Dear Vaccine-Refusing Parents

By Karen Ernst

Dear Vaccine Refusing Parents,

I get it. Vaccine Advocates like me have put a lot of pressure on you. Refusing to vaccinate your child is not as popular as it used to be, and some of your peers consider you a pariah, fearing that your children will make them sick. So you’ve gone underground.

You’ve been encouraged to go underground by charlatans, like the anti-vaccine Dr. Bob Sears, who uses fear of vaccines to promote his brand. In his book, he told you not to share with your neighbors the fact that you have left your children vulnerable to disease, and to “hide in the herd.” He probably didn’t bank on the fact that the herd would thin out and your choices would leave us all vulnerable. He sold you two lies: one–that you should be afraid of vaccines, and two–that disease would never visit your children.

So you’ve decided to lie about not vaccinating your children. You’ve told ER doctors that your children are up-to-date on immunizations. You’ve told nurses that your children have allergies that they do not have so that you could avoid vaccinating. And you’ve rationalized it all with the falsehood that if your child ever did become ill, you would keep her at home and not expose others.

But your children, as they’ve grown, have not learned that last part. They have only learned, as you have stated time and again, that they only need to be concerned about their own well being and that they don’t owe anyone the truth or anything else.

It turns out that one of you brought your unvaccinated children to Disneyland while they were contagious with the measles. Because measles is so infectious–90% of those not immune can catch measles from a space where a contagious person had been for up to two hours after he leaves–other unvaccinated people caught it.

One woman went home to Pasadena and visited her unvaccinated sister, who is now refusing to be quarantined. Her mother defended her, saying "It's not nice when my daughter is threatened like this because she's not even sick.”

Of course she can pass along measles before becoming ill with it. Chances are she will. But you’ve been lied to. Someone told you that your children were special and they couldn’t get measles. Someone told you that your children were owed more than children like Ben, who had to be quarantined after a potential measles exposure because his chemotherapy had wiped out all his immunity to the disease.

Someone told you it was okay to lie and to hide from the consequences of your decision not to vaccinate. And now it is time for you to own the truth. Are your children unvaccinated? Be honest about it so ER doctors can treat them appropriately, so schools can exclude them during outbreaks (for their own protection), so your neighbors will know not to visit you and catch diseases we can easily and safely prevent.

I know I’ve been tough on you, and that you disagree with me and all the science showing vaccines are safe. But you still need to have some honesty about your vaccine refusal so that we have some choices about how to protect our children best.

"Consumer-Led Charity" Lobbying Your Legislator About Vaccines

Chances are this summer your state's congressmen and women received a letter from a "non-profit, consumer-led charity" urging them to take note of an "urgent need for reform."

That "charity" is National Vaccine Information Center. The "urgent need for reform" refers to state vaccine laws. 

For anyone unfamiliar with National Vaccine Information Center, it is the preeminent anti-vaccine organization in the United States, extremely well-funded by big donors such as Joseph Mercola. You may have seen their billboards in large cities across the country warning parents of the dangers of vaccines. The organization presents itself as a consumer advocacy group, and perhaps once upon a time it might have been. However, it has morphed, under the watch of Barbara Loe Fisher, into one of the most notorious anti-vaccine groups in the world, and it specializes in cloaking its true intentions with proclamations about "vaccine safety" and "personal choice," when its true mission is to make vaccination completely optional and to eliminate any state requirements making it harder for a parent to get her unvaccinated child into daycare, schools, afterschool programs, or any other public space where public health is of particular importance. 

One of the richer sentences from the letter NVIC sent congresspeople, and which I'm going to talk about briefly, is this one: "NVIC does not make vaccine use recommendations and supports the legal right for adults and parents of minor children to make informed vaccine choices." The latter half of this sentence is an exercise in redundancy, which, I suppose, they feel is worth spending millions of dollars on--informed consent is already assured and part of the medical experience of anyone seeking a vaccine. The first half is a falsehood. ThinkTwice Global Vaccine Institute, which advises against vaccination, lists NVIC as a trusted source of information.  Fisher's own blog betrays her true feelings about vaccines, bearing the motto: "If the State can tag, track down and force citizens against their will to be injected with biologicals of unknown toxicity today, there will be no limit on which individual freedoms the State can take away in the name of the greater good tomorrow."

And whenever states begin considering strengthening immunization rules, NVIC is right there, making a stink, usually in the name of "personal rights" and "informed consent."In fact, that kind of opposition to better immunization rules on a state level is a core purpose of the organization. Think about that for a minute: this is an organization that devotes its time and considerable capital to making it easier for unvaccinated children to mingle with the public in public spaces, such as schools and daycares.

I bring this up because over the summer, National Vaccine Information Center sent letters and a slickly produced "book" to congressmen and women in Washington, which NVIC termed a "legislative guide." That guide was titled "Reforming Vaccine Policy & Law." That guidebook indicates to the legislators who receive it that there is an "urgent need for reform of existing state vaccine laws." Translated, this means that NVIC feels that immunization requirements for children entering school, day cares, and for health professionals caring for the elderly and immunosupressed or immunocompromised (such as children with heart defects, anyone going through chemo, etc) are unacceptable. This, even though the vast majority of states have either a religious, medical, or conscientious objection clause in their rules. 

