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Pertussis Epidemic — Washington, 2012
September 27, 2012 3:08 AM   Subscribe

Since mid-2011, a substantial rise in pertussis [Whooping Cough] cases has been reported in the state of Washington. In response to this increase, the Washington State Secretary of Health declared a pertussis epidemic on April 3, 2012. By June 16, the reported number of cases in Washington in 2012 had reached 2,520 (37.5 cases per 100,000 residents), a 1,300% increase compared with the same period in 2011 and the highest number of cases reported in any year since 1942 [Make sure you don't miss Figure 1]. Commentators are already drawing corellations with the fact that Washington State leads the nation in vaccine non-compliance, Washington State's recent cutbacks in public health funding, and increases in the number of uninsured (PDF).

Valid vaccination history was available for 1,829 of 2,006 (91.2%) patients aged 3 months–19 years. Overall, 758 of 1,000 (75.8%) patients aged 3 months–10 years were up-to-date with the childhood diphtheria and tetanus toxoids and acellular pertussis (DTaP) doses. Receipt of Tdap was documented in 97 of 225 (43.1%) patients aged 11–12 years and in 466 of 604 (77.2%) patients aged 13–19 years. Estimated DTaP coverage in Washington among children aged 19–35 months was 93.2% for ≥3 doses and 81.9% for ≥4 doses in 2010; Tdap coverage in adolescents aged 13–17 years was estimated at 70.6%*

This means that while vaccination still provides individual protection - with unvaccinated children being eight times more likely to get whooping cough and, when they do, become more infectious, have stronger symptoms, are sick longer and are at greater risk of severe outcomes, including hospitalization - communal failures to vaccinate have allowed gaps in herd immunity to expose vaccinated children to more pertussis than the vaccine can provide absolute protection against while also simultaneously breeding vaccine resistant strains.

Here is disturbing footage of what pertussis looks like in 12 week old and 6 month old babies, as well as various children, whooping cough is back.
posted by Blasdelb (111 comments total) 27 users marked this as a favorite

 
CDC on pertussis surveillance and reporting.

2004 - 2005 had an enormous increase, only to drop off in 06/07/08. I wonder why?
posted by the man of twists and turns at 3:15 AM on September 27, 2012


Ugh, that link about vaccine resistance is not good. I'd say people's right to being ignorant and endangering their own children ends when their ignorance starts endangering everyone else's.
posted by Justinian at 3:20 AM on September 27, 2012 [20 favorites]


"Ugh, that link about vaccine resistance is not good. I'd say people's right to being ignorant and endangering their own children ends when their ignorance starts endangering everyone else's."

Incidentally it is available as a Full Text PDF here
posted by Blasdelb at 3:25 AM on September 27, 2012 [1 favorite]


What is it with this era that we're ready and willing to throw out all of the societal and scientific advances we made in the past century? Vaccine 'deniers' are assholes. Fuck you guys, really.
posted by maxwelton at 3:26 AM on September 27, 2012 [86 favorites]


Another problem for Washington State is that a number of the insurers that operate in this state will not pay for the vaccine. Even if you're insured, it can be out of pocket and therefore out of reach, if you're on a limited income.
posted by Blazecock Pileon at 3:34 AM on September 27, 2012 [3 favorites]


Same thing as is happening in the US is happening in Australia with WC and several other diseases that were once considered under control.
posted by Mezentian at 3:34 AM on September 27, 2012 [1 favorite]


Aargh. So much willful ignorance, leading to so much suffering. I can't clearly express how dismayed and angry I get whenever I'm reminded of the anti-vaccination campaigners and the ever-growing list of people who've lives they've endangered or ruined. WE HAVE THE TOOLS TO SAVE LIVES, and they're so committed to their stupid, fearful ideologies that they lie about or ignore the evidence, and convince people to stay away from some of medical science's most significant and unambiguously positive contributions to humanity. If hell exists, I hope there's a special circle reserved.

/emotive ranting

In less infuriating vaccine news, India is still kicking Polio's arse: over 20 months since their last detected case.
posted by metaBugs at 3:41 AM on September 27, 2012 [12 favorites]


Every time anti-vax stuff comes up, I turn to Darryl Cunningham and his illustrated guide on the topic, "The Facts In the Case of Dr. Andrew Wakefield".
posted by Apoch at 3:46 AM on September 27, 2012 [29 favorites]


I'd say people's right to being ignorant and endangering their own children ends when their ignorance starts endangering everyone else's.

This, and listening to last week's episode of the Backstory, podcast has me wishing local governments would bring back forcible inoculation.
posted by ryanshepard at 4:19 AM on September 27, 2012 [3 favorites]


I returned to Australia after a visit to the U.S. in April of 2010 with the beginnings of a cold, assuming it was brought on by stress and the rapid change in climate. Seven weeks later, the nagging, low-grade cough still hadn't gone away, so I finally went to see a doctor. It took a few visits and several attempts, but imagine my surprise when finally I got a call saying, "You have whooping cough."

Isn't that something babies get? I asked. Yes, but it's been making a resurgence, with mutated new forms particularly in the U.S.

I was pretty shocked. It was just a mild cough that wouldn't go away! No 'whooping' or anything even close. I only hope in those seven or eight weeks I didn't pass it on to any parents or young children unknowingly.

Also, I am not at all a violent person generally, but I would like to inflict grievous bodily harm upon anti-vax campaigners and parents. W T F, people. Ignorance is all well and good when it's only hurting you. Not so much when you're putting everyone else's children at risk of awful, painful, deadly diseases. *headasplode*
posted by po at 4:22 AM on September 27, 2012 [6 favorites]


From reading Apoch's linked piece, I learned that once again, somebody took money to promote suffering. Tobacco lawyers, asbestos lawyers, paid climate-change deniers, social-service funding cutters, warmongers - these people are a disgrace to the species.
posted by Kirth Gerson at 4:23 AM on September 27, 2012 [6 favorites]


Christ. And from the NYT link it looks like that could be underestimating the cases, as some medical professionals are seeing the cases come so fast they don't have time to send the official pertussis tests out.

I'd be getting delicious schadenfreude from this situation if it was the idiots themselves getting hurt and not their children.
posted by schroedinger at 4:28 AM on September 27, 2012


Jenny McCarthy must be called to account. I'm not kidding.
posted by 1adam12 at 4:41 AM on September 27, 2012 [11 favorites]


Thanks, Blasdelb.
posted by MonkeyToes at 4:41 AM on September 27, 2012 [2 favorites]


I picked up whooping cough during my sophomore year of college in, I think, 1999. I've always wondered where I managed to find whooping cough. Was it in Eugene? Was it at school in Arizona? No idea.

For me the coughing came in intense spells. Often I'd cough away for a while and then my throat would seize up and close off entirely, which was terrifying. I was told this was a laryngeal spasm and while it felt like I would never breathe again, it always relented and I could draw breath after another 60-90 seconds of terror. Then I'd spit some blood and move on with my day.

The weeks I legitimately wondering if I was about to die from coughing were not super fun.
posted by Shutter at 4:44 AM on September 27, 2012 [5 favorites]


Allowing people to have control of their bodies has the unfortunate side effect of allowing idiots to have control of their bodies.
posted by notme at 4:45 AM on September 27, 2012 [10 favorites]


It used to be, in Houston, a child could get all their vaccines for free from the clinic attached to WIC offices. I am almost positive that non-WIC, non-Medicaid people could get them for their children on a sliding scale. Is this not possible in Washington?

A few years ago, we had a huge campaign to get vaccines in adults for DPT (diphtheria, pertussis, and tetanus). I had no idea before the campaign, but these vaccines you get as kids don't last forever -- you have to get booster shots even when you are an adult! So, just in case I wasn't the only one to know: Booster shots every 10 years, even as an adult!
posted by Houstonian at 4:48 AM on September 27, 2012 [4 favorites]


"It used to be, in Houston, a child could get all their vaccines for free from the clinic attached to WIC offices. I am almost positive that non-WIC, non-Medicaid people could get them for their children on a sliding scale. Is this not possible in Washington?"

"The current price (of vaccine) is $60, and for some people that's not doable with the economy right now," said Marci Reynolds, clinical-care coordinator for QFC. Most insurers cover the cost of the vaccine. . But with the state-supplied vaccine, the price drops to a $10 to $15 service fee if the underinsured or uninsured customer can pay. Otherwise, the fee is waived." (Source)
posted by Blasdelb at 4:55 AM on September 27, 2012 [2 favorites]


Antivax activism is complicity in murder and should be prosecuted as such.
posted by Pope Guilty at 5:05 AM on September 27, 2012 [14 favorites]


Wow i had no idea you needed a DPT booster. I got a tetanus shot awhile back because of a rusty thing incident. But heck. Im gonna have to find out how much the booster is an uninsured such as myself. I do not want whooping cough. I had a lingering cough a few years ago the doctors couldn't diagnose except to say "not pertussis". Im surprised they didnt suggest the booster.
posted by sio42 at 5:10 AM on September 27, 2012 [1 favorite]


"Allowing people to have control of their bodies has the unfortunate side effect of allowing idiots to have control of their bodies."

