 1:55pm

[kathymuggle]

One of reasons I have difficulty believing (in a significant way) in herd immunity comes from the fact we know adults are under immunized.  They have a lousy rate of getting any boosters. Some of them were children before specific vaccines were introduced.  Some vaccines wear off.  I remember reading that 1/7 of pregnant women do not have acceptable immunity to rubella, which is about 14%.  The immune status of adults is very questionable, yet we do not have a bunch of VADs floating around.  Why is that?

To play devils advocate though, I have read that if vaccine rates fall low enough (say UK, measles) there is an upswing in numbers.  Of course, even when some rates remain high (pertussis), some diseases make an appearance.  The whole thing goes back to herd immunity is not a one-size fits all argument.    

[Fyrestorm]

With adults being un or under vaccinated - herd immunity isn't possible even if you believe in the theory - besides, the theory was based on natural immunity, not false and waning vaccine induced immunity.
 

[kittentips]

Originally Posted by kathymuggle 

One of reasons I have difficulty believing (in a significant way) in herd immunity comes from the fact we know adults are under immunized.  They have a lousy rate of getting any boosters. Some of them were children before specific vaccines were introduced.  Some vaccines wear off.  I remember reading that 1/7 of pregnant women do not have acceptable immunity to rubella, which is about 14%.  The immune status of adults is very questionable, yet we do not have a bunch of VADs floating around.  Why is that?

To play devils advocate though, I have read that if vaccine rates fall low enough (say UK, measles) there is an upswing in numbers.  Of course, even when some rates remain high (pertussis), some diseases make an appearance.  The whole thing goes back to herd immunity is not a one-size fits all argument.    

Perhaps this is because of the way the disease is diagnosed?

Real life example - we had a children's party 2 weeks ago

Later that week one of the children had a fever, and soon after a rash and it emerged he had measles.

This last week one of the other babies developed a fever and a rash...his parents rushed him to the ER where they asked what vaccinations he had.  They replied and expressed their concern that it may be measles as they had been exposed to it.

The attending doctor immediately replied it was impossible as he had been vaccinated against measles

Anyway, after numerous tests and a lumbar puncture it was fianlly determined he had a virus...with measles type symptoms...but obviously not measles because he had been vaccinated

So basically I'm saying if doctors will rule out a disease purely on the basis of whether you've been vaccinated or not, rather than the actual symptoms and information available, it would follow that when vaccinations rates fall for a particular disease that suddenly diagnosis of that disease may increase.

[pek64]

Originally Posted by kittentips 

Perhaps this is because of the way the disease is diagnosed?

Real life example - we had a children's party 2 weeks ago
Later that week one of the children had a fever, and soon after a rash and it emerged he had measles.
This last week one of the other babies developed a fever and a rash...his parents rushed him to the ER where they asked what vaccinations he had.  They replied and expressed their concern that it may be measles as they had been exposed to it.
The attending doctor immediately replied it was impossible as he had been vaccinated against measles
Anyway, after numerous tests and a lumbar puncture it was fianlly determined he had a virus...with measles type symptoms...but obviously not measles because he had been vaccinated

So basically I'm saying if doctors will rule out a disease purely on the basis of whether you've been vaccinated or not, rather than the actual symptoms and information available, it would follow that when vaccinations rates fall for a particular disease that suddenly diagnosis of that disease may increase.

So he had a virus with measles like symptoms, but no diagnosis of *what* virus? Just measles is eliminated because he was vaccinated? No wonder the proclamation of "vaccines are safe and effective" is said confidently.

[kathymuggle]

Originally Posted by kittentips 

Perhaps this is because of the way the disease is diagnosed?

Real life example - we had a children's party 2 weeks ago

Later that week one of the children had a fever, and soon after a rash and it emerged he had measles.

This last week one of the other babies developed a fever and a rash...his parents rushed him to the ER where they asked what vaccinations he had.  They replied and expressed their concern that it may be measles as they had been exposed to it.

The attending doctor immediately replied it was impossible as he had been vaccinated against measles

Anyway, after numerous tests and a lumbar puncture it was fianlly determined he had a virus...with measles type symptoms...but obviously not measles because he had been vaccinated

So basically I'm saying if doctors will rule out a disease purely on the basis of whether you've been vaccinated or not, rather than the actual symptoms and information available, it would follow that when vaccinations rates fall for a particular disease that suddenly diagnosis of that disease may increase.

