Whenever I talk about my research on how parents come to decide to reject vaccines for their children, my explanations are met with a range of reactions, but I almost always hear the same questions.
What is wrong with those parents? Are they anti-science? Are they anti-expert? Are they simply ignorant or selfish? Are they crazy?
The year is not half over, and the number of measles cases has now exceeded highs not seen since the U.S. was declared measles-free in 2000. Given the indisputably large role unvaccinated individuals are playing in it, parents who reject vaccines are increasingly vilified. Some people call to have these parents arrested or punished. Many are asking states to tighten laws that make exemptions to school enrollment without vaccines too easy.
Others dismiss these “Whole Foods moms” as harming others and call for them to be socially ostracized.
As a sociologist, I have spent most of a decade talking to parents, pediatricians, policymakers, lawyers and scientists to understand competing views of vaccines. In my research, I find that parents who reject vaccines – by which I mean mostly mothers – work hard to make what they see as an informed decision to do what they think is best for their children. They also want to make a decision that best aligns with their belief system.
Experts, at least of their own kids
Many “anti-vax” parents see themselves as experts on their own children, as best able to decide what their children need and whether their child needs a particular vaccine, and better qualified than health experts or public health agencies to decide what is best for their family.
The MMR vaccine is an immunization against three viral diseases: measles, mumps, and rubella (German measles) that is scheduled to be given to children 12-15 months old and 4-6 years old. Adults are scheduled…
If there were ever any doubt that measles is a dangerous disease, astudy published in the journal Science yesterday blows that misconception away by finally explaining how large-scale measles vaccination caused such a plummet in childhood deaths – even from infections that seemed unrelated to measles.
Aside from the risk of death and disability that measles itself poses, the disease has another sneaky trick that scientists suspected but had trouble showing: it gives the immune system amnesia. By making the immune system forget how to fight past infections, measles throws the doors wide open for all those illnesses to visit again now that the body can’t immediately remember how to defeat them.
The measles vaccine then, in addition to preventing measles, actually prevents dozens of other infections that otherwise might occur even after a person recovers from measles. And that means widespread measles vaccination protects a community not only from measles but from other diseases as well.
Scientists had already known that measles infections suppressed the immune system for several weeks to several months, just as cancer and some other diseases do. While the immune system is beaten down, opportunistic infections such as pneumonia or diarrhea can wreak havoc on a person’s body even after they’ve recovered from the measles itself.
But there were hints that measles did more than suppress the immune system for a couple months, hints that became especially apparent after widespread vaccination. As lead author Michael Mina, an evolutionary biologist at Princeton University, and his colleagues explain in their paper, mass measles vaccination was wildly successful in reducing deaths – perhaps suspiciously successful since the drop in deaths that correlated with the vaccine’s introduction included those from non-measles infections. While advances in medical treatment and hygiene might appear to play some role in this drop, the correlation between non-measles infectious disease deaths and the vaccine’s introduction was too strong to ignore.
“They were trying to figure out just how and why measles vaccination had such long-lasting benefits and protection beyond simply preventing an active measles infection – how did it protect kids from other infectious diseases as well?” explained Tara C. Smith, an infectious disease researcher at Kent State University.
So they developed mathematical models to more closely examine deaths from non-measles infections before and after the introduction of the measles vaccine in four high-income countries: the U.S., England, Wales and Denmark. “They found that when measles infections were reduced, that led to a decrease in deaths from other infectious diseases as well – for up to three years,” Smith said. “They concluded that this was due to an effect of the measles virus itself, which they suggest causes the body to, in essence, ‘forget’ some of the immunity it has developed against other diseases.”
Other recent research had already tested the idea that this immune memory loss occurred after measles infections. Researchers created the same immunosuppressive conditions in macaque monkeys that a measles infection creates and found that the disease-fighting white blood cells basically forgot how to fight much of anything besides measles.
The researchers’ mathematical modeling was precise enough to calculate that the memory-wipe from measles infections lasts an average 27 months. Data showing infectious disease deaths occurring within a window of a few years after measles infections supported this finding as well.
