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February 20, 2009

Why We Immunize
Posted by Jim Macdonald at 01:09 AM * 916 comments

There’s a manual that every Navy gunnery officer was required to read or re-read every year: OP 1014; Ordnance Safety Precautions: Their Origin and Necessity. It’s a collection of stories about, and photographs of, spectacular accidents involving big guns and ammunition. Gun turrets that have fired on other gun turrets on the same ship. Holes in the coral where ammunition ships were formerly anchored. That sort of thing. It’s simultaneously grim and fascinating.

Nowadays there’s some kind of movement afoot for claiming that immunizations against common childhood diseases are unnecessary. That they cause disease. That they’re harmful. It is true that rare adverse reactions to immunizations occur. It is also true that adverse reactions to the diseases themselves are not at all rare if you don’t immunize. So let’s call this post Immunizations: Their Origin and Necessity.

Still, we have people fighting against immunizations. Observe:

Product:
Kids Vaccinations in general

Advantages: none

Disadvantages: enormous

I suppose that depends on whether you feel “Didn’t have to buy a teeny-tiny headstone” is an advantage.

Fair warning: If anyone shows up here to say “Immunizations Cause Autism,” that person will be flamed hairless.

The link between autism and immunization was based on faked research by a man who stood to profit if MMR was discredited. It has been completely exploded.

Here’s the US Government’s recommended schedule for childhood vaccinations:

  • Birth to 2 months: hepatitis B.
  • 2 months: polio; diphtheria, pertussis, tetanus (D.P.T.); Haemophilus influenzae type B (Hib).
  • 2 to 4 months: hepatitis B.
  • 4 months: polio; D.P.T., Hib.
  • 6 months: D.P.T, Hib.
  • 6 months to 18 months: hepatitis B and polio.
  • 12-15 months: D.P.T.; Hib, measles, mumps, rubella (M.M.R.).
  • 12-18 months: chicken pox.
  • 4-6 years: polio; D.P.T., M.M.R.

Let’s look at those diseases.

IN MEMORY OF MARY S. DAUGHTER OF CAPT. SAMUEL AND BETSEY TILLOTSON SHE DIED DEC 11TH 1819 AGED 9 MOS.

Hepatitis B

In the USA, 4,480 liver disease deaths per year are due to hepatitis B virus. Another 3,000 deaths per year in the USA are Hepatocellular carcinoma deaths due to hepatitis B.

Acute Hep B is usually fully cured, fairly quickly. The folks with chronic Hepatitis B are generally people who caught it as children, manifesting years later. The signs and symptoms of hep B include:

  • Loss of appetite
  • Nausea and vomiting
  • Weakness and fatigue
  • Abdominal pain, especially around the liver
  • Dark urine
  • Yellowing of the skin and the whites of the eyes (jaundice)
  • Joint pain
Most children who catch Hep B are asymptomatic (but are infectious).
Hepatitis B infection may be either acute — lasting less than six months — or chronic, lasting six months or longer. If the disease is acute, your immune system is usually able to clear the virus from your body, and you should recover completely within a few months. When your immune system can’t fight off the virus, HBV infection may become lifelong, possibly leading to serious illnesses such as cirrhosis and liver cancer.

Most people who acquire hepatitis B as adults have an acute infection. But the outlook isn’t nearly as hopeful for infants and children. Most infants infected with HBV at birth and many children infected between 1 and 5 years of age become chronically infected. Chronic infection may go undetected for decades until a person becomes seriously ill from liver disease.

[UPDATE]

Why should I vaccinate my newborn child if I know that I am not infected with hepatitis B virus?
Before the hepatitis B virus vaccine, every year in the United States about 18,000 children were infected with hepatitis B virus by the time they were 10 years old. This statistic is especially important because people are much more likely to develop liver cancer or cirrhosis if they are infected early in life, rather than later in life (most people are infected with hepatitis B virus when they are adolescents and young adults).

About 9,000 of the 18,000 children infected in the first 10 years of life caught the virus from their mother during birth. However, many young children didn’t catch the disease from their mother. They caught it from either another family member or someone else who comes in contact with the child. Because the disease can be transmitted by casual contact, and because many people who are infected with hepatitis B virus don’t know that they have it, it is virtually impossible to be “careful enough” to avoid this infection.

For these reasons, all young children are recommended to receive the hepatitis B vaccine. The best time to receive the first dose is right after birth. This will ensure that the child will be protected as early as possible from catching the disease from someone that doesn’t know that they are infected with the virus.


Let’s talk about the immune system a little bit. This will be a super-simplified overview.

Essentially, the immune system is what keeps us from rotting while we’re still alive. And it does this by being able to tell “us” from “not us” down at the cellular level and destroying the “not us” stuff. Most of us have immune systems that can do this. (Folks who can’t tell “us” from “not us” have their own immune systems attacking them and are said to have auto-immune diseases. Folks who can’t tell “not us” from “us” can’t defend themselves against invaders, and are said to be immunocompromised. This can be either from disease process, or done deliberately, for example in folks who have received organ transplants to keep them from rejecting their foreign tissues.)

You must know that all cells, including our body’s cells, and the cells of bacteria, are made of protein, and the exterior capsule of a virus is also made of protein. And proteins have shapes. The way the body recognizes us from not-us is by the shapes of the proteins.

Specialized blood cells, white cells, go around testing things for their protein shapes. When they find things that don’t belong, they destroy them.

Early in an infection, foreign proteins may not be recognized as “not us.” The viruses or bacteria use this time window to multiply, perhaps beyond the level that the body can cope with. But once the body has been sensitized to the unique protein shapes associated with specific invaders, it remembers them, it produces antibodies specific to them, and if that shape ever appears again is ready to instantly overwhelm the foreign proteins.

If the body’s defenses are so tuned that they destroy the foreign proteins before any signs or symptoms develop, the person is said to be immune.

DANIEL H. TILLOTSON SON OF SAMUEL & BETSEY TILLOTSON DIED AUGUST 9, 1813 AGED 1 YEAR 8 MONTHS

Polio

Polio is the reason the Iron Lung was invented.

Most people who catch polio don’t get sick and are never aware that they were infected. Nevertheless, they can still shed the virus for others to catch for several weeks or months. Photo. Photo. Photo.

Of those who are symptomatic, most show vague flu-like symptoms (e.g. fever, headache, sore throat) associated with any number of viral diseases.

5-10% of those infected develop nonparalytic aseptic meningitis. This lasts from two to ten days. Signs and symptoms include:

  • Fever
  • Headache
  • Vomiting
  • Diarrhea
  • Fatigue
  • Back pain or stiffness
  • Neck pain or stiffness
  • Pain or stiffness in the arms or legs
  • Muscle spasms or tenderness

In paralytic polio, the most common form is spinal polio. In children under five, this most commonly results in paralysis of one limb; in adults paralysis of both arms or both legs is most common. Limb paralysis can occur in any combination, however, and paralysis of the muscles that allow breathing is also possible. It used to be that everyone knew someone who’d been affected; one of my sister’s classmates, for example.

There’s bulbar polio. In bulbar polio, the brainstem is infected, and the cranial nerves are affected. These nerves control your ability to eat, speak, and breathe; seeing, hearing, taste, may be affected, as may the heart, lungs, and digestion.

Ten to forty years after a polio infection, the patient can develop post-polio syndrome. This includes sleep-related breathing disorders, muscle weakness, joint pain, and difficulty with breathing or swallowing. Doyle’s mother has post-polio syndrome. Of polio itself, all she remembers is having to learn how to walk—twice.

Perhaps the best-known polio victim was president Franklin Roosevelt. Used to be that everyone knew at least one person who’d been partly paralyzed by polio. Not so much, now. Wild polio was eradicated in the Americas in 1999. But polio could come back at any time if the immunization rate drops. Polio spreads via the fecal-oral route.

An essay on polio from Elizabeth Moon, below the cut.

Way back in the 18th century, Edward Jenner noticed that milkmaids generally didn’t catch smallpox. What Jenner didn’t (and couldn’t) know at the time was that the surface proteins of cowpox are similar enough to the surface proteins of smallpox that the antibodies specific to one also protected against the other. What he could, and did, notice was that an infection with cowpox translated into an immunity to smallpox.

Jenner published An inquiry into the causes and effects of the Variolae Vaccinae, a disease discovered in some of the western counties of England, particularly Gloucestershire, and known by the name of the cow-pox, in 1798. He called deliberately infecting someone with cowpox in order to grant immunity to smallpox “vaccination” after the Latin word for cow, vacca.

The practice of vaccination caught on rapidly. Still, there was opposition:

Christian Charles Schieferdecker, M.D.
Dr. C. G. G. Nittinger’s Evils of Vaccination.
Philadelphia: the editor, 1856.

Because of the lack of clear scientific explanation of its effects, the frequent side-effects, and contaminated vaccines, vaccination itself remained controversial throughout the nineteenth century. It certainly carried risks for the infants being vaccinated, and this volume, playing on parental fears, argued, inter alia, that vaccination was nonsensical, unscientific, criminal, and even sinful. Shown here is a satiric vignette of a protective mother’s discussion with the family doctor.

IN MEMORY OF CARLOS SON OF CAPT. SAMUEL AND BETSEY TILLOTSON WHO DIED NOV THE 4, 1818 AGED 5 YRS

Diphtheria

Here’s a nasty. Diphtheria is highly contagious and potentially life-threatening. Signs and symptoms include the lining of the throat turning into a thick, gray, moist membrane that can block breathing, requiring either intubation or a tracheostomy. The bacteria also creates a toxin that that circulates in the blood stream and can damage the heart and kidneys, and cause nerve damage leading to paralysis. Before the diphtheria immunization became common, the United States had some 200,000 cases and 15,000 deaths per year from the disease, 80% of them children. Post-immunization: 41 total reported cases in the US from 1980 to 1995.

Early signs and symptoms include:

  • difficulty breathing or swallowing
  • double vision
  • slurred speech
  • signs of shock

When the diphtheria anti-toxin was first used successfully in Berlin, Germany, Christmas 1891, it was the first time any disease anywhere had actually been cured. Up until then, all that medicine had ever been able to do was support a patient until that patient’s own immune system either worked—or didn’t.

Diphtheria is why Balto, The Bravest Dog Ever, has his statue in Central Park, and why the Iditarod is run every year, in memory of the run that brought diphtheria anti-toxin to Nome.

Diphtheria doesn’t just kill; it kills grotesquely (“bull neck”).

She wrung her hands and groaned and cried
And gnawed her tongue before she died.
Her nails turned black, her voice did fail
She died and left this lower vale.
Wicked Polly

It’s highly contagious. When you see in an old graveyard an entire family of children dead inside a week, think of diphtheria. Here’s a picture of a diphtheria lesion on a leg. (Teresa, don’t look.)

By the second half of the 19th century, the germ theory of disease was gaining ground. Robert Koch, the German bacteriologist, came up with some requirements of what would be necessary to show that a particular bacterium caused a particular disease.

First, the same bacterium had to be found in every victim of the disease.

Second, the bacterium had to be cultured, and when the culture was given to healthy patients, they had to develop the disease.

Third, each of those patients had to be cultured, and the same organism again recovered.

Louis Pasteur was trying this with chicken cholera. With one batch of chickens he used an old culture. The experiment failed: none of the chickens got sick. He tried again with a fresh, strong culture. The experiment failed again; still those chickens didn’t get sick. Even though the same fresh culture was sure-enough sickening other chickens who hadn’t previously gotten doses of old, dead bacteria.

“Holy Mackerel!” Pasteur said (or words to that effect in French), “I think I may be on to something.”

He called his process of creating immunity by inoculation with killed or weakened pathogens “vaccination” in honor of Jenner’s pioneering work with smallpox.

HULDAH DAUGHTER OF IRENE AND EBENEZER KNAPP BORN JUNE 18, 1811 DIED FEB 21, 1813

Pertussis

Pertussis is the fancy name for whooping cough. Here’s what it sounds like. Photo.

The course of the disease runs like this: One to two weeks of symptoms that resemble the common cold, followed by two to four weeks of severe coughing. What do I mean by severe? I mean coughing so hard that it can break ribs, cause cerebral hemorrhage, rectal prolapse, or seizures due to hypoxia. I’m talking about vomiting and aspirating the vomitus. That kind of coughing. Complications include pneumonia. Following that stage comes a recovery stage that can last months.

Pertussis was once a leading cause of infant mortality. Between the 1930s, when immunizations became available, and the 1970s, the rate of pertussis in the USA fell 99%.

In England, the percentage of people vaccinated over the last 4 decades decreased to less than 30%. This decline has resulted in thousands of cases reported recently, a rate that approaches the incidence in the prevaccination era. Similar epidemic outbreaks have recently occurred in Sweden, Canada, and Germany. Nearly 300,000 deaths from pertussis in Africa are thought to have occurred over the last decade.
Since the seventies, as rates of vaccination have gone down, the pertussis rate has been rising again, with a spike of 25,000+ cases in 2005. Pertussis is the most commonly reported vaccine-preventable disease in the United States in children younger than 5 years. It is highly contagious. Pertussis can be treated with antibiotics, and with mechanical ventilation and suctioning. Untreated, it has a mortality rate of around 50%.

Community immunity (AKA “herd immunity”) is when so many people are immune to a disease that the disease has no way to reach the rare non-immune patient. Think of those immune individuals as firebreaks. Enough firebreaks and the fire just won’t spread. And there will always be individuals who aren’t immune, no matter how rigorous the immunization schedules: Some will be immuno-compromised. There will be others for whom the immunization doesn’t “take.” Yet others will be unable to receive the immunization due to allergies. But enough firebreaks and they’ll be protected too, by the “herd”—the disease will have no way to reach them.

Pertussis is one of the diseases for which community immunity works well. Its only transmission route is human-to-human (by airborne droplets). But in order to develop community immunity between 92% and 94% of the population must be immune. Among those who are not immune: on average one index case creates 12-17 other cases.

Since Pertussis only exists in humans, like smallpox, it could be eliminated in the wild by sufficiently complete immunization.

CAROLINE DAUGHTER OF IRENE AND EBENEZER KNAPP BORN OCT 27, 1807 DIED JAN 27, 1808

Tetanus

Community immunity won’t help you with tetanus (AKA “lockjaw”). The bacteria that cause tetanus are common in the environment. Any contaminated wound can have a nice case of tetanus associated.

Tetanus causes prolonged contractions of the skeletal muscles. That’s what locks the ol’ jaw. That’s also what can bend you over backwards like a bow until you’re supported by just your heels and your head. (Photo) (Another photo) (Painting) (Child with tetanus, Photo) (Infant with tetanus, Photo)

I’ll fix your feet til you can’t walk
I’ll lock your jaw til you can’t talk
I’ll close your eyes so you can’t see
This very hour, come and go with me
I’m death I come to take the soul
Leave the body and leave it cold
To draw up the flesh off of the frame
Dirt and worm both have a claim
O Death

Signs and symptoms may include:

  • Difficulty swallowing
  • Sore muscles
  • Spasms in the facial muscles
  • Muscle spasms (may be strong enough to break bones or dislocate joints)
  • Difficulty breathing

Tetanus is life-threatening. Once the patient is symptomatic, in the US, the mortality rate is 25%. Worldwide it’s 50%.

We routinely inquire about a patient’s tetanus immunization status any time a tetanus-prone wound shows up, and routinely give the immunization any time the patient isn’t 100% sure he/she has had the shot within the past five years.

One of the early signs of tetanus is the rictus sardonicus, a smile like the Joker in the comic books. A highly accurate (and highly specific) test for tetanus is this: tickle the back of the patient’s throat with a tongue depressor. If the patient coughs, gags, or chokes, that’s negative. If, on the other hand, the patient bites down on the tongue depressor, that’s a positive: he’s got lockjaw.

If you have a deep or dirty wound, particularly a puncture wound, get it seen in an Emergency Room. If you have a wound and subsequently start feeling muscle cramps in the area … get to an Emergency Room now. We have people standing by.

“L. B.” IN MEMORY OF LYMAN SON OF MR. JACOB AND MRS. ABIGAIL BLACK WHO DIED SEPT 10TH 1801 AGED 6 YRS 10 MONTHS 23 DA

Haemophilus influenzae type B

This is the disease that inspired this post. The news story read, Rare sickness kills child; officials urge vaccination

A childhood illness that has mostly been curbed through vaccinations has killed one child and sickened four others in Minnesota, health officials said Friday.

The five children were infected with a bacterial infection known as Hib: Haemophilus influenzae type b.

Three of the affected children had not received any vaccinations, including the 7-month-old who died, according to the Centers for Disease Control and Prevention.

“The situation is of concern,” said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Disease at the CDC. “It could be happening elsewhere, and of course it’s tragic that one of the children actually died from a preventable disease.”

One of the infected children, a 5-month old, had not completed the three-dose series of the vaccination, and a 15-month old child had received all doses but had an immune deficiency.

Before the immunization was developed, 43 per 100,000 children got meningitis associated with Hib.

Of those 43, 20% would die. 8.6 out of those 43. One in five.

So, you see, five sick and one dead falls right into the expected mortality rate. It’s a mortality rate that’s worse than you’d get playing Russian Roulette (where the odds are one in six that you’ll die).

How about the ones who get Hib meningitis and don’t die?

15%-30% of survivors suffer some permanent neurologic damage, including blindness, deafness, and mental retardation.

Another 17% of invasive Hib cases include epiglottitis, an infection and swelling in the throat that can cause life-threatening airway blockage. Other forms of invasive Hib disease include: joint infection (8%), skin infection (6%), pneumonia (15%), and bone infection (2%).

With Hib vaccine, the rate of Hib meningitis is 0.11 per 100,000.

JOHN N. SON OF JOHN AND MARY HUBBARD DIED MARCH 21, 1836 AGED 1 YR (8 MO 1 DA)

Measles

Complications of measles are comparatively rare. But given that measles’ infection rate is around 90%, a small percent of a large number is still a large number. And in third-world countries, the fatality rate for measles runs around 28%. Among immuno-compromised folks right here, measles is around 30% fatal. (That’s where community immunity comes in handy—if the immuno-compromised folks never run into measles because everyone else is immune, they skate.) Photo. Photo. Photo.

Measles is comparatively mild in children; it can be devastating in adults. The 1911 measles epidemic killed 5% of the US Army.

And even “comparatively mild” is still nothing to laugh at. Those complications can include blindness and deafness from scarring. In The Five Little Peppers and How They Grew the children all get the measles, and there’s quite a bit of concern that Polly will go blind.

But Polly’s eyes didn’t get any better, with all the care; and the lines of worry on Mrs. Pepper’s face grew deeper and deeper. At last, she just confronted Dr. Fisher in the kitchen, one day after his visit to Polly, and boldly asked him if they ever could be cured. “I know she’s—and there isn’t any use keeping it from me,” said the poor woman—“she’s going to be stone-blind!”

“My good woman,” Dr. Fisher’s voice was very gentle; and he took the hard, brown hand in his own—“your little girl will not be blind; I tell you the truth; but it will take some time to make her eyes quite strong—time, and rest. She has strained them in some way, but she will come out of it.”

To poor Polly, lying in the darkened room, or sitting up in the big rocking-chair—for Polly wasn’t really very sick in other respects, the disease having all gone into the merry brown eyes—the time seemed interminable. Not to do anything! The very idea at any time would have filled her active, wide-awake little body with horror; and now, here she was!

Signs and symptoms of measles include:

  • Fever
  • Dry cough
  • Runny nose
  • Inflamed eyes (conjunctivitis)
  • Sensitivity to light
  • Tiny white spots with bluish-white centers found inside the mouth on the inner lining of the cheek, called Koplik’s spots
  • A skin rash made up of large, flat blotches that often flow into one another

Complications include:

  • Ear infection. Measles causes an ear infection in nearly one out of every 10 children.
  • Encephalitis. About one in 1,000 people with measles develops encephalitis, an inflammation of the brain caused by a viral infection, which may cause vomiting, convulsions and, rarely, coma. Encephalitis can closely follow measles, or it can occur years later during adolescence as a result of a slow virus infection. The late form, called Dawson’s encephalitis, is rare.
  • Pneumonia. As many as one in 15 with measles gets pneumonia, which can be life-threatening.
  • Diarrhea or vomiting. These complications are more common in infants and small children.
  • Bronchitis, laryngitis or croup. Measles may lead to inflammation of your voice box (larynx) or inflammation of the inner walls that line the main air passageways of your lungs (bronchial tubes).
  • Pregnancy problems. Pregnant women need to take special care to avoid measles, because the disease can cause miscarriage, premature labor or babies with low birth weights.
  • Low platelet count (thrombocytopenia). Measles may lead to a decrease in platelets — the type of blood cells that are essential for blood clotting.

In 2007, there were 197,000 measles deaths globally - nearly 540 deaths every day or 22 deaths every hour, mostly children under the age of five.

It remains a leading cause of death among young children globally, despite the availability of a safe and effective vaccine.
BETSEY HUBBARD DIED JULY 17, 1799 AGED 9 MO 5 DS
EBER DIED OCT 27, 1802 AGED 7 MO 16 DS
LUCINDA DIED AUG 29, 1810 AGED 1 YR 2 MO 20 DS
HARRIET DIED JAN 22, 1820 AGED 6 YR 4 MO 6 DS
PETER B. DIED MAR 10, 1820 AGED 9 MO 8 DS
CHILDREN OF PETER & POLLY HUBBARD

Mumps

Mumps is caused by a virus. The usual route of transmission is through droplets (coughing and sneezing). Photo. Photo. The most common presentation is a parotitis (inflammation of the major salivary glands located on either side of the face), which occurs in 30-40% of patients. Other reported sites of infection are the testes, pancreas, eyes, ovaries, central nervous system, joints, and kidneys.

  • Central Nervous System involvement is common, but symptomatic meningitis only occurs in about 15% of patients. It usually resolves without complications, but adults are at a higher risk for sequelae. Encephalitis is rare and is seen in fewer than 2 per 100,000 cases. It has a mortality rate of 1.4%.
  • Orchitis (inflammation of the testicles) can occur in 50% of postpubertal males. It causes testicular atrophy in as many as 50% of persons affected but rarely causes sterility.
  • Pancreatitis occurs in 5% of persons infected with mumps. The hyperglycemia that results is usually transient, but a few cases of diabetes mellitus have been reported. It is not conclusive that the mumps virus has been the definitive cause.
  • Deafness has been reported in 1 per 20,000 cases of mumps. In 80% of cases, the hearing loss is reported to be unilateral.
  • Some deaths due to myocarditis (inflammation of the heart muscle) have been reported. The incidence of this complication is reported to be up to 15%, but it is usually asymptomatic.
  • The risk of spontaneous abortion is increased in a woman who contracts mumps in the first trimester.
  • Other complications reported are chronic arthritis, arthralgias (joint pain), and nephritis (inflammation of the kidneys).

Serious complications are more common in adults.

One of the objections to the germ theory of disease was that not everyone who’s exposed to the germs gets sick. (Some debunkers deliberately ingested pure cultures of disease germs with no ill effects and used this as proof that germs don’t cause illness.) But it isn’t necessary for everyone to become ill for a contagious disease to be a serious public health problem. In order to have a pandemic as few as 15-40% of the population need to be affected.

VIANA DAUGHTER OF ASA & MARGARET ANDREWS DIED SEPT 2, 1823 AGED 2 YEARS

Rubella

Mild in children (a rash, low-grade fever, and aching joints), rubella (AKA German measles, three-day measles) is devastating in pregnant women.

In the first trimester, there’s a 90% chance that rubella would pass from the pregnant woman to her fetus, causing congenital rubella syndrome (CRS). In 20% of cases this results in spontaneous abortion.

Among those born alive:

Signs and symptoms in the infant may include:

  • Cloudy corneas or white appearance to pupil (43%)
  • Deafness (58%)
  • Developmental delay
  • Excessive sleepiness
  • Irritability
  • Low birth weight
  • Mental retardation
  • Seizures
  • Small head size
  • Skin rash at birth
  • Heart defects (50%)
  • Meningitis
  • Encephalitis
  • Learning disabilities
  • Schizophrenia

It is important for women to become immune to rubella before they reach child-bearing age. Herd immunity is also important to protect those who are either not immune or whose immunity is not complete. Photo. Photo.

Rubella is a virus; it is transmitted by contact or airborne droplets.

If you are pregnant and suspect you have rubella, do not visit your OB/GYN directly. Call ahead, to avoid contact with other pregnant women.

HIRAM BORN JAN 14, 1827 DIED FEB 14, 1827
CHESTER G. BORN MAY 5, 1832 DIED FEB 19, 1833
EMELINE BORN MARCH 24, 1825 DIED FEB 21, 1833
SUSAN BORN APRIL 14, 1836 DIED DEC 10, 1836
CHILDREN OF HIRAM & EMILY TAYLOR

Chicken Pox

Chicken pox (AKA varicella). A red itchy rash marked with blisters, low-grade fever, and aching joints that lasts for a few days. The rash appears primarily on the torso. Caused by a virus and spread by droplets or direct contact. Photo. Photo. Photo.

When a woman who is not immune catches chicken pox any time during pregnancy, but particularly in the first 28 weeks of pregnancy, the virus can infect her fetus, resulting in fetal varicella syndrome:

  • Under-developed fingers and toes
  • Anal and urinary bladder sphincter abnormalities
  • Spinal cord malformation
  • Damage to the eyes
  • Brain damage
  • Absent deep tendon reflexes
Maternal infection at any time in pregnancy exposes the fetus to a high risk of transplacental contamination and is indicative of fetal follow-up. The risk of fetal anomalies, however, is higher during the first and second trimesters. Sonographic signs of fetal disease include fetal demise, growth restriction, musculoskeletal abnormalities such as clubfeet and abnormal position of the hands (caused by both necrosis and denervation of the affected tissue), limitation of limb extension due to cicatrices formation, cutaneous scars, limb hypoplasia, chorioretinitis, congenital cataracts, microphthalmia, hydrops, polyhydramnios, hyperechogenic hepatic foci, cerebral anomalies such as ventriculomegaly or atrophy, and microcephaly, disseminated foci of necrosis and microcalcifications, encephalitis, echogenic bowel in the second trimester. The placenta can show a multifocal chronic villitis with multinucleated giant cells. Fetal infection can be demonstrated by detection of varicella-zoster virus DNA by polymerase chain reaction (PCR) in fetal blood and amniotic fluid or by detection of the specific IgM antibody, in the same fluids.

You don’t want that, now do you?

Immunization prevents it.

[UPDATE]

Chicken pox is the gift that keeps on giving. It never goes away—it just becomes inactive living along the nerve pathways in the body. It can return in the form of shingles later on, when the patient is under stress, immunocompromised, or otherwise has reduced resistance.

People who have had chickenpox (varicella zoster) in their youth can develop shingles (herpes zoster) in later years. During an acute attack of the chickenpox virus, most of the viral organisms are destroyed, but some survive, travel up nerve fibers along the spine, and lodge in nerve cells where they may lie dormant for many years. A decrease in the body’s resistance can cause the virus to reawaken decades later. It then travels back down the nerve fibers to the skin’s surface. Photo. Photo. Photo.

The reawakened virus generally causes a vague burning sensation or tingling over an area of skin. A painful rash usually occurs two to five days after the first symptoms appear. A cluster of small bumps (1) turns into blisters (2) that resemble chickenpox lesions. The blisters fill with pus, break open (3), crust over (4), and finally disappear. This process takes four to five weeks.

A painful condition called post-herpetic neuralgia can sometimes occur. This condition is thought to be caused by damage to the nerves (5), and can last from weeks to years after the rash disappears.

HERE LIE TWO SONS OF ELIJAH & MABEL ANDREWS.
ELISHA DIED OCT 21, 1802 AGED 1 YR & 5 MONTHS
RICHARD DIED OCT 25, 1797 AGED 2 YRS & 1 MONTH

Why do we immunize? Because if we don’t…these diseases come back.


More from the CDC

Index to Medical Posts



From Elizabeth Moon:
My mother had polio as a small child, and late in life developed post-polio syndrome. During WWII, she was working as liaison engineer for the Army Air Corps at a Douglas Aircraft factory outside Chicago when there was an outbreak of polio and a shortage of nurses because of the war…and power outages that meant more people were needed to hand pump the iron lungs that kept the most severely disabled alive. There was an emergency call for anyone with nurse’s training (which she also had.) She left the factory, and her boss threatened her—she was, after all, on a defense contract. “If it were your wife or child in that ward?” She worked long shifts at the hospital until the worst was over.

Polio was the terror of my early childhood…in bad years, we had “block quarantines” when children were not supposed to leave the block on which they lived. (And we sometimes did and we got in big trouble for it, if caught, which we always were.) One of my good friends in first and second grade had had polio and had the heavy leg braces and crutches; she was in my Brownie troop. When a second-grade teacher came down with polio, when I was in first grade, many of the children in that school (including me) were given gamma globulin shots, then the only “maybe” preventive. It hurt like anything—huge shot, bigger than a penicillin shot. Didn’t matter.

We had outbreaks yearly, where I grew up, and big ones on occasion. When I was five, and again when I was seven, I was sent to Colorado to escape the local outbreak, on the grounds that a cabin 12 miles from the nearest town might be safer, the air and water purer. But the second year, a Scout camp had been built upstream of the cabin on the same river, and the water was definitely not purer. Every child knew about polio. Every child (let alone the parents) had seen the pictures of polio wards, the rows of children in wheel chairs and braces, the rows of iron lungs with just heads sticking out. Every child knew someone who had died, or been crippled, by polio. Every family collected dimes for the March of Dimes; in school we were given worksheets to stick them on, and the Mothers of the Mother’s March handed out similar cards with little pockets. (Yes, mothers did actually march through the streets, and go door to door to collect donations.)

The year before the vaccine came out two children in one family came down with polio the day after a swimming party I’d been to. I will never forget my mother’s face as she turned to look at me—still holding the receiver—and said harshly “Put your chin on your chest!” (A test of nuchal rigidity, this was a command every child in that era knew.) She was terrified. Though the children had only shown clear symptoms that day, they would’ve been contagious the day before. One boy died; the other had permanent disabilities. Back in the day, no accommodations were made for disabled children in school—many kids with polio sequelae were sent to residential facilities where they did get schooling, because local schools routinely excluded kids with disabilities.

Every febrile illness in summer was suspect. Every febrile illness after children had played in water (in the street, for instance, if it rained, or in a swimming pool) was suspect. I had a different serious illness, an encephalitis, and at first it was thought it might be polio (and I’m sure other mothers, hearing that I was sick, told their children to “put your chin on your chest.”)

Then came the vaccines—first the Salk, then then Sabin. Three shots for the Salk, one or two weeks apart: they lined us up in the halls of a school, and bang-bang-bang it was done. Then a year or two later, we had another series of three shots. By then, the outbreaks were noticeably smaller. In five years, hardly a new case—a new case was news.

That didn’t cure those who’d already had it. When I went off to college, I did some volunteer work in a children’s hospital. There was only one polio patient: one of the last cases, then a teenager, in an iron lung. By then there were no more specialty polio centers, no more polio wards, in which at least the inhabitants could talk to someone who understood. In a ward for children, where the other patients were kids who’d had some other treatable illness or injuries, there was his iron lung. He wanted no part of the cheerfulness we tried to bring to the ward.

And no wonder. Unless he could adapt to one of the smaller respiratory assists that came later, he was stuck for life in a huge, unwieldy, scary case…immobile, having to be tended by people who reached in through portholes on the side to clean him up, change his diaper…and who, increasingly, would not have a clue what his life was like because people like him were so few now. He could not see his body, engulfed in the machine that kept him alive. He could see only what was directly above him or reflected in the mirror over his head. None of the electronic aids for the disabled existed then…or for another decade or two.

There were, and are, more lethal diseases than polio: those with a higher mortality, and greater infectivity as well. But polio had a special horror to it.

E.

http://webnews.sff.net/read?cmd=read&group=sff.people.elizabeth-moon&artnum=143531 archived February 2009
Children’s gravestones from the Black Cemetery, Berlin, VT. I learned about the Black Cemetery from this album, and I recommend it to everyone.

Copyright © 2009 by James D. Macdonald

I am not a physician. I can neither diagnose nor prescribe. This post is presented for entertainment purposes only. Nothing here is meant to be advice for your particular condition or situation.

Creative Commons License
Why We Immunize by James D. Macdonald is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 License.

(Attribution URL: http://nielsenhayden.com/makinglight/archives/010978.html)

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Comments on Why We Immunize:
#1 ::: Dichroic ::: (view all by) ::: February 20, 2009, 01:44 AM:

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.)

#2 ::: Mike Booth ::: (view all by) ::: February 20, 2009, 01:50 AM:

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!

#3 ::: JIm Macdonald ::: (view all by) ::: February 20, 2009, 01:59 AM:

Tetanus booster is every five years.

#4 ::: Alison Scott ::: (view all by) ::: February 20, 2009, 02:23 AM:

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.

#5 ::: John in Cambridge (UK) ::: (view all by) ::: February 20, 2009, 02:30 AM:

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).

#6 ::: Doug Faunt ::: (view all by) ::: February 20, 2009, 02:30 AM:

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....

#7 ::: ctate ::: (view all by) ::: February 20, 2009, 02:32 AM:

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.

#8 ::: Doug Faunt ::: (view all by) ::: February 20, 2009, 02:36 AM:

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

#9 ::: Clifton Royston ::: (view all by) ::: February 20, 2009, 02:39 AM:

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.

#10 ::: Jim Macdonald ::: (view all by) ::: February 20, 2009, 02:47 AM:

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

#11 ::: Michael Martin ::: (view all by) ::: February 20, 2009, 02:55 AM:

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.

#12 ::: bbrugger ::: (view all by) ::: February 20, 2009, 03:00 AM:

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."

#13 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: February 20, 2009, 03:08 AM:

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.

#14 ::: Dave Bell ::: (view all by) ::: February 20, 2009, 03:16 AM:

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.

#15 ::: Jim Macdonald ::: (view all by) ::: February 20, 2009, 03:23 AM:

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.

#16 ::: Lee ::: (view all by) ::: February 20, 2009, 03:24 AM:

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.

#17 ::: geek anachronism ::: (view all by) ::: February 20, 2009, 03:25 AM:

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).

#18 ::: siriosa ::: (view all by) ::: February 20, 2009, 03:27 AM:

(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.

#19 ::: Thomas ::: (view all by) ::: February 20, 2009, 03:35 AM:

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.

#20 ::: Terry Karney ::: (view all by) ::: February 20, 2009, 03:41 AM:

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.

#21 ::: Jim Macdonald ::: (view all by) ::: February 20, 2009, 03:44 AM:

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.

#22 ::: Kimberly ::: (view all by) ::: February 20, 2009, 03:53 AM:

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?

#23 ::: Emma ::: (view all by) ::: February 20, 2009, 04:03 AM:

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.

#24 ::: Tracey S. Rosenberg ::: (view all by) ::: February 20, 2009, 04:08 AM:

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'.

#25 ::: Chris ::: (view all by) ::: February 20, 2009, 04:08 AM:

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.

#26 ::: Sus ::: (view all by) ::: February 20, 2009, 04:24 AM:

*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.

#27 ::: abi ::: (view all by) ::: February 20, 2009, 04:49 AM:

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.

#28 ::: Tracey ::: (view all by) ::: February 20, 2009, 04:57 AM:

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.

#29 ::: takuan ::: (view all by) ::: February 20, 2009, 05:02 AM:

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.

#30 ::: Niall McAuley ::: (view all by) ::: February 20, 2009, 05:03 AM:

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.

#31 ::: Anna Feruglio Dal Dan ::: (view all by) ::: February 20, 2009, 05:09 AM:

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.

#32 ::: takuan ::: (view all by) ::: February 20, 2009, 05:18 AM:

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

#33 ::: David Goldfarb ::: (view all by) ::: February 20, 2009, 05:31 AM:

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

#34 ::: Debbie ::: (view all by) ::: February 20, 2009, 05:45 AM:

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.

#35 ::: Thomas ::: (view all by) ::: February 20, 2009, 06:01 AM:

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.

#36 ::: Roxanne ::: (view all by) ::: February 20, 2009, 06:02 AM:

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.

#37 ::: takuan ::: (view all by) ::: February 20, 2009, 06:13 AM:

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

#38 ::: takuan ::: (view all by) ::: February 20, 2009, 06:16 AM:

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

#39 ::: Giacomo ::: (view all by) ::: February 20, 2009, 06:25 AM:

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.

#40 ::: Pendrift ::: (view all by) ::: February 20, 2009, 06:25 AM:

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.

#41 ::: Jim Macdonald ::: (view all by) ::: February 20, 2009, 06:30 AM:

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

The answer is "yes."

#42 ::: turtle ::: (view all by) ::: February 20, 2009, 06:34 AM:

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?!

#43 ::: Charlie Stross ::: (view all by) ::: February 20, 2009, 06:38 AM:

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.

#44 ::: Debbie ::: (view all by) ::: February 20, 2009, 06:39 AM:

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.

#45 ::: turtle ::: (view all by) ::: February 20, 2009, 06:48 AM:

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

#46 ::: Juliet E McKenna ::: (view all by) ::: February 20, 2009, 06:51 AM:

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.

#47 ::: Chris Eagle ::: (view all by) ::: February 20, 2009, 06:51 AM:

@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!

#48 ::: Juliet E McKenna ::: (view all by) ::: February 20, 2009, 06:53 AM:

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.

#49 ::: Jim Macdonald ::: (view all by) ::: February 20, 2009, 06:55 AM:

#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.

#50 ::: Laura from Faraway ::: (view all by) ::: February 20, 2009, 06:59 AM:

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."

#51 ::: Epacris ::: (view all by) ::: February 20, 2009, 07:04 AM:

Roxanne @36 (& Jim D McD @41)

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

The answer is "yes."

I thought that was the point of the post.

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.

#52 ::: Emily ::: (view all by) ::: February 20, 2009, 07:05 AM:

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.

#53 ::: turtle ::: (view all by) ::: February 20, 2009, 07:09 AM:

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.

#54 ::: Jim Macdonald ::: (view all by) ::: February 20, 2009, 07:24 AM:

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.

#55 ::: dcb ::: (view all by) ::: February 20, 2009, 07:24 AM:

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.

#56 ::: Thomas ::: (view all by) ::: February 20, 2009, 07:28 AM:

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.

#57 ::: Meg Thornton ::: (view all by) ::: February 20, 2009, 07:41 AM:

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.

#58 ::: Ian Osmond ::: (view all by) ::: February 20, 2009, 07:51 AM:

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.

#59 ::: Ian Osmond ::: (view all by) ::: February 20, 2009, 07:51 AM:

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.

#60 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: February 20, 2009, 08:05 AM:

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.

#61 ::: TexAnne ::: (view all by) ::: February 20, 2009, 08:05 AM:

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.

#62 ::: Fragano Ledgister ::: (view all by) ::: February 20, 2009, 08:12 AM:

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'.

#63 ::: Fragano Ledgister ::: (view all by) ::: February 20, 2009, 08:16 AM:

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

#64 ::: inge ::: (view all by) ::: February 20, 2009, 08:20 AM:

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...

#65 ::: Ginger ::: (view all by) ::: February 20, 2009, 08:22 AM:

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.

#66 ::: missmeg426 ::: (view all by) ::: February 20, 2009, 08:25 AM:

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.

#67 ::: Sarah S. ::: (view all by) ::: February 20, 2009, 08:29 AM:

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.

#68 ::: Ginger ::: (view all by) ::: February 20, 2009, 08:31 AM:

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

#69 ::: Elaine ::: (view all by) ::: February 20, 2009, 08:35 AM:

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.

#70 ::: Charlie Stross ::: (view all by) ::: February 20, 2009, 08:37 AM:

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).

#71 ::: Anna Feruglio Dal Dan ::: (view all by) ::: February 20, 2009, 08:44 AM:

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."

#72 ::: inge ::: (view all by) ::: February 20, 2009, 08:53 AM:

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.

#73 ::: Connie H. ::: (view all by) ::: February 20, 2009, 08:54 AM:

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?

#74 ::: Charlie Stross ::: (view all by) ::: February 20, 2009, 08:58 AM:

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 ...

#75 ::: TKay ::: (view all by) ::: February 20, 2009, 08:58 AM:

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*.

#76 ::: Joyce Reynolds-Ward ::: (view all by) ::: February 20, 2009, 08:59 AM:

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.

