Don't forget the most pusillanimous excuse of all: "Well, there might be risks, and anyway I don't really have to immunize *my* kids - everyone else has the shots so there's no one to catch it from."

(I do know mothers who advocate waiting until te kid is a year or so old and their immune system a little more developed. This seems like a reasonable approach to me.)

I was vaccinated against most of these as a kid, but I got chicken pox from a cousin when I was 28. Let me assure you: You want to be vaccinated against the chicken pox.

At least that experience hasn't led me to get shingles. Yet.

And now I find that I can't remember when my last tetanus vaccine was, so I have to try and dig up the names of my last few doctors so that I can pull the records. Curse my bad notetaking!

Tetanus booster is every five years.

The problem is that in most cases people don't remember the worst effects of the diseases, and because as long as most people are vaccinating their children, you can benefit even if you don't (the tragedy of the commons) -- and of course, there remains a small risk of serious complications of vaccination.

In 1999 the UK introduced a new vaccination to the schedule, against meningitis C, which accounted for 1/3 of meningitis deaths. Deaths from this strain dropped 95% in 18 months. You'd think that would be enough to convince people; surely people have read enough scary stories about meningitis?

Anyway, there's beginning to be some tiny signs that the mood is turning -- such as this hysterical, clearly fictionalised, article in the Daily Mail. But in London, the damage is already done.

My brother had whooping cough as a small child; he'd been vaccinated so got a much milder form of the disease. I still wouldn't wish it on anybody.

There's a This American Life episode, Ruining It For The Rest Of Us, with a segment about this.
It was first aired in December of last year:
http://www.thislife.orgRadio_Episode.aspx?sched=1275

In that case, not much happened, but if immunizations were to get below critical mass....

This has been a scare story in the UK for much of the past decade - I'm sorry to see it's crossing the Atlantic.

The whole sorry saga has been covered brilliantly by Ben Goldacre - who writes a weekly column in "The Guardian", called "Bad Science" deconstructing poor media coverage of science. He's just published a book of the same title - which manages to be both entertaining, terrifying and depressing at the same time. It includes a remarkably painless introduction to how proper medical trials should be carried out - once you've finished flaming any MMR=Autism types you could do worse than give them this to put the fire out!

(I am in no way related to Dr Goldacre - this may seem like a shameless plug but it's just an enthusiastic recommendation).

Chicken pox vaccine is a curious one. It was developed in Japan in 1974, but didn't go into use there until 1988, and was not approved for use in the USA until 1995. I got chicken pox as a child in 1975 or 1976.

I was wondering why you didn't mention the later possibility of shingles in your writeup of why one would want to be vaccinated against chicken pox. It's bad.

The base incidence of shingles is roughly 5 per 1000 otherwise-healthy people per year. My brother had a typical episode a few years ago: no permanent damage, but a ring of rash around his torso (following a nerve line) accompanied by pain and hypersensitivity such that the weight of a bed sheet was agonizing.

1 in 5 shingles patients (!) develop some degree of neuralgia along the affected nerve line. That's some degree of permanent pain. More rarely there can also be impairment of nerve function. If the nerve line ran across the face, there can be some degree of facial-muscle paralysis. Sometimes the nerve line is a trunk for the eyes; blindness is a high-risk complication in such cases. Deafness is a risk in the parallel situation involving the aural nerve lines. Etc.

I wish they'd had varicella vaccine when I was a kid.

I messed up the link up there:
http://www.thislife.org/Radio_Episode.aspx?sched=1275

Thanks for writing this. The anti-vaccine craziness has set in to the point it's nearly self-sustaining; people tell each other "I heard" like a toxic game of Telephone.

I had chicken pox as a kid - I remember days of agonized itching, and long soaks in oatmeal baths to relieve some of it. When I had a worse than usual attack of immune deficiency about 10 years back following my cancer and radiation, I got the shingles. No fun.

The reason I didn't mention shingles is because it's a complication of both getting the vaccine and of not getting the vaccine.

Jim@10: Can you explain that? The only thing I currently know about shingles is that what I recall learning as a kid (that shingles was what you got if you got chicken pox as an adult instead of as a kid) was wrong.

I tell people who want to debate vaccination to go look up the following string- Hawaii. 1848. Measles, flu and whooping cough.- then get back to me.

In the somewhat stark words of one website's timeline "Flu, Measles, Diarrhea, and Whooping Cough come to Hawaii for the first time. Nearly every child born this year was killed, and whole families were wiped out."

I'm from the same generation as Elizabeth Moon; I remember the polio scares and the pictures of kids in iron lungs, and I had one classmate in elementary school who had braces on both legs. I also remember how stories about polio disappeared from casual conversation and the newspaper within a few years of general distribution of the Salk vaccine. It's not a good thing to forget so easily, sometimes.

For that matter, because I antedate some of the vaccines, I got measles, chicken pox, and mumps as a child. They are not fun even then, and the long-term possibility of shingles is scary: my mother-in-law was in severe pain for some time before being diagnosed with a case of shingles affecting a nerve next to the central line they'd put in when she had a heart attack.

As Jim points out, several of the childhood diseases can cause serious congenital defects if contracted during pregnancy. My mother had rubella when she was about 5 months pregnant with me; this is out at the end of the window of danger, which is probably why I don't have severe damage from it; my hearing nerve loss may or may not be the result of the rubella. Now there's a vaccine for rubella, but because the only real danger is to fetuses, and the illness is often asymptomatic, it's a prime candidate for a resurgence of the disease due to apathy about inoculations.

Yes,I read the Daily Mail article linked above. They're one of the papers who pimped the Autism scare.

And it's raging paranoia against people who haven't been vaccinated. Since the MMR vaccine didn't get used in the UK until 1988...

I look at Jim's list of diseases and wonder how come I'm still alive. Throw in this new paranoia with all the rest current in the UK and anyone over thirty is obviously a baby-raping plague-carrying pervert.

Shingles is caused by flare-up of herpes zoster, which is the same virus as chickenpox, Varicella zoster.

After you've had chickenpox, the virus never really goes away -- it lives along the nerve pathways in the body.

The next bit gets paradoxical:

Chicken pox vaccine associated with shingles epidemic

New research published in the International Journal of Toxicology (IJT) by Gary S. Goldman, Ph.D., reveals high rates of shingles (herpes zoster) in Americans since the government's 1995 recommendation that all children receive chicken pox vaccine.

Goldman's research supports that shingles, which results in three times as many deaths and five times the number of hospitalizations as chicken pox, is suppressed naturally by occasional contact with chicken pox.

Dr. Goldman's findings have corroborated other independent researchers who estimate that if chickenpox were to be nearly eradicated by vaccination, the higher number of shingles cases could continue in the U.S. for up to 50 years; and that while death rates from chickenpox are already very low, any deaths prevented by vaccination will be offset by deaths from increasing shingles disease. Another recent peer-reviewed article authored by Dr. Goldman and published in Vaccine presents a cost-benefit analysis of the universal chicken pox (varicella) vaccination program. Goldman points out that during a 50-year time span, there would be an estimated additional 14.6 million (42%) shingles cases among adults aged less than 50 years, presenting society with a substantial additional medical cost burden of $4.1 billion. This translates into $80 million annually, utilizing an estimated mean healthcare provider cost of $280 per shingles case.

There's been some work with shingles vaccines or boosters for adults who had chickenpox as children, but that isn't final yet.

I don't think MMR was common (or perhaps not available) when I was a kid. I had measles, missed mumps and rubella, got the rubella vaccine at about age 14*, and actually had a (thankfully mild) attack of chicken pox in my early 30s, probably because my then-husband was a day-care teacher; anything that went around the center, he brought home. I'm also one of the slowly-vanishing number of people with an upper-arm scar from smallpox vaccination.

That guy who made up the connection between MMR and autism ought to be publicly skinned alive. He'll probably end up being responsible for more deaths than the Iraq War.

* I remember this very clearly, because by that time I knew about the danger of rubella in pregnant women, and I made special note to remember that I'd been vaccinated. At that time I still thought I'd eventually have children.

My mother is a science nut, but also a hippie. So I got to live in hippie areas AND be vaccinated. Guess who ended up with rubella as a child? Luckily it was in the gap between my sister and I, although my mother did miscarry around that time. We get older and we move, to yet another hippie area, this time with a very low SES. This time it's my vaccinated fourteen year old sister who gets whooping cough. Which the local doctor refuses to diagnose as whooping cough because she is vaccinated (and she was also a terrible terrible doctor). So there's a month of my sister coughing until she vomits, then two months where she's terrified to eat because she might start coughing again. She lost about 15kg in this period - not of concern apparently, because all women want to be thin (have I mentioned how terrible this doctor was?) and 45kg wasn't dangerously underweight.

I also got chicken pox as a teen - I had always said it wasn't really a bad case. My mother overheard me saying that and was most puzzled. Turns out the five days we'd spent at my grandmother's house because I was too sick to leave didn't appear in my recollection - I was delirious for most of it. They had to bathe me. I only have one scar, but my mother spent five days bathing her thirteen-year old daughter.

It disturb me that the only recollection of the entire visit I have is of throwing egg and lettuce sandwiches out the window into the paddock.

My mother is only just now admitting that her beloved hippie small towns were not as healthy for us kids as she wanted to believe. Because when there's an epidemic, it ends up being bad for the immunocompromised (either by youth, or by a pre-existing issue).

(I was just this afternoon wondering when there'd be another of your fine posts. Thank you for this.)

When I was three, I was exposed to chicken pox on purpose. By adults. It was 1952. Was supposed to confer immunity. Nearly killed me.

Bright side, I have a corker of a near-death experience story to tell.

Rubella is an example of a negative form of herd immunity -- if everyone else is vaccinated you are ok without the vaccine, but if just most people are vaccinated you are a lot worse off.

As Jim says, rubella is pretty harmless in small children (I'm told I've had it, but I don't remember). If no-one is vaccinated then pretty much everyone gets it as a child. If, say, 2/3 of the population are vaccinated, the other 1/3 are still likely to get it, but it will take longer. As a result, moderate vaccination levels dramatically increase the risk of rubella in unvaccinated adults.

When I was a kid the policy in Australia was only to vaccinate girls, since the disease is only dangerous in pregnant women. Now everyone gets vaccinated, to get the herd immunity past the dangerous intermediate range.

The same problem with chickenpox was one of the issues debated when the vaccine was recently introduced.

Polio has always confused me, not the disease, but the suddeness with which it left the minds of the population.

The fight against it was huge. The numbers affected by it also huge. And when it was gone, it was as if it had never been.

I have a smallpox vaccination scar. I was proud of it as a kid (one of the last. My sister (14 months my junior doesn't have one. She had some cold, and my mother was told to bring her back... and then they weren't doing it anymore).

When we were being prepped to go to Iraq they vaccinated everyone. Three pokes if you weren't previously vaccinated, 15 if you were.

Even with 15 pokes, I barely reacted.

I've had some hideous cough. As bad as whooping cough, but only for a couple of days. It was only the memory of that which made it possible for me to choke down the codeine cough syrup, and that only for a couple of days. If the cough came back (it didn't) I figured I could take the stuff.

I don't understand people who won't vaccinate, and I have a friend whose wife (a primary teacher) is 3/4s against them. I was asked what I thought about it (they have a child, just a year old now), and I said.. do it!

She was thinking of not doing it.

Measles vaccine has been available since 1963. MMR has been available since 1971.

Widespread vaccination against diphtheria started in 1941; after that incidence dropped to nearly zero.

Most of the time the immune system works as it's supposed to; either you don't show symptoms, or you do but you recover.

But before vaccination, well into the twentieth century, it was just accepted that dying was something that little kids did.

I thought tetanus was every ten years? (Moot for me, I got my booster last year, but I may need to ask the spouse about his last one...)

I remember hearing about the 'vaccines cause autism!' scare around the time my son was born, nearly three years ago; whether there was a sudden flare up in scare activity or if it just came to attention because I was a new mom, I don't know. The husband and I wrote it off as bunk and followed the state's immunization schedule. It's reassuring to see we were right.

Just out of curiosity, and on the topic of vaccinations: is the requirement of two flu shots, administered a month apart, at some point between the ages of 18 months (may be 6 months, don't recall) and 8 years unique to South Dakota, or part of a broader standard?

In Australia they've just instituted whooping cough (pertussis) boosters for 10 year olds and not a moment too soon. My fully immunised twin boys both caught it at 10, and while it was horrible for them, it was worse for my cousin's four month old who spent some weeks in hospital, after we gave it to him. The young doctor I consulted about the dreadful cough my boys had, didn't diagnose pertussis because she had never seen it. My aunt, who trained as a children's nurse in the '50s, recognised the cough immediately, but it had already spread to the half-immunised baby. The guilt was huge, though he came through it ok.
My boys had recurrent severe coughs every time they got a cold for several years. Pertussis is a really horrible disease, even when it doesn't kill you. Needless to say, I am a total immunisation nazi, and liable to rip the throats out of foolish anti-immunisation types who are hapless enough to cross my path.

One thing that I never understood about the 'I don't have to vaccinate my kid because the other kids are vaccinated' argument: your kid may one day decide to travel, yes? To a place where these diseases are still active, and vaccinations are not yet widespread? (See: 1250 cases of chicken pox reported in Delhi in the first three months of 2008.)

Perhaps 'travel' is just not part of the mindset here.

Oh, and I concur with the thumbs up for Ben Goldacre. Thanks to him (though IIRC it was one of his readers who actually went after her), one of these 'I'm a doctor, honest, and so what if my institution is a PO Box' people had to stop using her 'title'.

I've had measles (twice), mumps, rubella and chicken pox (as an adult) and I can't understand any parent not vaccinating their children. Both of mine are getting everything that's available.

We don't vaccinate against chicken pox in the UK, but I wish we did. Looking after a scabby kid isn't a lot of fun.

My younger brother got whooping cough - there was a vaccine scare in the late 1970's so he was vaccinated - and that was pretty awful.

Re tetanus. The NHS advice is 10 years, or 5 if the wound is contaminated with manure.

*wild applause* Thank you, Jim, for putting this up here. Bookmarked, and will be used relentlessy to refute the 'autism, whaaaaa!' proponents.

I had both chicken pox and mumps as a child, and if I could go back in time and make them vaccinate me against those beforehand, I would.

Kimberley @22: I've learned that tetanus is every ten years, too. (In Germany, and in the UK.) Confusing.

When I was small, one of the kids in the neighborhood got rubella. The mother threw a rubella party, to which I went. I'm now immune.

I have heard that the immunity to rubella from vaccination wears off after a time, but the Google results I'm getting are too heavily polluted by crackpots to be reliable. Does vaccination, with booster, confer the same level of immunity? (Translation: are my MMR-ified kids done?)

Chickenpox vaccination is a new one to me. The UK wasn't offering it when we lived there, but both kids caught it quite young.

I got chicken pox in 1989 when I was 27; a woman at work had a daughter, and that daughter went to a birthday party where the birthday girl was in the contagious stage. The daughter was mildly sick; the mother got headache and fever.

I caught it from the mother, and nearly died.

To make matters worse, I had a very old-fashioned doctor who didn't believe that hospitalization would help; after all, who knew how to treat chicken pox anymore? So I stayed home for a month, and battled my way through through delirium, 104-degree fever, ague, violent vomiting, sweating (and dehydration), total loss of balance (I was reduced to crawling around so that I didn't fall), swelling around the eyes, extreme photosensitivity, and painful, oozing sores on every part of my body. Including the eyelids.

It was even money whether I would die of the fever. There was a 35%-40% chance that my scratching the blisters would get them infected and that I'd get sick and die from complications from the infection; my immune system (which only works at 50% capacity at the BEST of times--thank you so much, genetic lymphedema tarda!) was shot, and I couldn't have fought off another disease. My doctor didn't even want to talk about the odds about my eyesight; all that he would say was that given the proximity of the sores to the eyes...well, the odds were not in my favor.

I would not put a kid--or an adult--through that month of hell for anything. And if I could go back in time and get the varicella vaccine before it came to America, believe me, I would.

The medical books of two generations ago need to be republished. Especially the European ones. Every household had a copy of a guide to common ailments, usually lavishly illustrated with beautiful colour plates of the raddled skin of disease victims. You grow up sneaking THAT out of the bookcase and there is nothing subjective about why immunizing is a GOOD THING.

I imagine that those who have sat vigil over a mortally ill child take little stock in badly researched popular exposes of Evil Vaccine Conspiracies. I also note that bastard Wakefield may stand trial yet.

I had chicken pox as a child, I remember Camomile lotion and being given The Three Little Pigs Ladybird book to read, so I was about four. All three of my kids get all their jabs per the official schedule.

There was a recent flap about HPV vaccination for teenage girls. The Government planned a €30 million programme, but then ran out of cash and cancelled it. This reminds me that I must look into it: it's about €400 a pop privately, I believe.

I had measles when I was seven, and had a lot of the consequences: otitis, pneumonia, and hot on the heels of that, maybe connected and maybe not, acute appendicitis hurrying towards peritonitis with the might of a thousand armies. I was born in 1966, but apparently the vaccination hadn't made it to Italy by the time I came down with it. I didn't hear of even the possibility of a vaccination throughout my childhood. People did rubella parties but they sure as hell didn't do measles parties - you were quarantined until the spots went away and for a long time afterwards.

I had the rubella inoculation because we were never sure if I had it or if it was something else.

I had chickenpox at 14. It was all shades of Really Not Fun, but at least it stopped there. My grannie had shingles when she was in her eighties. It was Not Fun and I am not looking forward to it.

My mom's cleaning lady came down with rubella in the first trimester. Back then, even good Catholic girls had abortions in that case, and nobody felt the need to complain about it. It was therapeutic abortion, not elective. But when she went to her gyn, he laughed paternally and said, "Come on, come on, you let yourself be scared for nothing, you'll a flower of a baby!"

She did. The baby was a blond, beautiful, sweet girl. She was also deaf, half-blind, retarded, with a congenital heart defect, and needed constant care and physiotherapy to walk. She must be an adult now, and I wonder what happened to her. Her mom fought full-time to give her a normal life, and I really hope that she succeeded.

Ethics of vaccination: suppose your government covertly added this to your local supply. Would it be a good thing?

Covertly adding any pharmaceutical to anything is a bad idea. The problem is the "covert", not necessarily the pharmaceutical.

They haven't particularly promoted the varicella vaccine in Germany, and while I'm generally all for vaccinations, I've hesitated with this one for my son. He's been exposed to chicken pox multiple times, but is 14 and still hasn't gotten it. I'm thinking it's probably worth it at this point, because the course seems worse the older you get. He would have a lingering risk of shingles whether he had chicken pox or got vaccinated, right? And fortunately insurance covers the HPV vacc, at least for girls, so I'm glad my daughter will be able to get that one. They even have public service spots promoting it.

Cases of measles are on the rise here -- parents either don't get their kids vaccinated at all, or neglect the booster shots. Two years ago, the incidence of new cases got so high in our county that kids were required to submit their vaccination booklets to the county health department. They stopped short of forced immunization, but threatened to exclude unvaccinated kids from school. I've never understood the mentality of being willing to risk the health or even life of someone else, by not vaccinating and potentially being a carrier.

Abi@27

I think it's still genuinely unknown how long the MMR immunity to rubella lasts.

There was a paper in 2000 by people from the Finnish National Public Health Institute looking at what had happened over the 17 years since MMR vaccination started. They found that after 17 years 1/3 of people vaccinated as infants had antibody levels below the threshold that is supposed to indicate reliable immunity (no-one who had had actual rubella had low antibody levels).

As far as I can tell it isn't known what the actual risk of rubella is for people who have some antibodies but less than the target amount.

It also isn't clear whether the people with low levels of antibodies never had very high levels or whether they declined over time. That is, did the vaccine not work or did it wear off over time?
A recent paper in the New England Journal of Medicine (free access - thanks, NIH) found that antibody levels decline very very slowly over time, but they had a mixture of people who had real infections and people who were vaccinated.

Vaccinations are a gamble: Will the reduced chance of a future disease outweigh the chance of complications now? Everyone has to make the choice for themselves. No medical procedure - and that includes vaccination - should be required by law. Period. End of sentence.

One should choose one's vaccinations carefully, because there are some which cause serious side effects in some people. We don't hand out rabies vaccines or smallpox vaccines unless there's a reason to - and that should be the case with childhood diseases as well.

Did I not read something, somewhen in which capsaicin was used as a remedy for shingles pain?

ah yes:
http://www.irishtimes.com/newspaper/health/2009/0217/1224241278308.html

Roxanne, I'm sorry but you are wrong on "No medical procedure - and that includes vaccination - should be required by law".

The right of the human race to survive as a whole overrides the right of individuals to be careless. If an epidemic is endangering society as a whole, collective and democratic bodies have the right to impose vaccination. I think this thread made it quite clear.

It's a power which must carefully (and sparely) be used, but it's there. Because otherwise, under extreme circumstances, the mob will purge "individualists" in more cruel ways.

We don't hand out rabies vaccines or smallpox vaccines unless there's a reason to.

It doesn't make much sense to give the general population the rabies vaccine, because of its mode of transmission, i.e. through bites. Obviously people who have frequent contact with animals should receive it. Ditto for smallpox - few people will actually be in a situation where exposure is possible.

The same does not hold true for the highly contagious childhood diseases listed above, where, in many cases, breathing or touching is all it takes to catch the bug - and spread it.

Will the reduced chance of a future disease outweigh the chance of complications now?

The answer is "yes."

Hmmm... Two questions occurred to me as I was reading this thread...

1. I have a little white scar on my left arm, the circumference of about a pencil eraser or a bit smaller, that my mother told me was from "getting your baby shots". She also has two similar but larger scars, more like the size of a penny each, that she said were from the same thing. I asked about this when I was around five years old and haven't really thought about it until now, but it occurs to me now that the only other people I've seen with these are my sister, aunt, uncle, and one or two of my uncle's friends-- AKA people born after 1960 in the former USSR. (I don't know whether my grandparents have these scars.)

So: what was the difference between USSR and American vaccinations that caused this? We moved here when I was 14 months old, so that rules out only one or two vaccines as specific causes... Was it some kind of additive maybe, or really thick needles???

2. If the chicken pox vaccine was only approved in 1995, that means I had already entered the public school system and had all my required shots at least by the previous year. I am quite sure that I was never vaccinated for it later on... I don't mean to overreact, but how likely am I to get chicken pox as an adult?!

I missed out on some of my childhood shots; specifically the TB and smallpox jabs that were still on the menu. I had really bad atopic eczema at the time, and the initial TB sensitivity test brought out a strong enough reaction that they decided to skip the vaccination -- and they skipped the smallpox shot at the same time. (It was 1974 or 1975, and by that time the writing was already on the wall for that particular virus: why risk an anaphylactic reaction?)

Weirdly, I managed to contract shingles when I was 13; the left side of my rib cage felt like the worst case of sunburn I'd ever had.

turtle @42 -- I have no idea if the likelihood changes with age, but adults can certainly catch it. My husband got it in his early 30's from our 6-yo nephew, and it was Not. Pleasant.

Forgot to mention, I was born in 1990, so hopefully the obscure vaccination scars can't be too obscure...

Chicken pox is definitely worse the older you get. Husband spent his 40th birthday in isolation on intravenous acyclovir in our local infectious diseases hospital after picking it up from our young children. He was going rapidly down the same route as Tracey@28 (Sympathies!)

He caught almost nothing as a kid - only rubella and scarlatina. His brother and cousins had the full set up to and including measles - so our doctor reckoned he would have had sub-clinical exposure sufficient to generate antibodies. Not in the case of that chicken pox.

We're setting about getting him an MMR vaccination coz measles/mumps in his 50s doesn't bear thinking about.

Our kids have had the full set of everything - even bearing in mind my own medical history does raise the possibilities of genuine* complications for them. We looked into all the numbers and details with our GP and concluded the risks of vaccination were still definitely less than the risks of the diseases.

*I'm another huge fan of Ben Goldacre, and want to see Andrew Wakefield prosecuted to the fullest extent of the law. Seeing AW in a pillory being pelted with good old medieval midden refuse would suit me too.

@40: The only people likely to be exposed to smallpox are workers in a couple of government laboratories, because smallpox is dead. Extinct in the wild for three decades now, thanks to vaccination. Hooray for humanity's one total victory in the fight against disease!

By which I mean, our kids have had the full set of jabs.

Reading that back, I see that's not as clear as it might be. Apologies.

#42 I have a little white scar on my left arm, the circumference of about a pencil eraser or a bit smaller, that my mother told me was from "getting your baby shots".

Specifically, that's from the smallpox vaccine. I have one of those; so does everyone of my generation or older.

I used to think it was funny, watching sword-and-sandal movies, seeing the Romans gladiators with obvious smallpox vaccination scars.

You used to be able to get little plastic covers at the drug store to go over the blisters that formed from the vaccine blisters.

De-lurking to add that if one might expect to have much contact with people in college, it's a good time to have one's pertussis vaccinations updated. They aren't lifelong, and it's rather frightening to see the rate at which they will sweep through a college community--- we would literally step over people who had collapsed in the hallways because they were too tired to crawl back to their dorm room--- and we were too tired to help them. I've been told anecdotally that one of the hallmarks of a whooping cough outbreak on campus is the denizens half-jokingly referring to it as "the Plague."

Roxanne @36 (& Jim D McD @41)

Will the reduced chance of a future disease outweigh the chance of complications now?

The answer is "yes."

As a child I remember TB vans around suburbs in Australia. Then it all vanished*. Now I hear tuberculosis infections have revived. Is there a summary of what's happened with it over the last 50-100 years?

* Excepting Aboriginal communities, generally ignored.

Tetanus booster is every five years.

Sadly, in a lot of areas of the US, you have to fight to get it every 5 years. Often doctors will only give it if they think there's a reason manure might be in the wound... like you ride horses. Processing raw sheep's wool, playing with model airplane engines that get crashed into the ground and are filthy, hiking in remote areas, riding a bicycle off road... all sorts of perfectly normal activities tend to be ones where a 5 year cycle is wiser than not.

But you still get told every 10.

3 years left on mine.

Jim @ #49: Aha! Thank you for resolving this little mystery!

But why did they think smallpox immunizations were still necessary in 1990 if it's been extinct that long?

Laura @ #50: That's a little scary, because something called The Plague is going around campus right now and I have it (along with, well, everyone)... but on the other hand I am not coughing nearly hard enough to break my ribs, and nobody is collapsing in the halls. I rather suspect it's just a bad cold coupled with the worse-than-a-preschool contagiousness of dorm life.

But why did they think smallpox immunizations were still necessary in 1990 if it's been extinct that long?

I got my last smallpox vaccination in 2002. It blistered up a little, but not as bad as I remember from the first time around.

As a health-care worker, front line in the War on Terror, this came in the post 9/11 preparedness.

I don't know when routine smallpox vaccination ended. Some time after the last case in the wild was reported.

Tetanus: Every 10 years (UK advice). Used to be recommended every five years, but the advice changed a while back - you might still be given a booster with a very dirty puncture wound if your last booster was more than five years ago.

Vaccines and herd immunity: Those with perfectly healthy, non-allergic children who won't have them vaccinated with MMR or whatever are not only denying protection to their own children but also to those who, for reasons of poor immune status or allergy, cannot be vaccinated. That is selfish, antisocial, dangerous behaviour just as much as getting in a car and driving it on the roads without training.

The whole anti-vaccination think makes me really cross sometimes - such a lack of understanding of science. Measels is on the rise again in the UK at the moment.