“Studies like this are tough to do, but they purposely picked an outcome that was easily measurable – death – rather than something that would be more difficult to find in historical records, such as illnesses,” Smith said. “The three different countries and databases they chose all support the findings, even though measles vaccines were introduced in the UK and US in the 1960s but not until the 1980s for Denmark, so that rules out a simple worldwide trend that may have been occurring in the mid-century.”
Further, the researchers looked for similar patterns from pertussis and didn’t see the same effect.
“They have multiple controls that suggest this really is just an effect of the measles virus, and therefore prevented by the vaccine,” Smith said. “The data fit in with previous studies that have seen this effect (but they weren’t sure of the cause), and with others that looked specifically at immune responses following measles infections, so it looks fairly convincing.”
In a sense, then, you could think of the MMR as protecting against more than just measles, mumps and rubella. It protects against those three diseases as well as all the others that might have come along had a person not been protected from measles.
“Our results show that when measles was common, measles virus infections could have been implicated in as many as half of all childhood deaths from infectious disease,” the authors wrote. “The reduction of measles virus infections was the main factor in reducing overall childhood infectious disease mortality after the introduction of vaccination.” Further, because vaccination provided a population (herd) immunity against measles, that meant that, in effect, “measles vaccination might also be preserving herd protection against non-measles infections.”
Eliminating measles with the vaccine is a triple win: less measles, less death from other diseases in individuals and less infections overall within a highly vaccinated population.
Another study aimed at soothing the fears of some parents shows that vaccines don’t cause autism.
This one takes a special look at children with older siblings diagnosed with autism, who do themselves have a higher risk of an autism spectrum disorder. But even these high-risk kids aren’t more likely to develop autism if they’re vaccinated, according to the report in the Journal of the American Medical Association.
“We found that there was no harmful association between receipt of the MMR (measles, mumps and rubella) vaccine and development of autism spectrum disorder,” said Dr. Anjali Jain of The Lewin Group, a health consulting group in Falls Church, Virginia, who led the study.
“We found that there was no harmful association between receipt of the MMR vaccine and development of autism spectrum disorder.”
Kids who had older brothers or sisters with autism were less likely to be vaccinated on time themselves, probably because their parents had vaccine worries. But those who were vaccinated were no more likely than the unvaccinated children to develop autism, Jain’s team found.
Autism is very common. The Centers for Disease Control and Prevention says one in 68 U.S. kids has an autism spectrum disorder.
Numbers have been growing but CDC says much of this almost certainly reflects more awareness and diagnosis of kids who would have been missed in years past.
Although fears grew 15-20 years ago that vaccines might cause autism, research backing up these worries has been discredited and study after study since then has shown no link. The Institute of Medicine, an independent group that advises the U.S. government on health matters, has strongly advised that researchers stop wasting time looking at vaccines and look elsewhere for the causes of autism.
Most research shows genes are strongly involved, and some studies suggest the DNA flaws that cause autism often arise randomly. But fears persist about vaccines. The most recent fallout: a measles outbreak that started at California’s Disneyland that infected 147 people in the U.S., including 131 in California.
The Lewin Group looked at more than 95,000 children covered by health insurance who were born between 2001 and 2007. As expected, kids with an older sibling who had an autism spectrum disorder were more likely to have autism — about 7 percent of them did. And they were less likely to have been given an MMR vaccine.
“Their vaccination rates were about 10 percent less than kids with unaffected siblings,” Jain said.
But the risk of autism was less than one percent in vaccinated kids, whether they had an older sibling with autism or not.
“These findings indicate no harmful association between MMR vaccine receipt and ASD (autism spectrum disorder) even among children already at higher risk for ASD,” Jain’s team wrote.
MAGGIE FOX Maggie Fox is senior health writer for NBC News and TODAY, writing top news on health policy, medical… Expand Bio …………..’
It’s a shouting match dominated with bullies who make threats, scream about personal beliefs and fill your voice mail with angry phone calls.
Richard Pan – the Sacramento state senator and doctor – is getting a steady dose of such vitriol amid the hottest political fight in California. He strikes a solitary figure in sensible glasses as he gets pummeled every day in the public square.
