Help me figure this out "vaccinated populations contain outbreaks"... - Mothering Forums
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#1 of 28 Old 03-24-2011, 04:56 PM - Thread Starter
 
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So I read in a recent article that said, because most of the population is vaccinated, this is the reason that outbreaks are contained. If the population were not vaccinated, there would be an outbreak across the entire nation.

 

Trying, as a non-vaxer, to figure this one out.

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#2 of 28 Old 03-24-2011, 06:34 PM
 
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Okay, well, here's an example.  The relevant portion states:

 

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A total of 6316 varicella cases were reported. Among children and adolescents aged 1 to 14 years, secondary attack rates varied according to age and by disease and vaccination status of the primary case and exposed household contacts. Among contacts aged 1 to 14 years exposed to unvaccinated cases, the secondary attack rate was 71.5% if they were unvaccinated and 15.1% if they were vaccinated (risk ratio [RR], 0.21; 95% confidence interval [CI], 0.15-0.30). Overall, vaccinated cases were half as contagious as unvaccinated cases. However, vaccinated cases with 50 lesions or more were similarly contagious as unvaccinated cases whereas those with fewer than 50 lesions were only one third as contagious (secondary attack rate, 23.4%; RR, 0.32 [95% CI, 0.19-0.53]). Vaccine effectiveness for prevention of all disease was 78.9% (95% CI, 69.7%-85.3%); moderate disease, 92% (50-500 lesions) and 100% (clinician visit); and severe disease, 100%.

 

In other words, vaccinated people had less severe disease and were less likely to contract and to transmit varicella (chicken pox). 

 

So in a group with mostly vaccinated individuals, the disease will spread much more slowly.  Obviously a disease that spreads slowly is much easier to contain than a disease that spreads quickly. 

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#3 of 28 Old 03-24-2011, 07:24 PM
 
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More obviously, disease cannot really be contained without quarantining the entire exposed population, which is not going to be possible. 


Yes, yes.  I'm fabulous. loveeyes.gif  Moving on...

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#4 of 28 Old 03-24-2011, 07:54 PM
 
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Originally Posted by princesstutu View Post

More obviously, disease cannot really be contained without quarantining the entire exposed population, which is not going to be possible. 



And yet, most outbreaks somehow are contained without quarantine. 

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#5 of 28 Old 03-25-2011, 06:30 PM
 
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By cutting out links in the chain of infection. 

 

Let's say a six-year-old (let's call him Andy) gets measles.   There is no vaccine, so measles is pretty common, but Andy happened to pick it up while traveling overseas with his family, so as far as his local is concerned, he is the origin for this particular outbreak.

 

There are twenty kids in Andy's class at school, including him, but three of them have had measles before so are immune.  That leaves sixteen kids he could potentially pass it on to.  During the period where he is contagious but not showing symptoms yet, he passes it on to three of those sixteen - two kids at lunch when he sneezes over their open lunchboxes and the kid at the desk next to him just from breathing the same air.  Those three other kids manage to pass it on to four other kids in their class, for a total of eight kids in the class getting it this go-around. Eight kids still have never had measles, but they will likely all have had it by the time they are ten. 

 

Of the eight kids from Andy's class who get sick, maybe one or two don't happen to have much contact with kids outside of class during the time they are contagious at school and then spend a weekend home away from other kids before being too sick to go back to school on Monday, but others pass it on two another kid or two, and some may pass it on to several.  

 

One of those kids passes it on to her best friend at a playdate, who passes it on to her little brother, who infects several kids at his daycare, including one who passes it to her older sister, who passes it to several kids in her class at school including Suzy is about to fly across the country to attend her Aunt's wedding, and will be bringing the measles as a gift to the other children there.  She also may pass it onto people at the airport or on the plane, potentially sending it in several different directions. 

 

Or another infected child passes it through a chain of ten kids to Billy, whose young cousins are in town visiting from another state and will take it home with them.  Or another who starts a chain of infection that includes, among many others, Emily, who is infected right before she leaves for a Disneyland for a week long vacation with her family. 

