New back-to-school worry: Unvaccinated classmates

[wtbcrna]

"A growing number of children aren't getting required vaccinations for non-medical reasons. What will this new reality bring this school year?

As parents send their children back to school, some are grappling with a new worry: whether their children's classmates have received all their vaccinations.

An outbreak of measles in Texas this week shows why their concern is not without reason. Twenty-one people linked to a megachurch and its congregation have contracted the highly contagious disease, and the case has put a spotlight on falling vaccination rates in the U.S.

Measles was eradicated in the U.S. as of 2000, according to the Centers for Disease Control and Prevention, but outbreaks like the one in Texas are increasing, as is the percentage of parents choosing not to immunize their children, which has seen an uptick in recent years. Usually, the CDC expects to see 60 cases of measles per year, but there have been 135 cases of measles so far in 2013, and in 2011, more than 220 people were diagnosed with the disease.

This latest outbreak follows a rash of recent measles cases among New York's Orthodox Jewish population and an outbreak in San Diego in 2008."

http://news.msn.com/science-technology/new-back-to-school-worry-unvaccinated-classmates

[wtbcrna, MSN, DNP, CRNA]

Yeah, in a third world country. If they want to mandate something, mandate that people that travel out of country get the vaccines. Or put no fly on the sick ones.

You have to realize this does not make sense. It only takes one person to start an epidemic in a group of unvaccinated individuals. There is an estimated 11 million undocumented illegal immigrants in the United States. 11 Million Undocumented Immigrants: What's Behind This Number How many of those do you think are or were properly vaccinated before traveling to this country. Also, you do not have to be "sick" to be a disease carrier. Think about the story of Typhoid Mary. Typhoid Mary - The Sad Story of Typhoid Mary

The only way to ensure public safety is to mandate public vaccination of everyone.

[TexRN, BSN, RN]

"Also, consider that in 1963, the population was 189,241,798. That means that prior to the vaccine, the percentage of the entire US population that died from measles was .000237%. (Remember this figure, because it will be important in about two paragraphs.)

Now, if you read the little excerpt above, you might be scared, because even with vaccines, the global death count for children from measles is 197,000 in the stats above! That's a scare tactic and it makes me mad. First of all, it wasn't 197,000 children. It was 197,000 people and some of them were children.

Then the excerpt above goes on to talk about present day figures. There are over 6 billion people on the planet. That's shown as 6,000,000,000 numerically. Correct me if you disagree, but when over 150,000 people die each day total, is 540 people dying of measles each day really that outrageous? They're counting on us not comprehending the vast population of our global society. 240,000 children in low income countries alone die each year of neonatal infection. 1.26 million people die each year from diabetes and yet they're still pushing the high fructose corn syrup in school lunches.

With vaccines, the US went from a .000237 PERCENT death rate among the general population from measles in 1963 to a 0.000000% measles death rate. It's a different story around the world though (as the WHO points out to scare the crap out of you.) Currently, around 197,000 people die each year from measles... out of 6 billion. Want to know percent that equals? The calculator showed: 3.28e-5.

***pencil scratches on paper, moving the decimal point to the left five places because of the -e***

0.0000328.

***calculator clicking***

Which brings the percentage of people who die globally from measles today to:

0.00328%. (Remember when I told you to remember that figure above?)

0.000237%

So, comparing the two figures, as a country, we Americans did better in 1963 at not dying from measles than the general population of the world is doing RIGHT NOW.

But in fairness to vaccines, when compared to our own progress as a country, we no longer have that .0002% of our population dying of measles. Right?

But I digress, let's compare measles death rates in 1963 to other death rates in 1963.

In 1963, there were about 450 deaths from measles. Meanwhile, about 12,000 people died from stomach ulcers and the likes. Just over 43,000 people died from car accidents in 1963. Over 700,000 people died from heart disease.

In 1963, you were more likely to be one of the 9200 people murdered that year than to die of measles. If you were born in 1963, you were more likely to die from a congenital disease than from measles. In 1963, it was about 46 times more likely for a child to die from a congenital malformation than for someone to die from the measles.

Frankly, in 1963, you were about 46 times more likely to kill yourself than you were to die from measles."

That is a quote from vax truth. I know that vaccines have helped, I'm not denying that. I just think we over vaccinate, and I don't want parent's rights concerning their children's health being taken away.

Also, what about how third world countries live in filth and do not have access to good medical care like we do. I think that is a HUGE factor. Considering measles isn't usually a fatal thing to get.

