U.S. Whooping Cough outbreak worst in 70 years

[GostHacked]

Apparently you don't.

You cannot have herd immunity if the vaccine does not work. I will use this season's flue vaccine as an example. It is only about 25% effective. How do you expect to get herd immunity from the new strain when the vaccine is not effective?

And its certainly not that surprising to see more vaccinated people catch a disease than unvaccinated... Lets say you had 10 people exposed to a disease. 2 were unvaccinated, both got sick. 8 were vaccinated with an imperfect (but still partly effective) vaccine. 3 vaccinated people got sick, but the vaccine stopped the illness in 5. In that case, technically more vaccinated people got sick, but that's not the number you should look at... you should look at what percentage of vaccinated people got sick, and compare that to the percentage of unvaccinated people who got sick.

Hey those are not my studies, those were the CDC saying that more people are getting sick even if they are getting the vaccine.

Same with your '~90% were vaccinated' claim. You should not be looking at the numbers who were sick and saying "how many were vaccinated vs. unvaccinated". You need to look at the 2 groups separately, and compare the number of sick people in each group.

Then you need to complain to the CDC for presenting the information this way. According to those CDC numbers, 90% of the people who were vaccinated against the whooping cough, still got it. That's a failure and you won't get herd immunity.

Herd immunity works by eliminating as many as possible sources in transmitting the disease. Disease transmission is complex.. one person passes it to multiple people, who then pass it to multiple people. Stop the first transmission (via a vaccine) and you can stop a whole chain reaction.

And herd immunity does work... for example, the Smallpox vaccine was only 95% effective. In theory you could still have vaccinated people transmitting the disease to other vaccinated people (if they fell in the 5% for whom the vaccine was ineffective). But herd immunity took over, and as a result, smallpox was eliminated as a disease world wide.

At 95%, you will get herd immunity. Not at 25%.

Edited January 21, 2015 by GostHacked

[Mighty AC]

You cannot have herd immunity if the vaccine does not work. I will use this season's flue vaccine as an example. It is only about 25% effective. How do you expect to get herd immunity from the new strain when the vaccine is not effective?

At 95%, you will get herd immunity. Not at 25%.

The whooping cough vaccine is 98% effective for, complete prevention, of the disease for children receiving the full scheduled treatment. After 5 years the effectiveness for complete prevention drops to 70%, yet it still reduced the severity in 100% of cases.

The flu is tougher to vaccinate against due to the high number of strains. In Canada the effectiveness has been as high as 60% and as low as 10%. The upsides for children, the elderly and the weak are worth 10 minutes of my time.

http://www.cdc.gov/vaccines/adults/rec-vac/pregnant/whooping-cough/vacc-effectiveness.html

[segnosaur]

You cannot have herd immunity if the vaccine does not work.

Except of course that the whooping cough vaccine actually does work... not 100% effective, but most people do obtain immunitiy from it.

I will use this season's flue vaccine as an example.

The purpose of this thread was to talk about whooping cough... so now you're bringing up influenza?

It is only about 25% effective. How do you expect to get herd immunity from the new strain when the vaccine is not effective?

You really seem to have a problem understanding medical science, don't you.

Influenza is not just a single virus... its actually a collection of viruses, some strains that are similar, some which are very different. When vaccines are developed, they cannot include every single strain, so they pick what they think will be the most common.

The influenza vaccine is generally >90% effective, but its only effective against the strains that it is designed to stop. In fact, if each and every person in the world got vaccinated (that was medically able to receive the vaccine), the strains contained in the vaccine would be eliminated. Gone. Extinct. And that would partly be due to herd immunity.

This year, the strains contained in the influenza vaccine were not a good match to the strains of flu that are circulating. But that does not mean the vaccine is ineffective; it works against the strains it was designed for. It woudl be great if it were an exact match every year, but we don't live in a perfect world.

Oh, and your 25% claim? Yes, that might be the figure this year. But in other years there have been better matches... it often matches >60% of the actual circulating viruses.