Personally, I find NVIC's hubris (or perhaps cluelessness?) fascinating: to launch a campaign to weaken immunization rules at a time when the country is grappling with outbreaks of vaccine-preventable diseases, such as measles, mumps, and pertussis. There's no sign that the effort has worked, but the onus is on those of us who care about public health to make sure our legislators are informed about the true intentions of this "consumer-led charity" that warns of an impending crisis of personal liberty (i.e. the closing of certain personal exemption loopholes in some state immunization rules). It would take but a moment to write a quick e-mail to your local representative and senator just to say, hey, you may have received a letter and legislative guide this summer from a group purporting to be an "independent clearinghouse for information on infectious diseases and the science, policy, law, and ethics of vaccination" (a line straight out of NVIC's letter). However, I would like to clarify for you the organization's true position. A simple search of NVIC online or even on this blog will reveal countless examples of NVIC's attempts to dissuade parents from vaccinating. 

While I feel confident legislators grappling with immigration reform, budget issues, and the war on terror are probably not inclined to give NVIC's mailing a second thought, it's never good to let NVIC go unchallenged if you live in a state with pending changes to immunization rules. 

Letter to an Anti-Vaxxer from a Pro-Vax Mom

By Amanda Z Naprawa

I am pro-vaccine.

Vaccines are one of the greatest medical breakthroughs of the twentieth-century.  I believe vaccines  should be mandatory, except for a few very limited exemptions.  That because vaccines save lives. They prevent complications from disease by preventing the disease itself -- complications like blindness, deafness, infertility, paralysis. I am fully vaccinated. My children are vaccinated according to the recommended schedule. We all get flu shots every year.    

I'll say it again and without hesitation: I am pro-vaccine. 

You, on the other hand, are anti-vaccine. You may also be a beautiful celebrity or a best-selling author of childcare books. You may be the president of a "vaccine information group" or the leader of your local "clean living" club. But you are also anti-vaccine.  Please stop referring to yourself as "pro-informed consent" or "pro-safe vaccine" or any other name that tries to hide the truth of your position.

Individuals who urge parents to avoid vaccinating their children based on a slew of myths are anti-vaccine.  If, in the face of dozens of peer-reviewed, scientifically sound studies, you continue to scare parents into believing that vaccines cause autism, you are anti-vaccine.  If you use your good looks and flashy smile to convince parents that vaccines are more harmful than the diseases they aim to prevent, you are anti-vaccine. If you smile benevolently upon chickenpox parties, and mock concerns over the spread of measles, you are anti-vaccine.  If you threaten the scientists and doctors who have worked to create vaccines with bodily harm and death, you are anti-vaccine. If you bully high school students for making a documentary exploring the anti-vaccine movement, then, yes, you're anti-vaccine.

You are anti-vaccine, not "pro-informed consent."  If you were really for "informed consent," then you would push accurate information. True informed consent  requires that the relative risks, benefits and  uncertainties for each alternative treatment option be given to the patient.  When my child gets a vaccine,  my physician gives me an information sheet filled with all the benefits and potential risks of each vaccine.  I vaccinate my child knowing that the vaccine will offer significant protection against serious illness, and that my decision to vaccinate comes with a very, very small risk of some side effects.  I am fully informed.

If you were really pro-informed consent, then you would be giving the true risks of vaccines and the true benefits of vaccines.   You would tell parents --honestly -- that some vaccines carry an extremely small risk of seizure. You would also tell parents -- honestly -- that there is simply no evidence (aside from anecdotal, post-hoc stories) that vaccines carry a risk of autism.  You might tell parents, that you really really hoped that autism could be explained by vaccination (we would all like a simple explanation for autism)  but its not.

You claim to be pro-informed consent.  Informed consent requires that you give accurate, unbiased information necessary to make an informed medical decision.  If you were really  pro-informed consent, you would tell parents that the diseases that vaccines prevent are real. They are scary. They are dangerous.  Yes, many people have had diseases like measles and survived without lasting harm.  But why take the risk? Why let your child suffer an illness that is preventable? In the pre-vaccine era, 400-500 children died a year from measles. Per year. In contrast, 142 people have been compensated for measles vaccine-related injuries over the last eight years.  That's information that a parent can use to make an informed decision about vaccination. That's pro-informed consent.  But that is not what you are about. You minimize the death of children from vaccine-preventable disease by "putting them into perspective."

You are so proud of your accomplishments in increasing awareness of the alleged dangers of vaccination. You have worked so hard to increase the number of states with exemptions to mandatory vaccination. You have tirelessly spread the news that the government cannot be trusted, that vaccine manufacturers cannot be trusted, and that the average vaccine-friendly pediatrician cannot be trusted either.  You have made money, sometimes lots of it, selling the idea that vaccines are dangerous and should be avoided.

There's a name for that. And its got nothing to do with informed consent.

