The Autism link helped cause this in more recent years.

My sister works in a hospital that is trying to require the annual influenza vaccination and she's resisting the movement. I know the flu shot is a crap shoot, but I get it if I happen to come across it.

I tried to talk about it with her in the past, but she can't get the logical past her emotions and the "evidence".

Luckily she has sons and not daughters and won't really have the Gardisil debate.

Sorry - There's a long standing right to decline medical care....

NPR also recently did a story on the anti-vacciners having to perhaps pay a price - such as higher insurance premiums and restricted access to public/community services and events.

I work in the developing world where vaccines are not readily available and many diseases that have been eradicated here in the west are still endemic there - such as polio, meningitis, and measles. It's heartbreaking watching hundreds of children die from measles in a matter of weeks. To risk seeing a resurgence of these diseases here is crazy, and I think vaccines should be mandated in some way - at least with respect to public schools as you point out.

Amy: "Go ahead and decline vaccination. But, your kids don't get to be around other kids if you do."

That is quite authoritarian of you. If vaccinated kids are so frightened of the unvaccinated, maybe THEY are the ones whose freedom needs to be restricted.

Besides, if these vaccines are so great and effective, what are they afraid of?

-Jut

Jut, there isn't anything to be afraid of. However, it is impossible to reason with fools, bigots, and fanatics. In some cases, we have to deal with those who are a combination of all three.

Finally, a reasonable proposal. Not having kids vaccinated is just dumb, but people have a right to be dumb. However, they do not have the right to inflict their dumbness on others.

So, yes, perfect: If you choose not to vaccinate your children, then you forfeit your right to have them attend public schools. You must make other arrangements: home-schooling, private schooling, or whatever. (Not that parents shouldn't anyway, given the state of public schools, but still...)

This may at least give some of the people "on the fence" the motivation to do the right thing.

Jut the problem is is that even with a vaccination you can still catch a mutated version of what ever you are immune to.

So an unvaccinated kid can catch the disease from a natural source or possibly even from a vaccinated kid, and then with a full blown infection infect those too young to get the vaccine, or the disese can mutate into a variant that the innoculated have no immunity to.

You chose not to get the protection that is your right - but its not just protection from GETTING infections, but also protection from CAUSING infections

Mass vaccination was the single most important medical advance of the 20th century. 53,000 cases of acute poliomyelitis in 1953 vs. none today. I've been an MD since 1982 and have never seen a case of acute polio. My teachers would have loved to have said that.

That said, we in medicine have done a pretty poor job in confronting the anti-vaccination forces. We naively believe that just because we have the facts and data on our side that we will naturally prevail. We need to get in their faces more, pointing out that these people are killing children.

Unfortunately, many people are morons, and I don't mean that in the derogatory sense so much as I mean it in the objective sense. And I believe emotional campaigns -- showing polio-suffering children -- are the best motivator.

Ironically, many parents who refuse to vaccinate their children are highly educated. I read a story about an exclusive private school in the Bay area where something like 40% of the children aren't vaccinated. These kids come from wealthy, educated families.

Amy: Look up "herd immunity." Here: http://en.wikipedia.org/wiki/Herd_immunity

I did. Here is what it says:

"Unvaccinated individuals are indirectly protected by vaccinated individuals, as the latter will not contract and transmit the disease between infected and susceptible individuals."

It would appear that, unless there is widespread lack of vaccination, herd immunity will not be compromised. Makes sense. So, it would not appear to be a big deal if, say, 1% of the population does not get vaccinated. It is not clear to me that the "anti-vaxxers" are that numerous.

-Jut

It is not clear to me that the "anti-vaxxers" are that numerous.

See my post above. In some areas it's more numerous than you think. Herd immunity breaks down when the vaccination rate falls below 80% (precise number varies with the disease).

Besides, if these vaccines are so great and effective, what are they afraid of? -- JutGory at December 27, 2011 6:54 AM

At any given time anybody's immune system can be compromised by different drugs, medical conditions, stress, or just the time of the month.

For example oral steroids, commonly used to treat asthma, mildly suppresses the immune system. Adults over 30 generally never had the chicken pox vaccine.

The anti-immunization crowd puts all the rest around them at risk. For example, you send your child, unknowingly, at age eight to school with pertussis (whooping cough). My child contracts a very mild case (a days worth of active illness) because she was immunized but is taking steroids. But that days worth of illness infects my 8 month old baby, and her sixty year old grandmother who lives with us with a heart condition.

Where did the pertussis come from? The distant uncle that was doing work in Africa, Asia, or elsewhere that can't afford the $10.67 per child to immunize their children.