I was relatively lucky - I had measles and chickenpox as the "typical" childhood diseases - spots and not feeling so good, but nothing worse, and I had very mild mumps and subclinical rubella (my sister had it and I came up antibody positive when tested). I remember getting the oral polio vaccine on a bit of bread (my mother, a doctor, didn't coddle us with a lump of sugar!). I have the scars from other vaccines - BCG for example.

The memory of polio was still around in my childhood - maybe because my parents were doctors.

Jim@49

BCG vaccination (for TB) produces similar scars. I don't think the US did it, but Australia still did in the 1980s.

Epacris@51

TB was wiped out in some places but it always kept creeping in with migration from areas where it was common (which is why immigrants to lots of countries need to get chest x-rays). The problem is that lots of people who get it go into remission and look perfectly healthy until the infection reactivates years later.

There has been a real increase in rates over time, but there has also been a big increase in visibility. The interaction with HIV and the increase in drug resistance has made public-health types much more worried about TB, so there is more news than there used to be.

TB is still almost always treatable, but the second-line drugs aren't very nice and the treatment period is long. Fortunately there are finally some promising new drugs in development.

Incidentally, Larry Niven's story about a time machine and curing Heinlein's TB? A single-dose subcutaneous injection for TB is more plausible than a time machine, but not by a whole lot.

I grew up in a family with a history on both sides of nursing. Both of my grandmothers were nurses, as was my mother, and two of my aunts (my mother's sister, and her sister-in-law). I can remember watching "I Can Jump Puddles" as a child (the story of Alan Marshall, who contracted polio at age six, shortly after starting school) and asking my mother about polio. She'd started her nursing career early enough (late 1950s) to remember the polio wards, and the way she described it made me very glad the disease had been pretty much eradicated by the time I was alive.

Other fun diseases my mother described for me were tetanus (did you know that the reason there used to be all those "quiet, hospital zone" signs on the roads was because one of the things which set off tetanic spasms was loud noise?); tuberculosis (they stopped testing for and immunising against that one while I was in primary school; this worried Mum because of her entire nursing class of about twenty mostly middle class young women, she was one of two people who came up negative for prior exposure to the tuberculosis bug. She thought I should get tested for it just in case); and various varieties of hepatitis (she had Hepatitis A as a teenager; the blood bank had a big black mark on her donor card for years as a result). From her midwifery textbooks (which were all written in about the 1940s) I learned about the effects of a lot of infectious diseases on both pregnant women and unborn children (essentially, if you have a high fever during the first 12 - 16 weeks of pregnancy, you can expect foetal abnormalities as par for the course) as well as the consequences of incompatible Rh factors, and various other bits and pieces.

One thing I've never ever had any problems with is the notion of vaccinations as a Good Thing overall.

Oh, and on the shingles thing - I've had chickenpox as a kid, and shingles as a teenager (would you believe it targeted the nerve just underneath the breast area? At that time I was a D-cup, and there is nothing quite like not being able to wear a bra when you're that size). About the only side effect it had was that the blood bank thought my blood was wonderful - I'd just turned 16, thus becoming eligible to donate, and they leapt at the chance to grab as much of my blood plasma as they could. So, if you have shingles or chicken pox, once you're over them, go see your local blood bank - they will literally think your blood is worth bottling.

Wow. That thing you linked to in the beginning is . . . wow. REAL dumb.

So . . . 50% of tetanus cases were in the unimmunized, therefore tetanus immunizations are pointless.

Yeah, but when 90% of your population is immunized, that means that 50% of them happen in the other 10%, and 50% happen spread out in the OTHER 90%, so that you're 9 times safer if you have the shot.

People are stupid.

Wow. That thing you linked to in the beginning is . . . wow. REAL dumb.

So . . . 50% of tetanus cases were in the unimmunized, therefore tetanus immunizations are pointless.

Yeah, but when 90% of your population is immunized, that means that 50% of them happen in the other 10%, and 50% happen spread out in the OTHER 90%, so that you're 9 times safer if you have the shot.

People are stupid.

HPV is a classic case of a disease which could be eradicated relatively quickly given the current vaccine. The reason for wanting to eradicate it as quickly as possible is the link between HPV infection and cervical cancer. Example: the daughter of a friend of ours did not get vaccinated; by the time the vaccine was available she was over 18 and her parents didn't feel it appropriate to suggest it to her; she didn't consider it important, and her health insurance didn't cover it. Then she got HPV from her boyfriend, and not only has a significant likelihood of getting cancer later, but also has sufficient scarring that she's unlikely to be able to conceive a child, should she desire to.

The issue of HPV vaccination has gotten caught up in the culture wars here in the US. Because HPV is sexually-transmitted, the neoconservative zeitgeist for the last 8 years held that giving the vaccine was a tacit recommendation to have sex; you shouldn't give it to a girl under 18, and certainly not to a virgin (both categories being the ones least likely to have been infected before vaccination, and therefore the ones you most want to vaccinate). I'm hoping that the general disgust here at the excesses of the Bush era will result in a change in that attitude; we're facing an epidemic of STDs just now, and HPV is definitely among them.

My mother told me about the way they used to drain swimming pools during polio scares. That impressed me almost as much as finding out why Itzhak Perlman uses crutches.

I was vaccinated against smallpox as a child, and against measles and rubella (the doctor who immunised me was a kindly old Polish man who gave me boiled sweets). I did catch mumps at ten. I caught chicken pox at 14; my brothers who went to a different school caught measles at the same time (we didn't get boosters, which is why), so we had a miserable couple of months in early 1971.

Because I was in a country undergoing a polio epidemic at the time, I was immunised against polio for the last time in 1982.

Some people in rural Jamaica during that epidemic were, however, suspicious. A rural correspondent for the newspaper for which I worked sent in a report -- which was, alas, spiked -- detailing the suspicions of the government immunisation programme in one rural community. Some men, it seems, believed that the immunisation was an underhanded attempt to sterilise the population, because polio only affected children (so why were adults getting the vaccine?) Their proof of this, as I recall, was 'a decline in their nature' following the administration of the vaccine. The correspondent had determined that the complainers were all 'smokers of grade-A ganja' and had subsequently increased their intake; as a result they had all attained 'stiff erections of the penis'.

Niall McAuley #30; Calamine lotion. Camomile is taken internally. Calamine lotion, apparently, is a placebo.

abi: When I was small, one of the kids in the neighborhood got rubella. The mother threw a rubella party, to which I went. I'm now immune.

My mother said I got rubella twice: Once when I was four, once when I was eleven. So either something is not right here, or having it once does not necessarily confer immunity...

Jim Macdonald @3
Tetanus booster is every ten years. If you have an open wound and your last booster was 5 or more years ago, they will give you another. The vaccine protection has been shown to last as long as 12 years, but no one wants to take any chances when there's a wound with potential. Medline Plus

I am a CRS baby, and escaped with only hearing deficit (as far as I know...). I had mumps as a small child, chicken pox as a teenager (not fun), and mono as a 30-yr old (even less fun). I fall in between the polio generation and the MMR generation; I remember the fear that lingered in the community as polio faded from memory (and have the classic scar on my leg, not shoulder), and I recall very clearly when they started using MMR because I'd already had mumps.

As a veterinarian, I'm up to date on my tetanus and rabies. My last tetanus booster gave me a lovely case of vaccine reaction (fever a week after), but that's far better than having to deal with the toxin. I get my flu vaccine every year, as well; it's my small contribution to herd health.

I feel lucky that I was a child of the early 80's, because the whole MMR = autism thing hadn't come around yet, so I had the privilege of going to schools, daycares, and other places where every child was immunized, because the idea of not taking a kid to get their shots was unthinkable.

Let me tell you, living in a world where I didn't even know what measles, mumps, or rubella were because nobody got them? Was really nice.

Of course, we all got the chicken pox and I wish there'd been a vaccine for that back then, because if there had, at least it would have been in an era when parents would've had the common sense to make sure their kids got it. Seriously, I can't imagine a parent back then who - if for nothing else than not wanting to stay home with a miserable, sick kid - would not have marched their child right down to the doctor/Health Department and had it done the minute it became available.

Heck, I almost got disenrolled from high school just because I was a week late getting my booster shots (the ones you have to get around senior year, don't know if it's just TN law or other states have) from the Health Department because of scheduling problems.

It's too bad there's no legally acceptable way to prove where and from whom a child contracted a disease, because if there was, I would suggest suing the pants off of any family that didn't vaccinate their kids and caused another child to get sick.

But I also had a teacher in school who, because of polio, had an arm that was deformed and atrophied that she couldn't use and I've never forgotten that teacher.

I'm sure she'd have some choice words for any parent idiotic enough not to get their kids immunized.

I'm reminded of the episode of House where Dr. House tells the mother who doesn't want to vaccinate her kid exactly what happens when you don't. The "teeny tiny baby coffins" comment was just lovely.

I vote we have Dr. House go talk to these folks.

Jim MacDonald-

Thank you for this. I've got an 11 month old and a 3 1/2 year old and the amount of time I spend jumping up and down and trying not to holler at people who are *shocked* that I would take the risk of vaccinating them is...well, it's endless and distressing.

My pediatrician, bless her, has instituted an inviolable policy of not accepting any patients whose parents aren't getting them all their vaccinations.

inge@64: Or your mother mistook one rash with-a-fever for another. It happens quite easily; my mother thought she'd had rubella as a child, only it turned out to be incorrect. There are a fair number of childhood diseases which present as a fever, rash, and general malaise. Measles, chicken pox, Rubella, roseola, and fifth disease were once commonly seen in childhood, with other diseases like scarlet fever also presenting with similar signs. eMedicine article on 5th disease

Great article. I knew about the ten year requirement for tetanus boosters but not the five year requirement. Since we have horses, this is an issue for me and Jack. Fortunately, we both have had our most recent booster in the past two years. Goodness, I hate those things, but not enough to make me risk getting tetanus.

I had shingles a few years ago, in my right hand. I diagnosed it myself the morning I was already scheduled to go to the doctor to find out why my normal self-care for tendinitis wasn't working. (I've had eczema in the past, and the lesions looked similar.) The pain was fairly bad, but the phantom sensations were even more disturbing. At times, I felt as though I had insects crawling on my arm, or someone was running an ice cube or dripping water on the area. Very odd. I recovered completely, but was bummed to find out that shingles can come back.

Thomas @56: TB is still almost always treatable, but the second-line drugs aren't very nice and the treatment period is long.

Er, you might want to reconsider in light of MDR-TB.

As Wikipedia puts it, not inaccurately: The treatment and prognosis of MDR-TB are much more akin to that for cancer than to that for infection. It has a mortality rate of up to 80% ... and that's before we look at the nightmare case of XDR-TB (even higher mortality than MDR-TB; in the 2006 South Africa outbreak, median time from diagnosis to death was 16 days and 52 out of 53 victims died, putting it in roughly the same league as Ebola).

I liked the comment of one of the moms who had to be quarantined for a month with her baby during the measles quarantine in California: "do you think people have a right not to immunize their children?"

Pause. Long pause. Then:

"Sure. But they have to go live on an island."

Roxanne: No medical procedure - and that includes vaccination - should be required by law.

Quarantaines?

Also, I'm not too enthusiastic about anyone's right to endanger others by neglience.

One should choose one's vaccinations carefully, because there are some which cause serious side effects in some people.

IM unprofessional E, people who get vaccination complications are unlikely to have that kind of robust bring-it-on immune system that handles exposure to a kills-one-in-five diseases well.
Those who cannot be vaccinated because they are likely to suffer complications are the ones that need herd immunity most.

We don't hand out rabies vaccines or smallpox vaccines unless there's a reason to - and that should be the case with childhood diseases as well.

You get a rabies vaccine if there is a non-zero chance that you might become infected without instantly noticing it: i.e., working as a vet, or studying bats.

From experience I can say that you can catch measels, rubella, chickenpox and the flu without instantly noticing it.

I'm wondering -- with the incidence of drug-resistant tuberculosis increasing, would it be worth it to bring back widespread TB vaccination? Especially among the most at-risk population like people likely to be hospitalized, live in homeless shelters, et cetera?

Connie H: Alas, it looks like the BCG vaccine doesn't protect terribly well against MDR-TB or XDR-TB. Or even plain ordinary TB. We really need new and better TB vaccines, but it's not exactly a good money-spinning prospect for big pharma ...

Thank you thank you thank you for posting all of this information! The lack of concern--or intellectual curiosity--that parents display is maddening and heartbreaking at the same time. To go around with the attitude that "well, everyone else's children will be immunized, so *my* kids don't need shots" is akin to child abuse. Not only for your own children but for all other children.

I had chicken pox at 4 or 5 (this was in the early 70s). When I was 9, my best friend got it, but everyone assumed I was immune and was allowed over to her house to play. I'm sure you can guess what happened... I ended up with herpes zoster. It liked my scalp, and I had the rash/bumps/sores all over my head, along my neck, and just to the tip of my chin. I was lucky it didn't travel to my face. It was *painful* and nasty and embarrassing, especially because I was in 4th grade. I still have bumpy scars on my neck--they look like burn scars.

As a result, I'm TERRIFIED to be around anyone--child or adult--who has come into contact with chicken pox recently. The vaccine has helped, but I'm still paranoid about it, as you can imagine.

And I agree: I'm sure that if people were more experienced with these diseases--if they heard babies with whooping cough or saw what rubella and diptheria could do--they'd be lined up at the clinic for shots *yesterday*.

Like Charlie, I missed the smallpox vaccine due to eczema. When the last scare came around due to 9/11, I looked up why people with eczema shouldn't get the vaccine.

Shudder. Not good.

Meanwhile, I am at risk for measles because I am allergic to eggs. Not good, either. I work in a K-8 school. Otherwise, I keep up on my vaccines.

inge @64,

I, too, was diagnosed twice with rubella as a child. At 26, when I was pregnant with my first daughter, my GP tested me for rubella antibodies. Turns out I'd never had it. If kids are likely for anyone you know, you might want to get yourself checked out.

My parents weren't antivaxers or anything like that, I just went through school before MMR was routine in Australia. I was vaccinated against polio, diptheria and whooping cough. I had measles and mumps as a small child, and chickenpox as an adult. I was absent for some reason the day of our smallpox and TB needles and by the time I was old enough to look into them for myself, smallpox and TB jabs were no longer routine.

I have considered getting a rubella vaccination, but I'm immunocompromised due to rheumatoid arthritis treatment -- I could stop taking my methotrexate for a couple of months, but I'd seize up completely.

I nearly died of rubella as a small infant -- spiked a very high fever, the kind that can kill. I was too young for the vax. And I ended up in the hospital for two weeks as a child with pneumonia from influenza. And again as a teenager, same thing, flu + pneumonia, a week in the hospital and weeks out of school.

And I have coworkers who will refuse to get flu shots because they feel crummy the next day. My workplace offers FREE flu shots in the office!

*headdesk*

Also, do get your pertussis vax updated if you haven't had one since childhood. It's ... not fun ... to have it as an adult. I'm pretty sure I caught it from someone I worked with, who had the classic symptoms, and was a "pray and make it better" sort who didn't believe in going to the doctor, vaccines or, apparently, staying home from work when she was sick. Infected half the office, including me. (I'm amused about the "plague" reference above ... that's what we were calling it.)

I'm asthmatic, missed weeks of work, and that was also how I discovered I'm allergic to sulfa. It was just a lovely fun time.

(I WAS vaccinated but it had apparently worn off.)

-- Leva

I wonder how much of the traction the antivaccine types get has to do with the culture of dishonesty in US/world media and government. That is, the "official story" you get from the NYT or the Feds is, in this case, that these vaccinations are a huge win for your kids and the whole community. In this case, the official story is true, too. But in many other cases (think about the rampup to the invasion of Iraq, or the use of corn-based ethanol as an example of a path to energy independence), the official statements and advice of the government, respectable media, and similar folks at the top of the society are nonsense.

My suspicion is that crap like the antivaccination movement is partly a consequence of the apparent willingness of the "official sources" of information to lie or carelessly mislead people for their own purposes. (I think it would be easy to fill an entire thread with examples of this sort of thing, where respectable organizations and individuals in the society are expected to lie to achieve some greater purpose, or just to accomodate political or economy necessity.) I wish I had a good solution for this.

Charlie Stross@70

Yes, MDR-TB is extremely nasty. Fortunately it is still relatively rare. Resistance to isoniazid is fairly common, but resistance to rifampicin as well isn't. The last figure I saw was 3-4% of new TB cases.

MDR-TB could relatively easily become common, and that would be really bad.

I should possibly clarify about rubella.

I didn't assume I was immune because I had been to a rubella party and got ill. I had a set of blood tests as part of the checkup I got before trying to become pregnant; the immunity was confirmed there.

This also confirmed to my doctor (I knew it already, long since) that I am Rh negative. Since my husband is Rh positive*, we knew there were medical issues to watch for.

-----
* Actually, they never tested my husband. They assume the pregnancy is at risk without regard to the partner's Rh factor. It's a delicate way to avoid making, well, assumptions that might damage maternal health.

Ginger @68: Or your mother mistook one rash with-a-fever for another.

That's what I suspect. Both cases were very low on the fever scale (I don't generally get high fever), but I was looking very dotted and could to stay home for three weeks.

There was, near the town where I grew up, the remains of an old settlement connected to an early frontier ironworks. There, in the cemetery, is a set of graves--all of them children, all dead within about ten days to two weeks of each other. They'd had a diphtheria epidemic. A historian who has done research at the site told me it looked to him as if every family living there who had had children under the age of 15 lost at least one.

If you'd like further Fun With Public Health, I suggest taking a look at the history of yellow fever epidemics; although there's been an effective vaccine for this disease since 1937, it's not used as widely as it could be, and the WHO estimates 200,000 cases and 30,000 deaths yearly in unvaccinated populations worldwide. Dengue fever still doesn't have a vaccine, although work is proceeding there, I understand. Neither is a disease you'd like to have.

I work with a lot of old doctors; some trained back in the 1940s, and if they don't have horror stories of their own, they heard plenty from the doctors who trained them. Not a one has anything to say against vaccinations, including the HPV vaccine (one of them summed it up quite well--"So you plan on your daughter being a virgin when she marries--what are your plans for guaranteeing her husband is uninfected?"). Their suggestions for Wakefield's fate are as unkind as you could wish.

Ian@58: Agreed, the linked article is dumb and wilfully ignorant :
Tetanus is extremely rare and can safely be treated homoeopathically

I wish them all the luck they deserve with that.

That first grave marker fuddled me for a moment -- I knew a Mary Tillotson, and she lived into her eighties. Obviously not the same one.

When I was two my mother and I both had chicken pox. We both almost died. My three older siblings (one of whom had brought it home from school) had no problems with it.

My kids caught chicken pox in the early 1990s, when the vaccine existed but wasn't yet available in the U.S. Like my siblings, they had no problems, barely felt sick. Strange disease, that one.

I had measles when I was eight; the MMR vaccine wasn't available yet. I had rubella when I was nine, and really enjoyed it -- a week off from school just in case any of the teachers were pregnant, but I felt fine despite the spots. At the time, incidentally, everyone still called it German measles, and the fact that my Dad knew it was properly called "rubella" was attributed to him being a college professor who knew lots of useless stuff.

I kept waiting to complete the trifecta, but never got mumps.

As for polio, I'm of the first post-polio generation, but there was a kid in our neighborhood, my age, who had somehow missed the vaccine and became the last polio victim in our town, or several of the surrounding towns. All the adults were so constantly sorry for him that it was really uncomfortable. The other kids didn't like him much, as anyone who didn't treat him like a little prince would get hit with a crutch. Hit hard. As in, at least one girl needed stitches. Dale, though, was never blamed for hitting other kids; he would always deny it if no adult saw it, and claim it was an accident if it was seen, or that the other kids were teasing him. The adults would all yell at us for teasing the poor cripple -- but none of us did tease Dale, ever, because why would you tease a kid who effectively has permission to whack you over the head with a club? We weren't that dumb.

Dale probably gave me a very distorted view of polio sufferers.

Great post.

Like everyone else here, I'm shocked to discover how many modern people buy into anti-vaccination crankery. Then I think about it, and realize that it's not really surprising.

The fact is that one of the significant characteristics of our time is the near-complete moral and intellectual collapse of our credentialed elites.

In area after area, the great and the good, the very experts who we count on to have sensible answers, have shown themselves to be liars and fools. Our statesmen and military leaders are sadists and morons. Our financial guardians turn out to be sweat-soaked casino high-rollers in the last stages of losing everything. Our captains of industry can't make an automobile anybody actually wants to buy. The leaders of our most admired philanthropies are found to have parked their organization's money with fast-talking hustlers running Ponzi schemes. Our leading organs of "journalism" are staffed by gossipy, score-settling airheads. All too many of our doctors are the corrupt tools of an obviously evil multinational pharmaceutical industry.

I happen to agree with the scientists and medical personnel who urge that children be vaccinated, because I believe that by and large, these are people of integrity. And because what they say about the science in question correlates with my own small layman's understanding.

But it seems to me hardly surprising that, in a society in which one after another category of expert has been shown to be lying sacks of shit, many people should be ready to believe that vaccination is yet another scam.

Here and there on the sidewalks of New York, you'll see black people selling books, all on subjects of black interest, published by black-run firms for black readers. Some of them are romances or adventure novels with all-black casts. Some of them are manifestos of cultural pride. Some of them are relatively harmless crankery--for instance, treatises about how the pyramid-building Egyptian dynasties were actually black.

And some of them are more toxic: explanations that AIDS/HIV isn't real, or isn't transmitted by sexual contact, or can't actually be transmitted between heterosexuals, or was brewed up by secret government laboratories as an attempt at genocide against the black man.

How could anyone sensible believe this stuff?

Maybe because, in the real world, the United States Government was conducting secret medical experiments on unknowing black subjects--experiments in which the subjects were deliberately not told that they were infected with a lethal disease--as recently as 1972?

I'm not making an excuse for anyone. We are all obliged to be as smart as we can. The fact that vaccination is a good idea and even a moral imperative is apprehensible by the exercise of reason. The depraved condition of some of our elites is not an excuse for ignoring anything someone described as an "expert" tells you. If a munitions expert told you to point a gun that way, not the other way, you'd listen, whether or not you were pissed at the government and Wall Street.

But by god, the breadth and spread of moral rot among our elites certainly makes it more understandable when everyday people stop believing anyone.

(I see that albatross got in with essentially the same point, only less long-windedly, in comment #79.)

abi: I don't know about now, but I recall my mother saying that the timing of immunization was a problem, because it would wear off; not be boosted and women would think they were immune. That was, of course, some thirty years ago, and the vaccines may have changed. She (and she'd been a phlebotomist) seemed to think the immunization (even with the booster) attenuated, so that most people who'd been vaccinated were at risk again by thirty.

That strikes me as odd, because I'd expect to see a population getting it at about that age, unless the herd immunity is really strong. Then again, she thought giving kids rubella (as your mother arranged it) better, because the immunity would be permanent.

re Rh incompatibility: My mother was in the control group for one the studies for one of the first drugs to deal with it (but, as you say, maternity is certain, paternity implied. I'm Rh neg, so maybe they typed me at birth, and then put her in the control group).

Jim: If one has been exposed (i.e. vaccinated) the anti-bodies present will knock the pox at the innocculation site down. That's why I got a 15-poke vaccination, and the non-vaccinated got a 3-poke. I has three small pustules as reaction and was done with it in less than a week. Those who weren't immunized prior got 3 jabs, had a reaction site of great irritation, and some were still inflamed a month later (mostly because they kept occlusive dressings, and the pustules never really scabbed.

Routine innoculations stopped (in a random way), in the states, between 1968-1970. Overseas it seems the lasted (in some places) to the mid-'80s.

mismeg426: I wish (as someone born in 1967) that the attitude toward immunization had been as favorable as you said. Every year I recall the period when kids were excluded from school becuase their parents weren't keeping them up to date on their shots.

I got told to get a tetanus booster, at about 7 rears from initial (I was 14), and the reaction was horrid. But it was get the shot (which seemed no big deal) or be expelled. My reaction to it 12 years after that (Basic training) wasn't as bad, but my left arm was sort of useless for a couple of days, and sleeping on it hurt.

Scenes From the Home Life of the Nielsen Haydens. Chapter 1279.

P: Hey, read this long comment before I post it to Jim's vaccination post.

T: Okay. [reads] tum te tum... [reads some more] Oh, well, okay, that long passage where you're decrying all the different kinds of corrupt elites?

P: Yes? What?

T: Well, I kept expecting you to end it "And get off my lawn."

P: [pause] I don't get what you're saying.

T: Um, my dear, you sound like an aging crank.

P: [thunderstruck pause] But I am an aging crank! What's more, I'm your aging crank!

T: [helpless laughter, collapse, armies in confusion]

I wish we'd had the chicken pox vaccine when I was a kid. My brother got chicken pox (my brother got everything), but although I was exposed, I never came down with it. I try and avoid people who are sick--but my coworkers seem to enjoy dragging themselves in to work when they're barely conscious, so I figure I'm doomed.

In 1990 or early 91, while I was in college, there was a big scare throughout the U.S. about rubella outbreaks on college campuses. We were all required to be re-vaccinated for rubella. It may even have been the full MMR vaccination; I'm not sure, but I hope so. Chicken pox is bad enough.

I need to get a tetanus booster. It's been more than ten years, plus I do work with raw wool from time to time.

Patrick: alas, I read your rant @86 and thought "he's right". (The only thing I'd add is that you underestimated the culpability of the media in fostering the whole anti-vaccination scare -- without the cadre of medically illiterate panic mongers in the British press who took Wakefield seriously, it wouldn't have gotten anything like as much milage.)

It's not just you. Something's gone badly wrong with our elites in the past generation or so.

Kimberly @ #22, I don't know if flu shots are _required_ here in NY, but SteelyKid did get one at her six-month checkup and will be going back for the follow-up one. And Chad and I both got ours, even though he hates needles.

Roxanne -- gotta disagree, in a couple of areas. We *did* hand out smallpox vaccinations to everybody, in my generation. We stopped because smallpox was extinct in the wild, which seems like a decent reason. And at the very minimum, quarantine needs to be a legally enforceable consequence of some diseases.

I actually think the standard vaccination package should be mandatory except for people with real medical reasons not to get them. The value of high vaccination levels is very very high -- and especially high to people with real medical reasons not to get vaccinated themselves. I don't want to work, and wouldn't want to send any children to school, with people who neglected such basic medical precautions.

I was in the age group that wasn't even let come to school without the MMR and a bunch of other shots. Just a bit too young to get the smallpox ones, though - I had a classmate who emigrated from the USSR when I was a kid, and she had the smallpox scar even though she was my age.

I failed to contract chicken pox during exposure as a kid - my dad was exposed to the same sick kids, got chicken pox, and was our primary caregiver. I still didn't catch it.

I've been weighing getting the chickenpox vaccine ever since it came out (they first came out with the vaccine just as I was starting college), and have been putting it off because, frankly, I'm terrified of shingles and it's affecting my judgement.

Is there any connection between rates of health insurance coverage and rates of up-to-date vaccination? Because my vague impression is that there are programs that cover the cost of vaccination for young children but not so much for adults? Lacking health insurance has tended to cause me to just ignore health questions and hope they'll go away - even finding out about things seems tough with no official doctor I can consult.

I'd love to get the flu shot, but it seems I can't since I am not one of the at-risk categories. My office offered it for free to everybody last year, but I got the sack just before that.