Pan has people on his side in the fight to immunize as many children against measles and other infectious diseases as possible. But Pan’s support is expressed rationally, scientifically.
His bill, SB 277, would eliminate personal-belief exemptions that allow parents to avoid vaccinating their children, and would require that children be vaccinated before attending private or public schools. Supporters include the state PTA, California public health officers, the California Medical Association and the Los Angeles Unified School District.
The counties of Yolo, Santa Clara, San Francisco, Marin and Los Angeles support this bill, as do the Pasadena Public Health Department, the Silicon Valley Leadership Group, the American Nurses Association and the San Francisco Unified School District.
There are many more, but you get the point.
None of these groups has demonstrated support by invoking the Holocaust or their “God-given” rights. It doesn’t appear that any of Pan’s supporters have threatened people on the other side. But Pan requires extra security now thanks to threats against him as he lobbies for 277 while it teeters on the verge of being shot down by irrational fears about vaccinations.
Pan’s fellow legislators have begun to buckle. Suddenly, it’s about making sure that those who object to immunizations are not barred from public education.
If that becomes the excuse to undermine the undeniable science that children should be vaccinated to prevent the spread of disease, then it would be refreshing to hear legislators admit that they caved because they were scared.
A myth debunked by science – that vaccines cause autism – has already killed attempts to bolster vaccinations in Oregon and Washington.
“Members just received a lot of calls and emails from the public – some were their constituents and some were from all over the state and the country – just very adamant that they didn’t like it,” said Washington state Rep. June Robinson, a Democrat, to Jeremy B. White of The Sacramento Bee. “I think it changed the vote, quite frankly, for some members who thought they would vote for it and changed their mind. I think people were swayed by the constant barrage of communication.”
What kind of communication?
“They tend to bully, use hyperbolic language,” Pan said. “They’ll call and call and call. Some guy from Texas keeps calling us.”
One Facebook posting compared Pan to a Nazi; another suggested he should be hung with a noose.
Who could forget Robert Kennedy Jr. comparing the rise in autism – which he blames on vaccines – to a holocaust during a speech at the state Capitol?
Kennedy apologized, but the tone has been set. A 1997 British study that linked vaccinations and autism has long been debunked by the scientific community, which finds no link at all. The idea nonetheless persists.
Many people spoke against SB 277 at the Capitol last week. Their reasons were often steeped in fear or in the idea that they could hold themselves separate from a broader community.
The issue that may scuttle SB 277 is the prospect, as expressed by some legislators, that kids would be forced into inadequate home schooling if their parents or guardians refused to immunize them. If a workable compromise can’t be reached – if a mob mentality scares enough legislators to embrace a no vote as an opposed to a compromise – then those who shout the loudest will have won.
There are reasonable people in Sacramento who feel Pan is orchestrating a self-serving overreach. The most recent – and highly publicized measles outbreak – wasn’t at a school but at Disneyland. So why dictate that school kids only gain admission to schools by getting vaccinations first?
Those who ask that question aren’t paying attention.
After being on the wane a decade ago, measles is coming back. According to the Centers for Disease Control and Prevention, measles exploded with 668 cases in the U.S. in 2014. There have been more than 150 so far in 2015, according to the CDC. Most of these are in California. Most of them occurred in people who had not been vaccinated.
It’s not just measles. The Journal of the American Academy of Pediatrics found that clusters of unvaccinated people were one of several factors that led to the worst outbreak of whooping cough in California in 2010 – worse than any year since 1947.
“Why do we have to wait for someone to die?” Pan said on Friday. “One in five people who contract measles are hospitalized. This is not a benign disease.”
Pan said he is drawing a line at schools because it is where children cross paths and if you are allowing the pool of unvaccinated children to grow, you are creating more chances for more outbreaks among the unvaccinated.
“If you have a baby under the age of 1, that child cannot be immunized,” Pan said. “If your child has cancer or lupus, that child cannot be immunized. These are people that depend on everyone else being (immunized).”
In some respects, Pan knows he being outgunned by strident voices citing anecdotal evidence that vaccines are dangerous. Pan is appealing to supporters to speak up for increased vaccinations. But supporters of SB 277 are not vehement – and vehemence is carrying the day.