Things like this have, do, and will continue to happen.

It would appear that, unless there is widespread lack of vaccination, herd immunity will not be compromised. Makes sense. So, it would not appear to be a big deal if, say, 1% of the population does not get vaccinated. It is not clear to me that the "anti-vaxxers" are that numerous.

The problem is that they often cluster in groups, like students at the Shining Mountain School here in Boulder. Because many followers of the Waldorf movement don't believe in vaccinations, Boulder County now has one of the largest per capita rates of whooping cough in the country.

http://www.theatlantic.com/past/docs/issues/2002/09/allen_a.htm

We just had an issue with that in my city. A family went to Germany, where their non-immunized children got the measles. It spread into four schools, resulting in nine cases. Mind you, this was in an area with about 97% immunization rates!

For those who think measles is nothing, it isn't. It has a mortality rate of about 10%. It is the leading cause of vaccine-preventable deaths.

To follow up on the polio comment; my mother was born in 1930 and remarked that most everyone her age knew at least one child crippled or killed by polio (though it often wasn't until later in life that they learned why a classmate suddenly stopped going to school.)

Herd immunity only works if communities comply. Vaccinations don't always work - putting that person at risk if others around him are infected. Also immunities wear off and if someone is late with their booster, they will also be at risk. That said, of the 156 measles cases in the US last year (and this is the highest amount of measles in the US since 1994 when there were less than 20 cases), one in five were people who were vaccinated. The others were unvaccinated. Also, infants up to the age of 11 months can't be vaccinated against diseases like whooping cough and pertussis. Last year in California, there were 10 infants who choked to death from whooping cough because the disease was able to spread since herd immunity in the community was so low.

I do acknowledge parental rights. However, society at some point does have a duty to protect children, since they are unable to protect themselves. For example, the state will, quite correctly in my view, take children away from a physically abusive parent. The problem is where do we draw the line, when a parent is willingly putting their child at risk because of the parent's ignorance? And at the same time placing others at risk as well.

When this anti-vaccination comes up she starts giving the names of childhood school mates that died from some of these preventable diseases. She then asks me how many of my childhood school mates died of these diseases. The answer, of course, is none.

Those who ignore history are condemned to repeat it.

I don't think you should be forced to get vacs. But I agree with Amy- schools, hospitals, and any private company that wants should be able to require them to enter. You get to make your own choices and should get to, but the rest of us shouldn't have to pay for it with our own health.

Anti-vaccers are very common here in Austin. Also Boulder Colorado and other highly liberal enclaves. Austin had a pertussis epidemic a few years ago. My kids caught it, even having been vac'd. Had everyone been vac'd, it would never have gotten a toehold to expose my kids and others.

We vaccinate fully, even HPV when the girls are old enough and probably the boy too as I think they recommend that now too. My twins were born right after the first rotovirus vac got pulled from the market. They got roto. a full week of awful diarhea. Our younger 2 were born after the new vac came out. They never got roto. I can tell you the minor discomfort of the vaccine (actually that one is oral, but even if it was a shot) is so much better than the illness, even when it's not bad enough to require hospitalization.

If you want to mandate vaccinations, at least give us the right to sue when they are rushed into production bypassing standard safety practices.... PS smallpox doesn't exist in the wild anymore...

If you want to mandate vaccinations, at least give us the right to sue when they are rushed into production bypassing standard safety practices.... PS smallpox doesn't exist in the wild anymore...

Lawsuits almost destroyed the vaccine industry not too long ago.

If you want to mandate vaccinations, at least give us the right to sue when they are rushed into production bypassing standard safety practices....

The H1N1 (Swine flu) vaccine is about the most recent widely used vaccine introduced. It really was just a variation on your seasonal flu shot.

You have a malaria vaccine on about its fifth or sixth round of human trials in Africa (where it is prevalent). It has been in trials for about 10-15 years.

You have NicVAX (anti-nicotine vaccine) that has been in tests and trials since the mid 90's.

Gardisil and Cervarix (HPV) have been in general use for about 3-5 years after 10-15 of trials.

I can't see where any of these have been "rushed into production bypassing standard safety practices."²

Other than the standard "if you are allergic to eggs, have HIV, or have a bad cold or flu today" you should be able to take a vaccine today.

As far as the at least give us the right to sue¹ part; Congress passed the National Childhood Vaccine Injury Act (NCVIA) in 1986 because many of the vaccine manufacturers were getting out the business because they were getting their asses sued off by spurious lawsuits.

PS smallpox doesn't exist in the wild anymore...