You make a good point.

I think, particularly with milder diseases, that it can be be very difficult to figure out the real rate.

Even with more serious diseases (such as pertussis) it can be difficult to figure out real rate. Anecdotally, for many years it was very difficult to get a diagnosis of pertussis.  Patients would have to push for testing.  Now given the upswing in pertussis, testing is done far more frequently.  How much is an increase and how much is more testing?  

[Turquesa]

Here's where I take issue with the vaccinate-for-the-immunocompromised appeal:

1. I usually hear it as a sweeping generalization, ie comply 100% with your country's schedule. Vaccinating my children for Hep A, Hep B, tetanus, etc. will to little to nothing in helping the immunocompromised.

2. The planet is teaming with infectious agents, the overwhelming majority of which are NOT vaccine-targeted diseases. If 100% of everybody around an immunocompromised person were vaccinated, nothing would change in terms of the necessary commonsense precautions that immunocompromised people and their caregivers would take. .. give or take whichever vaccines they choose for themselves. But it's not like a fully vaxxed populace would be a licence to stop washing hands and start bending down to lick ice cream off the floor of a city bus! That would be dangerous for everyone...but especially the immunocompromised.

3. People are DEMANDING that everyone around them abandon all ethical, conscience-driven, and even medical concerns in order to engage in medical risk-taking so that the immunocompromised can not worry about a handful within millions of infectious diseases. It would suck to live in a bubble, literally or otherwise, and my heart goes out to people in this condition. I heartily support the development of cures, innovations, medications, and even *vaccines* for these conditions, provided that people may choose them with voluntary, informed consent. Compulsory altruism, however, isn't the answer. And frankly, it's an impossible goal.
Edited by Turquesa - 3/3/13 at 10:43am

[Turquesa]

I'll also add that I think that measles is pretty dang contagious and the two-dose measles component of the MMR vaccine--which I've chosen for my children after a careful risk-benefit analysis--is pretty dang effective. That said, I don't feel entitled to force everyone to consent to it. I say this as both a strong pro-lifer, (ie someone with ethical issues re: fetal tissue to make vaccines) and the mom of a baby who isn't yet old enough for MMR.

[kathymuggle]

Originally Posted by Turquesa 

I'll also add that I think that measles is pretty dang contagious and the two-dose measles component of the MMR vaccine--which I've chosen for my children after a careful risk-benefit analysis--is pretty dang effective. That said, I don't feel entitled to force everyone to consent to it. I say this as both a strong pro-lifer, (ie someone with ethical issues re: fetal tissue to make vaccines) and the mom of a baby who isn't yet old enough for MMR.

We do not vax.  None-the-less, I always felt measles was one of the better vaxxes in terms of efficacy.

I haven't completely changed my mind - but this article out of Quebec has given me pause:

http://www.cbc.ca/news/health/story/2011/10/20/measles-quebec-vaccine-schedule.html

Most of the cases of measles in a recent outbreak occurred in fully vaccinated people.

"It's generally assumed that the measles vaccine, when given in a two-dose schedule in early childhood, should protect against measles infection about 99 per cent of the time. So the discovery that 52 of the 98 teens who caught measles were fully vaccinated came as a shock to the researchers who conducted the investigation."

The article suggests that perhaps vaccinating later might be in order -that delaying  immunization until post 15 months might increase the effectiveness rate.

Or it could be the measles vaccine is less effective than we think. Alternately, the measles vaccine could be less effective in French Canadians for one reason or another - this is not Quebec's first go-round with measles outbreaks.  It seems a little far fetched until one reads other stuff like this:http://www.ncbi.nlm.nih.gov/pubmed/22871352  which talks about measles failure among children in Mozambique.

Edited by kathymuggle - 3/3/13 at 4:03pm

[rachelsmama]

Originally Posted by kathymuggle 

Or it could be the measles vaccine is less effective than we think.

Interesting.  A few years ago the mumps portion turned out to wear off sooner than previously thought.  I wonder whether the rubella portion of MMR is all it's cracked up to be? 

