Culling the Herd — Vaccinations

From time to time, in our Ultra doubleplussecret email list, we snigger and heap abuse on the subjects of various articles we turn up and promulgate to each other. The topic of vaccinations reoccurs frequently and the antics of Jim Carey or the San Francisco liberal elite (or as AM says “filthy hippies”) with their Bay Area whoooping cough outbreak only throw more fodder into the fire. Obviously others think about this also, as depicted in this map of school vaccinations.

Although we may find the logic of innoculations self-evident, many parents reject vaccines. Whether this is some consequence of new age thought, or some arcane academic research study percolating up through channels only available to the elite, I can’t say.

One hypothesis is that the effectiveness of vaccines is itself a contributing factor. One hundred years ago, most people were acutely aware of the consequences of German Measles, Measles, Mumps, Whooping Cough and Diptheria. I make the comparison to the situation with nuclear proliferation today: few are alive who walked in the devastation of Hiroshima and Nagasaki. To modern pundits, the tragedy of nuclear warfare is an academic exercise, not something to be seen, felt and smelt. Today, with actual acute cases minimized, the effects of these diseases are also academic. The relatively low risk of vaccination effects seem unjustifiable for little Johnny. The much larger risk associated with the disease is not visualized.

And vaccinations are effective. See Vitek CR, Aduddell M, Brinton MJ, Hoffman RE, Redd SC. Increased protections during a measles outbreak of children previously vaccinated with a second dose of measles-mumps-rubella vaccine. Pediatric Infectious Diseases Journal 1999;18:620-623.

The Center for Disease Control establishes a schedule of vaccinations for children . I reproduce a section here:

More information is available at the CDC Vaccine Page as well as more graphic photos of pathogens their results.

For those with shorter attention spans, the following table summarizes a few diseases and their characteristics as well as the vaccine risks.

Disease	Rubella (German Measles)	Tetanus (Lockjaw)	Pertussis (Whooping Cough)
Effect
Pre-vax Cases/Yr	47,745	1,314	147,271
2003 Cases/Yr	7 99.9% eff.	20 98.5% eff.	11,647 92.1% eff.
Disease Risk	CRS— 1 in 4 (preg.) Arthritis — 7 in 10 (adult)	Death — 3 in 100	Death — 1 in 20 Pneumonia — 1 in 8 Encephalitis — 1 in 20
Vaccine Risk	MMR Vaccine Encephalitis or allergy — 1 in 1,000,000	DPT Vaccine Convulsion with full recovery — 1 in 1750 Acute Encephalitis — 5 in 1,000,000 Crying with full recovery — 1 in 1000 Death — 0	DPT Vaccine See Tetanus
Disease	Measles	Polio	Mumps
Effect
Pre-vax Cases/Yr	503,282	16,316	152,209
2003 Cases/Yr	56 99.9% eff.	0 100% eff.	231 99.9% eff.
Disease Risk	Death — 1 in 3000 Pneumonia — 1 in 20 Encephalitis — 1 in 2000	Death — 3 in 100 (children) Death — 2 in 10 (adult) Paralysis — 1 in 200	Encephalitis — 1 in 300 Sterility (adults)
Vaccine Risk	MMR Vaccine — see Rubella	Vaccine acquired paralytic polio — rare 144 cases in 18 years (41% healthy, 24% immunodefficient)	MMR Vaccine — see Rubella
Disease	Diptheria	Smallpox
Effect
Pre-vax Cases/Yr	175,885	48,164
2003 Cases/Yr	1 99.9% eff.	0 100% eff.
Disease Risk	Death — 1 in 20	Death — 3 in 10 Blindness Disfigurement
Vaccine Risk	DPT Vaccine See Tetanus	Not Available to Public Life-threatening reaction — 14-52 in 1,000,000

Sources:

1. Cases & deaths 1950-2005 (pdf)
2. Impact of Vaccines (pdf)

Note: CRS is congenital rubella syndrome in which the disease is passed to the child in the womb with devastating consequences.

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Now if the hippy new age types believe that vaccinations are the result of a sadistic government cabal, and the CDC and evil pharmaceutical companies are covering up adverse vaccine reactions for profit motives, then they have the right. Or do they..?

If I were an immunodeficient AIDS patient who could not tolerate vaccines, or someone with severe allergies who also could not tolerate vaccines, the last place I would want to be would be in a herd of non-vaccinated humans. The chances for a wild vector of one of these diseases is bad enough, but an amplified stream of vectors due to a susceptible population would be a death sentence. The outbreak of pertussis in the Bay Area is a perfect example.

Clusters of people with similar beliefs tend to form sub-populations which diverge from the general population. (See also Latane, Axelrod, and Kennedy). These clusters tend also to localize geographically. When one of the organizing beliefs is an aversion to immunization, a susceptible sub-herd is formed with predictable consequences. Given this particular group’s traditional support for alternate lifestyles and support for the economically depressed, logic would dictate that vaccinations be offered and maintained. Alas … not to be. But on the bright side, in these particular sub-herds, the problem is self-correcting.

Note:All data obtained using tables of mortality and morbidity, New England Journal of Medicine, or Center for Disease Control Statistical Reports. Photos courtesy of CDC.