If we intend to live in community with each other, there absolutely must be limits to this. For example, while city dwellers absolutely have a right to the privacy and sanctity of their homes absent a hell of a lot of due process and good reason, however they do not have a right to keep firefighters from invading their homes, ripping them apart with axes, or drowning them with water or chemicals as part of efforts to prevent fires from spreading. The bare communal necessities of firefighting and epidemic control can absolutely require ways to set aside otherwise inviolate rights to personal integrity when there ends up being no other way.
posted by Blasdelb at 5:15 AM on September 27, 2012 [26 favorites]


I'd like to point people's attention to the third paragraph of the OP up there - about gaps in herd immunity.

This is the key point, here.

Sure, a vaccination protects you, but that's just the starting point. It also protects everybody around you, with the end goal of eliminating deadly diseases.

So when we say that there's a significant danger to other people when parents don't get their kids immunized, or when we talk in metaphors about not allowing firefighters into your house, it's not hyperbole.

Gaps in our collective immunity allow dangerous diseases to grow stronger.
posted by entropone at 5:29 AM on September 27, 2012 [5 favorites]


Allowing people to have control of their bodies has the unfortunate side effect of allowing idiots to have control of their bodies.

Well, the problem, in this case, is that these people are allowed to have badly-informed control over other people's bodies. We allow parents a terrifying amount of latitude to make decisions that will harm, cripple, or kill children, and we allow it on the flimsiest of pretexts.
posted by GenjiandProust at 5:30 AM on September 27, 2012 [6 favorites]


Science Based Medicine's dr Gorski weighs in. While not dismissing the importance of the above factors, he notes that the immunity granted by the acellular pertussis vaccine appears to wane faster than we thought, so an adjustment of the vaccine schedule to bridge the gap between young children and adolescents is in order.
posted by hat_eater at 5:31 AM on September 27, 2012 [4 favorites]


I have a very hard time keeping my cool against anti-vaccination parents. I want to shake them, slap them upside the head, and then call CPS on them.

Mini-Furnace just turned 1, and we're part of a couple kid-centric communities (daycare, a babysitting co-op, etc). There are quite a few anti-vaccination parents that we deal with on a fairly regular basis. It's insane. These are educated, fairly smart people, but we have the goddamn hardest time explaining herd immunity to them.

It's impossible, and the first deeply terrifying thing we've had to deal with as parents.

We're lucky that Mini-Furnace is built like a goddamn tank, and hasn't really gotten sick, but sweet jesus, we still get him immunized, FOR EVERYONE ELSE'S SAKE. We're immunized, and we paid for our low-income roomates to get immunized, because this shit is serious business.

I mean, whooping cough is bad enough, but do we really want to see shit like measles come back?
posted by furnace.heart at 5:51 AM on September 27, 2012 [12 favorites]


Well, for what it's worth
The US District Court in Ohio has ruled that a parent’s refusal to vaccinate her children against diseases is not “free exercise” of religion, and amounts to neglect.
The best I could find is a secularnewsdaily.com link, which I'm sure makes the citation-bias nazis cringe a bit, so if someone can find a better link somewhere I'm all ears.

But just the same, it seems as thought one of the anti-vaccine tools has the chance to be somewhat limited.
posted by Blue_Villain at 5:56 AM on September 27, 2012 [1 favorite]


Of course, there's always the other side of the coin.
posted by Blue_Villain at 5:58 AM on September 27, 2012


Another problem for Washington State is that a number of the insurers that operate in this state will not pay for the vaccine. Even if you're insured, it can be out of pocket and therefore out of reach, if you're on a limited income.


?????!!!!! Really?
posted by ocschwar at 6:03 AM on September 27, 2012 [1 favorite]


Bad news furnace.heart, bad news.

I came here to post pretty much exactly what Pope Guilty posted. Outspoken anti-vaxxers should be charged with manslaughter or conspiracy or something. Anti-vaccine campaigners and protesters will kill far far more people (and mostly children in all probability) than terrorists and drug dealers put together.

Depressingly now WHSmiths (a UK newsagent) have started stocking anti-vaccine propaganda.
posted by Just this guy, y'know at 6:07 AM on September 27, 2012 [1 favorite]


Wow i had no idea you needed a DPT booster.

I didn't know that, either, until I got pregnant (I'm pretty healthy and rarely went to the doctor otherwise). I was able to get one in the hospital shortly after the baby was born (at 4:30 a.m. no less, from an overeager night nurse); they routinely offer them to all the new Moms to help protect their infants.
posted by ThePinkSuperhero at 6:14 AM on September 27, 2012 [1 favorite]


Often I'd cough away for a while and then my throat would seize up and close off entirely, which was terrifying.

Shutter has it right - aside from the coughing itself, the episodes when your throat closes up and you can't breathe are completely terrifying. It's like a thick mucous clogs your throat like wet drywall paste. I suffered through it about 8 years ago, and honestly thought I was going to die a couple times.
posted by sixpack at 6:18 AM on September 27, 2012 [1 favorite]


I was in the swimming pool changing room with Jimmy Jr last week and 40-something Random Dude next to me is looking at her (creepy as it is) and then comes out with "she seems smart, don't vaccinate her. Have you vaccinated her?"

Now, I was in full Dad get-sock-on mode and yet this just stopped me in my tracks. I'd heard of these people, but like Holocaust deniers thought it was just something wacky I wouldn't really have to deal with.

"Yes."

"Well, looks like she survived it then."

I had to just walk away, quickly, before carnage ensued. I'd never wanted to do physical harm to someone, as an adult, as I did then.
posted by jimmythefish at 6:27 AM on September 27, 2012 [7 favorites]


ocschwar: "Another problem for Washington State is that a number of the insurers that operate in this state will not pay for the vaccine. Even if you're insured, it can be out of pocket and therefore out of reach, if you're on a limited income.


?????!!!!! Really?
"

We're not in Washington, but our insurer didn't used to cover vaccines, either. We basically paid out of pocket for each one, so for several months after our baby was born we were regularly getting bills for hundreds of dollars. We could have gone to the county clinic, which would have been very slightly cheaper but required taking more time off of work.

Now, though, our insurer is required to cover preventative care including immunizations. Thank you, Obamacare.
posted by that's how you get ants at 6:31 AM on September 27, 2012 [16 favorites]


"2004 - 2005 had an enormous increase, only to drop off in 06/07/08. I wonder why?"

If I recall correctly, this was when there was an epidemic in Illinois and Iowa high schools, some of which had to close for a couple weeks because so many students were out sick. Many others had a sort of quasi-quarantine thing where if you were coughing AT ALL you were not allowed in school. It passed among the properly-vaccinated high school students whose immunity had (somewhat unexpectedly) worn off, and after that outbreak was when they started pushing more frequent boosters for adults. One of my relatives was affected, not badly, but had to stay out of school for two entire weeks.

(And, yes: "In 2004-05, Iowa was at the center of a national whooping-cough epidemic that was the largest such outbreak in 30 years.")

If you're going to be around other people's babies, get your Tdap booster. Pertussis might not be so bad for an adult -- you might not know you're whooping rather than just having an annoying winter cold -- but it can be deadly for a baby, and they don't begin the DPT vaccinations until 2 months of age and require several boosters to get immunity running full-tilt.
posted by Eyebrows McGee at 6:35 AM on September 27, 2012 [3 favorites]


Also, yeah I'd heard that whooping cough was going around Victoria BC, where I live and also physically and mentally tucked into Washington St. We have a big nutbar population. With a one-month old and 2 year old in the house, I really fear for my children with that shit floating around. It should be made law that if your child attends a public school, or used public facilities like pools, or receives child care benefits, or attends a daycare, they must be vaccinated.
posted by jimmythefish at 6:35 AM on September 27, 2012 [2 favorites]


Sorry for the errors, I need to stop posting from my phone before I've had coffee.
posted by jimmythefish at 6:38 AM on September 27, 2012 [1 favorite]


I would be outraged about this but it would just be lost in the general outrage I feel whenever I read about children and how many of them we're making.
posted by Mooseli at 6:42 AM on September 27, 2012 [4 favorites]


It should be made law that if your child attends a public school, or used public facilities like pools, or receives child care benefits, or attends a daycare, they must be vaccinated.

