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    The Spread Of Infectious Disease: Measles On An Airplane
    By Kim Wombles | February 27th 2011 11:07 AM | 20 comments | Print | E-mail | Track Comments
    About Kim

    Instructor of English and psychology and mother to three on the autism spectrum.

    Writer of the site countering.us (where most of these

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    News story on a traveler with measles moving around the US: "More than 10 million people are infected with measles worldwide each year,and the disease is the leading cause of vaccine-preventable deaths in small children. Outbreaks are more common in Europe than in the United States, and most U.S. cases come from transatlantic travelers. U.S. law requires that any cases of measles be reported to public health authorities.
    "We don't want measles to be imported back into the U.S. once it gets a foothold," Dr. William Schaffner, an infectious disease specialist at the Vanderbilt University School of Medicine in Nashville, told The Associated Press."
    One of the myths that the anti-vaccine folks like to spread is the idea that everyone got measles and mumps and were just fine. Kim Stagliano of the blog Age of Autism trots it out regularly:


    "Were kids dying of measles in America when Leave it to Beaver was airing? How about Arthur the Aardvark and his sister DW contracting Chicken Pox? Did PBS, the station that brought you Mr. Rogers and Elmo, mean to scare children with an episode about a deadly disease or simply explain to them that they too could manage the itch and discomfort of the Chicken Pox. Just last week, I heard a Frank Sinatra song called, "Ev'rything happens to me," where he sings, "I've had the measles and the mumps." When did measles and chicken pox go from entertainment fodder to epidemic fear? And who's behind it?"
    Yes, because sitcoms covered it and nothing bad happened in a sitcom, it must mean that there's no danger. Wow. There you go, an explanation that makes sense: folks at Age of Autism think that television shows are real but the reports from the CDC and WHO are not.


    According to the WHO,
    "Measles is a highly infectious disease. In developing countries, 1-5% of children with measles die from complications of the disease. This death rate may be as high as 25% among people who are displaced, malnourished and have poor access to health care. The disease can also lead to severe health complications, including pneumonia, encephalitis, severe diarrhoea and blindness."


    WHO provides these figures on mortality: 


    "It remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. An estimated 164 000 people died from measles in 2008 – mostly children under the age of five."
     WHO provides this information on complications:


    "Most measles-related deaths are caused by complications associated with the disease. Complications are more common in children under the age of five, or adults over the age of 20. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia. As high as 10% of measles cases result in death among populations with high levels of malnutrition and a lack of adequate health care."


    Stagliano and other parents think chicken pox is no big deal, either, and often deride the idea of a vaccine for the disease. While for most, it is not a serious problem, it is also not a disease that leaves the body, vanquished. Instead it lies dormant waiting to attack as shingles later in a person's life.

    The CDC reports that:


     "In unvaccinated children, chickenpox most commonly causes an illness that lasts about 5-10 days. Children usually miss 5 or 6 days of school or childcare due to their chickenpox and have symptoms such as high fever, severe itching, an uncomfortable rash, and dehydration or headache. In addition, about 1 in 10 unvaccinated children who get the disease will have a complication from chickenpox serious enough to visit a health-care provider. These complications include infected skin lesions, other infections, dehydration from vomiting or diarrhea, or more serious complications such as pneumonia and encephalitis. In vaccinated children, chickenpox illness is typically mild, producing no symptoms at all other than a few red bumps. However, about 25% to 30% of vaccinated children who get the disease will develop illness as serious as unvaccinated children."


    Complications, according to the CDC:
    "Serious complications from chickenpox include bacterial infections which can involve many sites of the body including the skin, tissues under the skin, bone, lungs (pneumonia), joints, and blood. Other serious complications are due directly to infection with the varicella-zoster virus and include viral pneumonia, bleeding problems, and infection of the brain (encephalitis). Many people are not aware that before a vaccine was available approximately 10,600 persons were hospitalized and 100 to 150 died as a result of chickenpox in the U.S. every year."