The reason that smallpox no longer around is the vaccine developed in smallpox in 1796 was aggressively used from the early 50's until 1980 when they declared it gone.³

¹ -- cdc.gov/vaccinesafety/Vaccine_Monitoring/history.html
² -- cdc.gov/vaccines/vac-gen/side-effects.htm
³ -- wikipedia.org/wiki/Smallpox#Eradication

Having lived through the polio era, being told to stay out of the gutters by my mother, but still watching kids in the neighborhood get it, I vaccinate. Not just my children, but my dogs, cats and horses. It ain't cheap but neither is the alternative.

I don't particularly have any strong feelings against vaccinations.

I will get my children vaccinated, but I will do it because I want to, not because some egg-head says I have to. And, I will do it when I want to, not when they say I have to (even though those might be the same time-frames).

What bugs me about this dispute is that it is remarkably similar to lots of other "collectivist" arguments. To pick Amy's favorite, you could look at the light bulb ban.

I have to live by the "soft white light of tyranny" because some environmentalist is complaining that my 200 Watt "bulb of glory" causes too much coal to be burned and that smoke gives him asthma, causes global warming and is killing off the Amazon rain forest.

When you want to live in society, there are trade-offs. However, the trade-off can come from either side. I see no clear argument that says the "anti-vaxxers" have to conform to your behavior. If you want to be in a society, it might just be YOU who has to deal with THEM.

Now, if you will excuse me, I have an environment to destroy. These aerosol cans don't spray themselves, you know.

-Jut

And, I will do it when I want to, not when they say I have to (even though those might be the same time-frames).

You do understand that vaccination schedules were developed for a reason. They aren't just some egghead's whim. And the light bulb argument is totally irrelevant. Apples and oranges.

Drmaturin:
I bet they were developed for a reason. But, that does not mean that I have to forgo my own reasoning skills in favor of someone else's.

As for the light bulb argument, not apples and oranges. No, apples and apples.

They are part and parcel of the same kind of unthinking mind-set by which the individual is coerced by society into giving up his ability to think or act freely so that his behavior conforms to "the good of the masses."

-Jut

"PS smallpox doesn't exist in the wild anymore..."

Why do you think that is? Hint-vaccines. Also-they don't automatically vac for it anymore, either. Only people who work with etc can get the vac. So what was your point?

"I see no clear argument that says the "anti-vaxxers" have to conform to your behavior. If you want to be in a society, it might just be YOU who has to deal with THEM."

Nope. When one person's actions threaten the health of the whole, the person doing the threatening has to cede. Anything else is tyranny of the few to the many.

Jut, I hope you are an epidemiologist, immunologist, or at least a medical doctor of some sort if you are using your own reasoning for vac schedules (since if you aren"t I doubt you do the sort of journal reading that would be required to research this on your own). Diseases are most likely to kill babies. That's why babies need those vacs as soon as possible. Also, babies have very plastic immune systems that easily adapt to new stimuli, making it easier for them to produce the correct attack cells.

I bet they were developed for a reason. But, that does not mean that I have to forgo my own reasoning skills in favor of someone else's.

But sometimes it's best to rely on the expertise of experts. I don't tell pilots how to fly their planes. And even though I could figure out how to wire my home I prefer to trust electricians. I have spent years learning my field and expect people to defer to my expertise in my specialty (or they should look elsewhere). Do you know enough about immunology to trust your judgment vs. that of experts when it comes to your childrens' health?

And yes, just because government can act like bozos in areas like light bulb bans doesn't mean that vaccination schedules are wrong.

momof4:"Nope. When one person's actions threaten the health of the whole, the person doing the threatening has to cede."

Says who? The collective, right?

"Anything else is tyranny of the few to the many." Nope. That statement does not hold up to scrutiny

What you said only makes sense if the vaxxers outnumber the anti-vaxxers. If 20% want to vaccinate, they are free to. No tyrranny there. However, if 20% don't, you say they are not free to. That is the tyranny of the majority

Unless, of course, you think freedom is tyranny. That is a syllogism I would like to see.

DrMaturin: "But sometimes it's best to rely on the expertise of experts."

I agree, but only when I want to (not because YOU say so). The reliance has to be voluntary. Otherwise, it is not reliance; it is coercion. That is my only point.

I, too, have spent years in my field and I have no problem explaining my field to people until they understand what their options are before they make a decision. Some people want to know everything, then still ask me for advice. Some want to know everything, get my opinion, and still do the opposite. Some people simply tell me to do what I think should be done. They don't know, but they trust. I can pretty much deal with all three types of people. Why? Because I respect them enough to allow them to make a decision. i don't have a problem giving them as much (or as little) information they think they need to make a decision.