On the other hand, I haven't had a cold since I got sacked. Well, I may have one now, but that's because I nursed my poor infirm boyfriend. When I worked in the office, no matter how much I washed my hands, swathed myself in disinfectant gel, and cleaned the keyboard with Dettol, I came down with a virus a month, minimum. If only people would STAY HOME when they are sick, dammit.

As for the media scare, I have just finished reading Flat Earth News by Nick Davies, who lays into the Daily Mail with a vengeance, but has plenty of blame for everybody else, including the system itself.

I can understand some of the anti-vaccination things. For a variety of reasons*, I don't quite trust the chicken pox shot.

It came out when I was about ten, and thus aware that it existed. I had already had it-- brought it home from school when I was seven, my brother had just turned six, and my sister was four. We timed it pretty well, actually, as both my parents are teachers and we were a few days away from Christmas vacation... worst Christmas in memory, or it would be if I had any memory of it. Most of the people I knew had already had chicken pox.
Later, when I was a little more aware, I learned that there was some chance that immunity would decline after ten or fifteen years, leading to an epidemic at college.

I know it's not supported by facts, evidence, logic, anything, anymore. I know that my two weeks or so of nonremembered sickness is worse than a shot and better than hospitalization and death. But, as A Softer World put it, I know a lot of things I don't believe.

Minds are weird. Chances are, I will get any future children vaccinated.

*not least that I apparently want my future kids to have a childhood as similar to mine (or better yet, my dad's) as possible, in spite of the fact that I don't remember a lot of it.

On another subject, what the hell polio? I learned more about the Black Death than about polio. Or measles, mumps, et cetera. In Spanish, we learned the words and then had to complete conversations-- "My ears hurt. _______," was one of them, and none of us knew, "I have the mumps," was the answer because 'mumps' always goes along with 'measles' as in 'diseases no one ever gets, and that are in that one Shel Silverstein poem'.

In college Microbiology, we did two reports on diseases/microbes that caused them. We knew we weren't allowed to take polio-- I think the professor usually had a film to show about it. I did the 1918 flu and something that didn't have an entire book written about it.

As far as I know, smallpox vaccinations stopped before smallpox died in the wild, but after there were more deaths from the vaccinations than the disease.

I caught the usual childhood diseases -- chicken pox and measles -- even though I had been immunized. Both mild cases. When we came to the states I was fourteen and I was given all the shots all at once. It left a quarter-size scar in, of all places, the back of my knee (don't ask me why, that's what the doctor said when I pointed it out).

One of the interesting side effects of the vaccination is that every once in a while I am asked to take medication for tuberculosis or to provide proof of immunization because I carry the antibodies

I was born late enough to miss the polio, but measles screwed me out of a picnic.
Now, can an adult get vaccinated against mumps? I had something when I was 9 but we aren't sure that was mumps.

Charlie @ 91: Yeah, I've got a hate-on for the media culpability in the whole Wakefield business. It's nice that The Sunday Times did an investigation showing that Wakefield was cherry-picking his already-slim data; it would have been even better had The Times not been part of the 2002 braying hordes decrying vaccines.

The entire Wakefield MMR incident makes me want to stab people. If you plot UK measles incidents versus MMR vaccination rates, you can see very nicely how MMR vaccination rates dropped below the CDC's estimated herd immunity rate for measles (83% to 94%, and the UK MMR rate hit 80% in 2003 and has hovered around 85% since).

Jim, this is a great post, and something I'll point people to when they make noises about childhood diseases not being that bad any more.

Another issue I've seen raised with vaccines is that some vaccine lines were derived from cell lines from aborted fetuses.

This usually comes up with respect to the MMR vaccine product usually administered in the US, but there are a few others as well.

How pro-life folks treat this varies. Official statements I've seen from Catholic authorities is that the vaccines are permissible if necessary, but that alternative sources of vaccines should be sought whenever possible. (Among the mitigating factors: the fetuses in question were aborted about 40 years ago, and not for the purpose of using their cell lines, something that was thought of later on; no new fetal tissue is used to make new vaccines; and rubella itself frequently causes miscarriages in infected pregnant women.) Some folks do refuse all abortion-derived vaccines on principle.

There are alternatives available for a number of the vaccines, though I'm not sure that substitutes are easily available for all of them. (For instance, I'm told that in Europe, lines derived solely from animal tissue are more common than they are in the US, though they do carry a somewhat higher risk of allergic reaction.)

What is really driving me nuts with vaccine issues is Merck's decision to stop making the individual measles, mumps and rubella vaccines and only to make the MMR vaccine.

Here is my nightmare story -- my wife and I have always been ok with having our children vaccinated (for many of the reasons already discussed), but I was concerned with giving them three live viruses at the same time (after being born early at 27 weeks, I wasn't taking any chances -- various doctors felt it would be safer for them to get the shots separately). So, we get the mumps shot, wait a few months and get the rubella shot. I then go into the Dr's office and discover that they are out of the Measles vaccine. I call every pharmacy I can thing of -- no luck. There are no more single doses of the measles vaccine to give to them. Did Merck or any doctor provide any warning that this might happen -- nope.

So, my family is forced to deal with the decision of not to get vaccinated for measles at all or wait a while and eventually get the MMR.

What is really driving me nuts with vaccine issues is Merck's decision to stop making the individual measles, mumps and rubella vaccines and only to make the MMR vaccine.

Here is my nightmare story -- my wife and I have always been ok with having our children vaccinated (for many of the reasons already discussed), but I was concerned with giving them three live viruses at the same time (after being born early at 27 weeks, I wasn't taking any chances -- various doctors felt it would be safer for them to get the shots separately). So, we get the mumps shot, wait a few months and get the rubella shot. I then go into the Dr's office and discover that they are out of the Measles vaccine. I call every pharmacy I can thing of -- no luck. There are no more single doses of the measles vaccine to give to them. Did Merck or any doctor provide any warning that this might happen -- nope.

So, my family is forced to deal with the decision of not to get vaccinated for measles at all or wait a while and eventually get the MMR.

Sorry about that -- browser error caused it to post twice. Not sure how to delete the second one...

Charlie@91: Something's gone badly wrong with our elites in the past generation or so.

When I'm in the mood to mount up on my own cranky hobbyhorse and ride, I blame it on the decline of the classic liberal arts education, of the old-fashioned "nothing that you will learn in the course of your studies will be of the slightest possible use to you in after life, save only this, that if you work hard and intelligently you should be able to detect when a man is talking rot" variety.

Magnificent work, Jim, thanks. This goes into my reference file.

Patrick: Since your concern is (quite appropriately) the degradation of authorities, maybe "never trust anyone over 30 credit hours" is the thing?

Smallpox vaccinations: the phase-out in the Northeastern US may have been slightly later than Terry says. I was born in 1970, and have the scar; a friend born in 1971 does also. My brother, born 1972, does not.

I had chicken pox in -- must have been 1988 or 1989. It was summertime and I can't remember if I missed the first or the last week of first grade because of it. I remember seeing the first spot under my arm at daycare, and I remember drawing extra spots on my face with a purple Magic Marker because I got the idea from a book. The vaccine came out just a few years later; I remember being jealous of the kids who were going to get the vaccine and never have to get chickenpox.

It occurs to me that, along with being in probably the last cohort who remembers the World Without Internet, I may also be in the last cohort who considered chickenpox a childhood disease you just had to accept, a rite of passage.

The "This American Life" segment doesn't actually report nothing much happening. At least one infant was in grave danger, as I recall. He survived in the end, but it did not sound like that was a sure thing.

I generally have to leave online debates about vaccination because I get so frustrated and angry that I say things I regret. Generally it's something along the lines of "Do you want to see your child paralyzed because he swam in the wrong pool?" and the conversation goes downhill from there.

The discussion about how people feel betrayed by "the experts" raises excellent points. I'm sure that's where anti-vaccine sentiment comes from. But the ignorance still makes me spitting mad, as unreasonable as that may be. And once that goes away, it makes me determined that we need a good public education campaign.

@47: Hooray for humanity's one total victory in the fight against disease!

One would hope so, but there seems to be a possibility that some has been saved for posterity.

I am amazed at how many of my mom friends, who are otherwise well-educated and well-read, do not vaccinate their children or do so on a schedule that seems sort of pointless to me. Yes, there's a chance of a reaction, but there seems to be a lot of the mindset that these childhood diseases aren't that serious and can be treated now. Yeesh.

I had mumps when I was about 9. I did receive the MMR, but was a one-person outbreak: I don't know of anyone else who got mumps around the same time, even my sisters. It was also a very mild case, as it was only on one side. I was still miserable, and could barely open my mouth to eat -- even pizza was a trial. I've since worked in a hospital and had to have a rubella titer, which was fine.

There are two more vaccines routinely given to children now, too, but are still fairly new: Rotavirus, and Hep A. My 2 year old daughter received the rotavirus vaccine -- which is oral -- but my 4 year old son did not. They have both received Hep A within the last year. My daughter will be receiving the HPV vaccine, period.

I found The Vaccine Book, by Dr. Robert Sears (beloved by the crunchy crowd), to be good. He offers a different schedule, but does generally recommend full vaccination. Hallelujah.

Born 1967. I was ahead of the curve and got many of the childhood diseases before they came up in the vaccination cycle, measles and mumps in particular. I also got chicken pox, but they weren't vaccinating for that yet. Apparently, I caught diseases readily, but overcame them readily as well. I got strep throat two or three times a winter until I was six and they yanked my tonsils.

Once the tonsils were out, my immune system got herculean. I think I've had flu once in my life since then. I don't even catch con-crud.

When I got chicken pox, I had a mild case, but my infant sister got an extremely mild case, something like two pox, not enough to trigger her immunity. When she was seven, she caught it again, and had an epic case. One example is not data, but it convinced me. Let me be clear about that: You do not want your kid to risk catching chicken pox. Get them the vaccination. Get them vaccinated for everything. The only reason anybody is concerned about the risk from getting vaccinated is because they're ignorant of what happens when you don't.

I do not have the smallpox vax scar. I think I was on the leading edge of the period when it was being phased out in the US population.

I got epilepsy from the fever I had during chicken pox! I don't remember the disease itself, other than the amusement of picking off the pox. (There was a really big, gross one behind my ear I could feel but not see.) But I do remember a week later, having my first seizure and freaking the crap out of my mom. A really big petit mal, though several years later I had one, lone grand mal. But grand mals are boring, my really big petit mals would get fun and hallucinogenic. Tom and Jerry were running around my house. For serious.

My grandma had polio in Kansas, and the doctor had no idea what to do about it. There was one other girl with polio at the same time, so he recommended massage therapy for her, and motionlessness for my grandma. The poor other girl was crippled, but my grandma pulled through. Her leg sometimes bothers her to this day, but I never realized how lucky she was until I was older and learned more about polio. I definitely agree with what Diatryma said about modern kids not knowing anything about polio. To me, it was just something random thing my grandma had. I didn't know she was a walking miracle.

My ex-girlfriend (aged 29?) had a smallpox vaccination scar. She was from Romania originally. It was always odd, since the only other scar I'd seen was on my dad.

Additional fun with polio comes in the form of post polio syndrome where, years after recovery, there can be additional muscle weakness and atrophy in muscles that were affected originally and also even in muscles that were not affected originally.

My uncle--now aged about 55 or 60--just had both his knees replaced as a result of PPS.

Surviving a childhood disease doesn't necessarily mean it's over.

I am one of those for whom chicken pox was just one of those childhood diseases that you got and suffered through. In ~1981 when I was five or six, my cousins got chicken pox and my mother brought me and my brother over to play with them in hopes we would catch it too. I remember being very puzzled by this-- I didn't understand why we were allowed to play with my sick cousins, and why my mother wanted us to get sick. After that exposure, I had a very mild case, my brother (2~3 at the time) was much, much sicker.

We had all the other regular immunizations as children. I remember when Hep B immunization became common/required, because I was in college: the first time I started the course of immunization (at the time it was 3 shots spaced out over a period of months), I went back to school before I completed it, so I had to start all over again.

My dad (born 1946) grew up on Long Island, and was in a control group for one of the polio vaccines (Salk maybe?). He remembers being upset at having to get stuck with needles twice-- once for the placebo and once for the real thing.

Now, can an adult get vaccinated against mumps? I had something when I was 9 but we aren't sure that was mumps

Ask your doctor. If necessary, make noises about small children and wanting to be sure you can't expose them and they can't expose you. A responsible doc will then ask about your vaccination schedule, and can test you to see if you need boosters. If they do not do this and act like you shouldn't care, find a new doctor.

I think Patrick has a good point. I think the MMR/autism scare in Britain took off in the way it did at the time it did not because one person lied about some results but quite precisely because the government had lied so much about mad cow disease that nobody trusted anything anybody said, and maverick whistle-blowers seemed more plausibly trustworthy than actual experts.

With diptheria -- in my family it was always called "The diptheria", like "The plague", never "She died of diptheria" but always "She died of the diptheria". (Lots of people in my family died of "the diptheria". I know their names, and that's all I know, because they died before I was born.) Anyone else know this usage? I'm interested in how odd it is.

I'm severely asthmatic, and my doctor apparently sincerely believed that the risk of the booster immunisations you get before going to school was higher than the chance of my getting the illnesses. This was when they were just starting to get modern asthma medicines and before they had inhalers. So I have had measles at five (nearly died) whooping cough at six (nearly died, and I remember it much better than I wish I did) and mumps at seven (not all that bad for me, but my sister nearly died) and I cannot recommend the experience. The number of times I nearly died of asthma and complications of asthma (pneumonia) before I was ten is also startling. They never thought they'd raise me.

Ctrl-D

File under: Ammunition

thx tnh

@ PNH: And some of them are more toxic: explanations that AIDS/HIV isn't real, or isn't transmitted by sexual contact, or can't actually be transmitted between heterosexuals, or was brewed up by secret government laboratories as an attempt at genocide against the black man.

How could anyone sensible believe this stuff?

Maybe because, in the real world, the United States Government was conducting secret medical experiments on unknowing black subjects--experiments in which the subjects were deliberately not told that they were infected with a lethal disease--as recently as 1972?

In other countries too. Google "Dr. Death", "Wouter Basson" and "Project Coast"...

As late as 1993, in Apartheid era South Africa, Basson was the head of a state-sponsored research project into chemical and biological warfare designed to target Blacks.

Patrick:

An interesting question is, how should we (and people in general) be trying to evaluate the claims of various elites in various fields? How can we immunize[1] ourselves from being either spun/lied to by the elites, or from running wild with skepticism when it's inappropriate?

This seems kinda hard. I mean, I try to understand the issues involved in stuff like this. (I find immunology and, more generally, medical blogs and discussions, really interesting.) But a casual layman's interest just isn't going to make me able to independently evaluate medical claims. And most people don't find this stuff that interesting, or don't have the background knowledge of science to understand much of it, or just frankly aren't bright enough to work out much on their own.

A couple generally-useful tools I try to use are:

a. Not getting my information from sources that mostly cater to people like me. A scam or fraud or lie or bit of propoganda is usually based on the knowledge and beliefs of the intended marks. If I'm reading _The Economist_ or listening to NPR, I'm in the target market--scams and lies will be pitched at people very much like me in background and education and experiences, and to some extent in beliefs. If I'm reading El Pais or listening to the BBC, I'm a little further from their target market. Many of the lies and spin attempts and such will be a bit less well tuned to me. What's more, a big PR/propoganda campaign will often be spread out over many different media sources, and by consuming several different ones, you can sometimes notice the slightly different spin used in different news sources.

b. Trying to evaluate claims based on outside evidence. Greg Cochran is often quoted as using the question "how would the world look different if this were true" as a starting point here. A lot of lies and fraud fall apart as soon as you do some quick back-of-the-envelope calculations and get an outrageous result. A lot more fall apart when you start asking "how do they know?" about some claimed information. Still more quickly run into fundamental problems with basic science (homeopathic remedies apparently use enough dilution that it is extremely unlikely that even a single molecule of the original medicine ends up in the treatment) or realistic behavior of people in large organizations (like leak-proof 10,000-person conspiracies run with no paper trail or office space).

c. When looking at academic research, I try to take into account the extent to which the field is grounded in either practice or experiment. Thus, I have *way* more confidence in the claims of vaccine safety (which is tested with randomized trials and can also be followed up observationally) than in the claims of global warming models (which are basically built on massive computer simulations, using the best available understanding of the underlying processes)[2]. I have much more confidence in the ability of intelligence tests to predict academic and work success (this is what they're designed for and used for in practice) than in their ability to predict other incidental stuff like criminal tendencies or rate of illegitimacy (which various researchers have noticed observationally). And so on.

d. Probably most importantly, I really try to force myself to consider alternative views, to question my own assumptions about the world. It's too damned easy to build yourself a little fact-proof cocoon, into which contradictory facts simply never are allowed to stray, around some incorrect and basically stupid belief.

I'm curious what other people do to avoid either being too quick to believe or too quick to reject statements.
[1] *ahem*

[2] To clarify, I'm not claiming global warming isn't happening (that's not really debatable) or that it's not human caused (that seems to be the best available explanation). I'm saying I have very little faith in any kind of precise predictions from the existing models, along the lines of "if we modify our CO2 output by X amount, we will see Y amount of average global temperature change in the next century."

speaking of immune systems:

Fragano @63: My theory about calamine lotion is that painting it over what itches makes it so disgusting to scratch that it acts as a deterrent, which helps break the itch/scratch cycle. I agree that it has little function in and of itself in reducing itching. One of the great advances in my camp-attending life was non-calamine-based itch reducers for mosquito bites, that actually worked somewhat.

By the way, a recent episode of Private Practice dealt with this issue. A mother refuse to have her other children immunized after the older one developed autism shortly after his MMR -- and she was sure it was related.

The middle child developed measles (which took a while for the pediatrician to recognize, since I don't think he'd ever seen a real-life case before, and everyone in the clinic had been exposed by then), and everything went pear-shaped, with the child eventually dying. (PSA: Measles can kill.) The doctor on the show forciby vaccinated the youngest child over the mother's protests, just after the middle child died.

If I may request a clarification: I keep seeing variations on the phrase "people who have had chicken pox in their youth can get shingles later." Is there some difference in shingles statistics for those who get chicken pox as adults? I suspect not, but I figured I'd ask. I got the chicken pox during the February of my sophomore year in college. Just as it cleared up, I got the flu. And then I got pink eye. Yeah, that was a fun month.

Anyway, having seen my stepmother go a few rounds with shingles, I'm a little neurotic about the possibility of having to do that myself.

No statistics in my quick google-search, Andrew, but the CDC says there is a vaccine for shingles. It's approved and recommended for people over the age of 60 at present, and is new as for 2008.

Comments 100 and 101 are related--the individual measles and mumps vaccines, which Merck just stopped offering, are preferred by the pro-life contingent John Mark Ockerbloom mentions because the only rubella vaccine approved for US use has fetal tissue origins. Now, whatever most Making Light reader might think of the ethical reasoning involved in rejecting fetal-tissue-cultured vaccines, I think most people can agree that it is in all our interest for those parents to get their children immunized, and that the best way to accomplish that short of legal mandates is to keep the vaccines they find acceptable on the market. (It would also be a good idea to let them have the animal-tissue-based rubella vaccine now available in Japan, unless there are serious reasons why not.)

Merck's choice to make the MMR the only way to get vaccinated for measles, mumps, or rubella in the US is also not good for the few people who have legitimate medical contraindications to one of the components but not the others. And it may mean some of the parents who are, however irrationally, still worried about the alleged MMR-autism link won't get their kids vaccinated for any of the three diseases, whereas some now do so individually. What's easier, making those people see reason or giving them individual shots? Serving the public health involves considering how real human beings actually act, not just how perfectly rational beings would act after having things explained to them. This includes accommodating people's irrational preferences, where possible, especially when they are willing to bear any added cost. Apparently the single shots are not profitable for Merck, and the public health advantages to keeping them available don't matter.

[For the record, I am the same person who used to post here as S. Dawson, occasionally, a while ago.]

The number of times I nearly died of asthma and complications of asthma (pneumonia) before I was ten is also startling.

Not really. Asthma is *nasty*. Pre-inhalers also means pre-maintenance medications *and* pre-widespread effective antibiotics. Also pre-cheap peak flow meters. Not sure when adrenalin shots came into wide use, but before 1975 or so, dying of asthma was a serious risk and the treatments available were terrible.

I'm just lucky. I'm allergic to albuterol, so if I'd been born severe instead of ridiculously mild, odds are good I'd be dead. Instead I just would get a round of pneumonia or bronchitis every year, like clockwork. Antibiotics change both from dreadful to "eh, you might as well go to school" if it's caught early thanks to a peak flow meter.

abi @ 81

It's a delicate way to avoid making, well, assumptions that might damage maternal health.

How very tactful! Not what I would expect from the run-of-the-mill doctor here in the US. At least the ones who seem to get their bedside manner from watching doctors on television*.

* TV Doctor: "Ah, Ms. Jones, about your partner ..."

- long pause while Jones figures out her partner is dead, and the doctor stares at the ceiling so as not to have to say anything -

Jones: (bursts into tears) - "No! She just came in for a flu shot!"

Doctor: (mutters something theoretically exculpatory and runs off to do rounds)

Thanks for this.

My son recently had chicken pox. It wasn't fun, but because he had been immunized it was a mild case and not a big deal. He is 10. Why do I even mention this? My son also has a serious blood disorder, if he had gotten a full blown case of the chicken pox things might have been, in fact likely would have been a lot more serious.

If enough people stop immunizing their children we will not only see more infant and childhood mortality, but adults like myself with serious health issues will be further at risk.

Anyway, thanks again for writing this.

I wonder if the reaction against immunizations is nature's way of culling over-population, as the diseases do in the first place?

And thanks for the mention of the naval document: my last father-in-law was a chief gunner's mate in the Pacific and I'll have to look up a copy of this in his memory.

@Patrick in #86, from Jane Jacobs wiki:
Dark Age Ahead

"Published in 2004 by Random House, in Dark Age Ahead Jacobs argued that “North American” civilization showed signs of spiral of decline comparable to the collapse of the Roman empire. Her thesis focused on “five pillars of our culture that we depend on to stand firm,” which can be summarized as the nuclear family (but also community), education, science, representational government and taxes, and corporate and professional accountability. As the title suggests, her outlook was far more pessimistic than in her previous books. However, in the conclusion she admitted that, “At a given time it is hard to tell whether forces of cultural life or death are in the ascendancy. Is suburban sprawl, with its murders of communities and wastes of land, time, and energy, a sign of decay? Or is rising interest in means of overcoming sprawl a sign of vigor and adaptability in North American culture? Arguably, either could turn out to be true.”

Measles (rubeola), 1957
Chickenpox, 1958
Mumps, 1959

You really don't want them. (Rubella - I don't know.)
(Yes, my mother did keep records, not only of the shots, but also the diseases we got. I have the page for me.)

Jim, you're a mensch. Really. Some useful anecdotes.

One of my aunts had a mild case of rubella back in the late 40s, when she was pregnant. Lost the child, and the ability to have any more children. Fifty years later this is still a heartbreaker for her.

A friend's sister died of tetanus in the 60s--her mother had gone on an anti-vaccination kick a year or two before; then, when the family was overseas for a year, the daughter got sick and (tetanus being comparatively rare, and the mother's French being comparatively not good) it took a longer-than-should-have-been time to get diagnosed, by which time the sickness was entrenched. The girl died. You can bet that my friend got every vaccine known to man after that.

Last summer my fully vaccinated daughter got whooping cough at her summer camp. Only she and one other girl (the source of the infection) got it; they were quarrantined, treated, and returned to the general pop. The case was quite mild, thank God, but as Bec says, "that was some cough."

It seems to me that people who don't vaccinate either have no grasp at all of history, or that weird privileged point of view that allows them to believe that they are too clean, too healthy, too rich, too something to be infected. Too bad the microbes don't get that email.

Beth Friedman #120: You may be right. It's been decades since my mother slathered the stuff on me to stop me scratching when I had chicken pox.

Re Rh, a diversion from the thread:

The specific thing that the doctors were not assuming is that knowing my partner's blood type permitted them to do a risk assessment on the baby I was carrying.

In other words, if my husband were Rh- * (he's not), and they knew that, they might treat my pregnancy as low-risk. Now, if I had been living a more complex life than I was admitting to (I wasn't), this assumption could lead to Bad Things.

It is easier, and more politic, not to test the partners of pregnant women. This is apparently an NHS policy decision rather than an individual doctor's call.

They also didn't volunteer the kids' blood types when they told me they were Rh+. We asked, and got the answers. Turns out we're a neat little case study in blood types here at Chez Sutherland.

</digression>
-----
* The problem arises when the mother is Rh- and the baby is Rh+. The first Rh+ baby can sensitize the maternal immune system, so that any subsequent Rh+ babies are treated as invaders. This is generally very bad for the baby, and no great shakes for the mother either.

Rh+ is the dominant trait, too, so if the father is Rh+ the chances are that the baby will be as well.

My older sister got chickenpox three times; the rest of us kids got it once, all at the same time, and I still remember that my brother, the oldest of us, got a really peculiar version with discolored rings around the pox marks and a funny smell. (As in "the rest of us kids refused to sit near him at the dinner table." It was awful.) I still wonder whether that was just an odd set of symptoms, or something else entirely.

But what I remember most about the whole affair is that because of it, we had to cancel a planned family trip to spend a week in the jungle with one of the native tribes there, only accessible by plane. I still remember my mother explaining to me--I was young enough that I thought this was a horrible betrayal of trust, to have to cancel a vacation we'd looked forward to so much--that while we might be uncomfortable with the chickenpox, it could kill the people in this village if any of the adults caught it, especially so far from a hospital.

I never knew anyone in my age group who died of a disease that could be immunized against, but I still remember that weird queasy sense of shock as my mother explained to me that we could be responsible for the deaths of other people just by getting too close to them when sick. Somehow, I do not see myself objecting to having my kids immunized whenever I get around to having children.

In addition to Albatross' post at #118, http://chronicle.com/free/v49/i21/21b02001.htm

Its an oldy, but a goody. And I wonder how Wakefield's stuff stands up against it?

My family remembers polio, since my uncle was one of the last people in his area to get it, pre-vaccination. He walks with a bit of a limp, but otherwise is in pretty good shape.

On the other hand, my father almost died because of adverse vaccine reactions. They gave him three in one day (he says polio, smallpox, and tetanus) and he was in the hospital from the interreaction. Not like that combination is ever likely to happen again, but it did mean that my vaccine schedule was significantly altered to never give me two at once.

The chicken pox vaccine came out while I was in elementary school, but most of us had already had it by that point, thanks to a school-wide outbreak about two years before. It's now on the district's mandatory list. That's a really long, nice list. I was the year prior to them requiring Hep A & B shots, but my Gyn recommended it to me in college, along with the menichocal meningitis vaccine. When I get insurance again, I'm hoping to get the HPV shots. "Female" cancers run in my family, and I need to do what I can.

I got all sorts of interesting shots in my early teens, since my mom and I were planning on going to Peru. I should look and see what those were, and if any need boosters. I'm pretty sure TB was on that list.

I really don't understand the people who don't get their children vaccinated. Herd immunity is so important, as is making sure your kids don't get sick and die. As a historian, I am well aware of the mortality rates that are involved in the pre-vaccine era. A child wasn't really real until they were 6 - it was too likely they weren't going to make it. Even looking at my own family tree, I can see the epidemics running through. We've got several instances in the extended set where we lost 4 or 5 among farm-family cousins in a period of weeks in the early part of this century. I don't want to go back to that. We're already dealing with low birth rates among the populations that *can* get vaccinated and over-population among those who can't. The consequences in overcrowding if everyone went back to having the large numbers of kids just so some would survive...