 

Now let's take another look at the chain that starts with Andy, but this time with vaccination.  Sixteen kids in Andy's class are immune thanks to vaccination.  Two kids are not immune despite being vaccinated, and two others (besides Andy) are not vaccinated, leaving four kids who he could potentially pass measles on to.  However, none of those four happens to be sitting near him when he sneezes on open lunchboxes, and none is the kid in the desk next to him, so the infection chain stops right there.

 

Or maybe he still does pass it on, but only to the one or two kids who are home alone during their most contagious periods and wouldn't have passed it on anyway, so it is contained to a single class.  Or maybe he still passes it to the girl who would have passed it to her best friend at the playdate, but her best friend is protected by vaccination, so doesn't get it.  Or maybe it makes it all the way to the daycare, but the child who passed it on to the older sister is well protected by his vaccine and so doesn't get it.  The point is, there are so many places where the chain of infection could be broken before it gets to Suzy, Billy, or Emily and taken out of town. 

 

Basically, it is just herd immunity.  It's not perfect, the disease could occasionally pass through just the right path of un-vaccinated and not immune despite vaccination people to infect someone who is about to travel and infect others at their destination.  But high levels of immunization decreasing the number of people who can get it, which decreases the number of cases and the chane that someone who is just about to travel out of town will get it and take it with them is why most measles outbreaks are contained to a specific geographic area rather than being spread widely around the country.  

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#7 of 28 Old 03-26-2011, 04:47 PM
 
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Quote:
Originally Posted by miriam View Post

If you look up the story of Leicester, England in the 1830s, that town used quarantine to avoid a smallpox epidemic and refused vaccinations.  Leicester had fewer cases of smallpox than the vaccinated towns.  The smallpox cases were quickly isolated and so were the persons who cared for them.  This is largely ignored by provaxers.



On the contrary, it is a fascinating example for anyone interested in public health.  There do seem to be two different versions of history circulating, however.  For the another side of the story, you might read this account. 

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#9 of 28 Old 03-27-2011, 06:49 AM
 
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Originally Posted by miriam View Post

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.  


I'd trust the NHIS before I'd trust whale.to.  I'm not sure what that has to do with anything, though.

 

And, yeah, quarantine has been used for thousands of years...as has vaccination.  We've gotten a great deal better at sanitation, and of course that's important too.  And the combination of all three has the best results, as we saw with the eradication of smallpox. 

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#10 of 28 Old 03-27-2011, 07:02 AM
 
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Originally Posted by Tee25 View Post

So I read in a recent article that said, because most of the population is vaccinated, this is the reason that outbreaks are contained. If the population were not vaccinated, there would be an outbreak across the entire nation.

 

Trying, as a non-vaxer, to figure this one out.



I suppose the assumption is that the population is not immune from previous infection either. As was demonstrated in the example pers provided, immunity is what broke the chain, regardless of whether it was immunity from the vaccine or prior disease.

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#11 of 28 Old 03-27-2011, 07:28 AM
 
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#12 of 28 Old 03-27-2011, 08:29 AM
 
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Originally Posted by miriam View Post

I will take my chances with quarantine and sanitation since both are less likely to kill me.



That's your opinion.  My opinion is that disease is more likely to kill you (or someone you love) than a vaccine.  smile.gif 

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#13 of 28 Old 03-27-2011, 12:12 PM
 
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#14 of 28 Old 03-27-2011, 12:34 PM
 
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Originally Posted by miriam View Post

My opinion is backed up by my life experience and research. Caring for vaccine damaged people is a labor of love that I see few doctors, nurses and pharmacrats doing. 



As is mine. 

 

I'm not sure what it is that you do for people who have had vaccine reactions, but my experience with medical professionals (including family members) is that they often make great sacrifices for anyone who needs medical help.  That doesn't mean that they spend a great deal of time dealing with people who have had vaccine reactions.  DH, for example, has never had a patient who had a reaction severe enough to require medical help.  So obviously he spends his time taking care of patients who need help with other problems. 