Then you need to complain to the CDC for presenting the information this way.

Ummm... why?

Perhaps the CDC expects people who are reading those numbers to not be scientificly ignorant. The taking of numbers out of context is not the fault of the CDC, its the fault of the person who doesn't understand data.

Please don't take your lack of scientific understanding and project that on to others.

According to those CDC numbers, 90% of the people who were vaccinated against the whooping cough, still got it.

Uh, no. It says no such thing.

It says 90% of the cases of whooping cough were vaccinated... something totally different.

That's a failure and you won't get herd immunity.

No, you don't get herd immunity because there are idiots who don't get vaccination.

[segnosaur]

And just to add more information....

A recent study (in California) showed that in areas where you have a lot of people opting out of vaccination, the chance of getting Whooping cough roughly doubles. In areas where vaccination rates are highter (even with the vaccine being imperfect) the chance of getting whooping cough is lower.

And this comes from an actual medical journal. Not from some idiot on youtube who probably got his high-school degree from a box of crackerjacks.

From: http://pediatrics.aappublications.org/content/early/2013/09/24/peds.2013-0878.abstract

We analyzed nonmedical exemptions (NMEs) for children entering kindergarten from 2005 through 2010 and pertussis cases with onset in 2010...Census tracts within an exemptions cluster were 2.5 times more likely to be in a pertussis cluster...More cases occurred within as compared with outside exemptions clusters...

[Accountability Now]

After 5 years the effectiveness for complete prevention drops to 70%, yet it still reduced the severity in 100% of cases.

Is 70% enough to generate herd immunity though?

Also, what happens after 5 years? Does it drop even more? I know I had read a study on the measles vaccine and it had shown a significant percentage of people that lost complete immunity after 15-20 years. I wonder if its the same here.

[segnosaur]

Is 70% enough to generate herd immunity though?

Probably yes.

A couple of things to remember:

- Herd immunity isn't a perfect "this will immediately stop any and all cases". Statistically you reduce the amout of transmissions. It may take longer with a '70% effective' vaccine than a '99% effective' vaccine, but it will probably happen

- Keep in mind that that is 70% after several years. Immediately after vaccination people are 100% protected. The group that has the 100% protection will likely be composed of young children in school (i.e. in close proximity and most likely to pass the virus on).

- Even if immunization drops after several years, it does not mean that the vaccination has no effect. It does shorten the lengh of time a person is sick. Shorter illnesses mean less time for the virus to be transmitted to the uninfected.

[Accountability Now]

- Keep in mind that that is 70% after several years. Immediately after vaccination people are 100% protected. The group that has the 100% protection will likely be composed of young children in school (i.e. in close proximity and most likely to pass the virus on).

If you consider 5 years to be several years....then you are correct (as shown above). However I still wonder if it drops lower than 70% after the five years and if so by how much. Again, the measles study I saw showed that almost half of the people in the study had no immunity after 15 or so years regardless of 1 or 2 doses. Just curious if this vacccine is the same. When reading about herd immunity I saw another study that showed the calculations for herd immunity requirements and its showed the required percentage to be around 65% for measleas, Rubella and Flu but didn't mention pertussis.

[segnosaur]

If you consider 5 years to be several years....then you are correct (as shown above). However I still wonder if it drops lower than 70% after the five years and if so by how much.

It wouldn't be surprising if the percentage does drop further.

But, as I pointed out, the ones who are most protected will be the ones at the most risk of transmission. By the time the protection provided by the vaccine drops further, the child will probably have graduated school (or will be close to graduating).

When reading about herd immunity I saw another study that showed the calculations for herd immunity requirements and its showed the required percentage to be around 65% for measleas, Rubella and Flu but didn't mention pertussis.

I'm not an epidemiologist, but from what I've seen mathematical model can be quite complex. It depends on things like the trasmitibility of the virus, effectiveness of the vaccine, and how homogenous your population is. The big problem is that human populations are anythign but homogenous... people are often isolated by age (school age vs. retired individuals), geography, and economic status. You could have a relatively high rate of vaccination overall, but have one town with a higher portion of morons who don't get vaccinated, and that town will be more at risk.