There can be a cooling effect from any liquid put on an itchy rash, as I learned from my yearly poison-ivy case as a child (in one case, covering pretty much everything, head to toe). It can help, though not nearly enough.
#53: I seem to remember reading that in adults, whooping cough does not necessarily produce the characteristic whooping sound - that it is somewhat milder in adults than in children.
German measles was a murder motive in at least one classic mystery novel.
I wish I could find the book "The Horse and Buggy Doctor", which fell apart - I suspect pages have been lost, and the main part of the book is in two sections. It's a doctor's memoir, and the beginning describes a diphtheria epidemic when he was a child. One family lost something like ten out of eleven children, the last child being carried everywhere by her mother, who couldn't bear to put her down.

This is a wonderful post, but it's making me feel very old.

Smallpox scar from mid-fifties. Second smallpox vaccination in 1970, required to travel to Europe.

Measles as a child. The dim room, the fever, the hypersensitive hearing and vision, the rash. I was one sick five-year-old. A cowbell by my side to call my mother.

Chickenpox at 42. All praise to acyclovir, but I itched for weeks, infected lesions, fever. Aloe vera baths.

My smart parents vaccinated me against everything they could. I too had friends with polio.

I'm up to date now, you bet. Considering shingles vaccine, offered now at the hospital where I work.

I too feel like a cranky old woman when I hear ordinarily reasonable people spewing anti-vac gibberish, and tell them in clear terms how they are wrong. Even friends who won't get their flu shots. Have they ever had the flu? I have. Hope I am never that sick again.

Grumpy grump grump. Fools.

One of the problems with universal vaccination is that, if it's working correctly and as intended, eventually the number of accidental adverse reactions to the vaccine will be larger than the number of bad outcomes due to the disease itself.

(Speaking of quarantines: At times during polio outbreaks, right in New York City, you had to have a special permit in order to travel across the city.)

Another aphorism, more or less on-topic: The rare effects of common diseases are more common than the common effects of rare diseases.

(I'm sticking with five years on tetanus because that's the ED standard. Of course, the folks around here who get wounds seen in the ED are generally from farming accidents, logging accidents, and moose collisions. Tetanus is a nasty disease, and the microbe is everywhere.)

I'm going to testify from the olden days, here, when one could be vaccinated for pertussis, tetanus, and diptheria, and, just barely, polio, but not the rest:

I had measles and was sick for two weeks, including a wonderful period where the doctor spoke to my mother outside the blanket-hung enclosure over my temporary bed in the living room and said that if my temperature didn't come down I might die (what every second-grader needs to hear). I have minor hearing and visual damage from that disease; a neurologist I've spoken to says there's a good possibility that severity of my ADHD and learning disabilities was probably exacerbated by measles.

I came down with mumps on Girl Scout Sunday when I read the gospel in three protestant churches. I really hope no males over the age of puberty were exposed that day.

My sister caught rubella when she was in first grade; even though we shared a bed, I never caught it. These things happen.

My sister and I caught chicken pox the spring after I had measles; I was terribly sick and got pneumonia as a complication. My sister had a few itchy lesions and a low temperature. Too bad the seven or eight lesions on her face turned into big brown moles that she's worn for nearly fifty years now. Her husband didn't have chickenpox as a child. The year my kids got it we kept them away from the house for five weeks. A month later a woman brought her car in to the shop where he worked with four little kids with chickenpox in the back seat.

A year later I got a blackberry thorn in my heel, and ended up with shingles. I've had several outbreaks since, and now have post-shingles neuropathy on my upper back, which sucks more than I can express.

And then there was the winter of 1978, when I was a student at WSU. The whole university was taken down by the flu that year; at one point both radio stations went off the air. Pullman is an isolated community, where almost everyone is a student or works at the University; there were, then, only three grocery stores; it was like being in a model for epidemic transmission.

Why yes, my children are vaccinated. And we still caught whooping cough the year that it was discovered a booster was needed for that disease.

I was born in 1963. I have a smallpox vaccine scar; my younger brother and my husband, both born on the same day in 1965, do not. I remember lining up in school for measles and mumps vaccines. There were no doubts about getting vaccinated. My mother, who had gone through all these diseases with my older (by seven and eight years) brothers, was very happy that she didn't have to worry about her younger two kids.

I finally got chicken pox about ten years ago. I had high fever and pox *everywhere* - and I had lung involvement. I wasn't hospitalized because Valtrex had been recently put on the market, and my doctor decided I could stay home. My husband, who also had never had the disease, turned out to be immune anyway. He was given the anti-viral as well, until that was determined.

Meanwhile, my younger brother had been trying to convince my mother that he'd actually had it himself - they wouldn't give his son the chicken pox vaccine unless my brother could show he was immune - it was a live vaccine and dangerous to non-immune adults. The other alternative was to give him a series of dead vaccine shots first, and he hates shots.

I got sick, proving he'd never had it, either. He got the shots, and my nephew was vaccinated properly.

I now live in dread of shingles.

Before I get the flames, let me state that I firmly believe in vaccinations. I had mumps and chicken-pox as a child and possibly measles, too...I can't remember, and while I've suffered no lasting ill-effects from either, I really wish I hadn't had to go through either disease. My grandfather, who was born in 1900, had mumps at about age 17 while he was in rigorous cavalry training, in the saddle, day in and day out...the mumps "went down" as they used to say, and he ended up losing one testicle because of it...another really good reason to get the MMR.

About the flame thing, though, I have a co-worker who has fraternal twin boys, about 4 1/2 now. They were big babies, delivered by C-section and healthy...until about two weeks. After one round of vaccines, she noticed a definite change in the personality of one twin...and trust me, T**** is someone who KNOWS her kids, it wasn't something she just then noticed. Now that child is austistic and developmentally delayed physically--but incredibly smart and advanced mentally. I don't know which vaccine is in question, but both T**** and her son's doctor are pretty convinced that it was at least a partial cause. She's an extremely intelligent, devoted mother and not an alarmist; and, given the other twin is fine...makes you kind of wonder. (And no, I do not think autism is caused by some "mistake" made by the mother, nor by genetics. I've personally known three women now who've had autistic children and all three of them were careful during pregnancy and devoted moms. One was a single birth (fairly severe autism), the other two had fraternal twins--the one I mention above--the other had a boy and a girl both of whom are autistic. The one thing the two sets of twins have in common are older than "average" fathers; all three mothers were in their early-to-mid 30s.)

I do not believe for a second that we should let up on vaccines, but perhaps they'll develop a screen for certain factors, or learn which of them can be delayed just a bit longer until babies' systems are more developed? Medicine is as imperfect a science as any other, after all.

Oh goody, can I join in?
From the small book "Battle for Health", written for "The new democracy" in 1944. It uses photographs and up date brand spanking new graphical representation techniques that look rather like modern ones, to present the importance of social health and the fight against disease etc, and as importantly, the part you as a citizen of this democratic country of ours can play.

Typhoid fever in England and Wales.
1930, 2,952 cases, 313 deaths. By 1942, it was down to 858 cases and 89 deaths.

Small pox in England and Wales:
1911- 295 cases, 7.8% died.Increased in the 20's to 1927, 14,767 cases with 0.3% of deaths.
HOwever, interestingly enough back in the 19th century, in 1853, the vaccination of infants against smallpox was made compulsory. But "this was violently opposed by a vocal minority, and in 1898 a conscience clause was introdiced."
Therefore by 1939 only 34% of children were vaccinated.

It seems that the only reason Smallpox was apparently under control by the 30's, when cases dropped to 179 with only a couple of deaths, was because it took a couple of weeks for the disease to manifest itself, but if you were vaccinated your body started to show some resistance after only 5 days or so, therefore incipient epidemics could be nipped in the bud and threatened people saved by vaccinating them.

Doesn't this all seem familiar? Humans can be pretty damn stupid, can't they?

Diptheria, England and Wales:
1911- 1929 yearly average was 51,757 cases, 5,058 deaths. By 1942 it was down to 41,404 cases and 1826 deaths.
Diptheria uses to be a major and well known killer of children, yet the first I heard of it was in reading Axel Munthes book "The story of San Michele".

There is a table headed "Reasons for not having children immunised" (for Diptheria)

Good reasons (child ill, has had diptheria, going to be done)- 32%
Willing, but not sure how to act- 16%
Inadequate facilities - 1%
Apathy - 24%
Prejudice of one or other parent - 14%
False beliefs about immunisation (will not protect, will harm child, child too young, child too healthy) - 16%

So again, we see that despite another 60 years of education and experience, modern people can be just as stupid and badly informed as their ancestors.

takuan, #29: That would certainly be nice, but I didn't see specific mention of it in the linked article.

Niall, #30: The HPV vaccine flap over here is worse. Parents are refusing to have their daughters vaccinated because "it might encourage them to have sex". No, I'm not kidding. I guess they believe that death from cervical cancer is an appropriate punishment for having sex in ways that aren't ideologically approved.

takuan, #32: Where in the article does it say anything about "covert", or adding it to "your local supply" (of what?) Your statement doesn't make sense as written, especially since it's clearly stated that the process is still in the very early stages of testing and may not even work.

Roxanne, #36: Go back and read the main post again, in detail this time instead of just focusing on a few keywords, and follow all the links. Not vaccinating is gambling with the lives of everyone who comes in contact with you, and completely morally indefensible (barring medical issues such as allergies).

albatross, #118: WRT (a), I just wish something could get that across to the Faux News crowd.

CvH, #122: Thanks, I'll keep an eye on that. By the time I reach the targeted age group, the beta-testing phase should be done.

Paul, #127: If the anti-immunization types were the only ones dying, I'd be tempted to agree with you. The problem is that, like drunk drivers, they tend to take innocents with them.

Huh, that's interesting. I just took a close look at the outside of my left upper arm (something I don't do frequently), and my smallpox vaccination mark is so faded it's nearly gone. Just a slightly lighter patch of skin that I might not have noticed if I hadn't known exactly where to look. My partner's is much more visible.

Anyone know where I can find a copy of OP 1014? Google comes up with lots and lots of references to it but I can't find the text anywhere, and the Government Printing Office website doesn't seem to have a copy available, nor do Amazon or abebooks.com

As far as smallpox vaccine goes, I (born 1968) have a scar on my arm; my brother (born 1971) doesn't. It is a wonder and a terror to know that you're the last generation for that vaccine.

(And of course you have to read Leslie Fish's take on it.)

In 5th grade I became friends with a girl from Vietnam who'd had polio when she was about five. Her hip and leg on one side were affected, and while she could walk, it was with a severe limp due to a 3" difference in the length of her legs. She could do the splits without any kind of warm up--the affected hip was hyperflexible in odd ways.

She spent a month during 7th grade in the Shriner's hospital while they stretched her leg, by breaking the bone, then using a metal brace to spread the break while it regrew. Every morning they came around and turned the screws a tiny bit. It must have been excruciating.

Maybe I should stop in and get that tetanus booster I've been procrastinating on today. I'm glad I finally did the flu shot this year. Being sick, even the "mild" sorts, is no fun.

Apropos chicken pox, as it was explained to me by the nice doctors treating my husband as @46, it's one of those viruses that comes as a spectrum, from very mild forms, like my two-pox godson had, to the very severe, which was at epidemic* levels round here when husband caught it.

This is how folk can catch it twice or more - being exposed to a sufficiently different variant that their existing antibodies don't clobber.

And why the NHS don't vaccinate apparently - the cost/complexity of immunisation against all the likely variants would be prohibitive.

*as in, the local authorities were considering closing schools. It was bad. You couldn't put a finger on any of my family and not touch a spot. Large areas of junior son were raw coz there was no unaffected skin between spots. They had it in their ears, their eyes, under toe and fingernails, palms of hands, soles of feet...

Thankfully I'd had a medium-severe case as a kid and didn't succumb a second time. Collapsed with exhaustion and flu* after ten weeks of intensive nursing them all through that and the subsequent complications, mind you.

*the real can't-get-out-of-bed, delirious-with-fever kind.

Dear Lee: that is what I call "looking ahead".

And speaking of looking ahead, the northern range of many bird species in North America has increased sharply as of late. Which makes me wonder: what other organisms are on the move? Will we see malaria in the southern United States soon? Some things can be immunized against, others not yet, but the basic game IS changing.

How about Chagas Disease? I've been recently reading of a Venezuelan scientist's battle in this area. (I'm hoping he'll actually drop by here soon - you listening Guido-Davd?) Like most things in Central and South America, his work suffers for lack of funding and interest. Do you suppose the possibility of Chagas traveling north will spark some timely interest now? Maybe some support even?

paul @ 127:

I wonder if the reaction against immunizations is nature's way of culling over-population, as the diseases do in the first place?

My first reaction to this question was probably not fit for posting here. On further reflection, I realize it's not saying what I thought it was saying at first. If you're curious, the answer to your question is no.

I'm reading this question as wondering whether nature is making people decide that vaccinations are bad. Nature is not some anthromorphic personification that decides to make people stupid to cull the herd, it's an emergent property of the interactions of organisms. All that noble stuff about the great circle of life, like how wolves only eat the sick and keep the caribou healthy is bullshit. Diseases don't stop over-population as some goal, they just are. That they happen to spread well when population density is high is irrelevant.

People are subject to evolution, the same as all the other organisms on the planet, but we have intelligence and the ability to make our lives better. Survival of the fittest is not proscriptive, it's descriptive. We can, and have, changed that, and many of us here want to make not only our lives better, but everyone's lives better.

The reason for the vaccine backlash is not because nature is making people stupid, it's because people have been scared by stories that may seem plausible at first glance peddled by denialists and media outlets interested in sales, then propogated by well-meaning but fearful people who don't know the facts.

This portion of your post set me off because online I've often seen people who seem to believe in being tough guys who survive, and that all the stupid people should die off (as well as the toxic notion that stupid people breed stupid people, as if intelligence were solely genetic). I have to admit to laughing at stories like the person who fell out of the tree because he was sitting on the branch hes was cutting off, so I'm not completely innocent in that regard. However, everyone makes mistakes, and there are plenty of people who have had things just happen to them that they didn't deserve. Children are dependent on their parents for survival. The parents have probably been vaccinated and don't necessarily know what those illnesses were like (I certainly don't know, and I hope I never do).

If it were only the parents making fully-informed but in the end stupid choices, and the parents were the ones to suffer the consequences, I would have no problem with that. It's their children who have done nothing wrong who face the consequenses of their parents' actions. It's other people for whom the vaccinations didn't quite work or who couldn't have the vaccinations for medical reasons who face the consequences. The parents can't even make fully-informed decisions when their thoughts have been poisoned by anti-vaccination cranks.

I don't think you deserve having this massive screed dumped on you, but I've seen enough crap online that it kind of set me off. Sorry.

I had chicken pox, measles, German measles, etc during childhood - but not mumps. And none of my siblings ever had mumps. Neither of my parents ever had mumps. No shots for any of us. Should I be worried?

murfnik @141:

A diagnosis of autism, and autism-like disorders, is rather like a diagnosis of fever. It's a label on a set of symptoms, rather than a description of causes. And the symptoms aren't consistent from person to person, probably because there are multiple complex causes.

You say you don't think autism is genetic. Sorry, but unless you have some knowledge you'd like to bring to the table, I'm afraid your opinion isn't really that helpful. Some families have a lot of autism, neatly traceable through the generations*. Other times, autism does turn up in a family that's never had it before. But that's not to say it doesn't have a genetic component. The best we can say is that we don't know.

Likewise, some forms of autism are clear from birth, but others turn up later.

The fact that autism is a "bucket diagnosis" is the reason that we use large-population studies, such as the ones that have disproven Wakefield. Because we're dealing with a vague diagnosis of a messy and complex problem, we can't point to a single case and find a clear and unambiguous cause.

There is both autism and Asperger's Syndrome in my family. I know how difficult it is to deal with these things. And both my kids got the MMR.

-----
* My family runs strongly to Asperger's Syndrome, though my grandfather's immunizations were different than my father's, my brother's, my nephew's (and, for that matter, mine.)

Can we all sing together in four part harmony "Correlation doesn't equal causation" for doctors who tell their patients that vaccines might just maybe sometimes cause autism? And remember that few doctors are as general and comprehensive in their journal reading as we as patients would wish them to be?

In any case:

Debra Doyle @104, I myself think that rigorous thinking went out of the world when people stopped being taught to make sentence diagrams. I say this even though I know that bad grammarians are set to diagram some of my sentences in Hell.

Ginger @65, Mr. MacDonald et seq: put me into the short-cycle tetanus booster group. The large animal vets I know are on 5 year vaccine schedules. I live on an old farm and have scars on both hands from disentangling newborn calves from barbed wire (we vaccinate for a whole set of Clostridia before 48 hours); the whole place was fertilized with composted horse manure for years. And I've had the post-injury vaccine. It hurts like a son of a bitch.

murfnik @ 141:

I'm not going to flame you, but I am going to point out that people are led to believe that the two are related because the first symptoms of autism tend to manifest around the same time as the MMR vaccine is administered. It's an accident of timing, but human beings are remarkable at generating patterns and correlations where they manifestly do not exist. The entire game of craps is built around this, for example.

That said, your post sounds an awful lot like the usual food for thought posts from a lot of sthealth cranks and denialists. "I think vaccines are great, but [goes on to say why vaccines aren't great]." "I think that global warming is probably real, but [goes on to say why global warming isn't real and/or isn't caused by people]." I'm not saying that you're doing that, but it can sound as if you are.

The fact is that we know that vaccines don't cause autism. We also have become better at both diagnosing autism as autism instead of something else (even if autism is still a vague category), and admitting that it is a medical condition.

KeithS #148: Nature is [...] an emergent property of the interactions of organisms.

I like that definition.

There have been anti-vaccination cranks since Jenner's day.

(The process of inoculation: Deliberately infecting yourself from someone who has a mild case, had been around for centuries before Jenner, and is the basis for the various "measles parties" and such that we still see today.)

One of the reasons that flu is so nasty is this: The immune system creates antibodies that are tuned to specific protein shapes. But flu's nature involves constantly-changing shapes for its protein shell. Each year's flu vaccine is our best guess for what this year's primary shape will be ... and it could be entirely wrong.

See also the Flu Pre-pack post here.

@ JESR: Can we all sing together in four part harmony "Correlation doesn't equal causation" for doctors who tell their patients that vaccines might just maybe sometimes cause autism?

I delurk to say that this is my favourite image of today, and thank you for it.

(My family participated in a study on the genetics of autism, due to our high incidence, run in part by the BC Children's Hospital. The results are only just starting to come out, and will be for ages.)

ledasmom@136: http://www.amazon.com/Horse-Buggy-Doctor-Bison-Book/dp/0803257171

JESR @151

With, perhaps, a rousing refrain of "Post hoc don't equal propter hoc"?

This is a tangent, a question for the veterinarians of the Fluorosphere:

Eight to ten years ago, our vet stopped giving the cats vaccinations every year and switched to giving them every 3 years. Prior to that change we had lost five cats to cancer, and each of them died before they were 12 years old.

Since that time, the kitties who have passed away (at 17+ years of age!) succumbed to CRF. Our youngest living cat is 13, the oldest will be 18 this year.

My question: Which vaccine was causing the cancers in the kitties -- or was it frequency of vaccination that was the cause?

@ several commenters above who ask why people insist on coming to work when their sick.

This boggles my mind, as well. I work in an office environment at a University. We're given a ridiculous number of paid sick days, none of our work is that important that any of us would be missed for a few days, and yet co-workers still come in while feverish and then brag about it.

I and another co-worker (who's pregnant and extra pissed that these people are endangering her without reason) have tried to drop hints but they just aren't getting through.

Why? I ask. Is it just because it makes them feel like martyrs? I just don't get it.

Suzanne @159:
why people insist on coming to work when their sick

I can think of two reasons:

1. It's all too easy to feel that your work at this particular moment is too important to delay for a day or two. Sometimes it's self-importance, or the desire to be important. Sometimes it's just being too close to the work to judge its overall impact fairly.

2. Speaking personally, I despise malingering. I don't tend to doubt other people's illnesses, but I can easily convince myself that I'm just being a wuss wanting to stay home.

This is less of a problem now that my commute involves physical exertion. If I'm really sick, I know it within a few blocks and turn back. If I can make the whole ride to work, I'm not very sick. I may get worse during the day, but that's a different scenario than coming in already ill.

albatross@118,

Patrick's rant about the elites reminds me of Strauss and Howe's The Fourth Turning and my reaction to it, which is that our current Unraveling is characterized by revolutionary changes in the way expertise comes to be recognized and the way information comes to be regarded as authoritative. The skills needed for developing actionable intelligence are becoming more useful, and even necessary for lifestyle management, to a broader subset of the population.

In short, we're all having to learn about Philip Armour's Five Orders Of Ignorance [PDF].

It shouldn't be a surprise that our current generation of elites are ill-prepared to retain their status as authoritative sources of knowledge and wisdom. They came of age in a world where an essentially oligopsonistic* broadcast media industry ensured that only the elite classes really needed to develop the skills of intelligence acquisition and analysis. Everybody else got the fully baked authoritative information delivered by elaborate systems of indoctrination and advertising.

Now, all that's unraveling, and the way people achieve and maintain their status as experts is in the middle of a chaotic upheaval. In fact, I'd say we're either on the cusp of a Crisis, or a Crisis has already begun. (I lean toward the former.) On the other side of that Crisis, we hope there will be stable and well-understood methods for recognizing expertise wherever it arises.

In Philip Armour's terms, we hope for a general reduction in 3rd Order Ignorance throughout society.

To answer albatross's question, the first thing to do is to recognize that it isn't enough that each one of us develop a "suitably efficient" process for figuring out what we need to know; we need everyone to have better such processes. As I've said to my friends for years, "We're all spooks now." (When my friends say, "But I don't want to be a spook," I usually just lie to them and say, "Well, the good news is this: we're all on the same side," and I hope they believe me.)

* It was an oligopsony, in my view, because there was really a small number of buyers for the attentions of non-experts.

Cases that were surely Aspberger's or autism had been described long before MMR immunization was invented.

Lori @ 158: Most feline cancers are not related to the vaccines, although there is one that seems to be correlated (and as above, correlation does not equal causation). The correlation comes from the anatomic location of the vaccine and the later appearance of the sarcoma. The AVMA has some information on the subject.

I've lost several cats to different cancers; none of my cats have lived longer than 15 years, although I currently have two females who are 15 now. (Keeping my fingers crossed!) Back in the old days, any cat who was greater than 7 years was an old cat, so we've improved their lives -- and added cancer to their repertoire, so to speak.

Personally, I stopped doing multiple vaccines years ago, because my cats are all strictly indoors. Once they're through the kitten regimen, they get the required rabies booster, and if they need something else, I'd do it then.

Abi @ 150—perhaps I didn’t make myself clear on “genetic”: I meant genetic damage, per se, not necessarily congenital. Asperger’s (and even other types of autism) has been widely misdiagnosed in the past as many other things, to include retardation and ADHD. But there’s also room for the theory that there could be different causes for different types (as I think you’re saying).

KeithS @151—it is food for thought, but it’s not a reason why vaccines are bad (and to clarify, I personally do not believe they are bad—I’ve had them, both my kids have had them and I would not change that given the opportunity to do it again). Overall vaccines are good—there are reasons they aren’t but have nothing to do with the autism theory (most have to do with individual deadly allergic reactions…but that could happen with peanuts, shellfish or any number of other things the majority of us take for granted). I’m not really saying one thing with one side of my mouth and something else with the other; it’s really more that some of the people who have this belief have it for a reason that's valid to *them*.

Thanks for the info on when autism generally shows up…although that wasn’t the case with the other set of twins; theirs did not surface until their parents noticed they weren’t retaining language (one-ish, I think?). I’m not sure we can, at this stage, categorically say that vaccines don’t cause some form or forms of autism, given the wide-spectrum we’re talking about. Admitting it’s a medical condition does not preclude being caused by any number of factors, from genetics to using hair dye…just an example, not saying that’s a cause, mind you. ;) At best, the jury’s still out on all accounts. You might not be old enough to remember when doctors used to tell people to start smoking…for their health; research improves and theories change. The idea that cigarettes caused lung cancer was a crack-pot theory as late as the 50s.

Suzanne @ 159—I, too, work at a major University and wonder just why in heck people would have so little regard for their co-workers. Even my boss is a “power on through it” guy. I tried to do that this week and ended up sicker than I was before. The state recently issued a memo to its workers: if you’re sick, STAY HOME! Because so many people were getting sick and productivity drops when that happens—even if you do come into work.

People are lousy at figuring the odds.

They'll avoid an action that has a 1,000,000:1 chance of a bad outcome which will prevent an event that has a 100,000:1 chance of a bad outcome.

============

It is only rational to not immunize your kids if it is rational for all parents not to immunize their kids.

But it is not rational for all parents not to immunize.

Therefore it is not rational for any parent not to immunize.

(Exceptions for immunocompromised patients and for documented allergy to the immunization.)

===========

I remember when President Ford ordered all military personnel to get the Swine Flu vaccine. I was, so I did. And I thought I was going to die.

Based on the reaction to the vaccine, the real disease must be wicked. I'm glad that whatever he saw coming was averted.

(More people died of the vaccine than the disease, then -- but there wasn't a pandemic. Which is a good thing.)

Someone way upthread mentioned waiting until the child was a year old to vaccinate, because the immune system would be more developed. I'm a little fuzzy on the details after all this time, but when I was in college in the early 1980s (1982?), there was a widespread outbreak/(near-)epidemic of measles among college students. IIRC, many of the kids who caught it had been vaccinated, but young enough that they needed boosters, which they hadn't gotten. I believe the cutoff was one year. That is, younger than a year when vaccinated, needed a booster, older than that, didn't. A whole lot of people wound up getting revaccinated, including my older brother (I was okay). Hmmmm. Now that I think about it, maybe it wasn't the age of the patient but the date of the vaccine. Did the measles vaccine change in 1964? It may have been that an earlier version required a booster and a later version did not.

***************
My great-grandfather lost all six of his younger siblings to tuberculosis. He survived because he was away from home, working.

I'm not saying the dialogue in #89 has ever happened in our house. At least not more than once a day.

I was going to post something about getting a tetanus shot just on principle if you do renovation on a house before the Drywall Era ... but then I did a little judicious searching and realized I would have been repeating myself. Oh, well, at least I'm consistent.

Thanks, Ginger -- the interesting thing is that all five that died of cancer, the vet used the term "sarcoma."

So SEVEN(!) is considered old? Wow. The first cat I ever owned died of a stroke at age 18 (they built them tough back then...). Merlin had survived being thrown out of a tree by a raccoon (broken jaw) at age 10 and being leg-trapped at 16 (nasty looking, but she didn't lose the leg).

Hmm, looking at my records, rabies shots are the only vaccine our current vet is giving our elderly cats. But they are all indoor...and considering their ages, very healthy.

murfnik @164:

I'm sorry, but this sentence really makes no sense to me.

I meant genetic damage, per se, not necessarily congenital.

The only way I can parse it (which requires an inconceivable definition of "genetic") is that you mean that vaccination may bring out an inborn but otherwise inactive condition.

I still say, to that, that people who try to associate autism and vaccination in the face of the evidence are trying to avoid an unknown, unquantifiable, and possibly nonexistent risk by exposing their children—and others—to a known, quantifiable and definite one. There are enough people with genuine reasons to avoid vaccination that the rest of us should not succumb to concern trolling or FUD.