[kathymuggle]

On rubella:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770316/

It is really odd, as it seems younger pregnant women (less than age 20) are less likely to be immune to rubella than older mother (35-39).  I assume both groups were vaccinated so what the heck is going on??  Wouldn't you expect that younger women would be more immune given they had less time for the vaccine to wear off and were more likely to get 2 vaccines versus an older mother's one?  

"Of 159,046 prenatal specimens, 88.3% (n=140,473) were screened for rubella immunity. In total, 8.8% of specimens tested negative for rubella IgG. Younger women (23.2% of women younger than 20 years of age versus 4.7% of women between 35 and 39 years of age; P<0.001) and women from northern Alberta (11.9% versus 8.1% [overall]; P<0.001) were significantly more likely to have seronegative specimens. Of the 20,044 women who had multiple rubella immunity screenings, 88.1% (n=17,651) had multiple positive test results. In total, 20.7% of the 42,274 specimens submitted from women with multiple screenings were deemed redundant."

Despite this, there does not seem to be many cases of congenital rubella floating around, so who knows what is going on???

[kathymuggle]

Ok - I am getting my geek on tonight.

Another study looking at vaccine failure wrt measles possibly having a genetic component...

ttp://www.ncbi.nlm.nih.gov/pubmed/15176719

[Fyrestorm]

Having been adopted, I really can't speak to anything genetic in my case, but I can tell you that I was vaccinated up the wazoo as a child.  Mom was a peds RN and we got EVERYTHING!  I as even given small pox even though it had been removed from the schedule the year before I as born.  I still got both the measles and the mumps and who knows if I had rubella since it's so incredibly mild in children.  When I went for my marriage blood tests in 86 and again in 99 I tested non immune to all 3.  go figure - I don't even get to have natural immunity...I do remember they were pushing for all they were worth to shoot me up with the MMR both in 83 and 99 and once again while I was pregnant - like that was going to happen...LOL. 
 

[ssun5]

Kathymuggle:

It is really odd, as it seems younger pregnant women (less than age 20) are less likely to be immune to rubella than older mother (35-39).  I assume both groups were vaccinated so what the heck is going on??  Wouldn't you expect that younger women would be more immune given they had less time for the vaccine to wear off and were more likely to get 2 vaccines versus an older mother's one?  "

I am 35 and when you look back at my records and all my friends in that age group, no one got the MMR. We all received the individual vax for it as well as my older family bro/sis etc that are now in that age range. Perhaps the individual shots offered better immunity? My sis who was born in 79 was the first of us kids to even be offered the MMR so maybe that is what is really going on???

**It could be regional, or something else, but it is a thought**

Regardless, I just had the measles as well this last summer (mildly) but still.... I have always shown amazing amounts of immunity to all 3...and when I turned 5, a new school required us to get the MMR regardless of my past history, so I got it then and then my mom for some bizarre reason made me get it AGAIN at 15.... still got measles. I personally am not impressed. Why all that risk for NO reward???

It also makes me wonder about the titler test.. I am suppose to have immunity off the charts but I still got it.... what does that mean??? Oh well, another topic for another thread!
 

This last summer I posted on here about my whole family getting the measles and thankfully the non supporters aren't here. They were SURE that we didn't have it cause that's impossible and my 75 year old doc who has seen a zillion cases of it was to stupid to give a real diagnosis from the symptoms and sending him pics via the Internet. Yep... impossible!!!!

I also thought that it was a newly vaxed kid in Sunday school that gave it to my DD at 15 months old but was told in ALL of history, that has never happened either...... sigh, it is so nice they can't comment anymore.

SOOO, as the OP was stating, I think that herd immunity is a false sense of security. How many adults are up to date? And how about efficacy? How will we REALLY ever know

1)with the diagnostics always changing,

2)refusal of diagnosis if you have been vaxed,

3)mild /symptomless cases than no one knew,

4)including non-vax who did have a VAD but was never reported to anyone.

DS-13

DD-8

DD-2

[kathymuggle]

Here is more on rubella.  It is especially relevant as my earlier link was Canadian and this one is as well.