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#15 of 28 Old 03-29-2011, 02:08 PM
 
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OP- This could sound harsh, but I don't mean it that way. So I hope that you are able to recieve it in the spirit with which it's intended.

 

If you don't understand how immunity affects disease transmission then I don't think it's a good idea for you to be making decisions about infectious diseases for your kids.

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Originally Posted by heathergirl67 View Post

OP- This could sound harsh, but I don't mean it that way. So I hope that you are able to recieve it in the spirit with which it's intended.

 

If you don't understand how immunity affects disease transmission then I don't think it's a good idea for you to be making decisions about infectious diseases for your kids.


I don't know but this sounds awfully disrespectful no matter how it was intended.  Aren't we supposed to respect others and not make personal accusations?

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#17 of 28 Old 03-29-2011, 03:42 PM - Thread Starter
 
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Originally Posted by heathergirl67 View Post

OP- This could sound harsh, but I don't mean it that way. So I hope that you are able to receive it in the spirit with which it's intended.

 

If you don't understand how immunity affects disease transmission then I don't think it's a good idea for you to be making decisions about infectious diseases for your kids.



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... irked.gif [couldn't find a sarcastic smilie]

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#18 of 28 Old 03-29-2011, 06:47 PM
 
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Originally Posted by miriam View Post


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


Quarantine and exclusion are not the most effective means of controlling the spread of disease because they require every day citizens - most of whom feel the have no risk of contracting or spreading xyz disease - to greatly restrict their movements. The require the physical ability to isolate the healthy population from the infectious and the potentially infectious. They require a way to still provide medical care to those under quarantine. And even more politically, they require people who would be put under quarantine or exclusion to have a way to still earn their living while unable to go to work, so they have less incentive to break their exclusion orders and risk the general population. Sometimes it works really well. Especially if there is a short incubation period, and you get knocked on your butt really quickly by the symptoms. It's hard to spread sickness to the general population when you're lying on your bathroom floor wishing you would die. But sometimes it doesn't. And what should the consequences of breaking quarantine or exclusion orders during a pandemic be? Jail time? What if someone dies? Quarantine is still used today for many things, and people break it All The Time. You can't even imagine how hard it is to get some people to comply with quarantine orders, even when they have highly infectious diseases like TB and are actively symptomatic. People just do not like to have their movements restricted, and some people as long as they can still walk and aren't chained to their bed will find a way to get back out into the general population. But maybe that is what we should do. We might need a military force dedicated to quarantine and exclusion enforcement. :lol:

 

 

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#19 of 28 Old 03-29-2011, 06:56 PM
 
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Also, has anyone read "A Prayer for the Dying". It's a novel - but an interesting portrayal of a small down during a disease outbreak.

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#20 of 28 Old 03-29-2011, 08:10 PM
 
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Immunity or disease transmission aren't always factors in parents' vax decision making processes so I don't think we can make generalizations or recommendations to or about parents where that is concerned. If a parent objects to immunization based on religious or philosophical grounds, their understanding of infection and transmission have no bearing.

Just pointing out for those who might not be aware - there is a difference between quarantine and isolation. Isolating sick people is much easier than quarantining exposed but not sick people. I also think that those strategies were much more effective during times when society wasn't so mobile.
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#22 of 28 Old 03-30-2011, 11:46 AM
 
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Originally Posted by miriam View Post

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. 



greensad.gif  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. 

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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.

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Originally Posted by Tee25 View Post





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... irked.gif [couldn't find a sarcastic smilie]



 

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#25 of 28 Old 03-30-2011, 05:40 PM
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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:

 

 

Quote:
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.

 

 

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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.

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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. 

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#28 of 28 Old 04-09-2011, 03:14 PM
 
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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. 

 

 

 

 

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