Something is in the air right now. There’s a strange mix of vaccine-preventable illness sweeping the country (measles) and a strange bump in media coverage for celebrities and vocal opponents to tested and recommended vaccine schedules. Part of me thought we might be done with that but pageviews, clicks, and views all sell.
My hope is the coincidence of coverage and outbreaks is just that, a coincidence. But as a mom, pediatrician, author and media reporter, the view from here is unsettling. We can’t prove that mishandled media coverage is changing the way we immunize our children (or at least I haven’t seen the data) and how parents protect them, but there are moments like this it feels it’s possible that trust is simply being eroded with this 24-hour online/TV/print news cycle. Parents might be vulnerable to bad medicine when gowned as good business. A couple of examples:
Two weeks ago Kristin Cavallari (a wife to an NFL player and reality TV star) went on Fox News to discuss her career (and parenting) and ended up discussing her theories on a group of vaccine refusers and autism. Perhaps talking about medical theories is a really good model for accelerating a career? Next up was Huffington Post where she dropped the bomb, “’I’ve read too many books’ to vaccinate my child.” I suspect she’s yet to read mine. Particularly chapter number 57 entitled Measles In America.
Then Sunday night, Mother Jones published a lengthy expose of a pediatrician in Marin County, California who doesn’t immunize along the recommended and tested vaccine schedule. Although the reporter concludes the piece noting that the doctor “is playing a dangerous game,” the substance of the article discusses the tactics of this pediatrician going against the experts because of her hunch. The article likens her gorgeous waiting room to a Montessori classroom and provokes a sense that she is an inventive pediatrician, and one who really cares. Who wouldn’t want to see someone like that? Read this quote:
AT THE END of my visit to Pediatric Alternatives, I found that I liked Dr. Kenet Lansman. I could tell that she was bright and caring and open-minded, and most impressively, she tried to think creatively about how to keep her patients healthy.
WHAT??!??? We get confused with all the attention paid to these outliers. We forget that about 9 out of 10 parents in the United States DO immunize following their doctor’s recommended schedule. We forget not a single study finds an alternative schedule is any safer. We forget that unvaccinated and under-vaccinated kids are at risk for preventable disease. We get confused how stories like this make us feel and we ditch what the science tells us. We forget that when we immunize ourselves we protect our body, the children too small to be immunized and those at high risk for severe infection.
I feel parents are being duped. It’s really hard to know who is and who isn’t a good doctor; we all use different value systems to decide. We know in fact health care has yet to figure out exactly who is the best. So we patients are left to find a good match for ourselves when partnering with a doctor– sometimes it’s the wait times, the waiting room, the sense that someone really cares, the sense that they actually know what they’re talking about, or that the clinician comes recommended. There is little transparency about how good the quality of care a doctor provides so we are left to feel it out ourselves.
Measles In Washington, California, New York
- Here in Washington, we just learned last night of a new measles case on San Juan Island in an adult. Earlier this month, there was a California resident traveling through Seattle-Tacoma airport also infected with measles and we know Washington residents living in Whatcom County have also been infected secondary to an outbreak in Canada (see below).
- NYC is having a large outbreak of measles. Over 20 cases reported and some that may have spread at health care facilities. An opinion piece in the New York Times discusses remembering how to fight measles infections suggesting “the measles vaccine is a victim of its own success.” Some NYC schools show dismal vaccination rates.
- California has an outbreak of measles with more than 20 cases of active measles infections, the majority of cases (77%) in unvaccinated children.
- British Columbia, Canada has had a large outbreak this month with over 300 cases, which health officials have blamed in part to an under-vaccinated school and under-vaccinated church community.
Why does it take epidemics to grab our attention? What a miserable failure on our behalf (in health care and health reporting).