Ginger @ 163--I've lost a cat to cancer and two to hepatic lipidosis...and doubt the cancer was caused by vaccines (she was 9 1/2). I currently have a female cat who, other than being arthritic and a tad senile, is healthy as all get out at 20 years and 4 months. I stopped having her boosters on a regular basis a few years ago, with the vet's approval, since she's an indoor cat. The 14 YO cat is also on a reduced booster schedule. My personal belief is that like humans, cancers in pets come from things that alter genetics, either in breeding or from the environment...not from vaccines.

Something to remember about the tetanus bacteria is that it is an anaerobic bacteria...air kills it. Which is why things that have been buried are an issue, and why, if you get a puncture wound...you aerate it with hydrogen peroxide. Hydrogen peroxide itself really doesn't do much for open wounds as far as killing bacteria--it interacts with the catalase in blood and foams, helping to clean out the wound, but not sterilize it.

Lori@168: My vets here in Greater Boston say that with indoor cats the average lifespans they're seeing are 15-18 years.

The average lifespans of cats allowed to go outdoors regularly here? Three.

Anecdotal, of course, but fascinating to me.

Ours are 18 and 19 and are about as hale as one can hope for in antiquarian cats.

abi @ 169--Congenital...hmmm...sorry, used the wrong word again. I meant genetic. Congential and genetic damage are the same, something occurring due to external damage to the cells, rather than something that's passed on. My bad.

More smallpox vaccine anecdotal data: my husband, born in 1965 in Hawaii, has the smallpox vaccine scar. I, born in 1968 in Seattle, do not. I did get all of the usual range of vaccines as a child, and was later tested for resistance to measles and rubella (thanks to one of those outbreaks of measles among college students in the 1990s - I was working on a university campus at the time). I didn't need a booster for either.

I received my last tetanus shot almost 5 years ago (sliced my thumb in a kitchen accident), so I guess I should see about getting another one soon. I also need to check with my husband on his status, since we're doing a lot more gardening recently.

I had chicken pox in the first grade - a fairly mild case - but never came down with any other dire diseases, thank heavens.

Terry @ #20: Polio has always confused me, not the disease, but the suddeness with which it left the minds of the population.

I'm struck by the same phenomenon with regard to the 1918 flu epidemic. I never heard of it until I was in college, despite the fact that my father's brother-in-law died in it.

I had mumps and rubella as a child; can't remember if I had measles, but I've had the MMR vaccine as an adult. The immunization gave me a powerful local reaction (4-inch diameter hard raised welt) and I've been advised not to have another. So the last time I was due I had a titer which showed I still have antibodies.

I also have a smallpox vaccination scar, from the days when they lined everyone up in the halls at school and zapped us en masse. And I was re-immunized against polio in the early '80s because I was planning to make a trip to Haiti (I chickened out of the trip, but since I have an older cousin who had polio I certainly don't mind the extra vaccine).

All 3 of my kids had chicken pox. The last 2 had it the year before the vaccine became recommended for all kids (instead of just immunocompromised ones).

Re TB, my entire class of physical therapist assistant students had to have two consecutive negative TB tests before we could go out to our first clinical placement. I have to get tested again yearly. (That reminds me, I'm about due!)

JESR @ #151, what you said re diagraming sentences! My mother used to use diagraming to demonstrate faulty logic (as in ads, political speeches, and poorly written term papers).

There's a summer camp on an island a few miles off Kodiak. When the woods were being cleared for the construction of new cabins, we stumbled across a graveyard from the turn of the 20th century. At the time, this was the place where children were sent for quarantine, so that at least they wouldn't infect their siblings--there was nothing else to do.

The dates on one of the crumbling wooden markers were eighteen days apart. Cause: diptheria. The oldest child in that graveyard had not turned four. Measles. Mumps. Influenza. It was a little catalog of the horrors of lack of immunization.

I'm pretty "crunchy," and I did delay some of my daughters' early immunizations because (a) egg allergy runs in the family, (b) MY shots were up to date, (c) the kids were not in group day care, and (d) they were breastfeeding, but they did get the shots, every single one. Autism can derail a child's life, but strangling on their own snot--How can anybody who has read the symptoms of these diseases decide not to protect themselves and their children?

Speaking of which, Carla Emery, author of that crunchy Pantechnicon The Encyclopedia of Country Living, tells the story of how she was converted from anti-vax to vax on time, every time. It involved reaching into her toddler son's mouth with her fingers, every fifteen minutes around the clock, for nearly a week, to strip the gunk out so he could breathe. Not breathe better, just breathe.

Note: I lost an unvaccinated cat to sarcoma/FHIV. She was four. Her vaccinated daughter lived to 19 but also died of sarcoma.

Jo: That's a not uncommon formulation, though I think the specific form is regional. In the parts of the states I've inhabited influenza has a dimorphic usage: the flu/unfluenza (e.g. she died of the flu, she caught the flu/He died of influenza, he contracted/came down with influenza.

In the vein of innoculations: I got one against yellow fever in Oct. 1993. It was horrible. About one in three reacted to it, fevers, chills, bone aches, nausea, hot spells. You could spot us as we shambled about the barracks, wearing army-blankets as shawls, and huddling in the day-room chairs.

Rubella is in the same class as polio. A scourge which is lost to the common memory. I wonder how many people don't get a visceral understanding as to why Agatha Christie made it a motive for murder.

albatross: re Homeopathy: It had the blessed misfortune to come on the scene when leaving the patient alone was often better than any medicine which could be offered. Thus its claims seemed to have reasonableness which later facts don't bear out.

Oliver Wendall Holmes (the doctor, not the jurist) delivered a splendid set of lectures on the subject in 1842 (Homeopathy and Its Kindred Delusions). It's on the web. Reading this defense of it is amusing, not for what it says, but for how it misrepresents Holmes core point... the level of dilution.

So far as I can see, from the pills sold in the marketplace, a dilution of 30X is standard. Take a cc of the "medicine" and dilute it in a liter of water. Take one cc of that, and dilute it at the same ratio. Repeat for another t28 interations. One must use distilled water (lest some other ingredient contaminate the medicine. After all is said and done the odds of one molecule of the initial medicine being in the entire bottle manufactured is billions to one againt.

abi: I think you made a mistake in the Rh explanation. Since Rh is a dominant trait, the odds are either 100, for positive, or 50/50. I'd guess, all things being equal the incidence of +/+ in the gene pool is greater than 50 percent, so one parent with positive will increase the odds of a postive kid (which isn't a problem is the provider is the mother, the system won't respond to the lack of Rh protiens).

My mind just flashed back to punnet squares and diagraming out the indcidence of heritable traits. Martin's essay reminded me of one of my favorite pieces of nonsense-schtick in medical dramas (M*AS*H was fond of it). The AB+ patient who needs blood, when the hospital is fresh out. Being an O Neg (and I got in the habit of writing Neg, because it's easy for a record to get less than tidy, which could get bad) I was always amused at the staff rushing about to find some blood, when any vein in the place (more or less) can be tapped to pump the poor bastard up.

re 127: That's not what disease does. Diseases live. The happen to live in ways we are affected (the bacteria and viruses which don't make us sick, we don't care about. So much so it's arguable the trend to making every surface as close to sterile as possible might be making us sick, but I digress). They aren't "culling overpopulation". They are merely trying to survive. Sometimes that survival kills us.

Lori Coulson: In all probability you just had a run of bad luck with cancer. See above about correlation and causation.

When I worked in the office, no matter how much I washed my hands, swathed myself in disinfectant gel, and cleaned the keyboard with Dettol, I came down with a virus a month, minimum. If only people would STAY HOME when they are sick, dammit.

I think that's it, kids. Didn't the elite of the 1960s want some things better for people, through the Great Society? And hasn't the last 50 years been a revanchist attempt to erase those decent impulses from American culture?

Remember when 'social worker' was not an epithet?

Remember when the frakking public health clinic* gave out immunizations to everyone who needed them, FOR FREE?

It doesn't take a war to bring down a civilization, just powerful people aligned with elites to corrupt the social contract we hold with each other. From welfare to well baby clinics to denial of the need for both public health services *and* affordable healthcare for everyone, it's been a push to make everything a commodity that's dear to those who need it most.

I remember the STOP sign in my public health center, on the weekends, mind you, where kids lined up for shots. I was in the generation that first got MMR, and it was a blessing to not even know a friend who got sick. That's something at least two generations of kids do not know, with shots being made costly or complicated to get or fraught with disinformation.

If I carried my Nutbar Conspiracy Theorist tote (which TNR and PNR, I still find handy, and not in the totey way), I'd say that the vaccines = autism link was developed by staunch anti-feminists, who wanted women to suffer both the loss of their children and the loss of independence, being forced into a permanent nursing role again in their families. When your family keeps getting sick, it's much harder to demand anything like justice regarding employment, law enforcement, public services.

You can't have childcare in this country without immunizations; the sex abuse scares stopped working, so maybe de-immunizing innocents might.

You can't have healthy workplaces with people able to advocate for their rights if workers get the tacit message to come in sick, even if they have sick leave accrued. And, if money and someone else's power are seen in our culture as more important than our taking care of each other, then why wouldn't we begin to suffer from horrific reemergences of illness to the point of quarantine, if such a concept would even be enforceable, nowadays?

I'm sorry rancid libertarians have poisoned the concept of taking care of yourself. One takes care of oneself to lessen the burden government has in taking care of others, and it frees you up to have the time and resources to take care of others, too. That's why there are manners; that's we're not supposed to kill our children that we love the least. We are supposed to be civilized.

Man, this subject lends itself to the rant....

1) Bravo! (holds up lighter, as I don't have a cell phone)

2) I'm at work shedding viruses like crazy all over everyone here because if I don't, I won't have a job. They don't care if I can work efficiently, but by gum my butt better be in this seat... Corporate America isn't all that good with logic.

#115 Jo Walton: Been there, too. The evil Primatene Days, I said about them.

The epi shot, if a cat scratched me; the lack of real relief, living with wheezing. When I got my first taste of albuterol in college, it was as if someone stopped punching me in the gut. It's even better to just use a discus sucking thing, and not *worry* if a person I sit by has a pet.

Back in 2003, I was visiting friends in New Jersey for a couple of monhts when one of their parents had a flare-up of Shingles.

I've never had Chicken Pox, and am too old to have had the vaccine as a child. I called up a local doctor, who said I should get the vaccine, but he couldn't order or administer it to me. I called some other GPs and Interists. No luck.

Pediatricians had the vaccine, but wouldn't administer it to an adult.

I called the Essex County health department, who told me to call local hospitals. They all said they didn't have it and couldn't get it. So I called the Morris County health department, figuring that I might have more luck with a county that's more eveny affluent. (Essex is home of both Newark and upscale suburbs like Short Hills and Livingston).

The Morris County health department had no idea either.

I tried the Livingston township town nurse (an odd post, but they've got one.) She referred to me to a local Doc-in-the-Box, who had the vaccine and were happy to give it to me for cash on the barrel. I was able to get the second shot in the series from my own doctor in California.

I've never had a titer test for Chicken Pox, but I hope the vaccine took. FWIW, I've had the measles vaccine over and over again becaus I have had the titer test several times and always come up negative. Measles outbreaks make me nervous.

abi: I think that read (external factors relating to genetic expression) is reasonable to the questions murfnik is asking (though I don't really understand the way congenital/genetic are being conflated/defined). Reiter's is a disease which has genetic predispostion, but needs a triggering event to bring about, and seems to have a window (between the ages of 30-40) when that event is most likely to actually set it off.

Then you have it for the rest of your life.

That said... vaccination is the way to go, stright up, full-stop, which also seems to be murfnik's position.

Lila: I can see it with the 1918 epidemic (I forget when I heard of it, but it was in grade school somewhen). That was a one-time thing, it can be explained away as an abberent thing. Polio was endemic. Like smallpox it cut a broad swath through the population. At the same time we were being told FDR had polio, it was otherwise seen as some strange thing, never to be worried about... but eat this sugar cube (and whomever it was who was dosed on a piece of bread... nasty. My booster at basic was just shot down our throat and a more vile thing is hard to describe. Actually there are some things which notes of it... metallic and rancid and persistant. Yuck).

I had the chicken pox when I was a kid. This was in the 80's, before the vaccine. I'm amazed there's a vaccine these days---the good kind of amazement, not the sarcastic kind. I wish there had been a vaccine back then.

Of course, my parents wouldn't have let me take it. My father was a proponent of the "if you give your child modern medical attention you just make them weaker, and if your child dies, the race is strengthened" ideal. (Yes, it has been clearly established that my father was a dick.)

If there is a sole good thing I can say about the parents who don't want to vaccinate, is that they *probably* don't think like he did. But the result is as *if* they thought like he did, which is still bad.

I also got pneumonia as a result of the pox, and to this day I have breathing problems (and when the flu/cold season hits, I have a very hard time breathing even with inhalers). I think that's probably more a case of being forced to survive the first bout of pneumonia without medication, much less antibiotics, somehow. I'm not sure how. (I really hope these parents who don't vaccinate also don't refuse antibiotics, because if they do, their kids should be taken away. Seriously.)

Now I just get sick at the drop of a hat, it sometimes seems; and the third time pneumonia hit it nearly killed me, so I can't wait to see what the fourth time will do.

And yes, I have shingles. I didn't realize that was a long-term result of chicken pox.

Please vaccinate your children. And learn science.

Suzanne@159: The way to deal with co-workers who come in spreading contagion is not to hint. Stand by their desk, far enough back to not get sneezed on, and YELL at them. Be offended! Be grouchy! Admittedly, it's probably too late with respect to that guy's particular microbe, but it'll make the next half-dozen people think before they bring in THEIRS.

Suzanne, 159: Suppose your employer doesn't distinguish between sick days and vacation days, and that you have only two weeks of them. Now suppose that you're a single mother and your kid gets the flu. Are you going to waste your sick days on yourself?

I assume somebody's gotten around to proposing Salk and Sabin for sainthood by now? Polio is almost entirely gone, except in a few parts of Nigeria and Afghanistan where local politicians who deserve to be shot are saying that vaccination is an anti-Islamic plot. The vaccine had recently come out when I was a kid, so my generation was safe, but there was a kid across the street who'd gotten the disease when a few years earlier. And as far as other vaccinations go, the graveyard where my father's buried has way way way too many one-year-olds in it from the centuries before vaccines and sanitation.

There's now a pneumonia vaccine - yay! I had chicken pox as a kid, and watched my grandmother suffer from shingles, so I'm planning to get the shingles vaccine when it's a bit more ready; last I read they were still arguing about how long they expected it to be good for and what age you should be when you get it.

(I really hope these parents who don't vaccinate also don't refuse antibiotics, because if they do, their kids should be taken away. Seriously.)

I got my negatives confused. *facepalm* sigh

Intent was: "Parents who don't give their kids antibiotics in addition to not giving their kids vaccinations should have their kids taken away full stop."

Although now that I think about it more, just not giving antibiotics period should mean kids are taken away.

Alaska is backward in a lot of ways, but you can still get every vax on the chart, for free, except for the flu shot for adults, which costs $25.

I think that our new President's people could begin to apply socialized medicine--that is, A SYSTEM THAT ENSURES THAT NOBODY EVER DIES OF LACK OF MONEY, JESUS WEPT, THIS SHOULD NOT BE AN ISSUE--by making all preventive care absolutely free. The main selling point should be free vaxing and free face masks because nobody likes being sick. Along with that can come free periodic checkups and free prenatal care, because these can catch or eliminate little problems before they become big ones. But vaxing really should be the biggie.

And that man who made up the "vaccines=autism" data should do the Perp Walk of Shame on CNN.

Bill Stewart #186:

There's now a pneumonia vaccine - yay! I had chicken pox as a kid, and watched my grandmother suffer from shingles, so I'm planning to get the shingles vaccine when it's a bit more ready; last I read they were still arguing about how long they expected it to be good for and what age you should be when you get it.

Pneumonia vaccine? Wow.

I'll have to see if I can get one. Maybe I'm a lost cause already but that plus a flu shot every year would make me feel less anxious.

murfnik @ 172

No, you're still confused:
Genetic - associated with the genome; inherited.
Congenital: present at birth, whether recognised at that time or not .

"Why do some people insist on coming to work sick?"
Well, for the vast majority of people: because you will be cast aside like a piece of soiled toilet paper the moment you are of no immediate use to your employer. Be happy if your own circumstances are different - but rest assured the default status for most of humanity leaves little room for frailty.
This of course establishes a certain culture.

Arachne (189): I believe the pneumonia shot is good for five years, not just one like the flu shot. (Anyone here know if having had pneumonia within the last five years means I don't need the shot yet?)

Antibiotics when appropriate. They won't do a thing for you if the problem is viral, and they do have their own spectrum of side effects (as does everything else in medicine).

murfnik @ 164:

What I meant by saying that we now recognize autism as a medical condition is twofold. First, it's not some moral or any other failing on anyone's part. Second, that it's something that shouldn't have a stigma attached and that we can work with it. Autism is similar to depression in this way; now that we know it's a medical problem we can treat it instead of pretending it's a personal failing.

As to whether the jury is still out, it's not. It's come back with a resounding not guilty over and over again. Sure, science and medicine have been wrong before and will be wrong again, but the fact that study after study has shown there is no link is pretty conclusive.

Other than that, I think we're in agreement.

Yes, Arachne Jericho, there is a pneumonia vaccine! IIRC, from when my elderly parents got theirs, it's good for pneumococcal pneumonias, but not the viral types, but even so, that's a goodly range not to have to worry about any longer. I'm not sure what the current guidelines are, other than they are recommended for the elderly and healthcare workers; I suspect your history would incline an attending physician to feel that prevention was golden. Google will likely tell you more, so that you can have That Conversation with preparation, so to speak.

Which reminds me, I need to get a booster for pneumovac. It's not just for pneumonia; turns out a substantial percentage of ear and sinus infections are caused by pneumococcal infection.

Expanding on "If you're sick, stay home!" by more instructive examples:

I worked for the Washington Department of Revenue in January of 1976. A woman who was proud of never taking a sick day in twenty years at the state was the assistant supervisor of the main file vault; she came in sick about two weeks after I started work there and gave the whole (poorly ventilated) room the flu. I had no sick leave, and had to take four days of unpaid leave in my first month of employment. I did my usual "catch it first, keep it longest, have the worst cough" routine so emphatically that people in the account audit department at the other end of the floor were sending me cough drops. Everyone missed at least three days of work, in the busiest time of the year; the filing of annual reports wasn't finished until the college temps came in the next summer.

Now my household is being beset by people who stay home from work while sick and use that as an opportunity to go to the movies. My son works at a multiplex and inherited my immune system; even with flu shots we get a new virus every two weeks or so, and have caught the Unofficial Flu in the past three Februaries. I can't wait for him to get a job with less contact with the germ-shedding public.

I belong to a mother's group, and it constantly surprises me at how misinformed women are about vaccination. They still think MMR causes autism, they think they don't need to immunize because the disease is gone, they think they don't need to do their kid 'cause the other kids will be done...

I've survived mumps, chicken pox, and shingles; my shots are all up-to-date. Because you never know.

Bill Stewart @ 186:

Well, there is the Vaccination of a Child panel from the Rivera murals at the DIA: http://www.dia.org/education/rivera/info13.htm

dcb @ 190--I'm always confused...comes of trying to get into a discussion and work at the same time. Thanks for setting me straight...it's really what I meant, but tabbing back and forth does not lead to coherent thoughts, right? ;)

Perhaps the way to deal with illness at work is to fine employers for harbouring sick staff. Justify it in the name of national GDP. Since they can't flush ALL their staff down the toilet at once, perhaps then reasonable sick days would become the norm of corporate culture.

Another common reason why some people never take a single sick day is that their embezzlement will unravel if they are not there constantly. More evidence that employers are by and large, "stupid".

apropos James D. Macdonald @165,

I read somewhere, somewhile back, a very soundly-reasoned newspaper piece on how the prevalence of big money lotteries has made the average person's bad-at-figuring-odds a whole lot worse in a rather unexpected fashion.

In that when people come to believe they really do stand a chance winning that one-in-however-millions huge wodge of cash that will solve all their problems, buy all the ponies they want etc, they will believe far more readily that these other outcomes - like adverse reactions to medications - actually could happen to them. Regardless of logic.

takuan, #147: AKA "borrowing trouble". Let's see if it even works before we start worrying about what some nebulous "they" might do with it! This is exactly how some of those unkillable rumors get started -- somebody shoots off their mouth about something that's only their personal fantasy, and the next thing you know, "everyone knows" some piece of utter garbage.

Suzanne, #159: You're lucky, and I understand your complaint given the conditions you cite. But there are a lot of folks who have relatively few sick days (6 per year isn't uncommon) or none at all (most part-timers and minimum-wage workers), or whose jobs are seriously at risk if they take sick days at all (USPS is particularly bad about this). And mothers -- especially single mothers -- often have to reserve their sick days for use when their children are sick, which isn't how it should be but that's reality. Bottom line: there are a surprising number of people who literally cannot afford to take a sick day.

Terry, #177: Yes, AB is called the "universal receiver" for precisely that reason -- but it's still better to have the same type in patient and donor, not to mention that there are other factors, less well-known to the public, which can also have deleterious effects. (I found out I was AB+ at 17 when I had the bad wreck, and have done some dilettante-level research since then.)

cgeye, #178: You can't have healthy workplaces with people able to advocate for their rights if workers get the tacit message to come in sick, even if they have sick leave accrued.

That... makes a frightening amount of sense. Combine it with the other factors I've cited above, and it starts looking like a multi-pronged coordinated attack.

takuan @200:
Another common reason why some people never take a single sick day is that their embezzlement will unravel if they are not there constantly.

Yep, when I was a financial auditor one of the things we'd look for was whether people ever took vacations. If the same person signs every single weekly reconciliation all year, get the chips out, because something's fishy.

@James D. Macdonald #193 -

Of course. I forgot there was a whole other un-informedness out there about antibiotics, sort of the polar opposite of the one about vaccinations, and thus we have MRSA.

@fidelio #195 -

I'll definitely be checking it out!

takuan @200 and abi @ @ 203:

Yeah, back when I worked in banks, you started with 2 weeks of vacation and regardless of how much you eventually got, it was a federal requirement that you take at least two consecutive weeks....things show up that way. And boy, did they.

And to those who posted about single moms and limited time off...my apologies. I've been a university slug for too long (although I have come in sick because I was out of paid time off); when I was a single mom, I had the same kind of issues.

Another problem in the whole field is that germs aren't the only source of disease: You won't always find a bacteria, a virus, a fungus.

There are some diseases caused by chemical exposure. Others are genetic. Others are degenerative.

Sometimes there are surprises, when what we thought weren't germ-related turned out to be: Witness ulcers. It isn't stress, it's H. pylori.

And there is nothing wrong with immunizations for sexually transmitted diseases. They aren't God's Punishment for Immorality. They're bugs that have found a great way to move from one warm moist environment to another. They kill or debilitate, and drain society, and if I could wipe them out I would. People either will or won't boink whether there are STDs or not.

ah Lee! Dinna fash yersel far nought! If speculation troubles your soul so deeply, let others be the lookouts and stick to what is known because it is past. You will discover in time that the future has its uses too.

Lori, JESR:

'Sarcoma' is a pretty non-specific term. Solid (non-blood) cancers were historically divided into 'carcinoma' or 'sarcoma' depending on which type of tissue they occur in. Most of the commonest ones in humans are carcinomas, but I don't know if that's true for cats as well.

Albatross and Patrick have a kinder explanation of culture that allows people to think it's OK for their kid to avoid a very small risk of personal harm in trade for a less-small risk of harming others - I always figured it was the kind of immoral math that people use when they think "I should get a bigger SUV so if I get in an accident it's the other guy who dies."

But I don't think it's new, it just hit upper-middle-class people and the media recently. When I went to college in the early '90s I met a bunch of kids who hadn't been immunized, because their parents were hippies, chiropractors, or religious. At least one, her mom had a pet doctor from the same religious sect who faked immunization papers so the kids could go to school.

Lots of groups that don't include celebrities don't immunize. The Amish don't, some conservative Mennonites, Christ Scientists, some Seventh Day Adventists I've met, Jehovah's Witnesses - that's a significant number of people, once you bundle all those minorities together.

@ several commenters above who ask why people insist on coming to work when their sick.

They might be unlucky enough to not get paid sick time, and can't afford losing a couple of days' pay. (I don't - but I'm also fairly healthy and I can afford to take a couple of days when I do get sick.)

murfnik @ 199

"Glad to be of service."

They might be unlucky enough to not get paid sick time, and can't afford losing a couple of days' pay.

Pretty common. If you were instituting public health measures as preventatives, I'd be looking at 35 hours/week is *required* to have 2 weeks paid sick leave as a federal minimum, and hourly workers below that accumulate paid sick leave at a rate that gets them to 2 weeks if they hit 35 hours every week for 52 weeks.

It'd probably do wonders for our quarantine rate.

The 'vaccinations are counterproductive, if not dangerous' fallacy has hit Scandinavia as well, including Asperger's and autism support groups, according to the update I get from the blog and mailing list of our equivalent of CSICOP (called Skepsis). There has also been some information about measles parties and such being common among parents who send their children to Waldorf (Rudolf Steiner) schools in Scandinavia and German-speaking countries. This is allegedly because it is a tenet of Steiner education that children should go through certain phases, including childhood diseases, in order to emerge a full adult (this is also why they at certain ages emphasise artistic development, and deemphasis asking questions about what is being taught). One problem those who critisise this is that at least in my country Steinerism is a kind of obscurantism that upper middle class people subscribe to, that is, you get fairly influential people against you if you speak out against this.

abi @ 203
Last hear HR was getting on my supervisor's case because I didn't take enough vacation days to suit them. (I have ten days a year, and ten holidays.) I used all but threee days of vacation last year, four of them in one go. You'd think they'd never met anyone who takes time in little pieces ....

(Today is a vacation day, because I needed to get my taxes done, and the only time the preparer had was in the middle of the day.)

Re: Chicken pox vaccine

I never had chicken pox, but I was exposed so often as a kid my parents assumed I must've picked up a mild case somewhere, become immune, and never realized it.

To my horror, a few years ago I learned that I do NOT have chicken pox antibodies, and that because I'm on immunosuppressants I couldn't get the shot because it uses a live virus.

I've heard enough stories about chicken pox in immunnosuppressed adults to scare me silly, and I could easily get accidentally exposed to it through my nephews. Does anyone know if there's a "killed vaccine" or something out there? Thanks!

Lee: Yes, type, and cross match is best (because there are more than three protiens. My sister is negative for most of the really minor ones, so they really like her blood. Me, I don't really weigh enough to donate easily, so I don't. One gallon's worth of fainting and weakness for a couple of days was enough), but to see the sheer panic at the lack of AB Pos, when there are lots of people there, and cross matching is doable... amuses. They say it because it sounds scary (AB Positive has more oomph, than, "We need more O negative". It's a quirk of dramatic conventions).

Per Chr. J: Thank you. A woman recently made a comment about the evils of her ex; he was insisting on the wrong sort of schooling for their son. What I heard her say was, "But of course [the ex] insists on regular schooling, if he had him in a Steiner school, or some other rational system." Which may also have explained why she was adamant about not teaching him to read music (despite his apparent talent, and possible interest in learning that skill), because, "he isn't ready, he is already having troubles because he is being forced to read, adding more things to that would be bad for him."