#77 ::: cosmicfroggy ::: (view all by) ::: February 20, 2009, 08:59 AM:

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.

#78 ::: Leva Cygnet ::: (view all by) ::: February 20, 2009, 09:00 AM:

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

#79 ::: albatross ::: (view all by) ::: February 20, 2009, 09:03 AM:

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.

#80 ::: Thomas ::: (view all by) ::: February 20, 2009, 09:07 AM:

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.

#81 ::: abi ::: (view all by) ::: February 20, 2009, 09:17 AM:

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.

#82 ::: inge ::: (view all by) ::: February 20, 2009, 09:23 AM:

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.

#83 ::: fidelio ::: (view all by) ::: February 20, 2009, 09:23 AM:

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.

#84 ::: David Cook ::: (view all by) ::: February 20, 2009, 09:46 AM:

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.

#85 ::: Lawrence Evans ::: (view all by) ::: February 20, 2009, 09:53 AM:

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.

#86 ::: Patrick Nielsen Hayden ::: (view all by) ::: February 20, 2009, 09:59 AM:

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.

#87 ::: Patrick Nielsen Hayden ::: (view all by) ::: February 20, 2009, 10:00 AM:

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

#88 ::: Terry Karney ::: (view all by) ::: February 20, 2009, 10:05 AM:

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.

#89 ::: Patrick Nielsen Hayden ::: (view all by) ::: February 20, 2009, 10:06 AM:

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]

#90 ::: K.C. Shaw ::: (view all by) ::: February 20, 2009, 10:08 AM:

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.

#91 ::: Charlie Stross ::: (view all by) ::: February 20, 2009, 10:11 AM:

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.

#92 ::: Kate Nepveu ::: (view all by) ::: February 20, 2009, 10:12 AM:

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.

#93 ::: David Dyer-Bennet ::: (view all by) ::: February 20, 2009, 10:23 AM:

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.

#94 ::: vcmw ::: (view all by) ::: February 20, 2009, 10:24 AM:

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.

#95 ::: Anna Feruglio Dal Dan ::: (view all by) ::: February 20, 2009, 10:27 AM:

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.

#96 ::: Diatryma ::: (view all by) ::: February 20, 2009, 10:29 AM:

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.

#97 ::: Emma ::: (view all by) ::: February 20, 2009, 10:36 AM:

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

#98 ::: Angiportus ::: (view all by) ::: February 20, 2009, 10:38 AM:

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.

#99 ::: Stephen Granade ::: (view all by) ::: February 20, 2009, 10:39 AM:

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.

#100 ::: John Mark Ockerbloom ::: (view all by) ::: February 20, 2009, 10:39 AM:

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.)

#101 ::: Michael Adelstein ::: (view all by) ::: February 20, 2009, 10:39 AM:

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.

#102 ::: Michael Adelstein ::: (view all by) ::: February 20, 2009, 10:39 AM:

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.

#103 ::: Michael Adelstein ::: (view all by) ::: February 20, 2009, 10:42 AM:

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

#104 ::: Debra Doyle ::: (view all by) ::: February 20, 2009, 10:43 AM:

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.

#105 ::: Bruce Baugh ::: (view all by) ::: February 20, 2009, 10:43 AM:

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?

#106 ::: Rikibeth ::: (view all by) ::: February 20, 2009, 10:45 AM:

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.

#107 ::: Caroline ::: (view all by) ::: February 20, 2009, 10:53 AM:

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.

#108 ::: Adrian Smith ::: (view all by) ::: February 20, 2009, 11:06 AM:

@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.

#109 ::: Katie ::: (view all by) ::: February 20, 2009, 11:07 AM:

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.

#110 ::: Greg Morrow ::: (view all by) ::: February 20, 2009, 11:14 AM:

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.

#111 ::: Elizabeth Coleman ::: (view all by) ::: February 20, 2009, 11:18 AM:

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.

#112 ::: Sarah S. ::: (view all by) ::: February 20, 2009, 11:26 AM:

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.

#113 ::: Annie G. ::: (view all by) ::: February 20, 2009, 11:27 AM:

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.

#114 ::: Torrilin ::: (view all by) ::: February 20, 2009, 11:27 AM:

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.

#115 ::: Jo Walton ::: (view all by) ::: February 20, 2009, 11:27 AM:

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.

#116 ::: mdh ::: (view all by) ::: February 20, 2009, 11:29 AM:

Ctrl-D

File under: Ammunition

thx tnh

#117 ::: Irene Delse ::: (view all by) ::: February 20, 2009, 11:36 AM:

@ 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.

#118 ::: albatross ::: (view all by) ::: February 20, 2009, 11:40 AM:

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."

#119 ::: takuan ::: (view all by) ::: February 20, 2009, 11:42 AM:

speaking of immune systems:

#120 ::: Beth Friedman ::: (view all by) ::: February 20, 2009, 11:42 AM:

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.

#121 ::: Andrew Willett ::: (view all by) ::: February 20, 2009, 11:42 AM:

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.

#122 ::: CvH ::: (view all by) ::: February 20, 2009, 11:52 AM:

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.

#123 ::: SDE ::: (view all by) ::: February 20, 2009, 11:52 AM:

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.]

#124 ::: Torrilin ::: (view all by) ::: February 20, 2009, 11:54 AM:

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.

#125 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: February 20, 2009, 11:54 AM:

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)

#126 ::: amysue ::: (view all by) ::: February 20, 2009, 11:54 AM:

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.

#127 ::: paul ::: (view all by) ::: February 20, 2009, 11:56 AM:

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.

#128 ::: takuan ::: (view all by) ::: February 20, 2009, 12:02 PM:

@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.”

#129 ::: P J Evans ::: (view all by) ::: February 20, 2009, 12:04 PM:

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.)

#130 ::: Madeleine Robins ::: (view all by) ::: February 20, 2009, 12:04 PM:

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.

#131 ::: Fragano Ledgister ::: (view all by) ::: February 20, 2009, 12:11 PM:

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.

#132 ::: abi ::: (view all by) ::: February 20, 2009, 12:14 PM:

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.

#133 ::: Fade Manley ::: (view all by) ::: February 20, 2009, 12:17 PM:

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.

#134 ::: Trey ::: (view all by) ::: February 20, 2009, 12:18 PM:

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?

#135 ::: sisuile ::: (view all by) ::: February 20, 2009, 12:34 PM:

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...

#136 ::: Ledasmom ::: (view all by) ::: February 20, 2009, 12:41 PM:

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.

#137 ::: melospiza ::: (view all by) ::: February 20, 2009, 12:43 PM:

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.

#138 ::: James D. Macdonald ::: (view all by) ::: February 20, 2009, 12:48 PM:

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.)

#139 ::: JESR ::: (view all by) ::: February 20, 2009, 12:52 PM:

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.

#140 ::: MamaDeb ::: (view all by) ::: February 20, 2009, 12:53 PM:

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.

#141 ::: murfnik ::: (view all by) ::: February 20, 2009, 12:55 PM:

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.

#142 ::: guthrie ::: (view all by) ::: February 20, 2009, 12:59 PM:

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.

#143 ::: Lee ::: (view all by) ::: February 20, 2009, 01:03 PM:

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.

#144 ::: Tony Zbaraschuk ::: (view all by) ::: February 20, 2009, 01:04 PM:

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.)

#145 ::: Audrey ::: (view all by) ::: February 20, 2009, 01:09 PM:

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.

#146 ::: Juliet E McKenna ::: (view all by) ::: February 20, 2009, 01:13 PM:

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.

#147 ::: takuan ::: (view all by) ::: February 20, 2009, 01:13 PM:

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?

#148 ::: KeithS ::: (view all by) ::: February 20, 2009, 01:18 PM:

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.

#149 ::: Jon Meltzer ::: (view all by) ::: February 20, 2009, 01:29 PM:

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?

#150 ::: abi ::: (view all by) ::: February 20, 2009, 01:29 PM:

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.)

#151 ::: JESR ::: (view all by) ::: February 20, 2009, 01:29 PM:

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.

#152 ::: KeithS ::: (view all by) ::: February 20, 2009, 01:33 PM:

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.

#153 ::: Earl Cooley III ::: (view all by) ::: February 20, 2009, 01:36 PM:

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

I like that definition.

#154 ::: James D. Macdonald ::: (view all by) ::: February 20, 2009, 01:36 PM:

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.

#155 ::: merryarwen ::: (view all by) ::: February 20, 2009, 01:36 PM:

@ 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.)

#156 ::: David Dyer-Bennet ::: (view all by) ::: February 20, 2009, 01:37 PM:

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

#157 ::: Sarah S. ::: (view all by) ::: February 20, 2009, 01:42 PM:

JESR @151

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

#158 ::: Lori Coulson ::: (view all by) ::: February 20, 2009, 01:43 PM:

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?

#159 ::: Suzanne ::: (view all by) ::: February 20, 2009, 01:45 PM:

@ 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.

#160 ::: abi ::: (view all by) ::: February 20, 2009, 01:53 PM:

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.

#161 ::: j h woodyatt ::: (view all by) ::: February 20, 2009, 01:53 PM:

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.

#162 ::: James D. Macdonald ::: (view all by) ::: February 20, 2009, 01:54 PM:

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

#163 ::: Ginger ::: (view all by) ::: February 20, 2009, 02:07 PM:

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.

#164 ::: murfnik ::: (view all by) ::: February 20, 2009, 02:13 PM:

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.

#165 ::: James D. Macdonald ::: (view all by) ::: February 20, 2009, 02:20 PM:

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.)

#166 ::: Mary Aileen ::: (view all by) ::: February 20, 2009, 02:22 PM:

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.

#167 ::: Columbina ::: (view all by) ::: February 20, 2009, 02:23 PM:

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.

#168 ::: Lori Coulson ::: (view all by) ::: February 20, 2009, 02:27 PM:

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.

#169 ::: abi ::: (view all by) ::: February 20, 2009, 02:28 PM:

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.

#170 ::: murfnik ::: (view all by) ::: February 20, 2009, 02:29 PM:

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.

#171 ::: Columbina ::: (view all by) ::: February 20, 2009, 02:31 PM:

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.

#172 ::: murfnik ::: (view all by) ::: February 20, 2009, 02:33 PM:

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.

#173 ::: oliviacw ::: (view all by) ::: February 20, 2009, 02:35 PM:

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.

#174 ::: Lila ::: (view all by) ::: February 20, 2009, 02:41 PM:

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).

#175 ::: Jenny Islander ::: (view all by) ::: February 20, 2009, 02:50 PM:

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.

#176 ::: JESR ::: (view all by) ::: February 20, 2009, 02:51 PM:

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

#177 ::: Terry Karney ::: (view all by) ::: February 20, 2009, 02:55 PM:

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.

#178 ::: cgeye ::: (view all by) ::: February 20, 2009, 02:56 PM:
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....

#179 ::: Ab_Normal ::: (view all by) ::: February 20, 2009, 03:01 PM:

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.

#180 ::: cgeye ::: (view all by) ::: February 20, 2009, 03:06 PM:

#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.

#181 ::: Larry Brennan ::: (view all by) ::: February 20, 2009, 03:08 PM:

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.

#182 ::: Terry Karney ::: (view all by) ::: February 20, 2009, 03:09 PM:

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).


#183 ::: Arachne Jericho ::: (view all by) ::: February 20, 2009, 03:14 PM:

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.

#184 ::: mjfgates ::: (view all by) ::: February 20, 2009, 03:16 PM:

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.

#185 ::: TexAnne ::: (view all by) ::: February 20, 2009, 03:16 PM:

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?

#186 ::: Bill Stewart ::: (view all by) ::: February 20, 2009, 03:18 PM:

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.

#187 ::: Arachne Jericho ::: (view all by) ::: February 20, 2009, 03:20 PM:
(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.

#188 ::: Jenny Islander ::: (view all by) ::: February 20, 2009, 03:20 PM:

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.

#189 ::: Arachne Jericho ::: (view all by) ::: February 20, 2009, 03:24 PM:

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.


#190 ::: dcb ::: (view all by) ::: February 20, 2009, 03:33 PM:

murfnik @ 172

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

#191 ::: takuan ::: (view all by) ::: February 20, 2009, 03:38 PM:

"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.

#192 ::: Mary Aileen ::: (view all by) ::: February 20, 2009, 03:38 PM:

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?)

#193 ::: James D. Macdonald ::: (view all by) ::: February 20, 2009, 03:39 PM:

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).

#194 ::: KeithS ::: (view all by) ::: February 20, 2009, 03:40 PM:

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.

#195 ::: fidelio ::: (view all by) ::: February 20, 2009, 03:41 PM:

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.

#196 ::: JESR ::: (view all by) ::: February 20, 2009, 03:46 PM:

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.

#197 ::: Lisa Hertel ::: (view all by) ::: February 20, 2009, 03:52 PM:

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.

#198 ::: Natalie L. ::: (view all by) ::: February 20, 2009, 03:52 PM:

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

#199 ::: murfnik ::: (view all by) ::: February 20, 2009, 03:53 PM:

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? ;)

#200 ::: takuan ::: (view all by) ::: February 20, 2009, 03:56 PM:

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".

#201 ::: Juliet E McKenna ::: (view all by) ::: February 20, 2009, 04:00 PM:

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.

#202 ::: Lee ::: (view all by) ::: February 20, 2009, 04:01 PM:

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.

#203 ::: abi ::: (view all by) ::: February 20, 2009, 04:03 PM:

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.

#204 ::: Arachne Jericho ::: (view all by) ::: February 20, 2009, 04:03 PM:

@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!

#205 ::: murfnik ::: (view all by) ::: February 20, 2009, 04:17 PM:

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.

#206 ::: James D. Macdonald ::: (view all by) ::: February 20, 2009, 04:18 PM:

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.

#207 ::: takuan ::: (view all by) ::: February 20, 2009, 04:19 PM:

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.

#208 ::: Thomas ::: (view all by) ::: February 20, 2009, 04:27 PM:

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.

#209 ::: Rosa ::: (view all by) ::: February 20, 2009, 04:29 PM:

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.

#210 ::: P J Evans ::: (view all by) ::: February 20, 2009, 04:40 PM:

@ 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.)

#211 ::: dcb ::: (view all by) ::: February 20, 2009, 04:42 PM:

murfnik @ 199

"Glad to be of service."

#212 ::: Torrilin ::: (view all by) ::: February 20, 2009, 04:47 PM:

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.

#213 ::: Per Chr. J. ::: (view all by) ::: February 20, 2009, 04:47 PM:

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.

#214 ::: P J Evans ::: (view all by) ::: February 20, 2009, 04:57 PM:

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.)

#215 ::: Melissa Mead ::: (view all by) ::: February 20, 2009, 05:03 PM:

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!

#216 ::: Terry Karney ::: (view all by) ::: February 20, 2009, 05:14 PM:

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."

#217 ::: cgeye ::: (view all by) ::: February 20, 2009, 05:23 PM:

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.
#218 ::: James D. Macdonald ::: (view all by) ::: February 20, 2009, 05:28 PM:

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.

#219 ::: Stefan Jones ::: (view all by) ::: February 20, 2009, 05:45 PM:

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.

#220 ::: Sherri ::: (view all by) ::: February 20, 2009, 05:49 PM:

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.

#221 ::: VictorS ::: (view all by) ::: February 20, 2009, 05:56 PM:

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.

#222 ::: Fade Manley ::: (view all by) ::: February 20, 2009, 06:02 PM:

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.

#223 ::: Lee ::: (view all by) ::: February 20, 2009, 06:07 PM:

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.

#224 ::: takuan ::: (view all by) ::: February 20, 2009, 06:11 PM:

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.

#225 ::: Lizzy L ::: (view all by) ::: February 20, 2009, 06:16 PM:

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.

#226 ::: takuan ::: (view all by) ::: February 20, 2009, 06:23 PM:

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

#227 ::: Torrilin ::: (view all by) ::: February 20, 2009, 06:28 PM:

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...

#228 ::: EClaire ::: (view all by) ::: February 20, 2009, 06:42 PM:

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.

#229 ::: Larry Brennan ::: (view all by) ::: February 20, 2009, 07:20 PM:

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

#230 ::: Jen ::: (view all by) ::: February 20, 2009, 07:21 PM:

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.

#231 ::: Elizabeth "Archangel Beth" McCoy ::: (view all by) ::: February 20, 2009, 07:27 PM:

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.)

#232 ::: Jenett ::: (view all by) ::: February 20, 2009, 07:35 PM:

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.)

#233 ::: Mycroft W ::: (view all by) ::: February 20, 2009, 07:36 PM:

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.

#234 ::: Lizzy L ::: (view all by) ::: February 20, 2009, 07:38 PM:

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.

#235 ::: Mycroft W ::: (view all by) ::: February 20, 2009, 07:44 PM:

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.

#236 ::: P J Evans ::: (view all by) ::: February 20, 2009, 08:04 PM:

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.

#237 ::: sara ::: (view all by) ::: February 20, 2009, 08:08 PM:

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.

#238 ::: Linkmeister ::: (view all by) ::: February 20, 2009, 08:38 PM:

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.

#239 ::: Chris Quinones ::: (view all by) ::: February 20, 2009, 09:16 PM:

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.

#240 ::: Daniel Boone ::: (view all by) ::: February 20, 2009, 09:27 PM:

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.

#241 ::: Chris Quinones ::: (view all by) ::: February 20, 2009, 09:29 PM:

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.

#242 ::: Older ::: (view all by) ::: February 20, 2009, 09:38 PM:

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.

#243 ::: Quill ::: (view all by) ::: February 20, 2009, 10:06 PM:

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.

#244 ::: edward oleander ::: (view all by) ::: February 20, 2009, 10:17 PM:

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...

#245 ::: Elizabeth ::: (view all by) ::: February 20, 2009, 10:49 PM:

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.)

#246 ::: Quill ::: (view all by) ::: February 20, 2009, 10:50 PM:

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.

#247 ::: sara_k ::: (view all by) ::: February 20, 2009, 10:54 PM:

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.

#248 ::: Jon Lundy ::: (view all by) ::: February 20, 2009, 11:54 PM:

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.

#249 ::: flowery tops ::: (view all by) ::: February 20, 2009, 11:59 PM:

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.)

#250 ::: takuan ::: (view all by) ::: February 21, 2009, 12:08 AM:

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.

#251 ::: CHip ::: (view all by) ::: February 21, 2009, 12:09 AM:

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

The above is probably too generalized, and I'm not coming up with who \was/ credentialed in those eras -- maybe clergy?

"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.

#252 ::: Joyce Reynolds-Ward ::: (view all by) ::: February 21, 2009, 12:23 AM:

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.

#253 ::: David DeLaney ::: (view all by) ::: February 21, 2009, 12:58 AM:

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

#254 ::: Ellen Asher ::: (view all by) ::: February 21, 2009, 01:08 AM:

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.

#255 ::: Lisa ::: (view all by) ::: February 21, 2009, 01:30 AM:

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.

#256 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: February 21, 2009, 01:50 AM:

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.

#257 ::: takuan ::: (view all by) ::: February 21, 2009, 01:55 AM:

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

#258 ::: Terry Karney ::: (view all by) ::: February 21, 2009, 02:07 AM:

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.

#259 ::: Lee ::: (view all by) ::: February 21, 2009, 02:14 AM:

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.

#260 ::: takuan ::: (view all by) ::: February 21, 2009, 02:21 AM:

Ever read Demon in the Freezer, Terry?

#261 ::: takuan ::: (view all by) ::: February 21, 2009, 02:27 AM:

a not-bad review

#262 ::: Terry Karney ::: (view all by) ::: February 21, 2009, 02:46 AM:

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.

#263 ::: Tony Zbaraschuk ::: (view all by) ::: February 21, 2009, 02:57 AM:

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.

#264 ::: Terry Karney ::: (view all by) ::: February 21, 2009, 02:58 AM:

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.

#265 ::: Terry Karney ::: (view all by) ::: February 21, 2009, 03:01 AM:

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.

#266 ::: takuan ::: (view all by) ::: February 21, 2009, 03:19 AM:

"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.”

#267 ::: Jenny Islander ::: (view all by) ::: February 21, 2009, 04:09 AM:

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.

#268 ::: abi ::: (view all by) ::: February 21, 2009, 06:47 AM:

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.

#269 ::: A.J. Luxton ::: (view all by) ::: February 21, 2009, 08:00 AM:

@ 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.

#270 ::: legionseagle ::: (view all by) ::: February 21, 2009, 08:04 AM:

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.

#271 ::: A.J. Luxton ::: (view all by) ::: February 21, 2009, 08:06 AM:

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.

#272 ::: A.J. Luxton ::: (view all by) ::: February 21, 2009, 08:16 AM:

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."

#273 ::: Debra Doyle ::: (view all by) ::: February 21, 2009, 08:17 AM:

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.

#274 ::: Randolph ::: (view all by) ::: February 21, 2009, 08:41 AM:

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.

#275 ::: sgac ::: (view all by) ::: February 21, 2009, 08:48 AM:

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.

#276 ::: Cat ::: (view all by) ::: February 21, 2009, 08:59 AM:

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.

#277 ::: dcb ::: (view all by) ::: February 21, 2009, 09:43 AM:

Elizabeth @245

Thanks for the link to your post - nicely written and informative.

And I enjoyed the book.

#278 ::: Diatryma ::: (view all by) ::: February 21, 2009, 10:00 AM:

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.

#279 ::: Serge ::: (view all by) ::: February 21, 2009, 10:06 AM:

Lisa @ 255... my children were circumsided at 5

Meaning that someone walked around them thru 5 dimensions?

#280 ::: Throwmearope ::: (view all by) ::: February 21, 2009, 10:36 AM:

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.

#281 ::: Jessica ::: (view all by) ::: February 21, 2009, 10:49 AM:

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.

#282 ::: Xopher ::: (view all by) ::: February 21, 2009, 11:08 AM:

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.

#283 ::: Rachel ::: (view all by) ::: February 21, 2009, 11:18 AM:

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!

#284 ::: Rachel ::: (view all by) ::: February 21, 2009, 11:21 AM:

#267: There is NO MERCURY in children's vaccines in the USA.

#285 ::: sara_k ::: (view all by) ::: February 21, 2009, 11:22 AM:

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).

#286 ::: Dave Bell ::: (view all by) ::: February 21, 2009, 11:32 AM:

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.

#287 ::: Joyce Reynolds-Ward ::: (view all by) ::: February 21, 2009, 11:59 AM:

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.

#288 ::: Lila ::: (view all by) ::: February 21, 2009, 12:16 PM:

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.

#289 ::: abi ::: (view all by) ::: February 21, 2009, 12:23 PM:

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.)

#290 ::: Lila ::: (view all by) ::: February 21, 2009, 12:33 PM:

abi:

I beg your pardon, and takuan's. I had ceased to follow the zombie thread.

#291 ::: Giacomo ::: (view all by) ::: February 21, 2009, 01:30 PM:

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.

#292 ::: Kayjayoh ::: (view all by) ::: February 21, 2009, 02:31 PM:

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.

#293 ::: Renee ::: (view all by) ::: February 21, 2009, 02:36 PM:

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...

#294 ::: Fragano Ledgister ::: (view all by) ::: February 21, 2009, 02:36 PM:

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.

#295 ::: Nancy Lebovitz ::: (view all by) ::: February 21, 2009, 02:50 PM:

#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.

#296 ::: Renee ::: (view all by) ::: February 21, 2009, 02:52 PM:

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...

#297 ::: Renee ::: (view all by) ::: February 21, 2009, 02:53 PM:

Grr. Sorry about the double post.

#298 ::: Serge ::: (view all by) ::: February 21, 2009, 03:22 PM:

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.

#299 ::: albatross ::: (view all by) ::: February 21, 2009, 03:43 PM:

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.

#300 ::: dcb ::: (view all by) ::: February 21, 2009, 04:12 PM:

Renee @ 297

Yes, but you managed a double-post separated by two other posts - that's clever!

#301 ::: Lydy Nickerson ::: (view all by) ::: February 21, 2009, 04:16 PM:

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.

#302 ::: janetl ::: (view all by) ::: February 21, 2009, 04:19 PM:

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.

#303 ::: janetl ::: (view all by) ::: February 21, 2009, 04:24 PM:

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.

#304 ::: Nicole J. LeBoeuf-Little ::: (view all by) ::: February 21, 2009, 06:13 PM:

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)

#305 ::: sara_k ::: (view all by) ::: February 21, 2009, 06:16 PM:

Nicole @ 304

My nephews (16 and 13) were offered Hpv vaccine at their annual visits in January.

Sara

#306 ::: Nicole J. LeBoeuf-Little ::: (view all by) ::: February 21, 2009, 06:40 PM:

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.)

#307 ::: Nicole J. LeBoeuf-Little ::: (view all by) ::: February 21, 2009, 06:45 PM:

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.

#308 ::: James D. Macdonald ::: (view all by) ::: February 21, 2009, 06:52 PM:

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.

#309 ::: Giacomo ::: (view all by) ::: February 21, 2009, 07:04 PM:

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.

#310 ::: Lizzy L ::: (view all by) ::: February 21, 2009, 07:32 PM:

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.

#311 ::: Lee ::: (view all by) ::: February 21, 2009, 08:01 PM:

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.

#312 ::: Leva Cygnet ::: (view all by) ::: February 21, 2009, 08:08 PM:

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.

#313 ::: Amanda ::: (view all by) ::: February 21, 2009, 08:13 PM:

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.

#314 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: February 21, 2009, 08:18 PM:

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?

#315 ::: Linkmeister ::: (view all by) ::: February 21, 2009, 08:33 PM:

Bruce (StM) @ #314 Merriam-Webster doesn't have the originator's name for teleonomy, but it does have a precise year; 1958. Go figure.

#316 ::: Lila ::: (view all by) ::: February 21, 2009, 08:35 PM:

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.

#317 ::: James D. Macdonald ::: (view all by) ::: February 21, 2009, 08:36 PM:

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).

#318 ::: Diatryma ::: (view all by) ::: February 21, 2009, 09:10 PM:

I've done some cursory searching for books about polio-- specifically something memoirish, but anything good is, um, good. Any recommendations?

#319 ::: Kes ::: (view all by) ::: February 21, 2009, 09:13 PM:

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.

#320 ::: sara_k ::: (view all by) ::: February 21, 2009, 09:19 PM:

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.


#321 ::: Linkmeister ::: (view all by) ::: February 21, 2009, 09:20 PM:

Diatryma @ #319, here's a radio interview with an author who survived it.

#322 ::: Linkmeister ::: (view all by) ::: February 21, 2009, 09:23 PM:

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.

#323 ::: janetl ::: (view all by) ::: February 21, 2009, 09:26 PM:

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.

#324 ::: Linkmeister ::: (view all by) ::: February 21, 2009, 09:26 PM:

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.

#325 ::: KeithS ::: (view all by) ::: February 21, 2009, 09:38 PM:

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.

#326 ::: janetl ::: (view all by) ::: February 21, 2009, 09:45 PM:

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.

#327 ::: Nancy Lebovitz ::: (view all by) ::: February 21, 2009, 10:08 PM:

#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.

#328 ::: Arachne Jericho ::: (view all by) ::: February 21, 2009, 10:15 PM:

@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.

#329 ::: Marna Nightingale ::: (view all by) ::: February 21, 2009, 10:24 PM:

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. )

#330 ::: TexAnne ::: (view all by) ::: February 21, 2009, 10:48 PM:

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.

#331 ::: Andy Brazil ::: (view all by) ::: February 21, 2009, 10:51 PM:

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.

#332 ::: glinda ::: (view all by) ::: February 21, 2009, 10:58 PM:

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.)

#333 ::: CHip ::: (view all by) ::: February 21, 2009, 11:14 PM:

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).

#334 ::: Linda Hafemeister ::: (view all by) ::: February 22, 2009, 01:09 AM:

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.

#335 ::: Earl Cooley III ::: (view all by) ::: February 22, 2009, 01:38 AM:

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.

#336 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: February 22, 2009, 01:47 AM:

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.

#337 ::: RB ::: (view all by) ::: February 22, 2009, 02:15 AM:

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.

#338 ::: mythago ::: (view all by) ::: February 22, 2009, 02:21 AM:
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.

#339 ::: abi ::: (view all by) ::: February 22, 2009, 04:25 AM:

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?)

#340 ::: Greg Horn ::: (view all by) ::: February 22, 2009, 04:57 AM:

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).

#341 ::: Juliet E McKenna ::: (view all by) ::: February 22, 2009, 07:30 AM:

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.

#342 ::: Serge ::: (view all by) ::: February 22, 2009, 08:34 AM:

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.

#343 ::: albatross ::: (view all by) ::: February 22, 2009, 08:54 AM:

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.

#344 ::: Bruce Baugh ::: (view all by) ::: February 22, 2009, 09:27 AM:

Andy Brazil @ 331: Wow. That's a truly glorious "Reader, she married him."moment. Thank you for writing it up.

#345 ::: Serge ::: (view all by) ::: February 22, 2009, 09:51 AM:

Andy Brazil @ 331... What Bruce Baugh said. Plus some 'wow'.

#346 ::: Ledasmom ::: (view all by) ::: February 22, 2009, 10:02 AM:

#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.

#347 ::: Suzanne ::: (view all by) ::: February 22, 2009, 10:14 AM:

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.

#348 ::: James D. Macdonald ::: (view all by) ::: February 22, 2009, 11:12 AM:

Flu kills people. Every year, about 35,000 right here in the USA.

#349 ::: Pfusand ::: (view all by) ::: February 22, 2009, 11:55 AM:

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.

#350 ::: Lee ::: (view all by) ::: February 22, 2009, 12:15 PM:

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.

#351 ::: inge ::: (view all by) ::: February 22, 2009, 12:35 PM:

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).

#352 ::: Suzanne ::: (view all by) ::: February 22, 2009, 12:55 PM:

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. )-:

#353 ::: Jenny Islander ::: (view all by) ::: February 22, 2009, 01:32 PM:

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."

#354 ::: JESR ::: (view all by) ::: February 22, 2009, 02:23 PM:

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.


#355 ::: Mary Aileen ::: (view all by) ::: February 22, 2009, 02:55 PM:

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.

#356 ::: janetl ::: (view all by) ::: February 22, 2009, 03:02 PM:

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.

#357 ::: B. Durbin ::: (view all by) ::: February 22, 2009, 03:17 PM:

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 had rubella when pregnant with my oldest sister— while canvassing for the March of Dimes, now there's irony for you— was offered a therapeutic abortion in 1966 and declined it and my sister was in the lucky unaffected minority.

Don't know the stats on my in-laws' side but probably just as bad. Moreover, Evil Rob caught pertussis as a small child, though he'd been immunized; his mother sat up with him all night for two weeks to keep him breathing. Once, when I told this story, they said, "It could have been worse; he could have been asthmatic." Um... he is asthmatic, and asthma has been a major problem in his family. His father died from the long-term effects (though he made it into his 70s) and his niece was so severely affected that her bones became brittle and her immune system collapsed.

Yes, that's right. At one point she was well enough to go to school but every time a kid came in with the sniffles she had to travel three hours to a major city to get gamma globulin shots. And parents still sent their kids in sick, despite the extensive information they were given about Ash's health.

So anyway. She's now a more-or-less healthy twentysomething, though a bit shorter than she should be. (About 4'10".)

My pediatrician looked nervous when he first brought up vaccinations and then looked immensely relieved when I said I was all for them. It's a pity that's a battle they have to keep fighting.

On Sundays I run a board for a talk radio station. Four hours of my shift is Dr. Dean Edell, and last week he was talking about vaccines (he's very pro-.) He blames Oprah for a lot of the current hysteria because she's got such a large "voice" in terms of market share, and "she keeps bringing on celebrities such as Jenny McCarthy instead of actual doctors."

I want to see a campaign. Get together some little banner ads, one with the teeny tiny headstones, one with pictures of polio wards. Put together a Flash simulator that shows a randomly moving population of dots, green for immunized, yellow for not, and a red vector, and show how a disease spreads as the immunization levels fall. You could even make it decently illustrative by using CDC stats for percentage of successful vaccinations, and projective by showing what happens at various levels.

And of course, you'd need little black dots, for deaths.

I don't do Flash, so I can't build it myself.

#358 ::: guthrie ::: (view all by) ::: February 22, 2009, 04:21 PM:

This reminds me- I remember my grandfather picking me up from rugby I suppose about 18 years ago. He was talking to an old (ie probably early 60's) man when I came out, and when he took me to his car said that the old man had only one lung. I'm sure the other one had been lost to TB or some other disease.

#359 ::: Daniel Boone ::: (view all by) ::: February 22, 2009, 04:33 PM:

I'm one of those people with a family history of bad reactions to Tetanus boosters, but it's old history -- after my grandfather (if I got the family lore straight) lost a finger joint in a lawnmower, the tetanus booster triggered a massive allergic reaction. Attempts (possibly including medical misadventure) to treat the reaction had a bad outcome, with the post hac but perhaps not propter hac result that he suffered a massive stroke with verbal loss and physical paralysis.

By the time I knew him he was a lurching old man who had to fumble for every word, but was nonetheless managing to live an active and happy life. The years of relearning to walk and talk were mostly before my time.

Needless to say, my folks always advised me to refuse tetanus boosters, unless the need was clear. (I dunno why they didn't just advise me to avoid lawnmowers.) Nonetheless, I was immunized and I also remember a considerable parental wrangle before the decision was made to give me a booster around age nine after I stepped on the classic rusty nail.

Since then, I've had no wounds requiring medical attention, nor tetanus boosters either. I'm far from certain in my own mind where the best balance of risks lies.

#360 ::: MaryL ::: (view all by) ::: February 22, 2009, 05:30 PM:

I was born in Montreal in 1961 and know I got the smallpox vaccination before grade 1, because I remember the needle scratching, the crusty sore, and the resulting scar on my left arm. I know I went back for some kind of booster in grade 5, probably the Sabin sugar lump, although for the life of me I can't remember. I just remember being in a looooong line-up outside a French church or school, seeing the flickers of the cartoons shown inside for those who had gone through with it, then finally getting inside and -- well, that's it. Might have been a Sabin sugar lump, might have been another shot.

I know we got the rubella shot, which may or may not have consisted of getting scratched three times with a needle on my lower back when I was in grade 3 or 4.

Does anyone else remember getting vaccinated via scratches on the back? If so, what was it for?

#361 ::: janetl ::: (view all by) ::: February 22, 2009, 05:49 PM:

MaryL @ 360: The only scratches I recall were for a TB test. That was about 10 years ago, when a coworker was diagnosed with TB.

#362 ::: Dermott McSorley ::: (view all by) ::: February 22, 2009, 06:07 PM:

I went to a wake yesterday,a friend of my teenage son died from the flu. Seeing the casket hurt more than I can say.He, the child was going to get flu shot,but the slip allowing the shot got lost.
The child got the flu ,and died.Need I say more?

#363 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: February 22, 2009, 07:15 PM:

Lee @ 350

Much as I enjoy a good Repugnican bashing, there is another reason for the change in sick leave policy in the US. It's part of the "efficiency" mantra that resulted in almost universal use of "just-in-time" supply chain logistics, the rise in use of contract employees rather than permanent, and the leveling of job requirements to the minimum in order to reduce payroll. And all of those things make sense from a purely business standpoint if the only criterion is the quarterly bottom line on the balance sheet.

But in the long-term, wheels always come off, things turn pear-shaped, and the balloon goes up. Every one of those tactics works fine as long as the productivity or amount of supply in the system is sufficient to make up for people being sick, trucks breaking down, or small hiccups in the economy. But in the case of major faeco-ventilatory events, the system can't keep up, and a domino effect catastrophe causes every other part of the system downstream from the problem to fail as well. What would have been a minor inconvenience had the company kept on the employees who knew how the software was designed, becomes a disaster as the contractors spend weeks learning how it's supposed to work before they can fix it.

It's very much like the information on a music CD. Something like 40% of it is redundant, so if the disc gets scratched there's a good chance the lost information can be restored when it's played. But if you decide to take out that redundancy to save money, the least imperfection will cause a loss, and a problem that wouldn't be noticed before may make the disc unplayable.

ObSF: This problem is described in Vernor Vinge's A Deepness in the Sky, where it's expected that the fall of a planetary or system civilization due to loss of operating margin and the eventual arrival of an unrecoverable cascade failure can cause the deaths of billions of people.

#364 ::: Ginger ::: (view all by) ::: February 22, 2009, 07:22 PM:

Quill @ 243: It doesn't have to be rabies; any vaccine can cause a "vaccine reaction". It's more a function of how active your immune system is.

I had the prophylactic series of 3 intradermal rabies vaccines, and I had vaccine reaction to each one (mild fever, aching, enlarged lymph nodes, self-limited and over in about 24 hours). Anecdotally, I've heard that this kind of reaction to the vaccine indicates a strong response -- and my titer was high enough that I never got a booster.

I've had vaccine reaction to flu and to tetanus (the last tetanus shot gave me fever a week later, nothing else, but it was a wild 4 days of fever). I've seen my cats have mild fevers and crankiness after rabies vax, especially when combined with other vaccines.

BCG vaccine, by the way, is used by countries to manage an endemic population (TB is endemic in many countries outside the US). It is not used in the US since we do not have an endemic population, and instead we test at-risk populations, then treat. I am tested every six months by intradermal PPD; anyone who's had BCG vaccine gets a chest rad upon entry, to confirm clear lungs, and then are excused from ever having the test. I know one person who was exposed to TB (after taking an HIV-positive coughing patient to the doctor); he took the medicine for 6 months and is now treated just like the BCG vaccinated people.

Shingles: the CDC says yes, you can be vaccinated after an eruption.

Andy Brazil: that's a great story!

#365 ::: Suzanne ::: (view all by) ::: February 22, 2009, 07:40 PM:

(sorry, I seem to be chatty today)

One of the worst jobs I ever had was for a dot-com here in Massachusetts back when my oldest daughter was very young. She caught pneumonia at about a year old and I was home with her for a week, and even though I'd never used any sick time before then my a*hole boss called me at home every day and shouted "everyone here hates you!" before hanging up on me. Really. And he's still working there. (I, of course, am NOT.)

That's a huge part of the problem: there are people in positions of authority out there who regard anyone who uses sick-time as weak, lazy, or just plain lying, as if no one ever actually really gets sick.

#366 ::: albatross ::: (view all by) ::: February 22, 2009, 08:24 PM:

For those interested, the excellent Mystery Rays from Outer Space immunology blog has a post today covering some of the same issues. An earlier post covered the scientific fraud behind the origin of the vaccines-autism scare.

#367 ::: Stefan Jones ::: (view all by) ::: February 22, 2009, 08:43 PM:

I wonder if the vaccine-autism link is something like the Spiritualist movement. It began when two teenage girls faked communication with spirits via "knocking." Then eventually admitted they were cracking their toe knuckles . . . but not before the thing got way out of hand and elaborate beyond imagination.

Even if the original research on vaccines turns out to be fraudulent, the faux-empowerment that comes from shunning vaccines is too intoxicating to give up. Followers get a self-righteousness buzz and access to buzzwords and a body of knowledge that makes them feel superior to the unenlightened.

#368 ::: glinda ::: (view all by) ::: February 22, 2009, 09:56 PM:

Ginger @ 364:

Thank you! That's good to know about the shingles vaccination. I'll take it up with my doctor when I see her next month. (I never ever want to go through an episode again; I have chronic intractable migraines, and the nerve pain from the shingles was worse.)

#369 ::: Inquisitive Raven ::: (view all by) ::: February 22, 2009, 11:06 PM:

Jim MacDonald @ OP: I'm surprised that no one else commented, but you listed developmental delay twice in the list of signs and symptoms of CRS.
[b]@ 138:[/b] Steve Novella discussed this in an article on Science Based Medicine, including the fact that if we want to eliminate a disease in the wild (assuming it's possible), we can't back off vaccinating at that point because we'll end up, in his words "playing 'whack a mole'" with the disease.

This, BTW, has led to my own personal "Big Pharma" conspiracy theory in which the anti-vaxers are playing into Big Pharma's hands. It's predicated on the idea beloved of cranks that pharmaceutical companies care more about profit than people's health, and that vaccines are a big profit generator for these companies. If that's the case, then eradicating a disease in the wild eliminates profits from future vaccine sales. It is therefore in the pharmaceutical companies' interest to keep that from happening. If enough people get scared off vaccines for immunization rates to drop below herd immunity level, the disease makes a comeback and eventually, people get more scared of the disease again and resume vaccinating. Lather, rinse, repeat. I think I'm gonna keep this one on tap for whenever the anti-vax loons bring up the Big Pharma Shill gambit.

