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Monday, December 21, 2009

Mumps and Measles Revisited

Do read the CDC report and that looks at the connections between England and the outbreak of mumps in North America, primary areas of New York and New Jersey and Quebec. In England the rates of vaccination are very low and there is a general outbreak there of 4000 in the general community.

The Science-Based medicine blog has some history regarding low vaccination rates in England and makes a prediction that these communicable diseases with spread. I hope this will not be the case.

Meanwhile, the Lower Hudson newspaper is reporting a large Mumps outbreak in Monsey in the Dec 19 edition. According to the article, non-immunizing parents interviewed by health official report they do not immunize because of religious beliefs. I have no idea what religious beliefs they are referring to. Dr. Yakov Tendler, a Monsey internist, is on record stating,
"There are a lot of crazies out there who are putting their children and everyone else at risk."

It is interesting to note that mumps patients are 83% male with a median age of 14. It appears that the separation of genders and the fact that bochurim from the communities most affected tend to reside in yeshiva dorms rather than home environments is containing the mumps somewhat to a certain segment of the population. Given the incubation period, I don't see a great way to stop the spread of the disease without serious steps. Rabbis in Doctors in affected communities are calling for vaccination, but it seems to me that to put a stop to the spread, more than a call for vaccination is needed.

Camp registrations open up very soon and the CDC reports that the mumps outbreak is attributable to a camper from the United Kingdom in a Sullivan County, NY camp. I'm not a doctor and would very much like to hear from any doctors who read my blog what steps should be taken to try and contain the spread of mumps (what a disaster it would be if this outbreak leaves the confines of the community). Summer for many means camps --sleepaway and day camps, weddings, and travel. My unscientific analysis would lead me to think that foreign campers should not be accepted into American camps and that any parent who does decide to send to camp should be asking serious questions of their doctors. I know I'm setting myself to be accused of having the middot of a Sodomite. But, it seems to me that where herd immunity is weak, welcoming in campers from a country experiencing an outbreak shouldn't be repeated. I hope that doctors in the communities affected are working on making sure this disease stays contained.

Doctors? Scientists? Commentors? Your thoughts?

31 comments:

Sharon Udasin said...

I wrote an article on this in The Jewish Week, where I'm a staff writer, a couple weeks ago:
http://www.sharonudasin.com/2009/12/not-immune-from-mumps/
It seems that most people are vaccinated; it's just a select few who are causing the trouble to everybody in the community.

ProfK said...

Youch if that outbreak in Monsey is indeed limited to 14 year old males in yeshiva dorms. Mumps of all things can cause sterility in the male of the species.

The answer is of course a simple one, but it's implimentation is not: no vaccination certificates, no entrance to our schools and camps--full stop. Unless, of course, you can give legitimate proof of having had a particular disease and its attending immunity agaihnst reinfection. I don't care what your point of origin is. And for those rare few children allergic to the vaccines, well some tough decisions are going to have to be made re admitting them to regular schools and camps.

Stefanie said...

The Jewish Day schools here in Pittsburgh now do not recognize the state allowed religious exemption from immunization. I'm all for it!

http://pittchron.com/pages/full_story/push?article-Day+schools+adopt+vaccination+rules+stricter+than+state-s%20&id=5172110-Day+schools+adopt+vaccination+rules+stricter+than+state-s&instance=home_news_1st_left

Orthonomics said...

ProfK-Not so simple imo. The CDC reports shows infection amongst immunized children. Seems that the immunization rate isn't quite high enough and herd immunity breaking down.

Even if we shut non-immunized kids out of camp and school, there is still travel (including oversees travel) and a whole host of places where people meet up and disease can be spread.

Miami Al said...

The state must permit a religious exemption to protect those whose religious beliefs prohibit vaccination.

Since Judaism isn't one of those religions, I don't see why a Day School would recognize that exemption. After all, you clearly have a religion other than Judaism, perhaps your other religion offers a school for you.

Stefanie said...