    You know, having a college degree and affluence doesn't make you an expert in areas outside your degree. And Dr. Jay Gordon, Dr. Bob Sears, and Saint Andy Wakefield prove quite well that being doctors doesn't mean they know what they're talking about, either. So when you go outside mainstream, accepted scientific consensus and spout off crap based on availability heuristic and television shows, I'm going to think you're either intentionally ignorant, callous to the suffering and deaths of children from vaccine preventable diseases, or both.

    Comments

    Dr. Wakefield you made him a saint. Now we can pray to good old Santa Dr. Wakefield. I think you had to much
    mercury when injected, Kewl down. Breath in the fresh hair and say No to vaccination. thank u.

    Gerhard Adam
    ...say No to vaccination
    There truly are no bounds to the dumb things people will say ...
    kwombles
    Yup.
    “Nothing in the world is more dangerous than a sincere ignorance and conscientious stupidity.” --MLK, Jr.
    I am by no means "anti-vaccine," but I do speak as one who had both chicken pox and measles as a child, I think some of the above comments are blown out of proportion. For one thing, it isn't fair to quote global statistics, or statistics from developing countries, where health care is not comparable.

    Measles, especially, I would not wish on anyone. It was much the worse of the two. I had it at the age of 10, and no one went into panic mode or administered any special treatment. Only they kept the room dim to avoid direct sunlight on my eyes, and waited until it was over. Many of my friends must have had it too, and I never heard of anyone suffering complications from it.

    kwombles
    Bill, if vaccination rates decrease, especially with global travel, the diseases that have mostly disappeared in the US will return. It's absolutely appropriate to focus on a global level in today's world. 
    Allowing your personal experience of two diseases to decide what's the safest, best public health measure is not the best way to protect public health. 

    Chicken pox lies dormant and can reemerge as shingles. Just because someone gets through chicken pox with no big deal doesn't mean it won't be a big deal later on. And chicken pox can be life-threatening in the United States. It kills in the US.

    I really don't care about your availability heuristic as to friends and complications. What you remember, what you recall, may not be representative of actual reality at all. And the more I see people use availability heuristic as the be-all, end-all of their decision making processes, the more irritating I find that people can walk about blithely putting others' lives and well-being in danger. It's the dumbest way to go about making health care decisions I have ever seen.
    “Nothing in the world is more dangerous than a sincere ignorance and conscientious stupidity.” --MLK, Jr.
    Kim, I don't imagine that my case of measles will have much influence on any public health decisions, but if it makes you feel any better I promise not to ever mention it again to anyone. Memories of my childhood are not as faded as you contend, and I realize you dismiss out of hand anything I might say as "availability heuristic", far from reality compared to your statistics.

    What I can tell you, however, is what people surrounded by actual measles cases found to worry about. It was not measles. Children struggling on crutches. Rows of patients in iron lungs. Annual chest X-rays for tuberculosis. Good friends dying of childhood leukemia. You think we worried about measles? Believe me, it was way down the list.

    And it's way down the list today. If vaccination is your concern, be concerned about the upswing in whooping cough. Unlike measles, it has caused fatalities. Plenty of other diseases to worry about today too.

    kwombles
    Bill, 
    Did you miss something when you read the post? Like what it was in response to? 

    I write extensively about all vaccine-preventable diseases; this post was specific to the case of the woman carrying measles around airports and Age of Autism's response that measles and chicken pox were no big deal.

    Other articles I've written on other infectious diseases:

    Pertussis:

    http://kwomblescountering.blogspot.com/2011/01/offit-is-everywhere-you-want-to-be.html
    http://kwomblescountering.blogspot.com/2010/05/why-vaccines-did-this-crowd-is.html

    http://kwomblescountering.blogspot.com/2010/05/because-i-understand-how-science-works.html
    http://kwomblescountering.blogspot.com/2011/02/horror-dr-jay-against-preventing.html
    (not all of them)

    Polio:

    http://kwomblescountering.blogspot.com/2009/12/revisiting-huffington-post-and.html


    Hib:
    http://kwomblescountering.blogspot.com/2010/10/appealing-to-evidence.html

    Here's a link to my posts on vaccines that I labeled as such: http://kwomblescountering.blogspot.com/search/label/vaccines

    There's more, but I'm not hunting them down. You're welcome to dig through the posts here at Science 2.0 or over at Countering. 