[wtbcrna, MSN, DNP, CRNA]

Death is not the only reason to give vaccines or not always even the top reason.

"COMPLICATIONS

Measles virus infects multiple organ systems and targets epithelial, reticuloendothelial, and white blood cells, including monocytes, macrophages, and T lymphocytes [39]. Pathological studies of children dying during acute measles have found multinucleated giant cells typical of measles virus infection throughout the respiratory and gastrointestinal tracts and in most lymphoid tissues [40–51]. Measles virus infection leads to a decline in CD4 lymphocytes, starting before the onset of rash and lasting for up to 1 month, and resulting in suppression of delayed-type hypersensitivity as measured by anergy to skin test antigens, including tuberculosis antigen [52–56]. Whether measles predisposes to reactivation of latent Mycobacterium tuberculosis infections has been a subject of debate [57].

Complications from measles have been reported in every organ system (table 1). Many of these complications are caused by disruption of epithelial surfaces and immunosuppression [70–72]. Rates of complications from measles vary by age (table 2) and underlying conditions.

RESPIRATORY COMPLICATIONS

Otitis media. Otitis media is the most common complication of measles reported in the United States and occurs in 14% of children

Laryngotracheobronchitis. Laryngotracheobronchitis or “measles croup” was noted in 9%–32% of US children hospitalized with measles [73–78]. The majority of affected children were

Pneumonia. Measles infects the respiratory tracts of nearly all affected persons. Pneumonia is the most common severe complication of measles and accounts for most measles-associated deaths [80]. In studies of unselected hospitalized children with measles, 55% had radiographic changes of bronchopneumonia, consolidation, or other infiltrates; 77% of children with severe disease and 41% of children with mild disease had radiographic changes [81]. In recent years, pneumonia was present in 9% of children

Pneumonia maybe caused by measles virus alone, secondary viral infection with adenovirus or HSV, or secondary bacterial infection [39,80,90]. Measles is one cause of Hecht's giant cell pneumonia, which usually occurs in immunocompromised persons but can occur in otherwise normal adults and children [46,91–94]. Studies that included culture of blood, lung punctures, or tracheal aspirations revealed bacteria as the cause of 25%–35% of measles-associated pneumonia. S. pneumoniae, S. aureus, and H. influenzae were the most commonly isolated organisms [39, 80]. Other bacteria (e.g.Pseudomonas species,Klebsiella pneumoniae, and E. coif) are less common causes of severe pneumonia associated with measles. In studies of young adult military recruits with pneumonia associated with measles, Neisseria meningitidis was a probable cause in some cases [85, 95].

Pneumomediastinum and mediastinal emphysema have been reported as complications of measles in several countries [58, 60], 90, 96. Some children have the clinical pattern of bronchiolitis [39]. Because viral cultures are not always done, the possibility of coinfection with other respiratory viruses cannot be ruled out.

Measles pneumonia in immunocompromised patients.

Among immunocompromised persons, diffuse progressive pneumonitis caused by the measles virus is the most common cause of death [97–104]. These patients may first have typical measles with pneumonia, or they may have a nonspecific illness without rash followed by pneumonitis without a rash. In general, signs of pneumonitis develop in the 2 weeks after the first onset of symptoms [90, 96, 105]. Other patients have had reappearance of rash and pneumonitis after long intervals following “classical” measles [97, 106].

GASTROINTESTINAL COMPLICATIONS

Measles probably infects the intestinal tracts of most persons with measles. A gastric biopsy obtained the day before rash onset from a 44-year-old man revealed characteristic giant cells that were positive for measles by immunologic staining, and 8 of 10 children exposed to the man subsequently developed measles [51]. Several cases of appendicitis have developed before and during measles rash, and characteristic giant cells typical for measles have been found in appendix tissue [42, 43, 45, 107–109].

Diarrhea. In the United States, 8% of all reported measles cases during 1987–2000 were complicated by diarrhea. Rates were higher in those 30 years old (table 2). Among hospitalized persons with measles in the United States, 30%–70% had diarrhea [73–78, 88, 89]. Feachem and Koblinsky [110] found that 15%—63% of measles cases from community-based studies from developing countries in the prevaccine era were complicated by diarrhea and that 9%–77% of all diarrheal deaths were measles-associated. Stools of children with measles-associated diarrhea usually have the same bacteria as those of children with diarrhea not associated with measles [111–113]. Measles-associated diarrhea typically begins just before rash onset [63], suggesting that measles virus is responsible for most of the diarrhea episodes but that secondary bacterial or viral infections may contribute to the severity and duration of illness.