Amanda Z Naprawa is an attorney and graduate student in the Masters of Public Health program at University of California, Berkeley. She believe in promoting immunization through the dissemination of accurate information about vaccine safety. She is the author of various articles, including "Don't Give Your Kid That Shot: The Public Health Threat Posed by Anti-Vaccine Speech and Why Such Speech is Not Guaranteed Full Protection Under the First Amendment." 11 Cardozo Pub. L. Pol'y & Ethics J. 473 (Summer 2013)

Telling Anti-Vax Parents They're Wrong Only Makes Them More Anti-Vax

By Karen Ernst

Today, a study in the Journal of Pediatrics seemed to point out that what pro-vaxxers are trying to do is all wrong.  It might seem to suggest that debunking vaccine-autism myths, explaining relative risks of disease, and demonstrating the effects of vaccine-preventable disease is ineffective.  

The study tried to influence parents’ decisions about vaccines using four strategies, all utilizing online resources: correcting misinformation about the MMR-autism myth, giving information about the risks from vaccine-preventable diseases, presenting first-person narratives about children who had contracted VPDs, giving visuals of those risks. After being presented with one of these four strategies, parents were surveyed about how much more likely they were to choose an MMR for their children.  The information used came from the CDC, although the source of the information was not given to the parents surveyed.  The parents participating in this study came to the study with a wide variety of beliefs about vaccines, and almost none of them left with their beliefs being changed.

In short, the Pediatrics study found, in summary, that:

1. Showing ardently anti-vaccine parents proof that vaccines don’t cause autism only made them less likely to vaccinate.

2. Explaining the risks of vaccine-preventable diseases does not increase the chances that parents would agree to the MMR in the future.

3. Showing parents visuals about disease risk or giving them stories about children suffering from vaccine-preventable diseases did not make them more likely to vaccinate their children.

Those findings seem pretty damning for the pro-vaccine message, but I think we should take heart.  There is so much this study didn’t cover, and so much we can do that would work. Here are my thoughts on the findings:

1. Anti-vaccine parents have a broad range of concerns about vaccines beyond the vaccine-autism myth. Hitting one discussion point only irritates their sense of “they don’t get us.” The study might also fail to nudge ardently anti-vaccine parents because there is no human component, and the targeted parents have no opportunity to feel that someone took the time to genuinely hear out their concerns and address them in a personalized way.

2. Emphasizing risks often feels to parents like “fear-mongering,” and parents who refuse vaccines might feel that they are able to continue refusing vaccines since they live in communities with high vaccination rates where the risk of their child actually contracting a vaccine-preventable disease is low.  Just the other day on our Voices for Vaccines Facebook page, one mother commented, “I do not vaccinate, but would definitely consider it if traveling overseas.”  Anti-vaccine parents believe that their risk for contracting diseases is greater where those diseases are endemic, and trying to convince them that their children are at risk for complications from diseases they are unlikely to catch at home is problematic.

Conversely, anti-vaccine parents are likely to disbelieve in herd immunity. As Amy Parker’s mother once did, anti-vaccine parents often rely on organic foods and healthy living to protect their children from diseases that are often airborne and highly contagious. Those of us providing the cover of herd immunity to their children only make it easier for them to continue to delude themselves into believing that their lifestyle is the deciding factor. And because allowing children to become ill to prove our point is wrong in every sense of the word, it’s simply unlikely that anti-vaccine parents will change their minds due to fear of risk from disease.

In reality, what these anti-vaccine parents are doing is increasing the risk that these diseases will come back and that someone will suffer from a serious complication.  The parent who already vaccinates does so not only out of concern about serious complications, but also because they want to prevent illness in their children. But only ardent pro-vaccine parents are typically also passionate about the power of protecting her whole community.  However, maybe we can use pride in protecting the community not as a way to motivate parents to vaccinate but to motivate vaccinating parents to take pride in their actions and speak up about them.

3. Images and stories about children in peril because of disease only makes parents look for other dangers.  I call this the “Law and Order: SVU” effect, named so because after I have watched episodes of this show where children were in peril, I tend to see dangers for my children everywhere--beyond the scope of the subject of the episode.  

The researchers call this the “danger-priming effect.”  Priming parents for danger doesn’t make them more likely to take the solution you are offering, according to this theory.  It makes them more likely to look for dangers everywhere, including in that syringe you are holding out to them.

4. This study was limited in what it could reasonably do to ease fears about immunization because it was online and impersonal. There’s simply no way to quantify all of those conversations that occur on the playground among parents or around the Thanksgiving table or even between friends on Facebook.  

Parent-to-parent communication is entirely different than the communication in this study.  Think about what we know about ardently anti-vaccine parents:  They are more likely to believe conspiracy theories and thus less likely to believe officially sanctioned scientific evidence.  They are more likely to have a social network guiding them toward vaccine refusal, and providing them positive social reinforcement for their decisions.  The cold, impersonal online survey has no chance for success in the mind of a parent whose decisions are socially reinforced and are based on a distrust of official stances.

So what can we, as pro-vaccine lay-advocates, do? Are we likely to make parents less likely to vaccinate through our advocacy?  