Measles Info If You’re Concerned About An Exposure:
- The MMR Vaccine protects against measles. Read that link re: how it’s made, what it protects, and how to ensure you and your children are protected (have 2 doses of the shot). Over 99% of children and adults who get 2 doses of measles vaccine are protected for life. Experts describe the risk/benefit like this, “Because the measles vaccine has no serious permanent side effects, its benefits still clearly outweigh its risks.” It can cause pain at the injection site, fever in up to 10% of children who get it, rash, and rarely a decrease in platelets (blood cells that assist in blood clotting).
- Measles is a highly contagious disease. You can get it simply by being in a room that a person with measles was in up to 2 hours before you. Measles causes red rash that appears as if it was poured over your child head to toe, a fever, runny nose, eye infections and most dangerous, it can cause life-threatening pneumonia. Rarely it can cause brain infections, too. Measles is serious: on average, about 1 to 3 out of every 1000 children who get measles will die from it.
- Information from King County Public Health: Children should be vaccinated with two doses of the Measles Mumps Rubella (MMR) vaccine. The first dose should be at 12 through 15 months of age, and the second dose at four through six years of age. Infants traveling outside the United States can be vaccinated as early as six months but must receive the full two dose series beginning at 12 months of age; more information is available at the Centers for Disease Control and Prevention (CDC) website. Adults should have at least one dose of measles vaccine, and two doses are recommended for international travelers, healthcare workers, and students in college, trade school, and other schools after high school. For help finding low cost health services, call the Family Health Hotline at 1-800-322-2588.
Julie Murphy says
Hello Seattle Mama Doc,
I simply love your blog, especially your frank, yet kind hearted and compassionate, advice on immunization. The measles outbreaks are so scary AND preventable. Thank you for taking the time to inform people like me. Are you planning to attend the National Conference on Immunization and Health Coalitions in Seattle this May?
Thank you.
Julie Murphy
Wendy Sue Swanson, MD, MBE says
Julie, first off, many thanks for your kind comment. The current realities with measles are such a failure to prevent. I hate that.
I am not unfortunately attending the conf in May. Wish I was! I have another event — so sorry to miss it! It’s being organized by a great group (Within Reach) and has exceptional speakers. Enjoy! Also pls leave a comment on the blog if anything I should see/write about/follow-up on.
Sara Sanford says
Thanks for the shout-out, Dr. Swanson! We are glad advocates like you are providing parents with quality, accessible info about children’s health – including immunizations.
Also, we would love to see any immunization advocates out there at The National Conference on Immunization and Health Coalitions in Seattle this May: healthcoalitionsconference.org
Lori T says
What’s disturbing to me are places that theoretically focus on Wellness promoting an anti-vaccine agenda
This was offered by my Chiropractor (not my Chiropractor anymore);
https://events.seattlepi.com/bothell_wa/events/show/369864854-immunization-the-reality-behind-the-myth-free-workshop
Katie Peavy says
I love my chiropractor, but I understand where you’re coming from. My chiropractor was “shocked” that I would get a flu shot every year and that I would get other vaccinations and vaccinate my children as well. As a firefighter/EMT, I am NOT going to skip vaccinations for myself or my children. I have an aunt who lost her hearing as a child because of Rubella. Another aunt of mine lost her first husband to the flu. He left behind her and two very young children. A fellow firefighter friend of mine is going through some serious emotional pain because of a patient she had. A five month old baby she was treating died in her arms of a disease that could have been prevented with a simple vaccination. Her heart is broken and mine breaks for her, and for the family of that little baby who never got to live to his or her potential simply because the parents made a choice not to give the baby a simple vaccination. Vaccinating your children doesn’t just protect your children, it protects everyone else out there who may not be able to get vaccinated. Those with compromised immune systems, those who are allergic to eggs, etc. I do try to avoid unnecessary medication and take a more alternative approach for myself and my family, but just like antibiotics and life saving drugs in the right situations, vaccinations are necessary and I will not skip them.