The mama-bear parent in me would go even further and say YES MANDATORY VACCINATIONS, the cynical prochoice part of me says watch out when it comes to making any medical procedure mandatory across the board, because Congress is not a doctor, and even doctors have been wrong (not in this case, but they have been before) and I worry about establishing that precedent.

I wish that a) people weren't so gullible and b) I didn't have so much reason to mistrust my government when it comes to medical decisions.

On the other hand, dead and sick children. So I guess I would be ok with a law provided it had an appeal mechanism and was specifically limited to vaccinations. I don't want some dingleberry making circumcisions or tonsillectomies mandatory.
posted by emjaybee at 6:45 AM on September 27, 2012 [3 favorites]


"2004 - 2005 had an enormous increase, only to drop off in 06/07/08. I wonder why?"

Before the vaccine era pertussis oubreaks were always cyclical in nature neither immunity from vaccines nor immunity from exposure lasts forever and there used to be outbreaks every two to five years like we are begining to see emerge now.
posted by Blasdelb at 6:46 AM on September 27, 2012 [2 favorites]


Mooseli, yeah it's like how I get enraged about climate change but it just gets lost in my general outrage about how many squirrels there are.
posted by jimmythefish at 6:48 AM on September 27, 2012 [5 favorites]


1adam12: "Jenny McCarthy must be called to account. I'm not kidding."

Seriously.
posted by lazaruslong at 6:51 AM on September 27, 2012 [2 favorites]



"Allowing people to have control of their bodies has the unfortunate side effect of allowing idiots to have control of their bodies."

If we intend to live in community with each other, there absolutely must be limits to this.


If you can't prevent the state from injecting things through your skin and into your body, you can't claim to have control over your body. I don't see a way through that impasse.

But there are ways around it.

We need to forbid non-medical exemptions for public school students. Whether philosophical or religious, an exemption must also be an exemption from public school enrollment.

And forbid food service workers from being unvaxed. No Whooping Cough Hannahs.
posted by ocschwar at 6:57 AM on September 27, 2012 [2 favorites]


I think we can actually solve this via the market. Everyone who receives a vaccine pays a dollar or two into the National Vaccine Injury Compensation Program. If you have one of the listed side effects within a certain period of time after receiving a vaccination, you don't actually have to prove the vaccine caused it; you're just compensated for it. The theory is that vaccination is important enough that we want everyone in society to do it, but it will negatively affect a certain number of people, so we will compensate those people with a minimum of hassle. The costs of those injured by vaccines are fully covered by those in society who vaccinate.

So, those who choose NOT to vaccinate should have to pay into a Non-Vaccinated Injury Compensation Program. For every vaccination you skip (for any but specified medical reasons), you will buy a waiver for that vaccine. The cost of the waiver will be adjusted yearly to the cost of the most recent year's vaccine-preventable disease outbreaks whose transmission can be linked to people who are unvaccinated by choice. So if 600 people in California don't get their MMR, and there's a measles outbreak of 9 cases in California that costs the state $300,000 to contain, it will cost the non-vaccinators $500/certificate to not vaccinate for MMR. No exemptions or cost waivers, because it's not in society's interest for you to not vaccinate. But we will give you free vaccines!

Since, in my program, non-vaccinators would be responsible for the cost to the state of containing the outbreak, all treatment for the sick, and any permanent disability or death resulting from the outbreak, it will quickly become expensive, and the more people who refuse to vaccinate, the more expensive such refusal will become because the outbreaks will be larger. For example, "Last year, California had more than 2,100 whooping cough cases, and 10 infants died. Only one had received a first dose of vaccine." What would treating 2,100 whooping cough cases cost? Paying those parents for lost work? Paying a wrongful death payment for 10 infants? Those waivers are going to start to get very expensive very quickly.

Not only are those of us who vaccinate responsibly protecting everyone around us, but we're PAYING for those who are injured by our decision as a society to vaccinate. All I ask is that those who make an IRRESPONSIBLE decision not to vaccinate pay the societal costs of THEIR decision as well, instead of being allowed to externalize the costs of their decision.
posted by Eyebrows McGee at 7:00 AM on September 27, 2012 [48 favorites]


As the mom of a 4 month old, whooping cough is tremendously scary. Ask the grandparents to get the whopping cough shot as well. I personally know at least one adult (educated, not anti-vac, just didn't know about booster shots) that got whooping cough when my baby was really little and was not old enough for his first set of shots yet (luckily we didn't cross paths then).
posted by ejaned8 at 7:00 AM on September 27, 2012 [1 favorite]


My kids were all vaccinated. They all three got pertussis last year up here the PNW. They were sick for two months. It was unbelievable how persistent pertussis is.

It is a terrible sickness, and whatever this strain is, it's fucked up.
posted by roboton666 at 7:05 AM on September 27, 2012 [1 favorite]


This epidemic may not solely be due to the "autism from vaccines" panic (though I'm sure that hasn't helped).

The old form of the pertussis vaccine (not acellular form widely used today) had a documented history of causing serious side effects in a very small percentage of patients. Both my father and his sister had severe reactions to the old-style whooping cough vaccine in the 1950s, experiencing high fever and seizures. In my father's case the seizures caused permanent damage that led him to have seizures for the rest of his childhood; in adulthood he was able to get them under control with daily medication.

This family history prompted a doctor to advise my mother (who is actually generally very pro-vaccine) not to vaccinate my sister or me against pertussis in the 80s. (We received all other recommended vaccines on schedule.)

As an adult I learned about the new lower-risk acellular vaccine and finally got myself vaccinated. But only after my son was born and I asked his doctor about the vaccine.

I wonder how many adults like me, who were not vaccinated as children due to legitimate medical concerns surrounding the old vaccine, are out there totally unaware that there is now a safer version of the vaccine?

And then of course there is the fact that immunity wanes even among vaccinated adults, even moreso among adults who received the safer but weaker acellular form, and there doesn't seem to be a lot of public awareness about the need for boosters.

My family doctor told me that many doctors are now including the pertussis booster with the tetanus booster as standard practice, since the need for tetanus boosters in adulthood is already a generally known thing, but I'm not so sure most of the adults I know bother to keep up properly with their tetanus boosters, either, even if they know better.
posted by BlueJae at 7:05 AM on September 27, 2012 [6 favorites]


Dot: Who's your pediatrician? - Ed:We ain't exactly fixed on one yet, have we?
Dot: Jesus! Well, you gotta have one this instant! What if the baby gets sick, honey? - Even if he don't, he's gotta have his dip-tet.
Ed:He's gotta have his dip-tet, honey.
Dot: You started his bank accounts yet? - Ed:Have we done that? We gotta do that.
Dot: You gotta get 'em dip-tet boosters yearly or else they'll develop lockjaw and night vision
posted by Gungho at 7:05 AM on September 27, 2012 [7 favorites]


I work in a related field and have utmost respect for Paul Offit, his books are very good. If you have the time I highly recommend a NPR Science Friday with Paul Offit called Deadly Choices. There is a woman who calls midway through, claiming to be open minded and skeptical of vaccines, I won't spoil the rest but it really encapsulates the entire situation for me.
posted by oshburghor at 7:17 AM on September 27, 2012 [2 favorites]


I would be outraged about this but it would just be lost in the general outrage I feel whenever I read about children and how many of them we're making.

Then try considering that pertussis can also kill adults, especially those whose immunity is compromised due to illness or suffer from respiratory ailments such as asthma or emphysema?

I developed a vicious case of brochitis on top of asthma last year and nearly ended up in the emergency room. I can't even begin to imagine how much worse it would have if I had pertussis instead.
posted by theBigRedKittyPurrs at 7:27 AM on September 27, 2012 [1 favorite]


Mandatory vaccination for the popular!

The friendship paradox (NYT link, wikipedia) is this neat thing that I recently learned about. It seems to suggest that vaccinating people who know a lot of other people is a way to achieve herd immunity with a smaller percentage of the population vaccinated. Makes sense when you think about it -- vaccinating a hermit isn't likely to do a lot for herd immunity.

Also, the friendship paradox mathematically explains why my friends all seem have more friends than I do.
posted by selfmedicating at 7:30 AM on September 27, 2012 [2 favorites]


Hey everyone, community health clinic doctor in Washington state, here. I have to run off to work in a sec, but a couple of things I wanted to say:

1. The true incidence of pertussis is likely much higher than the statistics would indicate. In adults, pertussis often looks like a nasty cold and the test for pertussis is expensive, a little tricky, and not every primary care office is set up to do it, so I am sure we are missing lots of cases, even though our awareness for this is high right now.

2. The state has supplied *free* Tdap (tetanus-pertussis) boosters to hospitals and community health centers, specifically for uninsured people. At my clinic, we have run through our supply just a few days ago, but I am sure there are many other places that still have a supply. I don't know if we will receive more. The cost at a federally funded community health center is about $15 if you just pay for it. Everyone should get this, but if you have a small child in your life or someone with respiratory disease, it's kind of unforgivable if you don't get this.