Miami Al, (if your comment was directed at me) I was not very clear. I am FOR the schools' decisions to ban the religious exemption for the reason you mention - there is no reason in Judaism not to vaccinate. Additionally, I'm not sure why you think I am another religion. I'm an Orthodox Jew whose children attend those schools and resent that families have gotten away with not vaccinating their kids until now.

tesyaa said...

The DovBear blog has covered this subject in excellent detail. The reporting, comments, and conclusions are excellent.

Dave said...

Perhaps someone should spread a rumor that being immunized is a Segulah against having a Television in the house.

Bklynmom said...

I am a pediatrician. While I don't think I can add any medical information to what has already ben on the news and written here, I have a few comments:
1--I think the same mentality that causes some families to have more children than thay can afford, to not save for emergencies/retirement, to not educate their children enough to earn a good living, etc. is prevalent here. If you have enough faith and say enough Tehillim, your child will not get the mumps, no vaccination needed.
2--One can't worry about international campers without worrying about international staff. Kitchen, cleaning, waterfront are all staffed by people from other countries who come here for the summer. Perhaps the more right wing camps do not have international staff, but the more modern ones do. Also, many camps have travel and camper exchange programs. I do not know if those programs can be easily changed.
3--In lay media, the anti-vaccine lobby is vocal and visible. The pro-vaccine lobby is not.
4--Few physicians take the time to differentiate among vaccines that are required for school entry (MMR, DTap, etc), those that are not required, but a good idea for both individual and society (Hep A, Meningococcus), and those that may be optional in some circumstances (rotavirus vaccine in a breastfed baby who does not attend day care). With education and flexibility at least some parents may be convinced. Unfortunately, given the economics of healthcare in this country, pediatriciand do not have the time to do much educating and negotiating with parents. Much of our free time is taken up by negotiating with insurance companies just to get paid. This aspect of healthcare will only get worse as physicians' salaries continue to be cut.

Sorry this is long.

conservative scifi said...

SL,

You need to distinguish between "herd immunity" and when children who were vaccinated demonstrate active infection. If a vaccinated child is not protected, that may occur for one of several reasons. The vaccine dose may have been defective (e.g., not properly stored, not properly manufactured, not properly administerd). The child may not have mounted an immune response to the vaccine because the child is immunocompromised or "tolerant" of the particular antigen used in the vaccine. The child may have obtained some immunity, perhaps sufficient to prevent serious complications such as sterility, but not enough to prevent all symptoms of disease.

"Herd immunity" is the idea that if enough people are successfully vaccinated and made resistant to a particular infectious agent, the remaining small number of people who cannot be vaccinated because they are immunocompromised, or who are vaccinated but do not develop an immune response for some reason, will have a reduced likelihood of contact with an infected person, which should reduce their likelihood of getting the infection.

Prof K's solution is the easiest to implement. If every school and camp required vaccination without permitting "excuses, this would likely result in increased vaccination rates in the chareidi community and reduced morbidity and mortality.

Perhaps if it were pointed out that sterile yeshiva boys (sterile due to mumps) was bad for their ultimate marriage prospects, their parents might get them vaccinated. This seems very "bad4shidduchim" (to refer to a different blog).

(btw, not a medical doctor, just a phd virologist).

aaron from L.A. said...

Dave:After reading your post,I've come to the conclusion that we were twins separated at birth... Watch out people,they're two of us!

Miami Al said...

Stefanie, not directed at you, directed at people "hiding" behind a religious exemption over vaccination.

There is ZERO reason for a Jewish school to permit non-vaccination for religious reasons. If you (the generic you, not Stefanie) have religious reasons to not vaccinate, you clearly have another religion than Judaism, and shouldn't have your children in a Jewish school.

rosie said...

From my experience as a bubby of children in a Pittsburgh day school, I know that there are some children not vaccinated because their parents are worried about autism and other children who are not vaccinated for valid reasons such as a prior severe reaction. There is also a child in their school who had a liver transplant and cannot be around sick kids so the non-vaccinated breed is dangerous for immune-compromised kids.
While those who don't vaccinate due to fear of autism do not really have religious objections, they may claim to the government authorities that they do so that no one pesters them.

megapixel said...