I do not believe so.  In fact, I think lay-advocates--everyday parents and citizens--are key. Recent research shows that normalizing immunization works.  So let’s do that. Let’s let people know that we happily vaccinate our children because we understand the science behind it is clear and because we value our children’s health.

And vaccinating is normal.  Well over 90% of parents vaccinate on-time. If anti-vaccine parents feel that their position is being reinforced by their social network, then we as parents are not doing our job to protect our children and their friends. If every parent with fully vaccinated children simply stated that their children were vaccinated on-time, there would be a groundswell. The voices of these parents would drown out the fear-mongering and lies of the anti-vaccine movement, and concerned parents would feel more confident to join our ranks.

In other words--speak up. It just might work.

Moms Who Vax: Breastfeeding, Baby-Wearing, and Vaxxing

 By Kim Norton-Jurgens

I breastfeed my children until they self-wean – openly in public. I baby wear and partially attachment parent.  I aim for drug-free natural births.  

And I vaccinate my children.

Some of my spare time is spent helping mothers with breastfeeding problems, and this community tends to attract many "natural living" people.  Occasionally I find they assume I don’t vaccinate my own children because I do work in this community.  I don't feel its fair that such assumptions should be made based on the views of a few people on the fringes of some very worthwhile endeavours, like trying to live a healthier life.  To counter these assumptions about me, I'm vocal about the fact that I vaccinate my children. I talk about it on Twitter, I post informative articles on Facebook – and while nobody “likes” my posts or comments, I get personal messages from people thanking me for being brave enough to share what we know is correct. 

             Here in South Africa we have two vaccination schedules – a government one, which is free at state clinics, and a private schedule, which is fairly costly but includes the MMR vaccine rather than just the measles shot.  I chose to use the private schedule.  I know quite a few mothers who use the state schedule and then go to a private clinic for the MMR.  Additionally, I’ve had my children vaccinated for hepatitis A and varicella (chicken pox), which aren’t on either of the schedules.   

For us, here in South Africa, vaccine-preventable diseases are still a threat. When I was a child, there was a boy in my class who had had polio and who wore callipers and used crutches. On the farm I grew up on, one of our employee’s children had had polio.  I can remember friends having measles and my mother keeping us well away from their house.  Here TB is not an abstract threat – we all know someone who has had TB contracted from someone or from drinking unpasteurised milk.   

Unfortunately, if you’re a parent, you’re exposed to so much misinformation and emotional rhetoric about everything from the moment of conception onward that you do always have time to think carefully about the trustworthiness of the information you’re given.  Ironically, the very questions that anti-vaxxers feel one should ask of the medical community are the precise questions they don’t ask of the “natural health” purveyors and anti-vaccine organizations from whom they get their information. 

             What upsets me a lot is that with the relentless misinformation campaign of anti-vaxxers, even the most ardent vaccinator still takes a deep breath before booking the appointment for the MMR.  I know anti-vaxxers claim many other reasons for not vaccinating, but that false autism-MMR connection is the one that gets the most publicity.  Each and every claim made anti-vaccine activists make is so easily debunked – over and over and over—that it is shameful that there are still people who just swallow this information and don’t ask questions. 

             What I do know is that I am doing the best I can to protect my children from preventable diseases.  (I also know that both my son and my daughter will be getting the Gardasil vaccine.) I hope that by sharing this information, I can give courage to other parents who vaccinate to stand up and proudly say that they do, and to counter misinformation when they hear it.  Because vaccination is not a personal choice. 

Kim Norton Jurgens is a mother of two and a Human Resources Manager. She has a degree in business commerce and is married to a journalist. She lives in South Africa.

Editor's Note: Kim shared with us her favorite immunization sites:  "My little arsenal of web sites for sharing reliable information with others includes Anti-Anti-Vax, What's the Harm, QuackWatch, Science-Based Medicine, and Voices for Vaccines."

If you don't vax for measles, be prepared to help your child through this...

Jim Gehrz via Startribune.com

Editor's Note: Author of the now-defunct Vaccine Times, Leart Shaka, has graciously allowed Moms Who Vax to re-post several of his articles. His work on vaccine education was immensely helpful. The story below is his, sourced from Maura Lerner's excellent Minneapolis Star Tribune article.

Little Mahi is very unlucky: he nearly died of measles. He contracted measles while traveling overseas. He was not vaccinated due to his young age. He was 9 months when his family left for Kenya. Although Mahi’s parents intended to get him vaccinated on time according to the recommended schedule, they didn’t know that although the first shot of the MMR vaccine isn’t given until 12 months, for overseas travelers different rules apply. Mahi should have been given a vaccine prior to his trip to Kenya. His chances of getting the disease would have been slashed by over 90% if that had happened.

Little Mahi is very lucky: he nearly died of measles, but he didn’t; he beat the disease. After contracting measles he had a 1/20 chance of getting pneumonia, which he unfortunately did. On August 10, his mother brought him to the emergency room with very high fever. Within days, baby Mahi was on life support, hanging by a thread.