And, I almost forgot -- I thought this post was in reference to *this* failure of caution:

http://tinyurl.com/bychs7

Four children have died of the flu in Colorado since mid-January, alarming health officials who said that at least some of the deaths could have been prevented if the children were vaccinated.

We just had a child die of flu in the Boston area.

Flu vaccine is an every-year thing. And no, it isn't too late.

I had chicken pox as a little nipper, maybe first or second grade. A few boring days at home. My siblings and a childhood friend got it soon after.

If the vaccine helps prevent shingles, I'll get it.

I'm probably way overdue for a tetanus booster. Last shots I had (other than yearly flu shots) were before grad school, in 1995.

Shingles may not kill you, it will just make you wish you were dead. I had chicken pox (and mumps) when I was very young (under 2.5), but came down with a nasty, nasty case of shingles when I was pregnant. I had lesions on my forehead down to my eyelid; fortunately, the eye itself was not involved. It hurt like crazy, but everybody was afraid to give me anything because I was pregnant (second trimester). My OB finally gave me acyclovir, because it was so bad, and codeine, because I couldn't sleep at all due to the pain. Fourteen years later, I still have some post-herpetic neuralgia, though it's more itchy than painful.

Capsaicin was the only thing I found that could do anything about the itching and pain. Couldn't use that around my eye, though; goes right through the eyelid into the eye - you only do that once!

Because of my experience, my father participated in one of the clinical trials for the shingles vaccine, which is now recommended for people 60 and over. I did have my daughter vaccinated for chicken pox, even with the risk of shingles, though.

On coming in to work sick -- there is an increasing tendency in the USA for companies to have highly limited sick leave, and particularly to roll sick leave and vacation together into a "days off" pool.
In other words: you can stay home and get well, and cancel Christmas for lack of time off.

In those circumstances, anybody who can drag themselves in, does -- no matter how counterproductive it is.

My wife used to get a lot of "I'm too sick to work, so come fix my computer today" calls, back when she did that kind of thing. She eventually took to showing up with lab gloves and isopropanol wipes, just to lower her risk of infection from "sick man's keyboard".

One nice thing about working in biotech: most companies in the industry have sick leave policies that suggest they understand disease transmission.

The last place I worked was very firm about sick people staying at home. The employee handbook made a very strong point about this. Yes, it was in the publishing industry, which meant a lot of deadlines, and a small company, which meant if you were out an entire project might well grind to a halt because you specifically and personally were needed for some part... but that was still better than getting everyone else in the office sick.

Now that I'm back in classes, I'm discovering the "joy" of dragging myself in to class while sick. (Not horribly so, thank god.) I can't afford to miss the lecture, or the test, or the chance to turn in the paper... And I'm only allowed so many absences before they make me drop the class, so I'd better hold onto those in case I come down with something so serious I really can't make it into class.

I feel a bit guilty about exposing other people to what I have. I try not to cough on classmates. But those geology notes aren't going to take themselves without me there.

takuan, #207: Please stop putting words into my mouth. You're not "speculating" -- you're postulating unwarranted and possibly superfluous assumptions without providing the slightest basis for doing so. Which is fine for writing fiction, but an extremely poor approach to public policy, as the last 8 years have amply proven.

Also, you still haven't answered my original point back at #143: in what "covert" manner would this still-at-the-hypothetical-stage substance be added to our "local supply" of what?

And you're not impressing me with those flights of fancy, either. I eat more imaginative things than you for breakfast.

Torrilin, #212: That would be a good start, but it still doesn't help the people who will get canned if they take a sick day. We'll have to work on changing employer attitudes as well.

Jim, #218: Every year I waffle about getting the flu shot, and most years haven't bothered -- and I haven't had a full-blown flu in a couple of decades. But given that I'm getting into the higher-risk age range, I think you've convinced me to start doing it.

Dear Lee: are you here for a meal? Me, I like the company. Now be good and do not seek to molest me further, try to have a little respect for the house.

Fascinating: I had no idea that not getting your kids vaccinated was so widespread. I was aware that a bunch of people believe that vaccines=autism, and seem determined to believe it no matter how many studies seem to disprove it. I say seem because I am a "studies" skeptic. Having been one of those women who took hormone therapy because "studies" showed it would be good for my heart, I don't have a whole lot of faith in studies. But I also don't believe the autism/vaccine link.

I am older (Hi, Bruce) than a lot of folks here. At age eight, I was part of the Salk vaccine trial. The next door neighbor's kid -- my age -- had polio. I was vaccinated for smallpox. (After all this time, the scar is gone.) In my first decade I had chicken pox, and have the pox scars to prove it; I also had mumps and measles -- not "German measles," though. I have had the pertussis booster, pneumonia vaccine, tetanus shot, and the shingles vaccine. The shingles vaccine won't guarantee that you won't get shingles, by the way. It has about a 50% failure rate. But if you get shingles and you've been vaccinated, you may experience a milder case. I think it's worth getting anyway. Both my parents had shingles in the last few years of life. My father developed lingering nerve pain, which was horrible. My mother's shingles was diagnosed within the first 48 hours of her developing it, and she took Valtrex. She never had any pain.

People who skip getting their children vaccinated, as this post and the comments point out, assume a world where most children live, thrive, grow up to be healthy and strong. That world largely exists because of a few developments: modern plumbing and sewage, the understanding of germ theory, doctors who wash their hands, antibiotics -- and vaccines.

Another sidebar; many dog breeders seem to have similar ignorant suspicions about vaccines.

Torrilin, #212: That would be a good start, but it still doesn't help the people who will get canned if they take a sick day. We'll have to work on changing employer attitudes as well.

Well, that was why I specified federal requirement. OSHA does not have as many teeth as I'd like these days, but they do still have teeth. And it is a legitimate thing to regulate, since sick leave is quite obviously a matter of both health and safety. It ought not be under the Labor Relations board's jurisdiction, since it isn't about workers really... it's about protecting corporate idiots from their own malfeasance.

Sadly, since it is a sensible policy, it is unlikely to make it through in the US. But I can dream...

Oh, vaccines. So much to say.

Vaccines are necessary, yes. I'm currently on a mission to find a varicella vaccine for myself, because I've never had the chicken pox, despite being exposed three times. My doctor said to go to the health department, the health department won't give the vaccine if I have insurance, and no one seems to know where I can find the vaccine for adults. I did just get my tetanus booster updated. The health department will do that one, although they were confused as to why I would want it. I just tell them I'd rather take it now than have to worry about it if I'm hurt (bitten by a lab rat, scraped by a rusty nail are the two that surfaced during the duration of my last shot). I'd like to get the HPV vaccine, just in case, but it's apparently only approved for women up to 25.
Then there's pertussis. I was just looking at the vaccine information sheet on this yesterday (when the baby was in getting his 3rd DPT, amongst other things) and apparently the pertussis component is only approved for use up to 7 years old. Doing some googling, I see that a Tetanus/Diptheria/Pertussis vaccine was licensed for use in adults in 2005, but you can't get pertussis separately. Silly.
The problem I have is with the vaccine schedule, more than the vaccines. They pile everything into as few visits as possible, because parents can't be trusted to bring their kids back as necessary for boosters. Personally, I'd rather Stefan not have to deal with fighting off 5 things at once, because although he wasn't feverish, and didn't seem to be in pain, he has been incredibly cranky the last two days, leading to two very sleepless nights, which makes me very cranky as well. I'd happily go back to the doctor every 3 weeks if it meant I could avoid that.
This thread also reminds me that I need to take the kitties to the vet, if I can find someone that does the rabies purevax, rather than the 3 year rabies vaccine. That can be my research project for tomorrow.

EClair @ 228 - As I mentioned above, I found it at a local (for-profit) urgent care walk-in clinic.

Jim, thank you.
Thank you from my daughter with autism.
Thank you from myself, a parent who has to explain again and again that her vaccinations had nothing to do with it.
Thank you from the guilt I feel every time someone tells me her autism is my fault.
Thank you for this article because I can link to it every time I get into this debate with a parent who believes autism is worse than polio or diphtheria. (Or in one fun case... cancer.)

Thank you.

To Bruce @60: It's not quite true that HPV could be eradicated **by the current vaccine**. There are a whole lot of HPV strains, and the current vaccine only protects against 4 of them -- two of the currently most-common cancer-causing strains, and two of the currently most-common wart-causing strains. The other strains will be basically unaffected by the vaccine, and can still cause problems. I've read some material that says that *other* strains may become the "most common" as the protected-against ones are less-able to be transmitted.

Current PAP guidelines make the HPV vaccine one of the more optional ones -- yearly PAPs generally catch abnormal cells long before they turn into cancer, and there are treatments to remove the abnormal cells if they seem to be veering that way. (Not to mention that the body *usually* fights off the abnormality anyway, so monitoring for six months (or longer) to make sure it's not getting *worse* is par for the course.)

There are, obviously, skinny ends to the bell-curve where the lack of the vaccine maybe made a big difference. (Or it could have been caused by a different strain than the 4 that the vaccine immunizes against. O:( ) For the hump of the bell-curve, from all I've seen, it's not as clear-cut a necessity as, say, MMR (which I had to get as an adult, because my granola-nut sire thought that vaccines were dangerous).

(Had to, as in, insisted to my doctor that I wanted it. I would've gotten Polio vaccinated as well, but she called up the CDC or someone and said that it wasn't advised for adults; I just had to make sure my kid was given the dead vaccine. If I recall correctly, she wasn't vaccinated against polio either, for some reason. Do people think it's "dead" or something?)

That said -- the main text, not the parentheticals -- I'm a bit peeved that the HPV vaccine isn't available on health insurance for me, since I'm "too old." Feh.

(I will also say that I think preemies should only be vaccinated *after* their due date; I very much believe that an after-reaction to a pre-due-date vaccine is what landed me and my kid an overnight stay in the hospital... The same reaction to the second half of the shot, *after* her due date, was handled just fine and was not life-threatening.)

My parents were very adamant about vaccination. My father had mumps and whooping cough back to back right around 1940, and missed months of school. (He was just well enough to go out and see something other than his room when he got the second one.) He had the added bonus of the two on top of each other triggering lifelong kidney and liver issues.

I was born in late 75 in the Boston area - Mom tried very hard for me to get the smallpox vaccine, but they stopped making it available within months of my birthday, as far as she could figure out.

I was exposed to chicken pox at least 4 (and probably more like 7) times - never got it, and the blood titre confirmed I had no antibodies. When the vaccine became available, I was in college. And got it immediately, because asthma + some previous lung scarring (bacterial pneumonia was not my friend) mean diseases with lung complications are excellent things to avoid.

(My understanding is that there's less chance of lung complications with shingles than with chickenpox in cases like mine, so getting the vaccine is definitely recommended if there's no other reason to avoid it. Though reading up on this, I apparently should inquire about a booster.)

I get a flu shot every year for the same reasons - I work at a school, and they highly encourage it, and bring in a nurse to do them on site. We haven't had mass epidemics of things going around, but every cold in existence goes around at some point.

Two people I know have had shingles in the last year (both are over 50 and possibly over 60). One (a friend) had a miserable few weeks of it, but was basically able to work and keep functioning except for the few very worst days.

The other (who's a work colleague) has had repeated problems, spent months on substantial pain meds, and has had to take a couple of weeks off twice to try and get a handle on treatment. (The last round seems to have helped: she's doing a lot better. On the other hand, the initial outbreak was in early September, so the whole experience has been very lengthy. I'm pleased to say work has been supportive of her, and encouraged her to take the time she needs - we have a generally reasonable sick time policy.)

I have a problem with needles. Not pain - I had 7 years of dental work done without anaesthetic - needles.

I can control it, now. It takes time, and absolute knowledge of what is about to happen, but I can control it. The day they need to put me on IV is going to be wild; the day that I regain consciousness to an IV will probably kill me. However, I will cross those bridges...

As a result, I have no idea what my vaccination schedule was (except for tetanus; I have almost exactly 10-year-apart experiences to gauge those on, including one where the nurse was totally brain-deaf, and almost got herself run over by a screaming patient, but that's another story). I do know that I got some of them; I know also that I ducked some of them, quite ingeniously at times. When I was able to control things, I asked my doctor what I should do about it, and he got me something and said keep up with the tetanus as needed.

I don't feel good about it, but I've at least done what I can.

If I recall correctly, she wasn't vaccinated against polio either, for some reason. Do people think it's "dead" or something?

I think that's exactly what people believe -- dead and can't come back, because --- uh?

BTW, I am very aware that not everyone can take the vaccines which I have no trouble with. I took care of my mother in the last 11 years of her life, and she was allergic to or could not tolerate a whole bunch of very common drugs, including most serious painkillers (morphine, oxycodone, etc.) Thank God she tolerated Demerol. It was occasionally quite terrifying.

How's the current flu season in your locale? February is supposed to be peak season here in Northern California; I'm aware of some flu cases but not a whole lot. I'm wondering if we've had a light season.

Oh, and post-polio syndrome? Bad. Evil, nasty and bad. I learned that one early (from the grammar teacher with one shoulder almost 4" higher than the other); learned it again at church (from the sweet lady with a "shoe buddy" (when your feet are 3 sizes off each other, you find someone with the opposite problem, and share shoes) and an oxygen jar; learned it a third time from a bridge partner, who didn't have any issues whatever from the polio itself (so she thought), but post-polio put her in a wheelchair, withered her feet, and effectively ruined her career at 45.

Yeah, those times could come back never, thank you very much. Get your immunizations, so they don't.

I worry sometimes about my cousin who had polio. He came out pretty well - it affected one leg, but not to the point of requiring a brace (afaik). Given that he's an engineer, I expect him to find his own solutions to some of the potential problems.

This reminds me that I had chickenpox during a family winter vacation, in 1977 or '78. We had just reached the rented cabin (it looks exceedingly nostalgic now in memory -- A-frames, pine paneling, people in ski sweaters)and begun to unpack, and I began to whine that I felt yucky. The notorious rash clinched the diagnosis, and while the rest of the family and friends went tobogganing and ice-fishing, I had to stay inside by the heater reading Trixie Belden and drinking flat root beer.

Maybe the illness didn't come on as fast as that, but that's what I remember, time probably truncated by feverish sleep.

The military was pretty adamant about shot records; my memory says nearly every time Dad's job moved us (even from one coast to the other in the US) we had to take that little yellow record book to the new doctor at our new duty station and get whatever booster was required.

I have about half-a-dozen small pockmarks from chicken pox right between the eyebrows; they're not very noticeable. I think I was about six when I got it.

I got the Salk vaccine in the mid-50s, also when I was about six. I don't remember whether I subsequently had to have the sugar-cubed Sabin one; if I didn't, I'm sure I was either annoyed or proud of myself that I'd had to get a shot to save me from polio. I remember the photos of people in iron lungs; that seemed like incentive enough to get a shot.

I know I must have come down with something nasty in my early childhood - I was born in '68, and the earliest date I have clear memories of is my fifth birthday - but I don't know what, nor is my mother much help. I don't have the little card my immunizations are recorded on handy, but I don't recall missing any, I vaguely remember the polio vaccine, and I have a very faint smallpox scar. I lived in Puerto Rico the first year or so of my life, and in NY after that, and I don't know where I'd have gotten the smallpox shot.

I'm a bit hard of hearing, and have been for as long as I can remember. A remnant of whatever I was sick with, I suppose.

As for staying home sick: Four years ago I was working part-time, hourly, and without health insurance. I was paid on the 15th and the last of the month. I planned to work as many extra hours as I could manage to bulk up my February 28 paycheck, because I needed the wages of the usual 10-11 day pay period to pay rent, and had an 8-day pay period to look forward to.

I got rained on heavily the first day and developed a nasty sinus infection. I came in every day and worked as many hours as I could manage, and I was able to pay the rent. It's not a large firm so only a few people were exposed to me, and no one actually caught my bug.

I have a salary and insurance now, and I took all but one of my sick days last year.

Fragano #63: "Camomile is taken internally."

Well, not exclusively so.

When I had chicken pox, circa 1977, the scabs and itching caused me considerable discomfort. We were at that time living in a cabin some 160 roadless miles from the nearest road, perhaps 270 miles from the nearest pharmacy.

My mother applied cloth bandages soaked in strong chamomile tea in an effort to help control the itching. Whether it helped; I cannot say; it certainly didn't help much. Why she thought it might help, I also cannot say. But I'm confident she didn't invent the idea; I presume it was recommended in some herbal or other that she had studied. A quick Google turns up numerous indications that chamomile is sometimes recommended for external use against various skin inflammations, although of course this says nothing of its actual effectiveness in that role. (It seems possible to Google up references in support of using just about any herb for just about any ailment.)

My mother eventually moved on to poultices of comfrey, which actually did seem to provide considerable relief, but were messy and smelly.

Also, to drag William Carlos Williams into this: He was a physician by trade, and he wrote a fairly famous short story, "The Use of Force," that involves a diphtheria outbreak.

I was a hippy, but not a stupid hippy. I made sure all of my kids got every vaccination that was available. My son, born in 1970, was not allowed to have the smallpox vaccination (it had been required, but of course whatever is not mandatory is forbidden) until the family planned to visit the Canary Islands. The trip fell through, but he had the vaccination, so it wasn't a total loss.

I had been going crazy trying to find someone willing to vaccinate him. This was just after there was a smallpox outbreak in Yugoslavia, and in a Herculean effort, vaccination teams from all over the world swept across the entire country and vaccinated every one. Every one. Of course, before that outbreak the authorities had been saying "Oh, it's been wiped out."

I believe there is still some in a viral zoo somewhere. Godnose why, it's been completely sequenced; if we ever needed it(!) we could build it again.

Do people generally have reactions to the rabies vaccine? I had it a couple of years ago (thank you, feral kitten) and wasn't even sore afterwards.

For whatever reason (I never got a straight answer), I was never given the MMR... So of course I had all three of the larger measle family diseases. One as a baby that I don't remember, a quite long lasting bout at age 5 that I do, and finally as the last of an outbreak in our high school when I was 17.

That one I partially remember because I was apparently hallucinating for a good part of it. My fever was over 105 for three days straight, and most of my hair fell out.

What I do remember was VERY unpleasant.

I recommend ALL the vaccinations you can get, because you never know what lies ahead. I had to get my immunity from TB the old-fashioned way, by picking it up from remarkably casual contact with an infected street person. Nine months of meds should now protect me into the future.

I like to embarrass Melody by telling the story about the first gift she ever gave me: Chicken Pox

At age ten, I walked into her house (her brother was my best friend). Her mother yelled "Chicken Pox! OUT!" and I left... never got within 10 feet of Mel, and was there for only a few seconds, but it was enough. Got a week of miserable vacation from school for my troubles.

Thanks, Jim, for yet another wonderful post. You really should collect these, bind them, and put them out on the market...

I've done a recent post on the vaccines-cause-autism theory (something I've followed in the autism community for decades, since a) our son is autistic and b) people are always asking about our attitude towards immunizations).

If I get the coding right, you'll find it here

Otherwise you can call me a tech moron. In case that's true, here's the URL as a plain old string of stuff you can copy & paste:
http://www.speedofdark-thebook.com/blog/?p=57#more-57

Anyway--my original exposure to the anti-immunization campaign was via medical journals back in the 1970s (before our son was born) when there were very dodgy articles by someone later kicked out of the British Medical Association for falsifying data. The autism connection came in later, when autism was no longer being blamed on refrigerator mothers.

Growing up on the Texas/Mexican border in the late '40s and '50s, I saw & heard about the diseases that were mostly gone from the rest of the country, and experienced the success of the polio vaccine. Tetanus and diptheria still occurred in the unvaccinated, and that was before measles, mumps, or chicken pox vaccines, so those were a constant among schoolchildren. I had measles, rubella, mumps, and chicken pox (twice.)

Oh, I forgot--I had TB as a two-year-old (1973?), apparently not very advanced--I remember getting a chest X-ray at 6 or 7 during a check-up. I have no idea what I was given to cure it, but all but my last TB test resulted in...no results. As in, even the needle pricks disappeared. I had one doctor accuse me of offering him the wrong arm when I came in for the viewing.

Apparently this is unusual...at least, I've never heard of it happening to anyone else. But then, the little four-prong thingie seems to have been phased out.

I got my BCG at Nursery school in Kenya. In my teens in rural North Carolina, the doctor scoffed at the idea of a vaccine for tb and gave me a skin test a year to increasingly violent reactions. Each positive tine test was followed by chest xrays which ruled out tb. Finally, when I was in college, I ended up in the emergency room with a bad reaction and the doctor there told me not to get any more skin tests.

My current job requires yearly tb testing but neither the job nor my health insurance covers chest xrays.

My eldest child got only one HiB vaccine. In 1992 it was relatively new (or newly required) and she had a strange reaction to the vaccine. She became cranky, ran a low fever, and her skin became mottled red and white. The ER sent her info to the CDC who called for further info from us and the pediatrician. When she went to high school there was drama because the school nurse didn't like the doctor's note saying that my daughter could not have the last two of the set of vaccines.

I had encountered people who avoided vaccines before, and I think I'll keep this post as a first line of defense against what I consider very dangerous thinking. Reading this led me to see what misinformation is out there, and I found this gem of a site: www.know-vaccines.org. It's quite interesting reading, from a 'they wrote what' point of view:

---
Can mass vaccinations eliminate childhood disease?

A. All diseases declined by as much as 95% before the introduction of vaccines or antibiotics. Improved personal and public hygiene can account for a considerable drop in deaths from disease. Diseases will decline without intervention
---

or
---
Q. Are vaccines good preventive medicine?

A. Vaccinated individuals can contract the same disease they were vaccinated against, and vaccines carry risks of their own.
--
It saddens me that people are actively promoting this nonsense.

I was born in 1972, and had a smallpox vaccination (family moved to various tropical locations) and rubella vax when I was 12, but not measles, mumps or chickenpox. Despite my mother's best efforts in exposing me to all three, I never did catch any until I was in my early twenties when I caught chickenpox, and I really wasn't very sick at all. My doctor was all freaked out when I saw him the day or so before it appeared, my glands were all massively swollen and he urged me to run home and get ready for something serious. I think he was slightly disappointed that I was so well.

All three of my kids have had all their shots, but as I am currently preg again, I've been thinking about vaccinations again. Is there any indication that Anyone Who Knows knows to space vaccinations out more?

(And on the subject of rh, I am 0-ve, and all three offspting are +ve.)

Why do people seem to think smallpox has been eradicated? You can rest assured there are at least a few vials tucked away in many nation's bio-war freezers. I imagine it could be built from scratch if need be, but that is not how defense ministers think. Or tin pot dictators.

albatross, PNH, and subsequent speak of the decay of the credentialed. I wonder whether this is cyclic, e.g.

• crashes related to financial manipulation in the late 1800s, and to greater interest in selling than in thinking about the downside (1929ff); regulation controlled this for a while. (Now it takes a little more work to outsmart the regulations; OTOH, something like half of recent Harvard classes were going into finance.)
• Politicians were often held in sometimes-justifiable contempt, cf "A congressman is a hog!" / "No man's life, liberty, or property are safe while the legislature is in session", Mr. Smith Goes to Washington;
• doctors were not generally treated as gods (rich yes, respected no) until into the 20th century

"Herd immunity" is one of the last things people can be convinced of, with the Right pushing the meme that nobody has any obligations to the general good (cf cgeye@178)

The HPV issue has been complicated by the amount of money one firm would make, and the reports of the amount of money they've spent on lobbying. OTOH, there are suggestions that some of the \many/ varieties of HPV (including some of the ones covered by the vaccine) can cause cancer elsewhere if transferred, providing another reason for the vaccine (if you're not arguing with the anti-sex nutjobs).

Mary Aileen @ 192: IIRC, a flu shot will protect you against \that/ \strain/ for much longer than a year; the problem is that flu mutates (perhaps not as rapidly as HIV or the common cold, but much faster than most diseases), so you need to immunize each year -- against the strains \predicted/ to be serious -- to have substantial protection.

I remember my mother (who hadn't had mumps) calling on her older sister (who had) for help when my sister got it. I'm not sure whether I remember being encouraged to catch it (I didn't) or only the stories of other parents doing that. I don't remember Salk, or polio panics (which might have been because I grew up in a 2-acre-minimum zone), but do remember the oral vaccine (Sabin, which I kept mishearing as "saline")

I see this topic has struck quite a nerve; it's been a while since we've gotten past a quarter of the comment limit in less than a day.

On going to work sick:

I'm a teacher in a K-8 school. Unfortunately, teaching is one of those jobs that does require a warm body with certain licensing/credentialing, so when a teacher gets sick, we can't just call in and crawl under the covers. Substitutes have to be arranged (often by the teacher rather than the administration), lesson plans have to be ready to go, and copies need to be made. These days, given the budget crunch, we're discouraged from taking sick days because that means someone has to pay for a substitute, and pay for me as well.

But there's more to that issue. First of all, preparing for a substitute when you're healthy is bad enough. Preparing for a substitute when you're sick is a form of medieval torture, even if you're among the paragons who have lesson plans in triplicate made out weeks in advance with all of your worksheet copies made and neatly stacked.

If there's a nasty bug circulating around the district, the district can run out of substitutes, so no sub may be available for you. Just in the past few weeks we had to scramble to find a sub for a teacher so sick she could barely drag herself to school much less figure out who was going to substitute for her--so it took several of us calling different people until we found someone who either a.) wasn't already committed to a job that day or b.) wasn't already out sick.

I have plenty of sick hours, but just end up dragging myself to work because trying to do the substitute dance can get too crazy.

As I read down the lists of memories here of a more dangerous world, I'm happy to have been born in 1964 - after polio, though from very vague memories (I don't have access to my childhood medical records, alas) I had rubella and chicken pox and something else, a couple of them before I can remember at all. But survived them all. I don't THINK I ever had mumps, and am not sure about measles. The something else may have been whooping cough.

And I am also irresistibly and repeatedly reminded of the Gashlycrumb Tinies, as a window onto a world where children _did_ die of many and various things (though not necessarily in alphabetical order).

Thus endeth the digression.

--Dave

Not having a smallpox vaccination scar doesn't necessarily mean you weren't vaccinated -- I don't have one, and I certainly was. And revaccinated every three years once I began traveling abroad. I just dug out my old WHO booklet, and my last revaccination stamp is dated June 6, 1973, so it must have been in the mid-70s that it stopped being required.

I had the tetanus-typhoid-diphtheria shots, which were all that was available, when I was a kid. I remember my mother trying to expose me to all the childhood diseases, but the only ones I ever caught were mumps (which I loved; I was sick enough to not have to go to school or practice the piano or drink orange juice, but not too sick to read or play cards) and German measles, which didn't count because it didn't give you permanent immunity (or so we believed). The polio vaccine didn't come along until I was in high school, but fortunately my parents were well enough off to send me out of the city to summer camp during the worst of the annual epidemics.

I obviously had a lot of natural immunity, and a lot of luck. Kids today don't know what they're missing -- thank God.

Immunisation can cause Autism..
Its true.
And i dont care if you flame me hairless.
Cause i stand true to what i say!
I believe immunisation is a lame excuse for a cure.
I was never immunised and niether are my children.
I believe in cirsumsition.
Both of my children were circumsided at 5.

KeithS @ 148

Survival of the fittest is not proscriptive, it's descriptive.

Amplifying: there is no way to measure fitness, either for a single individual or a species, because "being fit" is a tautology: survivors are the ones who survive. Not only are organisms often selected for or against by random events, but also it is in principle impossible to predict all systematic selection criteria, because they are themselves the outcome of evolutionary processes.