Nicole J. LeBoeuf-Little @ 304: "prescribe" vs. "proscribe" has become my new pet language peeve. I saw someone use "prescribe" where "proscribe" was the right word once, but I see the one you commented on a lot and it drives me nuts.

Now for my childhood disease and vaccination stories. I recently got my hands on my childhood vaccination booklet, and I saw no entry for smallpox even though I was born in 1962. I do have several entries for the Sabin polio vaccine, but I remember exactly one from when I had to get a physical before starting high school. That just got squirted down my throat. I also got a diptheria-tetanus vaccine then (no pertussis component) that made raising my right arm extremely painful from about 6 to 24 hours after. I've had at least two tetanus boosters since then and didn't react nearly as badly. The paperwork that came with the last one (on the weekend of the Millennium Philcon, so I'm not likely to forget when I got it) indicates that what I got was a DTaP.

I also got a rabies shot because I'd taken in a stray cat, and well, I was told that with cats, scratches have to be treated like bites because the way they wash their paws has the potential to contaminate the claws. I got the second shot in that series, but not the third, because by the time I would have been getting it, the cat was confirmed uninfected.

As an EMT, I had to get vaccinated for hepatitis B. First shot was uneventful, second shot was miserable, but I don't know how much of that was caused by the colossal stupidity of donating blood the day after. I'd taken a friend in to donate, but wasn't figuring on donating myself because I'd gotten the vaccine the day before, but the lady at the front desk assured me that that wasn't a problem. I spent the hour after donating curled around an emesis basin. That's the only time I've ever had that severe a reaction to giving blood. The third shot was uneventful.

As for diseases, well, for some odd reason, when everyone else in my class was getting measles, I got rubella, and I have the antibody titer to prove it.

My dad never had the mumps as a child, so when my sister got it, so did he, despite us getting our hands on the mumps vaccine and vaccinating all the asymptomatic family members as soon as we realized what she had. My parents were both MDs and could obtain it. As for me, well, I never got the swollen salivary glands, but about a week after my sister got sick, I developed severe abdominal pain that my mom thought was consistent with a pancreatic infection. I wouldn't wish that on anyone.

I also got chickenpox, stayed home from school for a week, IIRC, correctly, but was over the worst of the itching in about two days. My sisters had it worse.

I was in high school when the Swine Flu went through. The school never quite emptied out, but it came close. I did get it, but I seem to have had a mild case.

In the unlikely event that I ever have kids, they're getting immunized. Since I probably have Asperger's myself, if any of them come up autistic, I'll know where it came from.

#370 ::: Rikibeth ::: (view all by) ::: February 22, 2009, 11:42 PM:

When did the Sabin vaccine switch from "sugar cube" to "oral polio drops" in a little plastic vial? That's what I got when I was a child in the 1970s; they were an odd shade of purplish-pink, and tasted sweet and inoffensive.

#371 ::: James D. Macdonald ::: (view all by) ::: February 22, 2009, 11:54 PM:

My Bonnie has tuberculosis
My Bonnie has only one lung
She hawks up the blood and corruption
And rolls it around on her tongue.

#372 ::: Bruce Baugh ::: (view all by) ::: February 23, 2009, 12:24 AM:

Stefan Jones @ 367: "Even if the original research on vaccines turns out to be fraudulent, the faux-empowerment that comes from shunning vaccines is too intoxicating to give up. Followers get a self-righteousness buzz and access to buzzwords and a body of knowledge that makes them feel superior to the unenlightened."

I've known my share of anti-vaccination advocates over the years. Every single one of them was responding to the genuine suffering of someone they loved, and genuinely interested in helping spare others that suffering. They were looking at a lot of the same stuff we've been talking about in this and many other threads about official lies and distortions, and attempting to make sense of their own observed reality.

(One thing that I don't think has ever been tallied systematically is how many anti-vaccination people have already suffered personally or seen someone they love suffer something to which official lies were applied - I remember Agent Orange victims, several folks with fraudently denied stress disorders from Vietnam or the first Gulf War, victims of pollution that was covered up, and so on.)

They're wrong, I'm pretty darned sure. But not one of them ever had that kind of motive, nor were any of those feelings part of their lives.

#373 ::: Rosa ::: (view all by) ::: February 23, 2009, 12:53 AM:

albatross @ 299 - I still think that among the positives of vaccinating are the benefit of not killing an immuno-suppressed person if you get sick. That's a moral good more than a medical one, but the parents I know who don't vaccinate are in other ways very concerned with their kids' moral development. And I've never seen them include that in their discussions of vaccines, and me bringing it up makes them *really* uncomfortable.

It doesn't invalidate what you're saying about corrupt authorities (and, ouch, the church!) but I think the equation is off on the FOR side as well as the AGAINST side.

combined time off/PTO (#303 & later) - I get 80 hours of paid time off, but if I have more than 6 unscheduled absences in a year, it's a fireable offense. That's one sick time every two months (it can be more than one day, as long as it's not broken up by work - so forget, say, juggling work time with your partner if your kid is sick).

Except, I just got a part-time flex-time job in the same company, so I expect to never waste my PTO on actually being sick ever again. I don't think mangaers use PTO for sick days either, they just work from home or use flex time. It's only the peons on the clock who get hit with the effects of stupid policies like that.

That's what the mute button on your phone is for, right? So you can hack up a lung without disturbing your customer. (Friday was my last day in the call center.)

#374 ::: James D. Macdonald ::: (view all by) ::: February 23, 2009, 01:49 AM:

I am not 100% convinced that everyone in the anti-vaccination movement has suffered a personal tragedy.

#375 ::: Arachne Jericho ::: (view all by) ::: February 23, 2009, 02:29 AM:

@Bruce Baugh #372 -

That sort of attitude/situation I understand. And of course ties in with the whole authority-lies! fears, unfortunately sometimes substantiated. The solution is to try to figure out where the truth lies. Unfortunately, we then meet a serious problem, which is that we don't teach people tools to think problems through with.

My own familial situation of not taking children (or anybody else) to doctors resulted from a 911 call that went awry and killed a relative. Ever since then, there were no more doctor's visits even during life-threatening events, because the conclusion was that doctors and modern medicine could only make it worse and kill you for sure instead of maybe. Best to let nature take its course, and if people die, then, well, nothing sensible could have been done.

And that, of course, proceeded to wreak terrible destruction throughout the family all by itself, but each time "some incident" of modern medicine (over the counter drugs, a doctor visit forced by the school/law, etc) could be found, and the conclusion was that whoever had died had brought it upon themselves. The entire extended family tunnel-visioned into seeing only this false cause-effect situation. You couldn't convince them otherwise, because they only focused on their own experience, and after the first one, everything else they looked at seemed to support it. The idea of bias wasn't something you could knock into their heads.

Logical thinking: not a strong point with them. Scientific method: they didn't believe in scientists (or, frankly, science).

At that point I believe it's called "the echo chamber."

So how do you crack it? All you can do, I think, is wait for another example to come along and disrupt their point of view. Usually said example must be drastic and personal---other people's experiences tend not to be weighed against one's own experiences (and, after all, that sort of thinking is what created the echo chamber in the first place).

I think timing is necessary as well (once you get into the 40s-50s, you are set in your ways).

The reason, of course, that pneumonia nearly killed me the third time (and half-killed me the second time) is because I was raised to not believe in doctors (though I believed in science, thanks to school teachers). No medication at all, not even for pain. Pure you-get-through-it-or-you're-weak-and-deserve-to-die. And unfortunately I didn't question that (raised not to question anything, and despite teachings from school that didn't take, because the home environment is so powerful. But I did believe in science. That was the only thing that saved me in the end).

Thankfully friends introduced me to the world of over-the-counter, doctors, vaccines, and prescription drugs. To me it was like magic. (This, and other things, is why I consider myself relatively new to the shores of modern America, despite having been born *in* America.)

I also almost died from wisdom teeth. Because dentists counted as doctors.

#376 ::: Terry Karney ::: (view all by) ::: February 23, 2009, 02:31 AM:

I have to wonder if the odd session of coughing to collapse (no oxegen to keep myself from being a loose lump on the floor) until the air was so dead in my lungs I couldn't drive the cough any more... gasping breath and repeat, might not have been a weak case of whooping cough.

#377 ::: Arachne Jericho ::: (view all by) ::: February 23, 2009, 02:51 AM:

@James D. Macdonald #374

There are always idiots in every apple barrel. I frankly think that some people do use the anti-vaccination as a power-brokering, blame-excuse, guilting lever, and they help propagate the awfulness, but it's not most of the anti-vaccination people.

(Said idiots are the same people who like to hear anything that supports their point of view or can be twisted as such, no matter how horrible it may be. And the worst part is that some of them might be able to suss out that vaccinations are actually good, but that would weaken them, and unfortunately they tend to be aggressive enough to actually have a hold over others. It is so very, very... argh.)

#378 ::: Jenny Islander ::: (view all by) ::: February 23, 2009, 03:16 AM:

Suzanne #365: What an ass! I feel a bit less bitter about the boss I had at that non-profit with the liberal* leave policy. She never got sick, but she wasn't quite as obnoxious about it. She just trotted out the "You don't have to get sick, it's all about willpower" line whenever anybody sneezed. I never got up the courage to ask her whether she took full credit for her naturally even teeth too. At least she never tried to intimidate or nag people into not taking their allowed sick leave.


*New Yorker cartoon from the early '90s: Maitre d' to waiter: "Pass the word. From now on our portions are 'generous,' not 'liberal.' "

#379 ::: Bruce Baugh ::: (view all by) ::: February 23, 2009, 03:49 AM:

ArachneJericho: Yes, I agree 100%, maybe even more. :) In a time when so much official discourse consists of lies, we all have to pick up the load with the basics of reasoning, logic, and rhetoric, to separate out the lies from the truth. I'm not trying to make excuses for the anti-vaccination people I've known except to say that I don't think they're in it for power-tripping, the thrill of being the vanguard party, or anything like that. Their honest intentions to keep them from being wrong in a dangerous way and that has to be addressed, partly by separating out actual motives from projections.

#380 ::: Individ-ewe-al ::: (view all by) ::: February 23, 2009, 06:45 AM:

My grandmother contracted rubella soon after she was sure she was pregnant. Her doctor offered to pass on the name of someone who wasn't too fussy about the legal status of abortion. My grandmother decided that the risk of potentially having a brain-damaged child was lower than the risk of an illegal (UK, 1947) abortion, so gave birth to my mother a few months later. Not brain-damaged, but severely to profoundly deaf. (My grandparents then spent the next eight years trying to convince the medical establishment that their oldest daughter had a hearing problem, and wasn't just "a bit dim, dear", but that's another story.)

Also, my other grandmother was a paediatrician, qualified in 1940. You can bet your boots her grandchildren were all fully immunized! I didn't have the option of mumps or chicken pox, presumably I was born too soon, and I had both diseases mildly in childhood. My father was unfortunate enough to catch mumps from us and was bedridden and in severe pain for several weeks. To make it even worse, that outbreak coincided with my youngest sister's birth, so my mother dealt single-handed with a new-born baby and three sick under-fives when he was suffering too much to help.

Interestingly, my grandmother the paediatrician advised us not to get the whooping cough vax; she figured that the disease was close enough to being elimated that the vaccine was riskier than exposure. (She'd dealt professionally with the nasty aftermath of a bad vaccine reaction, I think.)

The first grandmother started getting recurring shingles a few years ago. It's pretty miserable, and her odds of losing her sight to a future bout keep increasing. Probably she was exposed to the virus when we had chicken pox as kids and she was helping out.

#381 ::: OG ::: (view all by) ::: February 23, 2009, 07:21 AM:

I wouldn't dismiss the profitability of vaccines too quickly. The vaccines Wyeth makes are widely reported to be one of the reasons Pfizer wants to acquire them.

#382 ::: albatross ::: (view all by) ::: February 23, 2009, 08:58 AM:

Rosa #373:

Yeah, that's the (b) part of the decision, the side where you're assessing benefits. I'm just saying that it's not nearly as clear-cut how much of your child's expected lifespan you should be willing to spend to increase others' expected lifespans. A natural answer is 1:1, but I do not believe there are many parents who would accept such a tradeoff--I surely wouldn't. (To some extent, you can get acceptance for such tradeoffs when you're dealing with extremely low probability events, probably because humans don't reason about such events well.)

It's worth pointing out a subtle difference here: Part of the value of the vaccine to the patient depends on the fraction of other people taking it--the more widespread the vaccine is, the less value it has for me, because I'm less likely to encounter the disease. That sets up a classic prisoners' dilemma, in which, to maximize the benefit to all patients, it makes sense to push nearly everyone to have the vaccination, driving the expected well-being up for all patients.

There is also an effect on other people--my getting the flu vaccine partly protects my coworker who's going through cancer treatments, because now I'm less likely to expose his beaten-down immune system to the flu. It seems more natural to me to treat this as a separate issue from the benefit/cost to patient. Now, I'm willing to make some tradeoffs to avoid making other people sick, especially when the tradeoffs are pretty favorable (a tiny risk of death or serious illness for me trades for a much larger decrease in risk for my coworker). I'm even willing to make those tradeoffs on behalf of my kids, when the risk they take is small enough and the likely external benefit is large enough. But that tradeoff doesn't happen anywhere close to 1:1. If I can decrease a stranger's chance of dying by 10% by taking on a 10% probability of dying of a vaccine reaction, I'm not remotely interested. I'm not sure exactly where I'd be willing to make that tradeoff, but it's not 1:1, and I'd be more reluctant to make such tradeoffs for my kids.

#383 ::: FungiFromYuggoth ::: (view all by) ::: February 23, 2009, 09:33 AM:

Interesting article today in the Glob about a potential true Influenza A vaccine that targets the non-mutating parts of the flu.

#384 ::: Bruce Baugh ::: (view all by) ::: February 23, 2009, 09:51 AM:

It occurred to me in the wee hours that one thing influencing how various of us respond to people being (we're sure) wrong about something important is: How do we feel about being wrong?

I've had my times being one of those sort of expected people to be right about the things that mattered to them, for whom wrongness on an important point was remarkable and distressing. As I age, I'm more inclined to expect wrongness of this sort in myself as well as others, and I don't see it as a sign that there's anything unusually bad about people being wrong, even when it's very important. There's nothing there to explain - that's just how we are.

So trying to help fix wrongness in myself or others isn't like the special effort needed to deal with a rare and devastating disease, but rather like routine hygiene. So to speak.

#385 ::: Nancy Lebovitz ::: (view all by) ::: February 23, 2009, 10:05 AM:

In re the co-worker who won't touch refined sugar and makes awful cupcakes: Does anyone know how honey powder works out? I used to get a very good chocolate pudding mix that used dehydrated honey, but that isn't baking.

#341 ::: Juliet E McKenna:

Thanks for the explanation about child vs. adult immune systems.

It doesn't seem to cover all cases, though. Afaik, adults get fewer colds than children, but not worse colds.

Was your point about childhood cancers that children tend to only get the most aggressive cancers because the slower cancers get swatted down by children's immune systems?

#386 ::: Janet K ::: (view all by) ::: February 23, 2009, 10:18 AM:

Wonderfull discussion!

Recently PBS's American Experience aired a fascinating documentary on polio ( The Polio Crusade); I think it can be watched online. Fear of polio ran a close second to fear of atomic war. Scaring people (arguably beyond a rational level, considering the morbidity and mortality of the disease) was a side effect of the March of Dimes' highly successful campaign to raise money for polio treatment and research.

I'm old and remember lining up at school as a child for my Salk and Sabin vaccines.

I should have had a smallpox shot as a toddler in the 1940s. The vaccine was routinely given, mandated, I think, for school attendance. But my mother had had a very bad reaction to her smallpox shot (which would have been pre-1910) and talked the pediatrician into not vaccinating my sister and me. That felt odd and wrong to me, everyone else had the scar. Before I started high school I asked my doctor to vaccinate me and he did.

I had measles as a kid and rubella as a college student, maybe a mild case of chicken pox lost to memeory, but I don't think I had the other childhood diseases for which vaccines are now available.

I get flu shots every year and have had the pneumonia jab. Next visit I'll check with my doctor about getting a tetanus booster and discuss whether other vaccinations might be worth doing at my advanced age.


#387 ::: Sissy ::: (view all by) ::: February 23, 2009, 10:37 AM:

abi #27 writes, "I have heard that the immunity to rubella from vaccination wears off after a time"

I too attended one of those "rubella parties" and caught rubella -- and so thought I was immune. When I was pregnant with my first child, the routine bloodwork included a rubella titer that showed my immunity was there, but very weak. Once my daughter was born (healthy!), the doc gave me a poke so I wouldn't have to worry about it for the next one.

My advice, women should get the rubella titer when they decide they would like to get pregnant -- but before actually doing so. Then they and the docs can decide if they need a booster or not.

#388 ::: Caroline ::: (view all by) ::: February 23, 2009, 10:38 AM:

Regarding cupcakes without refined sugar:

I don't mind the idea of not touching refined sugar. I've cut way back on my consumption, and it would be ideal if I could cut it out entirely. (I get tired of my blood sugar dropping like a rock every four hours, to the point where I become irritable, shaky, and confused. Refined sugar and white bread tend to induce this for me. A two-hour glucose tolerance test came out normal, but I still suspect reactive hypoglycemia.)

But for the love of Cthulhu don't try to make cupcakes without refined sugar. Bring a fruit and cheese plate or something.

#389 ::: James D. Macdonald ::: (view all by) ::: February 23, 2009, 10:41 AM:

From the point of view of public health, if Choice A has 43 per 100,000 bad results and Choice B has 5.9 per 100,000 bad results, Choice B is clearly superior.

Sucks to be one of the 5.9, but it sucks to be one of the 43, too.

Speaking of small numbers having big effects:

A pandemic with 15-40% infection rate and a 2.5-5% death rate is still sufficient to overwhelm the hospitals, exhaust the supply of coffins, and to make it necessary to dig mass graves with steam shovels.

In this age of just-in-time ordering, I expect that a pandemic now will really screw things up.

#390 ::: JaneDoh ::: (view all by) ::: February 23, 2009, 11:04 AM:

My sister is allergic to something in the pertussis vax (we found out after her terrible reaction to her first DPT). So she got DT boosters after that, and depends on herd immunity to avoid pertussis. Unfortunately, she is a K-1 school teacher in an urban school, so her profession puts her at high risk. It really pisses me off when people refuse the DTaP for their kids, since that directly impacts my sister's health. Even after her terrible reaction, everyone in the family is still completely immunized. We just watch our kids carefully for reactions, especially after the DTaP.

When I lived on the West Coast, they had to close the schools for a few weeks on Vashon Island pretty much every year or two due to outbreaks among the unvaccinated (there is a very low rate of vaccination on Vashon Island). Some kids died/were permanently disabled by measles one year. One kid apparently infected 17 others, including 2 newborns (who nearly died). His Mom was like "oh well, that's life, I'm still glad we didn't vax."

Turns out I am a great titer--I have a large number of antibodies when checked (for rubella, I was last immunized in 1990, but titered as if current in 2005). I was still glad they checked when I had my planning to get pregnant checkup.

I think that part of the vaccination "problem" is the increased intolerance to risk of any kind in our society. This is the same thing that caused people to freak out when the Free Range Kids Mom let her 9 year old take the subway alone in NY. So even a 1 in 100000 risk is too high, especially since most people don't know anyone who had serious impacts from a vaccine preventable disease.

#391 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: February 23, 2009, 11:10 AM:

James D MacDonald @ 389

In this age of just-in-time ordering, I expect that a pandemic now will really screw things up.

ER Doctor: "Who ordered all these sick people?"

#392 ::: Nancy Lebovitz ::: (view all by) ::: February 23, 2009, 11:25 AM:

A non-fiction analysis of why an excessive search for efficiency is dangerous: Slack: Getting Past Burnout, Busywork, and the Myth of Total Efficiency by Tom DeMarco. I especially treasure the bit about the lawsuits resulting from companies that skimp on the work needed to evaluate contracts.

#393 ::: Trey ::: (view all by) ::: February 23, 2009, 11:39 AM:

Juliet Mckenna @ 341: Huh. That explains why mono and CMV tore me slap up last year and kept me a marginal human being for almost 9 months.

Bruce and James about JIT: Too right. There is no margin for error, which is a recipe for disaster, ie, if the system is so fragile it cannot tolerate any errors, it will fail. Something I learned when I had to read up on systems theory and design for my current job. And if you think a pandemic would screw things up, think about what the New Madrid quake would do.

#394 ::: Lila ::: (view all by) ::: February 23, 2009, 11:41 AM:

As someone mentioned way upthread, there's a strong sentiment in the dog community that dogs are being overvaccinated. IMO, if they are (and I have no data one way or the other), one major contributing factor is that titers are so damn expensive. I would love to have blood drawn annually from my dogs (especially my very old and very allergic dog) and have boosters only as required by low titers. But it would be far costlier than just assuming they need an annual booster for everything.

As for people--my MMR titer cost more than the shot. Because neither I nor my doctor liked that vigorous local reaction I had last time, I'll keep getting the titer, and when it's low, I'll get the shot--but I'll get it in a time and place where someone can keep an eye on me afterwards and call 911 if I start having a systemic reaction.

#395 ::: Cat Meadors ::: (view all by) ::: February 23, 2009, 12:37 PM:

For people born in the early '70s: you might want to get your measles immunity checked. When it first came out, they gave the MMR too soon, so the measles part didn't actually provide any protection.

I was part of a study about this; one theory was that kids who were vaccinated too early would never be able to develop measles immunity, but luckily that's not true. I was definitely not in the control group - the vaccine made me sick, although not nearly as sick as measles would have - but part of the deal was that you'd get the vaccine (if you'd had the placebo) & a titer check & all that after the study. So I know for a fact that I didn't have measles immunity before I was 15, and that after that, I did.

My father was a virologist. When my husband accuses me of being a germaphobe, I point out that with the upbringing I had, it's amazing I can function in modern human society at all. (A few things I was not allowed to touch as a child: bird feathers, handrails, anything on the subway, hospital doorknobs, any water that didn't come from a faucet.) I'm not certain, but based on some unclear childhood memories and things he said later, I think I may have gotten... more than the usual series of vaccines as a child. Like, kind of a lot more. At any rate, I never got sick as a child, and I'm not autistic, either. (If anecdotal data of autism showing up after vaccination "proves" a link, then anecdotal data of massive over-vaccination not causing autism should equally disprove such a link, right?)

So, yes, definitely got my child vaccinated against everything, although on a slightly modified schedule. (Fewer things at any given time, more spread out. And we waited a little on the chickenpox vaccine, but she's had it now.) More copays, but luckily nothing that stretched our budget. She will get the HPV vaccine when she's old enough, assuming nothing bizarre comes out about it in the next 8 years. Reading a few infectious medicine journals will really cure you of the idea that these childhood diseases aren't something to worry about. (Also helps to have long-lived grandparents; hearing the stories of how many friends of theirs died before high school is instructive.)

Re: sick leave in the US - I actually worked for a company that went from 15 days of "personal leave" (sick + vacation) to 10 days of vacation + 3 sick, and tried to sell it as a bonus because "now you've got sick leave"! I'm back to a place that does "personal leave", which seems to be the standard around here, unless you work in nonprofits or for the government (not as a contractor.) Those two sectors tend to make up for less-good pay with nicer benefits.

My husband has never had a job with any kind of paid time off. (Wait, I tell a lie; he had a job for three years where they got paid for Christmas even though the store wasn't open. Still not especially conducive to staying home when sick, though.) So, yeah, when it's a choice between coming in sick or suddenly finding yourself homeless, infecting your co-workers pretty much always wins. I've been following with great interest the idea of mandating sick leave - both the possibility of it happening and the idea that two days per year is so impossibly generous that it will bring all business in the US to a screeching halt. To people who think beyond employees being fungible cogs in a machine, it seems to make nothing but sense to keep plagues from spreading through a workplace - but the people who think that way seem to be in short supply.

#396 ::: Pendrift ::: (view all by) ::: February 23, 2009, 12:41 PM:

Nancy Lebovitz @385:

Re: childhood cancers, we were taught it was the speedy-cell-division part at work. Since kids are growing, when there's abnormal cell proliferation somewhere, it tends to happen very fast.

#397 ::: Lee ::: (view all by) ::: February 23, 2009, 02:04 PM:

Jim, #374: In particular, I am not convinced that the people who are making money off of the anti-vaccination movement have suffered personal tragedies. Con men know a good thing when they see one.

Fungi, #383: And at the very top of the comments (as I write this), there's someone claiming that massive doses of Vitamin C can cure avian flu, but the media won't report it because that doesn't make Big Pharma any money. How much you wanna bet that this person sells Vitamin C on eBay?

Janedoh, #390: My free-associating brain now wonders how much overlap there is between the "life begins at the moment of conception" group and the anti-vax movement, and whether it would be possible to charge anti-vax parents with negligent homicide if their child infects and kills someone else. It wouldn't be any more far-fetched than charging a pregnant woman who drinks with child abuse.

#398 ::: JESR ::: (view all by) ::: February 23, 2009, 02:14 PM:

I think that Bruce Baugh's experience of anti-vaccination people and mine are a vivid example of how much variation is possible in personal experience. The anti-vaccination folks I know in my 3-D life are home-birth Waldorf-school sorts, or very lucky Christian Scientists (the latter I'm related to). The ones I met in online forums were much the same, with the added component of crusading chiropractors. I'm the only person I know who withheld any portion of vaccine for reasons of bad reaction (the younger spawn screamed for 24 hours after her first DPT, got DT only on advice of our doctor, and had to be revaccinated when the new pertussis vaccine came out).

Selection bias is a mighty force.

#399 ::: Juliet E McKenna ::: (view all by) ::: February 23, 2009, 02:50 PM:

Nancy Lebovitz@385, exactly as per Pendrift@396, it's the rapid cell-division aspect that makes childhood cancers so aggressive, according to the nice doctors. Apologies for unintentional lack of clarity.

As to the-older-you-get-the-weaker-immunity explanation, doubtless there are subtleties the nice doctors didn't share with me.

They had realised I was one of those fairly clued-up relatives who would deal better with sensible information as opposed to a pat on the head and there-there-don't-fret. On the other hand, I was already several weeks into nursing very sick children and running on adrenaline fumes. I imagine they gave me the edited highlights/Cliff Notes version :)

#400 ::: KeithS ::: (view all by) ::: February 23, 2009, 03:09 PM:

Orac just put up a summary of the discoveries of Andrew Wakefield's fraudulent research and the results of the Autism Omnibus proceedings.

With regards to the people who believe that vaccinations cause autism, I think there are many different groups all combining around the cause. There are the cranks who have convinced themselves that they hold the truth and they want to spread it. There are the scammers who are happy to take advantage of people. There are people who can't accept that sometimes things just happen that we don't yet know the cause of, so they want to blame something. There are people who are vaguely aware of some (non-)issue, and so they don't vaccinate just in case it might be true. I don't think that the majority of people who are anti-vaccination are malicious, just misguided. It's the believers who need something to blame, cranks, denialists and scammers who stir up the trouble.

#401 ::: P J Evans ::: (view all by) ::: February 23, 2009, 03:13 PM:

#393
'The world market for used brick is not that big.' - Frisbie, on St Louis and the New Madrid fault zone

#402 ::: JESR ::: (view all by) ::: February 23, 2009, 04:01 PM:

Juliet McKenna @400, In my (personal and imperfect) experience, the loudest and meanest voices on the anti-vaccination side belong to true believers. The scammersmake their sales pitch and move on, while the true believers stay to press their point with any explanation that comes to hand, shifting blame for personal experience with infectious disease onto the people who press the case for vaccine. I once found myself in a long and pointless disagreement (on the AOL medical debate board) with a chiropractor who was convinced vaccines caused autism but small-pox, measles, and polio were inherited/caused by bad parenting/caused by eating meat.

#403 ::: Raphael ::: (view all by) ::: February 23, 2009, 05:36 PM:

I'm kind of surprised that several people said they don't know when they got their various shots for the last time so far- don't you have vaccination certificates in the US?

Lee @397, the antivacc folks come from all kinds of ideological backgrounds, drawing on their various ideologies for arguments- from "they're against harmony with nature and benefit big corporations" to "government is forcing them on people, so they have to be evil" to "they're peddled by immoral godless scientists and promote immorality". So there's overlap with the "life begins at the moment of conception" people as well as with other camps (and with otherwise unpolitical people who have a vague dislike of things they find unnatural).

#404 ::: David Dyer-Bennet ::: (view all by) ::: February 23, 2009, 06:05 PM:

Nicole@307: Hmm; how about managing to catch (well, be diagnosed with) something with legal quarantine requirements? Or manage to come in with clear symptoms of something other people won't want to catch? Like, say, ebola? I guess that last would be hard to arrange.

More seriously, I guess one could try an anonymous complaint to the state health department. One could also consider unionizing and having it become a contract issue.

#405 ::: Inquisitive Raven ::: (view all by) ::: February 23, 2009, 06:29 PM:

Raphael @403: Pediatric patients have vaccination booklets that log what they've gotten, but no, in the US, adults don't get a vaccination certificate. They do, however, get stacks of paper on what to expect after the vaccination that are apt to promptly get lost. I'm not sure I still have the paperwork from that last tetanus shot. I'm also not sure what exactly the valency of that shot was. I asked for a tetanus shot,and the resident gave me a shot (I was in an ED), but didn't say anything about it being a trivalent vaccine. The paperwork identified it as DTaP, but it was a preprinted form.

#406 ::: Stefan Jones ::: (view all by) ::: February 23, 2009, 06:37 PM:

My doggy has vaccination certificates, which I have to show when using a new kennel, groomer, and etcetera.

#407 ::: Inquisitive Raven ::: (view all by) ::: February 23, 2009, 06:54 PM:

Jon Lundy @ 248:

The first Q/A is conflating infection rates with mortality. Infection rates for some diseases, e.g. food and water borne diseases, can be significantly affected by improved sanitation, but others,notably airborne diseases, not so much. However, improvements in medicine meant that a lot of people who would have died of some diseases survived the infections. Think iron lungs for polio patients.

The second Q/A is a "Well, duh!" All vaccines have a failure rate. Some people who get vaccinated will not sero-convert. Others will respond poorly. The ones who respond poorly, may get the disease, but they'll have a milder case than they might otherwise have had. The ones who don't sero-convert at all are one of the reasons that herd immunity is so important.

Of course, that website is playing an all or nothing game, implying that because vaccines don't work as advertised for some people that they don't help anyone at all. In fact, if the failure rate is low enough, they're very useful. Not being a public health professional, I don't know what the minimum success rate for a vaccine needs to be, although I would assume that it needs to be sufficient to produce herd immunity.

#408 ::: James D. Macdonald ::: (view all by) ::: February 23, 2009, 08:17 PM:

Are you kidding? Everyone knows smallpox is caused by miasma.

#409 ::: Xopher ::: (view all by) ::: February 23, 2009, 08:37 PM:

And malaria, as the name implies, by exposure to bad air.

#410 ::: James D. Macdonald ::: (view all by) ::: February 23, 2009, 09:07 PM:

#407: ...although I would assume that it needs to be sufficient to produce herd immunity.

You're talking about immunizations somewhere in the 90-95% of population range, depending on how virulent the disease is (i.e. how hard it is to catch).

Some of these diseases have no non-human reservoirs: if we manage to go a generation without anyone falling sick they're gone and we can stop giving that vaccination. Wouldn't that be a good thing that would please the anti-vaxers?

#411 ::: Marna Nightingale ::: (view all by) ::: February 23, 2009, 09:40 PM:

Raphael @403: I'm in Canada, but AFAIK it works like this:

When I was in school, my immunization record was part of my school records, and had to be acceptable every September before I could start school.

AFAIK my high school destroyed my detailed school records 10 years after I left, the law is something like that, so that went along with all the details of my detentions and stuff, but my doctor always had a record, of course, and said record has been following me around all my life, cause I've always made sure they transferred.

As an adult I've only ever needed to show proof of vaccination once, for a Red Cross Disaster course I think. It was years ago, but I recall my doctor printed something off and signed it and that was all.

Tetanus, not being contagious, there's no certificate as such for at any age, and it's the one I always forget my dates on, though my doctor has it.

So when I say "I forget" I mean "I'm fuzzy because they just tell me when I need stuff and I am just kind of a forgetful sort when I can afford to be, but I could find out in 72 hours if need be", not that I absolutely don't know.

#412 ::: Terry Karney ::: (view all by) ::: February 23, 2009, 09:59 PM:

Raphael: In the United States one can ask for records to be entered into an international record of immunizations ("shot record"). I have two copies of mine.

But it's done when you demand it, not as a matter of course.

I seem to be one of those lucky people who sero-convert really strongly. When I was re-stuck for smallpox I barely reacted. When I was given an early tetanus booster it laid me out for three days. The shot for Yellow Fever walloped me hard, had me miserable for about 10 days, when most of my peers were done with it in 5-7.

Which is why I was glad not to be getting it as a routine update in 2003. That was not something I wanted to be slammed with hard again, should it be as tetanus was, not as smallpox.

#413 ::: Lee ::: (view all by) ::: February 23, 2009, 11:12 PM:

Jim, #410: Isn't that what happened with smallpox? There was no non-human reservoir, so once the last of the active cases was a generation gone, that was it.

#414 ::: Earl Cooley III ::: (view all by) ::: February 23, 2009, 11:21 PM:

I think bio-weapon stockpiles should probably count as "non-human reservoirs".

#415 ::: James D. Macdonald ::: (view all by) ::: February 23, 2009, 11:31 PM:

I think bio-weapon stockpiles should probably count as "non-human reservoirs".

Yes, but.

It would be wise for any bio-weapon stockpiles to be destroyed.

Even if they exist, however, the very low likelihood of their being used (since any release would be as likely to hit your own people as anyone else) makes the small-but-real numbers of adverse reactions from the immunizations the greater risk.

That leaves accident.

It would not grieve me to learn that some unknown worker at some lab had quietly added fuming nitric acid to the last archived samples, years ago.

#416 ::: Epacris ::: (view all by) ::: February 23, 2009, 11:44 PM:

@407 “that website is playing an all or nothing game, implying that because vaccines don't work as advertised for some people that they don't help anyone at all.”

A familiar technique. Like the scream/headdesk moment from a transcript of an abstinence-only sex ‘education’ course. Paraphrased lightly, “you can still get pregnant/catch STDs using a condom, so you might as well not use them”. This stuck & was repeated by pupils/victims questioned afterwards.

No discussion of incidence or probability, of course. My response:
“People have survived falling hundreds of feet from a plane without a parachute, so you might as well not use one: Discuss.”

#417 ::: Mycroft W ::: (view all by) ::: February 24, 2009, 12:23 AM:

403: Well, maybe. But they didn't chase me down at any time over what I didn't have, and I've never seen it. Also, I've changed doctors many times in my life - the vagaries of Canada's current health system being that I didn't *have* a doctor for several years (psychiatrist, yeah. Family doctor? I was one of the 100 000 who didn't have an FD in the Ontario Health Minister's riding). If I or my parents ever had a copy of it, it's lost - if it was in my care, almost certainly deliberately. After all, it would show what I missed and needed to get, no?

Please note, I had to have blood drawn today. I was freaking out (literally; shaking, using inappropriate language, sending the wrong information) all day as a result. And that's *with* the training on how to handle needles.

I do have a little yellow book (somewhere) that said when I last had an incident with rusty clothesline. Also, please note that I'm not proud of my vaccination record, and I did ask my family doctor (once I got one again) what I should do about it, and I have followed his instructions.

408 Xopher: Look, I've been in the Ontario backwoods. Trust me, air with cloud-thick mosquitoes *is* bad air.

All/nothing logic - I just love that. There can't be a gradation, or a third way, can there? Of course it works the other way, too - if we don't Clamp Down on Free^H^H^H^HTerrorism, it's going to be epidemic. Oops, sorry to raise my bugaboo in an irrelevant thread again.

#418 ::: cm ::: (view all by) ::: February 24, 2009, 01:11 AM:

I doubt anyone will read this far down in the comments, but: This is an amazing post. Enormous kudos to you!

#419 ::: Clare ::: (view all by) ::: February 24, 2009, 01:15 AM:

Thank you. People need to be reminded of these horrors. My mother's older brother died of diphtheria at two (hard to call him uncle when he lasted such a short time). Her brother and sister both had it. She had whooping cough. Vaccinations couldn't come fast enough for my grandparents.

#420 ::: Terry Karney ::: (view all by) ::: February 24, 2009, 02:20 AM:

My mother wasn't planned. She was, in fact, hoped against. My uncle Johnnie died at three, TB (b. 1936 d. 1939). Devastated my grandmother, so when my mother was born in 1947 it wasn't seen as being the bundle of joy it might have been.

Granma was too afraid she'd die too. Her brother is 15 years her senior. In a lot of ways she was his charge, and my grandfathers.

Such things have strange repurcussions, not all in keeping with the obvious ones.

#421 ::: James D. Macdonald ::: (view all by) ::: February 24, 2009, 02:22 AM:

This is Making Light. People read 400 comments down the threads All the Freakin' Time.

We do need to remember these horrors. And we need to remember how thin the veil is. Any of these could return at any time, and if the anti-vaxers get their way...they will.

I don't know if y'all have seen the other medical posts here. The theme I hit is endless preparation, knowing that no matter what we do, we will be called to do more.

I want to take the anti-vaxers into a 19th century hospital, walk them through the wards, and say to them "This is what you want, not just for yourselves, not just for your children, for all of us."

I just quoted a bit from another book, at the end of the Cholera thread. It's apropos to this thread too.

#422 ::: Lisa Padol ::: (view all by) ::: February 24, 2009, 02:24 AM:

So, I'm 41, and the last time I checked my immunization records was before I was 30. How do I find out what immunizations I should be getting? I have some vague idea that even grown ups need periodic re-immunizations.

#423 ::: Linkmeister ::: (view all by) ::: February 24, 2009, 02:37 AM:

cm @ #418, Jim @ #421 writes This is Making Light. People read 400 comments down the threads All the Freakin' Time.

We don't even start clamoring for new open threads until they get close to 950 comments! Make use of the left sidebar's "last comments" list to keep track.

#424 ::: DLC ::: (view all by) ::: February 24, 2009, 02:52 AM:

Orac at Respectful Insolence linked me here.
Excellent post, thanks.

#426 ::: Marna Nightingale ::: (view all by) ::: February 24, 2009, 03:38 AM:

Jim @421: Mitch Hepburn, when he was Premier of Ontario, brought in mandatory pasteurisation of milk. It was expensive and unpopular among dairy farmers.

My mother, who qualified as a nurse back when there was a women's TB ward, a men's TB ward, and a children's TB ward *at the (small) St Thomas-Elgin County General Hospital and every other hospital in SW Ontario* remembers the speech he made in Elgin County, which is where he'd been raised and had lived.

Well, not the actual content. She remembers him interrupting a heckler to yell to someone near him in the crowd "Hey! I know you! You're (so-and-so). You have a farm out near (Fingal?) and you have five children, right?"

*agreement from farmer*

"You used to have seven".

And that is how pasteurisation came to Ontario.

#427 ::: Alex ::: (view all by) ::: February 24, 2009, 06:01 AM:

One thing that annoys me: the meme about "why can't they wait until ickle baby's immune system has developed further?" That's the whole point of childhood vaccination - it's to stop your child getting diseases that kill children!

Essentially, if you're asking that question you might as well go the whole hog and become an all-out mercury-in-the-power-station-efflux antivaxer, because it shows you're not engaging with the content - it's just Jim MacDonald, the National Institute of Desirable Characteristics, etc going on again, and you're trying to do the minimum necessary to shut them up.

I do remember encountering someone who had a leg brace due to polio in Yorkshire in the 1980s, while out canvassing with my mum for the Liberal Democrats. You don't know where you live until you stand for election; personally I think it should be compulsory.

I got the full set, with the exception of BCG; I demonstrated an immune response to the test, but not enough to make them freak and send me for chest x-rays. This meant that for a couple of weeks I was the only kid in the playground without a huge, swollen, bleeding scab (we did the 1950s-ish "parade all the kids at school without warning and test/vaccinate the lot" trick - god knows how that would have gone down in the Wakefieldean late 90s).