“We need to protect all children; that’s what this is about,” Pan said. “God help us if someone gets permanent disability or dies because a minority made choices based on misinformation. Shame on us.”………….’
Sometimes we take the benefits of modern medicine for granted, but a small dose of data and history can easily remedy that. The chart below, created by Valentine Svensson, a PhD student in molecular biology at Cambridge University, shows the dramatic decline in the incidence of measles in 20th century America.
You can see that the incidence of measles fell sharply after the vaccine was introduced in 1963, only 50 years ago. As the vaccine did its work, the incidence of measles dropped to zero by the end of the century. (The left-hand axis is graphed as a base 10 log, a common technique that statisticians use to bring in spread-out values and illuminate a trend.)
Lest we forget where we came from, here’s a map that shows how deadly measles was in 1880. The map shows the ratio of deaths from measles to aggregate deaths, based on the tenth census ever conducted in this country. The graph at the lower left hand corner of the page shows how the states compared in terms of deaths by measles, while the key at the bottom right hand corner of the page tells you how many deaths the different shaded areas correspond to. (Click on the map, which is republished courtesy of the David Rumsey Historical Map Collection, to enlarge.)
In most states, fewer than 30 deaths per 1,000 were due to measles, or less than 3 percent of overall deaths. In some parts of Georgia, Nebraska, Colorado and Kansas, however, that proportion reached 3-6 percent of deaths, while in New Mexico it topped 6 percent of all deaths.
Finally, here’s a graphic showing how measles spreads in an area without a vaccination program, by Bonnie Berkowitz and Lazaro Gamio of The Washington Post. The differently shaded squares represent four generations of infection, from Patient Zero (the darkest red square at the top left) to the people he or she infects (the next 17 reddish squares), the people they infect in turn (the next five lines of peach-colored squares), and the people they infect (the rest of the graphic). The dark squares represent the people who die from measles.
Without vaccinations, each measles case will infect 12 to 18 other people on average every 10 to 14 days. You can see how quickly the disease spreads from the first generation (Patient Zero) to 12 to 18 people in the second generation, 144-324 people in the third generation, and 1728-5832 people in the fourth generation. That adds up to more than 6,000 infections, all within 40 days. In a country with substandard healthcare and malnutrition, up to 28 percent of those infected will die.
Now contrast that with a country with full vaccination: In that scenario the disease would spread to 0.8 people every 10 to 14 days, and less than .3 percent will die. In a country like the United States, where most people have been vaccinated but pockets have not, the disease would spread to 1.1 to 2 people every 10-14 days and less than .3 percent would die.
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A young boy who fought through leukemia is now fighting to keep unvaccinated children out of school.
After spending over three years going through chemotherapy, Rhett Krawitt, 7, remains unprotected against certain illnesses, including the measles. So the boy and his family this week asked his local school district to support new legislation that would abolish personal-belief exemptions, which allow families to opt out of required vaccinations, according to ABC station KGO-TV in San Francisco.
“For 3 1/2 Years I took chemo to get the bad guys out,” Rhett said in his speech that his father, Carl Krawitt, helped him write. “Now I can say gone with the cancer.”
To speak to the Reed Union School District, the boy stood on a chair to reach the microphone.
“Soon we will say Gone with the Measles,” he said. “My name is Rhett and I give a damn!”
Rhett and his Corte Madera, California, family asked the Reed Union School District to support state legislation introduced by state senator and pediatrician Dr. Richard Pan that would abolish personal-belief exemptions that allow students to attend school without being fully vaccinated. For the current school year, 5.89 percent of kindergartners in Marin County have a personal-belief exemption.
The family first made headlines last month after NPR reported they asked their local school districts to ban unvaccinated children from the school after a measles outbreak started in Southern California. Rhett attends school in Marin County in California, where just over 84 percent of kindergartners are fully vaccinated, according to the California Department of Public Health.
“The importance of vaccinations is about the expectant mothers and babies under the age one and hundreds of children who are at risk for getting these disease that don’t even need to be here,” Carl Krawitt told ABC News. “It’s really around making sure that we have public health policy that protects everyone in our community.”
