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Friday, February 20, 2015

Measles Outbreak-What It Means When Your Neighbors Don't Vaccinate

Outbreak in Preventable Childhood Diseases On the Rise in the United States
The measles outbreak in the nation has been on the rise for the past two years, but is nearly at epidemic proportions now.  There are 141 cases of measles in 17 states so far in 2015. This chart from the CDC shows the states which have the most outbreaks of measles.
2015 measles cases in the U.S., January 1 to February 13, 2015. Map of the U.S. indicates in shades of light to dark blue the number of cases. Fourteen states (Colorado, Delaware, Michigan, Minnesota, Nebraska, Nevada, New Jersey, New York, Oregon, Pennsylvania, South Dakota, Texas, Utah, and Washington ) and the District of Columbia have 1 to 4 cases (. One state (Arizona) has 5 to 9 cases. One state (Illinois) has 10 to 19 cases and one state (California) has 20 or more cases. These are provisional data reported to CDC’s National Center for Immunization and Respiratory Diseases.
 Measles, is a preventable childhood disease for which an immunization (a shot) is usually given to a child when the child reaches nineteen to thirty-five months of age. Measles causes red spots, fever, and in some cases can result in death. This article reviews changes in childhood immunization patterns, which were reported for all fifty states in Unraveling U.S. Healthcare-A Personal Guide, published in 2013.  Information is drawn from the U.S. Centers for Disease Control and Prevention and is inclusive of 2013 calendar year data.

In 2011, the national immunization rate for children between the ages of nineteen and thirty-five months was 83.34% for all recommended childhood vaccinations. In 2013, the immunization rates for the same age-group of children and the same vaccines had dropped to 83.07%.
 Here are the states with the lowest rate of immunization for these diseases as of  the end of the reporting year for 2013, as compared to the national average. As you can see, the western states do poorly for immunization compliance, as reported in my 2013 health scorecards. The one bright spot is Utah, which matches the national average for the top three vaccines. The outlier in the group is Vermont, which has achieved the dubious designation as the state with the lowest rate of childhood immunizations. And though much of the country seems to ignore the District of Columbia, seat of our nation's capitol, it has a better vaccination rate than the national average, at 86.7% penetration versus 83.07%. Here is information from the table, showing the worst states for immunizing their children:

Children's Health Scorecard-2013 National Average
Oregon Montana Wyoming New Mexico California Colorado Alaska Vermont
Ranking 44 45 46 47 48 49 50 51
DTaP 83.10
83.80 79.00 80.90 79.80 83.10 81.20 75.50 85.80
Hep B 74.20
66.80 73.90 67.00 67.50 70.30 60.20 59.40 44.80
MMR 91.90
89.40 87.30 89.00 89.10 80.70 86.00 90.50 91.20
Average Rate 83.07
80.00 80.07 78.97 78.80 78.03 75.80 75.13 73.93

-3.07 -3.00 -4.10 -4.27 -5.03 -7.27 -7.93 -9.13
Notes: Negative number means performance is worse than the national average.
Immunization rate is for Heb B only.
Immunization rates are from the Centers for Disease Control for 2013 year
In short, this is the reason there are large outbreaks of childhood diseases now. An immunization is a preventive dose to activate the body's immune system to the disease vector. In order to have adequate protection for a population, which means a community, a school, a state, the majority of the population has to become immunized. In the United States, especially on the west coast, we are in danger of losing our herd immunity, which is a scientific term that means the actions of a significant minority can imperil the entire population. The standards for public health in the United States and all developed nations are based on scientific data, using gold-standard studies and analysis, not spurious opinions of the uniformed in social media. The recommended immunizations for children in the above age-group are as follows:
  • Diptheria, Pertussis, and Polio- Pertussis is known as whooping cough and there has been an increase in preventable childhood deaths from this recently as well. Polio of course, causes paralysis and shortened life expectancy and was thought to have been eradicated in the U.S., but thanks to the actions of a minority, this may no longer be the case. Diptheria is a respiratory disease.
  • Measles, Mumps, & Rubella-Measles is an infectious disease causing fever and rash. Mumps is a disease of the salivary glands, causing swelling, fever, and muscle aches. Rubella, also known as German Measles can cause incurable illness for pregnant women, and significantly increases the chance of miscarriage.
  • Influenza-This is a respiratory disease which can and does cause deaths in infants and others whom have immune deficiencies.
  • Hepatitis B-This is a  blood disease which can damage the liver; is transmitted through bodily fluids, and can  be passed from mother to child.
  • Varicella or chicken pox-This is a blister-like rash, fever, and can result in death for those with compromised immune systems.
In The Russell Guide for Diabetics, I share information about the science and the reality of childhood diseases. A 2003 Italian study,  found that early childhood exposure to two diseases damaged the immune system and was significantly linked to causation of Type 1 or juvenile diabetes. Here is an excerpt from my book explaining the findings:

In 2003, a population-based case-control study in Italy, published results which found that childhood exposure to two infections significantly increased the likelihood of a child contracting Type I Diabetes. Infections which were reviewed in the study included; pertussis (whooping cough), varicella (chicken pox), rubella, parotitis, and morbilli.[1] Here are the findings of the study:
1.      The statistically significant finding with no confounding variables,  showed that children in the Abruzzo region of Italy who were exposed to two of the childhood viruses listed, had a higher incidence of Type I Diabetes compared to the population who had been exposed to a single childhood infection.
2.      Children who had been exposed to only one of the listed childhood infections did not show an increased incidence of contracting Type I Diabetes.
3.      Childhood immunizations were also analyzed as risk factors for contracting Type I Diabetes and there was no statistical increase shown in the incidence of juvenile diabetes for the immunized children.
4.      However, for children who had received the pertussis (whooping cough) and MMR (measles, mumps, and rubella) vaccinations, a significant decrease was found in the contraction of childhood Diabetes.

 My brother, Russell was diagnosed with Type 1  Diabetes when he was three years old, three months after his exposure to chicken pox. He had also been exposed to mumps within the year, by his school-age siblings (including moi). Unfortunately, this event was due to the fact immunizations were typically provided through the school at the time of enrollment, so children younger than school age were at risk. Russell died at 42 years of age, following multiple organ transplants, and amputations all related to Type 1 Diabetes.

To all parents who think they are "boosting their child's immune system" by avoiding immunizations, do take the long term view and consider all adverse consequences. This article of course, is written for those whom do base their decisions on scientific evidence. Considering the low-level of science readiness in our national population, as compared to other countries, perhaps this issue will ultimately be decided through tort action in the courts. The CDC clearly states these immunizations prevent 722,000 deaths over a lifetime, so the parents whom are abdicating these preventive measures must be assuming some other child or relative will be in that statistic and not their own. Truly it is just a question of time before the actions of one parent bring irreparable illness to the lives of others, which is similar to driving a vehicle without auto insurance. Considering that many of those eschewing immunizations are patrons of  the well heeled in private schools, this population is an easy target for social responsibility through the courts.
And this is the healthpolicymaven signing off, encouraging all to share this article virally, just as childhood diseases are spreading through our population.
Roberta Winter is the author of
Roberta E. Winter is a graduate of the University of Washington School of Public Health and Community Medicine and the Evans School of Public Affairs. She has spent the past 12 years advocating for consumer issues in health care.



Lacey Rockwell said...

I had no idea that so many childhood illnesses could affect you later in life. For example, I didn't know that certain things could cause certain types of diabetes. Does this affect your health insurance? Does it make it more expensive?

healthpolicymaven said...

Childhood infections can and do impact the immune system, so the delay or forfeiture of vaccinations can have life-long chronic disease impacts. Because of the Accountable Care Act, insurance companies can no longer discriminate based on health information. This means they can't charge more if you are sick, but must base their premiums on community rates or on a managed pooled rating system. For very large firms, they are rated using their own claim experience( if you have thousands of employees). For all of the others, some type of rate pooling mechanism is used, even for those whom are self-insured. Essentially nobody wants to take 100% of the risk for anyone's claims, it is a shared aspect.
I hope that helps.

Anonymous said...

I still don't get why people choose not to vaccinate themselves or their children. One day they will get very sick and will then see the consequences of not being vaccinated. It is important to get your shots when you are young and any follow-ups later on. You don't want to be stuck getting sick all the time when it can be prevented. For getting shots, I would check with your health insurance company if they will cover it. I would assume since it is a preventative measure, that they will cover it.