I don't know how I was exposed, but I reckon my dad spending his days raiding dodgy kebab shops in search of illegal immigrants may have had something to do with it.

The surge of British measles cases due to Andrew Wakefield has the odd property that, if you graph it, it tracks the great housing boom very closely - rises steadily in 1998-2000, goes exponential in 2001-2004, takes a bad break in 2005, then goes ape again in 2006. But I doubt there's much chance of a measles crunch.

Someone mentioned bovine TB; in the UK, this was eventually dealt with by the simple means of testing all the damn cattle and shooting the positives between the eyes, then disposing of the carcass in such a way as to keep it off the market. However, it took decades to get this past the farmers and the landed interest and the Conservative Party, who were completely fucking unreasonable about it, just like they were 50 years later about BSE; I think it took the second world war to cram it down once and for all.

#428 ::: Dave Bell ::: (view all by) ::: February 24, 2009, 06:07 AM:

The repeated mentions if titers (which we Brits probably spell "titres") is something we just don't seem to bother with in the UK, even in the wider sense of checking how treatments are working. My brother is getting something new for his hypertension, with some dramatic improvements, and his GP is keeping track of his blood pressure.

My GP just changed one of my tablets. Nothing about the possible medical benefits: it's cheaper. I think he's a bit of a wanker.

Maybe some of it is the apparent US habit of running medicine for profit?

And some of it is my brother living near Cambridge, where they have some very good specialists in hypertension.

The way I'm feeling this morning, first day on the changed medication, I'm rather glad my GP isn't switching me to the same medication as my brother takes.

Passing ML-style thought: are workplaces with well-grounded management inevitably unionised?

I shall think it over while I make pancakes.

#429 ::: Dave Bell ::: (view all by) ::: February 24, 2009, 06:23 AM:

Alex@427

Someone mentioned bovine TB; in the UK, this was eventually dealt with by the simple means of testing all the damn cattle and shooting the positives between the eyes, then disposing of the carcass in such a way as to keep it off the market. However, it took decades to get this past the farmers and the landed interest and the Conservative Party, who were completely fucking unreasonable about it, just like they were 50 years later about BSE; I think it took the second world war to cram it down once and for all.

And, after changes in government policy on bovine TB, the rate is rising again. Correlation is not causation, but after the foot-and-mouth outbreaks of the 21st Century, farmers don't quite trust the government. BSE also seemed to come after a government-introduced change in procedures, which reduced costs for certain large companies in the business of producing feed for farm livestock.

I wasn't around when the TB controls started, but remember that a part of these problems is reliable testing. The same with FMD, but jouranalistic wet dreams about new tests and vaccines were no help at all.

When the most recent FMD outbreak is down to virus escaping from the government's lab site, where a private company make FMD vaccine, and nobody seems to be responsible, it gets hard to trust the official line.

#430 ::: Rob Rusick ::: (view all by) ::: February 24, 2009, 08:59 AM:

Inquisitive Raven @405: Raphael @403: Pediatric patients have vaccination booklets that log what they've gotten, but no, in the US, adults don't get a vaccination certificate. They do, however, get stacks of paper on what to expect after the vaccination that are apt to promptly get lost. I'm not sure I still have the paperwork from that last tetanus shot.

I recently got a tetanus booster, but I'm pretty sure that the only record I have of it is the receipt.

#431 ::: James D. Macdonald ::: (view all by) ::: February 24, 2009, 09:15 AM:

Oh-- Australia's spectacular results in decreasing the incidence of measles seems to be related to moving the second shot from age four to age two.

#432 ::: Diatryma ::: (view all by) ::: February 24, 2009, 09:20 AM:

Alex at 427, waiting until a child's immune system has developed further doesn't mean a pox party and an gravestone with a lamb on top. A kid's immune system isn't entirely finished for a while after birth. Some immunoglobulins, though I don't remember which ones, come through breast milk. I don't know if any immunity comes over from the mother, just a passing thing.

When I was really little, three or four, I knew that if you get chicken pox when you're a baby, you can get it again later.

So some people wait a little longer than usual, space out the vaccines (seems useful just in case there's an adverse reaction to one of them-- this way, you can tell which one it was), but still get them all.

#433 ::: JESR ::: (view all by) ::: February 24, 2009, 11:56 AM:

I think the non-farmers in the group may not get the essential fact of farmer's resistance to solutions to disease outbreaks which involve slaughtering all infected animals: for people who hold breeding herds, especially, this is a terrible loss of intellectual and emotional capital. I went out in my nightgown this morning to check on a very pregnant cow who had come to the trough near the house for her morning water. I can recite her bloodlines back generations, and know the life history of every calf she's had (ten of them, including a set of twins which were born dead due to umbilical chord entanglement). Starting over with entirely new stock is the equivalent of being given a pile of computer parts and told it's the same as the data base which was just wiped by bombing from space for the good of society. That there is still governmental resistence to vaccination for some bovine diseases is hard for me to grasp; we vaccinate for a variety of diseases (which are endemic in our here because of migratory birds and breeding bulls, about equally) and consider it an animal welfare responsibility.

Memorials of loss: I keep forgetting to mention a creepy and heart breaking little time-bomb we found when cleaning the family house in Waco. My husband's grandfather was an only child, as far as anyone ever mentioned. However, in the attic of the house he built in the 1920's there was a 24" X 36" framed memento morii: a drawing of an urn and two doves flying downward and an inscription with the names of two baby girls, aged six months and eighteen months, who died, days apart, two years before his birth. The date was familiar; anyone who's seen the book Wisconsin Death Trip would recognize the date- there was a diphtheria epidemic which left scars on family histories across the continent.


#434 ::: Sharon ::: (view all by) ::: February 24, 2009, 12:49 PM:

Had I the resources, I'd charter a plane and take the most vocal anti-immunization folks on a trip (with their children) to Haiti, India, and other nice places where vaccinations are not widely available. Let them see (and expose their families) to what life is like without vaccinations. We could be the same in a short time if widespread vaccinations in the US ceased.

#435 ::: Xopher ::: (view all by) ::: February 24, 2009, 01:02 PM:

Mycroft 417: 408 Xopher: Look, I've been in the Ontario backwoods. Trust me, air with cloud-thick mosquitoes *is* bad air.

Mycroft, I grew up in Michigan. I know this very well. (I was astonished when I moved to Hoboken at the number of windows with no screens at all...and screen doors, a second layer on virtually every exterior door where I grew up, are virtually unheard-of here.)

It's just not the quality of the air per se that causes it. Do you know why Victorian beds were so high? They thought the "night vapors" crept along the floor. They slept sitting up for the same reason, which may explain why they were SO nasty. The curtains around the bed may have actually helped some, but not for the reasons they thought.

#436 ::: KeithS ::: (view all by) ::: February 24, 2009, 01:12 PM:

Sharon @ 434:

I'm glad you don't have the resources. It's a nice fantasy on the surface, but it's not something that I could ever support with a clean conscience.

I have no real problem if the people who preach anti-vaccination lunacy and who absolutely will not change their minds directly suffer the consequences of their actions. I do care if people who did not make that choice suffer for the actions of others. These people's children are innocent and don't deserve to suffer for their parents' faults. I do care if people who are simply ill-informed suffer for their indiscretions after they have changed their minds.

What makes the anti-vaccination movement so heartbreaking to me is that the ones who suffer directly are not the ones who made the decision not to be vaccinated in the first place.

#437 ::: Amanda ::: (view all by) ::: February 24, 2009, 01:23 PM:

I've skimmed through the majority of comments, but I apologize if this has been mentioned previously.

There is a shortage of HiB vaccine. My son was supposed to get it several months ago, but we are told it will be several more months until a supply is available.

#438 ::: Jenny Islander ::: (view all by) ::: February 24, 2009, 01:34 PM:

Alex @427: I delayed my first daughter's shots and spaced them out because of concerns about egg allergies on her father's side of the family and the nurse's concerns about giving five shots with mercury preservative in them on the same afternoon. But she did get every single one, and I verified that my husband and I weren't missing any vaxes so we wouldn't be exposing her. I started the same plan with my second daughter, but the MD told me that the new formulas didn't expose kids to eggs or mercury in the same way; he still advised me not to have a fistful of shots scheduled for the same day because in his experience the kids were more uncomfortable that way. But she got them all.

About anti-vaxing motivations: I am a regular at a forum that was set up for Christian parents who don't believe that the Bible calls for spanking spoons. By and large it's a very informative, knowledgeable pool of people who are strongly invested in helping their children be the best they can be. Unfortunately a lot of them also believe that the danger of vaxing outweighs the danger of not vaxing and the moderators don't want the board to erupt in flames, so it isn't argued very often or very strongly. So I can't come out and say, "Do you really, truly, honestly believe that it is better for your son to die at the age of two, or two months, or two days, than live with autism?" The main problem seems to be that these otherwise knowledgeable people have never seen kids dying of infectious diseases, but they have seen autistic kids. And it doesn't seem to sink in that vaccination is the reason they don't bury their children.

Now, I have never seen kids dying of infectious diseases either, but I have helped clean up a graveyard full of tiny tombstones, as I posted further up the thread. And I have read personal accounts by parents of nursing children who were fighting for their lives because they had no immunizations. I think my vivid imagination is good for something other than causing nightmares.

#439 ::: Susan ::: (view all by) ::: February 24, 2009, 01:40 PM:

Bruce @ 314 -- don't remember if Teilhard de Chardin originated the term, but he is strongly associated with it.

#440 ::: Raphael ::: (view all by) ::: February 24, 2009, 02:32 PM:

Inquisitive Raven, Marna Nightingale, Terry Karney, Mycroft W, Stefan Jones, thanks.

Terry Karney @412, In the United States one can ask for records to be entered into an international record of immunizations ("shot record"). I have two copies of mine. But it's done when you demand it, not as a matter of course.

I think that's what I meant- do you mean little yellow booklets with the WHO logo on the front page?

James D. Macdonald @425, 2009: Shaping up to be a really bad year for antivaccinationists

Nice to hear that, allthough I agree with the author that it won't do much to hold them back. And, Melanie Phillips is an antivaxer, too? Is there anything crazy and vile that this woman is not involved with?

#441 ::: clew ::: (view all by) ::: February 24, 2009, 02:33 PM:

#433, JESR: Don't you lose the animal stock anyway, if it's infected? Plus the additional animals that catch whatever it is? (Or are there significant 'Typhoid Bessie' non-symptomatic carriers?) I see that losing a herd or fraction thereof is terrible, but why would one, national, should-be-the-last-time culling be worse than endemic disease?

#442 ::: Jenny Islander ::: (view all by) ::: February 24, 2009, 03:06 PM:

OK, in the interests of fairness, I went into the "Vaccination Awareness" sub-forum, a place I usually avoid because I get so angry. Another reason that many of the moms who post there avoid vaxing is the use of live-virus vaccines. I simply can't grasp why this is supposed to be a problem. I was taught in grade school about how they work--that we were suffering the brief blah feeling we got from our immune systems working to kill the weakened virus, and the slight chance of catching the full-blown disease, in order to avoid the much higher chance of getting really, really, possibly lethally sick. I think it helped that the nurse who came in to talk to us on shot day had had the measles as a child; she knew whereof she spoke.

#443 ::: JESR ::: (view all by) ::: February 24, 2009, 03:08 PM:

Clew, there were several TB cullings around here in the 'thirties before the disease was eradicated in dairy herds; this was mostly because there were numerous people with one or two cows running in the woods who missed the testing. Luckily my maternal grandfather's Jerseys were never tested positive. And even with vaccination and culling for Brucellosis, there are reservoirs of infection in wildlife.

I'm mostly referring to the recent cullings for Hoof and Mouth, though; the disease, though extremely contagious, is amenable to vaccination. It is also neither 100% fatal nor does it produce absolute infertility. Getting one more healthy heifer calf out of a great cow (or a year's calves out of a proven bull) is a world away from starting over again with unknown young stock. Culling whole herds also has the effect of even further reducing the genetic diversity of domestic cattle.

#444 ::: Rikibeth ::: (view all by) ::: February 24, 2009, 03:25 PM:

Xopher @ 435, I thought the Victorians (and earlier; ISTR it was more prevalent in the 18th century than the 19th) slept sitting up for a more defensible reason: it allows mucus to drain more effectively and improves one's breathing when congestion is a problem. I may be misremembering the old household medical advice I've seen quoted.

I know that I breathed and slept more easily during my bout of flu in January when I was propped up at about a 45 degree angle.

#445 ::: Turtle Wexler ::: (view all by) ::: February 24, 2009, 03:34 PM:

If vaccination research is all faked by Big Pharma to make $$$ by sickening children, then it's not really a big stretch to believe that the reports that Wakefield faked data are faked, and that the people who signed off saying they retract were forced to do it. And this is exactly what one reads in the anti-vaccination forums right now.

Other than having measles etc come back in full force and having large numbers of children die (a non-ideal solution), what kinds of arguments could actually convince an anti-vaccinator?

#446 ::: Ginger ::: (view all by) ::: February 24, 2009, 03:47 PM:

JESR @ 443: I don't have much time, but I wanted to quickly point out that FMD is not a mild self-limiting disease, either. It has profound implications for economic as well as health consequences, so although it may not be 100% fatal (depending on species), it is 100% guaranteed to affect your income. Not only that, but in certain species, it gets more virulent, which means it spreads even more easily and creates more damage in the susceptible species around. Pigs are a good example.

Now that a safe and at least partly effective vaccine has been developed, it can be included in the control measures -- as long as the outbreak can be contained to the locality.

#447 ::: KeithS ::: (view all by) ::: February 24, 2009, 03:59 PM:

Turtle Wexler @ 445:

It depends on the type of person.

If you're talking about charlatans, they're already convinced but they're lying to make money.

If you're talking about cranks and denialists, there is, sadly, probably no helping them.

If you're talking about true believers, you have to just make sure the real information is out there and hope that some of them come around eventually. Some of them will, possibly after many months or years, have a few doubts and question their beliefs.

If you're talking about otherwise sensible people who have a distrust of modern medicine and go for nutty woo-woo stuff, again, you just have to make sure the facts are there and hope they'll eventually come around. Maybe try to plant doubts. Point out that vaccinations have saved lives, and point them at people who remember what it used to be like.

If you're talking about otherwise sensible people who have been convinced by the previous groups, rational discussion and facts should convince after time.

If you're talking about people who have vague concerns because they've heard things from all the previously-mentioned groups, rational discussion and facts should convince easily.

For the last two groups, this post and blog posts by authors like Orac should go a long way.

A lot of us, myself included, have a tendency to think that by picking the right argument we can easily convince other people that we're right. We become frustrated when other people don't come around to our point of view and look for another argument we can use to convince. Naturally, a lot of the anti-vaccination crowd think the same thing, and wonder why we won't be convinced that vaccination is harmful.

All this is to say that there isn't necessarily a lot that can be done, depending on the person. Rational argument might work, or it might be that just planting and nurturing the small seeds of doubt in their position is all you can do. Re-framing the discussion as pro-/anti-disease versus anti-/pro-vaccination might or might not help.

#448 ::: Stefan Jones ::: (view all by) ::: February 24, 2009, 04:00 PM:

#445: Organized bullheadedness of this sort cannot be countered by reason and argument.

I think the best we can hope for is for a decrease in new recruits, and eventually marginalization.

Either that, or we up the levels of flouride so that the mind-controlling effects of chemtrails breaks their will.

#449 ::: James D. Macdonald ::: (view all by) ::: February 24, 2009, 05:03 PM:

What will come are deaths or crippling or blindness among the anti-vaxers' children.

We won't have caused it. While they're innocent, they'll be the ones to suffer for their parents' opinions.

Nature doesn't care.

Meanwhile, anti-vaxers' kids are neither more nor less likely to turn up autistic than anyone else's.

#450 ::: James D. Macdonald ::: (view all by) ::: February 24, 2009, 05:07 PM:

No, no one's explicitly mentioned the shortage of Hib vaccine. (The shortage is mentioned in the news story linked from the main post in the Hib section, though.)

I've only had to ever transport one Hib case: Believe me, that was one sick little baby.

Y'all will probably be interested to learn that by age five practically everyone in the US has been exposed to Hib.

#451 ::: Lee ::: (view all by) ::: February 24, 2009, 05:09 PM:

Jim, #425: I noticed, in reading the first of your linked articles, that the anti-vax movement is attempting to draw parallels between their situation and that of the tobacco companies fighting to suppress the evidence that cigarette smoking causes cancer. I submit that they are portraying themselves on the wrong side of that fight, as THEY are the ones launching a multibillion-dollar campaign to discredit the medical evidence against their claims.

Turtle, #445: Sadly, the most likely answer to your question is "nothing". This is now to the level of being a religious argument, and it's like trying to convince a devout follower of James Dobson that letting gay couples get married isn't going to destroy civilization. What we're actually doing here is fighting for the minds of the undecided, and the lives of their children, neighbors, and friends.

And I see that KeithS has already laid out my argument in much more stringent detail @447.

#452 ::: Clifton Royston ::: (view all by) ::: February 24, 2009, 05:43 PM:

When completely incorrect scientific ideas get solidly established, either in the culture at large or in academic circles, it can take a generation for them to largely disappear. After those who can be convinced by evidence have been, those who are left are those whom nothing whatsoever will convince, and only retirement or death by old age removes their opinions from the pool.

#453 ::: Fragano Ledgister ::: (view all by) ::: February 24, 2009, 07:40 PM:

There was a spin-off from this disscusson on Matociquala's LJ, and a truly staunch anti-vaxer delivered herself of a number of declarations proclaiming that advocates of immunisation were bullies and cruel to children. What really annoyed me, in retrospect, was her declaring that all that was necessary was to build up a child's immune system, as if healthy eating could stave off a virus. You don't say stupid things like that if you've actually seen someone die of disease.

#454 ::: Stefan Jones ::: (view all by) ::: February 24, 2009, 07:52 PM:

If anyone brings up the term "structured water" in a discussion about this stuff, run away and call in an orbital strike.

#455 ::: Linkmeister ::: (view all by) ::: February 24, 2009, 08:37 PM:

Clifton @ #452, yes. You and I both know that Hawai'i water is not fluoridated in part because of Flat-Earthers who are convinced it will kill us all.

#456 ::: P J Evans ::: (view all by) ::: February 24, 2009, 09:50 PM:

Fragano @ 453
Or if you have a family member who got caught in a rubella epidemic.
I'd tell them to get their [expletive deleted] kids the [expletive deleted] shots if they want to have any grandchildren to spoil.

#457 ::: Allan Beatty ::: (view all by) ::: February 24, 2009, 11:10 PM:

If you want to see hysterics about vaccinations, just wait until there's a reliable one for AIDS.

#458 ::: Inquisitive Raven ::: (view all by) ::: February 24, 2009, 11:12 PM:

Rikibeth @ 444: Well, sitting up is certainly indicated for when you've got crap in your lungs and are trying to breathe. It's one of the reasons stretchers are designed so that the patient can be sat up. Usually, when I had a patient like that, we were looking at congestive heart failure, but there's a whole host of respiratory diseases, like TB where that might be good advice. We don't see some of those diseases much anymore in the West.

#459 ::: Lee ::: (view all by) ::: February 25, 2009, 02:55 AM:

Allan, #457: I'll take the hysteria in that case, and consider it a small price to pay for the availability of the vaccine.

Raven, #458: It doesn't even have to be a lethal disease. My last bout with cold-turning-into-bronchitis required me to spend the better part of two weeks sleeping in the recliner, because whenever I tried to lie flat it was cough, cough, COUGH, gag, sit up, swear.

#460 ::: Alex ::: (view all by) ::: February 25, 2009, 04:25 AM:

Dave: I was especially thinking of the resistance in the 20s and 30s to even making testing the milk compulsory.

#461 ::: dcb ::: (view all by) ::: February 25, 2009, 04:38 AM:

Dave Bell @ 429

The same with FMD, but jouranalistic wet dreams about new tests and vaccines were no help at all.

Re. FMD. I've researched this (very large electronic encyclopaedia volume on the subject, written 2001, revised 2007). Fact: the vaccines work pretty well (not 100% - like all vaccines, but the modern high potency vaccines work in just a few days). Fact: with modern vaccines and modern tests, it is possible to confirm whether a herd has been vaccinated or has been vaccinated AND met the virus. Fact: "carrier status" in domestic livestock is a myth - there is no proof that it's epidemiologically important (they have the virus in their tonsils but there is no proof they shed it - and lots of experiments trying to get recovered animals to pass the disease on to other animals have failed. (African buffalo are different).

The main barriers to vaccination in 2001 were the vested interests who wanted to get their export status back quickly (rules have changed - vaccination would now include less of a time penalty) and media stirring about "the public won't eat vaccinated meat" - which was nonsense, since they eat vaccinated meat all the time.

If you want references or a link to our website to check this stuff, let me know.

#462 ::: Mez ::: (view all by) ::: February 25, 2009, 05:58 AM:

Still don't know why, but main symptom of my cancer returning was breathlessness. My lungs kept filling with fluid. Made certain tests scary and uncomfortable, as lying flat led to feeling a lot like dying of suffocation. (After an operation and much treatment, it feels a lot better now.)

Sleeping propped up was a necessity, and using a fan to keep from feeling stifled in the summer heat (late 2007) helped a lot.

My vaccination tale is a bit long and boring, but I definitely had a couple of the usual childhood diseases. Got tetanus shots for my thesis work, but it hasn't been boosted/renewed for over 10 years now. Now my immune systems back up, it's probably a good idea to renew it. In a week or so I'm taking the free flu shots at work again after contraindication during treatment. This news of the new type is cheering.

One of my teachers at uni was old enough to have worked in hospitals when whooping cough, diphtheria and poliomyelitis (infantile paralysis) were around killing and maiming. It's good to pass on the memories of how things have changed.

#463 ::: Julia Jones ::: (view all by) ::: February 25, 2009, 07:48 AM:

Something I stumbled across a while back -- one of the most likely environmental factors in autism is Congenital Rubella Syndrome, and possibly other pre-natal viral exposure. So Wakefield may well have contributed to an increase in autism in the long term. And anti-vaxxers' children might not be more likely to turn up autistic, but their daughters' children may well be.

#464 ::: James D. Macdonald ::: (view all by) ::: February 25, 2009, 08:07 AM:

When I see a patient who sleeps sitting up (either sleeping in the lounge chair or propped up by multiple pillows), my first thought is respiratory compromise, and I start looking for CHF (congestive heart failure) or COPD (chronic obstructive pulmonary disease), pneumonia, or other things that fill lungs with fluid. One of my first questions will be, "How long have you been sleeping like this?" because if it's five days, that's different from five years.

Sitting up moves fluid down, clearing the tops of the lungs for air exchange. (It also allows gravity to help move the diaphragm down.)

Fluid in the lungs sounds like tiny crackling sounds when you listen with your stethoscope (which was itself a brilliant invention from the second half of the 19th century). Those sounds are called "rales." They sound very much like taking a bit of your hair and rubbing it between your fingers just outside your ear.

Signs of respiratory distress include rapid breathing, labored breathing, nasal flaring, pale or bluish skin tone, retractions (that's where the skin pulls in above or below the breastbone or between the ribs when the patient is inhaling), noisy breathing, clammy skin (and other signs of shock), and tripod positioning (where the patient is sitting up, leaning forward, supporting himself on his elbows).

#465 ::: Dave Bell ::: (view all by) ::: February 25, 2009, 08:28 AM:

I was farming in 2001, and what I remember was that the new tech--vaccines and tests--was not yet deployable. There were international rules, and the outbreak spread fast enough (apparent mismanagement of the initial reaction) that the logistics of vaccination were against that option.

The rules we followed may have been wrong, but they were the constraints on what could be done. For instance, FMD was reckoned so infectious that, if a vet diagnosed FMD he was barred from contact with livestock which had not been diagnosed with FMD. We could have run out of "clean" vets.

And what we had was a system which had worked. FMD outbreaks in the UK are rare. The last I heard, we still didn't know how the virus got into the Uk in 2001.

The next outbreak was an escape from the UK equivalent of Plum Island.

#466 ::: Fragano Ledgister ::: (view all by) ::: February 25, 2009, 09:02 AM:

PJ Evans #456: Hear! Hear!

#467 ::: dcb ::: (view all by) ::: February 25, 2009, 09:24 AM:

Dave Bell @ 465

You're right - the new tests, although validated in tens of thousands of animals e.g. in South America, were not accepted by the OIE yet for the purposes of international trade. I'm not inimising the importance of that - and as you know, the rules have since changed. But the new tests and vaccines also were not just "journalistic dreams."

Appropriate vaccines were available. However, in my opinion, the establishment stance was basically "we've never vaccinated in the UK before and we're not going to start now." This meant that vaccination was not seriously considered early enough, and the simulations which were run and purported to show that vaccination wouldn't be effective, didn't include proper vaccination options. The whole logistics was handled very badly. The lack of understanding of the authorities regarding the scale of e.g. sheep movements was not helpful.

Also, the cost/benefit analyses were only taking into account the direct effects on farming - they didn't take into account things like the knock-on effect on rural leisure activities and what that meant to rural finance.

And the rules were being applied in draconian ways, leading to idiocies such as a herd of sheep drowning because the farmer was not allowed to move them across a road to another field - with all due precautions (e.g. covering the road with appropriate-disinfectant-soaked straw and cleaning it up afterwards). Not to mention the tales I heard of veterinary students being ordered to (illegally) drown lambs when stocks of euthanasia solution had run out. Also, excessive, unnecessary (as shown later by appropriate models) culling which lead to delays in disposal of infected carcasses from farms which did actually have the disease - and therefore probably increased spread of the virus (which as you know, spreads from carcasses as well as live animals).

Don't get me wrong, I'm not saying culling isn't needed in control of a disease like FMD - but I don't think culling and movement control should be the only options considered. If the political will had been there, I think a way would have been found to vaccinate effectively (in addition to culling of infected herds and REAL contacts). I objected to the use of "the public won't eat vaccinated meat" as an invented reason for not vaccinating.

#468 ::: Lila ::: (view all by) ::: February 25, 2009, 10:51 AM:

Lee @ #459, yep, every time I've had bronchitis I've only been able to sleep sitting up.

#469 ::: Mary Aileen ::: (view all by) ::: February 25, 2009, 11:26 AM:

Pneumonia, too. When I had pneumonia a few years ago, I refused to take the prescription cough syrup they wanted to give me at the emergency room. Much as I would have liked the relief from coughing, codeine makes me incredibly nauseated unless I'm lying down flat, and I couldn't breathe like that.

#470 ::: dcb ::: (view all by) ::: February 25, 2009, 11:32 AM:

Lee @ 459

Agreed; even a bad cold can result in problems sleeping flat. If you normally sleep on your side, of course, it's even more difficult trying to find a propped-up position both allowing breathing and that's semi-comfortable so you vcan get to sleep.

#471 ::: JESR ::: (view all by) ::: February 25, 2009, 01:06 PM:

dcb@467, you've specified what I was alluding to in my last post- I'd forgotten the specifics of the reports I'd read and remembered only the reaction I had to what looked to me a case of mindless bureaucracy and horrible waste.

That the 2001 epidemic came on the heels of two new, bad disease outbreaks in our herds (which sounds grand, but amounts to 15 purebred Shorthorn cows and 60 or so Angus purebreds and black crossbreds) made me particularly sensitive to the mass cull aspects. We first had an outbreak of "red water fever" (which is a general term for a GI clostridium infection, yes? The vaccine is "7 way") probably brought by a wandering northering flock of white fronted geese coming from a wintering ground where the disease was endemic. Then we were hit by Bovine Viral Diarrhea brought in by an unvaccinated bull; in both cases, we were sideswiped by symptoms we didn't recognize. I lost about 40% of two years' calves, and it hurt. Vaccinating newborns within 48 hours and then giving boosters at three weeks- three months is now an important part of our herd management; all breeding stock is also vaccinated for BVD in the fall.

Part of the problem, of course, is that we are down to about half the acreage we used to farm, and can no longer let parcels lie empty under the sun or reset pasture regularly for lack of other places to put cattle. Dad had a near religious belief in "clean ground" (let me clarify: this doesn't have anything to do with overgrazing; at the greatest density we have two acres per cow/calf pair), and not having any feels like blasphemy.

About historic TB testing: a big part of the problem was that bovine TB carriers are not sick, and often they were milked by healthy human TB carriers, to boot. Positive TB tests could and often did mean that the farmer had to stop dairy farming entirely, and it was a bad time to find other work. Testing and vacciation/culling for Brucellosis was a much easier sell: infected cows aborted at five months, and undulent fever in humans was an unpleasant experience, to say the least.

#472 ::: James D. Macdonald ::: (view all by) ::: February 25, 2009, 01:32 PM:

I've just read the discussion on the link to this post at Matociquala's LJ, and I want to say:

STDs are diseases. They aren't God's Judgment on a Wicked People. They're mindless, soul-less microbes. To be prevented if possible, to be cured if not prevented.

Photo

Photo

Photo

#473 ::: dcb ::: (view all by) ::: February 25, 2009, 01:55 PM:

JESR - What you said up-thread about losing a herd and the impact of that. I agree. And slaughtering all the hefted sheep in places like Cumbria - you lose the whole herd memory of where to go for shelter, water, etc. as well as the genetics. Then there are the disease risks associated with restocking - bovine TB has been moved to areas of the UK where it was never previously a problem, by people re-stocking with cattle from TB-positive areas. Some farmers, unfortunately, didn't want any veterinary advice about the risks involved.

And my sympathies for your herd losses.

#474 ::: JESR ::: (view all by) ::: February 25, 2009, 02:53 PM:

dcb, one of the old cows I'm watching as they come to calving time is a BVD survivor who I tube-fed for ten days in her first month of life, until she stood up and ran away from me. She was a small brand snatched from the burning, since she has had mostly bull calves.

Our general rule of treating sick calves is that if you can't catch them, they're probably over it.

#475 ::: B. Durbin ::: (view all by) ::: February 25, 2009, 04:22 PM:

"It would not grieve me to learn that some unknown worker at some lab had quietly added fuming nitric acid to the last archived samples, years ago."

*note to self: fuming nitric acid good idea to get rid of disease stock

I was reading an article on vaccines in Time, of all places, as glory be, it wasn't pandering to anti-vaccination fears. Most of the article was a retread of stuff I already knew, but one piece of information that it had was new to me.

Our modern combination vaccines have fewer alleles than, for example, the smallpox vaccine that was used in the 1950s. In other words, there's actually fewer things in a modern vaccine for your body to react to than there were in the single vaccines of a half-century ago.

(This is because we can figure out more specifically which proteins are specific to a disease and train the body to react to only those proteins— a smart strategy when dealing with increasing numbers of allergies.)(At least, I think that's the reason. I Am Not A Biologist or Epidemiologist.)

#476 ::: Inquisitive ::: (view all by) ::: February 25, 2009, 05:57 PM:

I've had more than my share of grossly unpleasant disease, despite being born in the mid-1970s. I'm not immunocompromised, but I do often "present an atypical immune response." Sometime too low, sometimes too high, sometimes just ... wrong, which makes diagnoses a thing of art. But a couple of my trips to the world of infectious disease stand out.

Bacterial pneumonia. Presented with minimal cough. I felt like crap, but both a lingering strain of flu and mono were endemic in the area, and I wrote it off. Went in for something unrelated and had to convince the doctor not to admit me to the ER. Recovered with 90% of previous lung capacity, so I count myself lucky.

Scarlet fever. Highly nonstandard presentation. No strawberry tongue, no butterfly rash, no worse of a sore throat than the yearly cold. I did have the pebbly body rash, but because I had recently been exposed to chicken pox and that disease is pretty variant, it was assumed that's what I'd caught (this ended my relationship with that primary care physician). Then I spontaneously developed systemic joint pain and streptococcal sinusitis. I don't remember the next week, really, although I do recall thinking that this had to be as bad as being sick could get. I had that little bit of wisdom proven wrong by...

Dengue fever. Visiting family-of-a-friend in Rio de Janeiro in 2002, just in time for the start of the Dengue epidemic. I was fully vaccinated as I could be for a trip to the tropics, but there is no dengue vaccine. For once, I caught something that presented with all the textbook symptoms. Unfortunately. Muscle pain that wins the tug of war against the codeine is Absolutely. Not. Fun. I also don't recommend vomiting blood as a vacation activity. For most people reading this, be glad dengue isn't endemic where you are. Hope, as I do, that climate change doesn't drive dengue and other tropicals north....

I keep up with all my vaccine schedules. My daughter has gotten every shot, exactly on schedule. I may or may not have to pay for the HPV shot out of pocket; if so, I'll do it. I've had enough really nasty diseases to respect them -- certainly far more than I respect antivaxxers that put not only themselves, but also the rest of us and all our children at risk.

#477 ::: Mez ::: (view all by) ::: February 25, 2009, 06:44 PM:

J D Macd #464: "Fluid in the lungs sounds like tiny crackling sounds when you listen with your stethoscope"
I did a great deal of breathing in … and breathing out for a procession of many student doctors. (No-one ever offered to let me listen. (How do you deal with emoticons in parentheses?))
That bit was fairly fun and nice, and felt I was helping something useful. Remembering other bits still raises goosebumps, and I'm glad I don't think of them much any more.

JESR #474: "She was a small brand snatched from the burning, since she has had mostly bull calves." Sorry, confusion: First, I believe it's bad to have too many bulls(?) Second, don't all placental mammals have the same X/Y chromosome sex determination? Meaning it's the bull that determines the sex of the calf – something Henry VIII wouldn't like to have known.
Meanwhile I hope your birds, garden, camera, The Mountain, and such, help you with strength to get you through your problems.

#478 ::: JESR ::: (view all by) ::: February 25, 2009, 08:11 PM:

Mez, one goal in a purebred cow-calf herd is to have at least one daughter established as good breeding stock before a cow is too old to breed. I actually have a daughter from this cow, but she's got horns and these are supposed to be polled shorthorns. Getting a bull who carries a horned gene is not as absolutely disasterous as one carrying a deadly disease, but it's not great. Having a cow who only has bull calves means that you loose genetic variability in a small breeding herd over time. The sex balance over time is the near 50-50 probability predicts, but in a mostly random system, individual cows have different sex ratios without there being a sex-linked lethal gene.

Luck obtains, as always.

#479 ::: Libbie ::: (view all by) ::: February 25, 2009, 09:39 PM:

Five years ago I caught pertussis from a woman at my office. She was the mother of seven children, none of them vaccinated. She was one of those people who preached endlessly about the psuedoscience regarding vaccines. She herself did not have pertussis, but one of her children was in day care with a child who had it. Although I suppose I *could* have caught it almost anywhere, the coincidence of her unvaccinated children being little vectors of the illness from their daycare seems too much to ignore.

I understand that having pertussis is generally harder on an adult's health than on a child's. I can believe it. For over 100 days I could barely breathe at all without coughing uncontrollably. I lost control of my bladder from all the coughing and had to arm myself with pads every day so I wouldn't pee my pants. It goes without saying that I hardly slept throughout this torture; how I managed to hold down a job with this illness I'll never know. I had been in perfect health before I caught the disease. If I'd been the least bit sick already I'm sure I would have ended up in the hospital. It was awful. I still have lung scarring from the experience and I'm not able to be as active as I was before the disease. I used to jog for exercise. I can't anymore. I walk exclusively now. It's all my lungs can take.

Failing to vaccinate SPREADS DISEASE. I will never forgive the b*tch who gave me pertussis. Her ignorance and selfishness cost me my health and could have cost me my life. Who knows how many other people she and her children spread the disease to.

I'm angry enough about the whole affair--years later--to want vaccinations to be MANDATORY. We don't have high rates of these diseases anymore because of vaccinations. To fail to vaccinate is irresponsible and idiotic.

#480 ::: bugtussellmom ::: (view all by) ::: February 25, 2009, 11:19 PM:

I'm curious - how do adults get Hepatitus B?

How do babies get Hepatitus B?

#481 ::: P J Evans ::: (view all by) ::: February 25, 2009, 11:22 PM:

#464
Ah, so that's what rales are. Is. Whatever.

After multiple rounds with bronchitis - once was enough, really, Ghu, and the second time I surely didn't need - I know what they feel like. On several occasions, I went to the doctor and told them that I had it.
(The first time: on jury duty. Antibiotics and codeine-laced cough syrup, wonderful when you're sitting in the courtroom hoping not to end up on the panel.
The second time: Got bronchitis and started antibiotics on Tuesday (the only time I've ever been to a student hell center), got a cold after - it was near the beginning of the year - and on the next Sunday the congestion was bad enough that I had a friend take me to the hospital to meet my doctor. Chest x-ray to make sure it wasn't becoming walking pneumonia ('Take a deep breath, hold it - belay that!'), followed by three months of bronchodilators and a permanent case of mild asthma.
Bronchitis: Do. Not. Want.)

#482 ::: Bugtussellmom ::: (view all by) ::: February 26, 2009, 01:38 AM:

Libbie - Does a vaccine keep a person from being a carrier of a disease?

#483 ::: James D. Macdonald ::: (view all by) ::: February 26, 2009, 01:57 AM:

Libbie - Does a vaccine keep a person from being a carrier of a disease?

If the person is immunized, they aren't shedding viruses.

#484 ::: Terry Karney ::: (view all by) ::: February 26, 2009, 02:11 AM:

One of the painful quirks of bronchitis is that having it once leads to getting it more often, since it's a reacton to the breathing difficulties caused by lots of things.

#485 ::: James D. Macdonald ::: (view all by) ::: February 26, 2009, 02:24 AM:

Hepatitis B is spread through direct contact with bodily fluids.

From Vaccine Concerns:

Is the hepatitis B vaccine safe?

The hepatitis B vaccine has few side effects. However, one side effect is serious. About one of every 600,000 doses of hepatitis B vaccine is complicated by a severe allergic reaction called anaphylaxis. The symptoms of anaphylaxis are hives, difficulty breathing, and a drop in blood pressure. Although no one has ever died because of the hepatitis B vaccine, the symptoms of anaphylaxis caused by the vaccine can be quite frightening.

On the other hand, every year thousands of people die soon after being infected with hepatitis B virus. In addition, tens of thousands of people every year suffer severe liver damage (called cirrhosis) or liver cancer caused by hepatitis B virus. Children are much more likely to develop these severe and often fatal consequences of hepatitis B virus infection if they get infected when they are very young. For this reason, the hepatitis B vaccine is recommended for newborns.

Some parents wonder whether it is necessary to give the hepatitis B vaccine to newborns. They ask, "How is a baby going to catch hepatitis B?" But before the hepatitis B virus vaccine, every year in the United States thousands of children less than ten years of age caught hepatitis B virus from someone other than their mothers. Some children caught it from another family member, and some children caught it from someone outside the home who came in contact with the baby. About 1 million people in the United States now are infected with hepatitis B virus. However, because hepatitis B virus can cause a silent infection (meaning without obvious symptoms), many people who have hepatitis B virus infection don't even know that they have it! So it can be hard to tell who might be contagious. Worse yet, you can catch hepatitis B virus after casual contact with someone who is infected (for example, sharing hand towels).

Because the benefits of the hepatitis B vaccine clearly and definitively outweigh the risks, the hepatitis B vaccine is safe.

#486 ::: Juliet E McKenna ::: (view all by) ::: February 26, 2009, 04:55 AM:

Oh bother, this isn't going to improve matters.

Thousands of doses of the meningitis C vaccine have been withdrawn by the manufacturer Novartis following fears of contamination.

#487 ::: dcb ::: (view all by) ::: February 26, 2009, 05:13 AM:

JESR @ 474

Our general rule of treating sick calves is that if you can't catch them, they're probably over it.

Yes, I've used that rule as well - when we were treating a wallaby with toxoplasmosis for example. At the start, he couldn't manage two hops without falling over (he had neurological signs of the disease). We quit injecting him when he could run away from us fast enough.

I remember when we were bottle-feeding a llama cria because her mother had mastitis and wouldn't let her suckle. We always had to catch her - she would never come to the bottle - and after a few weeks she started getting harder to cath, and less interested in the milk - we worked out that she was now suckling from her mother and prefered that milk. Fine by us.

Dave Bell
Apologies if I came across too strongly about FMD. The decisions which were made in 2001 were made for political and trade reasons. As a veterinarian I found it frustrating that good science of disease control was not the primary basis on which the decisions were being made.