Dehydration was found in 32% of hospitalized patients in California [114]. Morley [10,115] first described the high rates of gastrointestinal complications that occurred after measles in developing countries: mouth sores, decreased food intake, protracted diarrhea, weight loss, and precipitation of severe protein calorie malnutrition [63]. Noma (cancrum oris), a progressive oral lesion that destroys orofacial tissue, has been noted after measles in Africa [116–118] and India [119]. In young adults, measles is associated with hepatitis, hypocalcemia, and elevation of creatinine phosphokinase levels [66, 67, 85, 89, 120–123].

NEUROLOGICAL COMPLICATIONS

Febrile seizures. Febrile seizures occur in 0.1%–2.3% of children with measles in the United States and England [75, 77, 124–127] and are usually benign and not associated with residual damage. Most children with uncomplicated measles have changes visible on electroencephalography, but these changes are most likely due to fever and other metabolic changes [128–130]. Postinfectious encephalomyelitis (PIE) occurs in 13 per 1000 infected persons, usually 3–10 days after onset of rash [39, 131]. Higher rates of PIE due to measles occur in adolescents and adults than in school-aged children (table 2 [124, 132, 133]). PIE usually begins with the abrupt onset of new fever, seizures, altered mental status, and multifocal neurological signs [131, 134]. Although measles virus was found in cerebrovascular endothelial cells in a person who died during the first few days of rash [135], the virus usually is not found in the central nervous systems of persons with PIE. PIE appears to be caused by an abnormal immune response that affects myelin basic protein [61, 136]. As many as 25% of people with PIE due to measles die, and ∼33% of survivors have lifelong neurological sequelae, including severe retardation, motor impairment, blindness, and sometimes hemiparesis [39, 131].

Subacute sclerosing panencephalitis (SSPE). SSPE is caused by persistence of measles virus in central nervous system tissue for several years, followed by a slowly progressive infection and demyelination affecting multiple areas of the brain [39, 137]. The initial SSPE symptoms, usually decreased school performance and behavioral disorders, are often misdiagnosed as psychiatric problems. Subsequently, myoclonic seizures develop, and a characteristic burst-suppression pattern may be seen on electroencephalography. Measles antibody is present in the cerebrospinal fluid. The disease slowly progresses until affected persons are in a vegetative state. Wild-type measles viruses, but not measles vaccine viruses, have been found in brain tissue [138]. SSPE occurs on average in 1 per 8.5 million persons who develop measles in the United States [139–141] but the rate appears to be higher in some other countries [141–144]. Factors responsible for persistence of measles virus in these persons are not known, nor is it known whether measles virus persists in otherwise normal hosts. Geographic clustering of SSPE occurs in several countries, and there is an increased incidence in children residing in rural areas. In 2 studies, children with SSPE had more close exposure to birds than did control subjects [140, 141]. These data suggest that as-yet-undefined environmental factors, most likely another infectious agent, contribute to this disease.

Measles encephalitis in immunocompromised patients. A progressive central nervous system measles virus infection, termed "measles inclusion body encephalitis," occurs in immunocompromised persons with disorders such as human immunodeficiency virus (HIV) infection or leukemia. Onset is usually 5 weeks to 6 months after acute measles. The illness begins with mental-status changes and seizures in the absence of fever; >80% of deaths occur within weeks [145–148].

OCULAR COMPLICATIONS

Conjunctivitis occurs in most persons with measles, and inflammation of the cornea (keratitis) is common. In a study of 61 Turkish military personnel with measles, 57% had keratitis detected by slit lamp examination [149]. In well-nourished persons, these lesions usually heal without residual damage. However, secondary bacterial (e.g., Pseudomonas or Staphylococcus) or viral infections (e.g., HSV or adenovirus) can lead to permanent scarring and blindness [150]. Vitamin A deficiency predisposes to more severe keratitis, corneal scarring, and blindness [151]. Measles associated with vitamin A deficiency is one of the most common causes of acquired blindness in children in developing countries [68, 69]. Blindness can also result from cortical damage from measles encephalitis.

OTHER ASSOCIATIONS

Measles has been hypothesized to cause or contribute to multiple sclerosis, but available evidence is weak and inconclusive [152]. Measles or measles vaccines have been suggested to contribute to or induce autism, but available data favor rejection of these hypotheses [153–155]. Studies from different laboratories have had conflicting evidence for persistence of measles virus nucleocapsid in affected tissue from patients with otosclerosis [156, 157], Paget's disease [158], and inflammatory bowel disease [153, 159, 160]."