(Probably TMI, but I just wrote an entry on my blog on this very subject for Darwin Day, so it's fresh in my mind and wants to come out)

James D. Macdonald @ 162

Cases that were surely Aspberger's or autism had been described long before MMR immunization was invented.

My partner, Eva, taught a number of such cases when she was a student teacher, and after she graduated and got a job as art therapy teacher for the Special Ed unit of a school district in New York state. This was in the late '60s, before MMR. No question about what those kids were (lots of questions about what to do about it; back then we couldn't figure out how to treat it, now we just don't know what it is, and the treatment eats the parents alive in many cases).

"Archangel Beth" @ 231

Thanks for the correction. I think I've been taking the vaccine manufacturer's hype a little too seriously.

Well now Lisa, what could I say to change your mind?

takuan: smallpox has been eradicated as a disease, i.e. it does not live in the wild. The only examples (known to exist) are in deposits in russia, and the US, ostensibly kept in case some strange quirk causes it to come out of hiding.

But no case of smallpox has been recorded since some time in the late '60s. So much so that with no vaccinations in the past 30 years, anywhere in the world, no one has contracted the disease.

takuan, #250: Read again. Smallpox has been successfully eradicated from the wild; those tucked-away vials you postulate (again, with what evidence?) would be the ONLY remaining reservoir. The only reason this could be done at all is (1) a huge push by a number of coordinating health organizations, and (2) the fact that there are no non-human carriers for the smallpox virus. Get it out of the humans, and you're rid of it.

Ever read Demon in the Freezer, Terry?

a not-bad review

Bruce Cohen (StM): I've been doing a lot of talking about this at Slacktivist, where the subject was almost certain to come up, because the nature of fundie-reactions to evolution. It has been a trifle warm, and occaisionally heated.

Lisa: That you believe it doesn't make it true. Just so you know. I believe you are a deluded poltroon, endangering not only your childrens' health, but the well-being of everyone around them. I believe you are foolish, ignorant and benighted.

Actually, the last wild cases of smallpox were in 1978 -- ironically, one of the cooks on the smallpox eradication team who hadn't been vaccinated and picked it up from a girl in the back seat while he was driving her to the hospital -- and there was a small outbreak in Britain in 1979 caused by the virus escaping from a lab; it was subsequent to this that everyone but the CDC in the US and the equivalent facility in Russia destroyed their strains. (Or claimed they did.) There is some evidence that the Russians were working on weaponizing smallpox (a program _probably_ dropped since glasnot), and it's always possible that someone else somewhere was or is. But there's no direct evidence of that as far as I know.

Lee: the US admits it has some (at Ft. Detrick), and the Russians also admit to having it. There is a treaty somewhere which deals with it.

takuan: No. All things being equal, I probably don't need to. My line of work exposed me to way too much information.

Tony Zbaraschuk: There's a reason I used 30 years. :)

The weaponisation... No guarantees about the cesation after glasnost. Actually... it's already pretty much weaponised, the trick is infecting the vectors; more I shall not say.

"An outbreak of weaponized smallpox occurred during its testing in the 1970s. General Prof. Peter Burgasov, former Chief Sanitary Physician of the Soviet Army, and a senior researcher within the program of biological weapons described this incident: This article is about the armed forces of the Soviet Union. ...

“On Vozrozhdeniya Island in the Aral Sea, the strongest recipes of smallpox were tested. Suddenly I was informed that there were mysterious cases of mortalities in Aralsk. A research ship of the Aral fleet came 15 km away from the island (it was forbidden to come any closer than 40 km). The lab technician of this ship took samples of plankton twice a day from the top deck. The smallpox formulation— 400 gr. of which was exploded on the island—”got her” and she became infected. After returning home to Aralsk, she infected several people including children. All of them died. I suspected the reason for this and called the Chief of General Staff of Ministry of Defense and requested to forbid the stop of the Alma-Ata—Moscow train in Aralsk. As a result, the epidemic around the country was prevented. I called Andropov, who at that time was Chief of KGB, and informed him of the exclusive recipe of smallpox obtained on Vozrazhdenie Island.”

EClaire @228: A nurse at my clinic actually told me that she was concerned about giving five shots all in a whop because of the strain on my baby's immune system and the possible, at that point not convincingly disproven, bad effects of that much mercury at once. The new vaccine schedule spaces the shots out more and uses a different preservative and my second baby wasn't as uncomfortable for the 24 hours after each one.

Daniel Boone @240: Chamomile and comfrey are both proven to accelerate the healing of skin lesions and minor wounds. Comfrey is much stronger, though. Chamomile is what my sister-in-law the midwife puts in her marvelous diaper rash cream, but comfrey is what she has mothers put in their underwear if they had a perineal tear during childbirth.

Also, I detect the odor of troll at 255. If the troll had just resisted putting in the last two lines, I might have mistaken hir for a semiliterate Web surfer doing a drive-by; however, trying to start a tangential argument just let out a big ol' troll fart. Ignore hir.

Recent radio program on this particular vaccination problem: Ruining it for the rest of us (This American Life). (I think this was the program quoted by Anna Ferglio Dal Dan in 71.)

I came across it from a Coding Horror article on group dynamics. The first section of the program covers what is, essentially, the way that trolls can ruin the atmosphere of a thread.

@ 255: Oh, dear.

Well, we can certainly see the results before our eyes.

I'm not a Southerner, but for the life of me the only thing I can think of to say to this person is "Bless your heart."

--

I do have a comment/theory for the rest of you about vaccines and autism, which I've been thinking of for quite some time.

This is my own crackpot theory. Nonetheless, knowing what I know, I tend to think it's more believable and realistic than other crackpot theories on the subject - seeing as it's compatible with both the consistent anecdotes (that autism often appears shortly after vaccination) and the medical evidence (that vaccines do not cause autism in any circumstance.)

Speculation is as follows: People with the genetic predisposition to autism are going to develop it at some point. Autoimmune reactions figure strongly in autism in some way. (See here, here, and especially here.) My guess: a child with this predisposition will have this reaction triggered at some point in early childhood, as their immune system develops, as soon as anything stimulates it (an immunization, a cold, some food their system doesn't like...)

Also compatible with anecdotes about autism showing up after an illness or a move - immune system meets new data, doesn't like it, freaks out.

Still waiting for the research, of course.

Daniel Boone @ 240

I wonder if there's a sort of etymological thing going on with the Chamomile? When I had chicken pox I was told to dab the blisters with calamine lotion (which a bit of Googling shows to be principally zinc oxide and of dubious efficacity) whereas Mrs Beeton, from the 1860s, swears by calomel (which was principally mercury) for all sorts of rashes and lesions, including teething rash in infants (!). Since so far as I can see nothing stops this itching perhaps there's just a kind of maternal folk wisdom that one waves something that sounds rather like calomel at it, and the child either ends up badly scarred or not.

takuan @ 266: Wow. A friend of mine was born in the USSR in the early eighties, and has a smallpox vax scar. I did wonder about that.

What a world to grow up in.

legionseagle @ 270:

There's more than that going on for chamomile - its essential oil apparently inhibits genital herpes, which is in the same virus family as chicken pox, and there are apparently a few studies out there that show some anti-inflammatory topical properties, but I can't get at anything informative.

There are many levels of efficacy in between "inactive" and "miracle drug."

Lisa@255: Please consider yourself scorched and hairless. If you can't understand the difference between a cure and a preventative, you aren't worth the effort of actually arguing with you.

For your grandchildren's sake, I hope your children eventually figure it out.

Albatross, Charlie, Patrick, it's not just the past generation. Something has been wrong with our elites for a very long time. The pervasive sense, though, that the wrong people are in charge deserves more thoughtful attention. I keep going back to hippie ideals: ideally authority is granted to the wise and compassionate--why is it so hard to do this? The failure of authority, though, is complemented by a stunning personal arrogance: the idea that, since the authorities are often wrong, we are right. There is also what I think of as the cult of the parent: the idea that, somehow, parental fears are a reliable guide to childcare. Hunh. There's more there, I think, but maybe when I'm really awake.

I had a mild case of whooping cough when I was seventeen. Because it was so mild, it was only diagnosed in retrospect, when I said to myself "I wonder if that awful cough I had years ago was whooping cough?" But the whoop was unmistakeable. So stupid. Now I'm horrified that I was going around potentially infecting babies with a deadly disease. It's not a nice thought.

I had a surprising number of diseases for growing up in the 1980s. Whooping cough (despite being vaccinated), scarlet fever (is there a vaccination for that?), measles, mumps, probably-rubella (I had encephalitis as a baby so I didn't have my MMR; I had it at 14, after I'd already had the illnesses anyway) and chicken pox (in the middle of my GSCEs, hurrah for antivirals).

I asked my GP about tetanus boosters, as my last was at 13, but he said that if your childhood boosters are up-to-date, you don't need any more unless you have a wound. Apparently this is now NHS recommendation. I'm not overly worried, as the chances of a software engineer contracting tetanus are pretty low, but it seems a bit dodgy.

The NHS has also switched from administering BCG to everyone at 14, to a targeted program, which seems a bit strange when TB is on the rise again.

Elizabeth @245

Thanks for the link to your post - nicely written and informative.

And I enjoyed the book.

Cat, regarding scarlet fever, are your fingernails ridgy? My brother had it when he was a kid, I think pretty soon after chicken pox, and all I remember of it is him taking an oatmeal bath and later, everyone mentioning how weird it was that his hands and feet peeled so much and that it made his fingernails ridgy.

Lisa @ 255... my children were circumsided at 5

Meaning that someone walked around them thru 5 dimensions?

From your mouth to ignorant parents' ears.

I took care of a non-immunized 15 year-old with tetanus. He survived after 6 months in the ICU. I remember yelling around the ER, to see if anybody had ever done an emergency tracheostomy. The kiddo's dad was a chiropractor who scorned traditional medicine.

Of course, traditional medicine wound up saving his son's life.

IMMUNIZE. Don't ever shade your eyes.

I've been immunized more than a few times... loss of paperwork/proof of shots meant that I had 'em done as a baby, boostered in eighth grade, had 'em redone before college mk 1, and had 'em redone again before college mk 2. (I am not good at keeping track of proof-of-immunization paperwork.)

I've also been done for smallpox (mid-seventies, rural Pennsylvania) because we went out of the country for vacation to the, er, wilds of Mexico. My parents were paranoid sorts.

I had a tetanus shot this past summer after I ran a nail through my boot and well into my foot (but not through it) at work. The doc's office let me come in at the end of the day, had me show 'em my foot, and poked me. It was not a problem. I do live in a very rural (dairy cows/horses, not at all urban) part of the country, though, and tetanus shots here have always been handed out pretty freely.

Lisa 255: you are an ignorant, stupid, antisocial troll. Circumcising boys at 5 will cause great psychological harm too.

I hope it's only you who get the lethal or crippling disease. I hope whatever passes for Child Protective Services where you live removes your children from your abuse and neglect, and that they are OK and forget you ever existed.

It seems like it doesn't matter how well one can prove that vaccinations are best, people are still stupid. Recently, I posted about the falsification of the vaccine-autism link to ASPecialParent (an LJ community for parents of special-needs children) and got back "but nothing has been proven, so I'm still not going to vaccinate my children" from MULTIPLE people. And the moderator is very firm that we don't yell at people for having stupid beliefs. Just... AAAAAAAARGH!

#267: There is NO MERCURY in children's vaccines in the USA.

My nephew has autism. Nobody is suing. The kids continue to get their vaccines. We acknowledge the genetic probablilites. We also think his tipping point was a vaccine given while he was sick. When he went in for his vaccines at 18 monthes, he was running a fever. The nurse offered my sister the option of giving him the vaccine that day or when he had no fever. There was no mention of increased risk in giving him the vaccine while he ran a fever or any benefit in waiting.

In the last couple of years, my pediatrician (different state) has not given vaccines if the kid is ailing but asked us to come in another day (with no additional copay).

I have a recollection of a discussion, a few years ago, of the possibility of building a virus from a published gene sequence.

It may even have been discussed here: this is one of the places I frequent with a suitably bizarre mix of knowledge.

We may be getting to the point where we could build a cow-pox equivalent--surface proteins from one virus and the core from something relatively harmless.

It would be easier to make a disease virus, because it wouldn't need a detailed understanding of what different parts of the gene sequence do.

As a special education teacher, and the parent of a now adult diagnosed with autism, I'm somewhat knowledgeable on the subject. Right out the door, I'm going to lean toward the genetic argument. Within my family, we have a lot of people who exhibit traits that fall into the autistic spectrum--and the thing to keep in mind is that autism is a spectrum disorder, so what can be eccentricism in Great-Uncle Charlie may come out as full-blown, head-banging, non-verbal, severe autism in little Jimmy, especially if traits exist on both sides of the family. I've yet to encounter a student with autism who doesn't have close family members who don't display some sort of autistic trait.

Another factor that appears to tie into autism is a familial connection to certain other mental disorders including bipolar disorders. The genetic research so far (I'm not completely up to date on this) suggests that autism can occur on several genes; what's interesting is that some of those also tie into asthma and gastrointestinal syndromes. This can tie into the apparent trigger of autism being something which triggers an autoimmune response.

The prevalence of autism is also a slippery issue. One thing which makes me crazy is that almost no one writing on the subject talks about whether their source for the autism "epidemic" is tied into medical diagnosis or educational identification. It's easier now to educationally label a child with autism than it is to get a formal medical diagnosis. Additionally, Asperger's Syndrome and the concept of milder levels of autism spectrum disorders was not considered to be credible before the early 90s--Asperger's research during World War Two was not made public until then, and up to that point it was pretty much all Kanner's research, which focused on severe autism. Before the early 90s people who are now identified as High Functioning Autism or Asperger's Syndrome got a different label, depending upon who they saw.

People with severe autism who had Down Syndrome or mental retardation comorbid with the autism also were considered to be retarded or developmentally delayed, period. Now there's an attempt to identify the comorbidity of autism with MR/DD/DS. I have seen a person with comorbid Down Syndrome and autism--the combination is vastly different from a straight Down Syndrome presentation.

Causes and management of autism go way beyond any alleged connection to the vaccine issue. I find it interesting that the anti-vax crowd has now moved beyond the mercury issue and into other arguments against vaccination--all which don't ring true, at least to me. I much prefer living in a world with workable vaccines, thank you very much--and wish that there were some vaccines I could take, just so I don't have to worry about that damnable flu and my asthma every winter.

takuan: I don't know whether to call it arrogance or overfamiliarity, but something in your tone (as opposed to content) has led me to start skipping all your posts. You might want to take a deep breath and try again. You are, as you point out, a guest in the Nielsen Haydens' virtual house.

But then, I'm assuming you actually want people to read what you're writing.

Lila,

The conversation has been had, for odd reasons, in the zombie thread.

(This is not scolding you for bringing the matter up, just clarifying to you—and subsequent people—that it has occurred.)

abi:

I beg your pardon, and takuan's. I had ceased to follow the zombie thread.

I was born in 1981, and the "vaccino trivalente" (MMR vaccine) wasn't yet approved in Italy, so my parents consulted with the pediatrician and my father went in Switzerland to buy it.

The vaccine against varicella (chickenpox) arrived a few years later, so I caught the disease from a schoolfellow, who got it from his younger brother, when I was 15. At the beginning it was relatively mild, high fever but not too much blisters... until three LARGE ones appeared on my foreskin. After that, it was a nightmare: they weren't just itchy, but actually painful, and they lasted for a week or so.

I remember my first real job out of college, which came with one day of sick leave per month. I tended to make use of those days, to head off small illnesses at the pass and keep them from becoming bigger illnesses. At my first (6 months?) review, by supervisor made a note on my file saying that I seemed less committed to the job, because I took so many sick days (no more than what was allowed, for sure). Of course, this was the sort of place where another of the managers would come in with some plague or another, dead on his feet, and get everyone else sick. It pissed me off.

I was pissed off again this year with the insurance at my new job. Went in for my annual exam, and got my flu shot while I was there. The doctor noticed that my last tetanus shot had been in 1999, and so she gave mo one of those as well. I thought this was fine...both shots a once.

Well, turns out the insurance only paid for the flu vaccine and not the administration of said vaccine (even though it is supposed to be covered 100%) and not at all for the tetanus (which was supposed to be covered after a $5 co-pay: "injections and serums, including allergy).

I appealed and got the flu shot paid for, but they still rfused the tetanus on the grounds that it was "preventative." Whisky Tango Foxtrot???

One of my co-workers had the exact same issue, at the same time. Tetanus shot not covered, even after appeal. It seems that the literature we were given that said it was covered was "marketing material" and not the plan documents. Total bull. So I hate Humana with a passion. I wish my employer would switch to a local HMO, but I doubt that will happen. Small employer (25 people) and tight economy.

I also wish that the HPV vaccine hadn't come out a few years to late for them to let me have it. I am all for getting immunized for whatever I can.

I'm old enough to have had most of the immunizations (smallpox scar, f'instance) but also old enough to have had most of the usual childhood diseases (sigh.)

I recall chicken pox very well. Summer, uncle's house, a rash so bad that photos make it look like sunburn. I also recall the treatment my mother used for the itching. Not chamomile, and not comfrey, nor any other herbal: she used spray-on Ban deodorant.

Relief: instant and lasting, at least for an hour or so. And I recall waking up one night from the itching and plotting how I was going to get out of bed and get to the can of Ban without waking my mother, who was sleeping in the same bed...

Daniel Boone #240: My mother used calamine lotion, plus repeated orders not to scratch because the scars would be permanent. I discovered that they were, and I have a couple of pock-marks on my nose (small ones, fortunately) to remind me of when I was fourteen going on fifteen.

#8 ::: Doug Faunt:

There was a mother on the show who was opposed to immunization and seemed to have extreme concerns about controlling the purity of everything that went into her kid. I suspect that if there were a super-pure vaccine (actually identical to the usual) that cost two or three times as much, she'd use it.

There'd be ethical problems with creating and marketing special upscale vaccines, though.

****

Are there any theories about why adults have a much rougher time with some diseases?

****

Patrick in #86:

Nitpick: the anti-vaccine movement was started well before we found out inept a lot of people in finance were.

****

#256 ::: Bruce Cohen:

I agree with all your points, with the caveat that evolution is more like the non-survival of the least fit for local conditions (and the unlucky). It isn't aiming at any sort of "fittest".

****

#287 ::: Joyce Reynolds-Ward:

About a possible link between autism and gastrointestinal problems: There's a book called The Second Brain about the digestive system and the amount of nervous tissue needed to run it. Frex, it's a tricky thing being made of meat and having stomach acid which digests meat-- you need to release just enough base to neutralize what's coming out of your stomach.

If autism involves a low-level problem in neurons, then it wouldn't be surprising if the GI tract gets affected.

I'm old enough to have had most of the immunizations (smallpox scar, f'instance) but also old enough to have had most of the usual childhood diseases (sigh.)

I recall chicken pox very well. Summer, uncle's house, a rash so bad that photos make it look like sunburn. I also recall the treatment my mother used for the itching. Not chamomile, and not comfrey, nor any other herbal: she used spray-on Ban deodorant.

Relief: instant and lasting, at least for an hour or so. And I recall waking up one night from the itching and plotting how I was going to get out of bed and get to the can of Ban without waking my mother, who was sleeping in the same bed...

Grr. Sorry about the double post.

I had the measles and jaundice when I was young. I remember my parents later blaming my myopia on my not having listened to what they had told me the doctor had told them - that I should refrain from reading. Talk about a guilt trip. Mind you, everyone in our family now wears glasses and they've never read a book in their life.

Rosa #209:

Actually, I think we're talking about two different and interestingly-overlapped phenomena:

a. There's a cost/benefit sort of decision involved in deciding whether to get vaccinations, that's based on the well-being of a particular patient. Folks who believe that vaccines have some unaccounted-for extra risks (causing autism, allergies, cancer, spontaneous combustion, whatever) disagree with that assessment because they suspect that the cost (risk of bad outcomes) is larger than the people proposing the vaccination lists believe.

b. There's a different aspect to the vaccination decision, which involves externalities and an interesting prisoners' dilemma kind of problem. It's not at all clear to me how much weight those should get in individual health/treatment decisions, and I can't see any way to get an unambiguously right answer.

I think (a) is where Patrick and my comments start having an effect--the question is, when someone says "We have weighed the risks and rewards of vaccinating all healthy kids for disease X, and it is a sensible tradeoff--the risk of bad things happening from the vaccine is less than the risk of bad things happening from the disease, even assuming pretty widespread vaccination (making the probability of getting the disease pretty low)." The problem is, the sorts of folks who've made those statements are also known to sometimes lie for their own purposes. For example, federal agencies involved in food safety changed their minds about the right response to the dangers of mad-cow-infected beef, once there was a documented case inside the US. Similarly, the acceptable level of melamine in baby formula was zero while there were no test results showing any contamination in US supplies, but changed after such results appeared. (My understanding is that the levels found in US supplies really weren't dangerous, but it was telling just how the statement (allegedly about science) changed based only on economic/political implications inside the US--there was a nice discussion of this on Effect Measure awhile back.) There have also been media stories about evidence of pharmaceutical lobbying influencing FDA approval decisions, and there was that whole completely political battle about approval of the morning after pill.

Those things undermine the good name of the agencies involved, and related agencies. And this is true for every group of elites/experts. You can and do find academics spinning their results for either political/philosophical impact or (probably way more common) to maximize their chances of getting more grants/funding. You can and do find churches acting in ways that are distressingly contrary to their stated ideals when their money is at stake[1]. Medical schools fund departments that basically teach and research woo, because it pays to do so. Respectable politicians and academics and businessmen all get up and lie, routinely. Sometimes they're the polite lies required to be a public figure. Sometimes, they're lies required to achieve their immediate or long-term goals. Sometimes, they're lies intended to conceal or spin away some wrongdoing or embarassment.

We're so used to this, it usually doesn't even surprise us. When a person in a position of trust is caught lying, people on his side (his party, his company, etc.) routinely can be counted on to make excuses for him or to try to spin things to minimize the impact.

[1] In Maryland a few years back, there was a Sunday Mass in which our priest read a statement from the bishop, urging us all to call or write our legislators about an impending bill in the state. Now, the is the Catholic church, so you might guess we were urged to oppose publically funded abortion, or birth-control, or stem-cell research, or perhaps capital punishment. But no. The bill they wanted us to oppose would have eliminated the statute of limitations on sex offence lawsuits in state court.

I find myself unable to express exactly how this made me feel. My wife was incensed, and sent an angry email to the priest afterward. (From body language and tone, the priest was pretty-much forcing himself to read something he'd been ordered to read.) This did not cause me to leave my church, but it certainly had a big impact on how I felt about my church. And I didn't speak up--which makes me part of the problem.

Renee @ 297

Yes, but you managed a double-post separated by two other posts - that's clever!

I got all my vaccinations. I had childhood asthma, and my parents didn't want to deal with any more sickness than they already had. There was no vaccine for chickenpox, which is the only childhood disease that I contracted. I think I was four. I had a medium miserable time of it. Strictly enjoined against scratching, I had the good luck to get lice at the same time as the chickenpox.

As an adult, I got a puncture wound from my cat, then called Monster. (He went through a lot of names.) The puncture was at the ball of my left thumb. The next day I noticed that my left elbow and shoulder felt a bit stiff and painful. In the morning, while at work, I called the clinic. The nurse listened, and asked me when I'd last had my tetanus shot. I said I couldn't remember, when I was little, probably. So she said, "We have an open appointment at 1:00. I'll see you then."

"No," I explained. "My boss hates me. I can't take time off work. How about Saturday?"

"How about today?" she counter-offered.

"No, you really don't understand. Today is not an option. Look, what's the worst that could happen if we wait until Saturday?"

"Oh, you know," she said in a cheerful, sing-song voice, "death."

"Death?"

"Death." Same cheerful voice.

"Oh, um. I'll see you at 1:00."

So I went and got my tetanus shot, and the pain in the arm and shoulder went away.

That's been more than 10 years ago, now, and I am reminded that I need another tetanus shot. Plus a whole bunch of others, actually, before I have clinicals in the fall. I forget what the battery is. I have no objections. I just hope insurance will pay for it.

I keep my tetanus up to date, as my doctor recommends. I'm fortunate in that my employer-paid insurance does pay for it without quibbling (Thanks, BC/BS!). I do not work with horses, or do much of anything dangerous, so I can't claim to have risks factors. However, I do have a paranoid (I hope) vision of the 8+ earthquake finally hitting the Pacific NW. As I'm picking my way out of my collapsed house, with lots of nails, glass, splinters, etc., getting to the Urgent Care for a shot is going to be way down my list.

That "don't come to work sick" thing is complicated for a manager. The one (and not quite only) thing I liked about working at Intel was that they didn't track sick time for salaried employees. I could tell someone to GO HOME and not worry about it. In other companies, I've had people who had 15 days per year of "flexible time off" to handle their vacation, their kids being sick, and being sick themselves. I could surreptitiously slip them a little comp time, and help them figure out how to work from home, but didn't feel that I should lecture them on how they should use the 15 days they had to work with.

Lila @288 - You're not the only one.

(In my writing group, they say "Even if others have made the same critique already, it's useful for the author to hear that multiple people have that reaction." But clearly I need to catch up on the zombie thread.)

Way upthread, someone mentioned something being "proscriptive not descriptive." I'll go out on a limb and pick that nit with my Handy Dandy Mnemonic:

PRESCRIPTIVE: Thou shalt do it.

PROSCRIPTIVE: Thou shalt not do it.

DESCRIPTIVE: It is done.

Re: HPV vaccine - My husband and I both want it, but are under the impression that it's not covered for me (too old) and it's not even available for him (not yet approved for males). I have been given conflicting info about this over the web and over the past year, possibly because the status is changing. Can anyone offer helpful pointers?

Also, wasn't acutely aware about shingles, which seems odd since usually I get good info from the medical professionals in my family on this stuff. As I had chicken pox in 1990 or 1991 (relatively mild case, thank goodness), perhaps I should be looking at the varicella vaccine....

(makes new list of questions to bring to annual check-up)

Nicole @ 304

My nephews (16 and 13) were offered Hpv vaccine at their annual visits in January.

Sara

Sara_k - awesome. Do you know if there's a cut-off age? Seems to me that my husband asked around last summer (his doctor, Planned Parenthood, etc.) and kept getting told "We can't give it to men".

(We're in Boulder, CO, btw; HPV vaccine is non-controversial in these parts.)

Another question: What is there an employee can do when the employer gives them a certain amount of sick days on paper, but makes it clear that they're On Notice if they use up more than one of them in a month (and they were given enough that by using up only one of them per month they'd have some leftover)?

Which is to say - You got sick days, but Gods help you if you use them. You get called into the office for a Serious Talk.

I ask not for myself (who am gainfully unemployed and happy about it) but for friends who have shared this anecdote. At the time I thought, "Bastards!" Reading this thread, I now am thinking, "Wow, that *is* a form of embezzlement, isn't it?"

So... what does joe/jane schmoe employee do? Something that's not prohibitively expensive or complicated? Is there a body to whom they can make a simple complaint?

FWIW, "find another job" is untenable, and besides does nothing for everyone else subject to the same bait-and-switch policy at that company.

Elephantitis secondary to scarlet fever (photo).

Amoxicillin (or any number of other antibiotics) clears scarlet fever right up. If your kids have strep throat, go to your doctor. Nothin' like those good old-fashioned Childhood Diseases, eh?