#488 ::: Individ-ewe-al ::: (view all by) ::: February 26, 2009, 08:55 AM:

The Wakefield story is almost a good thing, in a way. Reasonable people who are inclined, for good reason, to distrust authority, or to buy into the media presentation that the MMR scare was a balanced argument between two sides, can be hard to convince. However, it's much easier to grasp "Wakefield is a wicked man who faked data and endangered children's lives for money" than "there was some evidence that suggested a link between vaccines and autism, but further investigation showed that wasn't true".

I blogged this when the details of the Wakefield scandal first came out. That post gets more hits by an order of magnitude than anything else I've ever written about. So I harbour some faint hope that at least a few curious googlers will be convinced by what I wrote.

#489 ::: Cassandra ::: (view all by) ::: February 26, 2009, 09:20 AM:

My sister and I got whooping cough on a family vacation. I had a mild case (could walk, think I was hallucinating a bit in the hotel), but my sister...thinking you're going to see the desert for the first time and actually seeing the inside of the clinic for four days straight as your sister gets a spinal tap and tries to bite the nurse because she can't even keep down popsicles anymore and can't eat--that was not fun. Then three weeks in the hospital and two weeks of home quarantine for me. Special.

Vaccinate your kids.

#490 ::: Ken Brown ::: (view all by) ::: February 26, 2009, 11:47 AM:

Bruce@314 "teleonomy" seems to be generally assumed to have been coined by Colin Pittendrigh (a biologist better-, if not well-, known for work on "biological clocks") in "Adaptation, natural selection and behavior" in "Behavior and Evolution" (1958, YUP). It is sometimes attributed to George Gaylord Simpson or Anne Roe who were the editors of the book & rather more famous then Pittendrigh.

That sort of theoretical biology seems to have been in the air in those days. The term was soon taken up by by Jaques Monod and others, and in a different sense by Ernst Mayr; and Stephen Jay Gould railed against it as part of the Evil Adaptationist Program :)

#491 ::: Linkmeister ::: (view all by) ::: February 26, 2009, 03:02 PM:

The Wakefield fakery prompted Newsweek's Sharon Begley to write a layman's version of the autism/vaccination scare.

#492 ::: Bugtussellmom ::: (view all by) ::: February 26, 2009, 04:36 PM:

"Libbie - Does a vaccine keep a person from being a carrier of a disease?"

"If the person is immunized, they aren't shedding viruses."

The reason I asked is because my friend's husband gave me some literature, mostly peer-reviewed. It includes some articles that may or may not be published. He is a Chiropractor but he used to be a pediatric doctor or surgeon or something, I'm not sure. They don't vaccinate their children. She gave me all the package inserts from the vaccine vials and all these articles and links to websites with more articles.

Some of the package inserts from the vaccine vials state that the disease can shed from the vaccine. Unless I'm not understanding it.

What is the difference in shedding the disease and carrying the disease?

Thanks!

#493 ::: Bugtussellmom ::: (view all by) ::: February 26, 2009, 04:44 PM:

I have a couple of documents saying the Hep B vaccine doesn't last very long.

Does anyone know how long?

And why is it that somet things I read, the writer says Hep B is only spread through bodily fluids, like AIDS. And then some other people will say that babies can catch it. How?

My OB tested me for Hep B, and I don't have it. So why should I give my baby this vaccine?

TIA!

#494 ::: P J Evans ::: (view all by) ::: February 26, 2009, 04:53 PM:

My OB tested me for Hep B, and I don't have it. So why should I give my baby this vaccine?

You can't guarantee that anyone who handles your baby will be free of it.
It's preventive medicine: trying to keep something bad from happening.

#495 ::: Lori Coulson ::: (view all by) ::: February 26, 2009, 05:01 PM:

Bugtussellmom @492 -- "carrying the disease" means you are a vector for infection, carriers either are suffering from a subclinical version of the disease, just recovering from the disease (but still are contagious), or the disease is active and you're exposing everyone to it. This term is usually used for bacterial infections.

"Shedding" the disease is used for viral infections. Viruses turn your cells into little virus factories, so it can spread and spread and spread...

Now, vaccinations do expose your system to the virus or bacteria in a weakened form in order to encourage your body to make the antibodies needed to prevent the disease from manifesting in its virulent phase. Some vaccines carry a warning that you not go near someone who has a suppressed immune system -- so there is some chance of being a "carrier/shedder" after certain vaccines (but not all) are administered.

IIRC, chicken pox vaccine is one of these...

#496 ::: sara_k ::: (view all by) ::: February 26, 2009, 05:06 PM:

Lori #495 - Yes the chickenpox vaccine warns about shedding the virus. When my kids are vaccinated we always ask about risk to immunosuppressed bystanders. After the chickenpox vaccine we were told to avoid the vulnerable people for 10 days. Avoiding them did not include skipping school but did keep us from church and 2 birthday parties.

#497 ::: James D. Macdonald ::: (view all by) ::: February 26, 2009, 05:07 PM:

My OB tested me for Hep B, and I don't have it. So why should I give my baby this vaccine?

See comment 485 above.


=====

Some live-virus vaccines will have the person shedding viruses immediately after getting innoculated. Killed virus and protein derivative vaccinations won't. After the immunization is complete, the vaccinated person is no longer shedding viruses, and isn't going to start. See above, herd immunity and firebreaks.


The microbes in the live vaccines are not identical to the full-strength all-natural virulent microbes found in the wild. (There wouldn't be a whole lot of point to giving someone the exact disease they're trying to avoid, would there?)

#498 ::: Lizzy L ::: (view all by) ::: February 26, 2009, 05:13 PM:

Also -- if you have shingles, you can give not shingles, but chicken pox, to someone who has not had it. When my mother had with shingles, several of her caregivers had to stop coming to see her because either they or their children had never had chicken-pox and had not been vaccinated for it.

#499 ::: A.J. Luxton ::: (view all by) ::: February 26, 2009, 05:24 PM:

Anyone know how much it usually costs to get titer tests? I'm looking at going back to school for pre-health-professions studies, and so I'm sure immunity is going to come up, but the HMO I was immunized by as a child has repeatedly failed to respond to faxes to their records request number. (SMITE!)

I even got immunized for some weird stuff like Hep A and typhoid when I went to China, but again can't prove records of the full series. I'd like to be able to document my immunity status in order to avoid having to take them all again, especially the multi-stick ones.

#500 ::: Bugtussellmom ::: (view all by) ::: February 26, 2009, 05:36 PM:

My kids are around a few adults who have AIDS. Are you saying my kids could get AIDS from being in the room or like if the adult was helping my 6 yr old read...

Oh my gosh...

#501 ::: Trey ::: (view all by) ::: February 26, 2009, 05:43 PM:

#493:
My OB tested me for Hep B, and I don't have it. So why should I give my baby this vaccine?

Going to travel out of the country? If so, its a real good idea. When we told our pediatrician that we were headed to Mexico City to visit the family with our 16 month old, he broke out the Hepatitis vaccine (and some others (need the vaccination records)), and a administered them all.

The kidlet didn't like the shots, but was charming and healthy through the trip. I was a different story (CMV and mono - at the same time).
--
Viral shedding is when your system is cranking out the virii. Now, depending on the virus, that can be spread through droplets (rhinovirus (colds)), or bodily fluids (CMV, Mono, AIDS). And the bodily fluids vary from bug to bug. For AIDS, your kids are safe unless they're exposed to blood or semen. They getting transfusions or swapping needles with these folks?

#502 ::: Raphael ::: (view all by) ::: February 26, 2009, 06:03 PM:

Trey @501, Now, depending on the virus, that can be spread through droplets (rhinovirus (colds)), or bodily fluids (CMV, Mono, AIDS). And the bodily fluids vary from bug to bug. For AIDS, your kids are safe unless they're exposed to blood or semen.

For Hep B on the other hand, I've heard that, for instance, touching things while having a small cut in your finger could theoretically infect you if these things were touched before by someone infected who had a small cut, too, but I might misremember this.

#503 ::: Bugtussellmom ::: (view all by) ::: February 26, 2009, 06:06 PM:

Thanks Lori, I understand a little better now. I need to be more familiar with the terms as I'm reading.

Now on the Hep B, I am still not clear. Is it spread like AIDS? Everything I read about it says it can only be spread through bodily fluid exchange.

Thanks all!

#504 ::: Bugtussellmom ::: (view all by) ::: February 26, 2009, 06:19 PM:

No we won't be leaving the country, our vacations are a little cheaper, lol. The baby will be here in a few weeks and I don't think I will let them giver her that Hep B shot. My older children did not get that shot, they were born in a different hospital.

#505 ::: Lizzy L ::: (view all by) ::: February 26, 2009, 07:35 PM:

Bugtussellmom at 500: My kids are around a few adults who have AIDS. Are you saying my kids could get AIDS from being in the room or like if the adult was helping my 6 yr old read...

Oh my gosh.

NO, No, No. AIDS is spread through sexual contact, sharing needles, or blood transfusions. It cannot be spread through casual contact, sweat, sharing a toilet seat or a bathtub -- your kids are safe.

#506 ::: James D. Macdonald ::: (view all by) ::: February 26, 2009, 07:44 PM:

HIV/AIDS is very hard to catch. You have to work at it. A very brief exposure to air kills the virus.

Various of the hepatitis strains are much easier to transmit. Hep C, for example, can be spread by acupuncture, tattooing, sharing living quarters with another person with Hep C, and manicures. In 40% of the cases of Hep C, the infected individual can't identify the source of infection; in 10% of Hep C cases, no risk factor can be identified. "There are clearly other, as yet unidentified modes of transmission."

Here's a brief run-down on a bunch of viral Hepatitis strains (A through E).

#507 ::: Mary Frances ::: (view all by) ::: February 26, 2009, 07:44 PM:

Bugtussellmom @ 504: Before you decided definitely to avoid the Hepatitis-B vaccine, here's an informational article you might find useful: Hepatitis B Vaccine.

I had no idea the virus was so dangerous, or so common, myself, before reading this thread--check out the information about the virus being present in saliva (unlike the HIV-AIDS virus), and the fact that many carriers don't know that they are carriers at the time . . . and the bit about 18,000 children in the United States being infected with Hepatitis B during the first ten years of life, 5,000 people dying of Hepatitis during a given year and another 10,000 suffering from long-term consequences such as cirrhosis and liver cancer. The money quote seems to be: "In fact, with the exception of influenza virus, hepatitis B virus causes more severe disease and death in the United States than any other vaccine-preventable disease."

Yikes.

#508 ::: James D. Macdonald ::: (view all by) ::: February 26, 2009, 08:16 PM:

One thing to ask is "What if I'm wrong?"

Suppose I vaccinate my kids against Hep B, and they're never exposed. What happens? Nothing.

Suppose I don't vaccinate my kids against Hep B and they do get exposed? What happens? A chance at a prolonged, miserable, and painful death.

The thing about preventative medicine is that you never hear the bullets missing you.

Another, longer quote from the article Mary Frances cited:

Because the disease can be transmitted by casual contact, and because about 1 million people are infected with hepatitis B virus (many of whom don't know that they have it) it has been hard to control hepatitis B virus infection in the United States. The original strategy (started in the early 1980s) was to vaccinate only those at highest risk (for example, healthcare workers, patients on dialysis, and intravenous drug users). But because the disease can be transmitted to those who are not in high-risk groups, this vaccine strategy didn't work. The incidence of hepatitis B virus disease in the United States was unchanged 10 years after the vaccine was first used! For this reason, the vaccine strategy changed. Now all infants and young children are recommended to receive the hepatitis B vaccine and the incidence of hepatitis B virus infections in the United States is starting to decline. If we stick with this strategy, we have a chance to finally eliminate this devastating disease within one or two generations.

FWIW, I personally have had the Hep B series.

#509 ::: Bugtussellmom ::: (view all by) ::: February 26, 2009, 08:31 PM:

The way that some of this stuff is worded, it does not make sense. I find contradictions in almost every paragraph.

Casual contact in my world does not include the sharing of washcloths or toothbrushes. After carerfully reading that paragraph over and over, I notice that all I have to do is make sure my baby doesn't get tatoos, have sex or share needles.

The article was helpful, but it just wasn't convincing. Thanks, I appreciate your time.

#510 ::: Bugtussellmom ::: (view all by) ::: February 26, 2009, 08:35 PM:

This is just one of many stories I have read in the past few months. This is why I don't think the shot is worth it.

http://iansvoice.org/default.aspx

#511 ::: Bugtussellmom ::: (view all by) ::: February 26, 2009, 09:01 PM:

http://www.chop.edu/consumer/jsp/division/generic.jsp?id=75730

I find myself looking into every detail of this article. I can not backup the writers sources. I wonder why he/she didn't either?

In 2005 there wwere just 5 cases of Hep B in children under 5 years of age. The article on that website is obviously not stating the same. It leaves the new mom terrified. I want answers. I don't want to believe the conspiracy theory people but I don't understand why ther's no straight answers! Who who is lying and why? I got the above from the CDC, MMWR (March 30,2007).
I'm trying to find anything that will back up the claims made that thousands upon thousands die with Hep B each year. Something else I read led me to think that mostly drunks and drug addicts and prostitutes have the disease.

Why is this so dam confusing???

#512 ::: Diatryma ::: (view all by) ::: February 26, 2009, 09:06 PM:

Bugtussellmom, will it be as easy for your child to be vaccinated later in life? Presumably, your child will eventually have sex.

Worst-case scenario for this, may it never happen, is that someone molests your child and passes on a bonus virus.

I'm not sure if I've had this vaccination. Should ask before my good insurance runs out.

#513 ::: James D. Macdonald ::: (view all by) ::: February 26, 2009, 09:16 PM:

This is just one of many stories I have read in the past few months.

I have a great deal of sympathy for the parents.

I wonder if there was an autopsy, and if so what it found?

It seems to me, from reading the story, that Ian was a very sick little boy before the shot, and he was a very sick little boy afterward.

But let's say that the vaccination caused his death. Is immunization still the correct choice? Yes.

As I said a while back about seat belts: Nothing's safe, nothing's 100%, but it's best to play the odds that give you the best chance. When you're playing blackjack it's always the right choice to split a pair of aces, even though you can point to any number of people who've split their aces and lost anyway.

#514 ::: Diatryma ::: (view all by) ::: February 26, 2009, 09:17 PM:

Bugtussellmom, the CDC page I have pulled up says 4700 new HBV infections reported in 2006, which leads them to estimate 46,000 new cases total-- asymptomatic cases throw everything off.

While I agree that it seems a baby isn't really at risk-- and ew, sharing toothbrushes-- well, kids are kids. If a kid forgets or loses her toothbrush at summer camp, she may use a finger, not brush her teeth, or share. I know multiple people who don't see sharing toothbrushes as a big deal at all (ew sharing toothbrushes... okay, one was my brother. I yelled at him a lot). Kids make life risky by being kids.

#515 ::: Mary Frances ::: (view all by) ::: February 26, 2009, 09:27 PM:

Bugtussellmom @ 511: The article at http://www.chop.edu/consumer/jsp/division/generic.jsp?id=75730 that I originally linked to is from the Vaccine Education Center at the Children's Hospital of Philadelphia. If you click on the "About Us" link at the top, you will find information about the hospital; the "About the Center" link to the left offers information about the Center and the people who maintain it. There's also a "Contact Us" link at the bottom (vacinfo@email.chop.edu)--I suspect that if you asked for clarification on the information on the page, you might get some answers from that.

#516 ::: Mary Frances ::: (view all by) ::: February 26, 2009, 09:39 PM:

Diatryma @ 514: Good point, re: sharing toothbruses ("ews" and all). I also keep thinking about the number of times in my life I have been eating or drinking something, and had a small child crawl up on my lap to demand a taste. Would a sip or a bite be enough to transmit Hep B? Maybe or maybe not, but I think I'd just as soon not risk having someone I love find out the hard way. That is one nasty disease.

#517 ::: James D. Macdonald ::: (view all by) ::: February 26, 2009, 09:50 PM:

I find myself looking into every detail of this article. I can not backup the writers sources. I wonder why he/she didn't either?

To help you out: A Treatment Algorithm for the Management of Chronic Hepatitis B Virus
Infection in the United States: 2008 Update; CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2008;6:1315–1341

It is estimated that up to 5000 people die each year in the United States of these complications of HBV infection. The cumulative rate of morbidity and mortality from cirrhosis and liver cancer related to CHB is highest among individuals who acquire HBV infection as neonates or in early childhood.

In 2005 there were just 5 cases of Hep B in children under 5 years of age.

This is hardly surprising, given that Hep B infections in young children tend to be asymptomatic and chronic, only revealing themselves years later.

Here's a bit more, this from Australia, concerning cause of death in persons with Hep B and/or Hep C:

http://www.hivandhepatitis.com/hep_c/news/2007/051507_c.html


It sounds to me very much as if you've already made up your mind, Bugtussellmom. I wish you and your kids the very best of luck and the very best of health. Please do consider vaccinations and immunizations for other diseases.

#518 ::: cmk ::: (view all by) ::: February 26, 2009, 09:50 PM:

Bugtussellmom, if anyone else has made this point I've missed it--but for AIDS patients to be around unimmunized children can lead to life-threatening infections for the AIDS patients.

#519 ::: A.J. Luxton ::: (view all by) ::: February 26, 2009, 10:03 PM:

Bugtussellmom, how many people do you know of in the world who never have sex?

You may not be thinking of your child as an adult right now, but assuming your child reaches adulthood - and that's a good assumption to make, you WANT your kid to have a long and happy life, right? - they'll be an adult eventually, and adults generally have sex.

And Hep B is also spreadable by saliva, and doesn't die off quickly on surfaces outside the body, which means that if your kid shares lunches with friends (for instance) it may be possible to catch that way.

HIV/AIDS dies off quickly on surfaces outside the body, and is not spread by saliva. That's a major reason why it's hard to catch.

According to a study called "Epidemiology of Hepatitis B", in the Pediatric Infectious Disease Journal, at least 30% of reported hepatitis B among adults cannot be associated with an identifiable risk factor.

This study also shows that Hep. B is more likely to become chronic in young children - although young children are less likely to catch it, when they do, it can be permanent.

#520 ::: JHomes ::: (view all by) ::: February 26, 2009, 11:30 PM:

Bugtusselmom, in sundry posts:

If you are planning on your children never having sex, where are you grandchildren coming from?

JHomes

#521 ::: James D. Macdonald ::: (view all by) ::: February 26, 2009, 11:40 PM:

Guys, sex isn't the only way to get Hep B. It may not even be the major way to get it.

#522 ::: Lee ::: (view all by) ::: February 27, 2009, 12:35 AM:

Mary Frances, #516: We have a friend and business associate who has Hep B. He is meticulous about not sharing food with anyone else. But food-sharing with children is part of the bonding rituals of a lot of social communities, from the family level on up. Combine that with the risk of asymptomatic infection, and the picture isn't pretty.

Jim, #521: Also, the emphasis on sex may be contributing to Bugtussellmom's difficulty in distinguishing between HIV and Hep B. The former is (in the public view, never mind that it's not strictly accurate) transmitted by having sex. The latter can be transmitted that way, but is much more likely to be distributed by non-sexual casual contact. (As a side note, the references to Hep B as HBV in those articles probably don't help either.)

Bugtussellmom, consider the following not-at-all-unlikely scenario: Your 6-year-old is out on the playground at recess. One of his classmates has non-symptomatic Hep B. Said classmate has been eating candy and licks her fingers clean, or gets her finger pinched and sucks on it to ease the pain. Then she gets in the line for the slide, and climbs up, holding the ladder, with the saliva residue on her fingers. Your kid is next. Bingo, exposed!

This is what we're talking about when we say "casual contact". GET YOUR CHILD VACCINATED.

#523 ::: Terry Karney ::: (view all by) ::: February 27, 2009, 01:43 AM:

Bugtussellmom: . Are you saying my kids could get AIDS from being in the room or like if the adult was helping my 6 yr old read...

No. Not all diseases are built that way. HIV requires being in live cells, of types which don't survive being out of a living body long. Casual contact (even so intimately casual as sharing toothbrushes) isn't going to give them HIV, much less AIDS.

The reason the literature mentions things most people don't think of as "casual" is to point out how hard it is to catch HIV. A brief exposure to air is enough to kill it.

There are lots of variations in how diseases present, and progress. HIV is, outside it's contagion path, pretty hard to catch. That's why condoms are so effective. Kissing someone with HIV isn't a real risk to contagion.

Hepatitus infections, however, are easy to catch. Take a swig from a soda (esp. with a straw) and you are at risk. Kids share things. They take from grown-ups. They offer things to each other; sharing is what they do when they like someone.That's a risk behavior for Hep. They also sneeze, and cough, and lick things. Those are all rsk behaviors.

Vaccinations reduce that. Given the huge number of carriers who can't be identified, vaccination is the way to go. Please trust me on this.

To answer the question you started with: you don't have Hep B,why immunize your child... because it's easy to catch, and your child will interact with other people.

#524 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: February 27, 2009, 01:43 AM:

Ken Brown @ 490

and Stephen Jay Gould railed against it as part of the Evil Adaptationist Program :)

I think Gould would have been happier as a Marxist union organizer; he really did insist on turning debates into wars. I have a great deal of respect for him, but you'd think a scientist who was a principal in changing the paradigm of evolutionary time scales would have realized that there might be some blind spots in his own worldview. Then again, maybe it was just that he liked to argue.

#525 ::: don delny ::: (view all by) ::: February 27, 2009, 08:27 AM:

Bugtussellmom,

By the way, kudos on looking this stuff up for yourself and asking questions about what it actually means and how accurate it is. I really respect your curiosity and determination.

#526 ::: fidelio ::: (view all by) ::: February 27, 2009, 09:25 AM:

Bugtussellmom @511--You said "I don't understand why there's no straight answers! Who is lying and why?"

Please don't leap to the conclusion that the difference in opinion is the result of people lying about facts. It's possible for people of good intent to have radically different opinions about issues, based on what they understand about them, without any of them lying.

One of the problems with medical and other scientific issues is that there is often a stream of new research results and information coming in that makes experts change their minds about an issue--sometimes a trickle through a drinking straw, and sometimes a flood through a firehose*. This may be why a HepB vaccination was not recommended for your first child, and is being recommended now--the people urging this may now have more information about the number of asymptomatic cases, the lack of symptoms present in very young children who have nevertheless been infected, the ease of transmission through things like drinking from the same glass, and so on, that was available a short while ago.

For a comparable example, when we started seeing HepC cases where I work (and twenty-five years ago, when I started out in this job, we hadn't heard of Hep C, just A&B--new sicknesses can appear from what looks like nowhere), theories about transmission made it sound a great deal like HIV-AIDS transmission, where the patient had a significant amount of exposure, most typically via blood or semen; as more research has been done, and cases where people were infected and asymptomatic suddenly converted from "Entirely healthy as far as they knew" to "On the verge of total liver failure from a disease they didn't know they had" started showing up, more research was done, a better picture of how the disease could be transmitted began to appear, and we stopped thinking of HepC as a disease spread principally by sex and drug abuse, just as most in the medical profession no longer think of HepB in that way. (One reason may be that IV drug users and people who are highly active sexually have more opportunities to catch something, and so are the first to show up with it in significant numbers, although the disease will then show up more and more in the general population.--this happens more than many non-medical people realize, and medical researchers now try to assume that a disease that shows this pattern may turn out to have other means of transmission.)

So we may know more about HepB that we did even two years ago, and this would explain disagreement between people who have seen the newest information, people who have seen some of it but haven't seen enough yet to make up their minds, and those who haven't seen it yet.

Incidentally, my mother did a fair amount of travelling overseas when she was in her seventies and eighties--mostly places we would think of as nice, safe, healthy one, including a fair number of cruises. On her PCP's recommendation, she got a HepB vacination; he thought it was a bad disease for an elderly person to come down with, and advised it "Because you don't know how well someone else does the dishes" (there had been stories about cruise-ship diarrhea in the news, I think). He told her "Even if you end up never being exposed to it, you're now a firebreak in the spread of the disease--no one can catch it from you."

What ever you decide, enjoy your children and best of luck; parenthood is not a job for the weak of heart!

*Plate tectonics, for a non-medical example.

#527 ::: Jon Baker ::: (view all by) ::: February 27, 2009, 10:18 AM:

Debbie gave me permission to talk about her family.

Elizabeth: Debbie loved "The Speed of Dark", and recommended it to our rabbi's wife, who works with autistic kids.

Joyce: Debbie definitely subscribes to the "genetic component" idea regarding autism. Her oldest brother, J___, born 1955 in [a US airbase in] Japan, is autistic. He lives in a New Jersey state facility now, but lived at home until he was about 24. He started to show signs of it about age 2. My mother-in-law used to blame it on a relative, who shouted really loudly at them when they got off the plane from San Francisco (at the end of their long journey home from Japan), which frightened J___, but hey, what did they know in the 1950s? There was also the "refrigerator mother" theory, which clearly fails in my mother-in-law's case. She's openly affectionate.

Obviously, J___ never had MMR. I didn't, and he's 8 years older - I had separate mumps, measles and German-measles vaccines. Apparently I got a mump on one side as a reaction to the mumps vaccine, which I think I remember, I was about 3. Yes, I just asked Mom - she says it was my brother's birthday, and they had to cancel the party, so I must have been 3-1/2, which would have been April 1969.

Anyway, there was an article in Wired a few years ago, on autism-spectrum disorders, with a quiz to self-diagnose if one has Asperger's traits. She (and I) both came out a bit below the "you may have a spectrum disorder" threshhold.

http://www.wired.com/wired/archive/9.12/aspergers.html
http://www.wired.com/wired/archive/9.12/baron-cohen.html
http://www.wired.com/wired/archive/9.12/aqtest.html

Both of Debbie's brothers have also wondered if they have Aspergers' traits. One is married, with a bright & athletic son, one is a confirmed bachelor.

Given their family experience, a) we do think there's a genetic component, even if there might be an environmental trigger (per AJ Luxton @ 269), and b) maybe it's a good thing that we can't have kids - with both of us exhibiting traits, and J___ with real autism, there's a good chance our offspring might have had it as well.

J___ is lower-functioning than Dustin Hoffman's character in Rain Man, but Hoffman does capture the affect and responses really well. J___ responds to questions, and will speak up if the ritual of the Visit is not followed to the letter. For instance, one time we went and made the wrong turn at a 5-way intersection, and J___ pipes up saying "Turn around. Turn around. Turn around turn around. ..." He likes music, and puzzles. He thinks he's living at camp, because his grandfather told him so, repeatedly. He finally learned table manners (knife and fork) in his 40s.

#528 ::: Carrie S. ::: (view all by) ::: February 27, 2009, 11:50 AM:

I was born in February of 1976; no smallpox vacc, no chicken pox vacc.

At this remove, I suspect that my mother exposed me to chickenpox on purpose; my childhood best friend showed her first pox the morning after our sleepover, and both Mum and Janet seemed rather unsurprised when we came out to announce Emmy had chicken pox. I was six or seven at the time, I was uncomfortable for a week or so, and that was it. No scars or anything.

But I gave chicken pox to my babysitter (16) and she gave it to her mother, and the mother got really horribly sick. Melissa had had it, but it had been a really mild case; no idea about the mother.

This post has reminded me, though, that I haven't had a tetanus booster since before college; fortunately I have a doctor's appointment on Monday anyway, so I just called the office to check and make sure they have the vaccine in.

#529 ::: Nix ::: (view all by) ::: February 27, 2009, 12:00 PM:

A. J. Luxton@#269:
"People with the genetic predisposition to autism are going to develop it at some point."

Very little in biology is ever that simple, and especially not in the horrendously complex mass of interacting feedback loops which sculpts the growing brain. Autism is perhaps the most strongly genetically-influenced mental disorder known, with estimates of genetic influence running above 90% --- but if you are an identical twin, and you have autism, your twin's likelihood of developing it is only around 50%. That's far above the general population baseline, but it's not certainty.

It is not really very meaningful to ask how much of a condition like autism is 'genetic' and how much is not. Mammalian development is a story of interaction between genes and environment even right back at the one-cell stage: we are not fruit flies or nematode worms with every cell's fate specified in the genome. What matter is how much genetics can *increase* your probability of ending up autistic: and here the answer is 'a whole hell of a lot'. Whether you 'blame' the environment or not is a different matter.

So, yes, of course autism is environmentally influenced: a child deprived of all stimuli from birth would end up with a lot of the symptoms of autism even if there was no genetic predisposition (and a lot of other things wrong as well). But equally I can look at my relatives and say 'they look halfway autistic, even those I hardly ever meet'. (I suspect that my dad could get a diagnosis of Asperger's if need be.)

#530 ::: Lee ::: (view all by) ::: February 27, 2009, 12:40 PM:

fidelio, #526: The notion that "if two people disagree about something, one of them MUST BE LYING" is a natural outgrowth of One-True-Wayist thinking combined with the loss of distinction between facts and opinions over the last 40 years. I blame a combination of politics and religion, each of them reinforcing the worst aspects of the other.

Carrie, #528: Thus demonstrating that a significant part of the danger in not vaccinating children lies in the accidental infection of unexposed (or immunocompromised) adults. Unfortunately, I fear that to a lot of the people in the anti-vax movement, this would qualify as "collateral damage" in the Bush sense.

#531 ::: James D. Macdonald ::: (view all by) ::: February 27, 2009, 12:41 PM:

Nothing in medicine is 100%.

#532 ::: Nix ::: (view all by) ::: February 27, 2009, 12:59 PM:

Bruce@#256, your statement that we know how to treat autism is... surprising. As is true of many neurodevelopmental disorders, it's untreatable, incurable, and all you can do is work around its worst symptoms. There is no evidence that I am aware of that the various aggressive intervention strategies (possibly what you referred to as 'treatment'?) are any more effective at teaching compensatory strategies to autistics than is the knowledge you get by simply living (and there's plenty of evidence that they're unpleasant and disruptive both for the autistics and for their families).

(Thankfully, while we never get *good* at social interaction, we get vaguely halfway competent at it after thirty or forty years. Other things improve more slowly: I'm almost as good at reading facial expressions now as a normal ten-year-old. Instinctive theory-of-mind and multilevel he-knows-that-I-know-that-he-knows never develops; nor does the fear of change/love of routine alter with the passage of time.)

#533 ::: Carrie S. ::: (view all by) ::: February 27, 2009, 01:04 PM:

Lee @#530: Yep. I mean, I don't blame my mom for it; it was common at the time that it was better for the kid to just get it and get it over with, and Melissa was exposed to me after I was supposedly healthy again. Still, bad.

#534 ::: Dave Bell ::: (view all by) ::: February 27, 2009, 01:06 PM:

It's maybe overlooked, but some of the thinking about vaccines may be affected by the same behaviour patterns as surrounded the 1918 Spanish Flu pandemic.

And, it seems, the Black Death.

We were talking about some characters in a shared world setting I write in, and Spanish Flu came up as an alternative to just killing off the young men in the war. Spanish flu, I remarked, just didn't get mentioned by any of the family stories I've heard.

Apparently, partly because of censorship, people experienced it as an intensely traumatic, but fairly local, problem. They people who did know how bad it was--20% death rate in some places--were scared of starting a panic.

You can find histories which explain the Roaring 20s as a reaction to the war. Think of all the Bulldog Drummond types, it's certainly a factor. But the same thing happened after the Black Death, and it wasn't so much the same after WW2.

But the important thing is that people didn't talk about it, and it seems that people who experienced the old days of childhood diseases, and had the trauma of coping with the deaths, are reluctant to talk about their experience.

#535 ::: JESR ::: (view all by) ::: February 27, 2009, 01:22 PM:

Dave Bell, you might want to read Mary McCarthy's autobiography to get some feel of the 1919 pandemic; she and her little brother (the actor Kevin McCarthy) were put alone on a train from Seattle to New York after their parents died of the Spanish Flu. I did a lot of reading about the pandemic when I was still trying to be a writer of literary fiction, and you're right- most of what is out there is scientific studies. It doesn't get dealt with in either memoir or fiction except in (emotionally detached) passing mention.

There are two small gravestones between my father's paternal grandmother's and that of her son who died in the Atlas Powder Disaster in 1934- of two daughters who died in 1919. They were old enough to have been missed, but no one in my father's generation (he was the eldest, born in 1917) knew anything about them. The Atlas Powder Disaster was a hero tale, on the other hand, which my father told until his last days.

#536 ::: Jon Baker ::: (view all by) ::: February 27, 2009, 01:44 PM:

My grandfather's little sister Ruthie, born 1910, died in 1919 during the flu pandemic, of polio. Would flu have caused polio? Or was it just a coincidence? I know people get pneumonia from flu, because of the weakened immune system. Grandpa was 20, and Uncle Joe 18, and they never got over the loss, particularly Uncle Joe who never had children of his own.

#537 ::: Nix ::: (view all by) ::: February 27, 2009, 01:52 PM:

Jim, one thing in medicine *is* 100%: at least so far... everyone dies in the end. (Oh, also, everyone is born.)

Nothing else, though.

#538 ::: Lori Coulson ::: (view all by) ::: February 27, 2009, 02:00 PM:

Jon Baker @536: It is very possible that the Spanish Flu weakened Ruthie's immune system, and polio finished the job.

Flu in and of itself does not usually kill* -- it's the secondary infection (usually pneumonia) that does.

*However Spanish Flu did kill healthy young adults because it spurred their immune system into flooding the lungs with fluid, perspiration, etc. Victims "drowned" or could not be kept hydrated.

(Just realized that this last seems remarkably similar to the "sweating sickness" of Henry VIII's reign...hmmm.)

#539 ::: Xopher ::: (view all by) ::: February 27, 2009, 02:17 PM:

Nix, not everyone IS born. Depending on your definition of 'everyone' and 'born'. The first of which is a can of worms if we discuss it further, and the second...well, I know several people who could have killed MacBeth, let's just say that.

Lori, that sounds remarkably like the pattern of Hantavirus.

#540 ::: Sally ::: (view all by) ::: February 27, 2009, 03:05 PM:

You and Orac have been paraphrased. Maybe it will draw readers to you both for details. Thanks for your dedication.

http://xway.posterous.com/a-frightening-health-menace-is

#541 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: February 27, 2009, 04:04 PM:

Nix @ 532

I mispoke in using the word "treat"; to most people that connotes some form of cure, which I agree does not exist for autism. I was explicitly comparing what we know now with what was known in the late 1960s/early 1970s: as I understand it there are now some techniques which work on some fraction of diagnosed autistic children to ameliorate some of the problems.

There is no evidence that I am aware of that the various aggressive intervention strategies (possibly what you referred to as 'treatment'?) are any more effective at teaching compensatory strategies to autistics than is the knowledge you get by simply living

I have been told that in fact aggressive intervention does work in some cases. It's not something I've been motivated to research myself, though. Are there any studies on this, or do we only have anecdotal evidence either way?

(and there's plenty of evidence that they're unpleasant and disruptive both for the autistics and for their families).

That I have also heard; it's what I meant by "the treatment eats the parents alive in many cases".

#542 ::: Terry Karney ::: (view all by) ::: February 27, 2009, 04:38 PM:

Bruce (StM): It's not a failing unique to him. To be fair, some of the war is from folks who didn't admit to earlier mistakes (the guy who first posited the vast number of new pyhla from the Burgess Shales, which Gould Expanded on in "Wonderful Life", seems to have tried to deny he ever said such a thing, and railed against people who quoted him later).

So far as turning debate to war goes, SJ Gould isn't so bad. Cope and Marsh, to name a pair in Gould's discipline, come to mind.

#543 ::: James D. Macdonald ::: (view all by) ::: February 27, 2009, 05:05 PM:

There's a great book on the Spanish Flu which I wholeheartedly recommend:

The Great Influenza: The Story of the Deadliest Pandemic in History by John M. Barry

#544 ::: Diatryma ::: (view all by) ::: February 27, 2009, 06:02 PM:

I second the recommendation in 543. It's a very good book, not only on the flu but on the surrounding culture and history. After years of biology courses, it was weird to recognize names.

#545 ::: Serge ::: (view all by) ::: February 27, 2009, 06:28 PM:

If I get a cold, how far back in time before the first symptoms (sore throat) should I look to figure out where I caught it? Considering that I'm in the Bay Area this week, the Usual Suspects are many and range far, thus making the possibilities rather difficult to narrow. (Hopefully I won't pass the cold on to my 2-year-old nephew, the one whose parents distract him by putting on DVDs of Mozart chamber music.)

#546 ::: James D. Macdonald ::: (view all by) ::: February 27, 2009, 07:13 PM:

The incubation period of the common cold is generally 36-48 hours.

#547 ::: Rob Rusick ::: (view all by) ::: February 27, 2009, 07:24 PM:

Reading a book about 'end times' cults, I thought people living in 1917-19 had a decent excuse: wars and plagues in a scale beyond experience.

#548 ::: Kathryn from Sunnyvale ::: (view all by) ::: February 27, 2009, 07:51 PM:

Serge @545,

Ouch- aren't you flying soon? Per my comment in thread Ow: two words, "zinc lozenges."

(and get old-style decongestant for the flight unless you know beforehand that phenylephrine works for you. It does less than bubkas for me.)

#549 ::: Nix ::: (view all by) ::: February 27, 2009, 08:17 PM:

Xopher, everyone is definitely born, except if implantation fails, which happens in the dark and nobody notices: it's just that not everyone is necessarily healthy or alive when born. This is indeed something in medicine that is 100%. :)

I spent some time looking for ABA trial info a few years ago, and was unable to find any studies on ABA autistic interventions which didn't have both methodological flaws and enormous conflicts of interest (e.g. being run by people with lots of money to gain from a positive outcome). In the rare instances where followup studies have been done by unbiased observers they invariably show the endstate of the study to have been, um, *rose-tinted*.

(Plus the rhetoric of many ABA proponents that autistics aren't human beings until they've had their magic treatment *seriously* turns me off.)

#550 ::: Marilee ::: (view all by) ::: February 27, 2009, 10:29 PM:

Maryland has had a second teen die of the flu.

I can check my vaccinations back to 1991 on Kaiser's website and ask for my paper record for before that. If DT is now five-years, I'm due, so when I see the new primary, I'll have to talk to her about that. Definitely due for the pneumovax booster.

#551 ::: Lizzy L ::: (view all by) ::: February 27, 2009, 11:32 PM:

I enjoyed Gina Kolata's book about the 1918 pandemic; Flu:The Story of the Great Influenza Pandemic of 1918 & The Search for the Virus that Caused It.

#552 ::: Xopher ::: (view all by) ::: February 28, 2009, 12:30 AM:

No, Nix, you missed my point. In, say, Shakespeare's day, Caesarians did not count as birth. That's why Duncan was "no man of woman born" because he was from his mother's womb untimely ripp'd.

So it depends on your definition. Most people today would count Caesarians as "birth." But not everyone, and soon there may be even more dubious processes.

#553 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: February 28, 2009, 12:39 AM:

Xopher @ 552

Here's an interesting religious conundrum: if life begins at conception, the meeting of sperm and egg, and clones are created by replacing the nuclei of stem cells, without use of any haploid cells, then are clones alive? Could a human clone have a soul, or be born, even if the clone's body is gestated in a normal womb?

I forsee lots of medical procedures (and people!) for religious zealots to proscribe.

#554 ::: James D. Macdonald ::: (view all by) ::: February 28, 2009, 04:31 AM:

I forsee lots of medical procedures (and people!) for religious zealots to proscribe.

Oh, heck. We were talking about that when I was in high school a long, long time ago, in regard to identical twins.

This is a solved problem.

#555 ::: TexAnne ::: (view all by) ::: February 28, 2009, 08:22 AM:

John, 554: But twins are made by God, not man. So for the zealots, it's not a solved problem at all.

#556 ::: Diatryma ::: (view all by) ::: February 28, 2009, 09:15 AM:

If you define "zealot" as "person for whom this is a problem" then yeah.

#557 ::: Xopher ::: (view all by) ::: February 28, 2009, 10:51 AM:

James, could you explain the doctrine about identical twins? Does God provide an additional soul, or is it split in such a way that each "half" is still whole (which would be consistent with the doctrine about the nature of Christ being 100% human and 100% God)? Ensoulment is a miracle, so it's not like rules of biology would apply, and after all twins are (usually) both whole people, so even biology deals with "divide in half, get two wholes."