“I didn’t think I’d be able to hold him again,” his mother said Friday, as she cuddled him in her lap.

[...]

On his fifth day in the hospital, Mahi took a dangerous turn. He was transferred to intensive care, hooked up to a breathing machine and given antibiotics to battle the pneumonia. For days, he was sedated and barely moved.

“It was really hard,” said his mother. “It was like watching a dead body.”

The medical experts were equally worried. Mahi, said Stinchfield, was “teetering near death.”

After nearly two weeks in intensive care, Mahi started to wake up, as doctors eased up on the sedation.

On Tuesday, they took off his breathing tube. “He opened his eyes and looked at me,” said his mother, and he squeezed her hand. “Look at this!” she thought. “I couldn’t believe he could be that strong.” When he started crying when she stepped away, she was thrilled. “Wow, my son knows me,” she said.

Little Mahi is lucky to have beaten measles, unfortunately 1-2/1,000 children who contract the disease will not be so lucky, despite the best medical care they can be given. Measles is not a trivial disease. It can land you in the hospital like it did baby Mahi, it can leave a child deaf, and it can kill. Do not be swayed by the conspiracy theorists. Do not delay.

Inject to protect.


Editor's Comment: Mahi was not vaccinated because he had not yet reached the 12-15 months of age recommended for the MMR shot (though he should have been vaccinated before traveling overseas). But what happened to him can happen to any unvaccinated child. Delaying a vaccine out of fear or because of recommendations from a vaccine-hesitant parent-friend puts your child at grave risk for those months that she is left unprotected, especially now that measles has come roaring back to life all over the country because people are not vaccinating their children. My kids have received two MMR vaccines. My eighteen-month-old had to receive her MMR booster (typically scheduled for four-years-old) just six months after her first one because of the Minnesota measles outbreak this winter. It's not the time interval that bothers me--it doesn't bother me at all. What bothers me is that anti-vax parents forced me in to the doctor's office for a shot two-and-a-half years early. 

Peace of Mind

As a new or expecting parent, you'll have to get used to the idea that your child will be sick. A lot. It's part of life, this acquisition of viruses and bacterial infections. And while it can be hard to watch your child cough, sniffle, become feverish, battle a sore throat, etc., at least we know her immune system is growing stronger and figuring out a way to let her live among other human beings without being crippled by illness. 

That being said, you can probably expect to feel the way I still feel, after two kids, every time my kids get perhaps a little sicker than usual: anxious, worried, and perhaps even a little obsessed. For example, my nineteen-month-old has been sick for the last five days with what was a mysterious but brutal ailment. She was listless, not herself, eyes red-rimmed, running a high fever, and crying a lot. Her brother had been complaining of a sore throat. A visit to the doctor, and the follow-up three days later, showed no strep. He was off to school a couple days later, none the worse for wear. But my daughter was just not doing well at all. I found myself looking through my book of childhood illnesses, scrutinizing symptoms, wondering what she might have and if I should bring her to the doctor (my son's doctor didn't think it necessary to bring my daughter in, since his strep test was negative). 

As soon as I opened the book that old familiar feeling appeared. Blood and heart racing, getting hot, almost sweaty, feeling panicked. Measles? Meningitis? Mumps? Pertussis? I churned for about half a second, until I realized: wait, my daughter has been vaccinated against these deadly diseases. At least, I thought to myself, I don't have to worry about those. The peace of mind I felt instantly upon realizing that I had vaccinated my daughter (and son) so they would not contract these awful, sometimes fatal diseases was one of the greatest endorsements of my decision to vaccinate. Sure, I could move on to other worries, like strep throat (which is what it turned out to be after a visit to Urgent Care), but I no longer feared for my daughter's life. And while that may sound an extreme reaction to your child's illness, trust me, it's sort of a boilerplate reaction. Somewhere, in the back of your mind, a parent wonders if the sickness might be something awful.

My thoughts turned to parents who don't vaccinate. How, I wondered, could they cope psychologically with common childhood illness, not knowing if it was measles or the rather harmless roseola? Could it be pertussis or just a bad cough? The uncertainty would be my undoing. And in the middle of an outbreak, like the measles outbreak of Minnesota and the pertussis outbreak that killed children in California, the fear would be too much to bear. 

If you are trying to decide whether to vaccinate your children, consider your future self, waking up in the middle of some future night, and finding your baby running a terribly high fever in her crib. You don't what's going on--this is your first, perhaps. Do you want to run, in your head, the gamut of all the potential deadly vaccine-preventable diseases your child could have, signaled by this fever, that rash, this cough, these enlarged glands? Or do you want to have at least the peace of mind to know that the odds are hugely in your favor that your child is protected from the worst childhood diseases out there, and that this fever might indicate Fifth's Disease or Roseola or another annoying but basically harmless childhood virus? Do your future, sleep-deprived self, and your child, a favor and immunize.