And cover your mouth when you cough, you sicko!
posted by Slarty Bartfast at 7:32 AM on September 27, 2012 [29 favorites]


My local San Francisco quack chiropractic office regularly advertises vaccine seminars. Because apparently spine manipulation can cure measles.

My impression is most vaccine deniers in SF are good liberal people, reasonably well educated, but leaning too heavily on intuition instead of science. In a previous age they would have been religious people, believing in angels and saints. Now they believe in alternative medicine and gluten-free diets and the spiritual power of yoga.
posted by Nelson at 7:39 AM on September 27, 2012 [6 favorites]


I'm Washington resident, and both my cousin and an ex-coworker friend (also in state) had babies recently. While they were due, they made it clear, if communicated in a friendly fashion, that family and friends weren't welcome to see their new infants unless our pertussis vaccinations were up to date. I just got my DTAP booster for that reason. (diptheria, tetanus and pertussis/WP)

Also, I got it in my dominant arm, like a fool. When they say it gives you joint ache in the shoulder, they aren't kidding. It was really annoying. But hanging with babies was fun, and totally made up for it.
posted by Sunburnt at 7:46 AM on September 27, 2012 [2 favorites]


I wonder how many adults like me, who were not vaccinated as children due to legitimate medical concerns surrounding the old vaccine, are out there totally unaware that there is now a safer version of the vaccine?

I don't know, my twin and I had horrible reactions to the first of the pertussis shots in the 80's. We've been advised to not get the newer, safer formula based on our reaction, but I've had to discuss it with every doctor I've seen. My GP actually tried to give me the tetanus/pertussis booster last week, and we had to go over the reasons again. I think a bigger problem is lack of access to preventative services like boosters, coupled with the potential for a shorter effective period for the newer vaccine.
posted by jetlagaddict at 8:13 AM on September 27, 2012 [3 favorites]


Also, I got it in my dominant arm, like a fool. When they say it gives you joint ache in the shoulder, they aren't kidding. It was really annoying.

Ah, the classic vaccination blunder. Non-dominant arm. And relax, dude! All that muscle clenching in anticipation of the shot means more force is necessary and more bruising.
posted by Slarty Bartfast at 8:15 AM on September 27, 2012 [1 favorite]


I got this last month. It sucked.
posted by Ironmouth at 8:21 AM on September 27, 2012 [1 favorite]


I just made a Dr.'s appointment to get my 10 year booster.
posted by ChrisHartley at 8:23 AM on September 27, 2012 [4 favorites]


Of course, there's always the other side of the coin.

What other side? Same anti-vaxers wanting to endanger everyone else's kids while relying on herd immunity to protect their own.

How are these WVians any different from the Washingtonians doing the same thing?
posted by Pirate-Bartender-Zombie-Monkey at 8:25 AM on September 27, 2012 [2 favorites]


I wonder if the last generation before any widescale social or economic collapse in history tends to resemble contemporary libertarians. The kind of people who go, "well, why should we keep doing the things that have kept society together up until now? Paying taxes, acting in the common interest, maintaining infrastructure—so boring and unjust! There are BASIC FREEDOMS! Oh, and my children are special ..."

Then, after a few decades of this, the bridges all fall down, the trade-routes close off, the state's insolvent, and there are plagues circulating inside the city walls ...
posted by Sonny Jim at 8:46 AM on September 27, 2012 [5 favorites]


People have been peddling bullshit about vaccinations since before Andrew Wakefield; hell, people were peddling bullshit about inoculation before vaccination was even invented. There was significant controversy when inoculation against smallpox was first introduced to the West in the early 18th century. There's a good overview of that here, some of which sounds very familiar:
In his 1767 book, New Reflections on the Practice of Inoculation, the Italian physician Angelo Gatti captured what had, for 2 decades, thwarted Bernoulli's and the philosophes' efforts to promote voluntary adoption of inoculation. Gatti argued that without complete assurance of its safety, inoculation would never be widely practiced. The inoculation decision entailed a calculation of risk—the guaranteed risk of a mild case of inoculation-induced smallpox in the near term vs the uncertain probability of contracting natural, more virulent smallpox in the future. Challenging the philosophes, Gatti contended that individuals did not view medical risk through the lens of mathematical calculation. Echoing the arguments of the encyclopedist Jean le Rond d'Alembert, Gatti emphasized the paramount influence of the individual's subjective, psychological experience. The risk of death in the short-term from the inoculation had a paralyzing psychological effect. Gatti wrote, "An immediate risk, no matter how slight, will always make a greater impression than a very great, but distant and uncertain one."
But even though smallpox inoculation was genuinely risky (albeit much less risky than catching smallpox), people were also making the vaccines=unnatural=BAD connection back then outside the risk calculation, even when Jenner came up with the cowpox vaccine. Now, it's "vaccines contain chemical substances which are not supposed to be in our bodies and will harm us!"; then, it was "vaccines contain animal substances which are not supposed to be in our bodies and will harm us!" Antivax campaigners are all over the place about exactly which chemicals they're blaming because the specific chemicals don't seem to matter; what matters is that they're scary-sounding chemicals that sound like the sort of things that could do bad things to us.

And I think the claims that "these are just normal childhood diseases, kids always got these and they was fine" is not a million miles from the early anti-vax and anti-inoculation campaigners' claims that "this is against the will of God", too. They both boil down to "these are just normal and natural parts of the world, and messing with them would be a terrible thing."

I don't know what the best method is for dealing with this. Campaigns? We've been fighting the same battle over the usefulness of vaccinations for literally hundreds of years now, and still people are more willing to believe in conspiracy theories than they are in evidence. Showing people the reality of the diseases they're refusing to vaccinate against? I would like to believe that anyone who watched those videos of kids with pertussis couldn't possibly refuse to vaccinate their own, but then the early anti-inoculation campaigners must have seen kids die of smallpox. It's like a perfect storm of our awfulness at risk calculation plus our distrust of the medical establishment.

On the other hand - we wiped out smallpox, so surely we can wipe out antivax propaganda...
posted by Catseye at 8:56 AM on September 27, 2012 [6 favorites]


Catseye: Antivax campaigners are all over the place about exactly which chemicals they're blaming because the specific chemicals don't seem to matter; what matters is that they're scary-sounding chemicals that sound like the sort of things that could do bad things to us.
Interesting. So there's a long-term intellectual resistance to rationalism and the concept of cause and effect? I can buy this. I wonder if what we've seen since the rise—and eventual normalization—of "New Age thinking" since the '60s is a return of the doctrine of sympathies and antipathies into common currency. The New Age is essentially a form of popularization that repackages older occult ideas and epistemologies for mainstream consumption. Once enough people start thinking like that (and I use the word "thinking" loosely here), you're going to get problems maintaining institutions and practices predicated on scientific principles.
posted by Sonny Jim at 9:16 AM on September 27, 2012 [2 favorites]


DPT vaccine shots are available at grocery store pharmacies in WA for about $60. Insurers may or may not cover it depending on your plan. You can do it as a walk-in. I looked into this just a few weeks ago when I heard about the whooping cough news.

It was, by the way, irritatingly difficult to figure out where I was supposed to go to get this done. Turns out it was not a single, simple phone call.
posted by scaryblackdeath at 9:20 AM on September 27, 2012 [2 favorites]


I know two parents who are what might be called "partial objectors." DPT shots, absolutely. But they have grave reservations about the current approved vaccination schedule. Giving babies under 6 months vaccines against Hepatitis B, Rotavirus, polio, influenza, and pneumonia in addition to DPT is asking a lot of a brand new immune system. Are they endangering the herd? Or are they reacting sanely to another example of the over-medication of our modern health care system?

And if you don't think our health care system is completely insane on the subject of prescribed medication, than you're as much in denial as all the previous posters who dismiss wariness towards vaccines as unworthy of any consideration.

Mostly I'm just glad my kids are grown, and it's not an area I have to venture into. So much anger!
posted by kestralwing at 9:48 AM on September 27, 2012 [3 favorites]


Anger is an appropriate response to willful ignorance that causes people to get sick and die.
posted by Nelson at 10:05 AM on September 27, 2012 [2 favorites]


It's strange moving to a new city (a year ago) with a young child and meeting new parents and kids. In the bay area I think we had filtered out the folks who didn't believe in vaccinating because while very nice people we knew the risks associated with not vaccinating and just sort of drifted apart. When we moved to the new city, we were making playdates and meeting new families left and right. Inevitably some of them weren't quite on board with the vaccination routine, and we sort of had to make some decisions about kids and parents we're going to have in our house - not strictly hang out with but in the house because we have some immune system compromised family and also varied friends and family visiting with young children who haven't been through the full vaccination schedule yet due to age.