The other thing to keep in mind is that herd immunity is more of a concept than a hard-and-fast defintion. (i.e. I don't think there's a point where you can say "herd immunity is achived. No risk to anyone. Peace out".) More the idea that it statistically reduces the chance of widespread transmission to at-risk individuals.

http://www.mathepi.com/maindir/herd.html

[Accountability Now]

But, as I pointed out, the ones who are most protected will be the ones at the most risk of transmission. By the time the protection provided by the vaccine drops further, the child will probably have graduated school

Here's the problem I have with this. On one end you're saying all that matters is that the most at risk are vaccinated/protected. But on the other hand you are saying herd immunity is what matters. If the vaccine wears off after time then herd immunity isn't possible. So you're left hoping the vaccine will work for those who take it. If it does then nobody needs to worry about those who choose to not vaccinate. If it doesn't then everyone is screwed.

I get that the concept of herd immunity is difficult if not impossible to define or express as a number however I can't see how herd immunity is possible if immunity diminishes with time.

[Wilber]

I get that the concept of herd immunity is difficult if not impossible to define or express as a number however I can't see how herd immunity is possible if immunity diminishes with time.

Booster shots. Many very effective vaccines don't give permanent immunity.

[segnosaur]

Here's the problem I have with this. On one end you're saying all that matters is that the most at risk are vaccinated/protected. But on the other hand you are saying herd immunity is what matters.

Actually both of them matter.

We live in an imperfect world. Ideally we'd like to get everyone in the world vaccinated at the same time (Well, except for anyone unable to receive the vaccine for medical reasons.) In reality that's not possible... it takes time to produce the vaccine, to vaccinate people, etc. so it makes sense to concentrate on the people most at risk, and then finish off vaccinating the remainder.

If the vaccine wears off after time then herd immunity isn't possible.

Actually it is... immunity doesn't disappear overnight... it takes years. And it doesn't go away all at once. (People may still catch the disease after the vaccine has started to wear off, but will have less severe and shortened illnesses, which reduce the risk of transmission.)

How well herd immunity works depends on how long the vaccine is fully effective, how well it gives partial immunity, and how homogenized your demographics are. Herd immunity WILL come into play if everyone is vaccinated against whooping cough. The issue of how to deal with the vaccine wearing off will have to be addressed (perhaps they will try to give everyone boosters, perhaps they will bring back the old vaccine.)

So you're left hoping the vaccine will work for those who take it. If it does then nobody needs to worry about those who choose to not vaccinate.

Actually yes you do.... Even if the vaccine did not wear off, there are still problems:

- some people cannot get vaccinated for valid medical reasons. (For example, some vaccines use egg in their cultivation, and those allergic to eggs cannot receive them.)

- Some people, even though they are vaccinated, do not develop the required antibodies.

- Vaccinations require several days for immunity to be established, so in the short term the person will still be at risk.

Its for those above cases that vaccination should be wide spread, and any idiot who chooses not to get vaccinated should be looked down on as a first glass jerk, amoral monster.

And any claim that "The vaccine is imperfect/wears off so I shouldn't get it" is completely retarded. Partial protection is better than no protection. Its like saying "I'm not going to wear a parachute when I jump out of a plane because sometimes parachutes fail". Well, yeah, they do... but they generally work most of the time, and you're better off with it than without.

[Accountability Now]

Booster shots. Many very effective vaccines don't give permanent immunity.

Exactly. But how many adults actually get these booster shots thus leaving that many people expsosed to the virus and possible canditates for spreading it.

[Accountability Now]

Actually both of them matter.

So you don't see the hypocrisy in your statement? Do we just need to worry about the young being protected or do we all need to be protected. Its an either or thing....not both.

Actually it is... immunity doesn't disappear overnight... it takes years. And it doesn't go away all at once. (People may still catch the disease after the vaccine has started to wear off, but will have less severe and shortened illnesses, which reduce the risk of transmission.)