I am confused...
every school and camp I sent my kids to made me send in medical forms and insisted upon the child being up to date in their vaccinations. How is it that people are getting away with it?

The autism threat is scary, but I think the sterility/shidduchim threat will resonate with our people loud and clear. Imagine if it becomes common in the next few years to hear the following: what kind of tablecloths do they use? did the boy ever have the mumps?

Anonymous said...

I find it fascinating that the same people who don't vaccinate because of the now thoroughly debunked concern of a link to autism, are often the first to pooh pooh any other environmental concerns even though there is overwhelming evidence of the health effects of burning fossil fuels, particulates in the air and the enourmous amounts of man-made chemicals in our food stream.

Sima said...

I don't really understand -- I know personally of two cases of mumps, in two teenaged boys who go to Yeshiva in the NY area. However, both these boys were immunized as directed, as were most of their dorm-mates who have mumps (about 12 of them). What's happened?

Miami Al said...

Sima, viruses mutate over time and immunization declines over time. When vaccination rates exceed 95%, the virus can't really take hold unless it has mutates to completely avoid the immunization. With vaccination rates as low as 75%, the virus can quickly take hold.

Effectiveness of a childhood vaccine in a teenager is going to be 75%-85%... If the virus takes hold in a population of 100, 15-25 people are going to get the disease.

That's why the anti-vaccine people are so scary, even those doing the right thing are at risk from the free riders (economic term) on the system.

What happened is that as we reject modern medicine, we'll return to 19th century scourges and people will start dying.

Anonymous said...

Bklynmom, I have a question about your post. You mentioned vaccinating infants against Rotavirus. But the Rotashield vaccine was pulled off the market due to some cases of intussusception, and as far as I know no other rotavirus vaccine has been introduced in the US since. At least, my children's pediatrician, who recommended all the other vaccines for my young kids, never mentioned it.

rosie said...

Anonymous, I don't know that it is that obvious and simple that vaccines and brain damage are totally unrelated. If the brain damage produces autistic behavior, then in some cases, vaccination has caused autism. There are children who were severely damaged by vaccines and some of them suffered permanent damage. There is no dispute that the damage was a result of a vaccine reaction and the CDC acknowledges that such cases exist. Doctors warn parents of how to watch for extreme reactions and no doctor will say that vaccination is totally risk free.

Bklynmom said...

Anonymous 2:44--Rotateq is a rotavirus vaccine currently in use in the US.

CDC & AAP links about autism said...

Rosie, this is from the CDC website:
Does thimerosal cause autism?

"There is no conclusive evidence that any vaccine or vaccine additive increases the risk of developing autism or any other behavior disorder. Rather, evidence is accumulating of lack of any harm resulting from exposure to vaccine containing thimerosal as a preservative. In a 2004 report, the Institute of Medicine (IOM) concluded that there is no association between autism and vaccines that contain thimerosal as a preservative. Nonetheless, given the level of concern among parents and others regarding vaccines and autism, the CDC is committed to investigating this issue to the fullest extent possible, using the best scientific methods available. For more information, visit Frequently Asked Questions about Vaccines and Autism Spectrum Disorders."

http://www.cdc.gov/vaccinesafety/Concerns/thimerosal/thimerosal_faqs.html#7

The CDC also links to the AAP article "Study Fails to Show a Connection Between Thimerosal and Autism" here:
http://www.aap.org/profed/thimaut-may03.htm
"Research to date involving refined, controlled studies in large populations of patients has failed to demonstrate any association between vaccines that may have used thimerosal as a preservative and neurodevelopmental disorders including autism."

tesyaa said...

I agree with the latest comment that debunks the vaccine-autism link. I also agree with Rosie that there have been rare cases in which children have had severe neurological reactions to vaccines that have caused brain damage, epilepsy, and retardation. These are rare, they're obvious at the time (the child would be very ill and require hospitalization), and are not the cause of most cases of autism.

tesyaa said...
This comment has been removed by the author.
tesyaa said...