It was a weird conversation to have with my wife indicating people we thought were lovely and kids we had babysat and watched couldn't be welcome in our home any more because of some of their decisions around not vaccinating their 3 year old.
posted by iamabot at 10:26 AM on September 27, 2012 [2 favorites]


"Giving babies under 6 months vaccines against Hepatitis B, Rotavirus, polio, influenza, and pneumonia in addition to DPT is asking a lot of a brand new immune system."

I keep hearing this, and sentiments like it, but it reflects a fundamental misunderstanding of how the human immune system works and what its challenges are. Let me elaborate,

Our adaptive immune systems work in a really cool way that should, in theory, protect us from an infinite number of potential pathogens but has a few significant drawbacks. As the white blood cells that mediate the adaptive immune response get made they each are born with a completely new antibody through a very randomized process that has a very specific and very random shape on the business end that could, in theory, bind to anything.1 These antibodies are how our bodies recognize foreign invaders that have some means of evading our innate immune systems, and in theory there are enough white blood cells running around our bodies that one of them will have an antibody that will be effective. One white blood cell though is not enough to meaningfully fight off an infection, and so whenever a mature white blood cell encounters something that triggers its antibody it immediately races back to a lymph node and starts dividing like crazy to make enough cells to eliminate the infection. Then, once the infection is cleared, almost all of the new clones of the effective will trigger themselves for death to make room for new white blood cells. One of the big draw backs to the fantastically complex process that is the adaptive immune system is how long it takes to get going, so a significant portion of them will change in such a way as to protect themselves from degredation and remain as a resevoir of memory cells waiting in case the infection ever comes back such that the process has a big head start the second time. This is the biggest reason why when people get sick with infections they then get better as well as why people don't tend to get sick from the same thing twice.

I can sort of see the logic in assuming that this process is all pretty stressfull, and that maybe babies would have a hard time dealing with it, but you've got to understand that the moment that the child leaves the sterile uterus their immune system is suddenly surrounded by the functionally infinite number of antigens present on the 100 trillion bacteria found in the human gut and on human skin. The infant immune system is amazingly robust, the how of it all is truely beautiful if you've got the stomach for learning all of the four letter acronyms you've got to memorize to learn it, and the effort required for it to learn from the 14 vaccines delivered in 26 doses as infants is absolutely piddlyshit compared to the stress from learning the contents of a single sneeze. At the same time the benefits are amazing, instead of having to learn from a thing that is trying to kill it, the infant immune system gets to learn from target practice on something that is dead in the water or better yet a inert piece that happens to be the weak spot for the whole damn thing.


1One of the big problems with that strategy though is what happens when the antibody recognizes something that is actually us or for what ever reason actually belongs in us and shouldn't be attacked. Our bodies deal with this by immediately killing all of the white blood cells that are born with an antibody that recognizes a target within the first few weeks of being created, the idea is that if it sees something that quickly its probably something that should be there. Auto-immune disorders are what happens when this system fails for a variety of reasons and our immune cells start attacking things that are us.
posted by Blasdelb at 10:28 AM on September 27, 2012 [99 favorites]


TL;DR, Just the act of birth is asking more than 1025 more than the full compliment of vaccines
posted by Blasdelb at 10:33 AM on September 27, 2012 [17 favorites]


Vaccination is one of those things I can't really bring myself to argue about anymore. It's glaringly obvious to me that it's a both a personal and public health responsibility, really a civic duty, for all those healthy enough to do so to be vaccinated. And the "arguments" of anti-vaccination folks are so mind-bogglingly ill informed and flat out selfish that I don't even begin to know where to deconstruct them.

And so, I don't really argue any more -- except with my medical microbiology students, who are typically people who want to practice medicine as nurses and physicians. Them, I get on board.

So rather than spending mental energy on arguing the merits/dangers of vaccination, conversations like this make me wonder what an effective vaccination campaign would look like. It seems to me that mandating vaccination more strongly than is currently done would lead to an extraordinary public backlash given the current relationship between the populace and the government, at least in the US, and possibly lead to lower levels of compliance out of sheer orneriness. I love Eyebrows McGee's scheme in theory, but I can't imagine that being efficiently put into practice any time soon. So what marketing tactic is necessary to get people to want to be vaccinated, and to have their children vaccinated? What image is on a billboard that gets through to a parent driving to work, where science has not?
posted by amelioration at 10:34 AM on September 27, 2012 [4 favorites]


But they have grave reservations about the current approved vaccination schedule. Giving babies under 6 months vaccines against Hepatitis B, Rotavirus, polio, influenza, and pneumonia in addition to DPT is asking a lot of a brand new immune system.

No, it isn't. At that phase of life, the baby's immune system is the most vigorous it will ever be. That's how the baby is able to start sampling the environment for antigens literally at the moment of birth.
posted by ocschwar at 10:36 AM on September 27, 2012 [3 favorites]


So what marketing tactic is necessary to get people to want to be vaccinated, and to have their children vaccinated? What image is on a billboard that gets through to a parent driving to work, where science has not?

Considering they're ignoring the actual results of dead children, I shudder to think what would work.
posted by jetlagaddict at 10:39 AM on September 27, 2012 [5 favorites]


amelioration,
The effectiveness of a marketing campaign is entirely based upon it's impressionistic deliverable, i.e., does it ask the audience to think and reason or does it resonate with a more base emotional harmony with either a motivation to act upon said emotion or to remain passive. Fear campaigns work because of a triggering of the fight or flight response, just as ego stroking campaigns work through the simple message of "you are accepted because you do X". Marketing is a base sociology and really should be approached from that perspective. The problem of today's society is that there has been so many bad marketing campaigns or ham-fisted attempts at manipulation through a constant level of hyped up emotional triggers, that each new campaign has to try and crowd out the existing influences. It'd be great if people responded rationally and were willing to expend the energy to think about the subject rather than allow their decisions to be controlled by the base emotional "feeling" that the subject at hand brings up, but that just not how our tiny little monkey brains are wired. So an effective campaign needs to have a mark of shaming "if you love your child, you will do everything you can to protect them" and a note of safety "we've beaten with , come join the winning team" etc etc. Yes, it seems cheesy and cornball, but really, a lot of times the simplest message that aims for the lizard brain is really the most effective. Anti-vaxxers really hit this on the head, though, with the fear and paranoia spin, and the repetition. It takes 7 repetitions for someone to remember something, so the more it is repeated, the more likely it is to be believed. Humans suffer from source amnesia, which means they won't remember who said it, but they'll remember the message. Effective campaigns would need to be EVERYWHERE constantly for several months in order to have an effective broad reach (meaning a statistically significant part of the population is influenced).

At least that's my theory.

posted by daq at 10:49 AM on September 27, 2012 [2 favorites]


Sorry, I'm not following the argument that since a new baby's immune system is exposed to so many things, therefore it's fine to add even more things, especially against something like Hep B which the majority of babies would never be exposed to. And not all babies' immune systems are equally robust; in some cases fewer vaccines, or spreading the vaccinations out, would be appropriate, but there is very little recognition of individual differences in our current medical model.

Amelioration, that's a wonderful question. What would an effective vaccination campaign look like? I don't think it would involve jetiagaddict's image of dead children. But I could be wrong; I personally respond far better to projected positive outcomes than to fear-driven negative campaigns, but judging from the preponderance of fear-driven propaganda, I may be in the minority.

Maybe some kind of "we're all in this together" campaign, with the emphasis on preventing epidemics? It worked for polio. And maybe not using the word "vaccination." People are pretty open to getting flu shots; maybe "Get your whooping cough shot" would be more effective?
posted by kestralwing at 10:57 AM on September 27, 2012


I don't think it would involve jetiagaddict's image of dead children.

Whoa, hold on, I was referring to the children who have actually died from being exposed to pertussis-- a result which people who blithely bypass vaccines are either ignoring or unaffected by. In no way was I suggesting using images of the dead, that would be horrific.
posted by jetlagaddict at 11:11 AM on September 27, 2012 [3 favorites]


If you don't vaccinate you're an idiot.
posted by ZaneJ. at 11:41 AM on September 27, 2012 [4 favorites]



Sorry, I'm not following the argument that since a new baby's immune system is exposed to so many things, therefore it's fine to add even more things, especially against something like Hep B which the majority of babies would never be exposed to.


It's good to add more things because those things enable the baby to resist fatal diseases.

