Friday, December 5, 2014

Mississippi does something right. Will it continue to do so?

Is measles making a comeback? Dr.Haider Javed Warraich argues the once-conquered disease is indeed on the rebound, but in areas where parents are not vaccinating their children against the disease. Dr. Warraich asks if the state should mandate such vaccines. He lauds Mississippi for its tough policy against exemptions, but points out some Mississippians want to weaken the law and thus endanger public health. Ironic since Mississippi is probably one of the least healthy states. Dr. Warraich writes:

I was working on the hospital infectious-disease service when our team was asked to see a young girl with a mysterious illness that no one had been able to diagnose. She had come to the emergency room with a fever and runny nose and had a rash spreading across her body. She had developed a cough so harsh that “whooping cough” had been added to the long list of possible infirmities. But when the senior doctor on our team, Frank Berkowitz, an expert in pediatric infections—arrived at her room, he knew the diagnosis immediately: She had measles.

Many developing countries continue to suffer from measles, an extremely contagious respiratory disease, but the U.S. in 2000 was declared “measles free” by the Centers for Disease Control and Prevention. The news of a confirmed case set our hospital abuzz, and uniformed CDC officers soon swooped in.

How did the young girl get the disease? Her parents had refused to vaccinate her.

Hers is far from the only case. Measles is making a terrifying comeback in the U.S., with some 600 cases reported this year, more than in any year in the past two decades. There are two reasons: the ease of international travel, and an increasing number of people refusing vaccinations, usually on behalf of their children.

Because parents seeking exemptions tend to be geographically clustered, these communities can become outbreak hotbeds. For example, the exemption rate in Orchard Prairie in Washington state is 24%, five times higher than the state’s median exemption rate and 13 times higher than the national average.

Forty-eight states offer nonmedical waivers for parents to exempt their children from vaccination, and the states where exemptions are the easiest to get are also home to the highest rates of unvaccinated children. States such as Colorado and Oregon, which only require parental signatures for exemptions, have exemption rates close to 6%, among the highest in the country, according to CDC data.

These refusals have directly resulted in an increase in the incidence of almost forgotten diseases like whooping cough and measles. After the introduction of the whooping cough vaccine in the 1940s, cases dwindled to about 1,000 cases annually. Yet the CDC reported nearly 77,000 cases of whooping cough in 2012 and 2013.....

Refusing vaccinations also puts other children at risk. Vaccines work when given to individuals, but they are most effective when administered to an entire population. That’s because vaccines confer “herd immunity” that disrupts the chain of infections, but only if enough people get the immunization. For a highly infectious disease like measles, that threshold is about 92% of the population. At less than 92%, outbreaks can start to pop up, as is happening now.

Some people—such as chemotherapy patients—cannot be vaccinated. Parents who refuse to vaccinate their children are conferred protection from other children who get the vaccine and maintain a prepared herd—but when refusals reach a tipping point, they put everyone at risk, especially the most vulnerable.

We don’t let people do most things, such as drunken driving, that endanger themselves or others. So why do we allow people to prevent their children from receiving the most effective public-health intervention known to our species?

West Virginia and Mississippi have the strongest position against vaccine exemptions: Neither allows religious or personal exemptions, and neither has had an outbreak in more than 20 years.

When I asked Dr. Walter Orenstein, the former director of the CDC’s National Immunization Program, whether exemptions should be allowed, he offered caution. “I have some concern about ‘forcing’ vaccinations and not allowing any exemptions,” he said. “It could backfire and enhance anti-vaccination sentiment.” Yet with vaccine exemptions sharply increasing, doctors and public-health experts are running out of options.

Claims about the dangers of vaccines—such as their purported relationship with autism—have been rigorously studied and debunked. Yet anti-vaccine advocates are becoming more vocal. When scientific proof is overwhelming, and reason fails, they fall back on magical thinking. Lindey Magee, an antivaccine advocate in Mississippi, told Newsweek earlier this year, “I saw the Disney movie ‘Bears,’ and if God gave bears instincts to survive their harsh reality, then human beings certainly have the instincts to protect children.” She added, “Mumps, measles and rubella do not scare me.”.......

The re-emergence of measles may be the harbinger of other infections such as polio returning from the history books. While autonomy needs to be a central value driving medical decision-making, legislators need to protect American children. The young girl at my hospital with measles survived, but others might not be so lucky.

Dr. Warraich is a physician at the Beth Israel Deaconess Medical Center in Boston and an instructor at Harvard Medical School. Dr. Gohar Javed, a research associate at the Aga Khan University in Karachi, Pakistan, contributed to this op-ed. Rest of essay.


Anonymous said...