    As to anecdote, I'm sorry, but it really isn't relevant to determining reality. Solid science and collection of data give a far better picture of what the prevalence, incidence, mortality and morbidity are of infectious diseases at any point in time. Anecdotes may be helpful to illustrate points, to round out data, but it can not take the place of data. And it should never be what's used for making public health policy.

    To restate the points:

    Protecting against infectious disease where we have vaccines makes good sense.

    Preventing suffering and death is a good thing.

    I write a lot about infectious disease and vaccines and anti-vaccine groups. 

    I've covered many of the diseases that we currently vaccinate against in the US.  

    It's my blog, my column, and I'll write about and be concerned about what I choose to be. Thanks.

    Since you have no idea what my personal experiences are, presuming to tell me what people who experienced measles first hand are really concerned about is presumptuous at best. 









    “Nothing in the world is more dangerous than a sincere ignorance and conscientious stupidity.” --MLK, Jr.
    Kim, the people you want to save *are* the anecdotes. Treating them as statistics just serves to dehumanize them.

    kwombles
    Bill, I'm not doing that. In fact, I'd argue that my concern over saving the 100-150 people who died in the US from chicken pox shows that I'm doing anything but dehumanizing them. Your dismissal of those deaths by noting anecdotally that you and your friends were fine kinda dismisses those deaths and the additional suffering.
    "Before licensure of the monovalent varicella vaccine (Varivax; Merck) in March 1995, ∼4 million cases of varicella, 10,500–13,500 hospitalizations due to complications of varicella, and 100–150 deaths from varicella occurred annually [37]" http://jid.oxfordjournals.org/content/203/3/297.long  Let's not ignore the suffering, the fear,  the worry, the complications from those 10,000 plus hospitalizations. 1% of those hospitalizations ended in death.
    “Nothing in the world is more dangerous than a sincere ignorance and conscientious stupidity.” --MLK, Jr.
    kwombles
    Bill, if vaccination rates decrease, especially with global travel, the diseases that have mostly disappeared in the US will return. It's absolutely appropriate to focus on a global level in today's world. 
    Allowing your personal experience of two diseases to decide what's the safest, best public health measure is not the best way to protect public health. 

    Chicken pox lies dormant and can reemerge as shingles. Just because someone gets through chicken pox with no big deal doesn't mean it won't be a big deal later on. And chicken pox can be life-threatening in the United States. It kills in the US.

    I really don't care about your availability heuristic as to friends and complications. What you remember, what you recall, may not be representative of actual reality at all. And the more I see people use availability heuristic as the be-all, end-all of their decision making processes, the more irritating I find that people can walk about blithely putting others' lives and well-being in danger. It's the dumbest way to go about making health care decisions I have ever seen.
    “Nothing in the world is more dangerous than a sincere ignorance and conscientious stupidity.” --MLK, Jr.
    Pardon me for expressing an opinion, you obviously know more about it than I do.

    Gerhard Adam
    Kim, I think Bill raises a valid point about using global statistics and I can see that you also have a rationale for it.

    With respect to the prevalence of a disease, then the issue of traveling and the spread of disease globally becomes a relevant issue.  However, I'm also frustrated when I hear about how a particular disease kills thousands of people, only to discover that this occurs because of poverty and limited or no health care options.

    The latter case is not a fair representation of the virulence of a disease in a society like the U.S.  This doesn't actually have anything to do with vaccinations, but it does go to the heart of establishing credibility in a potentially divisive argument.

    In other words, if someone quotes 10,000 deaths worldwide, only to discover that 50 actually occur when medical care is readily available, then we aren't actually discussing the virulence of a disease as much as we're talking about the effects of poverty on disease outcomes.

    kwombles
    That's a fair assessment; however my approach in the piece was two-pronged: what the global numbers are because they are relevant when you're making a global argument, and what the actual effects of the disease are on the individual, what the risks are.
    However, his main argument, which I really took offense to is the cognitive bias of availability heuristic as a standard for making public health care decisions. No, he didn't frame it in those words; but that's what his anecdote is. 