Biography of a Measles Outbreak

Wondering how a vaccine-preventable disease outbreak can spread? Wired offers a clear-eyed view from the Arizona measles outbreak. As parents facing the choice about whether to immunize our children, we owe it to them to understand the truth about the presence of vaccine-preventable diseases in our country and communities, how they get here, and how they spread. You can read the story of the Arizona measles outbreak here, but below you'll find an excerpt from the play-by-play of how that outbreak unfolded. If any non-vaccinating parent has told you that these diseases are effectively gone in the United States, and that immunization is unnecessary, take a look at how measles spread in Arizona. Please also take special note of two facts: one, that the outbreak was started by an adult who had traveled to another country and returned to the United States and two, that many of the victims were children who had intentionally been left unvaccinated as well as infants who had not had a chance to be vaccinated:


In February 2008, a 37-year-old Swiss woman who had never been vaccinated against measles arrived in Tucson after a visit to Mexico. She developed breathing problems and a rash and went to a local hospital’s emergency room. They suspected she had a viral illness and admitted her.

Here’s what you have to know, to understand what happened next. Measles is extremely contagious; up to 90 percent of unvaccinated people who are exposed to it will get it. And if someone nearby has it, youwill get exposed — because coughed-out measles virus can travel across a room, and hangs in the air for hours. The best protection against spreading measles in a hospital is putting someone in a negative-pressure isolation room, which is engineered so no air can leak out into the rest of the hospital. It took two days to get the Swiss tourist into isolation, because measles is rare enough in the US that it was not the hospital personnel’s first thought.

Meanwhile:

A 50-year-old woman who had spent an hour in the ER at the same time as the Swiss woman caught the disease from her. Patient 2 got taken care of, went home, and started feeling feverish nine days later. She had difficulty breathing and thought at first she was having an asthma attack, so she went back to the hospital and was admitted for two days. That she had measles would not be discovered until six days after that.

While she was  in the hospital, Patient 2 unknowingly infected a 41-year-old health care worker who took care of her — and who was scheduled to get a measles-vaccine booster shot that very day, because the hospital was also caring for the tourist. Patient 2 also passed measles to an unvaccinated 11-month-old boy who was in the same ER while she was waiting to get checked for asthma, and to two unvaccinated siblings — 3 and 5 years old — who were visiting their mother on the same hospital floor after Patient 2 was admitted.

Patient 3, the health-care worker, passed measles to a 47-year-old woman in her emergency department — who later  ended up in an intensive care unit with measles pneumonia — and later to a 41-year-old man in his home. Patient 4, the toddler, gave the virus to an unvaccinated 1-year-old while they were both in the same pediatrician’s office. Five other people were infected somewhere in their everyday lives: a 2-year-old boy who had never been vaccinated and who also ended up in an ICU with seizures brought on by high fever; a 9-month-old and an 8-month-old, also unvaccinated; and two adults, 35 and 37, who might have gotten one dose as children, but had no documentation of receiving a second dose.

Those 14 are just the confirmed cases. In addition to them, there were 363 suspected ones, and today’s paper makes clear authorities believe there were more illnesses than they know. And for every known case, there were dozens or hundreds of exposed people who had to be checked: 145 passengers on the tourist’s flight from Mexico, 1,795 patients in the ER that treated Patient 2, 25 people who attended church with Patient 7, 10 kids in the same day care center as Patient 8.

I'm Mad, Part One: Mercury/Thimerosal

New and expecting parents are bombarded with information about all the bad things they'll need to keep their children away from: BPA in bottles, parabens in lotions and bath supplies, phthalates and PVC in toys and teethers. It can be overwhelming. And yet the science linking these three chemicals to negative health effects is thus far nearly conclusive (I will link to CDC studies on these chemicals at the end of the article). Luckily, phasing them out of your life is a risk-free and mostly hassle-free endeavor. Most if not all baby bottles today are free from BPA; in some states, including Minnesota, phthalates are not allowed in children's products. Parabens are easily identifiable in personal products (look for methylparaben, butylparane, propylparaben) and can be avoided. There is no trade-off. You are not putting your child at risk by choosing a BPA-free bottle.

So after crossing those things off the list, new and expecting parents often turn to vaccines. And many of them make the same mistake I made as a new parent. They turn to Google, the place where eminent scientific mind Jenny McCarthy says she got her "degree."The first sites we find are not Every Child By Two and the Centers for Disease Control, the Gates Foundation and Partners in Health. Instead, we find sites like the so-called National Vaccine Information Center, which masquerades as an impartial watchdog agency (hence the "org" in its web address), and Vaccines.net, which claims that vaccines cause all sorts of diseases and allergies. For the neophyte, it is nearly impossible to sort the wheat from the chaff here, and the effort to do so can be absolutely terrifying.

You will hear lots of terrible things about vaccines. Nearly all of them are lies. The word "lie" is inflammatory, but I use it here deliberately. It is a word, and a characterization, you will not see on public health websites, from the CDC, from Every Child by Two, or any of the sites of organizations whose job it is to study the safety and efficacy of vaccines. Even though they know this is true. 

But we're parents who have been on both sides of this debate. We've been scared, too. But after looking at the science and putting things in perspective--something the anti-vax community will not do, perhaps because they are incapable, perhaps because their science literacy is so low--we got mad. 