On the other hand, it's also clear that mumps, measles and rubella can cause brain damage in severe cases also, as well as other side effects. THe vaccines are not 100% risk free, but on the whole probably less risky than the illnesses themselves.

Miami Al said...

We've tried to get the non-Thimerosal versions of the vaccines, not because of the autism risk, or any real concern about it, but because why take any risk that isn't necessary.

Thimerosal isn't added to the vaccine to benefit my child. It's added as a preservative to the vaccines have a longer shelf life. That benefits the vaccine maker, the distributors, and the pediatrician's office, but not my children.

The level of mercury is low and within the safe range. However, mercury is a poison, and all things being equal, I'd like less. That said, children eating a healthy diet will be more exposed to mercury from their food sources, including fish, than they will from from the vaccines.

If they don't have preservative free ones, we get it with preservatives. We also spoke to our pediatrician with this kid and we're spacing out the vaccines a little more. Not out of autism risks, but our first child had adverse reactions to a few of them and we were up with a screaming child. Child two had a less aggressive schedule by coincidence, we switched pediatricians in the middle, and scheduling issues spaced things out a bit, and didn't have the fevers.

Given both working and two other children, the up all night with fevers is a bad thing for our family, so we'll make 1-2 more pediatrician visits to try to avoid the 8-shots at once visits and keep vaccination to 2-3 at a time.

We want to have all the "important" vaccines done by 2, and everything by 2.5. If a vaccine isn't super--critical, we'll give it, but not rush it.

I applaud the CDC for encouraging Thimerosal-free vaccines, so parents terrified of debunked autism still can vaccinate. This is a HUGE improvement from the previous approach of the FDA/CDC/Pediatric College to bludgeon parents.

I don't want my children exposed to vaccine-free children because the scientific establishment wants to prove a point.

Anonymous said...

Bklynmom, thanks for the update. I see that Rotateq is also associated with some intussusception as well as Kawasaki's, along with the slight additional risks associated with any live vaccine administration. Perhaps this is why my child's pediatrician did not recommend it for my younger children, who were breastfed & did not attend daycare.

Just wondering, do you recommend Gardasil for your frum female patients? If so, at what age do you administer it?

rosie said...

I NEVER MENTIONED THIMERSOL!!!! Some children had reactions to the vaccines themselves and became very, very ill.

rosie said...

http://www.cdc.gov/mmwr/preview/mmwrhtml/00046738.htm
Ok all you smart people. See for yourselves! The CDC admits that although rare, there are some bad reactions and some are unfortunately life altering. If you google vaccine reactions in children, you will see stories of children damaged from vaccines. This scares parents.

rachel in israel said...

rosie: Nothing in life is risk free. But the chance of a reaction caused BY the vaccines, as opposed by the imagination of the parents, is smaller than the combined risk of the diseases. And the more people that refuse or delay vaccines, the bigger the risk of the diseases.
Miami Al: All vacccines, except for the flu vaccine, are thimerosal free. They have been since 2001. (Autism rates have gone up since 2001, not down)

http://www.cdc.gov/vaccinesafety/Concerns/thimerosal/thimerosal_faqs_availfree.html

you mentioned yourself that eating healthy, especialli fish, contains more mercury than all the vaccines together.

Anonymous said...

What about the realistic possibility that the vaccine WEARS OFF? Did you know you need a booster shot for the chicken pox vaccine? Only a disease can really give you lifetime immunity. Maybe we should be vaxing boys at 9 or 10, not at 2, so if it does ch'v wear off, it's not when they're the most at risk for complicatons!

Charlie Hall said...

What is particularly depressing to me is the argument from personal autonomy that some allegedly frum people are making to excuse their irresponsibility in not vaccinating their kids. Personal autonomy is not a big value in Judaism. That people can have these arguments taken seriously by much of the frum community shows that we have assimilated non-Jewish values while continuing to be diligent about checking vegetables for bugs. Frankly, they would do less harm by eating a bug than by promoting philosophy that is so much in conflict with Torah values.