How well herd immunity works depends on how long the vaccine is fully effective, how well it gives partial immunity, and how homogenized your demographics are. Herd immunity WILL come into play if everyone is vaccinated against whooping cough. The issue of how to deal with the vaccine wearing off will have to be addressed (perhaps they will try to give everyone boosters, perhaps they will bring back the old vaccine.)

Sure...you may lessen the effects of the disease but it doesn't make you less contagious. You are still able to pass it on to those who aren't able to vaccinate at all. The disease is still out there....transmitting to others...which negates herd immunity.

If the vaccine wears out over time then you are bound to have 'x' amount of people that will be able to spread it further. If the vaccine wears out signifcantly then 'x' becomes larger and herd immunity is not achieved.

Actually yes you do.... Even if the vaccine did not wear off, there are still problems:

- some people cannot get vaccinated for valid medical reasons. (For example, some vaccines use egg in their cultivation, and those allergic to eggs cannot receive them.)

- Some people, even though they are vaccinated, do not develop the required antibodies.

- Vaccinations require several days for immunity to be established, so in the short term the person will still be at risk.

Exactly my point. Herd immunity is to protect these people. Again..if 'x' amount of people have the abilty to transmit this disease even though they are somewhat protected then how does this protect the people you mention above?

My claim in all of this is that people are quick to gripe about the anti-vaxxers but yet how many of us are actually fully protected? As Wilber stated, there should be just as much emphasis on booster shots OR even better having the tests done to see what your immunity levels are. We have a ton of false security regarding our immunization levels.

I rememeber reading a study done after the Quebec measles outbreak. The person who started the outbreak was vaccinated as were a signficant number of people who were ulimately affected most of which were university students (ie 15 years past vaccination date). I have to believe this was a shock to those who thought they were protected but weren't. They did a follow up study as a result of this and found that close to half of the people in the studay who had been vaccinated had completely lost immunity over a 15 year period. That means that 50% of people over 20 years old no longer have immunity to the measles and are able to transit the disease. So how many people in North America are over 20 years old? And half of those have no immunity? Yet we are worried about the 8-10% that choose not to vaccinate? If we truly want herd immunity then we need both.

[overthere]

- some people cannot get vaccinated for valid medical reasons. (For example, some vaccines use egg in their cultivation, and those allergic to eggs cannot receive them.)

- Some people, even though they are vaccinated, do not develop the required antibodies.

- Vaccinations require several days for immunity to be established, so in the short term the person will still be at risk.

The specific problem with whooping cough/pertussis vaccinations is that they cannot be given to pregnant women or children under one year old. That means that babies are at risk, and the source of infection is likely to be older unvaccinated children and adults whose immunity is degraded over time.

It is free and easy for an adult to get revaccinated for pertussis. I did it before Christmas, because there are babies in my life. I'd hate to be the reason one died.

[segnosaur]

So you don't see the hypocrisy in your statement? Do we just need to worry about the young being protected or do we all need to be protected. Its an either or thing....not both.

There is no hypocricy...

We should have everyone immunized. Older people who's immunity has worn off should get boosters.

Until everyone does get immunized, it makes sense to concentrate on those who are at most risk (in this case children)

Sure...you may lessen the effects of the disease but it doesn't make you less contagious.

Actually you would be...

If (for example) the immunization has started to wear off but still cuts the length of illness down, that's less time you can spend passing it to others.

My claim in all of this is that people are quick to gripe about the anti-vaxxers but yet how many of us are actually fully protected?

I agree that there is an issue of people not getting boosters as needed.

However, some context is important.

Anti-vaxers are idiots who at best deny the need for vaccines, and at worst actively campaign against them. Its an actual active stupidity that must be dealt with head-on. Those people should be categorized separately from people who accept the value of vaccines but have (just by a lapse in memory, or unfamiliarity with medicine) neglected to get vaccinated, or received boosters.

The first group deserves contempt, the second group deserves some sympathy and understanding.