Apropos Hep B, babies get the shot because that is when the immune system is best able to develop immunity for it. When you give it to adults, they don't get the immunity as effectively.
posted by ocschwar at 11:42 AM on September 27, 2012 [4 favorites]


Thanks for responding kestralwing, I know its got to be hard raising concerns in a forum filled with people calling for the arrest of anyone communicating doubts about vaccine recommendations. You mentioned two, so I will try to address them separately,

"Sorry, I'm not following the argument that since a new baby's immune system is exposed to so many things, therefore it's fine to add even more things, especially against something like Hep B which the majority of babies would never be exposed to."

Whenever a baby is exposed to a new antigen, or a molecular shape that can be recognized by the immune system, it can go through the whole process I described above. The sheer amount of exposures that babies just handle like champs is truly astounding, and while Hep B is certainly going to be fundamentally new to almost any baby, so is almost everything they encounter. How much stress each exposure to something new causes is entirely dependent on factors that we know very well and can manipulate easily in vaccines. For example, when your innate immune system sees one of a small set of very specific patterns embedded into our DNA that are associated only with pathogens in combination with something new, our immune system goes into overdrive, which can sometimes be dangerous. So, even though I could use these patterns in my lab to vaccinate rabbits for research purposes, no one would ever think to use them in human vaccines despite the fact that using them would make vaccines incredibly cheap and effective. Especially with infant vaccines, they are formulated to cause such a trivial amount of stress that the vast vast majority of babies notice nothing beyond the prick. The idea is just to make sure that the hundred or so most important antigens to have antibodies premade against are a part of the trillions and trillions that go through their systems on a daily basis.

"And not all babies' immune systems are equally robust; in some cases fewer vaccines, or spreading the vaccinations out, would be appropriate, but there is very little recognition of individual differences in our current medical model."

Here you have hit on one of the big weaknesses in the safety of vaccines, the surprisingly large number of people for whom they genuinely are more dangerous, but doctors and public health workers are EXTREMELY AWARE of this and are really extraordinarily willing to either not vaccinate or delay vaccination if there is ever any real reason to. These individual differences are one of the primary focuses of vaccine research, and while they are not a primary focus of public education campaigns, they are very much the center of what pediatricians are taught about vaccines. This is why infants are only ever vaccinated with the supervision of an actual pediatrician who is trained to screen for contraindications, and it is only ever done if everything checks out fine. With sixty years of experience doctors and public health workers have figured out really robust ways to determine who could even conceivably be in any real danger before they are exposed, and a big part of that is the current schedule. For example, egg allergies are tested for before exposing children to vaccines incubated in eggs, if they are allergic they either get an alternative or are SOL. Infants with allergies of any kind are only ever vaccinated against anything with an extraordinary amount of care, but a lot of infants simply can't be safely vaccinated and have to be left to the mercy of their neighbor's willingness to vaccinate.
posted by Blasdelb at 11:48 AM on September 27, 2012 [22 favorites]


Sorry, I'm not following the argument that since a new baby's immune system is exposed to so many things, therefore it's fine to add even more things, especially against something like Hep B which the majority of babies would never be exposed to. And not all babies' immune systems are equally robust; in some cases fewer vaccines, or spreading the vaccinations out, would be appropriate, but there is very little recognition of individual differences in our current medical model.

One of the key points that Blasdelb was making is that the immune system is set up to respond to any new "non-self" stuff that a person is exposed to. Until birth, the baby (and therefore its immune system) is basically only exposed to itself. The placenta acts as an amazingly specific molecular sieve, allowing the baby to receive nutrients and oxygen*, various hormones, and preventative help from its mum's immune system (in the form of IgG**), but basically nothing else.

So when the baby is born, everything that's "non-self" is new. The bacteria and fungi living on its parents' skin contain millions of unique molecular signiatures for it to recognise, its first spoonful of baby food has millions or billions more, and the fistful of dirt it eats when you're not looking would probably require me to make up a word like "squidrillion".

Over the first few months of life, the baby's immune system is ramping up from being a mostly blank slate to cataloging nigh-inconceivable numbers of new signatures ("antigens"), and learning which ones it can ignore (most of them) and which ones it needs to be ready to mount a response against. "A drop in the ocean" is a phrase that gets used a lot without much meaning, but when you consider the tens of antigens we're adding to the billions or trillions that a baby is already in the process of sampling, an eyedrop into an actual ocean is probably a nice metaphor for the scales involved.

Even if you don't buy any of that (you should), please remember that we have been vaccinating for a long time, and that the data pouring back out of the system is very closely watched. Not just by profit-driven drug companies (who you'd do well to treat skeptically), but also by governments, academic consortia and individual researchers. You might not believe that a single one of them wants the warm fuzzy feelings associated with improving millions of lives (not to mention how much academics enjoy pissing off Industry), but you should at least believe that they want the fame, fortune and groupies*** that would come along with it.

*The gas transfer is elegant. Babies' haemoglobin -- the protein & iron ion complex that's responsible for letting our red blood cells carry oxygen -- is slightly different to ours, making it cling on to oxygen more tightly. The mother's and baby's blood must never mix (otherwise, the mother would likely have an immune response against the baby's blood, which would not end well for either of them if untreated), but they're allowed to flow very, very close to each other in the placenta. Oxygen that's released from the mother's blood drifts across the barrier and gets snapped up by the baby's blood, which carries is back from the placenta to its body. The downside of this system is that a baby's blood is slightly more reluctant to release its oxygen to the surrounding tissues, making them very slightly more prone to being hypoxic.

The mechanisms for transfer of other stuff across the placenta are also very cool, but much more complex.

**Forgive the Simple Wiki link, but the actual Wiki page is too technical for any non-specialist, IMO

***If I refer to science groupies enough time, the idea is bound to catch on, right?

posted by metaBugs at 11:54 AM on September 27, 2012 [18 favorites]


Oops, should've previewed. Didn't mean to step on your toes, Blasdelb.
posted by metaBugs at 11:55 AM on September 27, 2012 [1 favorite]


"science groupies"

I'm totally stealing that
posted by Blasdelb at 11:57 AM on September 27, 2012 [3 favorites]


Try it and I'll set my groupies on you.
...*sob*
posted by metaBugs at 12:01 PM on September 27, 2012 [3 favorites]


"Anger is an appropriate response to willful ignorance that causes people to get sick and die."

I think you might have that first word mixed up with understanding and compassion, which can pretty much always be deemed more appropriate than anger.
posted by Blasdelb at 12:02 PM on September 27, 2012 [2 favorites]


I can't think about the antivax movement without feeling white hot rage, but I wanted to drop a note and thank metaBugs and Blasdelb and other more knowledgeable users than I for dropping some cold hard science.
posted by Phire at 12:03 PM on September 27, 2012 [14 favorites]


What Phire said.
posted by magstheaxe at 12:09 PM on September 27, 2012 [2 favorites]


I hear a lot about how impossible it is to argue with anti-vaxxers, but haven't really experienced it; even in Olympia, WA where I went to school, a dark heart of woo-dom at the center of this epidemic. I suspect the frustrating dynamics have at least as much to do with the arguers as anti-vaxxers. The trick, I think, is twofold: to actually know what the fuck you are talking about and not be a dick about it. Both unfortunately are very non-trivial. For example, with even the most hard core woo audiences, if you have a decent idea of how vaccines work, you can explain how it is actually about as natural as a therapeutic modality as we could possibly hope for. Vaccines can quite easily, and truthfully, be described using woo-esque language if you learn to speak it. As several people in this thread have noted from personal experience, the difference really doesn't generally result from any kind of lack of intelligence, so stop acting like it is and act with some goddamn dignity.

In terms of knowing what the fuck you are talking about, if you want to actually be convincing, learn how the human immune system works well enough to be able to describe it over some beers, it is incidentally amazingly cool. Really what I've found to be effective is the little things, like if you know where to find the mandatory declaration of the ingredients of all mandatory vaccines (PDF), you can just open a laptop and show it to anyone who still inexplicably thinks that the ingredients list is proprietary. With that you can also conveniently show them that there is no thimerosal in any of the required ones anymore.

In terms of not being a dick, I think it is most important to separate the 'what you are saying is dumb' conversation that you don't really want to have from the 'you are dumb' conversation that only assholes have; ala Jay Smooth. Without a real knowledge of how vaccines work, why we use them, and why they both are and aren't dangerous, woo-based arguments are pretty convincing. Make sure to remember that, even most of the readers in this thread will still have a turn of the last century level of understanding of immunology, and are thus ultimately relying on similar arguments from authority and hearsay to the ones anti-vaxers do.
posted by Blasdelb at 12:24 PM on September 27, 2012 [13 favorites]


"...academics enjoy pissing off Industry"

For context: these are people who do less than a third the work we do for more than three times the pay and, while almost all of them are actually really great folks, telling them that they've fucked up is so fucking fun. Proving that they could have never succeeded in the first place becuase their bosses are assholes is less fun, but considered a sacred duty.
posted by Blasdelb at 12:31 PM on September 27, 2012 [1 favorite]


Vaccines can quite easily, and truthfully, be described using woo-esque language if you learn to speak it....