"When scientific proof is overwhelming, and reason fails, they fall back on magical thinking. Lindey Magee, an antivaccine advocate in Mississippi, told Newsweek earlier this year, “I saw the Disney movie ‘Bears,’ and if God gave bears instincts to survive their harsh reality, then human beings certainly have the instincts to protect children.” She added, “Mumps, measles and rubella do not scare me.”......."

I bet she is a Teabagger stalwart!!!!

Anonymous said...

It's sad that it is children who will suffer, but this is evolution at work, preventing the "stupid gene" from being passed on to the next generation.

There have been several outbreaks in Britain in recent years, where the problem is even worse.

AT my medical school graduation the students gave a standing ovation to one of the recipients of an honorary degree, Marshall Nirenberg, who received the Nobel Prize for deciphering the genetic code. The parents and grandparents there gave a standing ovation to the other recipient of an honorary degree, Albert Sabin, who developed the oral polio vaccine. When I asked my grandmother about this difference in reaction she said "You're too young to know what it was like when their was an outbreak, when whole neighborhoods were quarantined and people died or were left crippled for life." The same situation exists today, when hardly anyone knows anyone who died of measles or polio or whooping cough, so they don't see the need to take the risk of a rare side effect from the vaccines.

Anonymous said...

The child who would have been my uncle died of a combination of the measles and the mumps at age 3.
I was quarantined in a polio outbreak. Later I visited my friend trapped in an iron lung. I was 7 years old.
A little boy in my Sunday school died of whooping cough.
I still bear a scar from a severe case of chicken pox.
When there were outbreaks of these disease, our parents were concerned and our activities were curtailed.
The parents acted as a group and nobody, nobody would send a sick child to school ever!
As a young woman working with children, I was thrilled that we had eradicated these diseases from our Nation.
Not only did my generation not seem to pass along this oral history, but unlike then, our media is willing to have any opinionated fool with zero expertise or even a rational basis of concern quoted in print or on film! Hence , a few anecdotal observations of distraught mothers who had children with autism became viral and given the weight of science.
We don't believe in the merits of science anymore! We believe in " feelings"!
Indeed, there's a new equivalent of " the bogeyman" at everyday. And, when science tells us of a real concern, it's too ! And, when scientists tell us of a real concern, it's not entertaining enough to get our attention!
Why worry about what's happening in our own backyard and deal with problems we can do something about when we watch problems in Ferguson or New York?

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Trollfest '09

Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).

Meet KIM Waaaaaade at the Entergy Tent. For five pesos, Kim will sell you a chance to win a deed to a crack house on Ridgeway Street stuffed in the Howard Industries pinata. Don't worry if the pinata is beaten to shreds, as Mr. Wade has Jose, Emmanuel, and Carlos, all illegal immigrants, available as replacements for the it. Upon leaving the Entergy tent, fig leaves will be available in case Entergy literally takes everything you have as part of its Trollfest ticket price adjustment charge.

Donna Ladd of The Jackson Free Press will give several classes on learning how to write. Smearing, writing without factchecking, and reporting only one side of a story will be covered. A donation to pay their taxes will be accepted and she will be signing copies of their former federal tax liens. Ms. Ladd will give a dramatic reading of her two award-winning essays (They received The Jackson Free Press "Best Of" awards.) "Why everything is always about me" and "Why I cover murders better than anyone else in Jackson".

In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.

In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.

Trollfest '09 is a pet-friendly event as well. Feel free to bring your dog with you and do not worry if your pet gets hungry, as employees of the Jackson Zoo will be on hand to provide some of their animals as food when it gets to be feeding time for your little loved one.

Relax at the Fox News Tent. Since there are only three blonde reporters in Jackson (being blonde is a requirement for working at Fox News), Megan and Kathryn from WAPT and Wendy from WLBT will be on loan to Fox. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both and a torn-up Obama yard sign will entitle you to free drinks served by Megan, Wendy, and Kathryn. Get your tickets now. Since this is an event for trolls, no ID is required. Just bring the hate. Bring the family, Trollfest '09 is for EVERYONE!!!

This is definitely a Beaver production.

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Trollfest '07

Jackson Jambalaya is the home of Trollfest '07. Catch this great event which promises to leave NE Jackson & Fondren in flames. Sonjay Poontang and his band headline the night with a special steel cage, no time limit "loser must leave town" bout between Alan Lange and "Big Cat"Donna Ladd following afterwards. Kamikaze will perform his new song F*** Bush, he's still a _____. Did I mention there was no referee? Dr. Heddy Matthias and Lori Gregory will face off in the undercard dueling with dangling participles and other um, devices. Robbie Bell will perform Her two latest songs: My Best Friends are in the Media and Mama's, Don't Let Your Babies Grow up to be George Bell. Sid Salter of The Clarion-Ledger will host "Pin the Tail on the Trial Lawyer", sponsored by State Farm.

There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.

If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

This is definitely a Beaver production.

Note: Security provided by INS