The other issue that should be addressed is that of demographics... Yes, ideally everyone should be fully immunized. But there ARE some groups that are more at-risk than others.... Herd immunity can apply to sub-populations within a larger group. (e.g. it would not be incorrect to apply the term "herd immunity" to vaccinating all the students at a school, even if the adults in the city were not similarly vaccinated.)

Again, herd immunity is a concept. A valuable concept and one that should be followed, but not one with any guarantees.

[Accountability Now]

Anti-vaxers are idiots who at best deny the need for vaccines, and at worst actively campaign against them. Its an actual active stupidity that must be dealt with head-on. Those people should be categorized separately from people who accept the value of vaccines but have (just by a lapse in memory, or unfamiliarity with medicine) neglected to get vaccinated, or received boosters.

The first group deserves contempt, the second group deserves some sympathy and understanding.

I appreciate and agree with your classification of the group however I can't say that most would do the same. The basis behind the recent anti-vax movement is not actually anti-vax at all. Instead its a movement to bring light to the timing and amount of vaccines given at a certain time. Even the infamous Jenny McCarthy is on record as saying that she is not against vaccines but would like to see the schedule adjusted. However, the media and all pro-vaccine people immediately grab the pitch forks and scream for head to be cut off saying that she is is Anti-Vax. Why is that we are not allowed to question these chemicals being pumped into our blood? Especially when the same people screming haven't gone to get a booster to ensure they are fully immunized themselves.

[Wilber]

Exactly. But how many adults actually get these booster shots thus leaving that many people expsosed to the virus and possible canditates for spreading it.

The reasons not to keep up to date are just as invalid as not getting the vaccination in the first place. I consult with my doctor to make sure I keep up to date in order to defend myself from idiots who don't or won't. It doesn't guarantee I will never catch anything but it is all I can do and I also have a moral responsibility not to put others in danger by infecting them.

[bush_cheney2004]

.... It doesn't guarantee I will never catch anything but it is all I can do and I also have a moral responsibility not to put others in danger by infecting them.

Millions of legal and illegal immigrants don't give that such a high priority.

[Wilber]

Millions of legal and illegal immigrants don't give that such a high priority.

I can only control what I do.

[Accountability Now]

Millions of legal and illegal immigrants don't give that such a high priority.

Just out of curiosity....I wonder how many of the non-vaccinated 10% would be attriibuted to immigrants.

[segnosaur]

I appreciate and agree with your classification of the group however I can't say that most would do the same. The basis behind the recent anti-vax movement is not actually anti-vax at all. Instead its a movement to bring light to the timing and amount of vaccines given at a certain time. Even the infamous Jenny McCarthy is on record as saying that she is not against vaccines but would like to see the schedule adjusted. However, the media and all pro-vaccine people immediately grab the pitch forks and scream for head to be cut off saying that she is is Anti-Vax.

First of all, I'm not sure what you mean by "recent anti-vax moviement". There is still a large contingent of people who say "no vaccines at all".

Secondly, it is possible to be an anti-vaxer but still approve of SOME vaccines. Probably the best example is the influenza vaccine... many people claim they support vaccines against measles, mumps, etc. but not influenza. Well, that's still being "anti-vax".

As for Jenny McCarthy, she may claim that she is not anti-vax, but she has made such wildly irresponsible claims about how vaccines cause autism, and contain "toxins". Such misinformation is clearly anti-vax. Its like the guy saying "I'm not a racist, but..." knowing that everything they say after the word "but" will likely be filled with rants about "bad minorities".

Even arguments like "we should give fewer vaccinations at a time" are of questionable mentality. Even though the person making that claim may think they are "pro-vaxination", delays in giving needed immunizations might mean children are left at risk.

Why is that we are not allowed to question these chemicals being pumped into our blood?

How do you define "questioning the chemicals"?

If you have concerns, by all means do some research. But if widespread testing has determined "chemical X as used in vaccines causes no harm", then follow the science. It may be imperfect, but it still is more accurate than following your own "gut instincts".