In terms of knowing what the fuck you are talking about, if you want to actually be convincing, learn how the human immune system works well enough to be able to describe it over some beers, it is incidentally amazingly cool...

posted by Blasdelb at 3:24 PM on September 27


Blasdelb, as someone who is not scientifically-minded (I barely passed high school physics and biology), I would very much appreciate:

1) an example of "woo-esque language " for describing vaccines
2) some recommendations of web site for learning about the immune system. An "Immune Systems for Dummies", if you will.

I understand and appreciate that the anti-vaxxers aren't stupid, but it's very hard to remember that when they do stupid things that put the lives of others at risk. So if you would be kind enough to educate me, I'll take up your banner and try to be better at talking about these things
posted by magstheaxe at 12:31 PM on September 27, 2012 [2 favorites]


I think a big reason why it is difficult to convince and debate with anti-vaxxers is that from the anti-vaxxer perspective, what they are doing is a method of keeping their child safe. At least, that's what the believe. So when the topic comes up, the response is an emotional one ("Why do you want to hurt my child?") and not a rational one ("Oh, there is evidence to the contrary that I did not consider!") which is not a great place to start. And inversely, the science minded crowd frequently are also starting from an emotional place of "What you are doing could hurt MY children / nieces / whatever" and that can be challenging to keep a throttle on.
posted by lazaruslong at 12:40 PM on September 27, 2012


The situation with whooping cough in Washington isn't just about bad/stupid parents. A high number of infants and children get whooping cough from adults. Everyone should be vaccinated against it, and that includes adults without any known contact with children.

Seriously: everyone. If you're railing against the antivax crowd, and you haven't gotten the shot yourself: this is me, making a tsk tsk sound and raising an eyebrow knowingly.

When I checked last year, the shot cost around $65 out of pocket. I have a super shitty health care plan through Regence with a $3,000 annual deductible - but nevertheless, it still covered the cost of the shot.

If MY health care plan covers the cost of the TDAP (or is it DTAP?) then yours probably will too, if you have one.

No need to make an appointment. You can get the vaccination at most Safeway pharmacies, as well as pharmacies at Walgreens, Rite Aid, Bartell's - tons of places.

If you don't have health care, please seek out one of the free/sliding scale clinics in your area. I promise you, they will be happy - thrilled, seriously - to give you the vaccination.

It takes just a few minutes of your time, the side effects are minimal, and it can literally save lives. Please do it as soon as you can.
posted by ErikaB at 12:46 PM on September 27, 2012 [2 favorites]


The pertussis vaccine lasts for 4-6 years. If you haven't had this shot in the last 4 years, then YOU are part of the problem.

I would venture that adults are more of a problem because there symptoms can be relatively minor, when compared with children. Thus leading to more exposure as they will still go to work and such with a 'cold'.

I am also going to guess that since 75% of the people who have caught it have been vaccinated, that there may be more going on here than than a few un-vaccinated kids.
posted by psycho-alchemy at 1:19 PM on September 27, 2012 [2 favorites]


"I love Eyebrows McGee's scheme in theory, but I can't imagine that being efficiently put into practice any time soon."

I actually think it would be fairly trivial; states already have systems in place for checking the vaccine status of children entering kindergarten, and many states have already unified their billing systems for the DMV, child support, subsidized health insurance, etc. You would merely check vaccine status at age 5 with the system already in place (homeschoolers in states that don't keep records on homeschoolers is a non-trivial problem, but it's a small enough number to ignore to start with). Around here if you're not up to date on vaccinations at the start of school, you have until October 1 to bring your child current on his or her vaccinations (the date varies in different places, but whatever date is in local use is fine); by that date, you must either vaccinate your child or provide a paid-for waiver to be entered into the child's vaccination records. If you do neither, your child will not be allowed to attend school (public or private), daycare, or any state-licensed education-providing or child-care-providing entity.

This does raise the problem that the wealthy can buy themselves out while the poor would end up on payment plans with the state for their waivers, but refusal to vaccinate is largely a problem of the middle class and above; poor children who are not up to date on vaccines largely miss vaccinations because of spotty access to medical care, and their parents are typically eager to bring them up to date.

Anyway. We already have a really good society-wide system for checking vaccination status. It would be pretty trivial to piggyback a paid-waiver system on top of that.
posted by Eyebrows McGee at 1:29 PM on September 27, 2012 [3 favorites]


"1) an example of "woo-esque language " for describing vaccines"

I've got the very new 4th edition of Pizzorno's Textbook of Natural Medicine open in front of me, embarrassingly enough this is because I'm actually an author in it, to the section on the Philosophy of Naturopathic Medicine. So for the moment I am working from that,

One of the core concepts involved is vis medicatrix naturae or the healing power of nature in Latin. Really even modern vaccines are profoundly natural products, especially when compared to many modern pharmaceuticals. They are made from viruses and bacteria found in nature which are then only really modified by killing the thing with heat, growing the thing at lower and lower temperatures until it can't replicate effectively in you anymore, or giving you only the weak spot of the thing. The actual techniques involved in manipulating the thing are almost all pretty old by now, are surprisingly low tech, and even when just the weak spot of the thing is given, it is in a form not meaningfully altered from nature.

Another thing to keep in mind is the woo duality of the philosophies of Vitalism vs Mechanism. I'm a scientist precisely because I LOVE mechanistic explanations of biology, it’s like learning the language of our creation for me, when I read a really good paper my pulse still goes up and I still get a smile plastered on my face for at least the day - but this is not the context to argue about Vitalism vs Mechanism, particularly since vaccine effectiveness is totally understandable with Vitalist explanations. In short Vitalism is the idea that life is too complex to well organized to be understood as a complex assemblage of physical and chemical reactions, in contrast to the contention that in Mechanism the only difference between life and non-life is the degree of complexity. Vaccines work by stimulating the body's innate wisdom, getting it to reject a dummy target now so that it will have the knowledge necessary to safely reject the real target later. For the most part vaccines aren't even developed Mechanistically, but through trial and error, the mechanistic explanations of why they work the specific way they do usually come later. We would never be able to design a vaccine to make just the antibody we want to patient to produce because every patient's immune system will find the antibody necessary in its own way through a fundamentally random process.

Similarly, unlike many pharmaceuticals, vaccines do not bother trying to just treat symptoms but absolutely follow the principle of Tolle Causam, or find the cause in Latin. They treat the whole person not just some model system within one, and they are fundamentally preventative medicine not reactionary medicine.

"2) some recommendations of web site for learning about the immune system. An "Immune Systems for Dummies", if you will."

Past a certain point immunology is pretty hardcore, mostly because immunologists have been assholes with their nomenclature, but the very basics can be understood from a two hour lecture. I'm not sure what level you are at, but this looks like an excellent online course that requires some knowledge of genetics, cell bio, and mol bio but doesn't get into the hardcore shit. Here are links to genetics, cell bio, and mol bio if you end up needing them. I'll always be available by memail if you ever have questions, I love this shit.
posted by Blasdelb at 1:30 PM on September 27, 2012 [15 favorites]


especially against something like Hep B which the majority of babies would never be exposed to

If an adult gets Hep B, in the vast majority of cases they will be sick for a few weeks and then get better. A few will get very sick. If a newborn baby gets Hep B - and you can't ever be sure of protecting them completely - the prognosis is much worse. Between 70% and 95% of them will have the virus for the rest of their lives. They will spend their lives seeing doctors and having liver function tests, and will always have to take precautions so as not to infect the people around them. They may have to take medication long term, and have a substantial risk of liver cancer or cirrhosis. Like pertussis, it is a far more horrendous disease in newborns and anything that can be done to protect them is OK in my book.
posted by Acheman at 1:48 PM on September 27, 2012 [5 favorites]


Thanks so much to Blasdelb, metaBugs, Acheman and others who have so clearly outlined information and increased my knowledge.

It occurs to me that most of the anti-vac folks I know also believe wholeheartedly in the Hygiene Hypothesis (that keeping children too clean makes them more likely to get sick). If dog hair and unwashed hands are good for your baby's immune system, then Natural, Low-Tech Vaccines sound great. It's all just an extension of those milkmaids who got cow pox and didn't die of smallpox! Honestly, I think many of them would change their minds if vaccinations were presented clearly to them as something simple, natural and healthy. Especially if the questions of what else is in the vaccine, and what care is being taken to identify potentially sensitive children, are addressed.

Which brings me to my other question, involving exhortations to get me to my local Safeway and get a pertussis shot. It's presented as "you should do it, there's no sane reason not to do it, don't kill any more babies by accident." My immune system isn't an infant's. In my case, I have post-polio syndrome, and there are real questions of damage vs value. But for anyone older than 12, should we really be ramping up our immune systems every 4 years against pertussis? Is it really a totally positive thing, not for our safety but for the possible safety of a possible child?