In other words, I see several ways to solve the problem, but I don't know which one is the accepted doctrine.

As far as cloning is concerned, the Church has generally opposed all new birth technology, including IVF,* so I doubt they'll think cloning is OK under any circumstances. I would be shocked, however, if they decided that human clones, when they inevitably arrive, have no souls.

___
*Hell, including painkillers during childbirth. "In suffering shalt thou bring forth children," or something like that. They've historically opposed such advances, but they get over it once the battle is lost. I'd be surprised if even Pope Rat thinks epidurals are sinful.

#558 ::: Tim ::: (view all by) ::: February 28, 2009, 12:17 PM:

I had whooping cough when I was a child, this was back in the early 80s or so.
And I do remember it well.
Horrific does not do it justice.

#559 ::: TexAnne ::: (view all by) ::: February 28, 2009, 02:58 PM:

Apparently the cough syrup hadn't worn off this morning. I do know the difference between James and John, though I don't know why my subconscious decided to type the wrong apostle. Sorry, Jim.

#560 ::: JESR ::: (view all by) ::: February 28, 2009, 03:59 PM:

Hidden dangers of vaccination, a story from real life:

Yesterday, my sister was out tagging and vaccinating baby calves as discussed above, and one of the momma cows took exception to the process and threw her into a stump; she was unable to stand after she hit the ground. Unfortunately, her cell phone was dead. Fortunately, her son (not quite 11) was with her and could run to the front of the place where my brother-in-law was working so they could call the medics.

She has a severely bruised/partly ruptured hamstring, and we all have a manpower problem when it comes to the standard calving season tasks.

I await data from an EMT friend on the other side of town on the elapsed time the "You'll never believe where we had to pick somebody up yesterday" report takes to reach him.

#561 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: February 28, 2009, 04:02 PM:

TexAnne @ 559

"The wrong apostle". Sounds like a Peter Sellars movie, with him playing all 12.

#562 ::: Nancy Lebovitz ::: (view all by) ::: February 28, 2009, 09:15 PM:

#530 ::: Lee:

fidelio, #526: The notion that "if two people disagree about something, one of them MUST BE LYING" is a natural outgrowth of One-True-Wayist thinking combined with the loss of distinction between facts and opinions over the last 40 years. I blame a combination of politics and religion, each of them reinforcing the worst aspects of the other.

I think there's a third factor-- something to do with a background belief that showing anger is the best way to deal with problems, so that explanations (like believing someone must be lying) that provoke anger become easy defaults.

We're just lucky that the country became sick enough of such stuff to elect Obama.

#563 ::: A.J. Luxton ::: (view all by) ::: March 01, 2009, 03:02 AM:

Nix @ 529: I did rather oversimplify that part. I wanted to introduce the idea (that vaccines may be one common trigger for autism, but definitively, or near-definitively, do not cause it) without having to negotiate the arguments that would ensue from my conjecture being lumped in with those of anti-vaxer types.

Gene expression can be changed by environmental factors, too.

JESR @ 560: Way to start your post to make us brace for it! And great followthrough. Good luck solving your calving season.

#564 ::: dcb ::: (view all by) ::: March 01, 2009, 09:13 AM:

JESR @ 560

Sympathies. I hope your sister's injuries heal swiftly (although given what you've told us, that doesn't sound likely, unfortunately).

fidelio, #526: The notion that "if two people disagree about something, one of them MUST BE LYING" is a natural outgrowth of One-True-Wayist thinking combined with the loss of distinction between facts and opinions over the last 40 years. I blame a combination of politics and religion, each of them reinforcing the worst aspects of the other.

I agree, sadly.

#565 ::: Lila ::: (view all by) ::: March 01, 2009, 09:21 AM:

Nix @ #532, there are treatments that considerably improve the symptoms of autism. For example, many autistic kids have coordination problems that respond well to various types of physical therapy; Temple Grandin talks about how much her homemade "squeeze machine" helped calm her down and how well her anxiety responds to meds. Speech therapy, OT, and various types of specialized training (such as teaching people with autism to recognize facial expressions) also have considerable benefit.

I suppose some people might think "treatment" implies "makes the problem go away", but the medical professionals I work with don't use the word that way. (Conditioning the residuum [stump] of an amputated leg to receive a prosthesis is "treatment". It doesn't imply that the leg grows back.)

#566 ::: Serge ::: (view all by) ::: March 01, 2009, 11:32 AM:

James McDonald @ 547... Hmmm. I had to spend 2 hours at the Phoenix Airport for the last part of my flight, but that had been 72 hours before. Then again, I usually have a good immune system and I wonder if it's possible that I kept the darn thing at bay for this long. Of course, after landing in the Bay Area, I rode around on BART, where some people may have thought that hygiene doesn't apply to them.

#567 ::: Serge ::: (view all by) ::: March 01, 2009, 11:35 AM:

Kathryn from Sunnyvale @ 548... Zinc losanges? I'll have to keep that in mind, should there be a next time. It was no fun flying back because, as we were approaching down toward Phoenix, my ear drums started hurting so bad I thought I'd faint. I tried yawning. In desperation, I blew my nose. Goodness, did my drums pop.

#568 ::: janetl ::: (view all by) ::: March 01, 2009, 12:15 PM:

Serge @ 567: My naturopath recommends a Neti pot and zinc lozenges for suffering less, and possibly recovering faster, from a cold. When I mentioned the zinc lozenges to my regular doctor, she said "Oh yes, those are great!"

A coworker of mine flew with a cold once, and had the combination of congestion and pressure changes damage one of his ear drums. There wasn't anything that could be done, and he's now deaf in that ear.

#569 ::: Serge ::: (view all by) ::: March 01, 2009, 12:21 PM:

janetl @ 568.... Ouch. That's why I hesitated about the drastic way of equalizing pressure in my ears.

#570 ::: joann ::: (view all by) ::: March 01, 2009, 01:49 PM:

Am I the only person for whom the zinc lozenges taste so terrible that the disease almost seems preferable?

#571 ::: Mary Aileen ::: (view all by) ::: March 01, 2009, 01:53 PM:

joann (570): No. I find the cherry flavor to be somewhat more tolerable than the citrus, if that helps.

#572 ::: janetl ::: (view all by) ::: March 01, 2009, 02:01 PM:

Joann & Mary Aileen: The most tolerable flavor zinc lozenge I've found is the Quantum brand "Zinc Elderberry Raspberry Lozenges".
Warning on zinc: I once took too many, too many days in a row, and got painful heartburn. It went away promptly when I realized what was causing it, and stopped the zinc.

#573 ::: Tae Kim ::: (view all by) ::: March 01, 2009, 02:33 PM:

Jim - "(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.)"

Sounds right. Dirty wounds should get Tdap if over 5 years of the last booster. Everyone else, 'clean wounds' - the box cutter laceration at the Staples, is fine for 10 years.

#574 ::: P J Evans ::: (view all by) ::: March 01, 2009, 02:54 PM:

I tolerate raspberry-flavored zinc tablets. (Mine are from Trader joe's.)

#575 ::: janetl ::: (view all by) ::: March 01, 2009, 04:03 PM:

Tae Kim @ 573: ...the box cutter laceration at the Staples...
That reminded me of when I worked at a company that produced hardware products, and I was responsible for the paperwork involved in Underwriters Labs (UL) safety certification. Updated forms would arrive with as many as 6 staples, all industrial strength, that had to be removed in order to add the pages to the 3-ring binder. Yup, got a nasty cut once while struggling with the safety certification paperwork. Healed cleanly, though.
My favorite aspect of UL certification was the "UL test finger". It's the standard size (fake) digit you use to test that a child can't poke a finger into through a opening and get cut or electrocuted.

#576 ::: Rikibeth ::: (view all by) ::: March 02, 2009, 12:12 AM:

Sydney Taylor's "All-Of-A-Kind Family" books deal with both the 1918 flu epidemic and polio, at about the level you'd expect for children's books; the girls don't catch flu, but it strikes many of their schoolmates, and there are descriptions of people wearing bags of camphor (and maybe asafoedita?) around their necks as a preventative measure, or so they hoped; and an adult family friend is stricken with "infantile paralysis," and it's the source of much worry, but she recovers, and although she needs a leg brace and crutches, she's still able to marry the girls' uncle.

I think other childhood diseases (measles and mumps?) come into it -- possibly scarlet fever? There was definitely a bit about quarantine and the difficulties it placed on a family.

What I remember more, though, was the part about childhood diseases in the Great Brain books. The mother's practice was to bundle all the siblings in with the sick one so they'd be sure to catch it and get it over with at roughly the same time. John, the youngest, found this entirely unfair since his older siblings would catch whatever disease first and thus recover first, and be able to come into the sickroom and taunt the still-sick siblings. So he made a point of exposing himself to a sick friend, just so he could be the first to catch something and get to rub it in when he was well and they weren't. When his parents discovered that he'd gotten sick on purpose, he got in big trouble.

#577 ::: Epacris ::: (view all by) ::: March 02, 2009, 06:57 AM:

Recalling my grandmother's scarlet fever story. (She remembered as a young girl seeing Queen Victoria's Diamond Jubilee procession in 1897.) Photos around then show her beautiful flowing hair tumbling right down her back. It fell out completely with the fever – her mother was devastated, thinking it prefigured death – & never grew past her shoulders again.

#578 ::: Peter Darby ::: (view all by) ::: March 02, 2009, 09:59 AM:

Xopher @282: point of information: my son was circumsized at, IIRC, 6.

HOWEVER...

It was a treatment for congenital balinitis (almost guaranteed anything you google for that is going to be NSFW, unless you work in a urethero-genitary unit).

It was done under general aneasthetic. He seems to be fine, physically and mentally*.

One other thing though: all of my family have been asked, at some point, "Are you SURE you're not Jewish*?" Until my son, all men in my family could have a quick answer to that one...

So you kind of caught me in a drive by judgement there, which I'm sure you didn't mean.

But anyone who refuses all immunizations for her boys then gets them electivley circumcized? I'll be generous. I'll restrict myself to saying to her, "I question your judgement."

Reminds me of the old gag about the guy who pulled a branch off a tree to poke a tiger. His friend said "Wow, aren't you worried about the danger?" "Nah, I checked the branch for splinters."

*apart from having apparently cheated nature and inherited all his genes from me, and most of my memes too. Poor kid.

**reasons: 1) My mother was raised on an estate in postwar London where her family were pretty much the only gentiles among the refugees from Europe. The acquired verbal and physical tics were passed down, what can you do?

2) Half the family are stocky, dark haired and olive skinned, the other are pale and lanky with big noses. In other words, we look more Jewish than most Jews we know. In the words of Spike Milligan, "The sort of person who looked so Jewish, passing rabbis would nudge each other and say 'who's that Jewish loking feller over there?'"

3)Anybody seen the subject of this thread anywhere? No?

#579 ::: Jon Meltzer ::: (view all by) ::: March 02, 2009, 11:38 AM:

#576: Readers of Gilbreth and Carey's "Cheaper By The Dozen" will notice that the "dozen children" are only eleven. The second daughter is mentioned twice, then disappears. In the sequels it is revealed that she died of diphtheria and that the parents didn't want to talk about her.

#580 ::: Xopher ::: (view all by) ::: March 02, 2009, 12:46 PM:

Peter, my apologies. I was so angry at the DBT I was addressing that I forgot that sometimes circumcision IS a medical necessity. Mea culpa.

But also...6 is better than 5, and 5 is better than 4. Babies remember nothing (except through a glass darkly), and 6-year-olds have a better shot at understanding medical necessity when it arises. ("Remember how much it hurt when [fill in medical TMI]? This is to make that stop happening.") I'm opposed to elective circumcision at any age, but while I'm no Freudian I think some ages are even worse than others.

Again, my apologies. I behaved badly, tarred with too wide a brush, and did not explain myself. Also, I let a troll goad me into doing the above, which makes it all worse. I did not intend to cast any aspersions on you, your family, or your medical decisions on behalf of your child, but the fault is still mine for writing something that could be construed that way.

On a lighter note, I was showering at a youth hostel in Germany in 1976, and some boys about my age (16 IICC) were talking about me. One of them finally asked me something that was probably rude, but fortunately I didn't understand him, and told him so in English, at which point he got that "comes the dawn" expression, said "Ah! Amerikaner!" and left me alone.

I didn't figure this out until much later. You see, I was pale and blond and had eyes that passed for blue; Teresa, who met me some years later, says I looked like a Dutch Renaissance angel, and I looked even more like that when I was younger. Seen naked, however, I was clearly a Jew until they found out I was American, at which point their confusion and hostility both evaporated.

(Please note that I'm quite aware that there are tall, blond Jews who look much more Aryan than I ever did, but you can't expect anti-Semitic teenage thugs to realize that fact.)

#581 ::: Lee ::: (view all by) ::: March 02, 2009, 01:29 PM:

Xopher, #580: Reading about that shower incident sends cold shivers down my spine; that was a very narrow escape. But my second reaction was that this is exactly the sort of tale that would be used (not by you!) to explain to women, but not men, why they shouldn't go backpacking around Europe.

#582 ::: Jacque ::: (view all by) ::: March 02, 2009, 02:28 PM:

I was in the ER last night with Close Encounters of the X-Acto Kind (no worries: only three stitches) and I picked up this sad bit of trivia: Boulder County has one of the highest pertussis rates in the US, 'cause all those progressive crunchie crystal liberals don't vaccinate their kids for anything. Oh, heavy *sigh.*

--embarrassed progressive crunchie crystal liberal

#583 ::: Xopher ::: (view all by) ::: March 02, 2009, 03:56 PM:

Lee, to clarify, I never felt physically threatened, and I was if anything hypersensitive to physical threats. They were asking questions as if they had a right to know the answers, but they didn't come within a yard of me at any point.

Perhaps I was/am naïve, but it never occurred to me until now that they might have beat me up for being a "stealth Jew."

#584 ::: James D. Macdonald ::: (view all by) ::: March 02, 2009, 04:13 PM:

Speaking of disease (as we were): Antibiotic-resistant infections among children on the rise

You can see how bugs and germs can beat antibiotics, but it's hard to see how they'll go about beating immunization.

Oh, and washing your hands is still a good idea. Along with not using antibiotics unless absolutely necessary, and if you do, taking the entire course.

#585 ::: Rikibeth ::: (view all by) ::: March 02, 2009, 04:53 PM:

Jim @584:

You can see how bugs and germs can beat antibiotics, but it's hard to see how they'll go about beating immunization.

I've just been having a discussion about this with a friend on her Livejournal. She suspects that our more widespread than in previous years, but still not total, program of vaccinating for flu is pushing the flu bugs to mutate more rapidly and to change more thoroughly from previous years' strains, leading to strains that spread more rapidly among the unvaccinated and hit them harder (because they have less partial immunity from previous years' similar strains, because they're just less similar).

Even if I stipulate that flu bugs ARE mutating faster and with more change within strains, I'm not convinced that it's driven by having a larger population of vaccinated individuals.

Would you be willing to give an opinion on this?

#586 ::: JESR ::: (view all by) ::: March 02, 2009, 05:30 PM:

Thanks, everyone, for the good wishes. Sorry for posting in the joke stage of shock. My sister is going to take a while to get better, which means the rest of us are going to be well worn down before she's able to take back the 90% of calf handling that's usually her job.

#587 ::: Rob Rusick ::: (view all by) ::: March 02, 2009, 07:15 PM:

Rikibeth @585: Even if I stipulate that flu bugs ARE mutating faster and with more change within strains, I'm not convinced that it's driven by having a larger population of vaccinated individuals.

Not an informed opinion, but it sounds like it describes a sort of agency to the population of viruses which is inappropriate. As if the viruses, as a collective, react to the diminished range of possible targets by mutating more.

The reason smallpox could be eradicated was that it could only live in a human host; there was no animal population that could also sustain it. By denying it human targets (vaccination being the principle weapon), it was possible to restrict its population. If smallpox as a collective could have reacted to its threatened extinction, the most effective thing it could have done would be to mutate to take advantage of another host.

If viruses are mutating more rapidly (and like you, I am not convinced that is the case), it could only be seen because they are reproducing more often, creating the opportunity for mutation. If their spread is restricted, they have fewer opportunities for mutation.

#588 ::: Rikibeth ::: (view all by) ::: March 02, 2009, 08:03 PM:

Rob Rusick @587, I've done some reading that suggests rural farming practices in China, where there's lots of opportunity for flu bugs to pass back and forth between poultry, pigs, and humans, is accelerating the number of changes that flu bugs can go through, and that increased travel and trade between China and the West is then spreading these bugs more widely than would have happened before.

This seems plausible to me by analogy -- I know someone personally who caught plague (pneumonic variant, not bubonic, but PLAGUE dammit) from attending a large software conference in California also attended by numerous people from India, where there were known plague outbreaks, so I can see the "increased commerce increases disease vectors."

But I think it's just coincidence that this happened at about the same time that flu vaccination became more widespread (instead of just targeted at the most at-risk).

My friend also argues that vaccinated people can spread flu without suffering symptoms, and I think that's possible in the case of surface-to-surface transmission if a vaccinated person has been around/caring for a sick person, but NOT airborne-droplet vector, because the vaccinated person WON'T GET INFECTED. She seems to believe that they can be infected but asymptomatic carriers.

We both agree that people being able to stay home when they're sick would do a lot to cut transmission rates, regardless of vaccination status.

But yes, my problem is also the ascribing too much agency to the viruses. Flu mutates whether or not anyone is vaccinated; changing the number of vaccinated people wouldn't seem to me to change the severity or number of the mutations.

#589 ::: James D. Macdonald ::: (view all by) ::: March 02, 2009, 08:04 PM:

Flu viruses are fascinating ... and weird in a lot of ways. I suppose I should write more on them, but I doubt this is the appropriate thread for that.

#590 ::: Ginger ::: (view all by) ::: March 02, 2009, 08:11 PM:

The flu viruses aren't mutating faster; they are possibly moving around the world at a faster rate. Movement through populations will cause some drift, thus enhancing the change. It's the problem with a highly mobile society -- whereas once it took you days to travel from point A to point B, now it takes hours. You can get on the plane before the fever starts, shed all kinds of virions into the enclosed air, deplane, and then "get sick".

#591 ::: Serge ::: (view all by) ::: March 02, 2009, 08:14 PM:

Ginger @ 590... they are possibly moving around the world at a faster rate

Remember how the end of the world happened in 12 Monkeys?

#592 ::: Rikibeth ::: (view all by) ::: March 02, 2009, 09:03 PM:

Jim @589, I'd welcome a front-page post on flu viruses, if you're so inclined. They fascinate me, and even more so since I started reading about them when I was sick with one in January.

#593 ::: John Mark Ockerbloom ::: (view all by) ::: March 02, 2009, 09:19 PM:

Xopher@557: Most of the references I've seen to religious opposition to pain medication in childbirth have involved Calvinists in Scotland in the 16th through 19th centuries. I'm not sure there was ever any consensus against childbirth anaesthesia in other major branches of Christianity. (Though it's not something I've studied in depth; I'd be interested in source materials concerning branches I may not have known about.) I haven't heard any religious objections to birth technologies like inductions, C-sections, ultrasounds, and epidurals per se, among other useful recent innovations.

I have heard some dubious arguments from some modern-day "natural childbirth" advocates, but they don't appear to be related to Christianity or any other specific identifiable religion. (Note: I'm fine with folks who make a free, informed decision to give birth with minimal intervention, as long as there's backup that can be brought in quickly in case of complications. I'm not so fine with folks who use guilt or misinformation to talk women out of treatments that could help avoid harm to them and their baby.)

#594 ::: Peter Darby ::: (view all by) ::: March 03, 2009, 02:50 AM:

Xopher, no harm, no foul. Just wanted to make sure we didn't get into the situation where I or someone else talks about non-medical circumcision and someone else says "Well, Xopher says it's bad and wrong!"

We need a warning sometimes "DANGER! POSTED WHILE UNDER THE INFLUENCE OF TROLL! MAY CONTAIN IMMODERATE STATEMENTS! VIEWERS IN SCOTLAND AND NORTHERN IRELAND MAY HAVE THEIR OWN PROGRAMS!"

#595 ::: Diatryma ::: (view all by) ::: March 03, 2009, 09:12 AM:

In my Bioethics class, which was not a good class, we discussed reproductive technologies and had a week or so of 'religious viewpoints'. Which was, in its entirety, the Vatican's official statement.

I was not then quite brave enough to call the professor on it. I think it may have started a rebellion, because a bioethics class of senior biology majors should not be lecture format.

Instead, my response was to do my midterm portfolio using selections from the IVF blog of a moderately strict Jewish woman. I would feel better about this if there were any evidence that the professor read it.

There can be a huge difference between what the authorities of a religion say, what the discussion is actually about, and what people of the religion do. Consensus among the people writing the rules is not consensus among the people.

#596 ::: James D. Macdonald ::: (view all by) ::: March 03, 2009, 09:17 AM:

Meanwhile, elsewhere on the 'net:

With all this heavy lifting to be done, all this landmark legislation to be drafted, all this human suffering to be relieved—with all this, why is that the Florida Legislature cannot summon itself to stop focusing on the picayune, stop pandering to the wingnuts among us, and stop trying to micromanage things about which they know next to nothing?

House Bill 33 and SB 308 pander to the scary people who are seeking to raise completely groundless fears about childhood vaccinations by actually making it harder for parents to do the right thing and give their children life-saving vaccinations. This bill would require health care providers to try to scare parents into thinking that vaccinations were somehow dangerous. Vaccinations not dangerous, but people who work against them are.

If you're in Florida, or know someone in Florida, or travel to or through Florida, it's time to write some letters. Otherwise the only ones the legislators will hear from are the nutjobs.

(It wouldn't do Florida tourism a lot of good if you had to update your booster shots to travel there, would it?)

#597 ::: Raphael ::: (view all by) ::: March 03, 2009, 01:23 PM:

with all this, why is that the Florida Legislature cannot summon itself to stop focusing on the picayune, stop pandering to the wingnuts among us, and stop trying to micromanage things about which they know next to nothing?

I'd say the problem is that since antivaxers are spread accross all ideologies, politicians in all camps have something to gain from pandering to them, and a lot to loose from standing up to them. (And, of course, politicians in all camps might believe the antivaxers' claims themselves.) With the current state of the Republican Party being what it is, it might even happen soon that some Republican politicians think that getting into antivaccination stuff might be a good way to keep their own fundie or libertarian voters happy while at the same time trying to attract crossover voters from the New Age or "science is a tool of the oppressors" wings of the left.

#598 ::: James D. Macdonald ::: (view all by) ::: March 03, 2009, 05:32 PM:
In 1736 I lost one of my Sons a fine Boy of 4 Years old, by the Small Pox...I long regretted bitterly and I still regret that I had not given it to him by Inoculation; This I mention for the Sake of Parents, who omit that Operation on the Supposition that they should never forgive themselves if a Child died under it; my example showing that the Regret may be the same either way, and that therefore the safer should be chosen.
Benjamin Franklin Autobiography
#599 ::: James D. Macdonald ::: (view all by) ::: March 03, 2009, 06:46 PM:

The "inoculation" that Franklin speaks of is the practice of finding someone with a particularly mild case of smallpox and deliberately infecting yourself from that person, rather than risking a later infection with a more virulent strain later.

Vaccination came along more than sixty years after the death of Dr. Franklin's son; I have no doubt, however, that had vaccination been available Franklin would have been one of the first lining up for it. Franklin died in 1790, eight years before Jenner published his work.

(Franklin himself was the tenth (of seventeen) children. Why did folks have such large families? Partly because of the lack of reliable contraception, true, but mostly because you needed that many to assure that enough would survive to adulthood to take care of you in your old age.)

#600 ::: Serge ::: (view all by) ::: March 03, 2009, 06:54 PM:

Jame Macdonald @ 599... you needed that many to assure that enough would survive to adulthood to take care of you in your old age

Where I come from, there's an affectionate expression to describe one's progeny - 'bâton de vieillesse', which colloquially translates as 'old-age stick'.

#601 ::: James D. Macdonald ::: (view all by) ::: March 03, 2009, 07:03 PM:

Immunization, effective contraception, and Social Security has turned Thomas Malthus on his head.


On My First Son
by Ben Jonson


Farewell, thou child of my right hand, and joy ;
My sin was too much hope of thee, lov'd boy.
Seven years thou wert lent to me, and I thee pay,
Exacted by thy fate, on the just day.
Oh, could I lose all father now ! For why
Will man lament the state he should envy?
To have so soon 'scaped world's and flesh's rage,
And if no other misery, yet age !
Rest in soft peace, and, asked, say, Here doth lie
Ben Jonson his best piece of poetry.
For whose sake henceforth all his vows be such
As what he loves may never like too much.


On My First Daughter
by Ben Jonson


Here lies, to each her parents' ruth,
Mary, the daughter of their youth;
Yet all heaven's gifts being heaven's due,
It makes the father less to rue.
At six months' end, she parted hence
With safety of her innocence;
Whose soul heaven's queen, whose name she bears,
In comfort of her mother's tears,
Hath placed amongst her virgin-train:
Where, while that severed doth remain,
This grave partakes the fleshly birth;
Which cover lightly, gentle earth!

#602 ::: Clifton Royston ::: (view all by) ::: March 03, 2009, 07:37 PM:

Have any other posters to this thread received some (apparently well-meaning) spam about vaccination programs in India?

#603 ::: Renatus ::: (view all by) ::: March 03, 2009, 07:42 PM:

Clifton, I haven't posted to the thread (although it did remind me I need to update my vaccinations) but I did get that spam a couple of days ago. It directed me to a website that, on the surface, looked informational. I didn't delve deeper.

#604 ::: Fragano Ledgister ::: (view all by) ::: March 03, 2009, 07:45 PM:

Clifton Royston #602: I have.

#605 ::: Mary Aileen ::: (view all by) ::: March 03, 2009, 07:52 PM:

I've gotten that spam, too.

#606 ::: James D. Macdonald ::: (view all by) ::: March 03, 2009, 07:58 PM:

I haven't gotten that spam.

#607 ::: P J Evans ::: (view all by) ::: March 03, 2009, 08:51 PM:

I got that one, too.

#609 ::: Lee ::: (view all by) ::: March 03, 2009, 09:13 PM:

I haven't seen that spam, but this doesn't mean I might not have gotten it. Earthlink's spam filter is mighty, and what gets thru it tends to get caught by the custom filters on my own machine, which are maintained by my partner.

#610 ::: Xopher ::: (view all by) ::: March 03, 2009, 09:46 PM:

I got that spam.

#611 ::: Linkmeister ::: (view all by) ::: March 04, 2009, 12:46 AM:

I haven't yet received that spam.

There's a well-acted scene in John Adams wherein Abigail and all the children are vaccinated for smallpox. One of his daughters contracts it anyway, but I think she recovers.

#612 ::: Raphael ::: (view all by) ::: March 04, 2009, 02:27 AM:

I'm one of those who got it.

#613 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: March 04, 2009, 05:59 AM:

I got that spam at the gmail account I use here, but not at my other email account (which I try to keep out of mailing lists by using it only for family and personal business). I poked at it as far as the first link to the website; it looked kosher that far, but I wasn't moved to go deeper either.

#614 ::: Jacque ::: (view all by) ::: March 04, 2009, 03:23 PM:

PNH @89: You people are just so damn good. It's not fair, I tell you. Not fair at all.

#615 ::: iayork ::: (view all by) ::: March 04, 2009, 08:39 PM:

Quick notes -
Even if I stipulate that flu bugs ARE mutating faster and with more change within strains, I'm not convinced that it's driven by having a larger population of vaccinated individuals.

I'm not aware of any evidence influenza viruses is mutating faster. Antigenic shift and drift have been going on for a long time and there have been several instances of massive change long before vaccination -- the 1918 flu was one such example of sudden major mutation. We are monitoring flu much closer now, obviously, and detecting far more changes for that reason.

That's not to say it's impossible for vaccine to drive changes in a pathogen population. Empirically it's surprisingly rare, but it does happen. There was a case of a variant pertussis bacterium that probably arose by escaping vaccine control (but that bacterium was less fit because of hte mutation, and as far as I know hasn't persisted). There's a better-studied, but still not definitive, case of vaccine-driven increased virulence -- Marek's Disease of chickens; I talked about it here.

One of the problems with an HIV vaccine is the probability that the virus population will quickly evolve away from vaccine control.

But aside from those cases, I don't know of any cases where it's actually happened. That's even with viruses that are highly unstable and mutate very rapidly, like poliovirus, for which vaccines have been highly successful.

#616 ::: David Harmon ::: (view all by) ::: March 04, 2009, 09:18 PM:

Rikibeth et al -- I likewise wouldn't expect the flu virus to be mutating faster, but flu's a fast mutator to begin with, especially considering the recombinations with bird and swine flu!

That's probably why it's coming to the forefront of the disease scene lately, and its resistance to long-term immunity makes it a tougher opponent than the "checklist diseases" that we've put on the vaccination schedule.

#617 ::: James D. Macdonald ::: (view all by) ::: March 05, 2009, 01:08 AM:

Mumps PSA

Featuring one of the signs in adult males.

#618 ::: comma ::: (view all by) ::: March 05, 2009, 09:33 AM:

http://counterknowledge.com/2009/01/measels-outbreaks-not-just-a-british-tragedy-but-a-european-one-as-well/

#619 ::: glinda ::: (view all by) ::: March 05, 2009, 04:30 PM:

Had a doctor's appointment yesterday, and asked her about the shingles vaccination; she checked, and said Medicare won't cover it until I'm 60. I can wait another 11 months...

I think I set myself up for this next part: she asked when I'd last had a tetanus shot (more than six years, since the clinic records go back that far). Next thing I knew, there was an assistant jabbing my shoulder.

Is it my imagination, or have they changed something? It hurts *much* less than I remember from past shots.

(Anyway, Jim, thanks so much for these posts.)

#620 ::: ghn ::: (view all by) ::: March 10, 2009, 01:26 PM:

I got a booster for tetanus/diphtheria/pertussis today when I had an appointment with my doctor. It is a looong time since I had a vaccination. Thanks for the reminder!

#621 ::: James D. Macdonald ::: (view all by) ::: March 10, 2009, 10:07 PM:

I got a booster for tetanus/diphtheria/pertussis today when I had an appointment with my doctor.

Go, you!

You're officially part of the solution.

#622 ::: Dan ::: (view all by) ::: March 13, 2009, 02:25 PM:

While I am in agreement for most vaccines, I am strongly against the chickenpox vaccine. I got chickenpox as a kid, and although it is annoying that is about it. The problem is the vaccine is not good for life, how many kids do you think will remember or care to get the booster in their twenties. If you get chickenpox as a child you will not get chickenpox again. As several of you have stated getting chickenpox later in life is much worse, even fatal. I know that shingles sucks as well but I have never had the chickenpox vaccine and if I have anything to say about it I will infect my kids with chickenpox at a young age so that they will not need the vaccine either.

Now all of the other vaccines I will be following although I believe they should be pushed back and started after 6 months since for the first 6 months you do not have an active immune system.

#623 ::: Julia Jones ::: (view all by) ::: March 13, 2009, 02:58 PM:

Today's local news report from Greater Manchester -- three children treated in hospital for measles. The news report I saw was making the point that Wakefield has been discredited and children should get the MMR jab or booster if they haven't already had it, which I was glad to see.

#624 ::: TexAnne ::: (view all by) ::: March 13, 2009, 06:57 PM:

I got a tetanus shot today. Owwwww crap it hurts, but it's better than the alternative.

#625 ::: Fragano Ledgister ::: (view all by) ::: March 13, 2009, 08:13 PM:

TexAnne #624: My favourite is the gamma globulin shot (the last one I got was in 2003 when I had to travel to Nicaragua). That one is a pain in the arse.

#626 ::: Earl Cooley III ::: (view all by) ::: March 13, 2009, 09:00 PM:

Jacque@582, "progressive crunchie crystal liberal" is a turn of phrase I had not heard before. Origin?

#627 ::: James D. Macdonald ::: (view all by) ::: March 16, 2009, 07:11 PM:

We had sailed seven years when the measles broke out
And the ship lost her way in the fog.
And that whole of a crew was reduced down to two.
Just myself and the captain's old dog.

#628 ::: Terry Karney ::: (view all by) ::: March 16, 2009, 09:10 PM:

Then the ship truck a rock
My Lord! what a shock,
She spun nine times 'round
And the poor ould dog was drown'd

I'm the last of the Irish Rover.

#629 ::: Pyre ::: (view all by) ::: March 17, 2009, 04:35 PM:

Rikibeth @ 585: She suspects that our more widespread than in previous years, but still not total, program of vaccinating for flu is pushing the flu bugs to mutate more rapidly and to change more thoroughly from previous years' strains,....

Multiple strains appear every year, and have for a very long time, without any "pushing" by the existence of vaccines. For instance, the animals among which the Avian and Swine flus evolved were not vaccinated to begin with. The catastrophic 1918 flu wasn't "pushed" by any "widespread vaccination program"; it hit so hard because there wasn't one.

The "flu shot" is prepared every year to target already existing strains -- not all of them, just the ones thought likeliest to be a danger over the coming year. With the best of research, this is still a guessing game, and sometimes we guess wrong. This year, for example, a strain is spreading that wasn't covered in the vaccine, and a new vaccine to cover it won't be ready until Fall.

A strain that isn't covered by the vaccine can spread among both those who didn't get the "flu shot" and those who did -- neither group has immunity, so there is no "herd immunity".

This is likelier to hit everyone than a strain that was covered by the vaccine. More people will get sick from it.

But the vaccine didn't "push" it to "mutate".

#630 ::: P J Evans ::: (view all by) ::: March 28, 2009, 04:45 PM:

Today's LA Times on kids and immunizations. Apparently 'well-off' and 'public school' are good markers for finding kids who have not gotten their shots. (Apparently it's easy for parents to get a certificate that says they object to immunizing their kids - even if it's based on hearsay like the vaccine-autism stuff.)

#631 ::: James D. Macdonald ::: (view all by) ::: April 19, 2009, 08:58 PM:

The Doctor Will Sue You Now

Pseudo-scientists using libel laws to stop criticism of pseudo-science.

#632 ::: Pendrift ::: (view all by) ::: May 26, 2009, 04:35 PM:

In today's news, a resurgence of whooping cough. And an older article on how vaccination coverage has dropped below levels needed for herd immunity for certain diseases.

#633 ::: Lee ::: (view all by) ::: May 29, 2009, 08:18 PM:

Speaking of whooping cough, a new study reveals that un-immunized children are 23 times more likely to have the disease than immunized ones. Source here.

#634 ::: Jim Macdonald ::: (view all by) ::: September 08, 2009, 10:10 PM:
Doctors slash vaccines due to rising costs
Parents who bring their kids to Dr. G. Andrew McIntosh for the chicken pox vaccine are out of luck. The Ohio physician doesn't offer that shot because most insurers won't sufficiently cover the cost, CNNMoney.com reports. A recent industry survey found that 11 percent of physicians are seriously considering dropping immunizations, which one pediatrician called "fantastically alarming."

Why? Because insurance won't pay the full cost for immunizations, and doctors can't charge patients the difference.

Another way in which the current health insurance industry is failing us.

#635 ::: James D. Macdonald ::: (view all by) ::: October 17, 2009, 01:16 PM:

I'm promoting this from PNH's Sidelights, so that when it scrolls off we'll still have it linked here:


Just in case you weren't clear on this, Bill Maher is in fact a complete idiot

#636 ::: Lee ::: (view all by) ::: October 25, 2009, 04:57 PM:

Yet another article on the risks of non-vaccination... and the lengths to which the anti-vaccine crowd will go. It is within the ethical bounds of my belief system to wish that those who send malignant energy toward others have it reflect on them without affecting the target, and that definitely seems to apply here.

#637 ::: Xopher ::: (view all by) ::: October 26, 2009, 11:57 AM:

We've had an outbreak of mumps in a town in my area. The "patient zero" for the outbreak was a kid who'd traveled to England recently.

Most kids here are vaccinated for mumps, but the vaccine is only 90% effective. That's enough for a herd immunity, in general, but not if you have a carrier coming in from a plague zone, and vaccination rates are much lower in the UK.

So thank you, UK anti-vaccination lunatics, for giving us preventable diseases. Just like old times. If any of those kids goes deaf from mumps it's on your worthless empty heads.

#638 ::: Fragano Ledgister ::: (view all by) ::: October 26, 2009, 03:05 PM:

Xopher #637: I had mumps in 1966. I was, as I recall, miserable as hell. Made worse by being blamed for having acquired it by my father -- I'd played with a dog in Bushy Park, and my father believed I'd picked up the disease from the dog.

#639 ::: Clifton Royston ::: (view all by) ::: November 03, 2009, 02:36 PM:

Seen elsewhere, in re the flu vaccine:

"It's a giant conspiracy by the medical industry to keep you alive for as long as possible so they can make money treating you. Dead people don't get sick." (Seebs)

#641 ::: Earl Cooley III ::: (view all by) ::: November 03, 2009, 05:53 PM:

H1N1 has a new class of victims: people who are not in the H1N1 major risk class but are at risk of seasonal flu yet were unable to be vaccinated because seasonal flu shot production was suddenly stopped so that Big Pharma could switch to H1N1 flue shot production.

#642 ::: Mez ::: (view all by) ::: November 04, 2009, 01:13 AM:

Going back to the ongoing consequences of earlier diseases, usually seen now in poor and undeveloped areas, or war zones, due to vaccination elsewhere …

Guinness World Record holder for the person who had spent the longest time in an iron lung has just died, aged 83, in a Melbourne (Vic) nursing home. Both her looks and attitude remind me of mother.

#643 ::: Nics ::: (view all by) ::: November 06, 2009, 05:59 PM:

I didn't have an opinion one way or the other regarding vaccinations until I trained as a nanny. We had placements with families to give us some practical experience working with children. One of my placements was in a very isolated area - an hour's drive on rough roads to the nearest medical facility, who could really only give out band aids and make ouchie noises. The hospital was a further hour and a half down the road.

Anyway, the family I worked with had 18 month old twin girls and believed that their isolation meant they didn't need to vaccinate their children. The twins got diptheria, and watching those beautiful little girls die horrible, pointless deaths is the worst thing I've ever had to do. This was in 1993, so not all that long ago.

My daughter has had every vaccination she's supposed to have. My partner was not that keen on that, but as far as I was concerned, it wasn't up for debate.

#644 ::: K. Vee ::: (view all by) ::: November 10, 2009, 03:09 PM:

I got Rubella somehow despite getting my MMR, I got the honor of being the first kid my pediatrician had seen with Rubella in something like 10 years. I think I must have missed a booster. Because my mother had described "possible measles", I had to come in through a back door, masked, and sit by myself in an isolation room until the doctor had examined me personally and was absolutely sure it was true Rubella and not the nastier (and unrelated) Measles virus.

Trust me. "German Measles" may be the milder disease, but that's like asking do you want to be shot in the arm, or just beaten up and robbed? You don't really want either.

As for everything else, well, my husband was born in communist Russia, he lost a sibling to Measles and everytime someone describes it as no big deal, I see him shake his head in disbelief.

His mother contracted Polio when she was small. She's had hundreds (literally) of surgeries over her lifetime to try and correct the damage caused by learning to walk with one leg half an inch shorter than the other. I once saw her chew out a naive new mommy in the family who was telling us how "Nobody gets Diphtheria, I don't even know what that is." Think about this.

An American was able to conduct a polio vaccine trial in the Soviet Union at the height of the cold war because the fear of polio was stronger than political differences.

#645 ::: Pendrift ::: (view all by) ::: November 13, 2009, 03:18 PM:

Does anyone have a link with a quick roundup of relative risk statistics, to help wavering parents tip over into the vaccine side? There's this article discussing how to explain risks, but it doesn't have the soundbite-y stuff that could do the trick. Something like "40,000 people die every year in car accidents, compared with X from adverse reactions to vaccines".

#646 ::: Tabaqui ::: (view all by) ::: November 30, 2009, 01:38 PM:

I remember having chicken pox - socks on our hands! My little brother got whooping cough and had to go to the hospital and be in an oxygen tent. I remember talking to him on the phone while he was in it, and feeling very sorry for him.

I'm iffy about the HPV vaccine only because it's so new - my daughter isn't sexually active - she's 12 - so i feel okay waiting on that one for a bit.