Heliotrope cyanosis typical of the Spanish Flu of 1918 (painting).

The flu will return in pandemic form. The only question is when. Do get your flu shots.

Smallpox (photo).

Be glad that it's no longer out in the wild; and that a vaccination is available.

Tetanus typical presentations (Photo) (Another photo) (Painting)

Don't screw around with this one. You want your tetanus shot.

In other companies, I've had people who had 15 days per year of "flexible time off" to handle their vacation, their kids being sick, and being sick themselves.

I'm sorry, I don't think I understand exactly what does this mean. Sick days, leaves and vacations are all lumped together?

I'm just a lowly junior network/system administrator on my first job with a one-year-contract but I'm entitled to 20 days of vacation (excluding the 12 days of national festivities, which are paid if they happen to be on a weekend day), 32 hours of leave, and if I'm sick I just need to go to my general physician who examines me and eventually gives me as many sick days as he deems necessary.

If you get viral pneumonia, the ugly soupy stuff that will inhabit your lungs can easily breed a bacterial infection. Hell, you can have a viral and a bacterial infection at the same time. The pneumovax will ward off the bacterial pneumonia.

The CDC recommends the shingles vaccine for people 60 years old and up. For those between 60 and 69, it's about 65% effective in preventing the disease or reducing its severity. Its effectiveness diminishes if you wait to get it until you are 70 or older.

albatross at 299, my sympathies. I'm in California; I had a hard time when the Knights of Columbus in my parish made a strong push to raise funds for Prop 8, the initiative which took away the rights of same-sex couples to marry in this state. Our pastor, interestingly enough, said nothing for or against Prop 8, or if he did, I wasn't there and it wasn't significant, because no one talked about it. I've stopped giving the Knights any money, even though they do really good work on other fronts.

Throwmearope, #280: You've got the germ* of a good filk there; you might want to consider finishing it.

Lydy, #301: Style points to your doctor's nurse for her skillful handling of the situation!

Jim, #308: If your kids have strep throat, taking them to the doctor is a mercy as well as a preventative against worse things. I now understand why in the 19th century it was referred to as a "putrid sore throat"!

Giacomo, #309: Your understanding is exactly correct. This is a new "cost-cutting" fad in many companies. They present it as if it were a feature -- rather than having specified amounts of time available for specific purposes**, you now have one pool of time off that you can manage in the way that works best for you. But typically the combined pool is anywhere from 25% to 50% smaller than the original vacation + sick leave + personal time was.

* You should only pardon the expression. :-)

** Which sometimes involves a certain amount of fibbing on the part of the employee, and/or leads to demands that vacation time be used if you've exhausted sick leave or personal time.

Giacomo -- yeah, that's right. If you get sick, you forego vacation.

One of my first jobs? Allowed forty hours paid leave. Period. If you got sick, you didn't get to take it for vacation. (I only worked there until I found something better.) This was for the peons, of course -- those of us who stocked shelves and made deliveries and slopped food in the cafeteria. The management got substantially better benefits.

My current job has essentially ample leave time, but a highly complicated system to qualify for it without penalty. The red tape and the if-then-but rules are mind boggling. It's so bad that I went into work Friday with a sore throat/laryngitis so bad I had to run to the bathroom to yak every time I coughed, and a fever in the 102 range.

Easier to just go to work than fighting with the third-party disability manager over the red tape. (Red tape usually involving multiple faxes between me, the doctor, and the disability manager, with ever escalating levels of annoyance of the doctor's part).

And this company really does have the best benefits of any company I've ever worked for ... sigh.

I was born in 1975, late enough not to have been vaccinated against smallpox (my mother has the scar on her arm), but before the chickenpox vaccine was available. I got chickenpox around age 4 or 5; all I remember of it is many days of itchy boredom.

One of my uncles had polio as a child, and lost the use of one arm. I'm amazed more people aren't aware of it, too.

Nancy Lebovitz @ 295

evolution is more like the non-survival of the least fit for local conditions (and the unlucky). It isn't aiming at any sort of "fittest".

That's the problem with using English to talk about evolution, all the good words imply some kind of teleology, which is completely wrong.* Certainly I intended no implication of any "aim" on the part of evolution, or any taxon or biological individual.

Since my point was that the concept of "fitness" is incoherent, I'm not going to feel bad about not using "nonfitness" instead. The only real question is who survives and reproduces, and how much.

You can't predict deterministically which organisms will win the reproduction contest, and even trying to assign probabilities is difficult because you don't have perfect knowledge of what might be decisive for survival. And it just now occurrs to me that one reason why assigning probabilities is difficult is that the distributions aren't gaussian, they're very likely a power law. I just finished reading Benoit Mandelbrot's The (Mis)Behavior of Markets, which states that the orthodox techniques for predicting risk in markets always misses the possibility of catastrophe because it assumes market events are gaussian, when they're not. If this is incomprehensible to you, ignore me.

* When I was more heavily into evolution theory, a couple of decades ago, I remember someone came up with the term "teleonomy" to use when referring to systems that converge on some optimum without prior intent (because saying that eyes evolved so that animals could see is just wrong). Does anyone remember who coined that term?

Bruce (StM) @ #314 Merriam-Webster doesn't have the originator's name for teleonomy, but it does have a precise year; 1958. Go figure.

Giacomo @ #309, that's exactly what it means. My husband works for a hospital and that's the way his vacation/sick leave is structured. In addition, employees were strongly encouraged to use their remaining vacation days before the end of last year, to "help balance the books"; this left some without any sick days when they got sick in January.

The reason Lisa @ 255 writes such poor English is that English doesn't appear to be her native tongue.

She is, however, a crank (if not a full-time troll). See, for example, her comment at this page "Unødvendig propaganda eller arroganse?"(last one at the bottom at this time).

I've done some cursory searching for books about polio-- specifically something memoirish, but anything good is, um, good. Any recommendations?

I'm a little surprised how many people have unpleasant reactions to the tetanus booster. I had mine last year after being bitten by a feral cat (my fault, I forgot about young male cat's biting when stimulated) and had no soreness.
Now, a typhoid shot -- that one's a bitch. Two days of aching and swelling.

Nicole @ 306 I don't know about the cutoff age. My sister is in South Carolina; she sent her eldest son, 18, in to get the vaccine as well.

We are in Maryland; it's been controversial but not among the other public school middle school parents in our county. The controversy seems to come from people who don't have children or who have children they are CERTAIN would not be at risk. I've seen things go from soaring to mud-puddle-stomped with great speed. There are no certainties.

Diatryma @ #319, here's a radio interview with an author who survived it.

FYI, Diatryma, the search term I used to find that was "polio survivor memoir" without the quotation marks. There appear to be quite a few matches.

Kes @ 319: I vaguely recall a tetanus shot that I had after cutting myself* did hurt a bit, but I don't have any vivid memories of the tetantus booster shots, so I assume they were no big deal. Perhaps they give a shot with more oomph if you're bleeding?

*Note to self: That annoying, in the way, bar on the paper cutter is there for a very good reason.

Huh. Here's the book list from the Post-Polio Health site. An awful lot of memoirs.

Sorry for this burst of activity; I was burning CDs and hit a stopping point.

Nicole J. LeBoeuf-Little @ 304 and 307:

That would be me with the pre/pro problem. I'd blame my typing if I could get away with it, but I think it's more a malfunction with the thing sitting between the chair and the keyboard.

In regards to the sick leave problem, your friend has a couple options. If your friend is in a union, this is one of those things that they're supposed to go to bat for you over. If not, the human resources department is where your friend wants to go. It will probably be a bit difficult convincing them with no proof, but if enough people complain or if there is some form of evidence then that will help.

Nicole J. LeBoeuf-Little @ 304 and 307:

What KeithS said @ 325 is correct. I'm assuming it probably isn't a union job, as so few jobs in the US are unionized. If your friend's situation is one boss that's a jerk, in a company that generally behaves well, then HR can help -- though that leaves them working directly for a jerk who is now pissed about being spanked by HR.

Some companies have a way to raise issues anonymously through a 3rd party website, like EthicsPoint. If their department is reasonably big, then they could complain there without creating a very high risk of getting targeted afterward.

#314 ::: Bruce Cohen (SpeakerToManagers):

The reason I promote "non-survival of the least fit" is that I think "survival of the fittest" implies that only a few survive, and I think that isn't the typical situation, at least for R-type species.

I haven't read Mandelbrot, but I've read some of Taleb's Black Swan stuff-- he thinks markets underestimate the likelihood of all sorts of events, not just the bad ones.

@Giacomo #309 -

I work for one of them Internet companies (what is actually fairly large these days) and my sick/vacation is still treated like that.

To some comfort, everybody from peons up the entire management train (up to the CEO, of course, I don't know what anybody can do to *him*), has their sick days structured like this. You have to have been with the company for years (as in, more than 5) to qualify for more than 10 days out of the year for holidays. AND we get two paid (single-day) holidays out of the year.

That said, we're allowed to work from home to minimize the spreading of communal disease, but I've found that I have a tendency to work too much anyways and prolong my illness.

I'm not in the most depressing position in the world, by far, but it's definitely not a great one.

Jim @ 308: Urkle. And I am the backwards of squeamish; that is just heartwrenching.

I'll be over here fondling my vaccination scar very fondly ... I'm up-to-date on everything except possibly tetanus, which I *think* I last had in '02, unless I've forgotten a puncture wound, and this thread has me wondering if it really is ten, or five, or what.

The usual proceedure is that whenever I manage to step on a nail or commit some similar self-injury I call the doctor and she checks the chart and decides if it's close enough to when I am due that I go in and get a booster. I have honestly never had to remember to get a booster, not once.

IOW, I have never since my baby shots wore off gone more than ten years without a puncture wound, and going more than five is rare.

Which makes me a hopeless klutz, yes, and also suggests that tetanus inoculation is my warm, fuzzy, and deeply beloved friend, which I shall hug and squeeze and refer to as George forever.

(I was bemused recently to notice that I appear to have two smallpox vacc. scars. I don't, of course; the second one is a chickenpox scar on the opposite shoulder, but honestly, if it weren't for location I'd be hard pressed to say which is which. )

Switzerland is a measles reservoir.

According to a story in the Lancet, most of Europe's measles cases are in Switzerland, Germany, Roumania, Italy, and the UK. Steiner schools and antivax activists--including doctors(!)--are to blame, says Le Monde.

My mother, aged 21, went to a party. On the way home it rained. She caught a chill, then a cold, then took to her bed. Then they had the doctor in. It was TB so they took her to the sanatorium to die.

In order to slow the disease the doctors chopped the infected part of the lung away. The TB came back. They chopped some more. In such a fashion she spent the years from 21 to 27, in a ward full of young girls her age. They had fun of sorts as they waited to die. Although occasionally they'd wake to find the curtains drawn around a bed. Nurses would come and go, and after a day or two the curtains would be gone when they woke.

And so would the girl who'd lain there.

Her mother would visit every Sunday, in the way you'd visit the graveside. She'd bring magazines and little treats, have a chat. And then she'd go back to the land of the living, and my mum would get on with dieing.

And then they invented a cure. And she didn't die. And one day as she was being wheeled around the grounds, still too ill to walk but getting better, a clumsy (?) nurse managed to get her wheelchair entangled with another patient's chair.

Reader, she married him. My father, also short a lung, but not dieing. They're still alive, still together and still only have one pair of lungs between them. I got immunised in the womb from my mother's antibodies, I didn't need the TB jab, but trust me, we got every immunisation going.

I've got the smallpox vaccination scar; I remember the polio scares when I was very little, and how Salk was considered a hero, and oh ghods those shots hurt and no one complained, because we all knew of at least *someone* who wore leg braces or had spent time in an iron lung from polio. (And the the Sabin vaccine came along, just a sugar cube...)

Before the age of 10 I'd had measles, rubella, scarlet fever, pneumonia, at least two or three strep throats a year. Also mumps, but so mildly I barely noticed.

Had pneumonia again, very severely, in '93; was elated when *that* vaccine came along.

Don't remember when I had my last tetanus shot; my memory for such things isn't good, but my doctor's the sort that will tell me emphatically when the next one's due, so I don't worry about it.

Had shingles in my early 30s, and the nerve pain was horrendous. Does anyone know if the vaccine would still be useful if one has already had one attack?

(Oh, and Jim? Bartells Pharmacies in the Seattle area are making Vial of Life 'scrip bottles available, complete with all forms, door sticker, and fridge magnet. Suggested contribution is $1; got mine and one for a friend.)

Giacomo@309: the other side of your comment is also uncustomary in the U.S.; practitioner verification of sickness is IME uncommon. Arguably this is because the practitioners are supposed to be generating money for somebody rather than taking care of the general health of the population. I'm also a bit croggled that a practitioner would state in advance how many days will be needed; I've had 1-bad-day colds, 3-bad-day colds, and a share in the office food poisoning that kept me running for several days (which, unlike the colds, may have been partly my fault -- bouillon got too boring after a while).

Re mistrust of elites & diagramming sentences:

I agree that a good deal of the problem with mistrust of experts/belief in bad science is that too many people lack the tools to tell which is which.

A personal anecdote of one cause for this lack --
In the 70s, my high school (semi-rural outskirts of Kansas City, MO) required only ONE year of 9th grade general science. I took all the science I could work in, but most kids never took a science class after.

(The school was fortunate that one of the teachers of that required class intentionally designed the class to be as memorable as possible, and included as many real-world problems and experiments as he could muster, but he couldn't work miracles. Oh, we could get credit for reading science fiction, too. Naturally, it was my favorite class!)

Back to my point...you might think that such a minimal requirement wouldn't be too bad because in four years almost all would take another science class just because they'd run out of anything else that was available. But no -- probably half or more of the kids went for vocational-technical training. I know programs vary around the country & world, but in this district it meant their entire junior & senior year they took a few classes in the morning directly related to their specialty (meaning no general science or history or literature), then spent afternoons at a job.

The upshot was that -- gut feel here -- 3/4 of the students were probably functionally science-illiterate about 5-10 years after graduation.

I thought about this a lot in the 80s when we heard so much ignorance about HIV transmission -- people clearly didn't believe what the experts were telling them because they had no idea how the researchers had arrived at their conclusions or how rigorously they were reviewed. In the absence of that knowledge, the scientific conclusions were viewed as simple assertions that could be believed or disbelieved.

Oh, my high school's other subject requirements were pretty minimal as well: 2 years math; 1 year "social studies" + 1/2 year civics; don't remember the English requirement -- I think 2 years but maybe only 1; 2 years of a language (Spanish, German, French only). The district wasn't *quite* anti-intellectual, but certainly didn't think 'book learning' was anything special.

Speaking of the Vial of Life idea, on the ML Vial of Life thread, the FAQ link is broken. That city moved the FAQ .pdf to a new page.

Nancy Lebovitz @ 327

The reason I promote "non-survival of the least fit" is that I think "survival of the fittest" implies that only a few survive, and I think that isn't the typical situation, at least for R-type species.

I take your point. Extra agreement considering that R-types are so much more common than K-types.

ObSF crossed with reproductive strategy: If you're familiar with Joss Whedon's Angel series, you might note that the god Jasmine may use the ultimate K-type strategy for "reproduction". Gung vf, fur fcrag lrnef znavchyngvat gur yvirf bs orvatf ba Rnegu, vapyhqvat pnhfvat znwbe qvfehcgvba gb ynetr cnegf bs Fbhgurea Pnyvsbeavn naq pnhfrq n certanapl ynfgvat nyzbfg n jubyr GI frnfba, nyy gb tvir ovegu gb urefrys.

When I was three, we were visiting my relatives when I woke up with a bad sore throat. My parents took me to the doctor (pediatrician) a couple of hours later. The doctor called an ambulance. I had HiB epiglottitis.
Apparently, I was lucky. The doctor told my parents many people don't recognize it is serious until their child stops breathing, which can happen within hours.
This was in the early eighties, just before the vaccine came out. My younger sisters got the vaccine. But quite a few adults were never immunized.

I’m not sure we can, at this stage, categorically say that vaccines don’t cause some form or forms of autism, given the wide-spectrum we’re talking about.

We also can't categorically say that space rays from evil aliens don't cause autism, since science has not adequately studied evil-alien-related space rays as a potential cause of autism. But I'm not going to be putting my bets on the Colour Out of Space as a cause just yet. Are you?

I am one of the least trusting-of-Big-Pharma people out there, being a plaintiffs' lawyer and all. I still vaccinated all my kids and yes, that included chicken pox.

American workplaces, sick leave, TB:

My grandfather, an accountant for Royal Dutch Shell in Los Angeles, came down with TB sometime between 1945 and 1950. No cure yet. He had a wife and young daughter; he was the breadwiner

They sent him away to get better. He couldn't work or stay home. It took a lot of time—I don't know how many months he was away. His employer kept him on, and paid his salary the entire time he was away.

It worked, too; my mother still tests negative for TB antibodies. My grandparents were very careful; they used to boil the flatware he'd used. But without the time away, he would almost certainly have given them both TB.

He never bought another brand of gas in his whole life.

(When we talk about conservative values in business, why doesn't this kind of story come up?)

There were some comments in the 50's regarding tuberculosis that I feel need a little clarification.

Tuberculosis is found in every country in the world and it is estimated 1/3 of the world's population is infected asymptomatically, with about 8 million new clinical cases per year, and 1.5 to 2 million deaths per year. It is responsible for the second highest number of deaths from infectious disease per year, trailing only HIV/AIDS.

The BCG vaccine shows effectiveness against Mycobacterium tuberculosis bacteria causing meningitis or disseminated infection in children (and cross-immunity against leprosy - caused by a different Mycobacterium). It does not prevent primary infection or reactivation of latent disease, which is how it most easily spread.

Interstingly, some primary infections are caused by Mycobacterium bovis (cow TB), usually due to unpasteurized milk productions. These infections are usually in cervical or intestinal lymph nodes rather than the lungs. For those who enjoy unpasteurized milk products - best of luck to you!

Most of that post is from a 2004 BCG position paper from the WHO, available online at http://www.who.int/immunization/wer7904BCG_Jan04_position_paper.pdf

You can read the rest, it has some good stuff in it. TB has been on my mind as I have to get checked for it again as I come into contact with populatoins most likely to carry TB (those who are HIV+, poor, homeless, or have been in prison).

Back upthread, someone was wondering why 'childhood' diseases are so much worse in adults.

This was explained to me thusly, by the nice doctors in the infectious diseases unit who were making sure chicken pox didn't kill my husband.

As a rule, a child's immune system is extraordinarily robust, since nature expects them to be exposed to all sorts of new infections, fight them off, generate antibodies etc, with all that speedy cell-division going on, what with growing and such.

This capacity decreases as one gets older, which isn't usually too much of a problem because the adult generally meets fewer infections that they haven't encountered before* and got a level of immunity against. Apparently this is why the older you get, the fewer common colds# you get.

Hence germs a kid could fight off landing adults in a hospital bed.

Hence childhood cancers, especially leukemia, often being so horrendously aggressive.

*This system doesn't work so well these days what with air travel exposing folk to whole new sets of germs.

#colds, not flu. These doctors were all for flu vaccine for the elderly and anyone at increased risk.

Abi @ 339... Mind you, in those days, a Democrat could be called 'conservative' too, the difference being that the values he/she wanted to conserve were different from those of a Republican. Unfortunately, today 'conservative' tends to mean 'social darwinist', I think.

abi #339:

Yeah, it's like it's some kind of deep surprising revelation that loyalty has to go both ways. Some employers manage that at the whole-institution level. Some individual bosses or divisions of large organizations manage that. And many more don't.

I've worked for a large organization and a smallish company that didn't have that insight--they expected some loyalty from you, but offered none in return. (Though in both places, I had good bosses who provided what loyalty they could.) I've also worked for a very small company and a very large organization that got it.

I suspect we don't normally hear about the decent employers (businesses, neighborhoods, etc.), because they aren't "news." But, FWIW, my current employer has been extraordinarily accomodating of the massive time and mental energy drain of our recent pregnancy and birth, including letting me shift my schedule to work from home, being flexible about my arrival and departure times, etc.

Andy Brazil @ 331: Wow. That's a truly glorious "Reader, she married him."moment. Thank you for writing it up.

Andy Brazil @ 331... What Bruce Baugh said. Plus some 'wow'.

#308, regarding strep throat: I would add that it's important to remember that not all kids have the classic horrible sore throat, with strep. Older Son had strep two or three times: he had fever, bilateral earache and upset stomach, and never complained of throat pain at all, although apparently it was pretty clearly strep when the pediatrician had a look at his throat.
Weirdly, younger son has never had anything involving a fever of more than a degree or two (that I remember: I don't guarantee my memory is accurate for either child's younger days) and apparently didn't catch strep from his brother the one time that would have been possible, quite a relief to us: my brother and I passed strep back and forth a lot when we were young, which eventually resulted in my brother's having his tonsils removed.

Once again I am reminded why Jim is my hero.

The area I live in, while great in many ways, is also chock full of anti-vaccination nuts. I watched a friend of mine's one month old son nearly die of whooping cough that he caught from an older, intentionally unvaccinated child several years back, and I didn't need to click on the "this is what it sounds like" link to remember very vividly the sound of the poor little boy coughing until he'd entirely emptied his lungs of air and then had to struggle to draw in the next breath.

I have a coworker who is similarly not vaccinating her kids, and who keeps offering to come over with her kids and babysit my nine month old twins. And as much as I could use an escape from the house, I just can't do it. She gives me her "lecture" every year when I get the flu shot, and it's both tedious in the extreme and offensive to boot.

OTOH, my nephew has severe health problems and there are a few vaccines that there is a family history of severe reaction to; what keeps him and other kids who can't be fully vaccinated safe is other parents being responsible and vaccinating kids who can be. What these people don't understand is that they are not only gambling with their own children's lives, but with the lives of other people's children too.

Flu kills people. Every year, about 35,000 right here in the USA.

Knew a kid who limped? Or wore braces? Hmpph. She was in a wheelchair, with braces on her short, shriveled legs that had long, surgical scars down their fronts.

Sent away for the summer? Oh yeah. I was in the cycling unit at Camp Hoffman during a bad outbreak. We get up, wash our faces and hands in the cold pump water, go to breakfast, wash our faces and hands in the c.p.w., go out cycling on the roads, eat by the side of the road, cycle some more, return in late afternoon, wash o.f.&h. in the c.p.w., go to supper, wash o.f.&h. in the c.p.w., chat, go to bed. We did not tour places with people, not even the cow barns at U.R.I. (a staple activity). We got ice cream once: We stopped across the street. One counselor went across, wrote down the menu, and came back. We placed our orders, the counselors went over again, got the cones, and brought them back. Not a very engaging experience.

I got the entire series of five Salk injections and three Sabine sugar cubes.

abi, #339: When we talk about conservative values in business, why doesn't this kind of story come up?

Because the way the terms have been redefined, that sort of loyalty from a company to an employee is now a liberal value. Today's corporate conservatives would view doing something like that as a waste of money, and money is what being in business is all about.

Suzanne, #347: My sympathies. If I had babies under a year old, I wouldn't want them exposed to those walking germ-warfare bombs either -- and after the second or third lecture, that's exactly how I'd phrase it. (Not that I'm saying you should do that; you're not me, and I don't know what your work situation is.) But if there's a way to express to her the gist of your last sentence without getting into too much trouble, you might consider it.

Sara K. @247: In my teens in rural North Carolina, the doctor scoffed at the idea of a vaccine for tb and gave me a skin test a year to increasingly violent reactions.

My mother was an elementary school teacher and had to get X-rays to check for TB once a year. The year she was pregnant, she switched schools and had to get three X-rays: on on the normal schedule of her old school (June), and one in the normal schedule of her new school (October), and one for switching (some time in between).

Lee #350: It's someone I generally get along well with at work, except for this one issue. She knows how I feel and I know how she feels and we generally try to avoid pushing each other's buttons on it, but I don't think she thinks of that every time she offers to babysit (which is in and of itself a very nice gesture). In fairness, I always make a point of inviting her along every time I'm heading off to the flu shot clinic, even though I know it means the lecture for me.

She's a nice, well-intentioned person who just seems really gullible for any mass hysteria of this type. She also won't eat *any* refined sugar, which I wouldn't care about except she keeps volunteering to bake for office birthday parties. If you eat one of her cupcakes you walk around for the rest of the day feeling like you've got a cinder block in your guts. )-:

I really like that my husband's boss will tell him to go home if he shows up looking like death. If one person shows up sick, everybody is going to get sick. This should not be unusual. I think that many local businesses have a relatively liberal sick leave policy because we are a port town and we get smacked with everything short of bird flu when the cargo ships come calling. Also most businesses are small enough that the boss is sure to catch it.

I used to work for a non-profit that paid bupkiss, but had excellent benefits. You got three weeks of paid leave after your six-month probation; this amount went up with seniority, topping out at five weeks. And as long as you gave a week's advance notice, you did not have to explain what it was for. If you called in sick that morning for yourself or in order to care for your child, you were supposed to bring a doctor's note, or at least have the doctor fax something to the office, when you came back. This could be, "Your secretary called me with a list of symptoms for her son, it sounds like he's too sick to leave the house, I advised her to stay home and feed him chicken soup and call me again if things aren't better by tomorrow."

On Tuberculosis: There was an epidemic in about 1959 or 1960 here; the original cases were all among people who'd been going to Indian Baseball League games, if memory serves; my sister and I had gone to Vacation Bible School at the Nisqually Mission Church, so we had to have skin tests, standing in long lines in the play yard at the church. At least one friend had to go to an inpatient facility.

And anyone interested in the experience of being a TB patient in the pre-antibiotic world is advised to read The Plague and I by Betty MacDonald as well as the TB chapters in Nissei Daughter (which then segues into the Japanese detention and deserves read for that reason alone).

Going to work sick, pattern analysis:

Kids get sent to school sick because parents have inadequate sick leave (and also because attendance laws make keeping sick kids home a hassle beyond toleration, in my experience) and then sick teachers have to stay at school because there are insufficient substitutes available. Add that to people grocery shopping sick, and catching up on their movie viewing when they do have sick leave, and the likelihood of stopping a 1919 style pandemic looks pretty slim.

Going to work sick:

It's not just teachers; anyone in a public-service job has to balance taking a sick-day against who's available to provide coverage if you don't make it in. (And that's assuming you have the sick-time, as others have said). There've been times when I've decided that I can't be sick today, there's too many people out (vacation, whatever) already; if I still feel bad tomorrow, I'll stay home then. In such circumstances, I do my best to clean shared phones, keyboards, etc. with alcohol wipes, but nothing's perfect.

We actually get a fair amount of sick-time, and the boss is reasonable about us taking it when we need to. But there are days when staying home puts the rest of the staff in a real bind.

abi @ 339 and Lee @350::: American workplaces, sick leave

I agree with Lee that that treating employees well has become a liberal, rather than a conservative, value.

Such good treatment hasn't entirely gone away. Someone I know had a terrible bout of ill health about a year ago, and was out for 6 months. Their employer made up the difference between their salary and the short term disability payments, and kept medical insurance paid up. The sad thing is that I'm not going to mention the firm's name, because I suspect that a manager and/or HR person might get into trouble with corporate over this.

The employee has worked for the same company for more than 20 years, which might be a factor, though the "company" as such has changed hands (up the ownership tree) at least 3 times.

In my case, not vaccinating my kid would cause death. In me. From my parents.

Let's see: my father lost a younger sister to measles. My mother had polio as a child (no apparent long-term issues; she's in her sixties now.) She also