I'm mad about lots of things. We all are. In an effort to save some new parents the same heartache, worry, anxiety that we suffered as we tried to figure out the vaccine thing--and to keep parents from delaying their children's immunizations out of fear, as a few of us did before we understood our mistake, putting our kids' lives at risk in the process--we are initiating a series of "I'm Mad" posts. These posts will address some of the most volatile but common claims anti-vaxxers make when trying to scare new parents out of immunizing their children. Today we start with the thimerosal question.

Claim: Thimerosal in vaccines causes/caused autism. If it doesn't, it's still toxic. 

I worried about thimerosal for a while. People told me it was straight-up mercury being injected into my child's body. Mercury is poison, right? It's what is causing all this autism, because although thimerosal has been used a preservative in vaccines for decades, without the attendant rise in autism, our kids just get so many more immunizations now, right? 

Well--except that thimerosal hasn't been in vaccines since 2000/2001 and autism rates continue to skyrocket. I shouldn't have to point out, but I will, that this is the exact opposite effect of what we'd see if thimerosal caused autism, as anti-vaxxers long claimed. I later learned that the preservative had been taken out of vaccines by the government and public health authorities not because of any toxicity concerns but because parents believed the Wakefield study and they feared vaccination rates would fall if this gesture was not made. Thimerosal does not cause autism (Immunizations and Autism: A Review of the Literature in the Canadian Journal of Neuroscience). 

Mercury poisoning? That sounds scary. Except that your typical tuna sandwich contains much more mercury than a single vaccine. Actually, the mercury in tuna is scarier, because it is methyl mercury, a serious neurotoxin, while the mercury in vaccines is ethyl mercury, which is, even at high doses, far less toxic than methyl mercury (but in the doses we're talking about in vaccines are literally traces anyway). Bottom line: mercury poisoning is an impossibility when it comes to vaccines, even if you were to get the whole course of childhood vaccines (back when they contained thimerosal) in a single week.

But here's the main point that goes overlooked. Right now, vaccines are nearly the lowest-risk medicine we have available to us. The reports of adverse effects--which include fever and soreness at the injection site--are so low compared to the number of doses administered, that they are considered one of the safest, if not the single safest, medicine in the world. And their benefits are this: they keep your child alive. It is as simple as that.

Too few of us parents have seen measles. I know of no one who has seen polio, except for people who have lived in Afghanistan and India, where polio is still endemic. Endemic. This means it is "regularly" found in a population. Know anyone who travels to India? Might there be any children at your local school who have Indian relatives? I know there are at least eight in my child's preschool alone. I hasten to add that their parents didn't think twice about immunizing them, because of their travels and because they, too, had seen these diseases take lives when they were growing up. Is there a reason why your husband or wife might be required to get a polio shot if he/she hasn't gotten one if she/he is deployed to Afghanistan? This stuff is a plane ride away. And it is not theoretical.

Haven't seen what Tetanus looks like? Here is a photo of a child with tetanus. Here is a photo of a child who suffered polio. Measles looks like this. Is it worth forgoing vaccines against diseases like this, and many others, that are absolutely extant in our world and either in this country (or in my case, my state) or a plane ride away, carried home by an unwitting traveler much like the toddler who brought measles back to Minnesota from Kenya this winter, because of fear of a toxicity that simply doesn't exist? It's something to consider. For me, it became an easy answer when considered this way. 

Science-Based Medicine offers a look at the claims of toxicity of vaccines that you are likely to hear as you explore the vaccine question. We owe it to ourselves to read the post in its entirety before making any decisions about whether or not to get on board with some of the more inflammatory claims we still hear from people who don't vaccinate their children and don't want you to vaccinate either. 

You can also get the word from these organizations. Below are links to their statements on the safety/toxicity of thimerosal. Again, this is really a moot point, as no childhood vaccines, save the multi-dose vial version of the flu shot, contain any thimerosal. But it's a point worth making, as it demonstrates the ways anti-vax proponents will manipulate and misinterpret the science to new parents, hoping that most of them won't bother to look into their claims.

World Health Organization's Statement on Thimerosal

 Centers for Disease Control Statement on Thimerosal

FDA on Thimerosal

Journal of Pediatrics publishes study on mercury in vaccines

View from the Exam Room: Baby's First Immunizations

Today my younger sister took her two-month-old daughter to get her first vaccinations. She asked me to be present. After we talked to the doctor about the baby's bowel movements, her tendency to spit up, her impressive head and neck strength, we got the vaccination question. At that point, my sister got tongue-tied, and she turned to me.

"Obviously you don't turn away unvaccinated children," I jumped in, "but I think what my sister is concerned about is exposure to infected unvaccinated children in your waiting room. We can't control the general population--who knows who is vaccinated and who isn't when we go to the mall. But several infants have been infected in waiting rooms and emergency rooms by unvaccinated children waiting for treatment." The doctor nodded and seemed grateful to hear from a couple of so-called "pro-vax" moms for once.