Again, thanks for the very clear responses to this. And the idea of being a Science Groupie sounds very exciting, and somewhat less strenuous than being in a mosh pit (an important consideration). Is there a sign-up sheet?
posted by kestralwing at 3:52 PM on September 27, 2012 [4 favorites]


As we sow, so shall we reap.
posted by atrazine at 4:11 PM on September 27, 2012


"So what marketing tactic is necessary to get people to want to be vaccinated, and to have their children vaccinated?"

Aside from the careful listening, the knowing what the fuck your talking about, and the not being a dick that I've already mentioned? There is a reason why I was careful to post the videos of babies with whooping cough, that shit chills my bones with fear and I don't even have kids. I can't even imagine how terrifying that would be to watch for a new parent.
posted by Blasdelb at 4:15 PM on September 27, 2012


"Which brings me to my other question, involving exhortations to get me to my local Safeway and get a pertussis shot. It's presented as "you should do it, there's no sane reason not to do it, don't kill any more babies by accident." My immune system isn't an infant's. In my case, I have post-polio syndrome, and there are real questions of damage vs value. But for anyone older than 12, should we really be ramping up our immune systems every 4 years against pertussis? Is it really a totally positive thing, not for our safety but for the possible safety of a possible child?"

The current recommendation is every 10 years for adults over 19 years old, though they suggest that you may consider getting it at faster intervals if you have frequent contact with infants. When the Tdap vaccine combo is taken at faster intervals there is some increased risk of mild local reactogenicity (your body putting up a small fight at the injection site against what it thinks is a pathogen) so the CDC is almost certainly puzzling over whether shortening the interval recommendation is worth the tiny extra risk and if so how much as we speak. They are crazy risk averse. With your particular health needs the cost benefit analysis for you it would certainly be worth a chat with your physician who will be familiar with your needs.

Again, thanks for the very clear responses to this. And the idea of being a Science Groupie sounds very exciting, and somewhat less strenuous than being in a mosh pit (an important consideration). Is there a sign-up sheet?

I suspect that what metaBugs originally meant might be better translated as lackey, or less politely undergrad, but there should totally be a science groupie club. I'd be in.
posted by Blasdelb at 4:56 PM on September 27, 2012


My son, who is almost 2, has horrible episodes of croup. He's been to the ER 4 times with it, admitted once. I don't shave my legs, and my son isn't circumcised; sometimes they ask where he was born, and I tell them he was born at home. The next question is "What has been your decision regarding vaccines?"

"Oh, he's fully vaccinated, believe you me. I may be a crunchy granola hippie, but that doesn't mean I don't believe in SCIENCE."

The look of relief on their faces is amazing. I can't imagine what kind of risk he'd be at if he did get pertussis, given his existing breathing problems.
posted by KathrynT at 12:21 AM on September 28, 2012 [10 favorites]


(We live in Washington State, just outside of Seattle)
posted by KathrynT at 12:21 AM on September 28, 2012


I suspect that what metaBugs originally meant might be better translated as lackey, or less politely undergrad

Nah, I meant actual, honest-to-god groupies. I'm working slightly crazy hours at the moment for a funding deadline (I'm posting in breaks while a microscope is capturing an image) and, damnit, if I'm working this hard to advance medical science then I feel entitled to some screaming fans!

Also, my pronounciation of "undergrad" sounds a lot like "hench(wo)man".
posted by metaBugs at 12:39 AM on September 28, 2012 [3 favorites]


"It occurs to me that most of the anti-vac folks I know also believe wholeheartedly in the Hygiene Hypothesis (that keeping children too clean makes them more likely to get sick). If dog hair and unwashed hands are good for your baby's immune system, then Natural, Low-Tech Vaccines sound great. It's all just an extension of those milkmaids who got cow pox and didn't die of smallpox! Honestly, I think many of them would change their minds if vaccinations were presented clearly to them as something simple, natural and healthy."

I hadn't thought of connecting it to the hygiene hypothesis, that’s a great idea. One weakness in my argument though is that Vaccine technology is always advancing. For example, often times the genes for those weak spots are taken out and put into bacteria so as to make a lot of it very quickly. There are also really cool new vaccines in the pipeline that we'd have a pretty hard time explaining in a Vitalistic way,

One of the big challenges of designing a vaccine is to get it to activate the immune system just enough to make it learn, but not so much that the immune system freaks out so much that it gets the patient sick in order to respond to the shadow attacker. One of the tricks we've learned is to inject the vaccine intramuscularly to get it to leach out of the muscle very slowly so that the immune system is exposed to a constant low level of the antigen. All of the recommended vaccines have each been designed with a balance of activating the immune system enough but not freaking it out that is both really safe and pretty effective, but it is tricky to accomplish and anything that would allow us to control the amount that the body sees would make vaccines both safer and more effective.

Our bodies first see most pathogens using starfish shaped cells found all over our bodies called dendritic cells. They actively look for things that seem strange by drinking of fluid and eating up stray particles and then racing back to our lymph nodes to present what they've found to white blood cells in case it activates any of them. One of the tricks that they have to better detect viruses is to take any DNA they happen to drink up, express it and then present the results to white blood cells.

There is now a Scottish company, Big DNA, that is currently making a vaccine using recombinant bacteriophages. It takes advantage of this way our immune system learns because it is especially safe, as it would be incredibly hard to make the immune system freak out from it. The idea is to take a gene for a weak spot in a bacteria or virus, put it into a virus that can only attack bacteria (and so is totally harmless to us), and get the dendrocytes to drink them up, express the weak spot, and show it to the immune system. This way we could use weak spots that might otherwise be a little risky to show to the immune system and vaccinate kids against more diseases more effectively.
posted by Blasdelb at 2:43 AM on September 28, 2012 [2 favorites]


This is going through my son's school and my office. People are getting tested, and they have honest-to-fucking-God whooping cough. In 2012.

Why don't we just burn us up a big ol' basket of cats under a full moon? That'll fix it!
posted by obiwanwasabi at 2:47 AM on September 28, 2012


Blasdelb, thank you for the info!

Also, because of this thread, I am going THIS MORNING to my doctor's office to get my adult TDAP booster shoot. It's been, I think, about twelve years since I last had my td booster, so I'm taking steps. And I'll get the flu shot for this season, too!
posted by magstheaxe at 7:04 AM on September 28, 2012 [3 favorites]


> I hear a lot about how impossible it is to argue with anti-vaxxers, but haven't really experienced it

So you're not on Facebook, then?
posted by The corpse in the library at 9:07 AM on September 28, 2012 [3 favorites]


I got my booster shot last week, not long after finding out about the limited protection they offer. But it got me thinking about the concept of herd immunity -- given that (from anecdotal observation) few adults know about the need for regular Tdap boosters to keep the immunity, shouldn't a pretty hefty percentage of the adult population go around with no (or limited) protection against stuff like pertussis? And if so, isn't that a pretty big problem on par with the anti-vaxxing movement? (I am genuinely curious, and this seems like the thread to get a good answer to this.)
posted by Bukvoed at 1:11 PM on September 28, 2012


I do not recall ever being offered booster shots. Physicals, yes. Shots, never. And I've had the same doctor for eons.
posted by five fresh fish at 9:12 PM on September 28, 2012


An old buddy of mine, Craig Egan, has been terrorizing antivax activist Facebook groups recently, even getting one to close up shop. Good times.
posted by Pope Guilty at 8:54 AM on September 29, 2012


Occasionally I look at the Mothering.com vaccinations forums when my rage meter is running low. Does the trick every time. I've never seen so much lack of knowledge and critical thought concentrated in such a small space; it's like a neutron star of ignorance.
posted by Justinian at 12:56 PM on September 29, 2012 [1 favorite]


Pope Guilty: "Antivax activism is complicity in murder and should be prosecuted as such."

Some anarchist and free speech proponent you are.
posted by dunkadunc at 5:07 PM on September 29, 2012 [2 favorites]


"Science literacy is a vaccine against the charlatans of the world that would exploit your ignorance." -Neil DeGrasse Tyson

Goddamn is that man a fucking Boss.
posted by Blasdelb at 5:18 AM on September 30, 2012 [2 favorites]


Feds probe whooping cough epidemic; are vaccines pooping out? (From today's Seattle Times.)
posted by The corpse in the library at 12:56 PM on September 30, 2012 [1 favorite]


" So you're not on Facebook, then?"

Its the Chronic Lyme Syndrome folks I can't really get through to. Damn is that a tough nut to crack.
posted by Blasdelb at 1:00 AM on October 11, 2012


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