[segnosaur]

Millions of legal and illegal immigrants don't give that such a high priority.

Ummm...first of all, why is that relevant?

While it would be nice if each and every resident (born here or immigrated) got vaccinated, the fact that someone else is neglegant does not abosolve you or anyone else of your moral obligation to get immunized yourself.

Secondly, the idea of the "diseased immigrants" might actually be a myth. In some cases, immigrants are often better immunized than the children in the communities they are moving to.

From: http://www.texasobserver.org/disease-threat-immigrant-children-wildly-overstated/

The vast majority of Central Americans are vaccinated against all these diseases. Governments concerned about health, and good parents investing in their kids, have made Central American kids better-vaccinated than Texan kids.... Consider, for example, Guatemala. According to the United Nations Children’s Fund (UNICEF), Guatemalan kids are more likely than Texans to be immunized for most infectious diseases.

[bush_cheney2004]

Ummm...first of all, why is that relevant?

While it would be nice if each and every resident (born here or immigrated) got vaccinated, the fact that someone else is neglegant does not abosolve you or anyone else of your moral obligation to get immunized yourself.

Secondly, the idea of the "diseased immigrants" might actually be a myth. In some cases, immigrants are often better immunized than the children in the communities they are moving to.

I have no "moral obligation" to be immunized....however...it's fine if you or others choose to do so for whatever reason.

Immigrants may or may not be "better immunized".

[segnosaur]

I have no "moral obligation" to be immunized.

Why? Do you live on a desert island with no contact with the outside world?

Most of us, you know, actually interact with other people. As such most of us think we should (to the best of our abilities) not take actions that risk the lives of other people unnecessarily... driving drunk, shooting firearms randomly in the air, etc. Should you decide not to get immunized, then you are either: A: An idiot who is ignorant of the basic science (perhaps falling for scientific bunk given by people like Jenny McCarthy), or B: antisocial, showing no regard to the welfare of those around you.

Do you fit into either of those categories?

Immigrants may or may not be "better immunized".

Please provide proof.

I provided a reference that showed many south American countries (a major source of illegal immigration into the US) have a higher rate of immunization than America. Where's your evidence that contradicts that?

[bush_cheney2004]

Why? Do you live on a desert island with no contact with the outside world?

Yes...it is defined in the U.S. Constitution. Keep your medical morals away from me please.

Please provide proof.

I provided a reference that showed many south American countries (a major source of illegal immigration into the US) have a higher rate of immunization than America. Where's your evidence that contradicts that?

Actually, the US CDC requires proof of vaccination/immunization (documentation) at entry, or receive such age appropriate immunizations regardless of what their immunization status may actually be.

See "Mexico":

...Many of the nation’s recent Mexican immigrants are characterized by the risk factors above. There are over 11 million individuals of Mexican origin in the US, representing about 25% of the US Hispanic population.[xvii] US Hispanics are the most uninsured ethnic group in the US, and within Hispanic subpopulations, Mexicans have the highest rate of uninsurance at 39%.[xviii] Over one-fourth of recent Mexican immigrant households live below the federal poverty level, and at least six million are without insurance.[xix] Currently, Mexico does not provide a Tdap booster, so recent immigrants will be unfamiliar with and unprotected by this vaccine. The Mexican Ministry of Health reports that a study of 13,000 adolescents in Mexico City schools showed pertussis to be a common cause of persistent cough, highlighting the need to include booster dosing into the country’s immunization regimen

...Focus groups suggest that differences in immunization practice and culture between sending societies and the US negatively impact immunization completion after US residency. Focus group participants report that they expect providers to ensure timely vaccines at no cost, await home visits associated with immunization campaigns, and are surprised to learn they need an appointment to get immunized. In Mexico, public health personnel routinely visit homes to administer free vaccine to children and pregnant women, recording vaccines in a national registry and providing the recipient with an updated personal record.

http://www.migrantclinician.org/issues/immunizations.html

Edited January 26, 2015 by bush_cheney2004