Emily Gibson, M.D. says
having helped manage the 1995 rubeola measles outbreak at Western Washington University (11 confirmed cases with over 140 individuals with fever and rash examined and tested and over 8000 vaccinated during that very long 3 weeks), I hope that our policy of no registration until proof of rubeola immunity will protect us just a few miles away from the BC outbreak. We are near 95% herd immunity at our University, which is about what we need.
p.s. love your book!
Emily
Wendy Sue Swanson, MD, MBE says
Thanks, Dr Gibson. Will you consider putting a review on Amazon or Target? Am indebted to those who already have but it does help spread that word.
https://www.amazon.com/Mama-Doc-Medicine-Confidence-Parenting/dp/1581108370
or
https://www.target.com/p/mama-doc-medicine-finding-calm-and-confidence-in-parenting-child-health-and-work-life-balance/-/A-15291035
erica pan says
CA is now up to over 50 cases in 2014 – our public health departments are overwhelmed with the response. Thanks for your blog on this.
Laura N says
Do you have any thoughts on children 6-11 months receiving MMR in outbreak areas? Since the vaccine is recommended if those infants are traveling internationally (presumably because of the increased risk of exposure), would it not also be reasonable that in outbreak areas for those infants to be vaccinated (presumably because of increased risk of exposure)?
I could understand not recommending it on a public health level given the cost, decreased likelihood of effectiveness, decreased likelihood that parents would have their 12-15m shot, etc. But what would you say to an individual parent?
Wendy Sue Swanson, MD, MBE says
You ask a great question, Laura. It would depend on the number of cases in a county, the patterns of potential exposure for an infant and would require discussion with someone who can tell me (in infectious disease/vaccine expert) how susceptible an infant is to measles during that time period (ie how much maternal antibody protection do they have specifically for measles during 6-11mo). Let me make a few calls and get back to you on how best to answer your question. You of course can always go in and discuss with your own peds!
Regardless, just a reminder that if an infant gets the dose at 6-11 mo of age, they do still need the regular MMR series (1 dose at 12-15 months of age and another dose at age 4).
Heather says
More potential public exposures in Whatcom, King and Pierce counties from Washington State Department of Health: https://www.doh.wa.gov/Newsroom/2014NewsReleases/14047MeaslesMultiCounty.aspx
Wendy Sue Swanson, MD, MBE says
I know. Thanks for posting this link.
Here’s the detailed list of places and times where possible exposure could have occurred:
https://www.doh.wa.gov/Portals/1/Documents/1500/NewsReleases/2014/04-02-2014-WhatcomMeaslesCaseItinerary-final.pdf
Aimee says
My child suffered a vaccine reaction, not autism or redness, swelling, crying but a legitimate near-catastrophic multi-organ event. Would there be any way to “catch him up” after this event? He was 6 months old, now 11. I’m equally worried about disease as well as a repeat reaction. Of the 5 vacs given, we have no way to tell which one(s) caused it. Other 3 children are all vaccinated.
–from peds RN
Shannon says
This is scary….any advice for children who cannot be immunized with any live vaccines due to complicated health situations? We were told by SCH that Herd Immunity would protect our son, but this has me worried now.
Wendy Sue Swanson, MD, MBE says
Hi Shannon,
It is likely that herd immunity will! But these outbreaks remind us we have work to do to boost the heard. If concerns about your child’s safety, talk with his/her pediatrician, of course. A blog is no place unfortunately for personal health care.
Lisa says
Thank you as always for your wonderful and balanced articles. I have children with rare disorders. Friends of ours who do not immunize don’t seem to understand some of our children who are immune deficient or have rare diseases would be seriously affected even hospitalized by their choices even if theirs would not. Immunizing is not just for one’s own children but for those around us in the community that are vulnerable. Other people MATTER too.
Warm Regards and thanks again~
Corina says
I’m wondering how you can claim that over 99% of people vaccinated for measles are fully protected but then turn around and say that nearly 30% of the kids in California who have active measles were in fact vaccinated.. So pardon my scepticism but it is exactly these kinds of claims and this kind of double speak that has parents feeling like they’re being “duped”.