"You're right," she said. "We don't turn away unvaccinated children. We try to convince the parents to vaccinate, of course, and give them the facts." She continued. "We had a case of measles here on Friday." It was like the air was sucked out of the room. The doctor was pregnant herself. I mentioned that I thought that must have been a bit scary for her. "Luckily, I was on the other side of the clinic at the time," she said. "But we have very clear protocols for handling that."
"Do other parents have the right to be notified?" my sister asked.
"Yes, we notify anyone who might have been in the waiting room that day, and if we suspect the child has measles, we put him in a specific room in the clinic."

I looked at my sister. This didn't see like enough. And I agreed. "It's really refreshing to hear from this point of view," the doctor added. "Parents who are concerned about unvaccinated children." She told us that since the Twin Cities measles outbreak, some parents who had, to this point, left their children unvaccinated had relented and brought their kids in for vaccines. I found this a hugely positive step.

Then it was time for the vaccines. The physician's assistant had set down a piece of paper and said: "Here are the vaccines for this visit. She then said: "You'll be getting shots for these eight diseases," and went down the list. I cringed. As soon as she left, I turned to my sister. "This will actually consist of two injections." Her eyes had grown wide, because it sounded like this baby was going to get eight shots. Going down the laundry list of diseases a combo vaccine prevents has become rote, but health providers really need to give careful consideration to the way they present these vaccinations. "These PAs need to be trained in how to talk about vaccines in ways that don't mislead or scare parents," I said to my sister. "Geez!"

In the end, my baby niece got three injections (dTaP--Diptheria, Tetanus and Pertussis--protecting her against three of the most devastating diseases known to man; Pneumonococcal, which prevents a disease that can lead to meningitis; and her Hep B vaccine, since she hadn't gotten it at birth).

When my sister laid her baby on the exam table, she said, "Oh, look at her looking at me, all trusting and loving." I said: "She's trusting you to do what's best for her because you love her. And you are."

Mom to Mom: Karen Ernst

Editor's Note: From time to time, we'll feature a blog post by a parent who vaccinates. If you're a parent who vaccinates or who was afraid of vaccines but now vaccinates and would like to write a guest post for us, please contact us. We'd love to hear from you!

If your children are vaccinated, why do you care whether or not I vaccinate mine?

Most of the parenting decisions I have made are none of your business.  Did I breastfeed or bottle feed my children?  Did I Ferberize them or sleep next to them in my bed?  Did I stay home with them or maintain my career and send them to day care?  I'm not telling you because these are personal decisions which will have no effect on your life or the lives of your children.

The decision to vaccinate my children, however, is not personal.  It is a matter of public health.  And I have the right to know that my neighbors, and that you, are vaccinating.  The answer about why I do care hinges on the concept of herd immunity.

Do not be fooled by herd immunity naysayers.  Doctors noticed the benefits of having a large population immune to certain diseases during the smallpox outbreaks in the nineteenth century.  150 years ago, doctors noted that in communties where a large percentage of the population had either been innoculated or had contracted smallpox, the virus could not make inroads and did not effect the susceptible remainders of the community. (See Fine P (1993). "Herd immunity: history, theory, practice". Epidemiol Rev 15 (2): 265–302.)  In the mid-twentieth century, public health officials used herd immunity to eradicate smallpox from the planet.

Herd immunity functions properly when enough of us are vaccinated to hinder the introduction of certain diseases into our communities.  For example, polio has been absent from the United States since 1994 simply because enough of us have received the polio vaccination.  The virus has trouble finding  bodies to grow in, and therefore it isn't in circulation.  But when too few of us are vaccinated, we find ourselves in the midst of an outbreak, like the measles outbreak Minnesotans are living through right now.

But my children are vaccinated, so why should I worry about the measles outbreak or the unvaccinated lot who are allowing the measles virus to circulate throughout our community?

Vaccines are not a guarantee.  They can't always provide complete immunity for every person every time.  The MMR vaccine produces immunity in 95% of those who receive the first dose.  Doctors intend for the second dose to catch those who did not build immunity after the first dose.  Nonetheless,  some who are vaccinated are still not immune.  

Not everyone can be vaccinated.  Some people are too immuno-compromised to receive the vaccine,  others have allergies to some of the components, and some are too young to receive the vaccine.  Many of those who died in this year's pertussis outbreak in California were too young to have completed the immunization against it.  

And some people in our world have such weakened immune systems that their survival depends on the health of the community.   The mother who has terminal cancer deserves to spend as many days as possible with her children without her life being cut short by a vaccine-preventable disease.  Grandchildren do not want to lose their grandparents early due to a bout of influenza.

I care whether or not you vaccinate because I care not only about my children and their health, but I care about others in my community.  I care about the people I see every day who have asthma or rheumatoid arthitis, and so I get my kids their shots, and I want you to do the same.

Karen Ernst is outnumbered by the four main men in her life, ages thirty-something, seventeen, seven, and two.  She is currently a stay-at-home mom, but has also worked as a high school English teacher, where, among other things, she taught her students to examine the credibility of what they read and the reliability of their own assumptions.  She carries this passion into her armchair advocacy for vaccines.