Here's my possibly Most Stupid Question Ever: If we consistently vaccinate for, say, MMR, then where, exactly, is the illness coming from if nobody gets it anymore? Are measles, mumps and/or rubella something that lurks in the trees? Or in animals? Smallpox is gone because, apparently, only humans can get it, but what gets mumps that's *not* human?

Like I said - could be the most stupid question ever, and could be i'm overlooking something amazingly obvious. My brain is a little addled from the huge flood of info in this excellent article.

#647 ::: Ginger ::: (view all by) ::: November 30, 2009, 04:38 PM:

Humans are the primary hosts for all three viruses, although non-human primates can get sick with measles (transmitted from humans). All three are transmitted through the respiratory tract, and all three have not been eliminated from human populations, particularly in "Third World" nations where vaccination is not as well-maintained. The problem is the lack of consistency in vaccination; wherever populations are not vaccinated for these diseases, that's your source of potential outbreaks anywhere in the world.

#648 ::: Tabaqui ::: (view all by) ::: December 01, 2009, 06:45 AM:

Ginger: Yes but...say it's the US and you have a group of people who are all MMR-vaccinated. Where do *they* get it, if they don't travel more than 100 miles?

Like i said, could the dumbest question ever.... I mean - do we just *have* it in us, like good bacteria in the belly, or....?
*flounders a little*

#649 ::: David Harmon ::: (view all by) ::: December 01, 2009, 07:46 AM:

Tabaqui: The answers vary with the disease, but yes, we do have small populations of various disease bacteria and viruses, hidden within our cells. (Most bacterial cells are very small -- hiding inside our cells is a standard tactic in general.) Other diseases have similar reservoirs in other animals, or even in the soil.

For immmunized (or even normally healthy) people, those bacteria mostly get swatted any time they poke their noses out of their hideyholes, because they don't have the numbers to establish an infection. But when someone gets stressed by events or another illness, the "sleeper cells" can make a try for it, and if the person hasn't been vaccinated, they're much more likely to succeed.

There's also the point that it only takes one person to start an epidemic e.g., one student coming back from Britain with a mumps infection, one guy getting an infected letter from his wife back in Mexico, one child playing too close to the sewers.

#650 ::: Ginger ::: (view all by) ::: December 01, 2009, 08:42 AM:

Tabaqui @648: Good question. For measles and mumps, there are no carriers -- by this I mean "healty people who are carrying this virus". However, in the case of mumps, there are two things that contribute to the spread of disease: it has a longer incubation period and a longer infectious period than measles; secondly, about 30% of patients have subclinical infections in which they don't know they have mumps. For both viruses, you can be infectious before clinical signs of illness begin, which is where the initial spread of disease begins.

In contrast, rubella has been shown rarely to remain within the patient even after the illness is resolved, indicating that for a very small percentage of the population there may be carriers. Otherwise, rubella follows the pattern described for measles and mumps: it's infectious before clinical signs begin, it has a longer incubation period and infectious period, and all three are easily spread by aerosol and in some cases fomites (i.e., clothing).

Having cases show up in the middle of nowhere, with the local patients remaining strictly local (no recent travel more than 100 miles) just indicates how easily these viruses travel all over. In every case, there will be a trail of people with illness -- some who never realized they had measles/mumps/rubella, and never needed any doctor.

There are different viruses which you do have within your body, such as herpesviruses (cold sores, chicken pox) and retroviruses. Remember that viruses have a crystalline form when they are outside of their host, which allows them to go into a sort of suspended animation mode until they are picked up by a suitable potential host. This is one reason why viruses are so difficult to eliminate, and in our history, only smallpox has been eradicated (out of thousands of other viruses).

#651 ::: Lee ::: (view all by) ::: February 03, 2010, 03:56 PM:

The Lancet's repudiation of the Wakefield study is actually getting some mainstream-media attention. That's encouraging.

#652 ::: Mary Aileen ::: (view all by) ::: February 03, 2010, 05:16 PM:

Lee (651): Yes. Except the article I read (not linkable, sorry) made it plain that the true believers are reading this as more evidence that the medical establishment is involved in a cover-up of the "link."

#653 ::: dcb ::: (view all by) ::: February 03, 2010, 05:45 PM:

Mary Aileen @ 652: Groan. Head-desk. But of course! Argh!

#655 ::: janetl ::: (view all by) ::: February 14, 2010, 07:30 PM:

Jim Macdonald @ 654: What's really interesting to me is that the article says this outbreak is in a "well vaccinated community", but since the vaccine is only be 85% effective that one kid's case has rippled out to 2,000.

#656 ::: Jim Macdonald ::: (view all by) ::: April 06, 2010, 01:10 PM:

In other news: The Guinea Worm may well be on the way to eradication.

Not that immunization would help against Guinea Worms. They're parasites, rather than viruses.

#657 ::: joann ::: (view all by) ::: April 06, 2010, 02:29 PM:

Now that an unfortunate experience is a couple of months behind me, it's a good time to mention that if you're eligible for shingles vaccine (over 60 and had chicken-pox as a child), pay the money and get it. Too bad I fell short of their minimum age requirement by several years. Even a mild case with a reasonably early diagnosis is no fun and leaves scars.

#658 ::: P J Evans ::: (view all by) ::: April 06, 2010, 02:44 PM:

657
Much closer to that age limit, and had shingles last year. I got an antiviral drug, which helped a lot - the virus was in a cranial nerve.

You don't want shingles. Really.

#659 ::: albatross ::: (view all by) ::: April 06, 2010, 02:46 PM:

Jim,

I don't know if there are vaccines against eukaryotic parasites, but there are immune responses against some of them that are pretty important, and there are certainly efforts to make vaccines against them. I gather the best available malaria vaccines make the disease less deadly, but don't prevent infection. (From listening to TWIP, I believe there are immune responses to both trichanella and tapeworm infections that have a big impact.) It sure seems like you could imagine vaccines being important in wiping out some nasty parasite, assuming it relies on humans for part of its lifecycle.

A little Googling doesn't show much in the way or antiparasite vaccines, other than malaria. Do you know if there are any in use anywhere? (Maybe for animals?)

#660 ::: joann ::: (view all by) ::: April 06, 2010, 02:50 PM:

PJ: I got an antiviral; the shingles picked *two* nerves on a thigh. At first I thought I had a really weird form of sciatica, and then the rash showed up. Quick Friday evening appointment ensued.

No, people, you do not want this stuff. You *do* want the immunization, even though it's nowhere near 100% effective.

#661 ::: Lee ::: (view all by) ::: April 06, 2010, 03:57 PM:

joann, #657: Does it still count if you had chicken pox as an adult? I missed it as a kid, but caught it (ironically, by being around a relative who was having a shingles attack) in my 30s.

#662 ::: fidelio ::: (view all by) ::: April 06, 2010, 04:36 PM:

Lee @661--Alas, yes.

All it takes is a history of chickenpox infection, because Herpes zoster can linger hidden for as long as it likes, waiting to surface again, and if you thought the chicken pox stank on ice, you don't want to try the shingles. What joann said about thinking it was sciatica is not exaggeration--I have known people who were contemplating back surgery when they found out it wasn't a herniated disc after all. My aunt described it as like having an ice pick jammed into her forehead.

Everyone, if you aren't 60 yet, out it on your to-do list for the week you turn 60. If you're sixty, and you've had chicken pox--ask about the vaccine.

#663 ::: Ginger ::: (view all by) ::: April 06, 2010, 04:47 PM:

Lee @ 661: The later you have chicken pox, the more likely it is you will develop shingles. I had my bout with chicken pox at 16, and will get the zoster vax as soon as I possibly can.

#664 ::: joann ::: (view all by) ::: April 06, 2010, 05:26 PM:

Ginger #663:

I was not quite two. There exist actual 8x10 glossies of me wearing nothing but chickenpox and a diaper.

#665 ::: David Goldfarb ::: (view all by) ::: April 06, 2010, 05:37 PM:

Hm, how old was I when I had chicken pox? I remember my brother caught it, and he was about two or three at the time -- we moved when he was just turning three, so that puts it in a fairly narrow window; I'd have been about six or seven. Shingles vaccine sounds good, although I have a couple of decades yet. (I'm having my Douglas Adams birthday at the end of this month.)

Speaking of multicellular parasites, I was just reading recently, linked from James Nicoll's LJ, about someone who deliberately infested himself with hookworm in order to suppress his asthma and allergies.

#666 ::: Stefan Jones ::: (view all by) ::: April 06, 2010, 06:07 PM:

#665: "This American Life" ran a piece about a guy who runs a hookworm supply business. They're harvested from his crap, disinfected, encapsulated, and sold to folks who want to become hosts.

As fucked up as this sounds, it somehow offends me less than the Jack LaLlane Miracle Juicer infomercial I caught the end of last night.

#667 ::: Janet K ::: (view all by) ::: April 06, 2010, 06:08 PM:

I'm old enough so I asked for and got the shingles vac the last time I saw my Kaiser doc.

And I'm fairly sure I first became aware of the vaccine's existence after reading about it on this ML thread.

#668 ::: Thomas ::: (view all by) ::: April 06, 2010, 06:33 PM:

albatross@659:

There is a new vaccine against pig tapeworm (in pigs), and there is research on a vaccine against schistosomiasis in humans (so far only of modest success).

There's even an Australian vaccine against the cattle tick, which produces antibodies to some tick stomach proteins, and research on an improved one.

#669 ::: Fragano Ledgister ::: (view all by) ::: April 06, 2010, 07:57 PM:

Ginger #663: I had chicken pox at 14, what should I ask my doctor?

#670 ::: Lee ::: (view all by) ::: April 06, 2010, 07:59 PM:

fidelio & Ginger -- Thanks, I'll make note of that. My case of chicken pox honestly wasn't that bad, a piece of luck I attribute to my having been on Accutane at the time. But I've known several people who have had shingles, and I know it's nothing I want to mess with.

#671 ::: Clifton Royston ::: (view all by) ::: April 06, 2010, 08:13 PM:

I didn't know there was a shingles vaccine. I will check into it.

I had an mild outbreak of shingles about 10 years ago, a while after the radiation therapy for cancer - for a period of several years I had some kind of weird immuno-suppression thing going on, though it seems to have receded. In my case, there was an almost undetectable rash and certainly no scarring.

Quite recently I had something very odd which I suspect was a form of herpetic neuralgia - for a week or so starting shortly before I came down with a bad cold and a couple of cold sores, any slight touch against my lower left leg felt like intense warmth. Not pain, just heat. The sensations went away around the same time the cold sores finished clearing up. (BTW, the Aleva ointment really seems to work against cold sores.)

#672 ::: Janet Croft ::: (view all by) ::: April 06, 2010, 08:40 PM:

Damn. Nowhere near 60 yet, and had chicken pox at the tender age of about 32. Fun to look forward to!

#673 ::: Tom Whitmore ::: (view all by) ::: April 06, 2010, 09:18 PM:

Does the shingles vaccine help folks who have gotten shingles attacks before the age of 60 (if they get it once they turn 60)? I did have the pox as a child (of under 6; I remember that it was in DC, and we moved west when I was 6), and haven't shown signs of shingles yet. But a good friend has the occasional attack, which antivirals work very well on, and she's a few years shy of 60. So I'm wondering if the vaccine would help her now or soon.

And I thought asking the question here, rather than going off and just researching it, might help others in the same boat.

#674 ::: Thomas ::: (view all by) ::: April 07, 2010, 12:56 AM:

Tom Whitmore@673:

The large clinical trial of the shingles vaccine excluded people who had previously had shingles, so there isn't good direct clinical evidence.

However, the CDC (who know what they are talking about) say

Should the zoster (shingles) vaccine be given to people who have already had shingles?
Yes, it should be given regardless of a history of shingles. Shingles does recur, and there is no biological or epidemiological evidence to indicate that persons are at reduced risk for shingles for any period of time following a prior episode of shingles. Furthermore, while shingles is a distinct condition, errors in diagnosis occur. ... Since there are no recognized safety concerns in giving the vaccine to persons with prior shingles, the vaccine should be made available to persons regardless of prior shingles history.

#675 ::: Thomas ::: (view all by) ::: April 07, 2010, 01:12 AM:

Joan @657 and follow-ups:

I should also point out that you don't need to remember having chicken-pox to be eligible for the vaccine or for it to be a good idea.

The CDC FAQ says: Anyone 60 years of age or older should get the shingles vaccine, regardless of whether they recall having had chickenpox or not. Studies show that more than 99% of Americans ages 40 and older have had chickenpox, even if they don’t remember getting the disease.

The reason for the 60-year limit is because that's who was studied in the clinical trials. Since shingles gets more common with age, the risk/benefit ratio for a vaccine gets more favorable with increasing age. Since the vaccine looked very safe in the clinical trial, it's likely that it is beneficial even for somewhat younger people, and the threshold may well be lowered after more research.

#676 ::: P J Evans ::: (view all by) ::: April 07, 2010, 01:14 AM:

673
It's a good question. I'll probably sign up for the shingles vaccine - once is enough. (I had chicken pox at 7 1/2 - my mother kept a record, one page for each kid, of what we got when both diseases and shots, right through high school.)

#677 ::: Tom Whitmore ::: (view all by) ::: April 07, 2010, 02:58 AM:

Thank you, Thomas, for both bits of information. So if I'm in my mid-50s now, it might be a good idea to get the vaccination early so that I don't get a case of shingles? I'm quite willing to believe everyone I've heard who says that I don't want to get it. I'll check with my MD to make sure, rather than rely completely on information from the internet.

#678 ::: Janet K ::: (view all by) ::: April 07, 2010, 05:21 AM:

If you're younger than 60 and have not had chickenpox or the chickenpox vaccine, the Mayo Clinic recommends for shingles prevention that you have the chickenpox vaccine now.

#679 ::: Thomas ::: (view all by) ::: April 07, 2010, 11:49 AM:

Tom Whitmore@677:

So if I'm in my mid-50s now, it might be a good idea to get the vaccination early so that I don't get a case of shingles?

It might be, and this is where, as a scientist rather than a physician, I'm going to do the 'not qualified to give medical advice' thing. The vaccine is not approved by the FDA for people under 60, so your MD might reasonably be reluctant to give it to you off-label.

#680 ::: Xopher ::: (view all by) ::: April 07, 2010, 11:54 AM:

Thomas, do you have any idea why it's approved only for people over 60? Is it because they're more susceptible to shingles, or because it's somehow dangerous for younger people?

#681 ::: Lexica ::: (view all by) ::: April 07, 2010, 01:08 PM:

Bother. What if you're younger than 60, don't remember whether you were vaccinated for chicken pox, but do remember an unsuccessful (no disease transmission occurred) "let's have the kids play together so she'll get chicken pox and get it over with" session?

Erf.

#682 ::: Thomas ::: (view all by) ::: April 07, 2010, 02:39 PM:

Xopher@680:

As far as I know there isn't any specific reason that the vaccine would be more dangerous for younger people.

The risk of shingles and the likely seriousness of an attack both go up with age, so the benefits are greater in older people.

The clinical trial was restricted to the post-60 age group presumably because you don't need to enroll as many people if the risk is higher, and the FDA has a (generally praiseworthy) reluctance to approve medications for groups that they haven't been tested in.

#683 ::: Paula Lieberman ::: (view all by) ::: April 07, 2010, 02:54 PM:

Tabaqui:

a) Rapists don't care....
b) TMI.

Please allow your daughter to be vaccinated.

#684 ::: Janet K ::: (view all by) ::: April 07, 2010, 05:12 PM:

Lexica @681
The chickenpox vaccine was approved for use in the US starting in 1995--that might help you figure out if you were likely to have been vaccinated. There's also a blood test available that can determine if you have antibodies to chickenpox.

The National Network for Immunization Information provides info on shingles and chickenpox infections and vaccines.

#685 ::: Lexica ::: (view all by) ::: April 07, 2010, 05:42 PM:

Janet K — thanks, that clears it up. (Answer: nope, not vaccinated for chicken pox.) I'm off to reread that Mayo Clinic page and the other references that have been posted.

#686 ::: albatross ::: (view all by) ::: April 12, 2010, 09:45 AM:

Thomas: Thanks!

#687 ::: Kevin ::: (view all by) ::: May 12, 2010, 02:59 PM:

Thank you for this wonderful and well written article.

As a parent, my heart is sad for those that lost their children due to childhood diseases. But their legacy lives on, as an example to those who decide not to give their children immunizations.

I came here looking for information on tetanus, and found much more then I expected.

Once again - thank you.

#688 ::: Lee ::: (view all by) ::: May 24, 2010, 11:47 PM:

Autism scam doctor to be struck from medical register.

Summary: Andrew Wakefield has been found guilty on more than 30 charges of gross misconduct and unethical behavior, and condemned in the strongest possible terms by the General Medical Council.

"The panel concluded that it is the only sanction that is appropriate to protect patients and is in the wider public interest, including the maintenance of public trust and confidence in the profession, and is proportionate to the serious and wide-ranging findings made against him."

Two of his former colleagues were also sanctioned for having violated professional ethics.

#689 ::: Clifton Royston ::: (view all by) ::: June 11, 2010, 01:37 PM:

... and on the opposite pole of progress, this week a team of researchers published in Nature an article with the first good description of what appears to be the genetic basis of autism, 'Functional impact of global rare copy number variation in autism spectrum disorders'

The article is right now available without a paywall at http://www.nature.com/nature/journal/vaop/ncurrent/full/nature09146.html though it's tough sledding to read.

What little I can glean from it is fascinating, though. It appears that the autism spectrum involves many different gene variations of the "copy number" type (involving changes in how often a particular DNA sequence is repeated), not all appearing in the same individual but appearing in different combinations. While these copy number variations are inherantly heritable, they also appear fairly often as spontaneous mutations.

This appears to match up with everything we've slowly learned about autism incidence: appearing in a wide range of severity, with virtually every individual having their own unique grouping of traits; sometimes appearing with and sometimes without features of mental retardation; much more likely if either or both parents has some spectrum traits, but sometimes appearing spontaneously in children of apparently normal parents.

It looks like a huge leap forward in our understanding.

#690 ::: Thomas ::: (view all by) ::: June 11, 2010, 02:27 PM:

On another tangent, the NYT has an article on why the shingles vaccine isn't getting much use.

The problem is that it often isn't covered by insurance, and even when it is, patients have to pay out of pocket and be reimbursed.

#691 ::: Lee ::: (view all by) ::: June 11, 2010, 05:41 PM:

Thomas, #690: No shit. Yesterday I saw a Walgreen's with a sign out that said "Shingles Vaccine Available Here", in the same strip center where I had another errand. So I stopped in to check; while I'm not yet in the high-risk pool, I thought it might be a good thing to get in on early.

$220 per shot, and we don't have medical insurance. Needless to say, I didn't even think about it. This is what happens when we allow insurance companies (and their partners in Big Pharma) to control access to health care.

#692 ::: Lee ::: (view all by) ::: June 11, 2010, 05:52 PM:

Quite apart from my irritation over the non-availability of the shingles vaccine, I have to say that I was extremely amused by this:

Among the increasingly complex and convoluted suggestions for health care reform that were brewing at that moment, here was a powerful intervention that relied on only three things: a needle, a syringe and a patient-doctor relationship rooted in promoting wellness.

Not.

When the NYT adopts a particular expression, that's pretty solid evidence that it's entered the language. If dorky teen-buddy movies had no other value, at least they gave us this.

#694 ::: Lee ::: (view all by) ::: June 24, 2010, 12:58 AM:

Follow-on to #693: California declares whooping cough epidemic.

As of June 15, 910 cases and 5 deaths. This outbreak is on pace to be the worst in 50 years. The Department of Public Health is recommending that in addition to the normal child vaccination schedule, parents, older siblings, and anyone who works with young children should get a booster.

#695 ::: James D. Macdonald ::: (view all by) ::: August 03, 2010, 07:50 PM:

The California outbreak continues.

From the LA Times:

August 3, 2010 | 6:05 am
The number of reported whooping cough cases climbed to 2,174 last week, six times the total at this time last year in an epidemic expected to be the worst in 50 years, public health officials said.

I'm told that the two major loci of the outbreak are in Fresno, and in Marin County.

"The pertussis epidemic is a sobering and tragic reminder that diseases long thought controlled can return with a vengeance," [Dr. Mark] Horton [director of the California Department of Public Health] said in a statement Monday. "We can protect ourselves and the most vulnerable in our community by getting vaccinated today."
#696 ::: Lee ::: (view all by) ::: August 17, 2010, 03:36 AM:

Yet more about the California whooping cough epidemic.

To no one's great surprise, flaming stupidity is running rampant in the comments.

#697 ::: Lee ::: (view all by) ::: September 14, 2010, 12:16 AM:

Somebody fooled a jury to the tune of $1.5M.

#698 ::: James D. Macdonald ::: (view all by) ::: September 14, 2010, 01:03 AM:

It wasn't a jury. It was settled out of court.

#699 ::: Terry Karney ::: (view all by) ::: September 14, 2010, 01:03 AM:

Lee: Worse, convinced the feds to make a settlement: . In 2002, Hannah's parents filed an autism claim in federal vaccine court. Five years later, the government settled the case before trial and had it sealed. It's taken more than two years for both sides to agree on how much Hannah will be compensated for her injuries.

#700 ::: Earl Cooley III ::: (view all by) ::: September 14, 2010, 02:11 AM:

There goes a decade, down the drain. The tinfoil hat crowd will salivate rivers over this one.

#701 ::: James D. Macdonald ::: (view all by) ::: September 14, 2010, 11:23 AM:

This won't prevent autism.

What it'll do is kill or cripple a whole lot of kids.

#702 ::: Lori Coulson ::: (view all by) ::: September 14, 2010, 11:39 AM:

Invoking AKICIML -- does anyone know what the vaccine industry uses to culture the Pneumonia virus?

I know influenza vaccine producers culture that virus in duck eggs -- to which I am allergic so no flu shot.

When my doctor recommended the pneumonia shot, I asked about this, and since he hasn't called me to come in and get it, I've got this feeling that I can't take this one either...

#703 ::: Lee ::: (view all by) ::: September 14, 2010, 11:50 AM:

Earl, #700: I'm afraid you're right about that.

#704 ::: Michael I ::: (view all by) ::: September 14, 2010, 07:00 PM:

Re: 697-703

According to Orac over at the Respectful Insolence blog (scienceblogs.com/insolence) the latest cbs.com article on the Poling case severely misrepresents the facts about the case and the meaning of the verdict.

His latest post on the subject is here and includes multiple links to related material.

From one of his earlier posts I gather that what Hannah Poling really has is a rare type of genetic mitochondrial disorder that shares some symptoms with autism. The symptoms of this mitochondrial disorder can be worsened by stress or fever. Basically, Hannah suffered a fever shortly after receiving a series of vaccinations which may have been related to the vaccinations. The fever may have been a cause of a worsening of her condition. Under the rules of the special "vaccine court" set up to adjudicate claims of injury due to vaccines, this was enough for the government to concede that compensation should be paid.

(From what I gather from Orac's postings, the rules of the vaccine court are INTENTIONALLY designed to be favorable to claimants.)

#705 ::: Linkmeister ::: (view all by) ::: September 14, 2010, 09:01 PM:

Lori @ #702, you wrote: "I know influenza vaccine producers culture that virus in duck eggs -- to which I am allergic so no flu shot. "

From HHS: "Influenza vaccines used in the United States and around world are manufactured by growing virus in fertilized hens’ eggs" (My emphasis)

I dunno if your allergy is species-specific, but if you're not allergic to hen eggs, or aren't sure, then you might want to check further.

#706 ::: Earl Cooley III ::: (view all by) ::: September 15, 2010, 11:53 AM:

Study Number Ten

#707 ::: James D. Macdonald ::: (view all by) ::: October 21, 2010, 01:59 AM:

10 infants dead in California whooping cough outbreak

..."That's why the real important message is -- whether it's a mom, dad, sibling, grandfather or grandmother that comes in contact with these really young babies -- all the close contacts, including the health care professionals, need to vaccinated," says Patti. It's called the "cocooning strategy," where the newborns are protected because the older people around them have been vaccinated and protected from pertussis, and therefore won't pass it on to little babies.
#708 ::: Niall McAuley ::: (view all by) ::: October 21, 2010, 04:54 AM:

Further to my own #30 above: since that date (Feb 2009) we had Daughter #1 immunized with the HPV vaccine for €426.

The Government has since found some change between the sofa cushions and introduced the planned mass vaccination program, but the delay means my daughter's school year missed getting it free, which means most of them won't get it at all.

#709 ::: Brat ::: (view all by) ::: October 23, 2010, 09:53 PM:

And another small mystery solved... I always wondered why my father made my nephews and I demonstrate that we could put our chins on our chests if we got ill. He was born in 1940, and knew a lot of children who got polio - Enough to be checking for it in his immunised offspring fifty years later.

#710 ::: Lila ::: (view all by) ::: October 23, 2010, 10:24 PM:

Brat @ #708, that's also a quick field test for meningitis. It's also not accurate.

#713 ::: praisegod barebones sees more indigestible SPAM ::: (view all by) ::: January 13, 2011, 08:32 AM:

Domuz eti içeridir (may contain pork products)

#714 ::: James D. Macdonald ::: (view all by) ::: February 27, 2011, 05:44 PM:

Passengers contacted after woman with measles goes through 3 airports

State public health officials are contacting airline passengers after a woman with measles traveled through three airports earlier this week, a spokesman for the U.S. Centers for Disease Control and Prevention said Saturday.

The woman traveled from an airport in Europe to Dulles International Airport in Virginia to Denver International Airport and, finally, to New Mexico's Albuquerque International Sunport, said CDC spokesman Tom Skinner.

...
"People who develop a fever should contact their health care provider or their local or state health department. People with symptoms should not go to child care, school, work or out in public, as they might have the early symptoms of measles and might be contagious," the department said in a statement Friday.
...
In a separate development, measles was confirmed in a 24-year-old woman who took a flight from France and two people in Boston were suspected of having the disease. Boston officials held a free measles vaccination clinic Friday.
#715 ::: thomas ::: (view all by) ::: March 01, 2011, 06:11 PM:

Benjamin Franklin, quoted in NYT today

“In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way. I long regretted bitterly, and still regret that I had not given it to him by inoculation.

“This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it, my example showing that the regret may be the same either way and that, therefore, the safer should be chosen.”

#717 ::: Clifton Royston ::: (view all by) ::: April 28, 2011, 02:43 PM:

Nice one, Teresa. I just linked that on my Facebook account, along with a comment about the number of children's headstones in old graveyards.

#718 ::: Clifton Royston ::: (view all by) ::: May 10, 2011, 01:04 PM:

Here's a bit from Wired on the impact and costs of containing a measles outbreak in Arizona, started by one unvaccinated Swiss tourist visiting the ER:

http://www.wired.com/wiredscience/2011/04/cost-vaccine-refusal/

It took 2 days to get her into isolation because measles is rare enough in the US the hospital didn't suspect it at first.

The result: 14 infected, 363 suspected cases, possibly more who weren't tracked down, anywhere from dozens to 100s to 1000s for each of those who needed to be checked for exposure. One unvaccinated 2 year old ended up in the ICU with febrile seizures, a ER worker ended up with severe pneumonia, etc. Around $800,000 in containment costs at the two hospitals, plus forced staff furloughs at 7 hospitals.

A particularly alarming thing from this article is that they discovered how many health-care workers have been lax about getting vaccine boosters. The hospitals had to send home 9% of their staff because they found they were never vaccinated or exposed and had no antibodies. Maybe that is like the well-known compliance problem with doctors or nurses and hand-washing: "Of course that's important, but I have Much More Important things to do right now."

#720 ::: Sandy B. ::: (view all by) ::: May 26, 2011, 08:26 AM:

Just came back to this, from quoting it on Facebook.

#722 ::: James D. Macdonald ::: (view all by) ::: May 27, 2011, 10:14 PM:

Antivaxxer Mark Geier has license revoked in Maryland

As far as his medical expertise, the Board also wrote that Geier’s "assessment and treatment of autistic children as described herein, however, far exceeds his qualifications and expertise" (p. 13). That dry assessment does nothing to convey the horror I felt reading the Board’s document, though. In several cases, he didn’t even diagnose the children in person.
#724 ::: Tom Whitmore ::: (view all by) ::: May 27, 2011, 11:27 PM:

Unfortunately, we can't immunize against tuberculosis.

#725 ::: Tom Whitmore ::: (view all by) ::: May 27, 2011, 11:34 PM:

More accurately, we don't, though Wikipedia says there's a vaccine (up to 80% effective) used in countries where TB is more common. It appears to be uncommon enough here to make that vaccination not very reasonable.

#726 ::: Julia Jones ::: (view all by) ::: May 28, 2011, 03:52 AM:

Tom Whitmore @726/7: And indeed, in countries where TB is not that much more common than the US, but the local strain is better controlled by BCG. I was vaccinated as part of a programme in Australia which at the time had the vax crew visit high schools every year and test/vaccinate everyone[*] in the first year (i.e. 12 year olds), anyone in later years who'd missed it the first time, and any staff members who needed it. Which is how I found out that you can lose immunity, because I tested negative and had to be re-done, even though I'd been vaccinated as a baby in the UK, and as a result of that my teacher went and got himself tested and found that he too had lost immunity and had to be re-done.

It was well known that it wasn't anywhere near 100% effective, and that immunity could be lost after some years (which is why they skin-tested all the kids, including anyone who had been previously vaccinated), but the idea was that it was effective enough to provide a significant level of herd immunity. That was probably my first exposure to the idea that you got vaccinated to protect not just yourself but people who couldn't have the vaccine or for whom it didn't work.

{*"Everyone" in the sense of "everyone whose parents didn't opt them out". I don't remember any opt-outs for other than medical reasons in my year.]

#727 ::: Lila ::: (view all by) ::: May 28, 2011, 08:38 AM:

It may be that the fact that BCG causes a positive skin test is one reason we don't use it here. CDC page on the vaccine.

#728 ::: David Harmon ::: (view all by) ::: May 28, 2011, 09:42 AM:

I remember getting a TB "shot" (more like a fourfold pinprick) in elementary school.

#729 ::: Lila ::: (view all by) ::: May 28, 2011, 10:32 AM:

David: that was a tine test, not an immunization. I too remember those, and I still have the scar on my upper arm from the smallpox vaccine they gave us at school, though I have no idea whether I'm still immune.

#730 ::: David Harmon ::: (view all by) ::: May 28, 2011, 12:22 PM:

Lila #731: Oh. Thanks for the info. Hmm, I note from the article you link, that the test is currently deprecated for inaccuracy.

#731 ::: Lila ::: (view all by) ::: May 28, 2011, 12:49 PM:

David: yup. It's been replaced by the PPD. I'm not sure when the changeover occurred. In the PPD they inject a small amount of liquid under the skin with a regular syringe, and you return in a couple of days to see if there's been a reaction. Note that even the PPD has about a 20% false-negative rate.

#732 ::: Thomas ::: (view all by) ::: May 28, 2011, 04:51 PM:

Lila, David Harmon.

Yes, the fact that it's much harder to test for TB after BCG vaccination is a major reason it's not used in the US, except sometimes for people who work with drug-resistant TB patients. Since TB in the US mostly occurs in identifiably high-risk people and is still nearly all drug-sensitive, it's much better to test and treat than to use a modestly-effective vaccine. The people in Atlanta who screen negative won't need to be treated; if they'd been vaccinated the CDC would probably want to treat all of them.

PPD has false negatives. It also has false positives -- I was in one of the last birth cohorts in Australia to get BCG vaccine, but I didn't get it because I had a positive PPD. The false positives are why there isn't population screening for TB -- the positive predictive value of the test in low-risk people is not good enough.

The standard practice in the US is to test you if you're a migrant, a health care worker, or HIV positive. It's a nice illustration of the tradeoffs in population screening. Healthcare workers have a higher probability of infection, so the positive predictive value is higher. HIV positive patients are in greater danger from TB, so the benefit of true positives is higher. Migrants from high-risk countries have a higher probability of infection, and it's more likely to be drug-resistant and so is important to catch. Migrants from low-risk countries like, say, Australia? Well, who are they going to complain to?

#733 ::: Lila ::: (view all by) ::: May 28, 2011, 06:29 PM:

Thomas: and at least one health-care organization I have been associated with made us be tested twice at 2-week intervals (not a post-possible-exposure situation but a before-you-can-work-with-our-patients one).

No idea what they'd have done if, for example, test one had been positive and test two negative.

#734 ::: Ginger ::: (view all by) ::: May 30, 2011, 01:17 PM:

I get TB tested once a year, down from twice a year (for the past 15 years), because I work with laboratory animals, including nonhuman primates, and we need to protect them from people carrying tuberculosis.

PPD is a population screening tool. If there is a positive, you go in for additional testing and if you are determined to be truly positive, then you are treated.

By the way, the PPD test is an injection within the skin, not beneath. It's intradermal.

#735 ::: Julia Jones ::: (view all by) ::: May 30, 2011, 02:36 PM:

In the high school test/jab programme I mentioned, if the skin test was positive that was not regarded as an indication that you definitely had TB, but that you had to have the follow-up test to find out *why* you were reacting. Three decades on I can't definitely remember what the follow-up test involved, but I think it was a blood test. (I was told before the skin test that if I reacted, it was probably just my previous BCG dose, but I would still need the follow-up, because being vaccinated was not a guarantee you couldn't get TB.)

#736 ::: Mary Aileen ::: (view all by) ::: May 30, 2011, 02:39 PM:

My father was exposed to TB as a child; although he didn't actually catch it, he still turns up positive on the skin test for TB.

#737 ::: Carrie S. ::: (view all by) ::: May 31, 2011, 02:19 PM:

I know a guy who gives false positives to TB testing because his mother was exposed early in her pregnancy.

#738 ::: thomas ::: (view all by) ::: July 28, 2011, 11:19 PM:

New research from CDC summarizing the impact of the chickenpox vaccine over the first 12 years of its availability.

Our study documents the impressive impact on varicella mortality of the 1-dose US vaccination program: a decline of 88% overall and 96% among subjects younger than 50 years.

#739 ::: Jim Macdonald ::: (view all by) ::: April 20, 2012, 01:38 AM:

Measles cases reached 15-year high in 2011

"It's really important for families to know that measles are still a threat," Schuchat said. "In some places it's easy to exempt from a vaccine. We believe that for many parents a reason to decline a vaccine is they don't think the disease exist, they believe it's gone ... No one wants their child to die from measles in 2012."

Schuchat says although many parents opt out of vaccinations for philosophical, religious or personal beliefs, the vaccine has been studied extensively and is safe and effective.

#740 ::: Lee ::: (view all by) ::: June 28, 2012, 02:55 PM:

The risks that non-immunization poses for the immuno-compromised.

Summary: A parent can't find day care for her son, who is undergoing chemotherapy for leukemia, because every day-care she's looked at has unvaccinated children... AKA "walking plague bombs" as someone called them upthread. Exposure to any of the standard childhood diseases could mean death for her child.

If I Ruled The Universe, unvaccinated children without a medical exemption would be banned from attending most day-cares or schools, in favor of special units dedicated to the unvaccinated. Let them expose each other and keep them out of the general population.

#741 ::: Carrie S. ::: (view all by) ::: June 28, 2012, 03:06 PM:

I've discovered that I have to get an MMR booster, because my remaining immunity from my childhood shots is insufficient to protect a fetus if (when) I get pregnant.

Of course, actually tracking down someone who will do this that my insurance will pay for is non-trivial.

#742 ::: SamChevre ::: (view all by) ::: June 28, 2012, 03:14 PM:

I do not know what your insurance cover is, but I got my tDAP at CVS, and IIRC it was covered by my insurance as a prescription. It was very much handier than a doctor visit, and cheaper as well.

#743 ::: Andrea ::: (view all by) ::: July 01, 2012, 05:27 AM:

I got chicken pox when I was little, this was in the early 90's so they weren't vaccinating routinely yet. I mostly just remember a lot of calamine lotion, I was 5 or 6. I also missed my whooping cough vaccine and may have had a 'mild' infection of whooping cough when I was 9, if "coughing fits for weeks straight" counts as 'mild'.

and this article has reminded me that i don't know when i got my last tetanus shot. Time to talk to my GP about it.

#744 ::: Vicki ::: (view all by) ::: July 01, 2012, 10:37 AM:

Carrie:

If paying for the vaccine is an issue, try checking with your local health department. New York City has walk-in clinics that will vaccinate for a wide range of things (though not flu) free of charge, with almost no questions asked. (I don't know what other jurisdictions are offering this, but it's probably worth checking.)

By "almost no questions" I mean that the staff didn't ask why I wanted a hepatitis B shot, only whether and when I had had a previous dose. (I had to argue with my GP over the first dose, and then she was out of stock and sent me to the city clinic for the next two.) They did ask if I was up to date on TDaP, and whether I'd had the MMR.

On the first visit I was apologetically asked whether I had health insurance, because they might be able to get some reimbursement, and assured that regardless of the answer I wouldn't have to pay anything.

#745 ::: Qaz Exx ::: (view all by) ::: July 06, 2012, 02:07 PM:

I have seen adults that haven't had the varicella vaccine, that are at high risk, yet can't afford the vaccine. In addition, there are many risks with live vaccines. There is a dead version of the varicella vaccine available, yet in other countries. Why do we have most of our vaccines made in other countries such as India?

For those who are concerned about conventional vaccines, there are nosodes & doctors that know how to use them. They are just as effective, and in some cases more effective, than conventional vaccines & without the risks associated with those at risk for vaccine-induced illness, such as retardation & yes, autism, and even death.

Those who feel they are at risk ought to have available to them genetic testing, which is also done in some other countries, but not in the US, or not that I've seen.

To blindly give, or force parents to vaccinate a baby or child with known or suspected risks (as we are behind on that here in the US) is utterly irresponsible, as is making high risks persons, such as those with autoimmune disorders, an older sibling with a vaccine injury or death need to be screened for their risks & given nosodes instead if there is a risk of death or injury. This is an issue that needs to be discussed between the family's choice of doctor & the mother, father &/or guardian.

Our doctors need to be trained to use nosodes. Most have no training or even knowledge of nosodes, as the research has been done primarily in other countries. Some are allergic to the base materials in vaccines, or have chronic viral infections, such as HCV, HIV, HHV6, EBV and other immune system problems, can have the vaccines & receive little or no benefit from the vaccines.

My children had ALL their vaccines & one had 1 extra MMR & the other had 2 extra MMR vaccines, yet one Christmas morning they both woke up with the measles. In following years, especially in colleges & universities, there were outbreaks of measles amongst those who had been vaccinated.

Why Medicare will not pay for a vaccine for someone with immune system difficulties, such as RA & other autoimmune disorders or immune deficiency, no matter the age, a varicella vaccine is ridiculous! They'll pay for the suffering & treatment of an adult that has already developed shingles, yet by then it is too late.

Our doctors need to catch up to the rest of the world & YES! Have separate vaccines in lieu of the MMR & other combination vaccines for those who can tolerate 1 or two of the component vaccines.

As an adult who has had immune system issues from a thyroid disorder fro childhood, when the H1N1 vaccines came out, I was exposed to a friend's children who had the live H1N1 vaccine. I had only been around the kids for maybe 5 minutes. Due to the shortages, the killed H1N1 vaccines were not available in our area, or I would have had it. I contracted the H1N1 (Swine) flu, and as a result, I have nerve damage & chronic pain, along with limited use of my right foot & leg. I developed osteopenia & RA after this illness & will likely never be the same. I have had other viral infections that are permanent (EBV, HSV, HCV from a blood transfusion as a child (hepatitis C) & very likely others.), I worked in health care, and took the prescribed vaccines roughly 20 years ago, yet never developed the immunity for at least Hep. B & perhaps others.We are sure of the non-immunity (inadequate immunity) to the Hep. B virus, so I avoid anyone that is sick & live alone. Contact with others in high risk groups, especially school-age children & families can be dangerous, if not deadly for me, even though I have had all the vaccines I've been able to, including all the childhood vaccines, yet trying to get the Hep. A & B series has had to be put off because of illness, as I was unable to get a vaccine to the H1N1, that did nerve damage because I was exposed to my friend's children who had been given the live version of the vaccine. I recently developed adult recurrence of varicella or "shingles" apparently, and have been VERY ill. One doctor thinks I had a "brain bleed (aneurysm) & another thinks it may be encephalitis.