Using a media outlet to all but claim an epidemic of non vaccinated children then saying that over 9 out of 10 people do actually follow the recommended vaccination schedule..
The one paragraph in this article that I completely agree;
“I feel parents are being duped. It’s really hard to know who is and who isn’t a good doctor; we all use different value systems to decide. We know in fact health care has yet to figure out exactly who is the best. So we patients are left to find a good match for ourselves when partnering with a doctor– sometimes it’s the wait times, the waiting room, the sense that someone really cares, the sense that they actually know what they’re talking about, or that the clinician comes recommended. There is little transparency about how good the quality of care a doctor provides so we are left to feel it out ourselves.”
We are indeed left to feel it out for ourselves and do what we as parents feel is best for our children, based on the information we glean, often from medical professionals who contradict themselves and their scientific facts which ironically are forever changing..
I’d also like to point out the very, very low risk of death by measles. A child is more likely to be struck by a car on their way to school..
It’s obvious to me, who is responsible for the fearmongering.
Wendy Sue Swanson, MD, MBE says
Hi Corina,
I didn’t make the claim you say I did; you read the data incorrectly. If >75% of children in the CA outbreak are unvax children, that leaves 25% of cases in outbreak either
1. under-vaccinated children (kids with 1 dose of MMR, not 2)
2. unvaccinated adults
3. under-vaccinated adults
4. vaccinated adults
You’re right dying from measles is HIGHLY unlikely thank goodness. This in part because the far majority of children are immunized against measles. Kids are at most risk while in a car (over age 4) when it comes to mortality data.
Arielle says
Regarding Corina’s comment,
Dr. Swanson’s stats are accurate and reasonable. This is pretty a basic math/logic problem. I don’t think she’s fear-mongering.
If 1000 people are exposed,
and 95% are fully vaccinated, that leaves 5% (50 people) unvaccinated or under-vaccinated. Not everyone who is exposed gets sick, but even if we assume 80% of the unvaccinated persons who were potentially exposed actually do fall ill, that’s 40 people sick.
If we assume 99% efficacy for vaccination, of the remaining 950 fully vaccinated people, about 9 or 10 could get sick.
So 9 fully vaccinated people get sick, and 40 unvaccinated people get sick.
49 total are sick, 40 of them unvaccinated.
That means that 82% of the sick people were unvaccinated.
Clearly the numbers don’t match but we’re working with some assumptions about vaccine rates etc.
It’s basic math… There’s probably an easier way to explain this with logic.
Hope that helps.
No fear mongering intended by anyone, but understanding math is essential to understanding epidemiology. By the time a doctor ears her MD she has most likely had 3-4 years of college-level math in addition to classes specifically in epidemiology. Doctors also get specific training on how to evaluate scientific studies for potential bias.
Doctors (including pediatricians) love helping people. They have your children’s best interests at heart, and only want to do what they can to protect you and your family from illnesses that can potentially be prevented.
I would like to give Dr. Swanson some credit for working to help parents understand and sort through all the information (and misinformation) available today on the Internet. I’m pretty sure she understands the math and probability behind vaccine risk and benefit, but not everyone does. It’s her job to help explain risk and make recommendations, which she is doing wonderfully.
Thanks Dr. Swanson!
Arielle Furtado, ARNP
Kathy Radom says
When you know people who had/have polio (symptoms can return in older age) in your life and boys that were left sterile from mumps you tend to take this all very seriously. Fear of needing an iron lung and a nuclear bomb ruled my childhood fears, forget the boogy man under the bed.
As an RN and grandmom, my question is how do you feel about all the other immunizations (i.e., hepatitis after birth before discharge). It would seem that postponing those not childhood diseases seems reasonable, don’t you think? Appreciate your expertise.
Nat Philosopher says
Hi Dr. Swanson,
The problem I’ve found with vaccines, by surveying the scientific literature, is that there are no cogent studies showing early adjuvanted vaccines are safe, and lots showing they are dangerous. There are hundreds of papers about MMR, but nothing good about early aluminum.
