Today is debunking day

[drwex]

(ask me separately about the trick-archery thing making the rounds)

http://www.vox.com/2015/1/29/7929791/measles-outbreak-2014

Why did we have so many cases of measles in 2014? Bad luck, basically. The source was an unvaccinated person traveling abroad to a country where an outbreak has been raging for years, coming back, and being mis-diagnosed while being in a community with low vaccination rates.

Key facts to remember:

- The epicenter of 2014's outbreak was Ohio, not California. The "personal exemptions" that have people up in arms in CA are irrelevant.

- The US national rate of vaccination against measles has remained roughly constant for 10 years. Despite bad science, the Internet, bad celebrities, and various combinations of the above, the rate of measles in the US has varied by almost a factor of 10x year to year without the rate of vaccination changing.

- The measles vaccine - even when administered perfectly - is about 97% effective. This is one reason why your doctor will test your immunity and recommend a re-vax if you say that you are traveling to a country where measles is known to be active. Blaming anti-vax parents and religious objectors for the fact that a vaccine is not a light switch is ignorant; don't do that.

- Measles is stupendously contagious. It can do survival tricks that no other known virus can do, like remaining potent in microscopic suspended air droplets for hours. Given that immunities and vaccines are not perfect mechanisms, it should be unsurprising that people get sick from this virus. We should stop freaking out about that.

Comments

[cos]

That is an amazingly misleading and disingenuous framing of the facts. I don't know why you're doing it. And if you read that article surely you must realize that the Amish outbreak in Ohio and the one centered on Disneyland were separate, even though your post tries to imply that it was "the outbreak" and Ohio is where it came from. That's just one example, but overall I'm really appalled at the way you presented what are mostly true facts here.

[drwex]

See my comment below to Ron. I believe that people are speaking in negative and near-hysterical ways in the wake of the 2015 outbreak, ways that are contradicted by facts highlighted in the Vox story.

[ron_newman]

The article doesn't explain how the disease spread from the isolated rural Ohio area to Disneyland in California. Is this known?

[cos]

It didn't. The Jan 2015 outbreak centered on Disneyland was a separate outbreak. That's part of why I think this post is misleadingly framed. One thing the article does make very clear, of course, is the high risk caused by clusters of unvaccinated people - even though this post implies that the article debunks those concerns.

[drwex]

As it says clearly in the article: a "new outbreak of measles at Disneyland in early 2015". The two are not connected. The point of the article is that in the wake of the Disneyland outbreak there has been (in my opinion wrongheaded) finger-pointing and hysteria that is contradicted by available facts.

[ckd]

I think it's pretty clear in the article that one of the ingredients for an outbreak is a cluster of unvaccinated people in contact with each other, which describes both the Ohio Amish and a number of communities in California and elsewhere (Eagle Mountain International Church in Texas, for example).

[sariel-t.livejournal.com]

*pebble*

[docorion.livejournal.com]

Sorry, I'm with cos and ron_newman. You've purposely framed this in a way that minimizes the issue of low vaccination rates. Yes, unvaccinated travelers bring the disease with them and then infect other unvaccinated people (and some vaccinated people in whom the vaccine didn't take, because, as you point out, the vaccine is not magic). But the fact of the matter remains that there are too many unvaccinated people: were it not for the low vaccination rates in the areas which have had outbreaks, perhaps somewhere in the tens of people would have developed measles (probably more like single digits, assuming 99% or better rates of vaccination). Case rates in the hundreds are directly caused by a failure of herd immunity, combined with a disease which is *stupidly* contagious (R₀ of around 10-15), remarkably dangerous for a "harmless childhood viral exanthem" (See here (http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/12-Meas.pdf) for a list of Badness which follows on the measles), and can do the tricks you cite in terms of lasting on surfaces and spreading via droplets which are surprisingly persistent in the environment.

It's also a virus whose only reservoir is humans, and which has only one antigenic variant. Which means that it's eminently eradicable-like smallpox-if only we can vaccinate enough people that the last virion is killed off by the immune system of some immune human, rather than spreading into one of the inevitable non-immune ones. There doesn't *need* to be *any more measles, ever*, if only we can make a sufficient percentage of the population immune.

So if I sound hysterical to you, it's not because I'm surprised that some people have become ill from this virus. I don't think most people are upset because they are surprised that some people became ill from this virus; they're upset for the same reason I am: Because *so many people* became ill from a virus which hardly any of them should have contracted. Because *so many people* claim some special status for themselves, or their children, with no other justification than that they object on personal or philosophical grounds-meaning, in my personal view, that they are willing to expose not just their children, but mine and others, including some who may not be able to get the vaccination for real (read: medical exemptions, such as "on chemo for leukemia" or "has HIV") reasons, to the measles. I've seen some of the downsides of measles, and of mumps (orchitis sucks, especially if you get it - I did not, but I've seen it. I've seen adults with chicken pox - no one is quite as miserable as an adult with chicken pox, I promise you; and I've seen varicella pneumonia, in a patient who died faster than Jim Henson). I *know* that vaccinations are damn well life-saving, because I've presided over the deaths of people from those diseases; people who either couldn't get the vaccine, or (more often, in the US) didn't get the vaccine. (The varicella pneumonia was a young woman in nursing school whose parents hadn't believed in vaccinations).

Continued in next comment.

[docorion.livejournal.com]

Here's a fun fact: which state has the highest vaccination rate, and hence the lowest measles rate? Mississippi. Missisfuckinsippi. The measles vaccine was invented right here in MA, at Children's Hospital, and Mississippi has the highest rate of vaccinations. Here's why: The only way you can avoid state mandated vaccination in Mississippi is by having a medical reason not to get it. No personal or religious exemptions. In Mississippi, Thou Shalt Be Vaccinated. You're right: there are wide variations in measles rates from year to year. You're also right that the reason is *somewhat* random: it depends on whether a susceptible person (vaccinated or not-sometimes the vaccine doesn't take, remember) who travels to a measles endemic place and contracts measles then goes somewhere in the US where there are many susceptible people (most of whom will be unvaccinated). If that happens: BAM, outbreak. If they go to Mississippi, maybe a few people get the measles, and then it hits the Giant Wall Of the Vaccinated, and dies. No outbreak, or at least not a big one. If they go to Ohio, California, or to college in Massachusetts, it's a crapshoot. There's an outbreak just about every year in MA, usually in college students; people from non-US areas come into a crowded dorm and pass the word to the unvaccinated of whom there are far too many because of the personal or religious exemptions available here and elsewhere. If they go to Ole Miss: not so much. Awesome; Welcome to Massachusetts, home of higher learning, and measles.