-Jut

When you want to live in society, there are trade-offs. However, the trade-off can come from either side. I see no clear argument that says the "anti-vaxxers" have to conform to your behavior. If you want to be in a society, it might just be YOU who has to deal with THEM. -- JutGory at December 27, 2011 10:50 AM

Jut,

There is a serious problem with your argument.

The use of a CFL, incandescent, candle, an LED, or even a candle generally will not have any effect on anyone around them or you in the short term. (I'm not going to get into the global warming argument.)

Would you say that society has to conform to a portion of the population that refused to any traffic laws at all such as stop lights and signs?

This is what you are talking about. You could be randomly killed or injured because John Doe doesn't believe in stop lights.

Measles case fatality ratios vary depending upon the average age of infection, the nutritional status of the population, measles vaccine coverage, and access to health care. In developed countries, less than one in 1,000 children with measles die. But in endemic areas in sub-Saharan Africa, the measles case fatality ratio often ranges from 5%–10%.¹

That means that the odds of dying from measles is .1% in the U.S. But that is in optimal conditions, i.e. hospitals, health insurance, and reasonably early detection and recognition.

There is a significant, immediate, difference between a light bulb or toilet and a disease.

¹ -- ncbi.nlm.nih.gov/pmc/articles/PMC1712354/

What you said only makes sense if the vaxxers outnumber the anti-vaxxers. If 20% want to vaccinate, they are free to. No tyranny there. However, if 20% don't, you say they are not free to. That is the tyranny of the majority -- JutGory at December 27, 2011 12:09 PM

The tyranny of the majority also insists on traffic laws. Why?

The tyranny of the majority insists on laws on rape, murder, theft and other similar laws. Why?

Toilets, light bulbs, CAFE standards, etc. do not have an immediate effect on anyone else. Pathogens can and do have that effect.

What you said only makes sense if the vaxxers outnumber the anti-vaxxers. If 20% want to vaccinate, they are free to. No tyrranny there. However, if 20% don't, you say they are not free to. That is the tyranny of the majority

I'm sorry Jut but in certain situations, such as public health, the tyranny of the majority has to prevail. You may feel you have the right to dispose of human waste on your property as you see fit but since it's a public health danger you will be prevented from doing so. The same thing is true of vaccination. Vaccination rates of 20% would be catastrophic. Herd immunity breaks down at 80%. It isn't just your children you place in danger it's everyone else's since no vaccine is 100% effective.

Like you I frequently explain my findings to non-experts and have no problem doing so. But just as I don't tell obstetricians how to deliver babies ultimately I expect people to trust me, or to find someone else they can trust.

Jim P.: The use of a CFL, incandescent, candle, an LED, or even a candle generally will not have any effect on anyone around them or you in the short term. (I'm not going to get into the global warming argument.)

Fine, you don't like that example? How about smoking bans. That is another favorite of the nanny-staters. In some places, you can't even smoke outside anymore. Or, the fat-food police. Sure, if you eat crappy food, it does not affect my health, but my premiums rise and so your activity must be banned!

Jim P.: "The tyranny of the majority insists on laws on rape, murder, theft and other similar laws. Why?"

Well, just looking at the examples you gave (and not your catch-all), those rights are all consistent (I forget the technical term). But, they are not analogous to this discussion.

In protecting life, my right to live is not impinged by your right to life. In protecting property, your right to property is not affected by my right to property. Same goes for rape. Those rights (life, property, bodily integrity) can live happily together; my right does not diminish yours. However, you want to use your freedom to get vaccinated to limit my freedom not to. That is more analogous to Warren Buffett who says, "I can afford to pay more to the government, so every billionaire should pay more in taxes."

Dr. Maturin: "I'm sorry Jut but in certain situations, such as public health, the tyranny of the majority has to prevail."

As long as you admit that it is tyranny....

-Jut

Momof4, did you vaccinate your kiddos right away? Were you up to date on all of your shots, or did you take any while pregnant?

No need to answer if you don't want, but I'm looking for some advice. I'm currently 20 weeks pregnant, and I do need the tdap/dtap (I've heard it called both!), but I wasn't sure if I should get it while pregnant or wait until the baby is born.

DrMaturin, I'd love it if you weighed in too, but of course, only if you want to! I know I need to do my own research, but I thought I would ask Amy's commenters since so many of you guys are intelligent!

I've asked my dr. and was told it was up to me when to get it, but I want to do some researching on when it would be safer for the baby to get the shot. I've heard that getting a shot while pregnant can pass some of the immunity onto the unborn baby, and I've heard that it might not be good for the baby, so I was just curious if anyone here had any thoughts on that.

