Friday, October 19, 2007

A Perfect WInter Storm Developing

I would like to thank Tara Smith, of Aetiology, for kindly giving me permission to disseminate this information to my readers, by posting it here. I think the information posted is very important and hope you will also take the time to click over to Orac's post on the topic as well. I do have some other crossposts to put up as well, I apologize but they will get up asap. This is rather important and took precedent.

My own short take on this, is simple. People who do not wish to vaccinate their children, should be allowed to make that decision, for whatever reason. But if they decide not to do so, they should not be allowed to send their children to public schools, nor should private schools be required to accept them. There are those kids who do not develop anti-bodies after being vaccinated. They depend on herd immunity to keep them healthy. They should not be put at risk, due to someone else's bad choices, religiously motivated or not.

From Aetiology;
Tara C. Smith is an Assistant Professor of Epidemiology. Her research involves a number of pathogens at the animal-human nexus. Additionally, she is the founder of
Iowa Citizens for Science and also writes for The Panda's Thumb. Please note the views expressed on this site are Dr. Smith's alone and may not be representative of the groups mentioned above.

A few news stories hit my inbox all at once yesterday--and the combination of them doesn't bode well for childrens' health; more after the jump.

First, despite several years now of banging the drum for having kids vaccinated against influenza, they're still being overlooked when it comes to pandemic planning:

Children would likely be both prime spreaders and targets of a flu pandemic, but they're being overlooked in the nation's preparations for the next super-flu, pediatricians and public health advocates reported Wednesday.

The report urges the government to improve planned child protections, including how to care for youngsters if a pandemic closes schools.

"Right now, we are behind the curve in finding ways to limit the spread of a pandemic in children even though they are among the most at risk," said Dr. John Bradley of the American Academy of Pediatrics, which co-authored the report with the Trust for America's Health.

The story brings up 3 issues that haven't been addressed: no masks available in childrens' sizes (and even if they were, would kids leave them on? Certainly it's tough enough to get even adults to use them effectively). What about vaccine doses for--and efficacy in--children? There has been some investigation already into H5N1 vaccine for adults (with not-so-great results thus far), but to my knowledge, nothing has been done yet in kids. (And of course, that's assuming H5N1 would be the pandemic strain, which is far from certain). Also, they mention something I'd not even considered regarding potential school closings: what happens to kids who rely on the school lunch program, if the schools are shut down in the event of a pandemic?

In a second story which comes as little surprise, parents are increasingly lying about their religious beliefs to avoid vaccinating their kids, due to autism fears:

Sabrina Rahim doesn't practice any particular faith, but she had no problem signing a letter declaring that because of her deeply held religious beliefs, her 4-year-old son should be exempt from the vaccinations required to enter preschool.

She is among a small but growing number of parents around the country who are claiming religious exemptions to avoid vaccinating their children when the real reason may be skepticism of the shots or concern they can cause other illnesses. Some of these parents say they are being forced to lie because of the way the vaccination laws are written in their states.

"Forced to lie." Right. Meanwhile, because she's worried about discredited research suggesting a link between vaccines and autism, she's putting everyone's kids at risk:

"When you choose not to get a vaccine, you're not just making a choice for yourself, you're making a choice for the person sitting next to you," said Dr. Lance Rodewald, director of the CDC's Immunization Services Division.

(Orac also offers his take on this topic).

These two stories also feed back into what I wrote on Monday about regarding methicillin-resistant Staphylococcus aureus (MRSA) increasing in the community, and specifically, recent outbreaks in schools. Following reports of a recent MRSA outbreak in a Virginia school comes news of another one in Texas.

So, more explicitly, how do all these stories tie into each other?

You may remember a few years back that there were reports of a spike in influenza deaths in children in the U.S.. These weren't due to influenza alone, but like many influenza fatalities, were caused by influenza complicated by secondary bacterial infections, including MRSA--which proved to be a highly fatal combination. Last year's flu season wasn't too bad, but still the combination of influenza and MRSA proved to be deadly for a number of children.

Kids still aren't getting influenza shots at the rate recommended, despite being in a high-risk group for influenza deaths (and being efficient little spreaders of the virus). Add in the resistance to vaccination that many parents are expressing (including to voluntary shots such as influenza), and the winter cold-and-flu season has the potential to be even worse than usual for kids in the coming years. Many schools are already increasing awareness regarding Staph infections, but as the article notes, they're incredibly difficult to control:

Rappahannock Superintendent Bob Chappell said school employees also followed a local hospital's advice to mop hallways and classrooms with a bleach solution. The cost of the cleanup: more than $10,000.


"What's clear to us is that this bacteria is coming into our schools from the community because the cases are so widespread, and there appears to be no pattern," said Montgomery schools spokesman Brian Edwards.

As always, washing hands and doing everything possible to keep one's germs to oneself are critical, but even our best efforts can be unsuccessful (as I can currently attest, suffering from a bad cold that unfortunately my son also caught). Once mainly a hospital pathogen, MRSA has become far more common in the community: as they note, it's widespread, and the isolates they've examined so far don't appear to be from a common source (which would likely be easier to get rid of). And of course, missed vaccinations don't only put children at a risk of serious complications from influenza, but a host of other diseases as well. I hope we don't need this kind of resurgence to make people remember how serious these diseases can be


Beth said...

I wonder how much overuse of antibiotics in recent years has also had an affect on the infectiousness of diseases today.

bullfighter said...

I am with Orac on this, and I'll go a step further. He says, correctly, that religious reasons should not be treated differently than others, so either parents should be allowed to refuse vaccinations for whatever reason they please, or not at all. I'll say that "not at all" is the clear choice in the context of how we approach other decisions in this society. We don't allow legitimization of polygamy for any reasons, religious or secular; and there is obviously more potential harm from parents denying vaccination to their children than from adults living in a polygamous marriage.

DuWayne Brayton said...

Beth -

I would have to say, quite a lot. For a more definitive response, I would recommend emailing Tara, who wrote this post. She is an epidemiologist and generally pretty good about responding to queries.

Bullfighter -

I don't have any real disagreements here. The thing is, that enforcement of vaccinations, is usually based on allowing kids into public schools. I know in MI, that is the case, as I have friends who homeschool, to avoid those evile vaccines. So in effect, my point is not far off yours.

On the underlying assumption that religious beliefs should trump secular positions, I agree too. Religious exemptions should not be given stronger weight than secular philosophical positions. One of the most obvious places this applies, is conscientious objections to violence/the draft. There was a time when non-religious pacifism was not an acceptable excuse for draft exemptions, while religious exemptions were.

kehrsam said...

As the local religious person, I have to go beyond even what Bullfighter suggests: There is no excuse, NONE, for foregoing vaccinations, religious exceptions included. If it were only the religious children and their community dying it would be one thing, but the threat is to the society in general. Exactly the same way that the Police Power allows for the inspection of dams and elevators and fire codes, it also allows for the vaccination and other public health measures on a mandatory basis. This is not about your individual freedom, it is about the lives of countless people in the surrounding community. It is as simple as that.

Further, do epidemiologists vaccinate their children? Yes, of course they do. Religion does not HAVE to make one stupid. It's merely optional.