In 2002 the National Vaccine Program Office (NVPO) convened an expert group to study safety issues with adjuvants in vaccines. Among their conclusions:
“pervasive uncertainty [from] missing data on pharmocokinetics and toxicities of aluminum injected into humans… There seems to be abundant data concerning risk levels for ingested aluminum, but scant data about risk levels for injected aluminum. The oral minimum risk level, for example, appears to be in the range of 2–60 mg/kg of aluminum per day but there are no comparable data for injected aluminum.”[1]
Since 2002 there is an extensive literature, and its all bad. I wrote a detailed literature survey, with cites and links to over two dozen mainstream journal articles showing danger:
https://whyarethingsthisway.com/2014/03/08/example-1-pediatrician-belief-is-opposite-the-published-scientific-evidence-on-early-vaccine-safety/
I’d appreciate any comment you have. Thanks in advance.
Jen F says
If I was vaccinated for measles as a child am I covered for life or do adults need to recieve a new round of immunizations?
Wendy Sue Swanson, MD, MBE says
We do not do measles “boosters” in adulthood. Childhood immunization (2 doses) is what is recommended.
Marci Miller says
Dr. Swanson, I really need to talk to you. I have done so much research and have been told by 1 ND who is practicing and 2 NDs who are retired and practiced homeopathy etc. that AT MOST 7 years is the only immunity offered my the mmr shot. Bearing this in mind, I had decided to forgo vaccinations with my 6 yr old who currently does not have the mmr shot. Then tonight I found this blog. You say 99% of people are immune for life?? In all the “books” I know, I know, and all the practitioners I have spoken to i have never seen this. Now I am thinking of hightailing it to the vaccination clinic, any advice?
Marci Miller says
Well we decided to get the measles vac. Love the blog, keep up the good work!
Wendy Sue Swanson, MD, MBE says
thank you, Marci. Good to know your family protected!
Nat Philosopher says
Where does the claim “Over 99% of children and adults who get 2 doses of measles vaccine are protected for life.” come from?
Chen et al, Measles antibody: reevaluation of protective titers
reported on data from a measles outbreak that came just after a school blood drive. So they had before and after titer information on the students. They observed that 7 out of 8 donors with titers below 120 got clinical measles, compared with none having titer above 120. So a titer of 120 appears to protect against getting clinical measles. However, 70% of donors with titers between 120 and 1050 reported symptoms without getting the rash, as did 30% of donors with titers above 1050, and about 70% of patients in the 120-1050 group also had their titers go up by a factor of more than 4, indicating that they had had a measles virus infection, even though short of clinical measles.
So the conclusion: below 120, vulnerable to measles. Above 120, won’t get clinical measles, but may get ill without rash and become contagious for measles. Below 1050, 70% chance of getting ill and becoming contagious for measles. Above 1050, less than 30%.
Le Baron et al, Persistence of measles antibodies after 2 doses of measles vaccine in a postelimination environment
studied how long titers persist in kids after their last booster. The results are plain in their Figure 3. They report that around 95% of recipients of the MMR have a titer over the 120 that Chen et al predict should prevent one from getting clinical measles for at least 10 years. (After that the percentage vulnerable starts rising rapidly.) That’s the good news. And its nowhere near “99% protected for life.”
The bad news is, they report that 2 years after their last booster, more than a third of kids will have titers below 1050, the region where, according to Chen et al, such kids will have a 70% chance of becoming ill and contagious if exposed, although they won’t show the rash. And 30% of kids with titers not far above that, and there are many of those, may also become ill and contagious. As each year passes from the MMR, still more kids fall into the camp vulnerable to illness and contagion, although not yet clinical measles. In a fully vaccinated population, even if most people are protected from clinical measles, most will be subject to infection by and transmission of measles virus.
For links to both papers, see my website.