Angie,

Here's a source for your question:

http://my.clevelandclinic.org/healthy_living/pregnancy/hic_vaccination_during_pregnancy.aspx

You'll note they recommend against dTaP during pregnancy.

DrMaturin, thank you!

I got a Dtap right after delivering #4, during the pertussis outbreak. Before they would even let me take him home. So you can request that when you deliver. If you BF it will still pass to baby. I am up to date on all others and was before the pregnancies-even tetanus and rabies (animal bite-no fun!)

I vaccinate fully and on-time. Which means my twins got their 2 month vacs on their due date. They were tiny, it was no fun for a day to two, but much better than having to go to the PICU. I have friends with preemies who got their 2 and even 4 month shots in the NICU. I assure you the perinatologists don't blithely go around sticking things into teeny babies-so there are obviously good reasons to do so. We've never had issues beyond soreness and low fever from them, and your pedi will probably tell you that you can give tylenol for that (although now they say that may lessen the effects of the vac somewhat). I did have #4 come down with a super high fever in the middle of the night right after he got his 12 month shots. Turns out he had Hand Foot and Mouth. So I think a lot of the more severe things like high fevers etc parents may blame on vacs are actually coincidence.

Congrats! And may I recommend "Healthy Sleep Habits Happy CHild" as some nighttime reading before you deliver? It's nice to know what to expect when you're expecting and all, but reading a bit about what comes after helps too :)

In protecting life, my right to live is not impinged by your right to life. -Jut

But if you are a walk disease factory you are inmpiging our right to live - as an unvaccinated person of choice your presence can very quickly become a life threatenhing medical emergency, if not a death sentance, to those around you

Fine, you don't like that example? How about smoking bans. That is another favorite of the nanny-staters. In some places, you can't even smoke outside anymore. Or, the fat-food police. Sure, if you eat crappy food, it does not affect my health, but my premiums rise and so your activity must be banned! -- JutGory at December 27, 2011 12:41 PM

I will agree with you on the smoking bans and the fast food stupidity. Those are still both long term issues.

The smoking bans should be up to the individual business or organization. The smoker should also be responsible enough to know where and when to smoke.

As for the fast food -- it is very doubtful that anyone can say just because I came in contact with a Big Mac® today, I will be facing hospitalization and/or death in two weeks. (That is barring food poisoning.)

If come into contact with you or your trail of germs while you're still asymptomatic with whatever disease and have a compromised immune system, I'm at risk of infection. All of the childhood diseases have some combo of fever, gastro illness, heart and lung issues, and as an adult possibly sterility.

"I agree, but only when I want to (not because YOU say so). The reliance has to be voluntary. Otherwise, it is not reliance; it is coercion. That is my only point."

This is about relying on expert sources.

So. You have an alternative?

Reading entrails?

Thanks momof4! I appreciate the info, and I will check into the book!

Luckily she has sons and not daughters and won't really have the Gardisil debate.

They're recommending Gardisil for boys now too, but I will let my daughters decide if/when they want to get it. (I'm still a little wary of it, but they know it's available.) Other than that, my girls have always gotten their vaccines, always on time. Better safe than sorry. And no, my girls are not autistic, and I do not believe that vaccines cause autism. In fact, I will say that vaccines do NOT cause autism, because there is NO PROOF that they do. Jenny McCarthy saying so is not proof.

Congrats, Angie! And might I add, always listen to your pediatrician. They really do know best when it comes to kids.

I don't understand how Amy can be so righteous about this, but so wrong about applied consent for organ donation.

Thanks Flynne! I have yet to choose a pediatrician, but will definitely respect their expertise once I have one!

DrMaturin: "We naively believe that just because we have the facts and data on our side that we will naturally prevail."

I think a lot of this is mainly due to there being so much crying wolf in America over safety. That when the gov't, media, (or their experts) begin classifying everything as hazardous. Be it second hand smoke, fast food, Alar, recalls, with a oddly positioned screw etc) Hazardous loses meaning. What do you say, "this time we actually mean it"?

Too many false alarms will ruin any alarms usefullness. Even if the alarm, when there is actual danger, is 100% true.

So rather than a public emotional campaign, showing polio victims, getting rid of the emotional campaigns for other things first would help out a lot.

For Joe: 1, 2

Implied consent, I mean.

Damn, that one stings.

There are a LOT of vaccines out there. Do you think they should ALL be required for public school attendance? Or just some?

Honestly, it is less a question of "To vaccinate or not to vaccinate", and more of a "Which vaccinations should we get, and when".