"1968–69 – Three different rubella vaccines were developed. At first, the vaccine was used in different ways in different countries. Some Canadian provinces followed the "American" approach which focused on widespread immunization. Others followed the "British" model which recommended the vaccine only for girls aged 10 to 12, and susceptible adult women.
1988 – British authorities changed to the American schedule, recognizing that immunizing girls alone was insufficient to protect them from the virus."

http://www.immunize.cpha.ca/en/diseases-vaccines/rubella.aspx

So if older women were vaccinated under the old British model in Canada, there is an excellent chance they had wild rubella before being vaxxed at 12 or so- which is why they are more immune to the disease.

[serenbat]

Quote:

So if older women were vaccinated under the old British model in Canada, there is an excellent chance they had wild rubella before being vaxxed at 12 or so- which is why they are more immune to the disease.

well, I can tell you (personally) that I am older and only got the Rubella vac ( not MMR) and I and many I know also in my age group are immune (testing via later 40+ pregnancy) and we in fact did not have natural rubella, only the vac- we are talking pre- 68!

[Mirzam]

Originally Posted by kathymuggle 

Here is more on rubella.  It is especially relevant as my earlier link was Canadian and this one is as well.

"1968–69 – Three different rubella vaccines were developed. At first, the vaccine was used in different ways in different countries. Some Canadian provinces followed the "American" approach which focused on widespread immunization. Others followed the "British" model which recommended the vaccine only for girls aged 10 to 12, and susceptible adult women.
1988 – British authorities changed to the American schedule, recognizing that immunizing girls alone was insufficient to protect them from the virus."

http://www.immunize.cpha.ca/en/diseases-vaccines/rubella.aspx

So if older women were vaccinated under the old British model in Canada, there is an excellent chance they had wild rubella before being vaxxed at 12 or so- which is why they are more immune to the disease.

I had "German Measles"/rubella as a child and was vaccinated according to the "British" model, and following a titre test was determined to be immune to rubella I did not receive the MMR as a child, but had the diseases. My sister although she was younger was not vaccinated for MMR, my mother refused all vaccines following a severe reaction to the DPT. She did not get natural rubella as a child. She did get the adolescent dose of the rubella vaccine, and was vaccinated again following her first pregnancy because she was not immune, After the second vaccination, she was still not immune to rubella because titre tests during her second pregnancy still showed no immunity. She didn't opt for third dose prior to her third baby.

Despite not being vaccinated for measles or mumps she never got those either. Only chicken pox.

[Mirzam]

Originally Posted by serenbat 

well, I can tell you (personally) that I am older and only got the Rubella vac ( not MMR) and I and many I know also in my age group are immune (testing via later 40+ pregnancy) and we in fact did not have natural rubella, only the vac- we are talking pre- 68!

The thing with rubella is it is so mild, you could have been exposed and not shown much in the way of symptoms. I remember German Measles as joke, ie a week off school for pretty much nothing! I remember being out on my bike riding around the neighborhood with it!

[kathymuggle]

More on rubella:

I was curious whether this lower immunity on titer testing held outside of Canada, and it seems it does.

http://www.hindawi.com/isrn/fm/2013/602130/

Once again, younger women (under 20 ) showed less immunity than older women (age 20-40).  Interestingly enough (to me, at least) native women  were the least likely to show immunity to rubella on titer testing.  Assuming everyone or almost everyone was vaccinated as a child (a big assumption, but the study does not mention otherwise) it seems natives are less likely for the vaccine to take - kind of the like the children from Mozambique and measles, up thread.  

"NRI was found in 6.9% of the study population. The highest prevalence rate of 10.2% was found among adolescents. NRI was highest among Native American women at 17.3%, compared to Whites 7.3%, African Americans 5.9%, and Hispanics 4.6%."

It does make me wonder what will happen in the future, as the immunity to rubella rate does seem to be lower in up and coming mommas.

Preaching to the choir coming:  I would be thrilled if wild rubella (and CP for that matter) was circulating, and teen girls (around age 15 or so) were given titer testing to determine if they had had it.  If they were not immune to rubella, they could determine how to proceed.  I am not sure why they abandoned this plan - probably issues with compliance and being overly optimistic about how much immunity the vax would offer.  I think if it were firmly followed through on, it might be the plan that offers the most protection for pregnant women and their fetuses.  

Edited by kathymuggle - 3/4/13 at 8:05am