Live, "weakened" vaccines are far from safe!

Many doctors in my area turned down the live version of the vaccine, as I live in an area with many seniors & they felt the risk was simply too high. A local hospital clinic decided to go ahead with the live vaccinations & were even giving them to at leas one child with active MRSA, which could have been deadly to that child. The same clinic didn't even ell the parents that their child had MRSA & he likely had picked it up at the clinic where he was seen, owned & operated by the hospital. The mother discovered it when they changed insurance & she got a copy of her children's medical records. She was NEVER told!

I myself could have died, thankfully didn't, yet do have permanent nerve damage in my leg. I now need help even taking a bath, have to have someone shop for me, do daily chores & so on, as I am not able to most of the time & lately not at all, and developed a complex breast cyst that may be cancer & could shorten my life a loy. I'm only in my 40's!

Bit all vaccines are safe for everyone & those that are aren't always available to those who need them. Just typing this from my bed ,while lying in bed, is difficult. My vision has been affected as well off & o & I have to pray that this is not permanent. I'm on oral & eye antibiotics, antiviral medication, an inhaler, cold & cough medications & others just to keep me alive & breathing. I have been in blisters & vomited the last 2 nights, have to call the doctor today & may be in the hospital by later today if this doesn't improve. I've had little to no appetite, & am not able to digest my foods properly. I have to take vitamin shots, for life.

We are still in our infancy in understanding viral infections, and it is a VERY complex subject, and research funding in this area is very limited & often the funds have been used for other than respectable research. I know, I was one such researcher & saw funding get pissed away on so-called, "experiments that the doctor knew darn well was a dead end, yet they made a LOT of money on bogus research. Thankfully, most government agencies have cracked down in such things, but I refuse to donate any money to "research", unless I know exactly who us doing the research & know that it is legitimate research.

Our ex-President Bush misrepresented stem cell research as using aborted fetuses for ALL such research, which was VERY sad as researchers at "Cal" (UC Berkeley) & UC Irvine had their research , which has a cure for Parkinson's, Alzheimer's & other brain & cellular, degenerative diseases in rats, mice & primates, very similar to our own DNA structure & was VERY promising for humans. They were close to stage 1 clinical trials, but were shut down, costing G-d knows how much suffering & lives. The animal trials were successful over 95% of the time.

I hope this gets some people angry! It should!

Needless to say, these trials are now being done in AGAIN, other countries!

I NEVER give money through private blind funding, such as at the grocery stores any more. Some of these studies are legitimate, others are tickets to a very few people making a lot of money on junk science.

If Pres. Bush hadn't misrepresented & misunderstood what stem cell research is, we might have a routine cure for many degenerative diseases,. He put our scientists out of business & many wonder why we are SO far behind in medicine & science here in the US. Some incredible research is going on in Mexico & Germany for one of my conditions with better than 50% cure rate. Without having roughly $70,000 CASH, I & others like me are going with "management" of the nerve damage & NOT a cure that isn't happening here in America. I would have been a great candidate about 2-3 years ago, and instead deal with chronic, intractable pain every day, which if clinical trials were allowed her in the US, I might have been cured & back to work, helping others heal by now!

President Obama reversed at least part of this mess with the stem cell research, but not until after the money was given out to companies who took the jobs overseas, when the research was started here. I have to wonder how many lives he destroyed as a result of his breaking the Constitution & destroying research that could have been a routine & fairly simple procedure by now.

The same it true of vaccines! Next time you get one, ask to see the insert & the box they come in... undoubtedly they aren't made here in the US, nut in a 3rd world country.

Most of our medications are made outside the US

Vaccines are wonderful if "clean" & used properly! The recurring EBV virus I, and many, many other Americans have, was likely from contaminated polio vaccines in the 1960's! A scientist who discovered this did a story about it on I believe "60 Minutes" &/or 20/20.about 10 years ago. With newer testing methods, he discovered that many of the polio vaccinations were contaminated & he suspected it when many children given the vaccine became ill with EBV. He took old stored samples, tested them, and confirmed his fears. Because if his agreement with the pharma company, he was unable to bring this forth until after his non-disclosure agreement was over with & he was retired. I'm sure you can Google it & find the interview, or references to it online, or contact CBS or NBC to find it.

Vaccines have become a necessity, yet knowing what I do about my family history, the risks in our family & viruses, I would likely have had my kids given nosodes for many of my vaccines, and not the conventional vaccines for many of the vaccines my kids have had, and likely prevented asthma in my son & cancer in my teenage daughter. These may have been prevented had I done my children's vaccines with nosodes. Not for all of them, but for many. My son is allergic to eggs & therefore can't take many vaccines, esp. for the flu, which for asthmatics is very important. He uses natural controls now & has done far better than having nothing, yet even his egg allergy prevents him from taking many conventional vaccines.

My daughter's cancer as a teen could have been caused by vaccines.

My illnesses were, at least in part, definitely caused by vaccines & other medical treatments that have been advanced in other countries, but unfortunately not here in the US, & other countries' labs don't have the level of education we have here in the US, the best in the world, yet wrapped up in red tape here & given to other countries with few, and in some cases no changes in more than 60 years.

We need to open up the doors to research here in the US before we make judgement on ANY vaccinations, as we are just now discovering the many downsides to some of them for certain populations that can't safely use them, yet people are damaged by vaccines every day. Check the WHO web sire for the reason why the vaccine damages recovery was stopped (they call it "vaccine court"). The hearings were stopped - not because the vaccines were safe, but because of the fear of most Americans refusing vaccines because of the VERY REAL dangers to some people, and their use and the use of alternatives, need to be carefully considered between doctor and patient.

The safest & most effective method of disease control needs to be carefully considered for that patient, the family and those in the community that may come into contact with the patient, as well as secondary, tertiary and community contact, should live vaccines be used.

Most doctors in my community (and many others) recognized that while the live version of H1N1 vaccine could help, or harm a patient, most refused the live vaccine because the risks outweighed the benefit. Unfortunately, I was infected from a very brief contact (their mom knew I had immune system problems, told with within minutes & I got out of the house immediately). Despite the mother's quick action, I had already been infected & haven't been able to walk at all and with physical therapy, still cannot correctly, or do other tasks as treatment with Levaquin for what my doctor assumed was a bacterial infection followed months later with corticosteroids for the actual problem (Complex regional pain syndrome - nerve damage created by the viral infection) combined with my old & years before treated autoimmune condition, and my body's constitution caused connective tissue tears in both shoulders, one which dislocated, as well as body-wide connective tissue problems and pain, as well as an auto accident that triggered rheumatoid arthritis. In routine screening for the medications for the RA, it was discovered that I have hepatitis C, human parvo and that the Herpes simplex I'd been diagnosed with not long before were likely the result of a blood transfusion I had when I was a child during surgery to treat another autoimmune disorder.

Live vaccines can be a risk to not only a patient being treated, yet also to those around them, and depending on carriers, life of the virus and especially with airborne transmitted and casual contact viral immunizations, can infect others causing illness in others, tissue, organ & nerve damage, disability or even death in a person unaware that those they are in contact are infected, even if a they are in contact with a carrier that can be several contacts away from the immunized person, can create a pandemic and can be inherently dangerous, especially to children, the older population, those with limited mobility, those with compromised immune systems &/or autoimmune disorders.

If you are going to utilize live viral immunizations, the immunized person, and those in contact with them, should be quarantined to prevent spreading of the illness they are being vaccinated for, for the duration of time where others can carry, or be infected by the illness for which they are being vaccinated.

Live vaccines can be incredibly dangerous and can create a pandemic of the illness they are supposed to protecting people from.

I may never fully recover from the damage that was done, so I hope those reading this will consider this when considering the use of live "weakened" vaccines, and if you chose to allow a doctor to use a live vaccine on you or a family member, I hope that you will use them responsibly, stock up on food, and stay in quarantine until it is certain that you and/or your family member will not be a danger to others whose immune system may not be as strong.

Just a note: The doctor that chose to administer told the mom that once her kids felt like it, thy could go to school. He treated many kids & some adults in our valley and as predicted by the doctors that chose not to use it, others were infected, some with disastrous effects like mine and worse. Some of these caused death, some permanent disability and some with a regular course of the disease.

A doctor told me that more people were infected by the immunizations, with the full-blown illness, than would have been without any immunizations.

That was three and a half years ago, and it seems doubtful that I will ever be as well as I once was & I will likely have life-long disability because a doctor threw caution to the wind and decided, quite on his own, that giving live vaccines for H1N1 was safe. It certainly was not.

#746 ::: Jim Macdonald ::: (view all by) ::: July 06, 2012, 03:49 PM:

Welcome to Making Light, Qaz Exx.

1) Vaccines do not cause autism. Period, full stop, end of sentence. That was a hoax by a man who stood to financially gain from discrediting vaccination.

2) We don't recommend vaccinating the immunocompromised. That's why it's so important to immunize everyone else. You want the herd immunity.

3) As dangerous diseases become rarer (thanks to vaccination), the bad outcomes due to vaccination will come to outnumber the bad outcomes due to the diseases they protect against. This is inescapably true. It also really sucks for the people who have those bad outcomes. Nevertheless vaccination needs to continue until each disease is extinct. When the diseases are eliminated, the need for vaccination against that disease is also eliminated. Have you heard of any adverse reactions to the smallpox vaccine in the past decade? No? Why not?

3) Nothing in this life is sure. We make the best choices we have with the information we have. At the moment, the best choice is vaccination against all vaccine-preventable diseases for all suitable persons. Worldwide. Until the diseases are eliminated.

4) Nosodes are homeopathic remedies: In other words, pixie-dust.

5) Ask yourself whose side you're on: Humanity's or diseases'.

#747 ::: janetl ::: (view all by) ::: July 06, 2012, 08:20 PM:

Whooping cough is sadly present in the area, so I looked into getting vaccinated. I was delighted to learn that my regular "Tetanus" shots actually protect against several things, including whooping cough.

#748 ::: janetl ::: (view all by) ::: July 06, 2012, 08:49 PM:

I think the common combo is DTaP: diphtheria, pertussis (whooping cough), and tetanus.

#749 ::: LMM ::: (view all by) ::: July 06, 2012, 10:34 PM:

@750: The CDC suggests that that might not be the case for everyone, however -- the standard booster shot given after exposure is just Td, which doesn't protect against pertussis. Tdap, which does, doesn't seem to be automatic.

My friends recently had a baby, so I went in for a Tdap booster -- the Td I'd gotten after a bad cut a few years back didn't cover it.

#750 ::: Dave Bell ::: (view all by) ::: July 07, 2012, 03:15 AM:

Apparently, there were around 140 cases per year of pertussis in the UK in recent years.

And now a rise to around 1700, in the first half of this year.

The newspaper I read this in is inclined to badly-worded medical scare stories. Still, I'd expect the numbers to be solid enough, even if they don't seem to know what they're talking about otherwise. I don't see that big an increase as attibutable to better diagnosis.

#751 ::: Thena ::: (view all by) ::: July 07, 2012, 09:21 AM:

I think they've started promoting TDaP boosters to anyone who hasn't had a pertussis booster recently - that's what I ended up getting the last time (was 11 years out from my last TD booster, which was... non-optimal, the result of intermittent insurance coverage and a successful avoidance of the kind of situations where you need one.)

It's just as well, whooping cough has been in the news lately and they are urging people who send their kids to summer camps to make sure the kids have been vaccinated, just in case someone comes down with it....

I already have asthma. I don't need whooping cough on top of that; I don't think I get that much sick time.

#754 ::: Caroline ::: (view all by) ::: July 20, 2012, 11:05 AM:

Jim Macdonald @ 755: This is why I'm still mad at the CIA for using vaccinations as a cover story to find bin Laden. Seriously, guys, in an area where vaccine conspiracy theories are already floating around, you want to just go and lend credence to them? Good job.

I hope I won't be worrying about polio at the swimming pool if/when I have kids.

My mother also reported that one of her friends got a smallpox vaccination before traveling to Africa. Some googling implies that no, smallpox isn't back -- but monkeypox is, a related virus which smallpox vaccines protected against. Now that people don't regularly receive smallpox vaccines, they're getting monkeypox -- which despite the name is often transmitted by rodents. There was an outbreak in the US from pet rodents in 2003. CDC fact sheet on monkeypox here. Not as deadly as smallpox -- but still no joke.

#755 ::: Lee ::: (view all by) ::: October 05, 2012, 06:55 PM:

6 children dead of whooping cough in Texas. Five of them were babies too young to have received their own immunizations, who got the disease from someone around them. Anti-vaxers are playing poker with other people's children's lives and should be shunned.

#756 ::: thomas ::: (view all by) ::: December 23, 2012, 12:05 AM:

A New Zealand story about tetanus and immunization.

Alijah Williams woke up with a sunken face. Within 36 hours, the 7-year-old Auckland boy was crippled by body spasms, unable to swallow and racked with pain.


Mrs Williams said they made what they thought was an informed decision not to vaccinate any of their children because of concerns over adverse reactions, but had since changed their minds.

Since tetanus isn't spread person-to-person, there isn't any herd immunity, and the risk to non-immunised people is still as high as it ever was.

#757 ::: Jim Macdonald ::: (view all by) ::: December 23, 2012, 12:18 AM:

And Representative Dan Burton shows that the opposite of "Progress" is "Congress":

Congress Holds An Anti-Vaccination Hearing

#758 ::: James ::: (view all by) ::: January 13, 2013, 06:01 PM:

I'm not a parent, but I plan to be one day. When that happens, I will be making sure that any visitors have had their vaccinations. I don't care if they are friends, family or anything. I don't want your stupidity risking the lives of my children. Especially if they are too young to have received the vaccinations.

My mother recently witnessed a child at a GP with pertussis. She grew up with pertussis being relatively common and was horrified.

The history of vaccinations, the data that accompanies it is undeniable. The rates of infection always plummet when a vaccination is introduced, for example the 99% for pertussis. 99% is the difference between one case per class in a school and 1 case in the entire school. It's the difference between allowing 10 strangers interact with your baby and 1000 strangers interact with it.

I don't argue with anti-vaccers. Arguing implies that I formulate statements and deliver them. I don't. I get angry, I open the door to unbridled rage and let them know what I think of them. To me, they represent the lowest level of anti-science. I don't care for the others, but most aren't going to potentially kill children.

You want to tell your kids that God created the world as-is, that dinosaurs and humans co-habitated? Fine, I still don't agree, but at least the effects are delayed and subtle. If our kids go to school together, the worst that happens is that my kids believe something I don't. If your un-vaccinated kids encounter mine, then the worst that could happen is that my kids die.

If my children are immunodeficient, then it is perfectly possible that your kids could recover, and my kids die, from a disease that they gave them. That isn't fair, that I suffer for your idiocy.

I would rather home-school my children than let them be exposed to some easily-preventable diseases. That is why many schools refuse to let un-vaccinated kids attend.

#759 ::: Lori Coulson ::: (view all by) ::: January 14, 2013, 12:24 PM:

That is why many schools refuse to let un-vaccinated kids attend.

In most of the USA it is against the law for an unvaccinated child to attend school.*

I can remember my mother bringing the vaccination records to my new school when we moved to Ohio. And being tested for TB every 3-4 years.

*It can be done, but it involves a lot of paperwork from the parent and the pediatrician.

#760 ::: Elliott Mason ::: (view all by) ::: January 14, 2013, 02:24 PM:

Lori Coulson: In Chicago, at least, the anti-vaccers are getting quite good at helping parents fill out the paperwork to claim a religious/ethical exemption.

The terrifying thing for me (as the parent of an about-to-be-kindergartener) is that there is no way for me to access Chicago Public Schools data like, "What percentage of your school's student body has filed vaccine-exemption paperwork?"

I'm not worried about kids with medical reasons not to get the jab (egg allergies, etc); that will never be a big enough percentage of the school to make a difference. But some of the northside Montessoris reputedly have 70% or higher vacc-refusal rates -- and this is being touted by people who dislike vaccs as proof it's a 'friendly' school for your parenting style.

Um. Yeah. Leave me (and my kid) out of that disease-ridden pesthole, thanks, no matter how good the curriculum claims to be.

#761 ::: P J Evans ::: (view all by) ::: January 14, 2013, 03:11 PM:

759 I have my mother's written record of shots I got from DPT at 6 months old, right up through high school. (It also includes getting the once-common contagious diseases, like measles.)

#762 ::: Lori Coulson ::: (view all by) ::: January 15, 2013, 11:02 AM:

There is good reason for some parents getting that paperwork...

Yesterday, I mentioned this thread to my Mom the RN, and her reply was:

"If you have two children who are autistic, and there is the possibility that the vaccines caused it, would you be willing to get the next two immunized?"

She had a co-worker with this exact problem, and I can understand and sympathize with the argument.

I suspect that only when large numbers of children actually die from one of the diseases will we see the pendulum swing the other way.

I note that there are people out there who still think that in the era of modern medicine, no one dies from getting the flu.

#763 ::: Lila ::: (view all by) ::: January 15, 2013, 11:29 AM:

Lori: given that the best available evidence shows that children who are immunized are slightly LESS likely to be autistic than those who aren't: Hell yes.

(OTOH, if I'd had 2 autistic kids, I might have seriously considered not having any more kids, given limited resources and the possible need for ongoing extra support for the first two. But I sure as hell wouldn't make that decision for anyone else.)

#764 ::: Jim Macdonald ::: (view all by) ::: January 15, 2013, 11:42 AM:

Lori #762: I note that there are people out there who still think that in the era of modern medicine, no one dies from getting the flu.

As you and all know, however, every year somewhere between thirty and forty thousand people in the USA do die from the flu.

#765 ::: Lee ::: (view all by) ::: January 15, 2013, 02:31 PM:

Lori, #762: In addition to what Lila said, it should be noted that the supposed "link" between autism and vaccination WAS FAKED TO BEGIN WITH AND HAS BEEN COMPLETELY DISCREDITED. So, no, not a valid argument.

Jim, #764: IOW, every single year, ten times more Americans die from the flu than were killed in the 9/11 attack. And a lot of those deaths are preventable.

#766 ::: Lori Coulson ::: (view all by) ::: January 15, 2013, 04:49 PM:

Lila, I agree with you, but I couldn't really say that to my Mom without sounding unsympathetic.

Every year I worked for HHS, we always got emails from CDC asking us to get our flu shots, and to urge family and friends to do so as well. HHS even had a clinic in a nearby Federal office building that gave them for free.

I'd be first in line to get a flu shot, if I weren't allergic to the darn things. Having had flu three times in my life, I really don't like spending one week wishing I were dead, and an entire month recovering.

#767 ::: eric ::: (view all by) ::: January 15, 2013, 05:34 PM:

It's pretty easy around these parts to get the exemption from vaccination, especially in preschool and private schools.

Washington has had a couple of waves of whooping cough in the past few years. In our little island, we get a lot of alternate theories of stuff, including vaccines. One of the hot spots for whooping cough last time was the local Waldorf School. They've lost herd immunity there because of the concentration of anti-vaxxers.

#768 ::: Lila ::: (view all by) ::: January 15, 2013, 07:08 PM:

Lori: sympathies on the allergy. I can't have the MMR shot any more for that reason. Luckily, last time it was due they did a titer that showed my immunity is still up to snuff.

#769 ::: Lee ::: (view all by) ::: January 19, 2013, 02:19 PM:

Anti-vaxxer parents change minds after their child nearly dies of tetanus.

At least they recognize reality when it hits them in the face. Too bad their innocent child had to be the one to suffer for it to happen.

#770 ::: GlendaP ::: (view all by) ::: January 23, 2013, 06:56 PM:

How long until this gets misinterpreted and exaggerated out of all recognition?

http://www.sciencebasedmedicine.org/index.php/pandemrix-and-narcolepsy/

#771 ::: GlendaP is visiting the Gnomes ::: (view all by) ::: January 23, 2013, 06:58 PM:

Link, maybe?

#772 ::: Jim Macdonald ::: (view all by) ::: March 06, 2013, 01:05 PM:
"CRE are nightmare bacteria," CDC director Dr. Tom Frieden said in a statement. "Our strongest antibiotics don't work and patients are left with potentially untreatable infections. Doctors, hospital leaders and public health must work together now to implement CDC's 'detect and protect' strategy and stop these infections from spreading."

CNN

#773 ::: Lila ::: (view all by) ::: March 06, 2013, 01:19 PM:

I have the impression that once upon a time workers changed from street clothes to scrubs at the hospital, changed back into street clothes at the end of the shift, and that the hospital laundered the scrubs. If that was ever true, it's certainly not true now. Restaurants nearest our 2 hospitals are FULL of people eating in their scrubs. Lovely route for transmitting something into the community (or from the community into the hospital, for that matter).

#774 ::: Jim Macdonald ::: (view all by) ::: March 06, 2013, 01:44 PM:

We're moving into the post-antibiotic era. Pretty soon immunizations will the the only things we have.

#775 ::: Lila ::: (view all by) ::: March 06, 2013, 01:57 PM:

Immunizations, absolutely, but I wouldn't give up on phage therapy either. It's a lot more complicated and difficult than antibiotic therapy, and so far the success rate is a lot lower--but not as low as the success rate of antibiotics on resistant bacteria!

#776 ::: Elliott Mason ::: (view all by) ::: March 06, 2013, 03:34 PM:

Lila @773: The last round of Killer Bacteria (MRSA) was first noticed in the Chicago area as a serious in-the-world problem (as opposed to inside hospitals) in children and immune-weakened people who had someone in their family recently released from prison.

So yeah. Which was, believe it or not, the first hint the CDC had that this stuff was spreading rampant in the Cook-County-area corrections department ... it was in swabs of SHOWER FLOORS for freak's sake. And they didn't find out until something like fifteen (unrelated-to-each-other) little kids showed up at south-side hospitals with REALLY BAD systemic MRSA.

At least this one's being spotted now ...

#777 ::: Lori Coulson ::: (view all by) ::: March 07, 2013, 12:26 PM:

Lila @773: According to my Mom, the RN, when she began working, the hospital would not allow you to leave the floor in scrubs. She had to change back into her uniform to go to the cafeteria.

I used to see folks in scrubs on my bus -- morning and evening. The route was within walking distance of three hospitals (OSU, Doctors, and Grant). And the Mount Carmel folk could switch to the Broad Street bus downtown...

#778 ::: Stefan Jones ::: (view all by) ::: March 07, 2013, 01:57 PM:

Hmmm.

When we speculate what will happen when antibiotics start to widely fail, we imagine the human impact.

Imagine what will happen on the feedlots! As I understand it, antibiotics are a required part of the fattening-up process. The corn-heavy diet simply isn't healthy for cattle; they "need" the antibiotics to ward off infections.

High-capacity get-them-bulked-up-quick feedlots would need to change drastically if antibiotics stopped working.

#779 ::: albatross ::: (view all by) ::: March 07, 2013, 01:59 PM:

I gather there's a huge amount of antibiotic resistance in the natural bacterial world, because antibiotics are mainly chemical warfare waged against bacteria by other bacteria, by fungi, and by other stuff[1]. Pretty much all living things have to have some strategy to avoid being eaten alive by the gazillions upon gazillions of bacteria surrounding them. But that means that there are already bacteria out there that have evolved resistance to most antibiotics we have, or at least to naturally-occurring relatives. Bacteria share genes pretty enthusiastically, even across species, so as soon as there are environments that strongly select for antibiotic resistance of some kind, the resistance is likely to arise and then become widespread.

What I suspect we mainly need to be doing is decreasing the environments that select for antibiotic resistance. It's absolutely batshit nuts, IMO, that we have routine administration of antibiotics to healthy livestock.

[1] That includes us. A lot of our innate immune system is basically evolved to look for stuff that tastes like bacteria and kill it, and our blood and plasma and tissues are full of antibacterial chemicals. And we *still* routinely die from bacterial infections without antibiotics.

I suspect the War of the Worlds ending was quite accurate. The aliens would have evolved with a completely different set of microbes around them, and so their built-in defenses would be well-tuned for stuff on the surface of those microbes, but would almost certainly not have any defenses to our microbes. Our viruses probably couldn't bother them at all (unless they miraculously shared almost all our DNA and RNA and protein making machinery), but our bacteria would think they looked like walking all-you-can-eat buffet tables.

#780 ::: albatross ::: (view all by) ::: March 12, 2013, 06:15 PM:

Explainer on drug-resistant bacteria

This Week in Microbiology is a wonderful podcast that has covered this from a lot of angles. It and its sister podcasts TWIV and TWIP are both great to listen to. They've covered transfer of resistance genes, phage therapies, infections that get worse from antibiotics, and (a major interest of one of the hosts) the use of copper-containing metal alloys for surfaces in hospitals to prevent spread of bacteria. (Apparently, most bacteria really don't like copper.) Anong many other things.

#781 ::: Lila ::: (view all by) ::: March 12, 2013, 07:21 PM:

Elliott Mason @#776, MRSA is also commonly found on wrestling mats.

#782 ::: Dave Harmon ::: (view all by) ::: March 12, 2013, 07:30 PM:

Stefan Jones #778: Those feedlots are a primary source of the resistance problem in the first place. In particular, they're why we're seeing this coming out in soil bacteria (some of which can decompose us when we're having a Bad Day) before the "usual" disease organisms. The feedlots should have changed (under force of law) decades ago when this became apparent... but their industry has too much money and influence, and has repeatedly staved off any attempts at such a thing.

#783 ::: Dave Harmon has been gnomed ::: (view all by) ::: March 12, 2013, 07:31 PM:

Probably for irregular punctuation.

[Three spaces in a row. -- Moriz Eux, Duty Gnome]

#784 ::: Nancy Lebovitz ::: (view all by) ::: March 12, 2013, 10:46 PM:

albatross, thank you very much for the link to This Week in Microbiology. It's very restful to listen to some detail about capable people finding out something quite interesting (if they're right, microbes make a major (total?) contribution to cave creation) that's somewhat more technical than a TED talk.

#785 ::: Stefan Jones ::: (view all by) ::: March 13, 2013, 12:33 AM:

#782: I know; I was pointing out that the feedlots' misuse of antibiotics wouldn't "only" ruin things for humans, but for themselves.

When cattle begin dying of horrible plagues, watch Red State congresscritters begin to demand that the federal government step up and spend money on antibiotic research.

#786 ::: Lila ::: (view all by) ::: March 13, 2013, 09:08 AM:

And like a trained raven, I'm going to pop back in with the refrain everyone is tired of hearing: WASH YOUR HANDS, for the love of everyone you love!

#787 ::: thomas ::: (view all by) ::: March 14, 2013, 06:23 PM:

From the Antipodes: Introduction of the varicella vaccine in Australia has been followed by a 70% fall in hospitalisations for chickenpox and shingles in that age cohort. All three children who ended up in intensive care were unvaccinated.

And the "Australian Vaccination Network" has been ordered by the Fair Trading authority to change it's name "on the grounds it does not convey the group's anti-vaccination stance and could be misleading."

#788 ::: Jim Macdonald ::: (view all by) ::: March 26, 2013, 12:57 PM:

26 March 1953.

Today in history Dr. Jonas Salk announced that he had successfully tested a vaccine against polio.

#789 ::: P J Evans ::: (view all by) ::: March 26, 2013, 01:16 PM:

788
28 March 1863: everyone in my great-grandfather's regiment was 'vaxinated'. (Given the year, it was smallpox vaccination.)

#790 ::: Fragano Ledgister ::: (view all by) ::: March 27, 2013, 09:21 AM:

I am thinking about vaccination because I am currently dealing with an outbreak of shingles.* As that's the sequel to the chicken pox I experienced 42 years ago (the result of not having received the booster vaccination) I am keenly aware of what having had the full range of vaccinations in my childhood would have spared me. I'd happily share my experience with any anti-vaxer were it possible so to do.

I've also been wondering why, since I have the shingles, I can't just redo my roof. Or just hang them out.

*The blisters, for whatever reason, are located inside my left ear canal and on my eardrum. This has been making me wonder if I will lose hearing in my left ear as a consequence. What fun.

#791 ::: Fragano Ledgister ::: (view all by) ::: March 27, 2013, 09:23 AM:

For some reason, the Gnomes has seized on a posting I have just written anent the shingles. I assure their Lownesses, neither my words nor the illness in question are contagious.

[Three spaces in a row. -- Bombex Nori, Duty Gnome]

#792 ::: Jim Macdonald ::: (view all by) ::: March 27, 2013, 09:43 AM:

The worst case of shingles I've ever seen involved an eye.

Modern medicine has had one true triumph in the fight against disease, and the anti-vaxxers want to throw it away. Those folks aren't just a menace to themselves; they're a menace to society. To human life on earth.

#793 ::: Fragano Ledgister ::: (view all by) ::: March 27, 2013, 09:57 AM:

An eye? Oh dear me.

#794 ::: P J Evans ::: (view all by) ::: March 27, 2013, 09:59 AM:

Fragano, they should have given you antivirals for that. (Had shingles. From bridge of nose, diagonally across forehead, into hair. Fortunately it didn't pick any of the nerves that would have involved eyes or ears.)

#795 ::: Janet K ::: (view all by) ::: March 27, 2013, 10:32 AM:

Sympathies on the shingles, Fragono.

I'm old so my doctor didn't hesitate to give me the shingles vaccination.

The CDC recommends it for those 60 and older, but it is also approved by the FDA for people 50-59.

#796 ::: Janet K ::: (view all by) ::: March 27, 2013, 10:34 AM:

And my apology, Fragano, for spelling your name wrong.

#797 ::: albatross ::: (view all by) ::: March 27, 2013, 11:04 AM:

Fragano:

My sympathies! My dad had shingles recently, and was horribly sick and miserable for about three weeks. He is diabetic, and had big problems keeping his blood sugar under control between the pain induced lack of apetite and the pain medicine induced nausea. (I'm definitely planning to get my shingles vaccine when I turn 50.).

#798 ::: Lizzy L ::: (view all by) ::: March 27, 2013, 12:21 PM:

Fragano at 790, sympathies! I got the shingles vaccine when I turned 60. My understanding is that the vaccine doesn't always prevent the disease, but if one does get sick, having had the vaccine may help one avoid the Full Nasty. I hope you totally recover with no adverse effects.

Jim, your comments are scary and, I suspect (morosely), accurate. OTOH, there may be something out there (to counter the bacteria) that we haven't thought of yet. Hoping so...

Hail Jonas Salk. I was part of the 1954 field trial of the Salk vaccine. I remember very clearly lining up with the other kids in my New York public school to get the shot. It had been explained to us what they were for, and we were all very proud to be part of the trials. We knew first hand what polio could do: we had a classmate in a wheelchair. (He lived two doors away from me.) We understood that some of us were getting the real vaccine, some not, and that if everything went well, we would all be re-vaccinated, as indeed, we were.

I wonder if such a large scale field trial could be designed and carried out today, or if the anti-vaxxers would scuttle it.

#799 ::: Lizzy L is visiting the gnomes ::: (view all by) ::: March 27, 2013, 12:24 PM:

Hi, guys! (Waves.)

Well, it's very pleasant here. I like the way you use the space. Um, sorry, no cookies...

#800 ::: Clifton ::: (view all by) ::: March 27, 2013, 12:41 PM:

I've had shingles once; it was definitely no fun. That was during a period where my immune system was massively suppressed for no apparent reason; eventually it came back to normal, also for no apparent reason. I should really ask my doctor about the vaccine.

Also, I only recently found out the varicella-zoster virus (chickenpox/shingles) is a possible culprit in my later attack of Bell's palsy: sudden, but not permanent, partial facial paralysis. I didn't do all the research on that which I should have at the time, probably because I was so relieved it turned out not to be a stroke.

So, yes, vaccinate.

#801 ::: Fragano Ledgister ::: (view all by) ::: March 27, 2013, 12:42 PM:

I'm taking medication for the shingles. It seems to be working (one effect of the illness was water-retention; that went fast, there's nothing like dropping five pounds in a day for brightening the mood).

Thanks for the good thoughts. I'll recall the firing squad, JanetK.

#802 ::: Tom Whitmore ::: (view all by) ::: March 27, 2013, 12:44 PM:

Bell's palsy is one of the relatively few problems that can be caused by improper massage techniques, Clifton. I gather it's often very painful as well as annoying, so my sympathies! Fortunately, as you note, it's usually temporary.

#803 ::: joann ::: (view all by) ::: March 27, 2013, 03:06 PM:

Fragano #800:

In my experience, the water loss occurred three days *before* I began medication, on the same day I first noticed what later became the rash.

albatross #797:

50? I've always been told the age was 60.

#804 ::: Jim Macdonald ::: (view all by) ::: March 28, 2013, 02:12 AM:

CDC recommends shingles vaccine for 60-and-over, while the FDA has approved the vaccine for 50-and-over.

Meanwhile: Bell's Palsy:

Blink reflex abnormal
Earache
Lacrimation [deficient, excess]
Loss of taste
Sudden onset

Palsy of cranial nerve VII muscle.
All symptoms are unilateral.

#805 ::: Brooks Moses ::: (view all by) ::: March 28, 2013, 03:21 AM:

Fragano: Add my sympathies! My wife just had a bout of shingles a couple of months ago. It was a mild case as far as I can tell, and caught very early so the antivirals actually had a chance to work, and even so it was horrid.

One of the worst things was: I've never had chicken pox. I had the vaccine for it some years ago -- but we did a blood test when my wife came down with the shingles, and discovered that the vaccine apparently didn't take. So, that meant contact quarantine -- luckily shingles doesn't get the virus airborne like chicken pox itself does, but it does spread it by touch from the blisters, so we had to have separate beds and she couldn't cook any food for me and I couldn't give her comforting hugs and that sort of thing, for weeks.

(Also, the life cycle of the chicken-pox virus is deeply, deeply weird.)

#806 ::: thomas ::: (view all by) ::: March 28, 2013, 05:17 AM:

Another uncommon but established cause for palsy of the facial nerve is middle-ear infection. This is important because treatment (cleaning out the middle ear, antibiotics, steroids) is relatively urgent, to stop it getting worse. I had this several years ago.

The mechanism is the same as for the more-common viral version: the nerve passes through a narrow hole in the skull, and inflammation causes swelling that squashes the nerve.

So: symptoms of Bells Palsy shortly after an ear infection are more worrying than at other times.

#807 ::: Rikibeth ::: (view all by) ::: March 28, 2013, 08:49 AM:

thomas @806: wouldn't you expect such a palsy to resolve quickly after the ear infection is treated, once the swelling goes down? Or would that signal that the ear infection ISN'T resolved yet?

#808 ::: thomas ::: (view all by) ::: March 28, 2013, 06:12 PM:

Rikibeth: yes, it signals the infection isn't resolved, although it may have felt that way. In my case, the pain and pressure had gone, and I hadn't really noticed the residual deafness, but I did notice when my left eyelid stopped working properly. They'd been using amoxicillin on the original ear infection, so they moved up to ofloxacin directly into the middle ear, and co-amoxiclav, plus the usual steroids to reduce inflammation.

The symptoms are pretty obvious -- I work with a lot of people who have medical or nursing training, and in the couple of days it took for the treatment to work, I got several people asking me if I was ok and if I'd seen a doctor.

#811 ::: James E ::: (view all by) ::: April 05, 2013, 11:23 AM:

Measles breaks out in Swansea as a consequence of the MMR scare.

Prof Finn said that meant that if the numbers in the Welsh outbreak continued to rise: "it's almost guaranteed a child is likely to die."

#812 ::: fidelio ::: (view all by) ::: April 05, 2013, 01:34 PM:

This seems like the point to mention that the reason Helen Keller was deaf and blind was because of a bad attack of measles.

I suspect she wouldn't have dismissed it as a harmless childhood illness, were we able to ask her.

#813 ::: Lori Coulson ::: (view all by) ::: April 05, 2013, 02:30 PM:

Hmm -- I'm seeing several different stories on the new avian flu outbreak in China, and number of victims/deaths seems to vary from source to source. Plus a story that 20,000 poultry were killed in Shanghai.

I think this is bigger than what we've been seeing in the news.

#814 ::: P J Evans ::: (view all by) ::: April 05, 2013, 03:34 PM:

813
It's apparently carried by pigeons (who don't get sick from it), there are at least three people dead from it, and they think it might possibly be transmissible human-to-human.

Also its name sounds like a Borg: H7N9.

#815 ::: Lila ::: (view all by) ::: April 05, 2013, 05:29 PM:

NPR reported 14 confirmed cases and 6 deaths as of this morning. There is some evidence of limited human-to-human transmission.

#816 ::: jnh ::: (view all by) ::: April 06, 2013, 05:57 PM:

A major measles outbreak in Swansea, Wales has caused a rethink about immunization and long lines at clinics to get the MMR (Mumps, Measles and Rubella) jab. People who were unwilling to get their children immunized due to popular misinformation have now queued up a hour before a clinic opened, The Beeb reported.

#817 ::: Jim Macdonald ::: (view all by) ::: April 08, 2013, 09:03 AM:

Hepatitis A scare at NYC restaurant prompts 239 to get vaccinated

The place in question is apparently Alta, a tapas restaurant in the West Village.

#818 ::: Pendrift ::: (view all by) ::: April 09, 2013, 10:25 AM:

60 cases of mumps (link in French) among students at the University of Liège in Belgium, after outbreaks at the Universities of Leuven and Ghent.

#819 ::: albatross ::: (view all by) ::: April 09, 2013, 11:44 AM:

PJ:

Vincent Raccaniello's blog has a bit of discussion on this. He's a virology professor at Columbia University, and knows what he's talking about. There's apparently some discussion of this on the most recent episode of TWIV, but I haven't listened to it yet.

As background, influenza spreads among birds (I think they're a much more important host for at least most strains of the virus than we are), but it binds to a different molecule on the surface of their cells, in order to gain entry, than it needs to gain entry into our upper respiratory cells. That's what he's talking about with the different Sialic acids--if the virus can't stick to our upper respiratory cells, it won't be able to infect those cells and we won't get sick from it in most circumstances.

This blog is by an apparently fairly clued-in journalist, and has what looks like pretty decent information, including some suggested links to reliable information sources.

#820 ::: Dave Crisp ::: (view all by) ::: April 12, 2013, 04:30 AM:

The measles outbreak in Wales has reached 693 cases, and is not expected to peak for another four weeks

Meanwhile, at least 6000 children in the area remain unvaccinated.

#821 ::: Jim Macdonald ::: (view all by) ::: April 12, 2013, 10:25 AM:

Measles is incredibly virulent; we can expect a large number of the unvaccinated to be infected. Serious complications are rare, but even rare complications, when you're looking at large numbers of cases, will be seen in large numbers of patients.

Infection rates with measles in unvaccinated populations are on the order of 90%. Ear infections as a complication are on the order of 10%. So .9 * .1 * 6000 gives us up to 540 ear infections, with possible deafness, in Wales.

#822 ::: albatross ::: (view all by) ::: April 15, 2013, 01:05 PM:

TWIV (virology podcast) episode discussing the H7N9 bird flu. The people discussing the story on the podcast are academic virologists (and one parasitologist), so while they had access to the same basic news as everyone else, they actually know a lot more about the details of how viruses work, how influenza works, how diseases jump between species, etc. (This is probably my favorite podcast, though I definitely notice my lack of formal education in biology!)

#824 ::: John A Arkansawyer ::: (view all by) ::: April 29, 2013, 12:43 PM:

The mouseover text of Patrick's Sidelight is perhaps a bit harsh--she's seen the error of her ways, if not the ridiculousness of her hunches--but the link title is right on.

#825 ::: Jim Macdonald ::: (view all by) ::: April 29, 2013, 02:06 PM:

I'm sure the lady's "hunches" were based on the fact that advertising/propaganda work.

Observe this linked article:

The story behind the MMR scare

Last week the Daily Mail reported that 2 million children risked catching measles as a result of the MMR scare. It is a scare that the paper knows all about, having been in the forefront of running a series of articles over the years that urged parents to beware of the multiple vaccination and its supposed links to autism.

The Mail's headlines speak for themselves: "MMR killed my daughter"; "MMR fears gain support"; "New evidence 'shows MMR link to autism'"; "MMR safe? Baloney. This is one scandal that's getting worse"; "Scientists fear MMR link to autism"; "Why I wouldn't give my baby the MMR jab". This is but a small proportion of the negative articles published by the paper.

But the Mail, though the most forceful and repetitive of newspapers, was certainly not alone in the media in making too much of the opinions advanced in 1998 by the now d