PHOTO: Jodi Krawitt holds her son Rhett in their home in Corte Madera, Calif. Jan. 28, 2015. Rhett is recovering from leukemia and his father is concerned his child could succumb to an outbreak of measles at his Northern California school.
The multistate outbreak of measles that started in Disneyland in December has infected at least 121 people, with 99 of those infections in California, according to the U.S. Centers for Disease Control and Prevention.
After the family’s plea, the school district voted to support legislation introduced by Pan.
Carl Krawitt also told ABC News that son Rhett will meet with his doctors to determine whether his immune system is healthy enough to get a measles vaccination.
Krawitt said the importance of vaccinations was underscored again Wednesday after the Contra Costa Public Health Department alerted Bay Area California residents that a passenger on the Bay Area Rapid Transport (BART) public transportation system has been infected with measles, meaning other passengers could have been exposed to the contagious virus.
“I’m not going to take BART on Saturday and I really wanted to,” Krawitt said. “There are certain things we will and won’t do” to protect Rhett. …..’
A baby receives a shot at a California clinic. With measles outbreaks in more than a dozen states, Autism Speaks now says “vaccines do not cause autism.” (Rick Loomis/Los Angeles Times/TNS)
Amid concerns about measles, the nation’s largest autism advocacy group has updated its stance on vaccines and autism, but remains mum on whether it will fund further studies on the issue.
Autism Speaks revised its policy on immunizations in a statement published on its website last week.
“Over the last two decades, extensive research has asked whether there is any link between childhood vaccinations and autism. The results of this research are clear: Vaccines do not cause autism. We urge that all children be fully vaccinated,” reads the statement from Rob Ring, the group’s chief science officer.
The language replaces a four-paragraph statement on the issue which had been in place since April 2013. The organization’s previous position also strongly encouraged parents to vaccinate but said “it remains possible that, in rare cases, immunization may trigger the onset of autism symptoms in a child with an underlying medical or genetic condition.”
The shift in Autism Speaks’ position comes as the nation grapples with a resurgence of measles. The illness was considered to be eliminated from the U.S. in 2000, but 102 cases were reported in 14 states from California to New York in January, according to the Centers for Disease Control and Prevention.
Most of those affected were not vaccinated, health officials say.
Concerns sparked by a 1998 study suggesting a link between autism and the measles, mumps and rubella vaccine have led some parents not to immunize their children. However, the study has since been retracted and the theory widely discredited by medical experts.
“The updated statement was issued this week to reiterate the importance of vaccinations in light of the measles outbreaks,” CJ Volpe, a spokesman for Autism Speaks, told Disability Scoop on Friday.
As recently as 2010, Autism Speaks affirmed its commitment to funding research examining a possible link between autism and vaccines even in the face of mounting evidence to the contrary.
Volpe did not respond to questions about whether Autism Speaks continues to fund research on vaccines. A search of the organization’s online grant database indicates that the group most recently funded a study looking at vaccines and autism, among other issues, in 2011.
Nonetheless, Autism Speaks’ Strategic Plan for Science outlining the group’s priorities for the years 2013 to 2017 continues to make mention of vaccines.
“Autism Speaks is funding studies on the underlying biology of autism, including studies to better understand medical and genetic conditions that are associated with autism that could potentially be linked to adverse responses to immunization,” the strategic plan states.
A sensitive subject and thank you for your insight.
No vaccine can be 100% safe, as can no other medical procedure, but one needs to assess, do the advantages outweigh any disadvantages or not and then decide accordingly.
As the mother of an Autistic child, I can’t help but put my two cents worth in on the recent uprising of controversy surrounding the outbreak of measles and the risk of administering the measles, mumps and rubella vaccination. I do believe I have a rather uncommon perspective on the matter. Unique? Maybe not. Nevertheless, here it is.
When my first son (who is completely “normal”) was one year old we went in for his MMR shot and the doctor suggested that I be immunized at the same time. Much to my regret, I did; I found out a few weeks later that I had been two weeks pregnant with my second son when I had the shot. When my second, Chris, was born everything seemed fine. He was developing according to his milestones and even beyond them. He spoke a few words and played normally. Then, at one year…