    It may be that I spend too much time in the trenches with staunch anti-vaccine folks and that this negatively impacts my reaction, but I can tell you that one of the biggest problems in countering the spreading of misinformation relating to vaccine-preventable diseases and, tangentially, autism misinformation, is that most of these people go by their gut. Their gut feeling trumps everything else. 

    If someone wants to make cogent arguments using sound science, wants to discuss the role that poverty, lack of access to clean water, safe food, and medical care create in worldwide mortality rates, it's not something I'm going to disagree with. 

    The fact is that before vaccination in the US, measles killed 450 kids a year and permanently disabled thousands more. Rubella led to thousands of lost pregnancies and tens of thousands of permanent disabilities in the infants born to mothers who had rubella during the pregnancy. Vaccination is responsible for the decline in deaths and permanent disabling. It's prevented untold suffering. 

    This is a big deal; the vaccine program is a victim to its own success and the relative ignorance that most people live under concerning infectious disease. Those old enough to remember having measles and chicken pox as a child see it through the blur of decades. How it is at all relevant what one "remembers" to assessing the real risks and dangers? It's not, and that has to be called out.

    Measles was mostly eradicated from the US; declining vaccine rates and a loss of community immunity have led to outbreaks; Boston's currently dealing with one unrelated to this story. It is a problem. 
    “Nothing in the world is more dangerous than a sincere ignorance and conscientious stupidity.” --MLK, Jr.
    Gerhard Adam
    I agree with you, and it's also important to note that everyone that remembers a childhood bout of measures or chicken pox, does so because they successfully survived it.  It is important to remember that no everyone that acquires a disease necessarily has the worst experience with it, and that can affect the reliability of the anecdotes.

    As you said, the more successful vaccination programs are, the more distant the memories of disease outcomes that were negative and there's a sense that perhaps we're overreacting with the vaccine programs we have.  This is always going to be a consequence when any danger appears to have been lessened. 
    Dear Bill K,
    Thank you for sharing your experience with the measles. I wish there were more voices of reason like this. My child is fully vaccinated, but I don't appreciate that the pediatricians have told us there is zero risk beyond soreness at the site, and I feel like the pro-vaccine people wildly exaggerate these risks of measles and chickenpox. If they really feel strongly about preventing measles deaths they should be focusing their energies on making vaccination universal in the developing world, as well as addressing vitamin A deficiency and malnutrition, because these cause serious susceptibility to severe complications. I've read many times from the pro-vaccine people that before the vaccine was available parents didn't bond with their children until after they had survived measles, and I know that's just untrue (from my grandmother, who certainly bonded with all 9 of hers). I read up extensively before vaccinating my child because I do feel responsible for making good decisions for her. If the pediatricians (we've had 3 because of moving) were more candid about risks I would feel much better--but since they insisted there are no risks and I knew that wasn't true, I read up on it extensively. My brother did the same but without a science background he fell for the anti-vaccine loonies and his kids are not vaccinated at all. I just wish the debate weren't so polarized and the pro-vaccine people didn't feel the need to be snarky and to misrepresent what death rates in measles outbreaks in refugee camps say about the risks for healthy, well-nourished, U.S. children. I think if it were easier to find accurate, non-inflammatory information more of the concerned parents like me who considered not vaccinating would actually decide to vaccinate.

    If I am right, why are you Gerhard wearing a hat and glasses. It make you so dumb as why are you wearing glasses.
    Breath in the fresh air and say No to vaccination. thank u.

    Gerhard Adam
    That's right.  Never let a little thing like actually have a rational position spoil your fun.
    kwombles
    This seems like a good comment to offer the following quote of Bertrand Russell's to: ‎"The whole problem with the world is that fools and fanatics are always so certain of themselves, and wiser people so full of doubts."

    This isn't even a coherent comment. 
    “Nothing in the world is more dangerous than a sincere ignorance and conscientious stupidity.” --MLK, Jr.
    Gerhard Adam
    When people want to speak, I had a friend that used to ask, "what's on your alleged mind?"

    Somehow that seems appropriate too :)
    kwombles
    Hah, yes, it does. :)
    “Nothing in the world is more dangerous than a sincere ignorance and conscientious stupidity.” --MLK, Jr.

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