The Clinical Significance of Measles: A Review

[wtbcrna, MSN, DNP, CRNA]

"Measles—Incidence (Historic)

During this century, there has been a dramatic decrease in measles epidemics. Prior to the development of the measles vaccine, 5.7 million people died each year from measles. (Some historians have suggested that measles might have contributed to the decline of the Roman Empire.)

In 1920, the United States had 469,924 measles cases and 7,575 deaths due to measles. From 1958 to 1962, the United States had an average of 503,282 cases and 432 deaths each year. (Measles reporting began in 1912; prior to this time, no statistics are available.) In large cities, epidemics often occurred every two to five years.

When the measles vaccine came on the market in 1963, measles began a steady decline worldwide. By 1995, measles deaths had fallen 95 percent worldwide and 99 percent in Latin America. In the United States, the incidence of measles hit an all-time low in 1998, with 89 cases and no deaths reported.

There have been several epidemics in the United States since 1963: from 1970 to 1972, 1976 to 1978, and 1989 to 1991. The epidemic of 1989-1991 claimed 120 deaths out of a total of 55,000 cases reported. Over half of the deaths occurred in young children.

Measles—Incidence (United States)

In 1997, the Centers for Disease Control and Prevention (CDC) reported a total of 138 cases of measles in the United States. Most of these outbreaks probably began when an infected person from another country (specifically Germany, Italy, Switzerland, Brazil, and Japan) entered the United States. The virus subsequently spread through the population, with the longest chain of transmission lasting five weeks. Children were most affected by these outbreaks: 29 percent of cases were children 1-4 years old; 28 percent were children 5-19; 26 percent were adults 20-39. In addition, unvaccinated people accounted for 77 percent of cases; people who received only one dose of vaccine accounted for 18 percent of cases; and people who received the full two doses of vaccine accounted for 5 percent of cases. (These statistics demonstrate that a small percentage of people fail to develop immunity after one or even two doses of vaccine.)

In 1998, the United States had only 89 cases and no deaths due to measles. Measles cases clustered in a few states. Arizona, California, Florida, Massachusetts, Minnesota, New York, Pennsylvania, South Dakota, and Texas reported 64 percent of measles cases in 1997. Most of these cases were from foreign visitors who brought the virus with them or from U.S. citizens who contracted the virus while traveling abroad. These patterns suggest that there is no established measles virus circulating in the United States."

http://science.education.nih.gov/supplements/nih1/diseases/activities/activity5_measles-database.htm

[wtbcrna, MSN, DNP, CRNA]

Vaxtruth is not a reliable or scientific website in anyway. The authors on there are cherry picking information to give outright lies or half truths about vaccination. You will never get a clear understanding of vaccines by visiting sites like this.

[wtbcrna, MSN, DNP, CRNA]

There is quote from Ethics class that I always remember. "Adults have the right to martyr themselves for their beliefs but not their children". This ethical/legal principle can be applied in a variety of cases including childhood vaccinations.

[TexRN, BSN, RN]

So based on that, the Vaccine causes more febrile siezures than contracting the actual disease does. "Overall, our data suggest that MMR vaccination and the other indicators for febrile seizures follow a multiplicative model; the rate of febrile seizures in all subgroups of children is approximately 2.75 times higher within 2 weeks of MMR vaccination than it would have been had the children not been vaccinated."

JAMA Network | JAMA | MMR Vaccination and Febrile Seizures: Evaluation of Susceptible Subgroups and Long-term Prognosis

Also ear infections? Those are a dime a dozen in kids.

What about how the MMR vaccine may be linked to enterocolitis? That would explain the imbalance of normal flora. Would taking a probiotic before and after the shot help with that?

[TexRN, BSN, RN]

If your child had an adverse reaction to a vaccine that was more than the average reaction would you still push vaccines so much? I no doubt agree they were a blessing back when there was a huge amount of people getting it. I think it's gone beyond that. I think there are many sincere people that want to help and heal others but it's the people above them that are tainting it by not admitting that some of these vaccines are not completely safe. They haven't been thoroughly tested before being approved by the FDA. Just like the whooping cough outbreak. They didn't study the vaccine enough so come 5 years when the shot wore off they were wondering why and blaming the non vaxers when really they just needed a booster shot.

[wtbcrna, MSN, DNP, CRNA]

So based on that, the Vaccine causes more febrile siezures than contracting the actual disease does. "Overall, our data suggest that MMR vaccination and the other indicators for febrile seizures follow a multiplicative model; the rate of febrile seizures in all subgroups of children is approximately 2.75 times higher within 2 weeks of MMR vaccination than it would have been had the children not been vaccinated."

JAMA Network | JAMA | MMR Vaccination and Febrile Seizures: *Evaluation of Susceptible Subgroups and Long-term Prognosis

Also ear infections? Those are a dime a dozen in kids.

What about how the MMR vaccine may be linked to enterocolitis? That would explain the imbalance of normal flora. Would taking a probiotic before and after the shot help with that?

"Conclusions MMR vaccination was associated with a transient increased rate of febrile seizures but the risk difference was small even in high-risk children. The long-term rate of epilepsy was not increased in children who had febrile seizures following vaccination compared with children who had febrile seizures of a different etiology."

Chronic ear infections lead to hearing problems. Those kids that have to get multiple PE tubes or have eustachian tube difficulty (which is common because of the more horizontal alignment of the eustachian tubes as a child) often end up with some loss of hearing from tympanic membrane scarring. By the way the pneumonia, eye, and neurological problems associated with measles are not something to just dismiss even if you do want to dismiss otitis media.

I don't recommend anything other than what is normally recommended for vaccines (Motrin and/or APAP) before and after the vaccines and keep the child/infant well hydrated.

[Mommy&RN, BSN, RN]

I'm just playing devils advocate here....Why are the parents of vaccinated kids worried about the unvaccinated kids? If the "other children" are vaccinated, aren't they protected?? So according to the way the science says vaccinations work why the need to homeschool unvaccinated kids? Vaccinated kids are supposed to be safe from whatever they are vaccinated with.

My personal experience is the HVB vaccine that was supposed to be life long immunity only lasted 10 years the first time. I found out when I had to have titers drawn. Had to retake the series. Would have never known if I didn't have to have titers.

My guess is that I'm not the only person this has ever happened to. There are also people who can not have vaccinations due to medical reasons. The more unvaccinated people, the more likely the disease will become more wide spread.

[TexRN, BSN, RN]

I'm not dismissing those. I really just don't think third world countries problems apply to why I don't want to fully vaccinate my kids. When those situations apply to us I'll rethink my decision. Which I already am opening my mind to them, if you can't tell by all of the brains I've been picking on these threads.

[wtbcrna, MSN, DNP, CRNA]

If your child had an adverse reaction to a vaccine that was more than the average reaction would you still push vaccines so much? I no doubt agree they were a blessing back when there was a huge amount of people getting it. I think it's gone beyond that. I think there are many sincere people that want to help and heal others but it's the people above them that are tainting it by not admitting that some of these vaccines are not completely safe. They haven't been thoroughly tested before being approved by the FDA. Just like the whooping cough outbreak. They didn't study the vaccine enough so come 5 years when the shot wore off they were wondering why and blaming the non vaxers when really they just needed a booster shot.

I would advocate vaccines no matter what. I got pancreatitis from Lisinopril and no longer take ACE-I, but I don't go around telling everyone that they should stop taking ACE-I because it is dangerous and made from snake venom.

My sister almost died as an infant from the small pox vaccine and I had a friend that got myocarditis from the small pox vaccine, but yet I lined up when it was time to get my small pox vaccine and got mine just like everyone else (military). I didn't seek an exemption for the small pox vaccination. I did my research through scientific peer-reviewed articles and got the vaccination. I was a little nervous but still I did it.

Okay, what is enough testing? Do you realize that vaccines are still be tested/monitored everyday? It is called Phase 4 testing/post market research/monitoring? We monitor vaccines constantly in US. We have a national monitoring database for vaccines.The FDA's Drug Review Process: Ensuring Drugs Are Safe and Effective

Vaccines: Resdev/Vaccine Testing and Approval Process

There is absolutely no proof that vaccines are not safe for widespread use. Yet, because people continue to believe what they want to believe we continue to spend millions of dollars annually providing more research to show the same statistics over and over again. If these anti-vaccination opponents had any credibility they could do their own scientific studies and prove the world wrong, but have they done that....no they have not and they never will. They continue to try to skew statistics to work in their favor and ask for money to continue their unproven treatments and their websites.

Non-vaxers are to blame for the whooping cough outbreak and pretty much every other vaccine preventable outbreak in the US, if everyone would have been vaccinated then there would not have been an outbreak.

There are efforts to work on long-term vaccines, but with the current sentiment of the public it will take decades to be released. Even then as we age are immunity declines still making us susceptible to certain diseases are body has difficulty fighting no matter what our immunization status. That is why it is especially important for everyone around susceptible populations to be immunized too.